Metabolic syndrome (MetS) is a complex disorder defined by a cluster of interconnected factors that increase the risk of cardiovascular atherosclerotic diseases and diabetes mellitus type 2. Currently, several different definitions of MetS exist, causing substantial confusion as to whether they identify the same individuals or represent a surrogate of risk factors. Recently, a number of other factors besides those traditionally used to define MetS that are also linked to the syndrome have been identified. In this review, we critically consider existing definitions and evolving information, and conclude that there is still a need to develop uniform criteria to define MetS, so as to enable comparisons between different studies and to better identify patients at risk. As the application of the MetS model has not been fully validated in children and adolescents as yet, and because of its alarmingly increasing prevalence in this population, we suggest that diagnosis, prevention and treatment in this age group should better focus on established risk factors rather than the diagnosis of MetS.

/pdf/metabolic-syndrome-definitions-and-controversies-4hey5uyogq.pdf

Metabolic syndrome: definitions and controversies

Long-term behavioral self-regulation is the hallmark of successful weight control. We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a randomized controlled 12-month weight management intervention. Overweight and obese women (N = 225, BMI = 31.3 ± 4.1 kg/m2) were randomly assigned to a control or a 1-year group intervention designed to promote autonomous self-regulation of body weight. Key exercise, eating behavior, and body image variables were assessed before and after the program, and tested as mediators of weight loss (12 months, 86% retention) and weight loss maintenance (24 months, 81% retention). Multiple mediation was employed and an intention-to-treat analysis conducted. Treatment effects were observed for all putative mediators (Effect size: 0.32–0.79, P < 0.01 vs. controls). Weight change was −7.3 ± 5.9% (12-month) and −5.5 ± 5.0% (24-month) in the intervention group and −1.7 ± 5.0% and −2.2 ± 7.5% in controls. Change in most psychosocial variables was associated with 12-month weight change, but only flexible cognitive restraint (P < 0.01), disinhibition (P < 0.05), exercise self-efficacy (P < 0.001), exercise intrinsic motivation (P < 0.01), and body dissatisfaction (P < 0.05) predicted 24-month weight change. Lower emotional eating, increased flexible cognitive restraint, and fewer exercise barriers mediated 12-month weight loss (R2 = 0.31, P < 0.001; effect ratio: 0.37), but only flexible restraint and exercise self-efficacy mediated 24-month weight loss (R2 = 0.17, P < 0.001; effect ratio: 0.89). This is the first study to evaluate self-regulation mediators of weight loss and 2-year weight loss maintenance, in a large sample of overweight women. Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss. For long-term success, interventions must also be effective in promoting exercise intrinsic motivation and self-efficacy.

/pdf/mediators-of-weight-loss-and-weight-loss-maintenance-in-5aa2ppi77w.pdf

Mediators of weight loss and weight loss maintenance in middle-aged women.

Summary
This is the first study to report the prevalence of general obesity and abdominal obesity (AO) in the adult population of Spain based on measurements of weight, height and waist circumference. The data are taken from the ENRICA study, a cross-sectional study carried out between June 2008 and October 2010 in 12,883 individuals representative of the non-institutionalized population on Spain aged 18 years and older. Anthropometry was performed under standardized conditions in the households by trained interviewers. Overweight was considered as body mass index (BMI) 25–29.9 kg m−2, and obesity as BMI ≥ 30 kg m−2. AO was defined as waist circumference >102 cm in men and >88 cm in women. The prevalence of obesity was 22.9% (24.4% in men and 21.4% in women). About 36% of adults had AO (32% of men and 39% of women). The frequency of obesity and of AO increased with age and affected, respectively, 35 and 62% of persons aged 65 and over. The frequency of obesity and AO decreased with increasing educational level. For example, 29% of women with primary education or less had obesity vs. only 11% of those with university studies. The prevalence of obesity was very high in the Canary Islands and in the south of Spain.

Prevalence of general and abdominal obesity in the adult population of Spain, 2008-2010: the ENRICA study.

Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese and Spanish were included. This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables and/or attempted to assess causality through the use of quasi-experimental designs. Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention.

/pdf/educational-attainment-and-obesity-a-systematic-review-38ktrfh8ng.pdf

Educational attainment and obesity: a systematic review

Research on the motivational model proposed by Self-Determination Theory (SDT) provides theoretically sound insights into reasons why people adopt and maintain exercise and other health behaviors, and allows for a meaningful analysis of the motivational processes involved in behavioral self-regulation. Although obesity is notoriously difficult to reverse and its recidivism is high, adopting and maintaining a physically active lifestyle is arguably the most effective strategy to counteract it in the long-term. The purposes of this study are twofold: i) to describe a 3-year randomized controlled trial (RCT) aimed at testing a novel obesity treatment program based on SDT, and ii) to present the rationale behind SDT's utility in facilitating and explaining health behavior change, especially physical activity/exercise, during obesity treatment.

/pdf/a-randomized-controlled-trial-to-evaluate-self-determination-33bcfkycwv.pdf

A randomized controlled trial to evaluate self-determination theory for exercise adherence and weight control: rationale and intervention description

Summary Obesity is an endemic health problem in most developed countries, requiring serious public health attention. The first Portuguese nationwide representative survey about obesity (with objective anthropometric measurement) was undertaken from 1995 to 1998. This paper presents data coming from the second and most recent nationwide representative study of obesity, with objective measurement of weight, height, waist and hip circumferences. Data were collected between January 2003 and January 2005. The survey collected objective body mass index (BMI) values of 8116 participants aged 18‐64. Main findings were: 2.4% of the sample had low weight (BMI < 18.5), 39.4% were overweight (BMI between 25.0 and 29.9), and 14.2% obese (BMI 30). Waist circumference measurement showed that 45.6% of the sample suffers increased cardiovascular health risks associated with high waist circumference. The overall overweight/ obesity prevalence increased from 49.6% (in 1995‐1998) to 53.6% (in 2003‐ 2005). These data suggest that although obesity was identified as a public health problem one decade ago, action to reduce it does not seem to have been very effective to date. Well-defined public health intervention must be targeted to specific population groups where higher levels of obesity prevalence were found: low socioeconomic level groups and low-education level groups.

/pdf/overweight-and-obesity-in-portugal-national-prevalence-in-3fwqqghegw.pdf

Overweight and obesity in Portugal: national prevalence in 2003-2005.

Summary Obesity is a serious health problem in developed countries. Knowledge of reliable and nationwide representative data is a must for any public health action. The dimension of this problem in Portugal was first assessed in 1995‐1998. A similar populational survey using objective anthropometric measures is now being conducted (field work started in January 2003). A total of 6411 subjects aged 18‐ 64 years old have already been measured and their respective body mass indexes (BMIs) calculated. Results from 2003 to 2005 show 38.6% is overweight and 13.8% has obesity. The total of overweight and obesity is 52.4%. In 1995‐1998 survey, overweight was 35.2% and obesity was 14.4%. The total was 49.6%. These results suggest an increase of the overweight/obesity (altogether) prevalence in the last 10 years. Actual results show that more than half of the adult sample has excessive weight and 2.4% of the sample has low BMI. Finally, 45.6% of the sample suffers increased health risks because of high waist circumference ( ≥ 80 cm for women; ≥ 94 cm for men). These results highlight the fact that, although obesity was identified as a public health problem one decade ago, action to reduce it does not seem to have been very effective to date.

/pdf/prevalence-of-obesity-in-portugal-47x2910zpa.pdf

A. Galvao-Teles

Papers

Overweight and obesity in Portugal: national prevalence in 2003-2005.

Prevalence of obesity in Portugal