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CORK Bibliography: Weight

85 citations. July 2011 to present

Prepared: June 2012

Ade JN; Rohrer J; Rea NK. Immigration, income, drinking and obesity in African American adults. Journal of Immigrant and Minority Health 13(4): 659-663, 2011. (9 refs.)

The objective of this study was to investigate the relationship between immigration status, income, drinking and overweight and obesity in African American adults residing in the United States using an internet web based survey. Data on 303 adult African American immigrants and non-immigrants was collected using a self-administered web based survey. Respondents were recruited using a snowball sampling technique to obtain a convenience sample. Multiple logistic regression analysis were used to test the independent effects of the immigration status while controlling for confounding effects of demographic, social and behavioral variables. The results of the study showed no significant difference between obesity and immigration status in black adults residing in the US (adjusted odds ration = 1.1095, P = 0.7489). Significance at the P < 0.05 level was demonstrated for obesity and two independent variables: age (OR = 1.0332, P = 0.0298) and days per month consumed more than 5 alcoholic beverages (OR = 1.7735, P = 0.0001). Adult African American immigrants in this study sample were not at risk of being obese due to their immigration status. However, age and days in a month in which more than 5 alcoholic beverages are consumed were significant risk factors for obesity. Primary care providers should be alert for obesity and alcohol consumption in this population.

Afonso A; Aubyn MS. Assessing health efficiency across countries with a two-step and bootstrap analysis. Applied Economics Letters 18(13-15): 1427-1430, 2011. (10 refs.)

Regressing Data Envelopment Analysis (DEA) output efficiency scores on nondiscretionary variables, with a two-stage DEA/Tobit and bootstrap procedures, we show that health inefficiency in Organization for Economic Co-operation and Development (OECD) countries is related to Gross Domestic Product (GDP) per head, education level, obesity and smoking habits.

Audrain-McGovern J; Benowitz NL. Cigarette smoking, nicotine, and body weight. Clinical Pharmacology & Therapeutics 90(1): 164-168, 2011. (40 refs.)

Smokers generally gain weight when they quit smoking; this weight gain can lessen some of the health benefits of quitting smoking. We review the effectiveness of behavioral and pharmacological approaches to mitigating weight gain in the context of quitting smoking and consider mechanisms that could potentially account for the effects of smoking and nicotine on body weight. Understanding how nicotine affects body weight may lead to novel pharmacological and behavioral interventions for obesity as well as concurrent obesity and nicotine dependence.

Baek SI; So WY. Association between weight status and recreational drug abuse in Korean adolescents. Central European Journal of Medicine 7(2): 224, 2012. (25 refs.)

The purpose of this study was to investigate the relationship between weight status and recreational drug use in Korean adolescents. A total of 72,399 adolescent students (38,152 boys and 34,247 girls) from the middle first to high third grade participated in the 5(th) Korea Youth Risk Behaviour Web-based Survey (KYRBWS-V) project in 2009. They were assessed for body mass index (BMI) and recreational drug abuse. The associations between BMI and recreational drug use were examined using multivariable logistic regression analysis after adjusting for the covariate variables of age, smoking frequency and cigarette consumption, frequency of alcohol consumption and severe alcohol intoxication, amount of alcohol consumed, parents' education level, economic status, sedentary activities during the week, mental stress, sleep duration, frequency of vigorous and moderate physical activities, and muscular strength exercises during the week. For boys, the odds ratio (OR) (95% confidence interval [CI]) between overweight and drug use were 0.990 (0.723-1.356; p = 0.950) for almost none, 0.939 (0.521-1.693; p = 0.834) for past use, and 0.791 (0.385-1.624; p = 0.523) for present use. The OR (95% CI) between obesity and drug use was 0.731(0.508-1.052; p = 0.091) for almost none, 0.755 (0.389-1.465; p = 0.407) for past use, and 0.701 (0.314-1.565; p = 0.386) for present use. For girls, the OR (95% CI) between overweight and drug use was 1.112 (0.702-1.763; p = 0.650) for almost none, 1.103 (0.464-2.619; p = 0.825) for past use, and 0.927 (0.267-3.218; p = 0.905) for present use. The OR (95% CI) between obesity and drug abuse was 0.594 (0.261-1.352; p = 0.215) for almost none, 1.318 (0.462-3.764; p = 606) for past use, and < 0.001(< 0.001-< 0.001; p = 0.998) for present use. We concluded that recreational drug use had no correlation with overweight and obesity in Korean adolescents.

Berglund L; Sundgot-Borgen J; Berglund B. Adipositas athletica: a group of neglected conditions associated with medical risks. (review). Scandinavian Journal of Medicine & Science In Sports 21(5): 617-624, 2011. (61 refs.)

At the 2008 Olympics, the body weight of the athletes varied from 28 to 181 kg and many Olympic athletes therefore today have a stature far from the ancient Greek athletic ideals. Athletes and sports associated with leanness and their medical problems have been researched extensively. However, there has been less focus on those athletes, who may gain a competitive advantage by having excess body fat, being large or oversized. The present review introduces for the first time the concept of Adipositas athletica and gives a description and classification of these athletes. Adipositas athletica is defined as having a higher than "athletic normal" (Greek Olympic ideals) fat mass and being an elite athlete. The condition is divided into subgroups based on the intent or non-intent to increase body fat per se. Another factor is the intent to increase body mass as well as increasing physiological factors such as strength or endurance. It is concluded that most of the sports-medicine community-physicians, researchers and nutritionists - has neglected these oversized and obese athletes, their long- and short-term morbidity and mortality, their eating problems and the use of performance-enhancing drugs. Although some data on overweight and obese athletes exist, the most remarkable finding when reviewing the literature is the paucity of data. Many unanswered questions remain and great strides remain to be made.

Bergmann MM; Schutze M; Steffen A; Boeing H; Halkjaer J; Tjonneland A et al. The association of lifetime alcohol use with measures of abdominal and general adiposity in a large-scale European cohort. European Journal of Clinical Nutrition 65(10): 1079-1087, 2011. (40 refs.)

Background/Objectives: The relation between lifetime use of alcohol and measures of abdominal and general adiposity is unknown. Subjects/Methods: Among 99 381 men and 158 796 women of the European Prospective Investigation into Cancer and Nutrition (EPIC) study, means of waist circumference (WC), waist-to-hip-ratio (WHR) and body mass index (BMI), and odds ratios (OR) for a larger WC than predicted for a given BMI (WClp = positive residuals of gender specific linear regression of BMI on WC) across categories of average lifetime use of alcohol (total, from wine and from beer) were calculated, all adjusted for socio-demographic, lifestyle and health factors. Results: WC, WHR and BMI in men using lifetime <= 6 g/d alcohol were 95.1 cm, 0.942 and 27.3 kg/m(2), and 96.2 cm, 0.961 and 28.3 kg/m(2) when using 496 g/d. WC and WHR in women was 83.2 cm and 0.813 for <= 6 g/d, and 84.6 cm and 0.830 for 460 g/d, whereas BMI deviated only slightly with the lowest BMI (26.7 kg/m(2)) observed for 46-24 g/d. Compared with <= 6 g/d, OR for a WClp in both genders increased steadily across categories of alcohol use (up to 1.40 (95% confidence interval 1.32, 1.49) in men using >60 g/d and 1.63 (1.54, 1.73) in women using >24 g/d), though increase was higher for alcohol from beer than from wine (P for difference between beer and wine <0.001 (men) and = 0.002 (women)). Conclusion: Lifetime alcohol use is positively related to abdominal and general adiposity in men, possibly following the male weight gain pattern; in women, it is positively related only to abdominal adiposity. In this context, beer may contribute additionally to abdominal adiposity.

Beyerlein A; Ruckinger S; Toschke AM; Rosario AS; von Kries R. Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring? European Journal of Epidemiology 26(5): 413-420, 2011. (57 refs.)

A number of cross-sectional and prospective studies suggested a priming effect of maternal smoking in pregnancy on offspring's obesity. It has been hypothesized that this association might be explained by low birth weight and subsequent catch-up growth in the causal pathway. We therefore examined the role of birth weight in children exposed versus not exposed to cigarette smoking in utero on later body mass index (BMI). Using data of 12,383 children and adolescents (3-17 years of age) recorded in a German population-based survey (KiGGS), we assessed mean body mass index standard deviation scores (BMI-SDS) in different birth weight SDS categories, stratified for children with smoking and non-smoking mothers. We calculated spline regression models with BMI-SDS as outcome variable, cubic splines of birth weight SDS, and potential confounding factors. Children whose mothers had been smoking during pregnancy had lower birth weight SDS and higher BMI-SDS at interview compared to children of non-smoking mothers. However, we observed a linear association between birth weight SDS and BMI-SDS in crude analyses for both groups. Similarly, almost linear effects were observed in adjusted spline regression analyses, except for children with very low birth weight. The respective 95% confidence bands did not preclude a linear effect for the whole birth weight SDS distribution. Our findings suggest that low birth weight is unlikely to be the main cause for the association between intrauterine nicotine exposure and higher BMI in later life. Alternative mechanisms, such as alterations in the noradrenergic system or increased food efficiency, have to be considered.

Blake H; Malik S; Mo PKH; Pisano C. 'Do as I say, but not as I do': Are next generation nurses role models for health? Perspectives in Public Health 131(5): 231-239, 2011. (55 refs.)

Aim: Promoting healthy lifestyles plays a key role in professional nursing yet nurses do not always practice what they preach. Efforts are currently being made to improve the health of NHS staff, yet little is known about the health and lifestyle behaviours of pre-registration nurses in the UK although these individuals are our next generation of NHS employees. The aim of this study was to investigate the health behaviours and wellbeing of pre-registration nurses based at an acute NHS teaching hospital in England. Methods: In this cross-sectional questionnaire survey, 325 pre-registration nurses (50% response rate) completed a health and lifestyle questionnaire, measuring levels of physical activity, smoking and alcohol behaviour, dietary practices and general health. Results: Age ranged from 19-53 years, and 96% of the sample was female. More than half of the sample did not meet public health recommendations for physical activity. Just under one-fifth were current smokers and over three-quarters did not consume five servings of fruit/vegetables per day. Two-thirds reported exceeding the recommended maximum daily alcohol intake and around one third were classified as either overweight or obese. Those who were physically inactive were less likely to report good general health, good dietary practices and more sleep, and were more likely to report cigarette smoking and alcohol consumption than their active counterparts. Conclusions: This study indicates that the health profile of pre-registration nurses is relatively poor, and that those who are sedentary engage in other negative lifestyle behaviours also. Despite significant education relating to health promotion and health behaviours of patients being targeted at pre-registered nurses, it seems that this knowledge is not always transferred to their own behaviour. There is a need for timely intervention to establish healthy lifestyle behaviours amongst nurses early in their career.

Bluml V; Kapusta N; Vyssoki B; Kogoj D; Walter H; Lesch OM. Relationship between substance use and body mass index in young males. American Journal on Addictions 21(1): 72-77, 2012. (52 refs.)

Recent findings in basic scientific research, such as neurobiological and neuroimaging studies, have suggested common pathways for food and drug intake. It was hypothesized that both compete for the same brain reward sites, and that a higher body mass index (BMI) may be associated with lower substance use. The aim of this study was to investigate the relationship between BMI and substance use in a large sample of young male adults. The sample consisted of 1,902 18-year-old males from a province of Austria in a naturalistic cross-sectional setting. Questionnaires were administered to assess alcohol abuse and dependence (CAGE) and nicotine dependence (Heavy Smoking Index). Urine samples were collected to assess the prevalence of recent illicit drug use. Associations between BMI and substance use were calculated by means of logistic regression analyses. An inverse relationship between BMI and recent illicit drug use was found. This relationship remained significant after adjusting for possible confounding factors such as level of education, nicotine dependence, breath carbon monoxide (CO) levels, and alcohol abuse and dependence. No significant association was found between BMI and nicotine and alcohol dependence. A higher BMI was associated with lower illicit drug use in our sample of young adult males. These results provide further evidence for the hypothesis that food and drugs may compete for the same brain reward sites.

Boardman JD; Alexander KB. Stress trajectories, health behaviors, and the mental health of black and white young adults. Social Science & Medicine 72(10): 1659-1666, 2011. (39 refs.)

This paper uses data from the National Longitudinal Study of Adolescent Health to examine the mental health of non-Hispanic black and white young adults in the US. We use latent growth curve modeling to characterize the typical stress trajectories experienced by black and white young adults spanning the bulk of their lives. We identify the following four stress trajectories: 1) relatively stress free; 2) stress peak at age 15 and a subsequent decline; 3) stress peak at age 17 and a subsequent decline; and 4) a moderately high chronic stress. Results. indicate that black adolescents have significantly higher risk of being in all three of the stressful classes compared to white adolescents. Stress exposure is strongly associated with depression and the race differences in stress profiles account for a modest amount of the observed race differences in mental health. We do not observe any race differences in behavioral responses to stressors; black youth are no more likely than white youth to engage in poor health behaviors (e.g., smoking, drinking, or obesity) in response to stress. We provide tentative support for the notion that poor health behaviors partially reduce the association between stress and depression for blacks but not whites. These findings contribute to unresolved issues regarding mental and physical health disparities among blacks and whites.

Bray GA. Medications for weight reduction. Medical Clinics of North America 95(5): 989-+, 2011. (88 refs.)

Only two drugs are currently approved for long-term use in the treatment of obesity, and four others for short-term use. Evaluating the risk-benefit profile is an essential first step. For individuals who have a low body mass index for whom the risk is small, the risk profile must make the drug acceptable for almost everyone. For higher-risk patients, such as those planning intestinal bypass or who have sleep apnea, a wider range of drugs may be considered. Obesity is a chronic disease that has many causes. Treatment is aimed at palliation that is, producing and maintaining weight loss. Regardless of the primary site of action, the net effect must be a reduction in food intake or increase in energy expenditure.

Carr KD. Food scarcity, neuroadaptations, and the pathogenic potential of dieting in an unnatural ecology: Binge eating and drug abuse. Physiology & Behavior 104(1, special issue): 162-167, 2011. (116 refs.)

In the laboratory, food restriction has been shown to induce neuroadaptations in brain reward circuitry which are likely to be among those that facilitate survival during periods of food scarcity in the wild. However, the upregulation of mechanisms that promote foraging and reward-related learning may pose a hazard when food restriction is self-imposed in an ecology of abundant appetitive rewards. For example, episodes of loss of control during weight-loss dieting, use of drugs with addictive potential as diet aids, and alternating fasting with alcohol consumption in order to avoid weight gain, may induce synaptic plasticity that increases the risk of enduring maladaptive reward-directed behavior. In the present mini-review, representative basic research findings are outlined which indicate that food restriction alters the function of mesoaccumbens dopamine neurons, potentiates cellular and behavioral responses to D-1 and D-2 dopamine receptor stimulation, and increases stimulus-induced synaptic insertion of AMPA receptors in nucleus accumbens. Possible mechanistic underpinnings of increased drug reward magnitude, drug-seeking, and binge intake of sucrose in food-restricted animal subjects are discussed and possible implications for human weight-loss dieting are considered.

Cena H; Fonte ML; Turconi G. Relationship between smoking and metabolic syndrome. Nutrition Reviews. (review) 69(12): 745-753, 2011. (121 refs.)

Obesity and smoking are important causes of morbidity and mortality worldwide. The diseases and conditions associated with smoking make tobacco use one of the leading causes of death worldwide. In the World Health Organization European region, overweight and obesity are responsible for many chronic diseases, causing more than one million deaths each year. Smoking cessation is associated with a significantly reduced mortality risk in every body-mass-index group. Reductions in smoking and obesity would increase both the psychophysical well-being of the population and its economic productivity; it would also reduce the direct costs of pharmacological therapies and other forms of treatment. The aim of this review is to critically evaluate how tobacco smoking and obesity interact to reduce life expectancy, and to offer a comprehensive view of this issue that should be useful for clinical practice.

de Blacam C; Ogunleye AA; Momoh AO; Colakoglu S; Tobias AM; Sharma R et al. High body mass index and smoking predict morbidity in breast cancer surgery: A multivariate analysis of 26,988 patients from the National Surgical Quality Improvement Program database. Annals of Surgery 255(3): 551-555, 2012. (40 refs.)

Objective: The purpose of this study was to examine the incidence of complications of breast cancer surgery in a multi-institutional, prospective, validated database and to identify preoperative risk factors that predispose to these complications. Background: There is an increased emphasis on clinical outcomes to improve the quality of surgical care. Although mastectomy and breast conserving surgery have low risk for complications, few US studies have examined the incidence of these complications in large, multicenter patient populations. The broad scale of the National Surgical Quality Improvement Program (NSQIP) data set facilitates multivariate analysis of patient characteristics that predispose to development of postoperative complications in breast cancer surgery. Methods: A prospective, multi-institutional study of patients undergoing mastectomy and breast conserving surgery was performed from the National Surgical Quality Improvement Program from 2005 to 2007. Study subjects were selected as a random sample of patients at more than 200 participating community and academic medical centers. Thirty-day morbidity was prospectively collected and the incidence of postoperative complications was determined, with particular emphasis on superficial and deep surgical site infections. Multivariate logistic regression was performed to identify independent risk factors for postoperative wound infections in each. Results: A total of 26,988 patients were identified who underwent mastectomy (N = 10,471) and breast conserving surgery (N = 16,517). As expected, the overall 30-day morbidity rate for all procedures was low (5.6%), with significantly higher morbidity for mastectomies (4.0%) than breast conserving surgery (1.6%, P < 0.001). The most common complications in all procedures were superficial surgical site infections and deep surgical site infections. Independent risk factors for development of any wound infection in patients undergoing mastectomy were a high body mass index, smoking, and diabetes (ORs = 1.8, 1.6, 1.8). In patients who had a lumpectomy, a high body mass index, smoking, and a history of surgery within 90 days prior to this procedure (ORs = 1.7, 1.9, 2.0) were independent risk factors. Conclusions: Although complication rates in breast cancer surgery are low, wound infections remain the most common complication. A high body mass index and current tobacco use were the only independent risk factors for development of a postoperative wound infection across all procedures. This study highlights the benefit of a multi-institutional database in assessing risk factors for adverse outcomes in breast cancer surgery.

Denoth F; Siciliano V; Iozzo P; Fortunato L; Molinaro S. The association between overweight and illegal drug consumption in adolescents: Is there an underlying influence of the sociocultural environment? PLoS ONE 6(11): e27358, 2011. (40 refs.)

Background: The aims of the study were to: a) Examine the distribution of gender-stratified body mass index (BMI), eating attitudes and use of addictive substances, under the hypothesis of a confluent prevalence of weight abnormalities, eating disorders and substance abuse. b) Demonstrate the extent to which family, peer-related and psychosocial factors are common elements in categories of compulsive behaviour. Methodology/Principal Findings: In the present cross-sectional study, data were collected through self reported questionnaires administered to a large sample of 33,185 15-19 years old adolescents (ESPAD (R) Italia), divided into weight categories based on the BMI percentile distribution. Multinomial analyses were adopted to address the influence of social, family, leisure time factors, Eating Attitude Test (EAT26) on the association between weight categories and drug use. Recent drugs use was more frequent in overweight and underweight adolescents (p < 0.05), especially in females. An EAT26 score >= 20 was more common in overweight adolescents. Multinomial analysis abolished the relationship between overweight and the use of most drugs, implicating self-esteem, parents' educational level, and friendships as mediators of the association. Within the overweight category, adolescents reporting recent drug use, showed greater frequency of having drug-abusing friends (similar to 80%), and severe problems with parents and school (similar to 30%) compared to overweight adolescents without recent drug use. Conclusion: The frequent association of overweight and substance use and the presence of common underlying social factors, highlights the need for an interdisciplinary approach involving individual-focused treatment models as well as public health, social and environmental changes to reduce food-and substances-related problems.

Donny EC; Caggiula AR; Weaver MT; Levin ME; Sved AF. The reinforcement-enhancing effects of nicotine: Implications for the relationship between smoking, eating and weight. Physiology & Behavior 104(1, special issue): 143-148, 2011. (104 refs.)

Concerns about body weight represent an important barrier to public health efforts aimed at reducing smoking. Epidemiological studies have found that current smokers weigh less than non-smokers, smoking cessation results in weight gain, and weight restriction is commonly cited as a reason for smoking. The mechanisms underlying the relationship between smoking and weight are complex and may involve a number of factors including changes in caloric intake, physical activity, metabolic rate, and lipogenesis. Amongst these possible mechanisms, nicotine-induced enhancement of food reinforcement may be particularly important. In this paper, we first review data from our laboratory that highlight two distinct ways in which nicotine impacts reinforced behavior: 1) by acting as a primary reinforcer: and 2) by directly (non-associatively) enhancing the reinforcing effects of other stimuli. We then elaborate on the reinforcement-enhancing effects of nicotine as they pertain to behaviors and stimuli related to food. Data from both laboratory animals and humans support the assertion that nicotine enhances the reinforcing efficacy of food and suggest that the influence of these effects on eating may be most important after nicotine cessation when nicotine's effects on satiety subside. Finally, we discuss the theoretical and clinical implications of this perspective for understanding and addressing the apparent tradeoff between smoking and weight gain. Better understanding of the mechanisms underlying the reinforcement-enhancing effects of nicotine broadly, and the effects on food reinforcement per se, may aid in the development of new treatments with better long term outcomes.

Drescher AA; Goodwin JL; Silva GE; Quan SF. Caffeine and screen time in adolescence: Associations with short sleep and obesity. Journal of Clinical Sleep Medicine 7(4): 337-342, 2011. (31 refs.)

Objective: To investigate the associations between sleep duration and obesity incidence and risk factors among preadolescents and adolescents. Design: Cross-sectional study of a community based cohort Setting: The Tucson Children's Assessment of Sleep Apnea follow-up study (TuCASA) cohort. Participants: 319 Caucasian and Hispanics between 10-17 years. Main Outcome: Parent-reported sleep duration and BMI z-score. Outcome Measures: Surveys of electronic screen time, dietary and caffeine intake, exercise and sleep habits by parents, and anthropometric measures. Results: Parent-reported total sleep time (TST) was inversely associated with BMI z-score, but not significantly correlated with any of the examined nutritional variables or exercise components. Hispanic ethnicity was associated with significantly lower parent-reported TST and higher BMI z-score. Parent-reported TST was inversely related to electronic screen time and caffeine use, but these findings were differentially related to age. Caffeine consumption was associated with decreasing parent-reported TST primarily in older adolescents. Electronic screen time was associated with lower parent-reported TST in younger adolescents. Conclusions: Hispanic ethnicity and parental reports of TST were found to be the most closely associated with BMI z-score. Decreased TST and increased caffeine intake and screen time may result in higher obesity risk in the adolescent population.

Durmus B; Ay L; Hokken-Koelega ACS; Raat H; Hofman A; Steegers EAP et al. Maternal smoking during pregnancy and subcutaneous fat mass in early childhood. The Generation R Study. European Journal of Epidemiology 26(4): 295- 304, 2011. (46 refs.)

Maternal smoking during pregnancy increases the risk of obesity in the offspring. Not much is known about the associations with other measures of body composition. We assessed the associations of maternal smoking during pregnancy with the development of subcutaneous fat mass measured as peripheral and central skinfold thickness measurements in early childhood, in a population-based prospective cohort study from early fetal life onward in the city of Rotterdam, The Netherlands. The study was performed in 907 mothers and their children at the ages of 1.5, 6 and 24 months. As compared to non-smoking mothers, mothers who continued smoking during pregnancy were more likely to have a younger age and a lower educational level. Their children had a lower birth weight, higher risk of small size for gestational age and were breastfed for a shorter duration (P-values < 0.01). We did not observe differences in peripheral, central and total subcutaneous fat mass between the offspring of non-smoking mothers, mothers who smoked in first trimester only and mothers who continued smoking during pregnancy (P > 0.05). Also, the reported number of cigarettes smoked by mothers in both first and third trimester of pregnancy were not associated with peripheral, central and total subcutaneous fat mass in the offspring at the ages of 1.5, 6 and 24 months. Our findings suggest that fetal exposure to cigarette smoke during pregnancy does not influence subcutaneous fat mass in early childhood. Follow-up studies are needed in children at older ages and to identify associations of maternal smoking during pregnancy with other measures of body composition.

Durmus B; Kruithof CJ; Gillman MH; Willemsen SP; Hofman A; Raat H et al. Parental smoking during pregnancy, early growth, and risk of obesity in preschool children: The Generation R Study. American Journal of Clinical Nutrition 94(1): 164-171, 2011. (47 refs.)

Background: Maternal smoking during pregnancy seems to be associated with obesity in offspring. Not much is known about the specific critical exposure periods or underlying mechanisms for this association. Objective: We assessed the associations of active maternal and paternal smoking during pregnancy with early growth characteristics and risks of overweight and obesity in preschool children. Design: This study was a population-based, prospective cohort study from early fetal life until the age of 4 y in 5342 mothers and fathers and their children. Growth characteristics [head circumference, length, weight, and body mass index (BMI; in kg/m(2))] and overweight and obesity were repeatedly measured at the ages of 1, 2, 3, and 4 y. Results: In comparison with children from nonsmoking mothers, children from mothers who continued smoking during pregnancy had persistently smaller head circumferences and heights until the age of 4 y, whereas their weights were lower only until the age of 3 mo. This smaller length and normal to higher weight led to an increased BMI [SD score difference: 0.11; 95% CI: 0.02, 0.20; P < 0.05)] and an increased risk of obesity (odds ratio: 1.61; 95% CI: 1.03, 2.53; P < 0.05) at the age of 4 y. In nonsmoking mothers, paternal smoking was not associated with postnatal growth characteristics or risk of obesity in offspring. Maternal smoking during pregnancy was associated with a higher BMI at the age of 4 y in children with a normal birth weight and in those who were small for gestational age at birth. Conclusion: Our findings suggest that direct intrauterine exposure to smoke until late pregnancy leads to different height and weight growth adaptations and increased risks of overweight and obesity in preschool children.

Edge PJ; Gold MS. Drug withdrawal and hyperphagia: Lessons from tobacco and other drugs. (review). Current Pharmaceutical Design 17(12): 1173- 1179, 2011. (76 refs.)

'Globesity' is a descriptive term for the obesity epidemic now facing the U. S. and indeed, the world. Hyperphagia (i.e. overeating) can lead to metabolic syndrome which in turn can lead to Type 2 diabetes mellitus, heart disease, stroke and some cancers. The World Health Organization even states that more people die each year from the consequences of obesity than from hunger. Something must be done to stem the tsunami of obesity and its resultant medical complications. Our work and that of others suggests that new obesity treatments and anti-obesity medications should be based on those already successful in treating other addictions. This paper looks at empirical evidence linking addictions to food and to drugs such as tobacco, alcohol, cannabis, amphetamines, and cocaine. Hypotheses are put forth as to why hyperphagia is so difficult to treat. Additionally, prenatal programming for addiction is explored. Lessons from successful drug treatment are elucidated and potential pharmaceutical targets for hyperphagia and obesity are suggested.

Eichen DM; Conner BT; Daly BP; Fauber RL. Weight perception, substance use, and disordered eating behaviors: Comparing normal weight and overweight high-school students. Journal of Youth and Adolescence 41(1, special issue): 1-13, 2012. (70 refs.)

Disordered eating behaviors and substance use are two risk factors for the development of serious psychopathology and health concerns in adulthood. Despite the negative outcomes associated with these risky behaviors, few studies have examined potential associations between these risk factors as they occur during adolescence. The importance of accurate or inaccurate weight perception among adolescents has received increased interest given documented associations with nutritional beliefs and weight management strategies. This study examined the associations among the perceptions of weight and substance use with disordered eating behaviors among a diverse sample of normal weight and overweight adolescent males and females. Data came from the 2007 National Youth Risk Behavior Survey (YRBS). The sample consisted of 11,103 adolescents (53.4% female; 44% Caucasian, 21% African American; 13% Hispanic; age responses ranged from 12 and under to 18 and over), with 31.5% meeting criteria for being either at-risk for obesity or already obese (i.e., overweight). As hypothesized, overestimation of weight among normal weight adolescents and accurate perceptions of weight among overweight adolescents were associated with higher rates of disordered eating behaviors. In normal weight adolescents, use of all three substances (tobacco, binge drinking, and cocaine) was associated with each disordered eating behavior. In contrast, findings revealed differences for overweight adolescents between the type of substance use and disordered eating behavior. Post hoc analyses revealed that gender moderated some of these relationships among overweight individuals. Implications for the development and implementation of secondary prevention programs aimed at reducing disordered eating behaviors, substance use, and obesity risk among normal and overweight adolescents are considered.

Farley AC; Hajek P; Lycett D; Aveyard P. Interventions for preventing weight gain after smoking cessation. (review). Cochrane Database of Systematic Reviews 1: article CD006219, 2012. (483 refs.)

Background: Most people who stop smoking gain weight. There are some interventions that have been designed to reduce weight gain when stopping smoking. Some smoking cessation interventions may also limit weight gain although their effect on weight has not been reviewed. Objectives: To systematically review the effect of: (1) Interventions targeting post-cessation weight gain on weight change and smoking cessation. (2) Interventions designed to aid smoking cessation that may also plausibly affect weight on post-cessation weight change. Search methods: Part 1 - We searched the Cochrane Tobacco Addiction Group's Specialized Register and CENTRAL in September 2011. Part 2 - In addition we searched the included studies in the following "parent" Cochrane reviews: nicotine replacement therapy (NRT), antidepressants, nicotine receptor partial agonists, cannabinoid type 1 receptor antagonists and exercise interventions for smoking cessation published in Issue 9, 2011 of the Cochrane Library. Selection criteria: Part 1 - We included trials of interventions that were targeted at post-cessation weight gain and had measured weight at any follow up point and/or smoking cessation six or more months after quit day. Part 2 - We included trials that had been included in the selected parent Cochrane reviews if they had reported weight gain at any time point. Data collection and analysis: We extracted data on baseline characteristics of the study population, intervention, outcome and study quality. Change in weight was expressed as difference in weight change from baseline to follow up between trial arms and was reported in abstinent smokers only. Abstinence from smoking was expressed as a risk ratio (RR). We used the most rigorous definition of abstinence available in each trial. Where appropriate, we performed meta-analysis using the inverse variance method for weight and Mantel-Haenszel method for smoking using a fixed-effect model. Main results: Part 1: Some pharmacological interventions tested for limiting post cessation weight gain (PCWG) resulted in a significant reduction in WG at the end of treatment (dexfenfluramine (Mean difference (MD) -2.50kg, 95% confidence interval (CI) -2.98 to -2.02, 1 study), phenylpropanolamine (MD -0.50kg, 95% CI-0.80 to -0.20, N=3), naltrexone (MD -0.78kg, 95% CI-1.52 to -0.05, N=2). There was no evidence that treatment reduced weight at 6 or 12 months (m). No pharmacological intervention significantly affected smoking cessation rates. Weight management education only was associated with no reduction in PCWG at end of treatment (6 or 12m). However these interventions significantly reduced abstinence at 12m (Risk ratio (RR) 0.66, 95% CI 0.48 to 0.90, N=2). Personalised weight management support reduced PCWG at 12m (MD -2.58kg, 95% CI -5.11 to-0.05, N=2) and was not associated with a significant reduction of abstinence at 12m (RR 0.74, 95% CI 0.39 to 1.43, N=2). A very low calorie diet (VLCD) significantly reduced PCWG at end of treatment (MD -3.70kg, 95% CI-4.82 to-2.58, N=1), but not significantly so at 12m (MD -1.30kg, 95% CI-3.49 to 0.89, N=1). The VLCD increased chances of abstinence at 12m (RR 1.73, 95% CI 1.10 to 2.73, N=1). There was no evidence that cognitive behavioural therapy to allay concern about weight gain (CBT) reduced PCWG, but there was some evidence of increased PCWG at 6m (MD 0.74, 95% CI 0.24 to 1.24). It was associated with improved abstinence at 6m (RR 1.83, 95% CI 1.07 to 3.13, N=2) but not at 12m (RR 1.25, 95% CI 0.83 to 1.86, N=2). However, there was significant statistical heterogeneity. Part 2: We found no evidence that exercise interventions significantly reduced PCWG at end of treatment (MD -0.25kg, 95% CI-0.78 to 0.29, N=4) however a significant reduction was found at 12m (MD -2.07kg, 95% CI-3.78 to-0.36, N=3). Both bupropion and fluoxetine limited PCWG at the end of treatment (bupropion MD-1.12kg, 95% CI-1.47 to-0.77, N=7) (fluoxetine MD -0.99kg, 95% CI-1.36 to-0.61, N=2). There was no evidence that the effect persisted at 6m (bupropion MD -0.58kg, 95% CI-2.16 to 1.00, N=4), (fluoxetine MD -0.01kg, 95% CI-1.11 to 1.10, N=2) or 12m (bupropion MD -0.38kg, 95% CI-2.00 to 1.24, N=4). There were no data on WG at 12m for fluoxetine. Overall, treatment with NRT attenuated PCWG at the end of treatment (MD -0.69kg, 95% CI-0.88 to-0.51, N=19), with no strong evidence that the effect differed for the different forms of NRT. There was evidence of significant statistical heterogeneity caused by one study which reported a 4.3kg reduction in PCWG due to NRT. With this study removed, the difference in weight change at end of treatment was -0.45kg (95% CI-0.66 to-0.27, N=18). There was no evidence of an effect on PCWG at 12m (MD -0.42kg, 95% CI-0.92 to 0.08, N=15). We found evidence that varenicline significantly reduced PCWG at end of treatment (MD -0.41kg, 95% CI-0.63 to-0.19, N=11), but this effect was not maintained at 6 or 12m. Three studies compared the effect of bupropion to varenicline. Participants taking bupropion gained significantly less weight at the end of treatment (-0.51kg (95% CI-0.93 to-0.09kg), N=3). Direct comparison showed no significant difference in PCWG between varenicline and NRT. Authors' conclusions: Although some pharmacotherapies tested to limit PCWG show evidence of short-term success, other problems with them and the lack of data on long-term efficacy limits their use. Weight management education only, is not effective and may reduce abstinence. Personalised weight management support may be effective and not reduce abstinence, but there are too few data to be sure. One study showed a VLCD increased abstinence but did not prevent WG in the longer term. CBT to accept WG did not limit PCWG and may not promote abstinence in the long term. Exercise interventions significantly reduced weight in the long term, but not the short term. More studies are needed to clarify whether this is an effect of treatment or a chance finding. Bupropion, fluoxetine, NRT and varenicline reduce PCWG while using the medication. Although this effect was not maintained one year after stopping smoking, the evidence is insufficient to exclude a modest long-term effect. The data are not sufficient to make strong clinical recommendations for effective programmes to prevent weight gain after cessation.

Fasting MH; Nilsen TIL; Holmen TL; Vik T. Changes in parental weight and smoking habits and offspring adiposity: Data from the HUNT-study. International Journal of Pediatric Obesity 6(2-2): E399-E407, 2011. (38 refs.)

Objective. Adverse parental life-style habits are associated with offspring adiposity, but it is unclear how changes in these habits affect offspring adiposity. Thus, the aim of this study was to assess how parental change in body weight, smoking habits and levels of physical activity were associated with adiposity in their children. Methods. The study population consisted of 3 681 adolescents and their parents from the Nord-Trondelag-Health-Study (HUNT). The parents participated in the two first waves of HUNT (HUNT-1: 1984-86, HUNT-2: 1995-97), where information on anthropometry, smoking habits and physical activity were obtained. The adolescents participated in the Youth-Part of HUNT-2. We used logistic regression to calculate odds-ratios (ORs) for adolescent offspring overweight according to parental change in body-weight, smoking habits and physical activity, adjusting for these factors in both parents, as well as for socioeconomic status and adolescent age and sex. Results. Children of parents who changed weight from normal weight to overweight from HUNT-1 to HUNT-2 had higher OR for overweight in adolescence than children of parents who remained normal weight (mothers: 1.9 [95% CI: 1.4,2.5], fathers: 2.2 [95% CI: 1.5,3.0]). Children of mothers who reduced their weight from overweight to normal weight had no higher OR for overweight in adolescence than mothers who remained normal weight (OR: 1.0; 95% CI: 0.2, 4.7). Children of mothers who quit smoking (OR: 0.5; 95% CI: 0.3, 0.8) had lower OR for overweight in adolescence than children of mothers who persisted in smoking. Conclusions. Healthy changes in parental life-style during childhood are associated with lower occurrence of offspring overweight in adolescence.

Flegal KM. The conundrum of smoking cessation and weight gain. (editorial). Preventive Medicine 54(3-4): 193-194, 2012. (31 refs.)

Foddy B. Addicted to food, hungry for drugs. Neuroethics 4(2, special issue): 79-89, 2011. (47 refs.)

There is a growing consensus among neuroscientists that people can become addicted to food, and that at least some cases of obesity have addiction as their cause. By contrast, the rest of the world continues to see obesity as either a disease of the metabolism, or as a reckless case of self-harm. Among obesity researchers, there has been a lively debate on the issue of whether obesity ought to be considered a disease. Few researchers, however, have suggested that obesity is a disease in the same sense as addiction is usually claimed to be a disease-that is, a disease of behaviour with a neurological cause. In this piece, I review what is now a compelling body of evidence for food addiction, to establish that many or most cases of obesity have addiction at their foundation. I then argue that in spite of this, obesity ought not to be considered a neurobehavioural disease in the sense usually attributed to drug addiction. Given the link between addiction and obesity, this implies that the disease conception of addiction must be abandoned. I conclude by assessing some of the implications this move has for policy and ethics, with regard to both obesity and drug addiction.

Fogger SA; McGuinness TM. The relationship between addictions and bariatric surgery for nurses in recovery. Perspectives In Psychiatric Care 48(1): 10-15, 2012. (22 refs.)

Purpose: Determinants of morbid obesity are complex and numerous, yet understanding the neurobiological underpinnings improves our knowledge of this serious issue. Emerging science supports a comparison of disordered eating with other addictive substances. Design And Methods: The study used a sub-analysis of a cross-sectional study of nurses in a state-monitoring program. Findings: A study of 173 participants in a state-monitoring program for impaired nurses revealed that 14% (n = 25) had undergone bariatric surgery. Of these, 17 developed an addiction after surgery. Practice Implications: Evidence suggests that some individuals may require additional treatment, similar to those with pharmacological addictions.

Gearhardt AN; Corbin WR. The role of food addiction in clinical research. (review). Current Pharmaceutical Design 17(12): 1140- 1142, 2011. (26 refs.)

Recent research has uncovered neurobiological and behavioral similarities between substance dependence and excess consumption of highly processed foods. These findings have led to the theory that food addiction may play a role in obesity and disordered eating. The inclusion of validated food addiction measures in clinical research, such as the Yale Food Addiction Scale, will add to the understanding of the clinical utility of this concept. Further exploring the food-addiction construct may also lead to a better clinical understanding of obesity and eating disorders and suggest future avenues for more effectively treating these problems.

Gearhardt AN; Yokum S; Orr PT; Stice E; Corbin WR; Brownell KD. Neural correlates of food addiction. Archives of General Psychiatry 68(8): 808-816, 2011. (75 refs.)

Context: Research has implicated an addictive process in the development and maintenance of obesity. Although parallels in neural functioning between obesity and substance dependence have been found, to our knowledge, no studies have examined the neural correlates of addictive-like eating behavior. Objective: To test the hypothesis that elevated "food addiction" scores are associated with similar patterns of neural activation as substance dependence. Design: Between-subjects functional magnetic resonance imaging study. Setting: A university neuroimaging center. Participants: Forty-eight healthy young women ranging from lean to obese recruited for a healthy weight maintenance trial. Main Outcome Measure: The relation between elevated food addiction scores and blood oxygen level-dependent functional magnetic resonance imaging activation in response to receipt and anticipated receipt of palatable food (chocolate milkshake). Results: Food addiction scores (N=39) correlated with greater activation in the anterior cingulate cortex, medial orbitofrontal cortex, and amygdala in response to anticipated receipt of food (P <.05, false discovery rate corrected for multiple comparisons in small volumes). Participants with higher (n=15) vs lower (n=11) food addiction scores showed greater activation in the dorsolateral prefrontal cortex and the caudate in response to anticipated receipt of food but less activation in the lateral orbitofrontal cortex in response to receipt of food (false discovery rate-corrected P <.05). Conclusions: Similar patterns of neural activation are implicated in addictive-like eating behavior and substance dependence: elevated activation in reward circuitry in response to food cues and reduced activation of inhibitory regions in response to food intake.

Gelkopf M; Noam S; Rudinski D; Lerner A; Behrbalk P; Bleich A et al. Nonmedication smoking reduction program for inpatients with chronic Schizophrenia: A randomized control design study. Journal of Nervous and Mental Disease 200(2): 142-146, 2012. (38 refs.)

People with schizophrenia are more likely to smoke, and to smoke more frequently, than those without schizophrenia. Furthermore, inpatients smoke even more frequently compared with those living in the community. In light of this, we implemented and assessed a smoking reduction intervention using a wide array of behavioral group techniques and methods in chronic hospitalized schizophrenic clients. Using a controlled design, we randomly assigned chronic schizophrenic clients to either a five-session smoking reduction intervention (it = 35) or a waiting list (WL; n = 18). We assessed self-reported smoking behavior, clinical status (Positive and Negative Syndrome Scale, Hamilton Rating Scale for Depression; Clinical Global Impression Scale for Psychosis), subjective quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire-abbreviated version), and weight before and 3 months after the intervention. The intervention successfully reduced the number of cigarettes smoked compared with nonintervention. No clinical worsening or weight gain was observed. Behavioral group-oriented smoking reduction interventions can significantly reduce smoking behavior in hospitalized chronic clients with schizophrenia.

Goetzinger KR; Cahill AG; Macones GA; Odibo AO. The relationship between maternal body mass index and tobacco use on small-for-gestational-age infants. American Journal of Perinatology 29(3): 153-158, 2012. (22 refs.)

We sought to estimate the association between prepregnancy body mass index (BMI) and small-for-gestational-age (SGA) neonates and to determine if there is a synergistic effect of tobacco use on SGA across all BMI strata. We performed a retrospective cohort study of 65,104 patients seen for second-trimester ultrasound. BMI was categorized into underweight, normal weight, overweight, and obese. SGA was defined as birth weight < 10th percentile and < 5th percentile. Univariable and multivariable logistic regression analyses were used to evaluate the association between BMI and SGA. Stratified analyses and tests for effect modification were performed to evaluate for a potential synergistic effect between tobacco use and abnormal prepregnancy BMI on SGA. After controlling for potential confounders, underweight BMI was associated with an increased risk for SGA < 10th percentile (adjusted odds ratio [aOR] 1.8, 95% confidence interval [Cl] 1.5 to 2.1), while overweight (aOR 0.7, 95% Cl 0.7 to 0.8) and obese BMIs (aOR 0.6, 95% Cl 0.5 to 0.7) were associated with a decreased risk of SGA. There was no effect modification of tobacco use on the risk of SGA across all BMI categories. Although both tobacco and underweight BMI are independently associated with SGA, there was no evidence of synergism. Continued emphasis on both smoking cessation and maintenance of normal prepregnancy BMI remains paramount to decreasing the incidence of SGA.

Gold J; Gold MS. Exercise for the overweight and obese. (review). Current Pharmaceutical Design 17(12): 1193- 1197, 2011. (45 refs.)

The development of new phamacological treatments for obesity has been challenging. In part, the lack of early diagnosis, early detection, early intervention and treatment has meant that more cases progress to life-threatening co-morbidities and surgical options. Pharmacological treatment of obesity has been limited. Self-medication with drugs of abuse and tobacco has been successful for some patients, but abuse and addiction make this approach quite dangerous. The advent of trendy 'diets du jour' has apparently made obesity and eating disorders more likely rather than less likely. Trials of novel anti-obesity compounds have generally compared the new medication and placebo to a dietary counseling intervention. Interventions for patients who are not obese enough for gastric banding or bariatric surgery are quite similar to those given to alcoholics in the 1970s, "drink less or stop drinking". We need to consume less in a modern life of desk and computer work, driving, and even internet shopping. However, we are driven and reinforced to consume and easily fall prey to television and other cues and messages driving this relationship to eating. This paper, after briefly reviewing the consensus on consumption and exercising suggests that new treatments may be developed by increasing exercise adherence and even increasing the reinforcing value or power of exercise itself. Food, sex, and drugs of abuse are highly valued and reinforced in our brains, so why not exercise?

Gold MS; Graham NA. Food addiction & obesity treatment development. (editorial). Current Pharmaceutical Design 17(12): 1126- 1127, 2011. (13 refs.)

Goldfield GS; Lumb AB; Colapinto CK. Relative reinforcing value of energy-dense snack foods in overweight and obese adults. Canadian Journal of Dietetic Practice and Research 72(4): 170-174, 2011. (43 refs.)

Purpose: Obese people find energy-dense food more reinforcing than do their non-obese peers, and reinforcement influences food intake. We examined how the degree of adiposity, measured by body mass index (BMI), is associated with the relative reinforcing value of energy-dense snack foods versus fruits and vegetables in overweight and obese people. Methods: Ninety-two overweight or obese students in introductory psychology courses completed questionnaires on age, sex, BMI, hunger, smoking status, dietary restraint, and hedonic (liking) ratings for energy-dense snack foods and fruits and vegetables. The questionnaire also was used to evaluate the relative reinforcing value of these snack foods in comparison with fruits and vegetables. Results: The BMI predicted the relative reinforcing value of energy-dense snack food. This positive relationship remained significant after we controlled for age, sex, dietary restraint, hunger, smoking status, and snack food hedonics. Conclusions: The greater the degree of overweight and obesity, the greater the motivation to obtain energy-dense snack foods. Because the rewarding value of food is a strong determinant of energy intake, a useful approach to preventing and treating obesity may be introducing pharmacological or behavioural nutrition intervention to reduce the rewarding value of energy-dense snack foods, or increasing the rewarding value of fruits and vegetables.

Gonseth S; Jacot-Sadowski I; Diethelm PA; Barras V; Cornuz J. The tobacco industry's past role in weight control related to smoking. European Journal of Public Health 22(2): 234-237, 2012. (29 refs.)

Background: Smoking is thought to produce an appetite-suppressing effect by many smokers. Thus, the fear of body weight gain often outweighs the perception of health benefits associated with smoking cessation, particularly in adolescents. We examined whether the tobacco industry played a role in appetite and body weight control related to smoking and smoking cessation. Methods: We performed a systematic search within the archives of six major US and UK tobacco companies (American Tobacco, Philip Morris, RJ Reynolds, Lorillard, Brown & Williamson and British American Tobacco) that were Defendants in tobacco litigation settled in 1998. Findings are dated from 1949 to 1999. Results: The documents revealed the strategies planned and used by the industry to enhance effects of smoking on weight and appetite, mostly by chemical modifications of cigarettes contents. Appetite-suppressant molecules, such as tartaric acid and 2-acetylpyridine were added to some cigarettes. Conclusion: These tobacco companies played an active and not disclaimed role in the anti-appetite effects of smoking, at least in the past, by adding appetite-suppressant molecules into their cigarettes.

Gonzalez-Quintela A; Tome S; Fernandez-Merino C; Rey J; Meijide L; Gude F. Synergistic effect of alcohol consumption and body mass on serum concentrations of cytokeratin-18. Alcoholism: Clinical and Experimental Research 35(12): 2202-2208, 2011. (64 refs.)

Background: Cytokeratin-18 is an essential component of the cytoskeleton of epithelial cells (including hepatocytes). Serum concentrations of cytokeratin-18 (tissue polypeptide-specific antigen [TPS]) are used as a marker of epithelial neoplasms. Here, we investigated the potential interaction between alcohol and obesity in relation to serum TPS concentrations. Methods: Alcohol consumption, body mass index, and components of metabolic syndrome were measured in a random sample (n = 420) of the adult population (aged 18 to 92 years, 45% men) from a single municipality. Regular alcohol intake of > 20 g/d (women) or > 30 g/d (men) was considered risky drinking. Serum TPS was measured with a commercial immunoassay. Results: Risky drinking was associated with increased serum concentrations of TPS, which was particularly evident among obese individuals. Among individuals without risky drinking, TPS concentrations were similar for all levels of body mass. Conversely, among risky drinkers, serum TPS concentrations increased in parallel with body mass (p = 0.002). The odds ratio of a high (> 100 U/l) TPS concentration for the combination of risky drinking and obesity was greater than the additive effect of the 2 separate factors, after adjusting for age and sex. A similar interaction was observed between risky drinking and abdominal adiposity, a major component of the metabolic syndrome. Serum TPS concentrations were correlated with markers of liver damage. Serum TPS was not superior to standard markers (gamma-glutamyl transferase and red blood cell mean volume) for the detection of risky drinking. Conclusions: There is a synergism between risky alcohol consumption and common metabolic disorders (particularly obesity) in relation to serum concentrations of cytokeratin-18 (TPS), which probably reflect liver disease.

Gronbladh L; Ohlund LS. Self-reported differences in side-effects for 110 heroin addicts during opioid addiction and during methadone treatment. Heroin Addiction and Related Clinical Problems 13(4): 5-12, 2011. (28 refs.)

Although methadone maintenance treatment (MMT) has been shown to be effective, poor compliance is always a threat. It has often been pointed out that one variable that inevitably reduces adherence to treatment regimes is the negative side-effects of the treatment. This study examines seventeen known side-effects in a sample of 110 former opiate addicts consecutively admitted to methadone maintenance treatment. Self-reported side-effects were collected through a questionnaire. Despite the considerable increase, from 23 to 74% of the sample, in the proportion that reported individual side-effects between the period of opiate use and that of methadone treatment, the overall result was a significant decrease in eleven symptoms, no change in four and a substantial increase in only two. In some individuals a symptom that is liable to be problematic actually does become problematic, while the same symptom becomes less frequent in the group as a whole. Weight gain is the symptom that increases most in the whole group and needs to be constantly monitored. Other side-effects that remain high and need to be kept under review in clinical practice are nervousness, decreased libido, daytime drowsiness, constipation and perspiration.

Grossbard JR; Neighbors C; Larimer ME. Perceived norms for thinness and muscularity among college students: What do men and women really want? Eating Behaviors 12(3): 192-199, 2011. (48 refs.)

Background: Perceived norms are related to health-related attitudes and behaviors, including body image. The current study examined body dissatisfaction and perceived norms for thinness and muscularity among male and female college students. Method: Participants included 842 undergraduate students (64.5% female) who completed an online survey assessing body image and other health-related attitudes and behaviors. A series of independent sample and paired sample t tests were conducted to document sex differences in body dissatisfaction and misperceptions of thinness and muscularity norms. Results: Based on pictorial ratings, both males and females reported discrepancies between their ideal and actual figures. Females perceived other females as significantly thinner and less muscular than the actual norms. Males perceived other males as significantly heavier than their own figures, but the difference between men's self-reported muscularity and perceived norm was not significant. Both males and females misperceived opposite-sex attractiveness norms for thinness and muscularity. Discussion: Results suggest the importance of evaluating same-sex and opposite-sex perceived norms of thinness and muscularity in the etiology of body dissatisfaction, and this research informs social norms interventions targeting misperceptions of body image norms among both males and females.

Hansson J; Galanti MR; Magnusson C; Hergens MP. Weight gain and incident obesity among male snus users. BMC Public Health 11(e-article 371), 2011. (27 refs.)

Background: Snus is a moist smokeless tobacco product which has recently reached beyond its original market of Scandinavia. Snus is now being increasingly used in both the United States and South Africa. The effect of snus use on weight is unknown. This study has therefore investigated the relationship between the use of snus, weight gain (>= 5%) and the incidence of obesity (body mass index >= 30 kg/m(2)). Methods: The study participants (n = 9,954 males living in Stockholm County, Sweden) were recruited in 2002 and reassessed in 2007. Tobacco use was categorized according to information obtained in both the baseline and follow-up surveys. Outcomes were assessed by comparing self-reported weight and body mass index between the baseline and follow-up surveys. Results: Stable current snus use (according to both surveys), compared to never having used any kind of tobacco, seemed to be associated with both weight gain (odds ratio = 1.31, 95% confidence interval: 1.04-1.65) and incident obesity (odds ratio = 1.93, 95% confidence interval: 1.13-3.30) after adjustment for age, baseline weight, alcohol consumption, physical activity, education, consumption of fruit and berries, and the frequency of having breakfast. No associations with incident obesity or weight gain were seen for stable former users of snus (according to both surveys) or among men who quit or began using snus during follow-up. Conclusions: These data suggest that the use of snus is moderately associated with weight gain and incident obesity among men.

Heck JE; Marcotte EL; Argos M; Parvez F; AhMedicine A; Islam T et al. Betel quid chewing in rural Bangladesh: Prevalence, predictors and relationship to blood pressure. International Journal of Epidemiology 41(2): 462-471, 2012. (54 refs.)

Background: Betel quid is chewed by 600 million people worldwide and it has been linked to obesity and cardiovascular disease. The purpose of our study was to examine the prevalence and predictors of betel quid chewing in a rural area of Bangladesh, and determine its effects on body mass index (BMI) and blood pressure. Methods In this population-based prospective study, we analysed data on 19,934 Bangladeshi adults. Linear and multivariate logistic regression was used to determine the socio-demographic predictors of betel quid chewing and the effect of betel quid on change in BMI and on systolic and diastolic blood pressure, pulse pressure, arterial pressure, overweight or obesity, and hypertension. Results At baseline, betel quid was chewed by 33.2% of the cohort (35.5% of men, 31.6% of women). In a subsample in which we collected methods of use, 17.5% chewed it without tobacco and 82.5% chewed it with tobacco. In multivariate analysis, betel quid chewing was associated with female sex, older age, tobacco smoking and lower socio-economic status, as measured by fewer years of formal education and not owning land. Betel quid was chewed more times per day among women and older persons. At follow-up, persons who chewed betel quid without tobacco had higher systolic blood pressure, diastolic blood pressure and arterial pressure in comparison with never users. After controlling for other explanatory variables, chewing betel quid without tobacco was associated with general hypertension [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.04-2.10] and systolic hypertension (OR 1.55, 95% CI 1.01-2.37). We did not observe associations of betel quid chewing with BMI or overweight. Conclusions: Betel quid chewing is likely contributing to high blood pressure in Bangladesh, particularly among women.

Hendricks EJ; Greenway FL. A study of abrupt phentermine cessation in patients in a weight management program. American Journal of Therapeutics 18(4): 292-299, 2011. (31 refs.)

Phentermine is the most widely used antiobesity drug in the United States. Although no evidence of phentermine addiction has been published, fear that phentermine has addiction potential has contributed to curtailment of its worldwide use in clinical practice. The aim of this study was to evaluate the abuse and addiction potential of long-term phentermine pharmacotherapy in patients in a weight management program. Thirty-five patients in a weight management program who abruptly stopped taking prescribed phentermine on their own initiative were examined using the 18-item Kampman Cocaine Selective Severity Assessment scale modified for phentermine. The Kampman Cocaine Selective Severity Assessment scale has also been modified by McGregor for amphetamines to assess withdrawal from amphetamine in amphetamine-addicted subjects. For comparison, 35 new patients were examined with the same scale before any treatment was initiated. Data from the treated and untreated groups were compared by t test with each other and with published data from amphetamine-addicted subjects. There were no significant differences in individual items or total scores between the patients who stopped phentermine abruptly and the patients who had never taken phentermine. There was a striking and significant difference in individual and total scores between the phentermine-treated subjects and the amphetamine-dependent subjects. Cravings for the substance abused, the hallmark characteristic of substance dependence and withdrawal, were entirely absent in the phentermine-treated subjects. Abrupt cessation of long-term phentermine therapy does not induce amphetamine-like withdrawal. Long-term phentermine therapy does not induce phentermine cravings. Symptoms observed after abrupt phentermine cessation represent loss of therapeutic effect and are not withdrawal.

Horstmann A; Busse FP; Mathar D; Muller K; Lepsien J; Schlogl H et al. Obesity-related differences between women and men in brain structure and goal-directed behavior. Frontiers In Human Neuroscience 5(e-article 58), 2011. (56 refs.)

Gender differences in the regulation of body-weight are well documented. Here, we assessed obesity-related influences of gender on brain structure as well as performance in the Iowa Gambling Task. This task requires evaluation of both immediate rewards and long-term outcomes and thus mirrors the trade-off between immediate reward from eating and the long-term effect of overeating on body-weight. In women, but not in men, we show that the preference for salient immediate rewards in the face of negative long-term consequences is higher in obese than in lean subjects. In addition, we report structural differences in the left dorsal striatum (i.e., putamen) and right dorsolateral prefrontal cortex for women only. Functionally, both regions are known to play complimentary roles in habitual and goal-directed control of behavior in motivational contexts. For women as well as men, gray matter volume correlates positively with measures of obesity in regions coding the value and saliency of food (i.e., nucleus accumbens, orbitofrontal cortex) as well as in the hypothalamus (i.e., the brain's central homeostatic center). These differences between lean and obese subjects in hedonic and homeostatic control systems may reflect a bias in eating behavior toward energy-intake exceeding the actual homeostatic demand. Although we cannot infer from our results the etiology of the observed structural differences, our results resemble neural and behavioral differences well known from other forms of addiction, however, with marked differences between women and men. These findings are important for designing gender-appropriate treatments of obesity and possibly its recognition as a form of addiction.

Hussaini AE; Nicholson LM; Shera D; Stettler N; Kinsman S. Adolescent obesity as a risk factor for high-level nicotine addiction in young women. Journal of Adolescent Health 49(5): 511-517, 2011. (40 refs.)

Purpose: Obesity and cigarette smoking are two of the most frequent and preventable causes of disease and death in the United States; both are often established during youth. We hypothesized that obese, adolescent girls would be at higher risk for nicotine addiction in young adulthood, and that particular individual and social factors would mediate this association. Methods: Students surveyed in the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative school-based and in-home survey conducted in three waves, comprised the sample. More than 4,000 respondents were used for the multivariate linear and logistic regression analyses used to determine the association between obesity and level of nicotine addiction. Potential mediation effects of the association were also examined. Results: Obesity doubled the risk of the highest level of nicotine addiction after controlling for demographic factors, parent and friend smoking, and baseline smoking (OR, 2.12; 95% CI, 1.22-3.68). Family smoking was the strongest predictor of nicotine addiction (OR, 4.72; 95% CI, 2.89-7.72). Grade point average was a partial mediator of this relationship (OR,.48; 95% CI,.32-.74). Conclusions: Obese, adolescent females are at increased risk for high-level nicotine addiction in young adulthood as compared with their nonobese peers. Grade point average partially mediates the association, and may represent a confluence of factors including increased absenteeism, social marginalization, biases, and lack of confidence in academic ability. Obese, adolescent females may require targeted interventions to address their risk of subsequent high-level nicotine addiction, especially if risk factors such as parental smoking and poor school performance are present.

Julius BR; Ward BA; Stein JH; McBride PE; Fiore MC; Colbert LH. Ambulatory activity associations with cardiovascular and metabolic risk factors in smokers. Journal of Physical Activity & Health 8(7): 994-1003, 2011. (48 refs.)

Background: We examined the association between ambulatory activity and biological markers of health in smokers. Methods: Baseline data from 985 subjects enrolled in a pharmacologic smoking cessation trial were examined. Body size, blood pressure, total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), total and small LDL particles, LDL size, high density lipoprotein cholesterol, triglycerides (TG), C-reactive protein (CRP), creatinine, fasting glucose, and hemoglobin A1c were assessed in relation to pedometer-assessed ambulatory activity, as was the odds of metabolic syndrome and CRP > 3 mg/L. Effect modification by gender was examined. Results: Only waist circumference was lower with greater steps/day in the men and women combined (P(trend) < 0.001). No other significant relationships were noted in men, while women with >= 7500 steps/day had lower weight, BMI, CRP, TG, total, and small LDL particles compared with those with < 7500 steps/day. These women also had 62% and 43% lower odds of metabolic syndrome and elevated CRP, respectively, compared with the less active women. Adjustment for BMI attenuated all the associations seen in women. Conclusions: Greater ambulatory activity is associated with lower levels of metabolic and cardiovascular risk factors in female smokers which may, in part, be mediated by a reduction in BMI.

Kamaura M; Fujii H; Mizushima S; Tochikubo O. Weight gain and risk of impaired fasting glucose after smoking cessation. Journal of Epidemiology 21(6): 431-439, 2011. (35 refs.)

Background: Observation of early changes in fasting plasma glucose level induced by post-smoking cessation weight gain is useful in predicting the risks of diabetes mellitus (DM) and impaired fasting glucose (IFG). We investigated the effect of post-smoking cessation weight gain on early changes in the risk of a high fasting plasma glucose (IFG) level (>= 100 mg/dL). Methods: In 946 subjects who underwent repeated health examinations after smoking cessation, changes in body mass index (BMI) and the odds ratio (OR) for IFG risk (adjusted for sex, age, BMI, fasting plasma glucose at year 1, and alcohol consumption) were calculated every year for 3 years after smoking cessation. Results: After smoking cessation, the rate of BMI increase significantly increased in quitters: 2.36% at year 2 (never smokers: 0.22%, current smokers: 0.39%) and 0.46% at year 3 (never smokers: 0.14%, current smokers: 0.32%). However, it decreased by 0.15% at year 4 (never smokers: 0.12%, current smokers: 0.26%). The ORs for quitters did not significantly increase at any time during the follow-up period. However, among quitters who had smoked at least 20 cigarettes per day, it was significantly higher (OR 1.51, 95% confidence interval 1.1-2.01 at year I and 1.71, 1.23-2.38 at year 2). Conclusions: The time course of the risk of IFG after smoking cessation was similar to that for the rate of BMI increase. In contrast to the findings of previous reports, the increase in IFG risk after smoking cessation was brief and disappeared in the absence of a significant increase in BMI.

Keast RSJ; Sayompark D; Sacks G; Swinburn BA; Riddell LJ. The influence of caffeine on energy content of sugar-sweetened beverages: 'The caffeine-calorie effect'. European Journal of Clinical Nutrition 65(12): 1338-1344, 2011. (42 refs.)

Background/Objectives: Caffeine is a mildly addictive psychoactive chemical and controversial additive to sugar-sweetened beverages (SSBs). The objective of this study is to assess if removal of caffeine from SSBs allows co-removal of sucrose (energy) without affecting flavour of SSBs, and if removal of caffeine could potentially affect population weight gain. Subjects/Methods: The research comprised of three studies; study 1 used three-alternate forced choice and paired comparison tests to establish detection thresholds for caffeine in water and sucrose solution (subjects, n = 63), and to determine if caffeine suppressed sweetness. Study 2 (subjects, n = 30) examined the proportion of sucrose that could be co-removed with caffeine from SSBs without affecting the flavour of the SSBs. Study 3 applied validated coefficients to estimate the impact on the weight of the United States population if there was no caffeine in SSBs. Results: Detection threshold for caffeine in water was higher (1.09 +/- 0.08 mM) than the detection threshold for caffeine in sucrose solution (0.49 +/- 0.04 mM), and a paired comparison test revealed caffeine significantly reduced the sweetness of sucrose (P<0.001). Removing caffeine from SSBs allowed co-removal of 10.3% sucrose without affecting flavour of the SSBs, equating to 116 kJ per 500 ml serving. The effect of this on body weight in adults and children would be 0.600 and 0.142 kg, which are equivalent to 2.08 and 1.10 years of observed existing trends in weight gain, respectively. Conclusion: These data suggest the extra energy in SSBs as a result of caffeine's effect on sweetness may be associated with adult and child weight gain.

Kim O; Jeon HO. Relationship between obesity, alcohol consumption, and physical activity of male office workers in South Korea. Nursing & Health Sciences 13(4): 457-462, 2011. (38 refs.)

This study investigated the relationship between obesity, alcohol consumption, and physical activity of males in South Korea. A total of 141 middle-aged office workers were recruited from two companies in Seoul, Korea. The data were collected through a structured questionnaire and body composition analyzer (Inbody 230). Based on body mass index, 30.5% of the study participants were overweight and 48.9% were obese. Based on the percentage of body fat and the waist-to-hip ratio, 21.3% and 47.5% were obese, respectively. Most of the participants drank alcohol, with a mean of 52.26 drinks in the preceding month. Among them, 38.8% were heavy drinkers. The prevalence of low and moderate physical activity was 73% and 22%, respectively. Significant differences were found for body mass index, percentage of body fat, and waist-to-hip ratio after controlling for physical activity as a covariate. Body mass index, percentage of body fat, and waist-to-hip ratio of light and heavy drinkers were higher than that of moderate drinkers. The prevalence of overweight, obesity, and alcohol consumption was high in male office workers. Heavy alcohol consumption should be considered a relating factor of obesity in office workers.

King G; Soneji S. The future of death in America. Demographic Research 25(e-article 1), 2011. (71 refs.)

Population mortality forecasts are widely used for allocating public health expenditures, setting research priorities, and evaluating the viability of public and private pensions, and health care financing systems. In part because existing methods forecast less accurately when based on more information, most forecasts are still based on simple linear extrapolations that ignore known biological risk factors and other prior information. We adapt a Bayesian hierarchical forecasting model capable of including more known health and demographic information than has previously been possible. This leads to the first age- and sex-specific forecasts of American mortality that simultaneously incorporate, in a formal statistical model, the effects of the recent rapid increase in obesity, the steady decline in tobacco consumption, and the well known patterns of smooth mortality age profiles and time trends. Formally including new information in forecasts can matter a great deal. For example, we estimate an increase in male life expectancy at birth from 76.2 years in 2010 to 79.9 years in 2030, which is 1.8 years greater than the U.S. Social Security Administration projection and 1.5 years more than U.S. Census projection. For females, we estimate more modest gains in life expectancy at birth over the next twenty years from 80.5 years to 81.9 years, which is virtually identical to the Social Security Administration projection and 2.0 years less than U.S. Census projections. We show that these patterns are also likely to greatly affect the aging American population structure. We offer an easy-to-use approach so that researchers can include other sources of information and potentially improve on our forecasts too.

Klijs B; Mackenbach JP; Kunst AE. Obesity, smoking, alcohol consumption and years lived with disability: A Sullivan life table approach. BMC Public Health 11(e-article 378), 2011. (44 refs.)

Background: To avoid strong declines in the quality of life due to population ageing, and to ensure sustainability of the health care system, reductions in the burden of disability among elderly populations are urgently needed. Life style interventions may help to reduce the years lived with one or more disabilities, but it is not fully understood which life style factor has the largest potential for such reductions. Therefore, the primary aim of this paper is to compare the effect of BMI, smoking and alcohol consumption on life expectancy with disability, using the Sullivan life table method. A secondary aim is to assess potential improvement of the Sullivan method by using information on the association of disability with time to death. Methods: Data from the Dutch Permanent Survey of the Living Situation (POLS) 1997 1999 with mortality follow-up until 2006 (n = 6,446) were used. Using estimated relative mortality risks by risk factor exposure, separate life tables were constructed for groups defined in terms of BMI, smoking status and alcohol consumption. Logistic regression models were fitted to predict the prevalence of ADL and mobility disabilities in relationship to age and risk factor exposure. Using the Sullivan method, predicted age-specific prevalence rates were included in the life table to calculate years lived with disability at age 55. In further analysis we assessed whether adding information on time to death in both the regression models and the life table estimates would lead to substantive changes in the results. Results: Life expectancy at age 55 differed by 1.4 years among groups defined in terms of BMI, 4.0 years by smoking status, and 3.0 years by alcohol consumption. Years lived with disability differed by 2.8 years according to BMI, 0.2 years by smoking and 1.6 by alcohol consumption. Obese persons could expect to live more years with disability (5.9 years) than smokers (3.8 years) and drinkers (3.1 years). Employing information on time to death led to lower estimates of years lived with disability, and to smaller differences in these years according to BMI (2.1 years), alcohol (1.2 years), and smoking (0.1 years). Conclusions: Compared with smoking and drinking alcohol, obesity is most strongly associated with an increased risk of spending many years of life with disability. Although employing information on the relation of disability with time to death improves the precision of Sullivan life table estimates, the relative importance of risk factors remained unchanged.

Koopmann A; Dinter C; Grosshans M; von der Goltz C; Hentschel R; Dahmen N et al. Psychological and hormonal features of smokers at risk to gain weight after smoking cessation: Results of a multicenter study. Hormones and Behavior 60(1): 58-64, 2011. (53 refs.)

Preclinical and clinical data suggest modulating effects of appetite-regulating hormones and stress perception on food intake. Nicotine intake also interferes with regulation of body weight. Especially following smoking cessation gaining weight is a common but only partially understood consequence. The aim of this study was to examine the interaction between smoking habits, the appetite regulating hormone leptin, negative affectivity, and stress vulnerability on eating behavior in a clinical case-control study under standardized conditions. In a large population-based study sample, we compared leptin and cortisol plasma concentrations (radioimmunoassay) between current tobacco smokers with high cognitive restraint and disinhibition in eating behavior and smokers scoring low in both categories as assessed with the Three Factor Eating Questionnaire (TFEQ; Stunkard & Messick, 1985). As a measure for smoking effects on the stress axis, the saliva cortisol concentrations were compared before and after nicotine smoking. Additionally, stress perception was assessed with the Perceived Stress Scale (PSS), symptoms of depression and anxiety with the Beck Depression Inventory (BDI) and the State Trait Anxiety Inventory (STAI). In smokers showing high cognitive restraint and disinhibition we found significantly higher leptin concentrations than in the group of smokers scoring low in both categories. Furthermore there was a significant group difference in saliva cortisol concentrations after nicotine intake. Smokers showing high cognitive restraint and disinhibition were also characterized by significantly higher scores in the STAI, the PSS and the BDI. Our results suggest that smokers with a pathological eating behavior show an impaired neuroendocrine regulation of appetite and are prone to experience higher levels of stress and negative affectivity. This interaction of behavioral and neuroendocrinological factors may constitute a high risk condition for gaining weight following smoking cessation.

Koshy G; Delpisheh A; Brabin BJ. Dose response association of pregnancy cigarette smoke exposure, childhood stature, overweight and obesity. European Journal of Public Health 21(3): 286-291, 2011. (36 refs.)

Background: The combined dose response effects of pregnancy cigarette smoke exposure on childhood overweight, obesity and short stature have not been reported. Method: A community based cross-sectional survey of 3038 children aged 5-11 years from 15 primary schools in Merseyside, UK. Self-completed parental questionnaires were used for family characteristics, socio-economic status and parental smoking practices. Children were measured for height and weight and z-scores calculated for parental smoking categories. Results: Of 689 (34.0%) mothers who smoked during pregnancy 50.5% smoked ten or more cigarettes daily (heavy smokers). Children of maternal non-smokers had prevalence estimates for overweight, obesity and short stature of 25, 9.6 and 3.2%, respectively. Prevalence estimates were higher in children of mothers who were heavy smokers during pregnancy, 31.5% (P = 0.001), 15.6% (P < 0.001) and 5.5% (P = 0.001), respectively. Mean height for age z-scores was lower among heavy maternal (P < 0.001) and paternal smokers (P < 0.01) compared to non-smokers. Childhood overweight, obesity or short stature were all associated with heavy maternal smoking during pregnancy (all P < 0.001). Mean body mass index (BMI) z-scores were higher in boys of mothers who smoked (P = 0.043). The adjusted odds ratio for short stature in children of heavy maternal smokers was 2.76 (95% CI 1.21-6.33) and 4.28 (1.37-13.37) if both parents were heavy smokers. The adjusted OR for obesity in children of maternal smokers was 1.61(1.19-2.18). The population attributable risk for short stature was 8.8% (1.1-22.7) for heavy maternal smokers. Conclusion: A dose-response association was observed between pregnancy smoking exposure, short stature and obesity.

Le Strat Y; Le Foll B. Obesity and cannabis use: Results from 2 representative national surveys. American Journal of Epidemiology 174(8): 929-933, 2011. (30 refs.)

The role of cannabis and endocannabinoids in appetite regulation has been extensively studied, but the association of cannabis use with weight in the general population is not known. The authors used data from 2 representative epidemiologic studies of US adults aged 18 years or older, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002) and the National Comorbidity Survey-Replication (NCS-R; 2001-2003), to estimate the prevalence of obesity as a function of cannabis use. The adjusted prevalences of obesity in the NESARC and the NCS-R were 22.0% and 25.3%, respectively, among participants reporting no use of cannabis in the past 12 months and 14.3% and 17.2%, respectively, among participants reporting the use of cannabis at least 3 days per week. These differences were not accounted for by tobacco smoking status. Additionally, after adjustment for sex and age, the use of cannabis was associated with body mass index differences in both samples. The authors conclude that the prevalence of obesity is lower in cannabis users than in nonusers.

Lee SS; Seo JS; Kim SR; Jeong JE; Nam BW; Lee JY et al. The changes of blood glucose control and lipid profiles after short-term smoking cessation in healthy males. Psychiatry Investigation 8(2): 149-154, 2011. (45 refs.)

Objective. Our aim was to evaluate the changes in blood glucose control and lipid profiles after 2-months of smoking cessation in healthy males. Methods. Smoking abstinence was evaluated through self-report and urine cotinine levels. 12 individuals who succeeded in quitting smoking were analyzed. Fasting values of glucose and insulin were used to estimate the beta-cell activity and insulin resistance was evaluated using the Homeostasis Model Assessment (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI). Results. The data showed that the subjects had a significant increase in weight, body mass index and fasting plasma glucose levels after smoking cessation. The HOMA-Insulin Resistance and the HOMA beta-cell function increased significantly (p=0.005, p=0.047 respectively). The QUICKI showed a significant decrease (p=0.005). In addition, the low-density lipoprotein cholesterol levels decreased significantly (p=0.028); however, changes in the high-density lipoprotein cholesterol, the triglyceride and total cholesterol levels were not significant (p=0.284, p=0.445 respectively). Conclusion. During the initial stage of smoking abstinence, insulin resistance increased and insulin sensitivity decreased due to elevated body weight and fat composition. Therefore, it is important to educate individuals that stop smoking about the necessity of weight control during smoking cessation programs.

Lent MR; Swencionis C. Addictive personality and maladaptive eating behaviors in adults seeking bariatric surgery. Eating Behaviors 13(1): 67, 2012. (28 refs.)

This study examined the relationship between addictive personality and maladaptive eating behaviors in bariatric surgery candidates. Ninety-seven bariatric surgery candidates completed the Eysenck Personality Questionnaire (EPQ-R) Addiction Scale, the Overeating Questionnaire (OQ), binge-eating questions from the Questionnaire of Eating and Weight Patterns (QEWP-R), and the Eating Attitudes and Behaviors Questionnaire. Participants with Binge Eating Disorder (BED) displayed addictive personality scores comparable to individuals addicted to substances (M=17.5, SD=5.3). Addictive personality was associated with Overeating (r=.45, p<.001). Cravings (r=.31, p=.005), Affective Disturbances (r=.62, p<.001) and Social Isolation (r=.53, p<.001). Addictive personality was associated with maladaptive eating behaviors, suggesting the potential for addictive eating.

Lillis J; Levin ME; Trafton JA. Elevated BMI and illicit drug use are associated with decreased ability to inhibit prepotent behaviors. Addictive Behaviors 37(4): 544-547, 2012. (28 refs.)

The current study examined the impact of BMI and illicit drug use on the ability to inhibit prepotent behaviors. Participants (n = 290) completed surveys and behavioral tasks: the Stroop Test and Go/No-Go. After controlling for age and gender, higher BMI was an independent predictor of poorer performance in both the Stroop and Go/No-Go tasks. Illicit drug use was a predictor of poorer Stroop performance only. However, post hoc analyses showed that illicit drug use significantly impacted Go/No-Go performance in normal weight participants. We conclude that elevated BMI and illicit drug use are predictive of poorer performance on executive functioning tasks that require inhibition of a prepotent response.

Lindberg MA; Dementieva Y; Cavender J. Why has the BMI gone up so drastically in the last 35 years? Journal of Addiction Medicine 5(4): 272-278, 2011. (30 refs.)

Objectives: We attempted to answer the following questions: Why has the body mass index (BMI) increased so dramatically in the last 35 years? Are some food groups or additives more responsible than others? Methods: Data for per capita food production available for consumption after spoilage for different food groups and additives from the US Department of Agriculture were used as independent variables to predict BMI increases. The heights and weights were taken from the Centers for Disease Control and the US Census Bureau for the years 1970 to 2004. Results: The additives of fats and sugars in combination, not separately, best predicted increases in BMI accounting for 97% of the variance in the linear regression analyses. When all food groups were entered into regressions to predict increases in BMI, fats and sugars in combination accounted for 96% of the variance for women and 97% for men, with the other food groups adding very little. Path analyses showed that fat and sweeteners had direct effects on BMI and were also the mediators of increased caloric consumption. Conclusions: In line with the major physiological theories emphasizing palatability as the addictive stimulus in models of incentives and addiction, fats and sugars in combination rather than calories per se or particular food groups accounted for the increases in BMI. These empirically based theories and data suggest that one should focus on palatability and addictive models in dealing with the increasing problem of obesity in the United States.

Luo JH; Horn K; Ockene JK; Simon MS; Stefanick ML; Tong E et al. Interaction between smoking and obesity and the risk of developing breast cancer among postmenopausal women. American Journal of Epidemiology 174(8): 919-928, 2011. (46 refs.)

Obesity is a well-established risk factor for postmenopausal breast cancer. Recent studies suggest that smoking increases the risk of breast cancer. However, the effect of co-occurrence of smoking and obesity on breast cancer risk remains unclear. A total of 76,628 women aged 50-79 years enrolled in the Women's Health Initiative Observational Study were followed through August 14, 2009. Cox proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals. Over an average 10.3 years of follow-up, 3,378 incident cases of invasive breast cancer were identified. The effect of smoking on the risk of developing invasive breast cancer was modified significantly by obesity status among postmenopausal women, regardless of whether the obesity status was defined by body mass index (P(interaction) = 0.01) or waist circumference (P(interaction) = 0.02). A significant association between smoking and breast cancer risk was noted in nonobese women (hazard ratio = 1.25, 95% confidence interval: 1.05, 1.47) but not in obese women (hazard ratio = 0.96, 95% confidence interval: 0.69, 1.34). In conclusion, this study suggests that the effect of smoking exposure on breast cancer risk was modified by obesity among postmenopausal women. The modification effect did not differ by general versus abdominal obesity.

Majer IM; Nusselder WJ; Mackenbach JP; Kunst AE. Life expectancy and eife expectancy with disability of normal weight, overweight, and obese smokers and nonsmokers in Europe. Obesity 19(7): 1451-1459, 2011. (40 refs.)

The goal of this study was to estimate life expectancy (LE) and LE with disability (LwD) among normal weight, overweight, and obese smokers and nonsmokers in Western Europe. Data from four waves (1998-2001) of the European Community Household Panel (ECHP) were used; a standardized multipurpose annual longitudinal survey. Self-reported health and socioeconomic information was collected repeatedly using uniform questionnaires for 66,331 individuals in nine countries. Health status was measured in terms of disability in daily activities. Multistate Markov (MSM) models were applied to obtain hazard ratios (HRs) and age-specific transition rates according to BMI and smoking status. Multistate life tables were computed using the predicted transition probabilities to estimate LE and LwD. Significant associations were observed between disability incidence and BMI (HR = 1.15 for overweight, HR = 1.64 for obese, compared to normal weight). The risk of mortality was negatively associated with overweight status among disabled (HR = 0.77). Overweight people had higher LE than people with normal-weight and obesity. Among women, overweight and obese nonsmokers expect 3.6 and 6.1 more years of LwD than normal weight persons, respectively. In contrast, daily smokers expect lower LE but a similar LwD. The same patterns were observed among people with high education and those with low education. To conclude, daily smoking is associated with mortality more than with disability, whereas obesity is associated with disability more than with mortality. The findings suggest that further tobacco control would contribute to increasing LE, while tackling the obesity epidemic is necessary to prevent an expansion of disability.

Matijasevich A; Brion MJ; Menezes AM; Barros AJD; Santos IS; Barros FC. Maternal smoking during pregnancy and offspring growth in childhood: 1993 and 2004 Pelotas cohort studies. Archives of Disease in Childhood 96(6): 519- 525, 2011. (32 refs.)

Objective To explore the effects of maternal smoking during pregnancy on offspring growth using three approaches: (1) multiple adjustments for socioeconomic and parental factors, (2) maternal-paternal comparisons as a test of putative intrauterine effects and (3) comparisons between two birth cohort studies. Methods Population-based birth cohort studies were carried out in Pelotas, Brazil, in 1993 and 2004. Cohort members were followed up at 3, 12, 24 and 48 months. Multiple linear regression analysis was used to examine the relationships between maternal and paternal prenatal smoking and offspring anthropometric indices. In the 2004 cohort, the association of smoking with trunk length, leg length and leg-to-sitting-height ratio at 48 months was also explored. Results: Maternal smoking during pregnancy was associated with reduced z scores of length/height-for-age at each follow-up in both cohorts and reduced leg length at 48 months in the 2004 cohort. Children older than 3 months born to smoking women showed a higher body mass index-for-age z score than children of nonsmoking women. Conclusions: The results of this study strongly support the hypothesis that maternal smoking during pregnancy impairs linear growth and promotes overweight in childhood.

Moreno C; Tandon R. Should overeating and obesity be classified as an addictive disorder in DSM-5? (review). Current Pharmaceutical Design 17(12): 1128- 1131, 2011. (21 refs.)

Overeating and associated obesity are major public health problems. In addition to its notable adverse health consequences, the behavior of overeating has significant neurobiological and psychological underpinnings. Current classification systems of mental disorders (DSM-IV and ICD-10) address this increasingly prevalent "disorder" in a limited and inconsistent manner. Several similarities between overeating and substance dependence have been documented with regards to phenomenology, shared neurobiology, and treatment. This has led to suggestions that a new category of "food addiction" be added to our psychiatric nosology and that this category be included with substance use disorders under a broad rubric of "addiction disorders". In this article, we consider the rationale for this recommendation and evaluate its pros and cons. We summarize how the problem of overeating is addressed in our current classification systems and discuss DSM-5 approaches to the issue.

Napolitano MA; Lloyd-Richardson EE; Fava JL; Marcus BH. Targeting body image schema for smoking cessation among college females: Rationale, program description, and pilot study results. Behavior Modification 35(4): 323- 346, 2011. (58 refs.)

Smoking among young adults is a significant public health problem. Despite the negative health effects, many young women smoke for weight and body image reasons. Understanding the factors that prompt young women to initiate and continue smoking is important for designing smoking cessation interventions. The aim of the current article is to outline a potential pathway for smoking behavior among young women, specifically applying a cognitive bias framework previously used to describe disordered eating behaviors. This article provides the rationale for using two different treatments targeting body image schema among female smokers. The authors describe the development, feasibility, and acceptability of these two treatment approaches among a sample of female college smokers (N = 24). Preliminary pilot data are presented as well as the significance and implications for future clinical interventions.

Naude CE; Senekal M; Laubscher R; Carey PD; Fein G. Growth and weight status in treatment-naive 12-16 year old adolescents with alcohol use disorders in Cape Town, South Africa. Nutrition Journal 10: article 87, 2011. (62 refs.)

Background: Heavy alcohol consumption during adolescence has many known harmful health and social consequences and is strongly associated with numerous health risk behaviours. The consequences of heavy alcohol use during adolescence on nutritional status, specifically growth and weight status are largely unknown at this time. Methods: Substance use, anthropometric indices of growth and weight, dietary energy intake and physical activity in heavy drinking adolescents (meeting DSM-IV criteria for alcohol use disorders) and matched light/non-drinking control adolescents were assessed. Results: Lifetime alcohol dose, measured in standard drinks of alcohol, was orders of magnitude higher in adolescents with alcohol use disorders (AUDs) compared to controls. The AUDs group was selected to represent relatively 'pure' AUDs, with minimal other drug use and no psychiatric diagnoses. The growth and weight status of adolescents with AUDs were generally comparable to that of controls, and is in line with the growth and weight status of the South African adolescent population. A greater proportion of overweight/obese females was found in both groups, with this percentage tending to be greater, although not significantly so, in the AUDs group. Adolescent females with AUDs had increased odds of being overweight/obese compared to controls, after adjustment for smoking, physical activity and energy intake. Conclusion: Anthropometric indices of growth and weight status of participants in the Control and AUD groups were generally comparable. Female adolescents with AUDs may have an increased risk of being overweight/obese compared to adolescent females without AUDs. The presence of an AUD in our adolescent sample was associated with higher energy intake. Longitudinal studies are needed to elucidate the effects of heavy alcohol use on energy balance, growth and weight status in adolescents as they age. Nonetheless, the current study contributes to our understanding of the impacts of heavy alcohol consumption on important aspects of adolescent development.

Nobili V; Pinzani M. Alcoholic and non-alcoholic fatty liver in adolescents: A worrisome convergence. Alcohol and Alcoholism 46(5): 627-629, 2011. (30 refs.)

Health problems related to alcohol abuse are characterized by a heavy socio-economic impact with major consequences on health costs and national productivity both in industrialized and developing countries. The observation that alcohol-related problems seem to disproportionately affect adolescents and young adults constitutes an additional reason for concern. Independent of gender and of region of the world, individuals in the age range 15-29 years consistently present the highest proportion of alcohol-attributable deaths. A growing body of evidence suggests that the introduction to alcohol use in childhood followed by alcohol abuse in adolescence lead to an increased risk for high-impact diseases in adulthood such as cancer, liver cirrhosis, respiratory and cardiovascular disease, mental and behavioural disorders). Besides these long-term risks, alcohol abuse in childhood and adolescence is associated with an increased risk of developing acute and chronic liver diseases. This is aggravated by the parallel increase in the occurrence of fatty liver due to metabolic factors in the same age group. Indeed, as a consequence of the growing prevalence of childhood obesity and overweight, paediatric Non-alcoholic Fatty Liver Disease (NAFLD) has become the most frequent chronic liver abnormality in children and adolescents both in industrialized and developing countries. This article reviews the physiological factors which underlie alcoholic liver disease, and the synergy with obesity, with attention to the oxidative stress, metabolic syndrome, increased intestinal permeability, and factors predisposing to inflammation and fibrosis.

Pantic I; Malbasa M; Ristic S; Turjacanin D; Medenica S; Paunovic J et al. Screen viewing, body mass index, cigarette smoking and sleep duration in Belgrade University student population: Results of an observational, cross-sectional study. Revista Medica de Chile 139(7): 896-901, 2011. (28 refs.)

Background: Subjects that spend more time working on computers or watching television could have a higher body mass index. Aim: To assess the relationship between time spent in front of a screen and studying, body mass index (BMI), smoking, and sleep duration among university students. Material and Methods: A cross-sectional study of 734 randomly selected students aged 21 +/- 2 years (450 females) that responded an anonymous, structured questionnaire about time spent watching television or in front of a computer, time spent studying, number of daily hours of sleep, smoking habits and number of daily meals. Body mass index was also calculated for all subjects Results: Among males, the number of daily sleep hours, time spent working with computers and number of daily meals were significantly higher and time spent studying was significantly lower than females. Nonsmokers ate a significantly higher number of meals and spent less time watching television. No association was observed between time spent in front of a screen and number of sleep hours of body mass index. Conclusions: Men and smokers spend more time working in computers. There is no association between body mass index and time spent in front of screens.

Pasch KE; Velazquez CE; Cance JD; Moe SG; Lytle LA. Youth substance use and body composition: Does risk in one area predict risk in the other? Journal of Youth and Adolescence 41(1, special issue): 14-26, 2012. (44 refs.)

Both substance use and obesity are prevalent among youth. As youth age, substance use rates increase and over the past three decades, obesity rates among youth have tripled. While these two factors have both short- and long-term health impacts, little research has explored how substance use and obesity among youth may be related. This study explores the bi-directional longitudinal relationships between substance use and body composition. Participants (N = 704; 50.7% female) were mostly white (86.4%) with a baseline mean age of 14.7 years. Objectively measured body composition was used to calculate body mass index z-scores (BMI z-score) and percent body fat. Cross-lagged structural equation models, accounting for clustering at the school level, were run to determine the longitudinal association between body composition and self-reported substance use (alcohol, cigarette, and marijuana), adjusting for socio-demographic characteristics, pubertal status, and weight satisfaction. Baseline alcohol use predicted decreased BMI z-score at follow-up and a similar association with percent body fat approached significance. Baseline cigarette use predicted increased percent body fat. No longitudinal associations were seen between baseline body composition and future substance use. Our results suggest that substance use contributes to subsequent body composition; however, body composition does not contribute to subsequent substance use. Continued research that explores these relationships longitudinally is greatly needed.

Penzes M; Czegledi E; Balazs P; Foley KL. Factors associated with tobacco smoking and the belief about weight control effect of smoking among Hungarian adolescents. Central European Journal of Public Health 20(1): 11-17, 2012. (51 refs.)

Introduction: The relationship between body weight and smoking has been well-documented among adult populations, but the data among youth are inconsistent. This study explores the relationship among social, behavioural, body weight-related factors and adolescent smoking while identifying factors associated with the belief that smoking controls weight. Materials and methods: Baseline data from a three-year, prospective cohort study started in 2009 in Hungary's six metropolitan cities. Randomly selected 6th and 9th grade students completed a self-administered questionnaire during the 2009-2010 school year (n=1445; 45% boys, mean age of 6th graders: 12.06 years, SD=0.63; mean age of 9th graders: 15.06 years, SD=0.63). Calculations of Body Mass Index (BMI) were based on objectively measured weight and height data of participants. Appetite-Weight Control Scale of the Short Form of Smoking Consequences Questionnaire was used to measure the belief that smoking supports weight control. Bivariate and multivariate logistic regression analyses were performed to examine the association between the perception of weight control and smoking, while controlling for potential confounding variables (e.g., gender). Results: 24.8% of participants smoked cigarettes within the past 30 days. The odds of smoking were increased among students who were older, had smoking friends, were exposed to parental smoking, and had poorer academic performance. BMI showed positive association with smoking (increases in BMI were associated with higher odds of smoking), and the belief that smoking controls weight mediated this association. There was no difference in smoking prevalence among those motivated either to lose or gain weight (similar to 30%), but was considerably lower among adolescents satisfied with their body weight (19%). The belief that smoking supports weight control was more common for girls, older students, and those who perceived themselves as overweight. Conclusions: Dissatisfaction with body weight and the belief that smoking has weight controlling effects are associated with an increased likelihood of adolescent smoking, therefore they must be considered in smoking prevention programmes among youth.

Phillips MCL; Leyden JM; Chong WK; Klelnig T; Czapran P; Lee A et al. Ischaemic stroke among young people aged 15 to 50 years in Adelaide, South Australia. Medical Journal of Australia 195(10): 610-614, 2011. (26 refs.)

Objectives: To report risk factors, aetiology and neuroimaging features among a large series of young Australian patients who were admitted to hospital for a first-ever occurrence of ischaemic stroke; to analyse the effect of age, sex and ethnicity on the presence of risk factors; and to compare Australian and overseas data. Design, setting and patients: Retrospective evaluation of data for all patients aged from 15 to 50 years who were admitted to a public hospital in Adelaide, South Australia, from January 2006 to June 2010 with a primary diagnosis of ischaemic stroke. Results: Among 326 patients (184 males), the most frequent stroke risk factors overall were dystipidaemia (187), smoking (161), hypertension (105) and obesity (92). Fifty-one patients used illicit drugs, mostly comprising marijuana and amphetamines. The most frequent stroke aetiologies overall were cardioembolism (85), arterial dissection (49), and small-vessel occlusion (31). Cardioembolism was highly prevalent among our study population compared with patients in other countries. Neuroimaging showed that more patients in our study had strokes that involved both vascular territories concurrently (9%) compared with patients in other countries. Conclusions: Risk factors, aetiology and features of ischaemic stroke among young people in Adelaide differ significantly from published data for young patients around the world. Patients in Adelaide are more likely to be obese, to be misusing marijuana and amphetamines, to suffer a cardioembolic event and to have a stroke that concurrently affects both the anterior and posterior cerebral circulation.

Pickering RP; Goldstein RB; Hasin DS; Blanco C; Smith SM; Huang BJ et al. Temporal relationships between overweight and obesity and DSM-IV substance use, mood, and anxiety disorders: Results from a prospective study, the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry 72(11): 1494-1502, 2011. (76 refs.)

Objective: To present nationally representative findings on the prospective relationships between overweight and obesity and DSM-IV substance use, mood, and anxiety disorders. Method: A nationally representative sample of 34,653 US adults was interviewed in Wave 1(2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. The target population was the civilian population residing in households and group quarters, with gathered data adjusted to be representative of the civilian population of the United States on the basis of the 2000 Decennial Census. The main outcome measures were the incidence of DSM-IV substance use, mood, and anxiety disorders and changes in body mass index status during the 3-year follow-up period. Results: Regression analyses that controlled for a wide array of covariates showed that overweight and obese women were at increased risk (P < .05) for incident major depressive disorder during the follow-up period (adjusted OR [AOR] = 1.3 [95% CI, 1.02-1.56] and AOR = 1.2 [95% CI, 1.02-1.51], respectively). Overweight men and obese men were at decreased risk (P < .05) of incident drug abuse and alcohol dependence (AOR = 0.7 [95% CI, 0.44-0.96] and AOR = 0.7 [95% CI, 0.52-0.97]), respectively. Obese women had a decreased risk (P < .05) of incident alcohol abuse and drug dependence (AOR = 0.6 [95% CI, 0.45-0.88] and AOR = 0.4 [95% CI, 0.21-0.91], respectively). Men with drug dependence and women with specific phobia had a decreased risk (P < .05) of becoming overweight or obese during the follow-up period (AOR = 0.4 [95% CI, 0.19-0.99] and AOR = 0.8 [95% CI, 0.66-0.95], respectively). Conclusions: Increased risk of major depressive disorder among overweight and obese women could be attributed to stigma and greater body dissatisfaction among women in Western cultures. Overweight and obesity may serve as protective factors against developing incident substance use disorders, possibly due to shared neural functions in the brain underlying addictions to numerous substances. Results are discussed in terms of their clinical implications, including the need to update treatment guidelines for the management of overweight, obesity, and major depressive disorder.

Ratcliff MB; Jenkins TM; Reiter-Purtill J; Noll JG; Zeller MH. Risk-taking behaviors of adolescents with extreme obesity: Normative or not? Pediatrics 127(5): 827- 834, 2011. (67 refs.)

OBJECTIVE: Present first published data detailing high-risk behaviors of adolescent high school students (HSS) with extreme obesity (BMI >= 99th percentile for age and gender) compared with healthy weight peers (5th-84th percentile). METHODS: The 2007 Youth Risk Behavior Survey was used to compare HSS with extreme obesity (N = 410) and healthy weight peers (N = 8669) in their engagement in (1) tobacco use, (2) alcohol/other drug use, (3) high-risk sexual behaviors, and (4) suicidal behaviors. Logistic regression was used to calculate gender-stratified odds ratios (OR) and 95% confidence intervals (CI), controlling for age and race. RESULTS: HSS with extreme obesity were similar to healthy weight peers in the prevalence of most behaviors related to alcohol/drug use, high-risk sexual activities, and suicide, with the following exceptions: relative to healthy weight HSS, both male and female students with extreme obesity more frequently reported ever trying cigarettes (female students, adjusted OR: 2.0 [95% CI: 1.3-3.2]; male students, OR: 1.5 [CI: 1.2-2.0]). Compared with healthy weight female students, female students with extreme obesity had lower odds of ever having sex (OR: 0.5 [CI: 0.3-0.9]), but greater odds of drinking alcohol/using drugs before their last sexual encounter (OR: 4.6 [CI: 1.2-17.6]), currently smoking (OR: 2.3 [CI: 1.2-4.4]), and using smokeless tobacco (OR: 4.6 [CI: 1.2-17.2]). Compared with healthy weight male students, male students with extreme obesity had greater odds of smoking before age 13 (OR: 1.4 [CI: 1.0-2.0]). CONCLUSIONS: With few exceptions, HSS with extreme obesity engage in high-risk behaviors at rates comparable with healthy weight peers, sometimes in even more dangerous ways. Health care providers should assess risk-taking behaviors in this cohort.

Richards R; Merrill RM; Baksh L. Health behaviors and infant health outcomes in homeless pregnant women in the United States. Pediatrics 128(3): 438-446, 2011. (30 refs.)

OBJECTIVE: To describe selected demographics; maternal health behaviors before, during, and after pregnancy; and infant health outcomes among homeless women in the United States. PATIENTS AND METHODS: Analyses are based on Pregnancy Risk Assessment Monitoring System data from 31 participating states from 2000 to 2007 that were linked to birth certificate data, which contain demographic and medical information collected through the state's vital records system. Responses were then weighted to be representative of all women who gave birth in each state during that year. Assessment of these data takes into account the complex sampling designs employed by the states. RESULTS: Four percent of women reported homelessness within 12 months before pregnancy, with the highest percentage in Illinois, followed by Oregon and Washington. Homeless women were younger, unmarried, uninsured, less educated, less likely to initiate and sustain breastfeeding, and had less prenatal care and well-visits. They were also more likely to be black, Hispanic, smoke cigarettes, be underweight or have class III obesity, and not take preconception multivitamins. Infants had lower birth weights, a longer hospital stay, and were more likely to receive neonatal intensive care. CONCLUSIONS: In this study we provide additional insight into homelessness in the perinatal period and provide information on ways to direct interventions aimed at improving the health of homeless mothers and infants. Additional research is needed to determine factors that influence pregnancy weight gain and infant feeding practices among homeless women and how this affects infant health.

Rogers PJ. Obesity - Is food addiction to blame? (editorial). Addiction 106(7): 1213-1214, 2011. (3 refs.)

Sayon-Orea C; Bes-Rastrollo M; Nunez-Cordoba JM; Basterra-Gortari FJ; Beunza JJ; Martinez-Gonzalez MA. Type of alcoholic beverage and incidence of overweight/obesity in a Mediterranean cohort: The SUN project. Nutrition 27(7-8): 802-808, 2011. (34 refs.)

Objective: The effects of alcohol on body weight might be modulated by the total amount of alcohol intake and type of alcoholic beverage. However, available results are contradictory. There is a scarcity of studies on this topic in Mediterranean areas where wine consumption is high. We prospectively evaluated the association between the type of alcoholic beverage intake and weight change in a Mediterranean cohort. Methods: We followed for an average of 6.1 y 9318 adults without previous chronic disease at baseline. Validated data on diet including alcohol consumption were collected at baseline. Weight was recorded at baseline and updated every 2 y during follow-up. The outcomes were average weight gained every year and incidence of overweight/obesity after a 6-y follow-up. Results: During follow-up, 1006 incident cases of overweight/obesity were identified in participants with normal weight at baseline. Beer and spirits consumption (>= 7 drinks/wk) was associated with a +119 g/y (95% confidence interval +27 to +212) higher average yearly weight gain after adjusting for relevant confounders. It was also associated with a higher risk of developing overweight/obesity compared with non-drinkers. No association between wine consumption and yearly weight change or the risk of developing overweight/obesity was apparent. Conclusion: The type of alcoholic beverage can modulate the effect of alcohol intake on the risk of developing overweight/obesity.

Schneider MB; Benjamin HJ; Bhatia JJS; Abrams SA; De Ferranti SD; Schneider MB et al. Clinical report. Sports drinks and energy drinks for children and adolescents: Are they appropriate? Pediatrics 127(6): 1182-1189, 2011. (45 refs.)

Sports and energy drinks are being marketed to children and adolescents for a wide variety of inappropriate uses. Sports drinks and energy drinks are significantly different products, and the terms should not be used interchangeably. The primary objectives of this clinical report are to define the ingredients of sports and energy drinks, categorize the similarities and differences between the products, and discuss misuses and abuses. Secondary objectives are to encourage screening during annual physical examinations for sports and energy drink use, to understand the reasons why youth consumption is widespread, and to improve education aimed at decreasing or eliminating the inappropriate use of these beverages by children and adolescents. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigorous physical activity is beyond the scope of this report.

Schnoll RA; Wileyto EP; Lerman C. Extended duration therapy with transdermal nicotine may attenuate weight gain following smoking cessation. Addictive Behaviors 37(4): 565-568, 2012. (31 refs.)

Aim: People who quit smoking often gain 11-12 lb, on average, which can frequently lead to a relapse to smoking. This study evaluated whether extended vs. standard duration treatment with nicotine patch helps those able to quit smoking to reduce cessation-induced weight gain and explored nicotine patch adherence as a mediator of treatment effects. Design and setting: We examined data from a completed randomized placebo-controlled clinical trial of extended (24 weeks) vs. standard (8 weeks plus 16 weeks of placebo) transdermal nicotine patch therapy. Changes in measured weight over 24 weeks were compared across the two treatment arms, controlling for gender, baseline smoking rate, and previous weight. Adherence to patch use was assessed using self-report of daily use over 24 weeks. Participants: 139 clinical trial participants who were confirmed to be abstinent at weeks 8 and 24. Findings: Compared to participants who received 8 weeks of nicotine patch therapy, participants who received 24 weeks of treatment showed significantly less weight gain from pre-treatment to week 24 (beta = -4.76, 95% CI: -7.68 to -1.84, p = .002) and significantly less weight gain from week 8 to week 24 (beta = -2.31, 95% CI: -4.39 to -0.23, p = .03). Extended treatment increased patch adherence which, in turn, reduced weight gain; patch adherence accounted for 20% of the effect of treatment arm on weight gain. Conclusion: Compared to 8 weeks of transdermal nicotine therapy, 24 weeks of patch treatment may help to reduce the weight gain that is typical among smokers who are able to achieve abstinence from tobacco use. Extended treatment increased nicotine patch adherence which, in turn, reduced weight gain.

Seeley RJ; Sandoval DA. Neuroscience: Weight loss through smoking. (editorial). Nature 475(7355): 176-177, 2011. (6 refs.)

Thornley S; Russell B; Kydd R. Carbohydrate reward and psychosis: An explanation for neuroleptic induced weight gain and path to improved mental health? Current Neuropharmacology 9(2): 370-375, 2011. (55 refs.)

Evidence links dopamine release in the mid-brain to the pathophysiology of psychosis, addiction and reward. Repeated ingestion of refined carbohydrate may stimulate the same mesolimbic dopaminergic pathway, rewarding such eating behaviour and resulting in excessive food intake along with obesity. In this paper, we explore the role of dopamine in reward and psychosis, and discuss how reward pathways may contribute to the weight gain that commonly follows antipsychotic drug use, in people with psychotic illness. Our theory also explains the frequent co-occurrence of substance abuse and psychosis. From our hypothesis, we discuss the use of carbohydrate modified diets as an adjunctive treatment for people with psychosis.

Travier N; Agudo A; May AM; Gonzalez C; Luan JA; Wareham NJ et al. Longitudinal changes in weight in relation to smoking cessation in participants of the EPIC-PANACEA study. Preventive Medicine 54(3-4): 183-192, 2012. (36 refs.)

Purpose. We assessed the association between smoking cessation and prospective weight change in the European population of the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of smoking. Eating out of home And obesity (EPIC-PANACEA) project. Methods. The study involved more than 300,000 healthy volunteers, recruited between 1992 and 2000 in 9 European countries, who provided data on anthropometry and smoking habits at baseline and after a follow-up of 5 years on average. Adjusted mixed-effects linear regression models were used to obtain sex-specific summary estimates of the association between the change in smoking status and the annual change in weight. Results. Smoking cessation tends to be followed by weight gain; when compared to stable smokers, annual weight gain was higher in men (0.44 kg (95%CI: 0.36; 0.52)) and women (0.46 kg (95%CI: 0.41; 0.52)) who stopped smoking during follow-up. When smokers who stopped smoking at least 1 year before recruitment were compared to never smokers, no major differences in annual weight gain were observed. The excess weight gain following smoking cessation appears to mainly occur in the first years following the cessation. Conclusions. When considering the benefits of smoking cessation, such findings strengthen the need for promoting cessation offering information on weight gain control and support to weight-concerned smokers in order to remove a barrier to quitting.

VanKim NA; Laska MN. Socioeconomic disparities in emerging adult weight and weight behaviors. American Journal of Health Behavior 36(4): 433-445, 2012. (38 refs.)

Objectives: To explore weight, weight behaviors, and tobacco and alcohol use among emerging adults by parental education and financial strain. Methods: Cross-sectional analyses of 2010 survey data from an urban Minnesota public 4-year university and 2-year community college (n=1201). Results: Low parental education was associated with lower fruit/vegetable consumption and physical activity and more fast food and unhealthy weight control. Financial strain was associated with less physical activity and more unhealthy weight control, binge drinking, and tobacco use. Conclusions: Unique relationships exist between socioeconomic indicators and emerging adult health behaviors. Additional research is needed to understand financial context among emerging adults.

Voigt M; Zels K; Guthmann F; Hesse V; Gorlich Y; Straube S. Somatic classification of neonates based on birth weight, length, and head circumference: quantification of the effects of maternal BMI and smoking. Journal of Perinatal Medicine 39(3): 291- 297, 2011. (30 refs.)

We defined neonates as small, appropriate, or large for gestational age (SGA, AGA, LGA) based on birth weight, length, and head circumference. We analyzed the effects on the somatic classification of maternal body mass index (BMI) (< 18.5, 18.5-24.99, 25.0-29.99, >= 30) and smoking during pregnancy (0, 1-7, 8-14, >= 15 cigarettes daily). Data were from the German Perinatal Survey (1998-2000; 433,669 cases). The following refers to the classification by birth weight. In the normal maternal weight population SGA rates increased with cigarette consumption: 9.8%, 17.8%, 21.6%, and 25.4% for non-smokers, and smokers of 1-7, 8-14, and >= 15 cigarettes daily, respectively. In non-smoking underweight women the SGA rate was 17.4%. In underweight smokers of >= 15 cigarettes daily the SGA rate was 38.5% [odds ratio 5.77, 95% confidence interval 5.10-6.53, compared with normal weight non-smokers]. In the normal maternal weight population, LGA rates were 9.9%, 5.3%, 4.6%, and 3.5% for non-smokers, and smokers of 1-7, 8-14, and >= 15 cigarettes daily, respectively. In the obese, LGA rates were 20.9% (non-smokers) and 11.4% (>= 15 cigarettes). Similar findings were obtained for the somatic classifications based on birth length and head circumference. Results for the various combinations of maternal BMI and smoking status in the three classification systems are described. Our findings may assist in individualized risk assessment for SGA and LGA births.

Wakabayashi I. Age-dependent inverse association between alcohol consumption and obesity in Japanese men. Obesity 19(9): 1881-1886, 2011. (24 refs.)

The aim of this study was to determine whether age influences the relationship between alcohol drinking and obesity. Japanese men receiving periodic health checkups (20-70 years old, n = 36,121) were divided into non-, light (< 22 g ethanol/day), moderate (= 22 and < 44 g ethanol/day), and heavy (= 44 g ethanol/day) drinkers. Relationships between alcohol intake and obesity-related indices were compared among the quartiles of age. BMI was lower in light and moderate drinkers than in nondrinkers, and these differences were more prominent in the 1st and 2nd quartiles of age than in the higher quartiles. In the 1st and 2nd quartiles of age, waist circumference and waist-to-height ratio were significantly smaller and lower, respectively, in light and moderate drinkers than in nondrinkers, and these differences were less prominent in the 3rd quartile and were not found in the 4th quartile. In the 1st and 2nd quartiles of age, odds ratios vs. nondrinkers for large waist circumference were significantly low (P < 0.01) in light drinkers (1st quartile: 0.64 (0.54-0.75); 2nd quartile: 0.69 (0.60-0.80)) and moderate drinkers (1st quartile: 0.69 (0.61-0.78); 2nd quartile: 0.84 (0.76-0.93)), whereas the odds ratio was significantly low (P < 0.05) only in light drinkers in the 3rd quartile (0.84 (0.73-0.97)) and was not significant in any drinker groups of the 4th quartile. The results suggest that alcohol consumption is associated with lower risk of obesity in Japanese men and this association is more prominent in younger men than in older men.

Wehby GL; Fletcher JM; Lehrer SF; Moreno LM; Murray JC; Wilcox A; Lie RT. A genetics instrumental variables analysis of the effects of prenatal smoking on birth weight: Evidence from two samples. Biodemography and Social Biology 57(1, special issue): 3- 32, 2011. (73 refs.)

There is a large literature showing the detrimental effects of prenatal smoking on birth and childhood health outcomes. It is somewhat unclear, though, whether these effects are causal or reflect other characteristics and choices by mothers who choose to smoke that may also affect child health outcomes or biased reporting of smoking. In this paper, we use genetic markers that predict smoking behaviors as instruments to address the endogeneity of smoking choices in the production of birth and childhood health outcomes. Our results indicate that prenatal smoking produces more dramatic declines in birth weight than estimates that ignore the endogeneity of prenatal smoking, which is consistent with previous studies with non-genetic instruments. We use data from two distinct samples from Norway and the United States with different measured instruments and find nearly identical results. The study provides a novel application that can be extended to study several behavioral impacts on health and social and economic outcomes.

Wehby GL; Murray JC; Wilcox A; Lie RT. Smoking and body weight: Evidence using genetic instruments. Economics & Human Biology 10(2): 113-126, 2012. (86 refs.)

Several studies have evaluated whether the high and rising obesity rates over the past three decades may be due to the declining smoking rates. There is mixed evidence across studies - some find negative smoking effects and positive cigarette cost effects on body weight, while others find opposite effects. This study applies a unique approach to identify the smoking effects on body weight and to evaluate the heterogeneity in these effects across the body mass index (BMI) distribution by utilizing genetic instruments for smoking. Using a data sample of 1057 mothers from Norway, the study finds heterogeneous effects of cigarette smoking on BMI - smoking increases BMI at low/moderate BMI levels and decreases BMI at high BMI levels. The study highlights the potential advantages and challenges of employing genetic instrumental variables to identify behavior effects including the importance of qualifying the instruments and the need for large samples.

White MA. Smoking for weight control and its associations with eating disorder symptomatology. Comprehensive Psychiatry 53(4): 403-407, 2012. (21 refs.)

Objective: This study examined interrelationships between cigarette smoking for weight control and eating disorder symptoms in a community sample of adult female smokers. Method: Participants were 107 female smokers who completed a battery of questionnaires, including the Eating Disorder Examination-Questionnaire (EDE-Q). Key items measured weight-control smoking, including smoking to prevent overeating, smoking to undo the effects of overeating, and smoking to feel less hungry. Smokers who endorsed smoking in an attempt to control weight were compared with those who denied such behaviors on EDE-Q scores and frequency of binge eating and purging. Results: A substantial proportion of participants reported weight-control smoking. Participants who endorsed weight-control smoking reported elevations on eating disorder symptoms as measured by the EDE-Q. Compensatory smoking was related to the frequency of binge eating. Discussion: The findings have implications for clinicians working with eating disorder patients; for some individuals, cigarette smoking may be used as an attempt to compensate for overeating.

Zhang Y; von Deneen KM; Tian J; Gold MS; Liu YJ. Food addiction and neuroimaging. (review). Current Pharmaceutical Design 17(12): 1149- 1157, 2011. (145 refs.)

Obesity has become a serious epidemic and one of the leading global health problems. However, much of the current debate has been fractious, and etiologies of obesity have been attributed to eating behavior (i.e. fast food consumption), personality, depression, addiction or genetics. One of the interesting new hypotheses for explaining the development of obesity involves a food addiction model, which suggests that food is not eaten as much for survival as pleasure and that hedonic overeating is relevant to both substance-related disorders and eating disorders. Accumulating evidence has shown that there are a number of shared neural and hormonal pathways as well as distinct differences in these pathways that may help researchers discover why certain individuals continue to overeat despite health and other consequences, and becomes more and more obese. Functional neuroimaging studies have further revealed that pleasant smelling, looking, and tasting food has reinforcing characteristics similar to drugs of abuse. Many of the brain changes reported for hedonic eating and obesity are also seen in various types of addictions. Most importantly, overeating and obesity may have an acquired drive similar to drug addiction with respect to motivation and incentive craving. In both cases, the desire and continued satisfaction occur after early and repeated exposure to stimuli. The acquired drive for eating food and relative weakness of the satiety signal would cause an imbalance between the drive and hunger/reward centers in the brain and their regulation. In the current paper, we first provide a summary of literature on food addition from eight different perspectives, and then we proposed a research paradigm that may allow screening of new pharmacological treatment on the basis of functional magnetic resonance imaging (fMRI).

Zhao JH; Zhu Y; Wang PP; West R; Buehler S; Sun ZY et al. Interaction between alcohol drinking and obesity in relation to colorectal cancer risk: A case-control study in Newfoundland and Labrador, Canada. BMC Public Health 12: e-article 94, 2012. (41 refs.)

Background: While substantive epidemiological literature suggests that alcohol drinking and obesity are potential risk factors of colorectal cancer (CRC), the possible interaction between the two has not been adequately explored. We used a case-control study to examine if alcohol drinking is associated with an increased risk of CRC and if such risk differs in people with and without obesity. Methods: Newly diagnosed CRC cases were identified between 1999 and 2003 in Newfoundland and Labrador (NL). Cases were frequency-matched by age and sex with controls selected using random digit dialing. Cases (702) and controls (717) completed self-administered questionnaires assessing health and lifestyle variables. Estimates of alcohol intake included types of beverage, years of drinking, and average number of alcohol drinks per day. Odds ratios were estimated to investigate the associations of alcohol independently and when stratified by obesity status on the risk of CRC. Results: Among obese participants (BMI = 30), alcohol was associated with higher risk of CRC (OR: 2.2; 95% CI: 1.24.0) relative to the non-alcohol category. Among obese individuals, 3 or more different types of drinks were associated with a 3.4-fold higher risk of CRC relative to non-drinkers. The risk of CRC also increased with drinking years and drinks daily among obese participants. However, no increased risk was observed in people without obesity. Conclusion: The effect of alcohol of drinking on CRC seems to be modified by obesity.

Ziauddeen H; Farooqi IS; Fletcher PC. Obesity and the brain: How convincing is the addiction model? Nature Reviews. Neuroscience 13(4): 279-286, 2012. (101 refs.)

An increasingly influential perspective conceptualizes both obesity and overeating as a food addiction accompanied by corresponding brain changes. Because there are far-reaching implications for clinical practice and social policy if it becomes widely accepted, a critical evaluation of this model is important. We examine the current evidence for the link between addiction and obesity, identifying several fundamental shortcomings in the model, as well as weaknesses and inconsistencies in the empirical support for it from human neuroscientific research.