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Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Public Health Statistics and Risk Assessment".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 45472

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Dr. Dorothea Kesztyüs

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Guest Editor

Department of Medical Informatics, Georg-August-Universität, University Medical Center Göttingen, 37075 Göttingen, Germany
Interests: overweight; obesity; non-communicable diseases; public health; health services research

Dr. Susanne Kobel

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Guest Editor

Division of Sports and Rehabilitation Medicine, Universitätsklinikum Ulm, 89075 Ulm, Germany
Interests: health promotion; primary school children; physical activity; healthy eating and drinking behavior

Special Issue Information

Dear Colleagues,

Overweight and obesity are omnipresent, as are research and programs to reduce their incidence and prevalence. In recent decades, an obesogenic environment has developed that not only leads to reduced physical activity and increased sedentary behavior but, together with a perpetual supply of obesity-promoting ready-to-eat processed food, creates an almost insurmountable barrier to returning to a healthy lifestyle. Governments hardly fulfill their obligation to protect the population from harmful environmental conditions and an industrial food production that has gone astray. The lobby of the producers of adipogenic food and beverages not only massively resists any restrictions but also influences scientific research by targeted funding. Furthermore, excess weight is not sufficiently addressed in healthcare, while the focus is strongly on sequelae and preventive measures are underrepresented. The decline in life expectancy in the USA is a first indicator of political and social failure. It is now high time for governments to legislate, levy taxes, and take comprehensive measures to address the roots of this pandemic. This requires scientific evidence to identify the best and most cost-effective measures in prevention, healthcare, and policies. Hence, we invite you to share your newest research on these topics with us in this Special Issue.

Dr. Dorothea Kesztyüs
Dr. Susanne Kobel
Guest Editors

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Keywords

overweight and obesity
pandemic
prevention and control
healthcare
policies
lifestyle
living environments
all ages

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Published Papers (11 papers)

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13 pages, 775 KiB

Open AccessArticle

Physical Activity Trends in Korean Adults from Korea National Health and Nutritional Examination Survey from 2014 to 2019

by Hoyong Sung, Geonhui Kim, Xiaonan Ma, Harim Choe, Yunmin Han, Jiyeon Yoon, Yeun Ryu and Yeon Soo Kim

Int. J. Environ. Res. Public Health 2022, 19(9), 5213; https://doi.org/10.3390/ijerph19095213 - 25 Apr 2022

Cited by 13 | Viewed by 3507

Abstract

The current study aimed to examine the adherence trend for aerobic and muscle-strengthening physical activity (PA) guidelines among Korean adults using the Korea National Health and Nutritional Examination Survey from 2014 to 2019. Korean adults (N = 2642) were included in the current study to examine the trend of PA adherence from 2014 to 2019. The PA guidelines are: (a) aerobic activity (a minimum of 150 min moderate to vigorous PA weekly) and (b) muscle-strengthening activity (a minimum of two days weekly). Self-report questionnaires in the survey measured both activities. The adherence to PA guidelines by survey year was examined using a multivariable logistic regression analysis adjusted for covariates. There was a significant decreasing trend in which the adherence rate to aerobic PA guidelines changed from 57.0% in 2014 to 45.6% in 2019 (p < 0.001). On the other hand, the trend in adherence rate to muscle-strengthening activity was not significant (p = 0.976). The adherence rate to muscle-strengthening activity guideline was slightly increased but still low from 20.8% to 23.3% during 2014–2019. The aerobic PA guidelines are significantly decreasing, and more than half of the Korean adults in 2019 have not followed the guidelines. In addition, there has been a slight increase in muscle-strengthening activity; however, the adherence rate is meager. Therefore, this study suggests that Korean adults’ aerobic and muscle-strengthening PA participation is necessary for their low adherence rate and decline tendency. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

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15 pages, 505 KiB

Open AccessArticle

HealthyLIFE, a Combined Lifestyle Intervention for Overweight and Obese Adults: A Descriptive Case Series Study

by Nicole Philippens, Ester Janssen, Sacha Verjans-Janssen, Stef Kremers and Rik Crutzen

Int. J. Environ. Res. Public Health 2021, 18(22), 11861; https://doi.org/10.3390/ijerph182211861 - 12 Nov 2021

Cited by 7 | Viewed by 5609

Abstract

(1) Background: The aim of this study is to investigate changes over time in participants of healthyLIFE, a Combined Lifestyle Intervention (CLI) based on the Coaching on Lifestyle (CooL) intervention. This study focuses on changes in behavior, physical fitness, motivation and Positive Health eight months after the start of the intervention. (2) Methods: In total, 602 Dutch adults, meeting the CLI inclusion criteria, were included from January 2018 until October 2020 in this descriptive case series study. We collected a broad set of data regarding weight/BMI, physical fitness, motivation, self-efficacy, social influence, personal barriers and needs towards food and physical activity and perceived personal health by means of the six dimensions of Positive Health. (3) Results: Eight months after baseline, positive effects of the intervention were found on most outcome measures. We found an increase in all measured aspects of physical fitness (stamina, flexibility, mobility, hand grip strength and BMI). Dietary changes were limited during the healthyLIFE intervention, except for fruit consumption (increase with an effect size of 0.42). The largest effect sizes were found for the dimensions of Positive Health ranging from 0.41 to 0.68. (4) Conclusion: The healthyLIFE intervention is successful in improving participants’ BMI, physical fitness, and perceived physical, mental and social health. A broad health perspective, beyond physical measurements, is recommended when studying effects of the CLI. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

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9 pages, 958 KiB

Open AccessArticle

The Development of a Nutrition Screening Tool for Mental Health Settings Prone to Obesity and Cardiometabolic Complications: Study Protocol for the NutriMental Screener

by Scott B. Teasdale, Sabrina Moerkl, Sonja Moetteli and Annabel Mueller-Stierlin

Int. J. Environ. Res. Public Health 2021, 18(21), 11269; https://doi.org/10.3390/ijerph182111269 - 27 Oct 2021

Cited by 12 | Viewed by 4782

Abstract

People living with serious mental illness (SMI) experience physical health complications at disproportionate rates to people without an SMI. Unhealthy dietary intake and disordered eating behaviors are key driving factors. There is a lack of valid nutrition-risk screening tools targeted to mental health services, and typically used nutrition-risk screening tools are not suitable for mental health services. This paper details the rationale and study protocol for development and validation of the NutriMental screener, a tool for use in clinical practice to identify service users who are at risk for common nutrition issues experienced by this population group and trigger referral to a specialist clinician. The development process includes five phases. Phase I is the development of nutrition-related domains of interest from screening tools used in mental health services. Phase II involves a literature review and service-user interviews to identify additional domains. Phase III consists of international workshops with relevant clinicians and persons with SMI to gain a consensus on questions to be included in the draft tool. Phase IV involves conducting multinational feasibility and preliminary validation studies. Phase V consists of performing formal validation studies. The development of a nutrition-risk screening tool for mental health services is a necessary step to help rectify the physical-health disparities and life-expectancy gap for people with SMI. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

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13 pages, 1073 KiB

Open AccessArticle

Early or Delayed Onset of Food Intake in Time-Restricted Eating: Associations with Markers of Obesity in a Secondary Analysis of Two Pilot Studies

by Dorothea Kesztyüs, Petra Cermak, Tibor Kesztyüs and Anne Barzel

Int. J. Environ. Res. Public Health 2021, 18(18), 9935; https://doi.org/10.3390/ijerph18189935 - 21 Sep 2021

Cited by 2 | Viewed by 3010

Abstract

Time-restricted eating (TRE) has rapidly gained interest in the public and the scientific community. One presumed mechanism of action is the adaptation of the eating–fasting rhythm to the evolutionary circadian rhythm of the metabolism. Study results regarding the suggestion that earlier beginning of food intake leads to better outcomes are heterogeneous. We conducted a secondary analysis of pooled data from two pilot studies on TRE to examine an association between the timing of onset of food intake with obesity-related outcomes. Participants (n = 99, 83 females aged 49.9 ± 10.8 years) were asked to restrict their daily eating to 8–9 h for three months. Tertiles of the onset of food intake were assessed for changes in anthropometry, blood lipid levels, and health-related quality of life. We detected no significant differences in outcomes between early (before 9:47), medium (9:47–10:50), and late onset (after 10:50) of food intake. However, the duration of the eating period was longest in the group with the earliest (8.6 ± 1.0 h) and shortest in the group with the latest onset (7.5 ± 0.8 h). Subsequently, fasting duration was longest in the last group (16.5 h). This may have compromised the results. More research is needed in this area to address this question. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

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13 pages, 339 KiB

Open AccessArticle

Healthy Dietary Choices and Physical Activity Participation in the Canadian Arctic: Understanding Nunavut Inuit Perspectives on the Barriers and Enablers

by Victor O. Akande, Timothy O. Fawehinmi, Robert A.C. Ruiter and Stef P.J. Kremers

Int. J. Environ. Res. Public Health 2021, 18(3), 940; https://doi.org/10.3390/ijerph18030940 - 22 Jan 2021

Cited by 8 | Viewed by 3734

Abstract

Background: Research shows that unhealthy diets and low physical activity are associated with high rates of obesity-linked chronic diseases amongst Nunavut Inuit. To provide contextual insights and deepen our understanding of the factors that underlie these lifestyle choices, we explored the perspectives of Nunavut Inuit on the barriers and enablers of healthy diets and physical activity participation in the community of Iqaluit. Methods: One-on-one semi-structured photo-elicitation interviews were conducted with 16 participants of 18 years and over (10 women, six men). The interviews uncovered the participants’ perspectives on the factors influencing healthy diets and physical activity in their community. Interviews were audio-recorded, transcribed, and uploaded to QSR NVIVO Version 12. Data analysis was achieved using an inductive thematic approach. Results: Six main factors were identified as barriers or enablers to energy balance-related behaviors: cost and affordability of healthy choices; availability of traditional foods and activities; weather conditions and climate change; infrastructure and community resources; social networks of family and friends; and effect of substance use. Conclusion: This study identified six broad areas that should be considered while mapping out interventions to reduce the burden of obesity-related chronic diseases in Nunavut communities. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

16 pages, 1073 KiB

Open AccessArticle

Parental Self-Efficacy as a Predictor of Children’s Nutrition and the Potential Mediator Effect between the Health Promotion Program “Join the Healthy Boat” and Children’s Nutrition

by Ricarda Möhler, Olivia Wartha, Jürgen Michael Steinacker, Bertram Szagun and Susanne Kobel

Int. J. Environ. Res. Public Health 2020, 17(24), 9463; https://doi.org/10.3390/ijerph17249463 - 17 Dec 2020

Cited by 12 | Viewed by 3385

Abstract

Overweight and obesity, as well as their associated risk factors for diseases, are already prevalent in childhood and, therefore, promoting healthy eating is important. Parental self-efficacy (PSE) and early health-promotion can be helpful in promoting healthy eating. The aim of this study was to examine the influence of PSE on children’s nutrition behavior and identify PSE as a mediator between an intervention and children’s nutrition. The kindergarten-based health-promotion program “Join the Healthy Boat” was evaluated in a randomized controlled trial with 558 children (4.7 ± 0.6 years; 52.3% male) participating at both times. Linear and logistic regressions as well as mediation analyses with potential covariates such as parental outcome expectancies or parental nutrition were carried out using questionnaire data. In children, PSE was positively associated with fruit and vegetable intake (β = 0.237; p < 0.001) and showed a protective effect on soft drink consumption (OR 0.728; p = 0.002). Parental nutrition was a stronger predictor of children’s intake of fruit, vegetables (β = 0.451; p < 0.001), and soft drinks (OR 7.188; p < 0.001). There was no mediator effect of PSE. However, outcome expectancies were associated with PSE (β = 0.169; p = 0.032). In conclusion, interventions should promote self-efficacy, outcome expectancies, and healthy nutrition for parents as well in order to strengthen the healthy eating habits of children. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

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14 pages, 542 KiB

Open AccessArticle

Intervention Effects of the Health Promotion Programme “Join the Healthy Boat” on Objectively Assessed Sedentary Time in Primary School Children in Germany

by Susanne Kobel, Jens Dreyhaupt, Olivia Wartha, Sarah Kettner, Belinda Hoffmann and Jürgen M. Steinacker

Int. J. Environ. Res. Public Health 2020, 17(23), 9029; https://doi.org/10.3390/ijerph17239029 - 3 Dec 2020

Cited by 9 | Viewed by 3152

Abstract

Sedentary behaviour (SB) in children is related to negative health consequences that can track into adulthood. The programme “Join the Healthy Boat” promotes reduced screen time and a less sedentary lifestyle in schoolchildren. This study investigated the effects of the programme on children’s SB. For one year, teachers delivered the programme. A total of 231 children (7.0 ± 0.6 years) participated in the cluster-randomised study; there were 154 one year later at follow-up. Children’s SB was assessed using multi-sensor accelerometery, screen time via parental questionnaire. Effects were analysed using (linear) mixed effects regression models. At baseline, children spent 211 (±89) min daily in SB, at follow-up 259 (±109) min/day with no significant difference between the intervention (IG) and control group (CG). SB was higher during weekends (p < 0.01, for CG and IG). However, at follow-up, daily screen time decreased in IG (screen time of >1 h/day: baseline: 33.3% vs. 27.4%; follow-up: 41.2% vs. 27.5%, for CG and IG, respectively). This multi-dimensional, low-threshold intervention for one year does not seem to achieve a significant reduction in children’s SB, although screen time decreased in IG. Therefore, it should be considered that screen time cannot be the key contributor to SB and should not solely be used for changing children’s SB. However, if screen time is targeted, interventions should promote the replacement of screen time with active alternatives. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

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9 pages, 457 KiB

Open AccessArticle

Cardiometabolic Risk Factor in Obese and Normal Weight Individuals in Community Dwelling Men

by Hyunsoo Kim, Kijeong Kim and Sohee Shin

Int. J. Environ. Res. Public Health 2020, 17(23), 8925; https://doi.org/10.3390/ijerph17238925 - 30 Nov 2020

Cited by 4 | Viewed by 2460

Abstract

The aim of this study was to investigate the cardiometabolic risk factors (CRFs) in community dwelling men based on a combination of body mass index (BMI) and waist circumference (WC). This cross-sectional study was based on 867 males between the ages of 20 and 71 years. Subjects were categorized into 4 groups by BMI and WC (Group 1, BMI < 25 kg/m² and WC < 90 cm; Group 2, BMI < 25 kg/m² and WC > 90 cm; Group 3, BMI > 25 kg/m² and WC < 90 cm; and Group 4 BMI > 25 kg/m² and WC > 90 cm). The proportion of subjects with a normal weight with high WC was 3.2%. Among normal weight men with the high range of WC, significantly high Odds ratios (ORs) and 95% CI were found for hypertriglyceridemia (3.8, 1.8–8.2) and high blood glucose (3.2, 1.5–6.9). The probability that the general obesity group (Group 3) had one CRF was around twice that of the reference group (Group 1) (1.9 to 2.1 times), but Group 2 had probability more than 4 times higher (4.3 to 4.6 times). In community dwelling adult men, normal weight with high waist circumference was associated with the highest cardiometabolic risk. In conclusion, follow-up screening of those with high WC may be necessary to detect and prevent cardiometabolic diseases, particularly for men with a normal weight. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

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14 pages, 358 KiB

Open AccessViewpoint

The Weight Problem: Overview of the Most Common Concepts for Body Mass and Fat Distribution and Critical Consideration of Their Usefulness for Risk Assessment and Practice

by Dorothea Kesztyüs, Josefine Lampl and Tibor Kesztyüs

Int. J. Environ. Res. Public Health 2021, 18(21), 11070; https://doi.org/10.3390/ijerph182111070 - 21 Oct 2021

Cited by 16 | Viewed by 4398

Abstract

The prevalence of obesity already reached epidemic proportions many years ago and more people may die from this pandemic than from COVID-19. However, the figures depend on which measure of fat mass is used. The determination of the associated health risk also depends on the applied measure. Therefore, we will examine the most common measures for their significance, their contribution to risk assessment and their applicability. The following categories are reported: indices of increased accumulation of body fat; weight indices and mortality; weight indices and risk of disease; normal weight obesity and normal weight abdominal obesity; metabolically healthy obesity; the obesity paradox. It appears that BMI is still the most common measure for determining weight categories, followed by measures of abdominal fat distribution. Newer measures, unlike BMI, take fat distribution into account but often lack validated cut-off values or have limited applicability. Given the high prevalence of obesity and the associated risk of disease and mortality, it is important for a targeted approach to identify risk groups and determine individual risk. Therefore, in addition to BMI, a measure of fat distribution should always be used to ensure that less obvious but risky manifestations such as normal weight obesity are identified. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

15 pages, 1776 KiB

Open AccessSystematic Review

Overweight and Obesity in Patients with Congenital Heart Disease: A Systematic Review

by Laura Willinger, Leon Brudy, Michael Meyer, Renate Oberhoffer-Fritz, Peter Ewert and Jan Müller

Int. J. Environ. Res. Public Health 2021, 18(18), 9931; https://doi.org/10.3390/ijerph18189931 - 21 Sep 2021

Cited by 32 | Viewed by 4674

Abstract

Background: Overweight and obesity have become a major public health concern in recent decades, particularly in patients with chronic health conditions like congenital heart disease (CHD). This systematic review elaborates on the prevalence and the longitudinal development of overweight and obesity in children and adults with CHD. Methods: A systematic literature search was conducted in PubMed, Cochrane, and Scopus from January 2010 to December 2020 on overweight and obesity prevalence in children and adults with CHD. Results: Of 30 included studies, 15 studies evaluated 5680 pediatric patients with CHD, 9 studies evaluated 6657 adults with CHD (ACHD) and 6 studies examined 9273 both pediatric patients and ACHD. Fifteen studies received the quality rating “good”, nine studies “fair”, and six studies “poor”. In children with CHD, overweight prevalence was between 9.5–31.5%, and obesity prevalence was between 9.5–26%; in ACHD, overweight prevalence was between 22–53%, and obesity was between 7–26%. The prevalence of overweight and obesity was thereby similar to the general population. Overweight and obesity have been shown to increase with age. Conclusion: The prevalence of overweight and obesity in children and adults with CHD is similar to the general population, demonstrating that the growing obesity pandemic is also affecting the CHD population. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

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10 pages, 322 KiB

Open AccessBrief Report

Overweight and Obesity among Adults in Iraq: Prevalence and Correlates from a National Survey in 2015

by Supa Pengpid and Karl Peltzer

Int. J. Environ. Res. Public Health 2021, 18(8), 4198; https://doi.org/10.3390/ijerph18084198 - 15 Apr 2021

Cited by 27 | Viewed by 4627

Abstract

This study aimed to estimate the prevalence and correlates of overweight and obesity among adults in Iraq. Data from a 2015 nationally representative cross-sectional survey of 3916 persons 18 years or older (M (median) age = 40 years, IQR (interquartile range) age = 29–52 years; men: M = 41 years, IQR = 29–54 years; women: M = 40 years, IQR = 30–51 years) who responded to a questionnaire, and physical and biochemical measures were analysed. Multinomial logistic regression was utilised to predict the determinants of overweight and obesity relative to under or normal weight. The results indicate that 3.6% of the participants were underweight (body mass index (BMI) <18.5 kg/m²), 30.8% had normal weight (BMI 18.5–24.9 kg/m²), 31.8% were overweight (25.0–29.9 kg/m²), and 33.9% had obesity (BMI ≥30.0 kg/m²). In the adjusted multinomial logistic regression, being aged 40–49 years (compared to 18–39 years old) (adjusted relative risk ratio (ARRR): 4.47, confidence interval (CI): 3.39–5.91), living in an urban residence (ARRR: 1.28, CI: 1.14–2.18), and having hypertension (ARRR: 3.13, CI: 2.36–4.17) were positively associated with obesity. Being male (ARRR: 0.47, CI: 0.33–0.68), having more than primary education (ARRR: 0.69, CI: 0.50–0.94), and having a larger household size (five members or more) (ARRR: 0.45, CI: 0.33–0.60) were negatively associated with obesity. Approximately two in three adult participants were overweight/obese, and sociodemographic and health risk factors were found that can be utilised in targeting interventions. Full article

(This article belongs to the Special Issue Prevention, Health Care and Policies for Populations at High Risk for Overweight and Obesity)

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