Obesity is a communicable disease.

Obesity has multiple causes and correlates. Usually studied as a metabolic and endocrine disease, with mechanical and musculoskeletal comorbidities, obesity also has a communicable angle to it. Obesity can be considered a communicable disease from the conventional point of view, as it is associated with viral etiology in animal and human models. It is also associated with increased prevalence and worse prognosis of infectious diseases. Not only that, obesity is a 'socially communicable' disease, as it 'spreads' amongst people living in similar environments.

The Barocene Era.

This communication defines and describes the Barocene era, as that phase of human development which is characterized by a major impact of overweight and obesity. We use this term to highlight the fact that overweight and obesity need to be prevented and managed on an urgent footing. If not checked, these endocrine diseases will retard our growth and reduce our well being.

Ultra Processed Foods: A South Asian culinary perspective.

There is a vast multitude of foodstuffs available, and health care professionals find it challenging to distinguish between healthy and unhealthy offerings. Recent evidence suggests that ultra processed foods should be avoided, as they are associated with harmful effects on health. This communication defines and describes ultra-processed foods, using the internationally accepted NOVA classification. It uses South Asian examples to make the concept easy to understand for South Asian readers.

Exercise And Physical Activity Diversity.

In this reflective opinion piece, we introduce the concepts of exercise diversity and physical activity diversity. Similar to dietary diversity and dietary variety, exercise/physical activity diversity represents part of a comprehensive target of ideal health, an objective parameter to audit one's progress towards such a goal, and a means of accomplishing this aim. We define this concept as the number of types of exercise, the number of limbs and body parts exercised or muscle groups involved, the variety of intensity, or the number of variations in methods of exercise used. A non-weighted score may be allocated to each exercise, limb, and muscle group to get a raw idea of diversity.

Bariatric Triage: Weight Loss As A Tool For Therapeutic Decision Making.

This communication highlights how early weight loss can be used as a technique for triage in persons who have undergone bariatric surgery, and as a tool for therapeutic decision making. Weight loss is a target for obesity medicine, but can also be used to plan further treatment strategies and interventions. In this manner, early weight loss is similar to HbA1c (glycated haemoglobin) which is a diagnostic tool, a monitoring device, a therapeutic target, and also a technique to decide intensity of treatment in diabetes.

Hidden Obesity.

This communication proposes the term "hidden obesity" to describe normal weight obesity, or increased adiposity without a corresponding increase in body mass index. It uses the concept of hidden hunger to craft semantics which will generate greater attention to this condition from all stake-holders, including policymakers and planners. The article describes simple tools which can be used to suspect and confirm the diagnosis of hidden obesity. This phenotype is very commonly seen in the south Asian population.

Culinary Counselling in Chronic Care: The Pentad of Cs & Ps.

Diet and nutrition are an integral part of chronic metabolic disease management. Medical nutrition therapy (MNT) providers focus upon caloric and nutrient adequacy, but do not necessarily incorporate person-friendly recipes in their ambit. In this communication, we share a simple framework of culinary counseling. This supplements MNT, and enhances its value by encouraging adherence and persistence to prescribed therapy.

The Bariatric Pyramid: A framework for therapeutic targets.

The Bariatric Pyramid is a model which serves to explain the goals of obesity management, act as a milestone for monitoring of therapy, and to benchmark the utility of various anti-obesity medications and interventions. Built upon a base of sustainability, it lists three more desired aspects of care: sufficiency (sufficient strength) safety and security. Each of the four aspects of the pyramid: sustainability, sufficiency safety and security have three angles, which allows the reader to understand them easily. The model that we propose is useful in training health care professionals, in therapeutic patient education, for assessing various anti-obesity therapies, and in reaching the right decision while managing obesity.

Baro-buddies: Supporting the fight against obesity.

Obesity has reached pandemic proportions across the world. Though novel therapies continue to emerge to promote weight loss, long term maintenance of the lost weight is one of the major challenges in obesity management. A multidisciplinary team approach is often useful in recommending the best patient centric method of losing weight, but this requires constant motivation, guidance, support and need for troubleshooting at times of need. To address this, we propose a new avatar in the obesity management of obesity called the "Baro-Buddy" which is a portmanteau, derived from 'baros'(weight) and buddy (friend). This brief manuscript describes the eligibility, role and utility of a barobuddy in day-to-day management of obesity.

Screening for syndromic causes of obesity.

Syndromic obesity is sometimes encountered in clinical practice, but may often be misdiagnosed. This is more often seen in the south Asian region due to higher rates of consanguinity. This article simplifies the clinical features which should prompt a high index of clinical suspicion, and ensure a detailed assessment for syndromic obesity including a genetic test. This manuscript lists various aspects of history and physical examination in an alliterative manner.

Factors associated with feeding practices of black immigrant mothers of African and Caribbean origin living in Ottawa, Canada.

In Canada, Black immigrant women and their children are at higher risk of developing obesity. Factors that could influence children's weight status include parental feeding practices. Feeding practices such as monitoring, restriction and pressure to eat, are well studied among non-Hispanic White and Latinos groups, however, little is known about the feeding practices of Black immigrant parents of African and Caribbean origin. The aim of this study was to identify factors associated with feeding practices of Black immigrant mothers in Ottawa, Canada. The sample includes 188 Black mothers of African and Caribbean origin and their 6-12-year-old children. The Child Feeding Questionnaire was used to assess mothers' feeding practices. Demographic and socioeconomic data were collected using questionnaires. All participants' weight status was determined from measured weight and height. Pearson Chi-square tests and multivariate logistic regressions were performed. Results showed that mothers who felt responsible for feeding their children were more likely to monitor their children's food intake (p < 0.05). While mothers of children with underweight or normal weight were more like to use pressure to eat (p < 0.01), mothers of children with overweight or obesity were more like to use restriction (P < 0.05). Recent immigrant mothers were also more likely to use pressure to eat (P < 0.05). This study also provides evidence for associations between maternal feeding practices and mothers' weight status, household income and food security status. Findings build on previous research suggesting that parental feeding practices vary based on parents' and children's characteristics. Longitudinal studies are needed to assess the directionality of the association between mothers' feeding practices, and children's weight, diet quality and health in this population.

The Ominous Octet of Obesity: A framework for obesity pathophysiology.

The pathogenesis of obesity is complex and is beyond the simple equation of excess calorie intake and inadequate calorie expenditure. It involves the role of multiple organ systems and these complex interactions are often challenging to address in a busy clinical practice. We propose a simplified framework akin to the ominous octet of diabetes, to help understand the role of these different organ systems in relation to obesity. The Ominous Octet of obesity includes the hypothalamus, islet cells of Langerhans, gastrointestinal tract, adipose tissue, adrenal gland, gonads, thyroid gland and the muscle. This framework would also help to understand the use of different therapeutic targets in patients with obesity and improve the care of these patients.

The hamster wheel: a case study on embodied narrative identity and overcoming severe obesity.

Based in narrative phenomenology, this article describes an example of how lived time, self and bodily engagement with the social world intertwine, and how our sense of self develops. We explore this through the life story of a woman who lost weight through surgery in the 1970 s and has fought against her own body, food and eating ever since. Our narrative analysis of interviews, reflective notes and email correspondence disentangled two storylines illuminating paradoxes within this long-term weight loss process. Thea's Medical Weight Narrative: From Severely Obese Child to Healthy Adult is her story in context of medicine and obesity treatment and expresses success and control. Thea's Story: The Narrative of Fighting Weight is the experiential story, including concrete examples and quotes, highlighting bodily struggles and the inescapable ambiguity of being and having one's body. The two storylines coexist and illuminate paradoxes within the weight loss surgery narrative, connected to meaningful life events and experiences, eating practices and relationships with important others. Surgery was experienced as lifesaving, yet the surgical transformation did not suffice, because it did not influence appetite or, desire for food in the long run. In the medical narrative of transforming the body by repair, a problematic relationship with food did not fit into the plot.

Leptin at birth and at age 7 in relation to appetitive behaviors at age 7 and age 10.

Leptin contributes to the control of food intake and energy balance. However, its association with appetitive behaviors during childhood is not well understood. We aimed to investigate the association between leptin, assessed at birth and at 7 years of age (y), and appetitive behaviors assessed at 7 and 10 y. Children from a Portuguese cohort with assessment of leptin levels at birth from umbilical cord blood (n = 645) and at 7 y from venous blood samples (n = 587), were included. The Children's Eating Behavior Questionnaire assessed appetitive behaviors at 7 and 10 y. Weight and height were measured at 7 and 10 y to derive BMI z-scores (BMIz). A series of Generalized Linear Models tested relationships between leptin and appetitive behaviors, adjusting for potential confounders (maternal age, education, pre-pregnancy BMI, smoking during pregnancy, child physical activity and child BMIz), and interaction terms for child sex and child BMIz. At 7 y, 116 boys and 118 girls were classified as having overweight/obesity, and these children had higher leptin levels. Cross-sectional analyses using the 7 y data produced the strongest results. Higher leptin at 7 y was significantly associated with lower scores on Satiety Responsiveness, Food Fussiness and Slowness in Eating, and higher scores on Food Responsiveness, Enjoyment of Food and Emotional Overeating at 7 y. Only the association with Emotional Overeating remained when adjusting for child BMIz. Significant interaction effects between child sex and leptin were found for appetite at 7 y, such that higher leptin was associated with higher Food Responsiveness (p < 0.001) and lower Slowness in Eating (p < 0.001) to a greater extent among boys. Umbilical cord blood leptin was not associated with appetitive behaviors at 7 or 10 y. Our results show that leptin levels are positively associated with food approach and negatively with food avoidant behaviors. Associations were more consistent in cross-sectional analyses (at 7 y), were largely dependent on child weight, and tended to be stronger among boys. Our findings support a role for leptin in affecting appetite, with potential consequences for current weight status and future weight gain.

Associations of appetitive behaviors in 7-year-old children with their cardiometabolic health at 10 years of age.

BACKGROUND AND AIMS: Atherosclerosis begins early in life, thus optimal cardiovascular health needs to be promoted early. We investigated whether appetitive behaviors among 7 year olds are associated with their cardiometabolic health years later. METHODS AND RESULTS: A sample of 2951 children from a Portuguese birth cohort was analyzed. The Children's Eating Behavior Questionnaire assessed eating behaviors, and a measure of cardiometabolic risk (higher risk group: those in the upper quartile of triglycerides, homeostatic model assessment-insulin resistance, waist circumference and systolic blood pressure and in the lower quartile of high-density lipoprotein cholesterol z-scores) was created. Linear and logistic regressions were run. Children with more food avoidant behaviors had lower cardiometabolic risk (Satiety Responsiveness - boys: OR = 0.39, 95% CI 0.16; 0.93, girls: OR=0.37, 95% CI 0.17; 0.82 and Slowness in eating - boys: OR = 0.49, 95% CI 0.25; 0.95, girls: OR = 0.49, 95% CI 0.27; 0.91). Food approach behaviors (Food responsiveness (CEBQ-FR), Enjoyment of food (CEBQ-EF) and Emotional overeating (CEBQ-EOE)) increased cardiometabolic risks (e.g. CEBQ-FR: boys: OR = 2.50, 95% CI 1.45; 4.32, girls: OR = 2.33, 95% CI 1.46; 3.71). CEBQ-EF had stronger effects in boys, while CEBQ-EOE was positively associated with cardiometabolic risk among girls. When adjusting for BMIz at 7y, associations did not remain significant. Appetitive behaviors were also associated with isolated cardiometabolic parameters; the strongest association being with waist circumference. CONCLUSIONS: Appetitive behaviors at 7-years are associated with cardiometabolic risk at age 10. While 'food avoidant' behaviors protect against cardiometabolic risk and 'food approach' behaviors increase cardiometabolic risk, these associations are largely dependent of child's adiposity.

Quinary Prevention and Bariatric surgery.

Obesity is a major pandemic with significant clinical and public health implications. Surgical modalities have emerged as an important means of treating obesity. Lack of awareness about the utility of other therapeutic options, and about the limitations of bariatric surgery, may lead to misuse of these interventions. This article describes quinary prevention in the context of bariatric surgery, i.e, the need to dispel misinformation, and promote accurate knowledge of the procedures. Optimal quinary prevention will help utilize this useful treatment modality, to ensure better outcomes in obesity management.

Risk factors of subclinical atherosclerosis in obesity and overweight.

OBJECTIVE: To examine the relationship of carotid intima-media thickness with weight-gain, overweight and obesity.. METHODS: The experimental, analytical study was conducted at the CF University Hospital, Cluj-Napoca, Romania, from 2012 to 2014, and comprised randomly selected in patients from the Medical Ward. The patients were divided into normal-weight subjects in Group I and overweight and obese subjects in Group II Intimate-media thickness was measured by carotid Doppler ultrasound. Data was analysed using SPSS 13. RESULTS: Of the 111 subjects, Group I had 27(%) and Group II had 84(%) subjects. Mean carotid intimamedia thickness was significantly greater (p<0.001) in Group II compared to Group I, especially in those with metabolic syndrome (p<0.001) and higher high-sensitivity C reactive protein (p<0.05). With the exception of Group II where there was a direct correlation (p<0.05) between triglycerides and intimamedia thickness, and an inverse correlation (p<0.05) between high-density lipoprotein and intimamedia thickness, no significant correlations were recorded (p>0.05). CONCLUSIONS: Intima-media thickness was found to be increased in asymptomatic overweight and obese subjects, significantly higher in those with associated metabolic syndrome and high levels of highsensitivity C-reactive protein, as an indication of the presence of early, subclinical atherosclerosis.

Obesity/overweight and asthma control in LEBANESE adults: a cross-sectional study.

BACKGROUND: Studies exploring the association between weight and asthma are not conclusive. Both obesity and asthma have been increasing in Lebanon, their association is not yet documented. The aim of this study is to explore the effect of weight on asthma control in adults. METHODS: This is a cross-sectional study, involving all consecutive asthma patients presenting to the outpatient allergy clinic at the Hotel-Dieu de France (HDF) University Hospital between January 1, 2014 and December 30, 2016. Patients included were those who consented to fill the Asthma Control Test (ACT) after 3 months of therapy. BMI was reported at the same time of the questionnaire. RESULTS: A total of 183 records of diagnosed asthma cases in adults were included. Sixty-three (34.4%) were males and 120 (65.6%) females, with a mean age of 38.5 (SD = 14.3). Ninety patients (49.2%) were of normal weight, 65 (35.5%) overweight and 28 (15.3%) obese. Seventy-one percent had an ACT score ≤ 19, which corresponds to poor asthma control. Patients who were overweight or obese were more likely to have poor asthma control compared to patients who had a normal weight at the time of evaluation. CONCLUSION: In conclusion, our study showed a significant association between asthma control as assessed by the ACT and high BMI defining overweight or obesity. This is the first national study exploring the association between asthma and overweight/obesity in Lebanon. A larger study with sampling from different specialists' sites is needed to draw more conclusions about this association.

Targeting CSC in a Most Aggressive Subtype of Breast Cancer TNBC.

Triple negative breast cancer (TNBC) is a more aggressive subtype of breast cancer and is characteristic of the absence of the expressions of estrogen receptor, progesterone receptor, and human epithelial growth factor receptor 2 in breast tumor tissues. This subtype of breast cancer has the poorest prognosis, compared to other subtypes of breast cancer. TNBC is heterogeneous by showing several different histo-pathological and molecular subtypes with different prognosis and is more commonly found in younger age of women, especially African-American and Hispanic women. Recent epidemiological data indicate that TNBC is highly associated with overweight/obesity. Due to the absence of the common tumor biomarkers of breast cancer, the current molecular target therapy is not effective. TNBC patients have a shorter survival rate and an increased tumor recurrence. The concept of cancer stem cells (CSC), also called tumor initiating cells (TIC) has been more and more accepted and considered to contribute to aggressive phenotypes of many tumors including breast cancer. Moreover, CSC/TIC has been identified in the tumor tissues of breast cancer including TNBC. These rare subpopulations of CSC/TIC cells might be one of the key contributors to the aggressive phenotypes of TNBC such as drug treatment resistance, metastasis, and tumor recurrence. Therefore, targeting these CSC/TIC cells will provide a new therapeutic strategy for the treatment of TNBC.

Illness perception in overweight and obesity and impact on bio-functional age.

PURPOSE: Obesity is pandemic. Yet, the success of most weight loss programmes is poor. The aim of the study was to assess illness perception in overweight/obese people and its impact on bio-functional age (BFA) reflecting physical, mental, emotional and social functioning. METHODS: 75 overweight/obese subjects from the cross-sectional Bern Cohort Study 2014 were included. Participants followed a validated "bio-functional status" test battery amended by the validated questionnaires Patiententheoriefragebogen (illness perception) and AD-EVA (eating and movement behaviour). BFA was calculated in subjects aged ≥ 35 years (n = 56). RESULTS: (1) Mental occupation with the cause of overweight/obesity was generally moderate to high, but decreasing with age. (2) The predominant theories for being overweight/obese were health behaviour (58.7%) and psychosocial factors (33.3%). (3) Overweight/obese people with psychosocial theories on illness causes were more likely to have emotional or disinhibited eating patterns. (4) Cognitive control of eating patterns increased with age in both sexes. (5) Overweight/obese people were still bio-functionally younger than their chronological age (8.6 ± 0.8 year equivalents), although (6) quality of life was below average and (7) the risk for functional pro-aging was increased in those being especially mentally occupied with causes for overweight/obesity (r = 0.38, p < 0.001) and those having psychosocial (r = 0.32, p < 0.05) or naturalistic theories (r = 0.47, p > 0.001). CONCLUSIONS: Consciously perceived psychosocial stress was found to be a main factor to disturb health and promote unhealthy cognitive patterns regulating eating and moving habits. Thus, successful weight reduction programmes should integrate subjective illness perceptions to not only improve the therapeutic outcome, but also functioning (BFA).