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1.
N Engl J Med ; 381(25): 2440-2450, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31851800

RESUMO

BACKGROUND: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity. METHODS: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes. RESULTS: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2). CONCLUSIONS: Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).


Assuntos
Obesidade Mórbida/epidemiologia , Obesidade/epidemiologia , Adulto , Índice de Massa Corporal , Feminino , Previsões , Humanos , Renda , Masculino , Obesidade/etnologia , Obesidade Mórbida/etnologia , Prevalência , Autorrelato , Distribuição por Sexo , Estados Unidos/epidemiologia
2.
BMC Public Health ; 19(1): 1458, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694587

RESUMO

BACKGROUND: The overweight/obesity epidemic is a public health issue in the United States (US), that disproportionately affect certain racial/ethnic minority groups. Perceived discrimination has been implicated as a health risk factor. However, research on race/ethnicity, perceived discrimination, and obesity has been mixed. Researchers suggest that perceptions of discrimination may be dependent upon nativity status. This study evaluated the role that nativity status and race/ethnicity play in the relationship between perceived discrimination and overweight/obesity. METHODS: We used Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005) [N = 33,319]). Multinomial logistic regression assessed a three-way interaction (perceived discrimination × race/ethnicity × nativity) on overweight and obesity, adjusting for sociodemographic factors and health-related behaviors. RESULTS: The three-way interaction was significant for overweight [F (17, 49) = 3.35; p < 0.001] and obesity [F (17, 49) = 5.05; p < 0.001]. Among US-born individuals, US-born non-Hispanic Blacks had a decreased risk of being obese compared to US-born non-Hispanic Whites at mean levels of perceived discrimination [aRRR = 0.71; 95% CI (0.51-0.98); p = 0.04). Among foreign-born individuals, foreign-born South Americans had an increased risk of being overweight at mean levels of perceived discrimination compared to foreign-born non-Hispanic Whites [aRRR = 8.07; 95% CI (1.68-38.77); p = 0.01], whereas foreign-born Dominicans had a decreased risk of being obese compared to foreign-born non-Hispanic Whites [aRRR = 0.05; 95% CI (0.01-0.20); p < 0.001]. CONCLUSION: Perceived racial discrimination is a risk factor for overweight/obesity for certain groups. Race/ethnicity and nativity may play important roles in the relationship between perceived discrimination and overweight/obesity. Future research is needed to identify the behavioral and psychological pathways that link perceived discrimination and overweight/obesity.


Assuntos
Grupos Étnicos/psicologia , Grupos Minoritários/psicologia , Obesidade/psicologia , Sobrepeso/psicologia , Discriminação Social/psicologia , Adulto , Feminino , Inquéritos Epidemiológicos , Hispano-Americanos/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etnologia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Percepção , Fatores de Risco , Discriminação Social/etnologia , Estados Unidos/epidemiologia , Adulto Jovem
4.
Medicine (Baltimore) ; 98(33): e16815, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31415397

RESUMO

BACKGROUND: Acupuncture is effective for reducing body weight; however, evidence in Asian populations is lacking. We performed a systematic review and meta-analysis to evaluate the efficacy of acupuncture for body weight reduction in Asians. METHODS: The Medline, Embase, Cochrane library, and Chinese databases were searched for relevant studies through October 20, 2018. Publications describing randomized controlled trials (RCTs) comparing acupuncture with other treatments for the reduction of body weight were compiled. Reviewers assessed bias and collected data on trial characteristics and outcomes. The study was conducted based on the reporting items of the guidelines for systematic evaluation and meta-analysis (PRISMA). Review Manager 5.2 software was used to calculate weight mean difference (WMD) and 95% confidence intervals (CIs). RESULTS: Twelve RCTs involving 1151 subjects were included. Compared with the control groups, the acupuncture groups exhibited significantly greater reductions of body mass index (BMI)(WMD -1.20kg/m2; 95% CI -1.91, -0.48)and waist circumference (WMD -1.85 cm; 95% CI -3.20, -0.49) In the subgroup analyses, significant differences in the reduction of BMI was observed between the acupuncture and sham acupuncture groups, the acupuncture plus diet and exercise, and the diet and exercise groups, and the acupuncture and no intervention groups, but not between the acupuncture plus exercise and exercise groups [corrected]. CONCLUSIONS: Our study demonstrates that acupuncture is effective in the intervention of overweight/obesity in Asians; however, compared with exercise alone, acupuncture combined with exercise had no effect on the BMI or waist circumstance in the short term. Long-term studies are needed to evaluate the efficacy of acupuncture in weight reduction in Asians.


Assuntos
Terapia por Acupuntura/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Terapia por Exercício/estatística & dados numéricos , Obesidade/terapia , Sobrepeso/terapia , Terapia por Acupuntura/métodos , Adulto , Índice de Massa Corporal , Terapia por Exercício/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Sobrepeso/etnologia , Resultado do Tratamento , Perda de Peso
5.
Orv Hetil ; 160(32): 1279-1283, 2019 Aug.
Artigo em Húngaro | MEDLINE | ID: mdl-31387375

RESUMO

Introduction: Short sleep duration and poor sleep quality may be associated with weight gain; this association has not yet been studied in Roma (Gipsy) population. Aim: Our aim was to study sleep patterns in two adult Roma subgroups (the wealthy Gabor and the poor Lovari Roma), compared to the majority of Hungarian population, in relation to obesity, knowing that Roma population has specific socio-cultural characteristics, with a rapidly changing lifestyle. Method: A population-based cross-sectional survey was conducted in a rural region in Transylvania, where the above groups are cohabiting. The groups were age- and gender-matched. Results: Sleep duration was 7.18 ± 1.6 hours in the Gabor Roma, 7.67 ± 1.5 hours in the Lovari Roma and 7.37 ± 1.5 hours in the non-Roma group. In average, 70% of them had enough sleep (≥7 hours). 38.6% of Gabor Roma, 27.1% of Lovari Roma and 23.5% of non-Roma had poor-quality sleep (p = 0.05). Gabor Roma had significantly higher body mass index (31.1 ± 4.6 versus 27.4 ± 5.2 and 28.66 ± 5.7 kg/m2, p = 0.004), and this correlated inversely with sleep duration (F = 14.85, p<0.000). Conclusion: Gabor Roma had significantly higher percentage of poor-quality sleep. Sleep duration and sleep quality were linked with obesity, mainly in the Roma population. Orv Hetil. 2019; 160(32): 1279-1283.


Assuntos
Obesidade/etiologia , Transtornos do Sono-Vigília/complicações , Sono/fisiologia , Adulto , Estudos Transversais , Humanos , Hungria/epidemiologia , Obesidade/epidemiologia , Obesidade/etnologia , Roma , População Rural
6.
Aust N Z J Public Health ; 43(5): 429-435, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31339603

RESUMO

OBJECTIVE: To examine country of birth differences in the odds of reporting chronic diseases among those of Lebanese ethnicity in comparison to those of Australian ethnicity. METHODS: Participants were 41,940 Australians aged 45 years and older, sampled from the 45 and Up Study baseline dataset. Participants included those of Lebanese ethnicity born in Lebanon (n=401), Australia (n=331) and other countries (n=73); and those of Australian ethnicity (n=41,135). Logistic regression models were conducted to examine differences in the odds of reporting chronic disease between those of Lebanese ethnicity and those of Australian ethnicity. RESULTS: Those of Lebanese ethnicity had higher odds of reporting diabetes (OR 1.62; 95%CI 1.32-2.00) and lower odds of reporting hypertension (OR 0.82; 95%CI 0.70-0.96) when compared with those of Australian ethnicity. After country of birth stratification, only those born in Lebanon had higher odds of reporting diabetes (OR 2.21; 95%CI 1.71-2.85) and also had lower odds of reporting cancer (OR 0.66; 95%CI 0.46-0.97), when compared with those of Australian ethnicity. CONCLUSIONS: Country of birth differences in health exist among those of Lebanese ethnicity. Implications for public health: Country of birth is an important factor that could assist in explaining differences in health among ethnic groups of the same origin.


Assuntos
Doença Crônica/etnologia , Emigrantes e Imigrantes/psicologia , Comportamento Alimentar/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Estilo de Vida/etnologia , Obesidade/etnologia , Comportamento Sedentário/etnologia , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Doença Crônica/epidemiologia , Grupos de Populações Continentais , Comparação Transcultural , Estudos Transversais , Emigrantes e Imigrantes/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Líbano/etnologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Vigilância da População , Qualidade de Vida/psicologia , Características de Residência , Fatores de Risco , Autorrelato , Fatores Socioeconômicos , Inquéritos e Questionários
7.
Public Health ; 174: 85-96, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31326761

RESUMO

OBJECTIVES: We systematically reviewed the literature on risk factors for obesity in American Indians (AIs) and Alaska Natives (ANs) of all ages. STUDY DESIGN: We searched titles and abstracts in PubMed with combinations of the following terms: obesity, body mass index (BMI), American Indian, Alaska Native, and Native American. METHODS: We limited our review to articles that provided an empirically testable claim about a variable associated with obesity, measured obesity as a dependent variable, and provided data specific to AI/ANs. RESULTS: Our final sample included 31 articles; 20 examined AI/AN youth (<18 years), and 11 examined AI/AN adults (≥18 years). Risk factors for obesity varied by age. In infants, low birth weight, early termination of breastfeeding, and high maternal BMI, and maternal diabetes increased the risk of childhood obesity. In children and adolescents, parental obesity, sedentary behaviors, and limited access to fruits and vegetables were associated with obesity. In adulthood, sedentary behaviors, diets high in fats and carbohydrates, stress, verbal abuse in childhood, and the belief that health cannot be controlled were associated with obesity. CONCLUSIONS: Extant studies have three limitations: they do not apply a life course perspective, they lack nationally representative data and have limited knowledge of the resilience, resistance and resourcefulness of AI/ANs. Future studies that avoid these shortcomings are needed to inform interventions to reduce the prevalence of obesity in AI/ANs across the life course.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Obesidade/etnologia , Humanos , Fatores de Risco , Estados Unidos/epidemiologia
8.
Aust N Z J Public Health ; 43(4): 328-333, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31268219

RESUMO

OBJECTIVE: To explore participation, consistency of demographic and health profiles, and short-term impacts across six Aboriginal Knockout Health Challenge (KHC) team-based weight loss competitions, 2012 to 2015. METHODS: Data comprised one competition each from 2012 and 2013 and two per year in 2014 and 2015. We compared baseline and change (pre- to post-competition) in weight, fruit and vegetable consumption, physical activity and waist circumference (baseline only) across competitions using mixed models. RESULTS: Numbers of teams and participants increased from 2012 to 2015 from 13 and 324 to 33 and 830, respectively. A total of 3,625 participants registered, representing 2,645 unique people (25.4% repeat participation). Participants were mainly female and >90% were classified obese at baseline. Baseline weight and weight lost (between 1.9% and 2.5%) were significantly lower in subsequent competitions compared with the first. Improvements in fruit and vegetable consumption and physical activity were comparable across competitions. CONCLUSION: The KHC has increasing and sustained appeal among Aboriginal communities, attracting those at risk from lifestyle-associated chronic disease and effectively reducing weight and promoting healthy lifestyles in the short term. Implications for public health: Community-led programs generated by, and responsive to, Aboriginal Australians' needs can demonstrate consistent community reach and sustained program-level lifestyle improvements.


Assuntos
Exercício , Promoção da Saúde/organização & administração , Estilo de Vida Saudável , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Sobrepeso/etnologia , Perda de Peso , Adulto , Pesquisa Participativa Baseada na Comunidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Obesidade/prevenção & controle , Grupo com Ancestrais Oceânicos/psicologia , Sobrepeso/prevenção & controle , Programas de Redução de Peso , Adulto Jovem
9.
Orv Hetil ; 160(28): 1097-1104, 2019 Jul.
Artigo em Húngaro | MEDLINE | ID: mdl-31280599

RESUMO

Introduction: The Roma population rapidly gains in importance in the social structure of Hungary. An adverse consequence of the multiple disadvantageous position of this minority is the unhealthy nutrition, which leads to obesity and high prevalence of its co-diseases. Aim: Based on primer anthropometric data collection, we will determine the nutritional status of the Hungarian Roma population, then on the basis of official statistical data, an estimation and prognoses will be prepared on the disease burden of obesity according to genders and age. Method: A long-range forecast of the population size of the Roma minority's prognosis has been prepared on the basis of official statistics and time-series by Spectrum 5.0 demographic software. On this basis, applying the Dynamic Modeling for Health Impact Assessment software, we have prepared a forecast for the incidence and prevalence of the most important diseases attributable to obesity. Results: In the next decades, the number of the Roma population will be doubled, but there is a high level of uncertainty of different forecasts. The nutritional status of the Hungarian roma population is less favorable, than the indicators, characterizing the Hungarian population as a whole. In the next half a century, the prevalence of co-morbidities of obesity will be increasing from 6 thousand up to 26 thousand in the case of women, while in the case of men from nearly 6 thousand up to 17 thousand. Conclusions: The rapidly increasing number of the Roma population is an increasing challenge for the Hungarian healthcare system, which highlights the importance of evidence-based prevention and intervention programs. Orv Hetil. 2019; 160(28): 1097-1104.


Assuntos
Obesidade , Roma , Feminino , Humanos , Hungria/epidemiologia , Masculino , Estado Nutricional , Obesidade/epidemiologia , Obesidade/etnologia , Prevalência
10.
J Allied Health ; 48(2): 100-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167011

RESUMO

BACKGROUND: American Indian (AI) populations suffer disproportionately from cardiovascular disease and depression as compared to other racial/ethnic groups. Behaviors that contribute to obesity are considered obesogenic and include poor diet, low physical activity, and high screen time. This study examined the relationship between depressive symptoms and obesogenic behaviors on cardiometabolic risk factors in AI youth. METHODS: Participants (n=121) were evaluated for depressive symptoms, obesogenic behaviors, weight, blood pressure, lipids, and glucose levels. RESULTS: All participants failed to meet guidelines for intake of sugar-sweetened beverages and fruits/vegetables, 74% did not meet physical activity guidelines, and 85% did not meet screen time guidelines. Lower physical activity was associated with higher body fat percentage (b=-4.20 ± 1.82, p=0.022). Elevated depressive symptoms and presence of at-risk cardiometabolic risk factors were found. Higher depressive symptoms were associated with higher blood glucose (random, fasting, and hemoglobin A1c). CONCLUSIONS: Low physical activity, high screen time, and the presence of depressive symptomology heighten cardiometabolic risk factors in AI children. Associations between depressive symptoms and blood glucose underscore the impact of emotional health on cardiometabolic disease and emphasize need for proper depression assessment in chronic disease prevention efforts.


Assuntos
Doenças Cardiovasculares/etnologia , Depressão/etnologia , Doenças Metabólicas/etnologia , Obesidade/etnologia , Adolescente , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , Pesos e Medidas Corporais , Criança , Estudos Transversais , Dieta , Exercício , Feminino , Hemoglobina A Glicada , Humanos , Índios Norte-Americanos , Lipídeos/sangue , Masculino , Fatores de Risco , Tempo de Tela
11.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(6): 621-626, 2019 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-31238608

RESUMO

Objective: To understand the control attempts of body weight and its related factors among overweight and obese adults in China. Methods: Data was from the 2013 Chinese Chronic Diseases and Risk Factors Surveillance Program, which covered 302 surveillance sites. 179 570 adults, selected through multistage stratified cluster sampling method, were interviewed. Demographic characteristics and weight-control attempts were collected via face-to-face interview. BMI, waist circumstance and blood pressure were individually measured under physical examination. Venous blood samples were obtained and tested for FPG, OGTT-2h, TC, TG, LDL-C and HDL-C. A total of 87 545 overweight and obese patients were included in this study, with the exclusion of 152 patients having the missed critical information. Rates on weight control and attempts were analyzed, using the complex weighting on samples to represent the overall overweight and obese adults in China. Results: The rate of weight-control attempts was 16.3% (95%CI: 14.9%-17.7%). Among all the 12 133 patients who had undergone weight-control measures, the proportions of different attempts were as follows: diet (40.9%, 95%CI: 38.4%-43.3%), combination of diet and physical activity (31.5%, 95%CI: 28.9%-34.0%), physical activity (22.8%, 95%CI: 21.0%-24.6%) and drug control (1.3%, 95%CI: 1.0%-1.7%). Factors as: being female (OR=1.26, 95%CI: 1.15-1.38), at younger age (18-44 years old, OR=1.51, 95%CI: 1.31-1.74), with high education levels (college degree or above, OR=4.52, 95%CI: 3.76-5.43), having high annual income (≥24 000 Yuan, OR=1.94, 95%CI: 1.63-2.30) etc., appeared as favorable factors for taking the measures vs. rural residency (OR=0.63, 95%CI: 0.55- 0.72) as the unfavorable one. Conclusion: The rate of weight-control attempts appeared low among the overweight and obese adults who were affected by factors as age, education and income level. Personalized intervention measures should be carried out for people with different characteristics.


Assuntos
Obesidade/prevenção & controle , Sobrepeso/prevenção & controle , Vigilância da População , Triglicerídeos/sangue , Adolescente , Adulto , Índice de Massa Corporal , China , Dieta , Exercício , Feminino , Humanos , Lipídeos/sangue , Obesidade/sangue , Obesidade/etnologia , Sobrepeso/sangue , Sobrepeso/etnologia , Características de Residência , Fatores de Risco , Adulto Jovem
12.
Clin Lab ; 65(6)2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31232044

RESUMO

BACKGROUND: The aim of the study is to evaluate the cross-sectional association between serum ferritin level and nonalcoholic fatty liver disease (NAFLD) in a non-obese Chinese population. METHODS: A cross-sectional study was performed among 1,020 non-obese subjects (body mass index < 25 kg/m2) who took their annual health examination at the First Affiliated Hospital, College of Medicine, Zhejiang University. Serum ferritin level and other clinical and laboratory parameters were measured in the population. Liver ultrasound examinations were performed to diagnose NAFLD. RESULTS: Of the 1,020 enrolled participants, 148 (14.51%) fulfilled the diagnostic criteria for NAFLD. Subjects with NAFLD had a higher level of serum ferritin than individuals without NAFLD in non-obese subjects. Serum ferritin level was significantly and positively correlated with parameters of MS (BMI, SBP, TG and FPG) in NAFLD group. Stepwise logistic regression analysis showed that serum ferritin level was significantly associated with the risk factor for NAFLD. After adjusting for confounders, serum ferritin level was an independent factor predicting advanced fibrosis (FIB-4 ≥ 1.3) in NAFLD participants. CONCLUSIONS: Increased serum ferritin level is significantly associated with NAFLD, and elevated serum ferritin level is an independent factor predicting advanced fibrosis for NAFLD in a non-obese Chinese population.


Assuntos
Biomarcadores/sangue , Ferritinas/sangue , Hepatopatia Gordurosa não Alcoólica/sangue , Obesidade/sangue , Adulto , Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , China , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Hepatopatia Gordurosa não Alcoólica/etnologia , Obesidade/etnologia , Fatores de Risco
13.
Nutrients ; 11(6)2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31248113

RESUMO

This study investigated associations between cardiovascular health (CVH), adiposity, and food insecurity by race, sex, and health literacy in a sample of 800 underserved patients with obesity (body mass index [BMI] ≥ 30 kg/m2). CVH was assessed using American Heart Association Life's Simple 7 (LS7) and adiposity was estimated using BMI and waist circumference (WC). Mixed models including interaction terms between food insecurity and sex, race, and health literacy were analyzed for LS7, BMI, and WC. Stratified models were analyzed as indicated by significant interactions. Mean BMI and WC were 37.3 kg/m2 (4.6 SD) and 113.5 cm (12.4 SD), respectively. Among patients, 31% were food insecure and 31% had low health literacy. There were significant positive associations between food insecurity and BMI (p = 0.03) and WC (p = 0.03) in the overall sample. In sex-stratified models, women who were food insecure had higher BMI (p = 0.02) and WC (p = 0.007) than their food secure counterparts. Further, food insecure patients with better health literacy had greater BMI (p = 0.004) and WC (p = 0.007) than their food secure counterparts. Results suggest that adiposity is a greater burden in food insecure patients, which may be an important consideration for obesity treatment in underserved populations.


Assuntos
Adiposidade/etnologia , Doenças Cardiovasculares/etnologia , Doenças Cardiovasculares/fisiopatologia , Abastecimento de Alimentos , Área Carente de Assistência Médica , Obesidade/etnologia , Obesidade/fisiopatologia , Determinantes Sociais da Saúde/etnologia , Populações Vulneráveis , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Estudos Transversais , Alfabetização em Saúde , Humanos , Louisiana/epidemiologia , Pessoa de Meia-Idade , Estado Nutricional/etnologia , Obesidade/diagnóstico , Obesidade/terapia , Ensaios Clínicos Pragmáticos como Assunto , Fatores de Risco , Fatores Sexuais , Circunferência da Cintura
14.
Public Health ; 172: 125-134, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31227270

RESUMO

BACKGROUND: Epidemic obesity poses a major threat to global health. This phenomenon reflects the inability of the average person to cope, biologically and behaviorally, with environmental contexts that promote caloric overconsumption and inadequate caloric expenditure. There is still much to be learned about how to improve these contexts nationally and within-countries for sociodemographic groups with above-average obesity risks. METHODS: Higher obesity risks relative to respective white majority populations were identified among diverse indigenous, other native-born, or migrant 'racial' or ethnic minority (hereafter, ethnic minority) populations in the United States, Canada, Australia, New Zealand, and the Netherlands, using publicly available national survey data or other sources. Cross-national comparisons were of interest for identifying common risk pathways associated with social and economic inequities. Potential explanations were explored through a narrative review of peer-reviewed literature, informed by the World Health Organization's Conceptual Framework for Action on The Social Determinants of Health. MAIN FINDINGS: Identifying viable solutions to the high risk of obesity in ethnic minority populations in these high-income countries requires examination of national-level social, economic, and health system contexts, food systems, and built environments for physical activity, as well as patterns of social stratification and cultural biases related to ethnicity, migration, and other determinants of social disadvantage. These factors can be linked to mediators of exposure or vulnerability to obesity-related risks, such as poverty, being an 'outsider', stress and trauma resulting from historical and current oppression, exposure to bias and discrimination, related biological or behavioral consequences, and inadequate health and social care. CONCLUSIONS: Focusing on ethnic minority populations in high-income countries is critical for public health efforts to address epidemic obesity. Mitigating intersecting risk pathways arising from stratification and bias based on ethnicity and migrant status should be prominent in these efforts.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Países Desenvolvidos/estatística & dados numéricos , Epidemias/prevenção & controle , Grupos Étnicos/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Obesidade/etnologia , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Austrália/epidemiologia , Canadá/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Nova Zelândia/epidemiologia , Obesidade/prevenção & controle , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
15.
PLoS One ; 14(5): e0216502, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31059553

RESUMO

BACKGROUND: African-born individuals in the U.S. are disproportionately affected by HIV yet have low HIV testing rates. We conducted a mixed methods study to assess the uptake and feasibility of a novel strategy for integrating HIV testing into residential health fairs among African-born individuals in Seattle, WA. METHODS: From April to May 2018, we held six health fairs at three apartment complexes with high numbers of African-born residents. Fairs included free point-of-care screening for glucose, cholesterol, body mass index, blood pressure, and HIV, as well as social services and health education. The health fairs were hosted in apartment complex common areas with HIV testing conducted in private rooms. Health fair participants completed a series of questionnaires to evaluate demographics, access to health services, and HIV testing history. We conducted 18 key informant interviews (KIIs) with health fair participants and community leaders to identify barriers to HIV testing among African-born individuals. RESULTS: Of the 111 adults who accessed at least one service at a health fair, 92 completed questionnaires. Fifty-five (61%) were female, 48 (52%) were born in Africa, and 55 (63%) had health insurance. Half of African-born participants accepted HIV testing; all tested negative. The most common reasons for declining testing were lack of perceived risk for HIV and knowledge of HIV status. We identified a high prevalence of non-communicable diseases (NCDs) among health fair participants; among those tested, 77% (55/71) were overweight/obese, 39% (31/79) had blood pressure > 140/90 mmHg, and 30% (22/73) had total cholesterol > 200 mg/dL. KIIs identified community stigma and misinformation as major barriers to HIV testing among African-born individuals. CONCLUSIONS: Residential health fairs are a feasible method to increase HIV testing among African-born individuals in Seattle. The high prevalence of NCDs highlights the importance of integrating general preventive services within HIV testing programs in this population.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/métodos , Doenças não Transmissíveis/epidemiologia , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Adulto , África , Estudos de Viabilidade , Feminino , Infecções por HIV/etnologia , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/etnologia , Obesidade/etnologia , Sobrepeso/etnologia , Projetos Piloto , Sistemas Automatizados de Assistência Junto ao Leito , Prevalência , Estudos Prospectivos , Sistemas de Apoio Psicossocial , Estigma Social , Inquéritos e Questionários , Estados Unidos/etnologia
16.
Fam Community Health ; 42(3): 213-220, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31107732

RESUMO

Low-income children of Mexican immigrants are at high risk for obesity. Drawing on a sample of 104 Mexican American children (Mage = 8.39 years; 61% female), this longitudinal study considered relations between food insecurity and chronic stress (ie, parent report and hair cortisol measurement) on body mass index (BMI) and examined whether stress moderated associations between food insecurity and BMI. Analyses revealed that undocumented status was associated with food insecurity and chronic stress but not when accounting for poverty. Food insecurity was only associated with higher BMI for children with the highest hair cortisol. Results suggest that chronic stress may impact body weight among food-insecure children.


Assuntos
Índice de Massa Corporal , Abastecimento de Alimentos/estatística & dados numéricos , Obesidade/etnologia , Pobreza/etnologia , Estresse Psicológico/psicologia , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Americanos Mexicanos
17.
Wei Sheng Yan Jiu ; 48(2): 173-178, 2019 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-31133091

RESUMO

OBJECTIVE: To analyze the epidemiological characteristics and clustering of cardiometabolic risk factors in people 60 years old and above, and to explore the influence of population economic factors on them. METHODS: The database of China Health and Nutrition Survey in 2015 was used. Basic information(age, gender), anthropometric data(height, weight and waist size), blood biochemical data and demographic data(occupation, income, education level and geographic location) were included. A multi-stage stratified cluster random sampling was adopted, the county, city, village and suburban village as the basic survey points. Twenty families were randomly selected from each survey site, and all family members were investigated. A total of 3276 people aged 60 years and above were selected as subjects, with the proportion of males was 46. 8%, and the average age was 68 years. According to the definition of the metabolic syndrome released by the International Diabetes Federation(IDF) in 2005, there were five cardiometabolic risk factors, central obesity, raised triglycerides(TG), reduced high density lipoprotein-cholesterol(HDL-C), raised blood pressure and raised plasma glucose. Existing of 2 or more risk factors in a person at the same time was recognized as a risk factor clustering. Multivariate logistic regression model was used to analyze the relationship between socioeconomic factors and metabolic risk factors. RESULTS: In elderly of 15 provinces(regions, municipalities) of China, the prevalence of central obesity, raised blood pressure, raised plasma glucose, raised TG and reduced HDL-C were 57. 8%, 71. 3%, 25. 0%, 27. 6% and 40. 1% respectively. Multivariate Logistic regression analysis showed there were more risk of central obesity(OR=3. 66, 95%CI 3. 16-4. 26), raised TG(OR=1. 60, 95%CI 1. 36-1. 88) and reduced HDL-C(OR=2. 77, 95%CI 2. 38-3. 23)in women than those in men, and less risk of raised blood pressure(OR=0. 84, 95%CI 0. 0. 72-0. 99) in women than those in men. Elderly in the eastern region were significantly more likely to suffer from raised blood pressure(OR=1. 45, 95%CI 1. 20-1. 76) and raised plasma glucose(OR=1. 38, 95%CI 1. 14-1. 67) than those in the mid region. A correlation was found between gender, education level, regions and metabolic risk factors(P<0. 05). Income and metabolic risk factors clustering were positively correlated(P<0. 05). CONCLUSION: The problem of elevated blood pressure and central obesity in cardiometabolic risk factors were more prominent in the 15 provinces(regions, municipalities) of China. The elderly which was female, in eastern region, had high income or education level relatively had higher risk of risk factors clustering, which should be focused on prevention and control.


Assuntos
Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Hipertensão/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Idoso , Glicemia , Pressão Sanguínea , Índice de Massa Corporal , Doenças Cardiovasculares/etnologia , China/epidemiologia , HDL-Colesterol , Cidades , Feminino , Humanos , Hipertensão/etnologia , Masculino , Síndrome Metabólica/etnologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade/etnologia , Prevalência , Fatores de Risco , Triglicerídeos
20.
BMC Public Health ; 19(1): 365, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940108

RESUMO

BACKGROUND: Obesity is a rising global threat to health and a major contributor to health inequalities. Weight management programmes that are effective, economical and reach underprivileged groups are needed. We examined whether a multi-modal group intervention structured to cater for clients from disadvantaged communities (Weight Action Programme; WAP) has better one-year outcomes than a primary care standard weight management intervention delivered by practice nurses (PNI). METHODS: In this randomised controlled trial, 330 obese adults were recruited from general practices in London and allocated (2:1) to WAP (N = 221) delivered over eight weekly group sessions or PNI (N = 109) who received four sessions over eight weeks. Both interventions covered diet, physical activity and self-monitoring. The primary outcome was the change in weight from baseline at 12 months. To indicate value to the NHS, a cost effectiveness analysis estimated group differences in cost and Quality-Adjusted Life-Years (QALYs) related to WAP. RESULTS: Participants were recruited from September 2012 to January 2014 with follow-up completed in February 2015. Most participants were not in paid employment and 60% were from ethnic minorities. 88% of participants in each study arm provided at least one recorded outcome and were included in the primary analysis. Compared with the PNI, WAP was associated with greater weight loss overall (- 4·2 kg vs. - 2·3 kg; difference = - 1·9 kg, 95% CI: -3·7 to - 0·1; P = 0·04) and was more likely to generate a weight loss of at least 5% at 12 months (41% vs. 27%, OR = 14·61 95% CI: 2·32 to 91·96, P = 0·004). With an incremental cost-effectiveness ratio (ICER) of £7742/QALY, WAP would be considered highly cost effective compared to PNI. CONCLUSIONS: The task-based programme evaluated in this study can provide a template for an effective and economical approach to weight management that can reach clients from disadvantaged communities. TRIAL REGISTRATION: ISRCTN ISRCTN45820471 . Registered 12/10/2012 (retrospectively registered).


Assuntos
Análise Custo-Benefício , Dieta , Exercício , Obesidade/terapia , Avaliação de Programas e Projetos de Saúde , Perda de Peso , Programas de Redução de Peso/métodos , Adulto , Idoso , Peso Corporal , Grupos Étnicos , Feminino , Medicina Geral , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Obesidade/economia , Obesidade/etnologia , Razão de Chances , Pobreza , Atenção Primária à Saúde , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Padrão de Cuidado , Desemprego , Programas de Redução de Peso/economia
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