obesity

#Low birth weight linked with development of #metabolic disease

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  • Noticias Médicas Univadis

Low birth weight (LBW) could be linked with the subsequent development of hypertension, obesity and diabetes in later life, suggests new research carried out on a Chinese population.

While LBW has previously been associated with subsequent risks of certain chronic diseases and of obesity, there is limited evidence for these associations for Chinese populations.

As part of a new study, published in the Journal of Diabetes, researchers analysed data for 13,569 women and 11,515 men from the Shanghai Women’s Health Study and the Shanghai Men’s Health Study to examine the associations between LBW and the risk of obesity and chronic diseases.

They found LBW was linked with lower body mass index (BMI), smaller waist circumference, and larger waist:hip and waist:height ratios. LBW participants showed a higher risk for type 2 diabetes (T2D) and hypertension.

“The results suggest that nutrition in early life is of considerable importance to health in later life,” said the authors. “Low birth weight should be considered as an important risk factor for obesity, diabetes, and hypertension in the general population and can be used to identify high-risk individuals,” they added.

#Obesity: what’s the best weight-loss intervention?

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  • Noticias Médicas Univadis

A new scientific statement on obesity management from the Endocrine Society has identified a high degree of variability when it comes to the effectiveness of various weight-loss interventions. In writing the statement, the authors examined the latest scientific evidence on a variety of diets, exercise, obesity medications and types of bariatric surgery.

Of note, there was little difference in the long-term effectiveness of diet plans; however, the authors said that there were variations among individuals in the response to each diet. They advised that clinicians should consider genetic differences in dietary response to weight loss, as personalised dietary regimens might improve the efficacy of long-term weight-loss regimens. Surgical approaches tended to lead to greater and longer lasting weight loss than other treatment options.

“Individual weight-loss approaches worked well for some people and not for others,” said Dr George A. Bray, who chaired the task force that developed the Scientific Statement. “Currently, we have limited genetic and other information to predict which intervention will work for a given individual. This demonstrates just how complex the problem of severe obesity is.”

The statement is published in Endocrine Reviews.

#Prevalence of #Obesity Among Adults, by Household Income and Education — United States, 2011–2014

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Cynthia L. Ogden, PhD; Tala H. Fakhouri, PhD; Margaret D. Carroll, MSPH; Craig M. Hales, MD; Cheryl D. Fryar, MSPH; Xianfen Li, MS; David S. Freedman, PhD

Abstract and Introduction

Introduction

Studies have suggested that obesity prevalence varies by income and educational level, although patterns might differ between high-income and low-income countries.[1–3] Previous analyses of U.S. data have shown that the prevalence of obesity varied by income and education, but results were not consistent by sex and race/Hispanic origin.[4] Using data from the National Health and Nutrition Examination Survey (NHANES), CDC analyzed obesity prevalence among adults (aged ≥20 years) by three levels of household income, based on percentage (≤130%, >130% to ≤350%, and >350%) of the federal poverty level (FPL) and individual education level (high school graduate or less, some college, and college graduate). During 2011–2014, the age-adjusted prevalence of obesity among adults was lower in the highest income group (31.2%) than the other groups (40.8% [>130% to ≤350%] and 39.0% [≤130%]). The age-adjusted prevalence of obesity among college graduates was lower (27.8%) than among those with some college (40.6%) and those who were high school graduates or less (40.0%). The patterns were not consistent across all sex and racial/Hispanic origin subgroups. Continued progress is needed to achieve the Healthy People 2020 targets of reducing age-adjusted obesity prevalence to <30.5% and reducing disparities.[5]

NHANES is a biannual cross-sectional survey designed to monitor the health and nutritional status of the civilian noninstitutionalized U.S. population.[6] The survey consists of in-home interviews and standardized physical examinations conducted in mobile examination centers. During the physical examination, standardized measurements of weight and height were obtained. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. Obesity was defined as a BMI ≥30 kg/m2. The NHANES sample is selected through a complex, multistage probability design. Participants self-reported race/Hispanic origin, and were divided into five categories: non-Hispanic white, non-Hispanic black, non-Hispanic Asian, Hispanic and “other.” During 2011–2014, non-Hispanic black, non-Hispanic Asian, and Hispanic persons, among other groups, were oversampled. A total of 308 non-Hispanic persons reporting other races or more than one race were placed in an “other” category, and their data were included in the overall results. The NHANES examination response rate for adults aged ≥20 years was 64.5% in the 2011–2012 survey and 63.7% in the 2013–2014 survey.

Household income was categorized using FPL information, which accounts for inflation and family size (https://aspe.hhs.gov/prior-hhs-poverty-guidelines-and-federal-register-references); income levels were designated as ≤130%, >130% to ≤350%, and >350% of FPL. The cut point for participation in the Supplemental Nutrition Assistance Program is 130% of the poverty level, and 350% provides relatively equal sample sizes for each of the three income groups. Education was categorized as high school graduate or less, some college, and college graduate.

All estimates were adjusted to account for the complex survey design, including examination sample weights. Estimates were age-adjusted to the 2000 projected U.S. Census population using the age groups 20–39, 40–59, and ≥60 years. Confidence intervals for estimates were calculated using the Wald method. Differences between income and education groups were tested using a two-sided, univariate t-statistic, with statistical significance defined as a p-value of <0.05. Temporal trends from 1999–2002 to 2011–2014 were analyzed using orthogonal contrasts and 2-year survey cycles. Pregnant women (122) and participants with missing weight or height (571) were excluded, resulting in a total sample size of 10,636 for the period 2011–2014. For estimates by FPL, an additional 851 participants were excluded because of missing FPL data, and for estimates by education, eight participants were excluded because information on education was missing.

During 2011–2014, the age-adjusted prevalence of obesity was 38.3% among women and 34.3% among men (Table). The prevalence of obesity was 34.5% among non-Hispanic white adults, 48.1% among non-Hispanic black adults, 11.7% among non-Hispanic Asian adults, and 42.5% among Hispanic adults.

Among women, prevalence was lower in the highest income group (29.7%) than in the middle (42.9%) and lowest (45.2%) income groups. This pattern was observed among non-Hispanic white, non-Hispanic Asian, and Hispanic women, but it was only significant for white women. Among non-Hispanic black women, there was no difference in obesity prevalence among the income groups.

Among men, the prevalence of obesity was lower in both the lowest (31.5%) and highest (32.6%) income groups compared with the middle-income group (38.5%). This pattern was seen among both non-Hispanic white and Hispanic men, although among non-Hispanic white men, the difference between the highest-income and middle-income groups was not statistically significant. Among non-Hispanic black men, obesity prevalence was higher in the highest income group (42.7%) than in the lowest income group (33.8%). There was no difference in obesity prevalence by income among non-Hispanic Asian men.

In 2011–2014, the prevalence of obesity was lower among women and men who were college graduates (27.8% [women], 27.9% [men]) than among women and men with some college (41.2%, 40.0%) and women and men who were high school graduates or less (45.3%, 35.5%). By race/Hispanic origin, the same pattern was seen among non-Hispanic white, non-Hispanic black, and Hispanic women, and also among non-Hispanic white men, although the differences were not all statistically significant. Although the difference was not statistically significant among non-Hispanic black men, obesity prevalence increased with educational attainment. Among non-Hispanic Asian women and men and Hispanic men there were no differences in obesity prevalence by education level.

From 1999–2002 to 2011–2014 the prevalence of obesity increased among women in the two lower income groups, but not among women living in households with incomes above 350% of FPL. Obesity prevalence increased among men in all three income groups during this period (Figure 1). Obesity prevalence also increased among both women and men in all education groups except men who were college graduates (Figure 2).

Figure 1.

Obesity prevalence among adults, by household income (percentage of FPL) and sex — National Health and Nutrition Examination Survey, 1999–2002 to 2011–2014*
Abbreviation: FPL = federal poverty level.
*Estimates age-adjusted by the direct method to the 2000 projected U.S. Census population using the age groups 20–39, 40–59, and ≥60 years.
Significant linear trends for all groups except >350% of FPL for women. For >350% of FPL for men also significant quadratic trend. All p<0.05.

Figure 2.

Obesity prevalence among adults, by education level and sex — National Health and Nutrition Examination Survey, 1999–2002 to 2011–2014*
*Estimates age-adjusted by the direct method to the 2000 projected U.S. Census population using the age groups 20–39, 40–59, and ≥60 years.
Significant linear trends for all groups (p<0.01) except men who were college graduates. For women college graduates p = 0.056.

Discussion

During 2011–2014, the relationships between obesity and income, and obesity and education were complex, differing among population subgroups. Whereas overall obesity prevalence decreased with increased levels of income and educational attainment among women, the association was more complex among men.

Similar to results based on data from 2005–2008,[4] during 2011–2014, obesity prevalence was lower in the highest income group among women, but this was not the case among men. In fact, among non-Hispanic black men the prevalence of obesity was higher in the highest income group than in the lowest income group. Both women and men who were college graduates, on the other hand, had lower prevalences of obesity than did persons with less education.

In general, prevalence of obesity among women was lowest among college graduates, although among non-Hispanic Asians there was no difference in prevalence by level of education. This relationship was not seen when obesity was examined by income level. For example, obesity prevalence was lower in the highest income group among non-Hispanic white women, but among non-Hispanic black women, prevalence did not differ between the highest and lowest household income groups. In contrast, among both non-Hispanic black women and non-Hispanic white women, the prevalence of obesity was lower among college graduates than among women with some college. This difference in the relationship between obesity and income and obesity and education has been reported in at least one other study[7] in children. These findings demonstrate that lower levels of income and education are not universally associated with obesity; the association is complex and differs by sex and race/Hispanic origin.

This is the first report to describe differences in obesity prevalence by income and education among non-Hispanic Asian adults. There were no significant differences in prevalence by income or education among either non-Hispanic Asian women or men; however, there was a pattern of decreasing prevalence with increasing income among non-Hispanic Asian women.

The findings in this report are subject to at least two limitations. First, BMI is a proxy for body fat and BMI ≥30 was applied to persons in all racial/Hispanic origin groups, which might result in underestimating health risks for certain populations. For example, it has been suggested that the BMI cut point (≥30 kg/m2) that typically defines obesity might be too high for Asians and underestimate associated health risks.[8,9] Second, the small sample size among some subgroups reduced the ability to detect differences when differences exist. Additional years of data might provide more information about obesity prevalence by income, especially among non-Hispanic Asian women.

Trends in obesity prevalence over time show that differences by income and education have existed at least since 1999–2002 among women. Among men, college graduates have consistently had a lower prevalence of obesity, whereas differences by household income have been less consistent. Further study is needed to understand the reasons for the different patterns by sex and race/Hispanic origin in the relationship between obesity and income or education.

#The Biggest Loser: El #ejercicio físico es clave para #mantener el peso reducido

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Miriam E. Tucker

WASHINGTON, USA. La mayor actividad física persistente probablemente es esencial para mantener el peso reducido a largo plazo, sugiere una nueva investigación de los participantes del programa de televisión estadounidense The Biggest Loser.[1,2]

Los nuevos datos fueron presentados el 31 de octubre de 2017 en el congreso Obesity Week 2017 y publicados en Obesity por la Dra. Jennifer C. Kerns, del Washington DC Veterans Affairs Medical Center y sus colaboradores.

Utilizando medidas objetivas de la ingesta de energía y la actividad física en 14 exparticipantes de The Biggest Loser seis años después que participaron en la competencia, la Dra. Kerns y sus colaboradores encontraron que los que habían recuperado el menor peso fueron los más activos, y viceversa.

Por otra parte, la ingesta de alimento tuvo un efecto muy pequeño sobre el mantenimiento del peso reducido a largo plazo.

“Los participantes de The Biggest Loser que tuvieron más éxito para conservar el peso reducido presentaron el máximo incremento en la actividad física después de seis años. Nuestros resultados respaldan recomendaciones previas de que los grandes incrementos persistentes en la actividad física pueden ser necesarios para el mantenimiento del peso reducido a largo plazo”, dicen la Dra. Kerns y sus colaboradores.

Al pedirle su comentario, Eric Ravussin, PhD, Profesor Boyd en la Louisiana State University en Baton Rouge, Estados Unidos, y coeditor de Obesity, dijo a Medscape Noticias Médicas que los datos se alinean con los de seguimientos de estudios importantes ( Diabetes Prevention Program , Action for Health Diabetes , National Weight Control Registry ) de miles de personas que han reducido al menos 13,6 kg (30 libras) y que se mantuvieron así durante un mínimo de un año.

“Todos los que lograron bajar de peso comunicaron altos niveles de actividad física” para mantener el peso, en contraste con la reducción de peso, para la cual el déficit calórico desempeña un papel mucho más importante, hizo notar el Dr. Ravussin.

“Me parece que tenemos que distinguir la fase de reducción de peso frente a la de mantenimiento del peso reducido. Para la primera fase, la mejor manera es realmente la restricción de calorías”, dijo, pero añadió que es mejor comenzar a hacer ejercicio en esta etapa también, a fin de llegar a acostumbrarse al mismo para la fase de mantenimiento posterior.

El motivo de la diferencia entre lo que funciona para reducir frente a mantener el peso, afirma, probablemente tiene mucho que ver con la adaptación metabólica.

Este fue el tema de otro estudio de The Biggest Loser publicado en Obesity en 2016, en el cual el metabolismo de una persona se lentifica en respuesta a una reducción considerable del peso, lo cual dificulta mantenerlo reducido sin un “impulso” adicional por el ejercicio, explicó.[3]

Ejercicio intenso por 35 minutos al día para mantener el peso reducido

Los sujetos en el nuevo estudio eran 14 participantes con obesidad de clase III que participaron en una sola temporada de The Biggest Loser, durante la cual se sometieron a un programa intensivo de dieta y ejercicio de 30 semanas y redujeron un promedio de 60 kg. La mayoría recuperó el peso después que terminó el programa, aunque el grado de recuperación fue muy variable.

La mediana de reducción de peso después de seis años fue 13%. Siete sujetos por arriba de la mediana pesaron 24,9% menos que al inicio (los que mantuvieron el peso), mientras que los siete por debajo de la línea (los que recuperaron el peso) pesaron 1,1% por arriba de su peso inicial (p = 0,0005).

Al inicio, 6 semanas, 30 semanas y 6 años después de la competencia, se midió la composición corporal de los sujetos a través de densitometría ósea (DEXA), el consumo de energía en reposo se midió utilizando calorimetría indirecta, y la ingesta de energía y la actividad física se evaluaron utilizando agua doblemente marcada, un método para medir el consumo de energía con base en la estimación de la tasa de eliminación de dióxido de carbono por el organismo.

Los que mantuvieron el peso reducido tuvieron incrementos significativamente mayores en la actividad física con respecto al inicio en comparación con los que lo recuperaron (160% frente a 34%, respectivamente; p = 0,0033).

A los 6 años, la actividad física media fue 12,2 frente a 8,0 kcal/kg/día para los que mantuvieron el peso reducido y para los que lo recuperaron, respectivamente, también significativamente diferente (p = 0,04).

El Dr. Ravussin hizo notar que una de las limitaciones del estudio es que las medidas objetivas utilizadas para evaluar la actividad física no podían verificar algo sobre el tipo, la intensidad o la duración del ejercicio, pero dijo que 35 minutos de ejercicio intensivo al día, o 60 minutos de actividad moderada, se aproximarían burdamente a los consumos de calorías entre los que mantenían el peso reducido.

Por otra parte, la ingesta de energía con respecto al inicio no fue diferente a los 6 años (-8,7% para los que mantuvieron la reducción de peso frente a -7,4% para los que recuperaron el peso (p = 0,83).

Para los 14 participantes no hubo correlación significativa entre la reducción de peso absoluta o porcentual al final de la competencia con respecto a los valores 6 años después.

El porcentaje del cambio de peso después de 6 años no se correlacionó significativamente con el cambio porcentual en la ingesta de energía desde el inicio (p = 0,36), pero se correlacionó significativamente con el cambio porcentual en la actividad física (p = 0,017).

El Dr. Ravussin concluyó: “Este es un tamaño de muestra pequeño y es un grupo especial, pero creo que es un estudio muy bueno, que muestra que la actividad física funciona para mantener la reducción del peso”.

La Dra. Kerns previamente fue competidora en otra temporada de The Biggest Loser así como consultora médica. El Dr. Ravussin fue coautor en el estudio original Biggest Loser, pero no ha intervenido en la iniciativa durante varios años ni intervino en el presente estudio.

#Consuming #energy-dense food may increase #obesity-related cancer risk in people of #normal weight

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Experts suggest that higher dietary energy density in normal-weight women may lead to metabolic dysregulation independent of body weight.

A new analysis has identified a link between increased intake of energy-dense food and the occurrence of obesity-related cancer in women of normal weight.

While the link between obesity and certain types of cancer has been well-documented, this research sought to specifically explore the relationship between the ratio of energy to food weight, or dietary energy density (DED), and cancer risk.

The study, published in the Journal of the Academy of Nutrition and Dietetics , included data from over 92,000 postmenopausal women from the US’s  Women’s Health Initiative .  It was seen that DED was associated with a 10 per cent increased risk of any obesity-related cancer, but that this risk was limited to women who had been normal weight at the time of enrollment in the study.

The authors, who say the finding was “novel and contrary to their hypothesis”, suggest that higher DED in normal-weight women may lead to metabolic dysregulation independent of body weight, another variable known to increase cancer risk.

They suggest that specific nutrition interventions that target energy density, in addition to other dietary cancer preventive approaches, may be needed to reduce the cancer burden among postmenopausal women.

El # ‘mindfulness’ para combatir el #estrés también puede reducir los niveles de # azúcar en sangre (Obesity)

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Podría jugar un papel en la prevención y tratamiento de la diabetes.

Podría jugar un papel en la prevención y tratamiento de la diabetes.

Investigadores de la Pennsylvania State University (Estados Unidos) han descubierto que el ‘mindfulness’ puede ayudar a las mujeres con sobrepeso a bajar su nivel de estrés y, al mismo tiempo, contribuir a una reducción de sus niveles de azúcar en sangre.

En su trabajo, cuyos resultados publica la revista “Obesity”, pusieron a prueba un programa de reducción de estrés de ocho semanas basado en el ‘mindfulness’, un plan intensivo de entrenamiento que incluye diferentes ejercicios de meditación, relajación y ejercicios corporales para reducir la ansiedad.

Esta estrategia se ideó hace décadas en el University of Massachusetts Medical School (UMMS) en Worcester para ayudar a los pacientes a controlar el dolor y el estrés mientras reciben tratamiento de un cáncer u otras enfermedades graves, pero ahora se ofrece para una amplia variedad de indicaciones.

El estudio incluyó a un total de 86 mujeres que fueron divididas bien para participar en este programa de ‘mindfulness’ o en un programa de educación de la salud que se centraba en la dieta y el ejercicio. En ambos casos, el objetivo principal era ver si conseguían reducir el estrés.

Después de las ocho semanas que duró el programa e incluso 16 semanas después, los autores analizaron los cambios en los niveles de estrés, humor, calidad de vida, sueño, presión arterial, azúcar en sangre y peso.

De este modo, vieron que los participantes en el grupo de ‘mindfulness’ redujeron su nivel de estrés, en comparación con el grupo control, pero en el caso de las mujeres también observaron un nivel más bajo de azúcar en sangre, unos 9 miligramos por decilitro de sangre.

Además, en ambos grupos se observó una mejora del estrés psicológico, la ansiedad y el sueño, pero en cambio en ninguno hubo pérdida de peso y mejores niveles de colesterol o de respuesta a la insulina, hormona encargada de controlar el azúcar en sangre.

“Se necesitan más estudios para determinar más beneficios a largo plazo del ‘mindfulness’ para el sobrepeso y si también puede jugar algún papel en la prevención y tratamiento de la diabetes”, ha reconocido Nazia Raja-Khan, autora del estudio.

#Exercise Benefits Even Older, Extremely # Obese Adults

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Miriam E Tucker

A structured exercise program may improve mobility even among the most obese elderly patients, new data indicate.

Results from a post hoc analysis of a large, prospective, randomized trial examining the impact of physical activity on mobility disability in adults aged 70 to 89 years were published June 26 in Obesity by Stephen B Kritchevsky, PhD, director of the Sticht Center on Aging and professor, Gerontology and Geriatric Medicine Center on Diabetes, Obesity, and Metabolism at Wake Forest University, Winston-Salem, North Carolina, and colleagues.

In the Lifestyle Interventions and Independence for Elders (LIFE) Study, a structured program focused on walking, strength, balance, and flexibility training produced a significant 18% reduction in major mobility disability compared with those randomized to simply a health-education program (JAMA. 2014;311:2387-2396).

Now, in a new analysis in which the subjects from that study were divided into four groups based on baseline body-mass index (BMI) and waist circumference, the findings were contrary to what the authors had hypothesized: rather than benefiting less, those in the highest obesity category (class 2+) actually benefited the most.

That group was the only one to achieve statistical significance, although there was a trend toward benefit for the physical-activity program across the board regardless of body size.

“We wanted to look at different obesity classes because prior data suggest that obesity may blunt the benefits of physical activity for the prevention of mobility disability.…We were surprised to see the strongest apparent benefit of the intervention was in the heaviest group,” Dr Kritchevsky told Medscape Medical News.

The clinical message, he said, is: “You should not give up on an older person just because it looks like the odds are stacked against them….We know from our research that it’s never too late to start.”

Dr Kritchevsky noted that local community senior centers often offer structured exercise programs similar to the one used in the LIFE study and that the National Institute on Aging also has a web page with instructional videos of safe exercises that seniors can perform at home. While some seniors may need to work on strengthening before they can achieve daily walking goals, overall “it doesn’t take a lot to get this benefit,” he noted.

Overall Trend for Greater Mobility, With Significance for Heaviest Group

The current analysis included 1613 inactive adults aged 70 to 89 at high risk for mobility disability based on scoring 9 or less on the 12-point Short Physical Performance Battery (SPPB), comprising tests of walking, rising from a chair without using arms, and standing balance.

Subjects were randomized to a physical-activity program or to a health-education (control) arm.

The physical-activity program focused on walking, strength, balance, and flexibility training, with goals of 30 minutes of walking at moderate intensity, 10 minutes of lower-extremity strength training using ankle weights, and 10 minutes of balance training of major muscle groups. Participants attended twice-weekly in-person sessions and were asked to perform activities at home for three to four times weekly and to keep an activity log.

The health-education arm involved once-weekly 60- to 90-minute in-person discussions on topics such as nutrition, safety, and legal/financial issues related to aging.

The participants were classified into four categories based on BMI and waist circumference:

  • Nonobese without abdominal obesity (BMI <30 kg/m2; n=437).
  • Nonobese with abdominal obesity (waist circumference >102 cm [men], >88 cm [women]; n=434).
  • Class 1 obesity (BMI 30 to <35 kg/m2; n=430).
  • Class 2 to 3 obesity (BMI >35 kg/m2; n=312).

The median follow-up time was 2.7 years. At 24 months, attendance at the scheduled center-based intervention sessions was 63% for the physical-activity program and 73% for the health-education program.

The primary outcome of major mobility disability was defined as the inability to complete a 400-m-walk test within 15 minutes without sitting and without the help of another person or walker. Point estimates for the intervention effect were <1 in each obesity category and the strongest effect was observed in those with class 2+ obesity (hazard ratio, 0.69). Interactions between obesity category and treatment arm did not reach statistical significance (P = .49).

There was no overall effect of the intervention on 400-m-walk speed over the first 24 months of the study (P = .73), nor was there evidence of an interaction between intervention arm and obesity status (P = .36).

However, there was an overall beneficial effect of the physical-activity program on SPPB score (mean change, 0.23; P = .013), with the largest effect on the group with BMI <30 and abdominal obesity. But there was no statistical interaction between intervention arm and obesity category (P = .23).

In the class 2+ obesity group, participants in the health-education arm reported no increase in their walking at 6 months — remaining around 30 minutes/week — while the physical-activity group increased their walking to 135 minutes/week.

Although this level was still below that of the lesser obese categories, it could at least partly explain the mobility benefit seen in the heaviest group, the authors note.

Dr Kritchevsky commented that physicians should advocate for community resources such as senior centers with health-promotion programs if they’re not already available, given that seniors may not feel comfortable at facilities such as YMCAs and gyms that tend to target younger people: “If you don’t have them, let somebody know you need them.”

The LIFE Study is funded by a National Institutes of Health (NIH)/National Institute on Aging Cooperative Agreement and a supplement from the National Heart, Lung, and Blood Institute and sponsored in part by the Intramural Research Program, National Institute on Aging, NIH. The research is partially supported by the Claude D Pepper Older Americans Independence Centers at the University of Florida, Wake Forest University, Tufts University, University of Pittsburgh, and Yale University and the NIH/ National Center for Research Resources Clinical and Translational Science Awards at Stanford University. Investigators have also received support from the Boston Rehabilitation Outcomes Center and the US Department of Agriculture. Dr Kritchevsky has no relevant financial relationships. Disclosures for the coauthors are listed in the paper.  

Obesity. Published online June 26, 2017. Abstract