Obesity and Black Women: Special Considerations Related to Genesis and Therapeutic Approaches
TL;DR: More work is needed to understand barriers to behavior change for black women, and knowledge gaps remain in identifying mechanisms by which pharmacologic and surgical treatments for obesity modify cardiovascular risk in black women.
Abstract: Black women in the United States are disproportionately affected by obesity, with almost two-thirds considered obese based on body mass index Obesity has been directly linked to cardiovascular morbidity and mortality in black women Therefore, understanding contributors to the genesis of obesity in black women is imperative While biologic differences likely result in varying obesity prevalence across racial/ethnic groups, behaviors such as post-partum weight retention and limited leisure-time physical activity, may especially contribute to obesity in black women Black women also appear to be particularly susceptible to cultural, psychosocial, and environmental factors that can promote weight gain Therapeutic interventions are being tailored to specifically address these social determinants of health and to foster lifestyle modification; however, more work is needed to understand barriers to behavior change for black women Knowledge gaps also remain in identifying mechanisms by which pharmacologic and surgical treatments for obesity modify cardiovascular risk in black women
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Lars Sjöström1, Markku Peltonen, Peter Jacobson, C. David Sjöström, Kristjan Karason, Hans Wedel, Sofie Ahlin, Åsa Anveden, Calle Bengtsson, Gerd Bergmark, Claude Bouchard, Björn Carlsson, Sven Dahlgren, Jan Karlsson, Anna Karin Lindroos, Hans Lönroth, Kristina Narbro, Ingmar Näslund, Torsten Olbers, Per-Arne Svensson, Lena M. S. Carlsson •
TL;DR: Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.
Abstract: Context Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking. Objective To study the association between bariatric surgery, weight loss, and cardiovascular events. Design, Setting, and Participants The Swedish Obese Subjects (SOS) study is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care. Patients were recruited between September 1, 1987, and January 31, 2001. Date of analysis was December 31, 2009, with median follow-up of 14.7 years (range, 0-20 years). Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Exclusion criteria were identical in surgery and control patients. Surgery patients underwent gastric bypass (13.2%), banding (18.7%), or vertical banded gastroplasty (68.1%), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals. Main Outcome Measures The primary end point of the SOS study (total mortality) was published in 2007. Myocardial infarction and stroke were predefined secondary end points, considered separately and combined. Results Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P Conclusion Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.
1,117 citations
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TL;DR: Pregnant US women from minority groups had higher stroke risk during delivery admissions, compared with non‐Hispanic whites, and the effect of race/ethnicity was larger in women with chronic hypertension or pregnancy‐induced hypertension.
Abstract: Background Racial disparities contribute to maternal morbidity in the United States. Hypertension is associated with poor maternal outcomes, including stroke. Disparities in hypertension might cont...
51 citations
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TL;DR: There is a suggestion that negative emotions, in particular, perceived stress, may be predictive of emotional eating among non‐Hispanic Black women and the need for more studies that examine various negative emotions that may lead to emotional eating and weight gain among non-HispanicBlack women is highlighted.
Abstract: Emotional eating may be a particularly important contributor to differences in body weight and weight loss response to behavioural interventions among non-Hispanic Black women. We performed a systematic review on the impact of psychological factors (stress, anxiety, depression, and discrimination) upon emotional eating and weight among non-Hispanic Black women, applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis for relevant studies. The initial search yielded 4593 articles with 15 accepted for review. Based on this review, there is a suggestion that negative emotions, in particular, perceived stress, may be predictive of emotional eating among non-Hispanic Black women. Results from the only two longitudinal studies identified by the review indicate that stress influences emotional eating, and emotional eating predicts weight gain over time. Findings from this review highlight the need for more studies that examine various negative emotions that may lead to emotional eating and weight gain among non-Hispanic Black women. Findings from this review also highlight the need for more rigorous studies to differentiate the effects of emotional eating from that of the physiologic (ie, activation of the hypothalamic-pituitary axis) responses to stress and its impact on high-risk groups.
17 citations
Cites background from "Obesity and Black Women: Special Co..."
...These health consequences are disproportionately linked to disparities in obesity prevalence among nonHispanic Black women.(1,5) Causes of overweight and obesity among non-Hispanic Black women are multifactorial....
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TL;DR: Hair harassment can be defined as the direct or indirect unwanted, unwelcomed, and offensive behavior made either explicitly or implicitly typically toward women or girls of African descent, based on the texture, look, or subjective assumptions of their hair as mentioned in this paper.
Abstract: Hair harassment can be defined as the direct or indirect unwanted, unwelcomed, and offensive behavior made either explicitly or implicitly typically towards women or girls of African descent, based on the texture, look, or subjective assumptions of their hair. The purpose of this investigation is to explore the hair experiences of adolescent girls of African descent in physical education class, and how these experiences shape their decision to participate in physical education class. Thirty-seven adolescent girls of African descent attending school in an urban, low-income community participated in focus groups and follow-up interviews relating to hair experiences. Strong themes of hair harassment emerged occurring socially via peers, physical touching of hair, and verbal comments regarding their hair during physical education class, and society-imposed harassment stemming from pressures to constantly have straight or neatly styled, non-sweaty hair. During the stage of adolescence, girls are exploring their identity and making decisions about who they will be, how they should look, and behave. Findings from this study suggests harassment and bullying policies in schools should extend to include hair harassment for its propensity to influence the self-image of girls and their decisions to participate in physical education class.
14 citations
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TL;DR: It is concluded that ald testosterone is produced from subcutaneous adipocytes of obese postmenopausal women and use of an ARB significantly reduces aldosterone production within 6 months of use in these women as well as in cells exposed to their adipocytes.
Abstract: Increased abdominal obesity is associated with increased cardiovascular risk, especially in African American women. The adipocyte is documented to produce a number of inflammatory factors including the hormone aldosterone. There are very few data documenting aldosterone production from adipocytes of postmenopausal women as well as data demonstrating the effects of angiotensin receptor blockade (ARB) on its production in predominately African American women. The authors hypothesize that increased central adipocyte mass in obese postmenopausal women contributes to increased production of aldosterone that is suppressed with the ARB azilsartan medoxomil. The authors tested this hypothesis in a double-blind, placebo-controlled pilot study of 34 hypertensive postmenopausal women (mean age 57.5±7.5 years), 91% of whom were African American. Patients had a mean 24-hour ambulatory systolic blood pressure of 127±13 mm Hg off any blocker of the renin-angiotensin system but while taking other antihypertensive medications. The authors further validated aldosterone production in a nested cohort of women using fat cells from a fat pad biopsy. Azilsartan reduced 24-hour urinary aldosterone by 47.3% from baseline (P=.03), with between-groups differences in urine aldosterone of -5.3±52.3% placebo vs -47.3±32.9% azilsartan (P=.07) at 6 months. An adrenal cell line treated with adipocyte-conditioned media from subcutaneous abdominal adipocytes of postmenopausal women (n=3) showed an increase in aldosterone production blocked by an ARB (1948±1297 pg/mL fat alone vs 894±438 pg/mL fat + ARB; P=.022). The authors conclude that aldosterone is produced from subcutaneous adipocytes of obese postmenopausal women. Moreover, use of an ARB significantly reduces aldosterone production within 6 months of use in these women as well as in cells exposed to their adipocytes.
11 citations
References
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Alan S. Go1, Dariush Mozaffarian1, Véronique L. Roger1, Emelia J. Benjamin1, Jarett D. Berry1, William B. Borden1, Dawn M. Bravata1, Shifan Dai1, Earl S. Ford1, Caroline S. Fox1, Sheila Franco1, Heather J. Fullerton1, Cathleen Gillespie1, Susan M. Hailpern1, John A. Heit1, Virginia J. Howard1, Mark D. Huffman1, Brett M. Kissela1, Steven J. Kittner1, Daniel T. Lackland1, Judith H. Lichtman1, Lynda D. Lisabeth1, David J. Magid1, Gregory M. Marcus1, Ariane Marelli1, David B. Matchar1, Darren K. McGuire1, Emile R. Mohler1, Claudia S. Moy1, Michael E. Mussolino1, Graham Nichol1, Nina P. Paynter1, Pamela J. Schreiner1, Paul D. Sorlie1, Joel Stein1, Tanya N. Turan1, Salim S. Virani1, Nathan D. Wong1, Daniel Woo1, Melanie B. Turner1 •
TL;DR: Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Borden, William B; Bravata, Dawn M; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huff
Abstract: Author(s): Go, Alan S; Mozaffarian, Dariush; Roger, Veronique L; Benjamin, Emelia J; Berry, Jarett D; Borden, William B; Bravata, Dawn M; Dai, Shifan; Ford, Earl S; Fox, Caroline S; Franco, Sheila; Fullerton, Heather J; Gillespie, Cathleen; Hailpern, Susan M; Heit, John A; Howard, Virginia J; Huffman, Mark D; Kissela, Brett M; Kittner, Steven J; Lackland, Daniel T; Lichtman, Judith H; Lisabeth, Lynda D; Magid, David; Marcus, Gregory M; Marelli, Ariane; Matchar, David B; McGuire, Darren K; Mohler, Emile R; Moy, Claudia S; Mussolino, Michael E; Nichol, Graham; Paynter, Nina P; Schreiner, Pamela J; Sorlie, Paul D; Stein, Joel; Turan, Tanya N; Virani, Salim S; Wong, Nathan D; Woo, Daniel; Turner, Melanie B; American Heart Association Statistics Committee and Stroke Statistics Subcommittee
5,449 citations
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TL;DR: In 2009-2010, the prevalence of obesity was 35.5% among adult men and 35.8% amongadult women, with no significant change compared with 2003-2008, and trends in BMI were similar to obesity trends.
Abstract: Results In 2009-2010 the age-adjusted mean BMI was 28.7 (95% CI, 28.3-29.1) for men and also 28.7 (95% CI, 28.4-29.0) for women. Median BMI was 27.8 (interquartile range [IQR], 24.7-31.7) for men and 27.3 (IQR, 23.3-32.7) for women. The age-adjusted prevalence of obesity was 35.5% (95% CI, 31.9%-39.2%) among adult men and 35.8% (95% CI, 34.0%-37.7%) among adult women. Over the 12-year period from 1999 through 2010, obesity showed no significant increase among women overall (age- and race-adjusted annual change in odds ratio [AOR], 1.01; 95% CI, 1.00-1.03; P=.07), but increases were statistically significant for non-Hispanic black women (P=.04) and Mexican American women (P=.046). For men, there was a significant linear trend (AOR, 1.04; 95% CI, 1.02-1.06; P.001) over the 12-year period. For both men and women, the most recent 2 years (2009-2010) did not differ significantly (P=.08 for men and P=.24 for women) from the previous 6 years (20032008). Trends in BMI were similar to obesity trends.
5,333 citations
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TL;DR: A simulation model used to project the probable health and economic consequences in the next two decades from a continued rise in obesity in two ageing populations--the USA and the UK used to find that effective policies to promote healthier weight also have economic benefits.
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TL;DR: It is indicated that both walking and vigorous exercise are associated with substantial reductions in the incidence of cardiovascular events among postmenopausal women, irrespective of race or ethnic group, age, and body-mass index.
Abstract: Background The role of walking, as compared with vigorous exercise, in the prevention of cardiovascular disease remains controversial. Data for women who are members of minority racial or ethnic groups are particularly sparse. Methods We prospectively examined the total physical-activity score, walking, vigorous exercise, and hours spent sitting as predictors of the incidence of coronary events and total cardiovascular events among 73,743 postmenopausal women 50 to 79 years of age in the Women's Health Initiative Observational Study. At base line, participants were free of diagnosed cardiovascular disease and cancer, and all participants completed detailed questionnaires about physical activity. We documented 345 newly diagnosed cases of coronary heart disease and 1551 total cardiovascular events. Results An increasing physical-activity score had a strong, graded, inverse association with the risk of both coronary events and total cardiovascular events. There were similar findings among white women and bl...
1,352 citations
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Lars Sjöström1, Markku Peltonen, Peter Jacobson, C. David Sjöström, Kristjan Karason, Hans Wedel, Sofie Ahlin, Åsa Anveden, Calle Bengtsson, Gerd Bergmark, Claude Bouchard, Björn Carlsson, Sven Dahlgren, Jan Karlsson, Anna Karin Lindroos, Hans Lönroth, Kristina Narbro, Ingmar Näslund, Torsten Olbers, Per-Arne Svensson, Lena M. S. Carlsson •
TL;DR: The Swedish Obese Subjects (SOS) study as discussed by the authors was conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care.
Abstract: Context Obesity is a risk factor for cardiovascular events. Weight loss might protect against cardiovascular events, but solid evidence is lacking. Objective To study the association between bariatric surgery, weight loss, and cardiovascular events. Design, Setting, and Participants The Swedish Obese Subjects (SOS) study is an ongoing, nonrandomized, prospective, controlled study conducted at 25 public surgical departments and 480 primary health care centers in Sweden of 2010 obese participants who underwent bariatric surgery and 2037 contemporaneously matched obese controls who received usual care. Patients were recruited between September 1, 1987, and January 31, 2001. Date of analysis was December 31, 2009, with median follow-up of 14.7 years (range, 0-20 years). Inclusion criteria were age 37 to 60 years and a body mass index of at least 34 in men and at least 38 in women. Exclusion criteria were identical in surgery and control patients. Surgery patients underwent gastric bypass (13.2%), banding (18.7%), or vertical banded gastroplasty (68.1%), and controls received usual care in the Swedish primary health care system. Physical and biochemical examinations and database cross-checks were undertaken at preplanned intervals. Main Outcome Measures The primary end point of the SOS study (total mortality) was published in 2007. Myocardial infarction and stroke were predefined secondary end points, considered separately and combined. Results Bariatric surgery was associated with a reduced number of cardiovascular deaths (28 events among 2010 patients in the surgery group vs 49 events among 2037 patients in the control group; adjusted hazard ratio [HR], 0.47; 95% CI, 0.29-0.76; P = .002). The number of total first time (fatal or nonfatal) cardiovascular events (myocardial infarction or stroke, whichever came first) was lower in the surgery group (199 events among 2010 patients) than in the control group (234 events among 2037 patients; adjusted HR, 0.67; 95% CI, 0.54-0.83; P Conclusion Compared with usual care, bariatric surgery was associated with reduced number of cardiovascular deaths and lower incidence of cardiovascular events in obese adults.
1,291 citations