This Week in JAMA FREE

A JAMA THEME ISSUE

Edited by Edward H. Livingston, MD, and Jody W. Zylke, MD

To assess the effect of aerobic training on metabolic risk in overweight, sedentary children, Davis and colleagues randomly assigned 222 children (mean age, 9.4 years; 58% black; 85% obese) to participate in aerobic training, 20 min/d or 40 min/d, or a usual activity control condition for a mean duration of 13 weeks. The authors report that aerobic training—either 20 or 40 min/d—was associated with improved fitness. Dose-response benefits of exercise were observed for insulin resistance and general and visceral adiposity.

Elevated urinary concentration of bisphenol A (BPA)—a manufactured chemical found in food and beverage containers—is associated with increased risks of obesity, diabetes, and cardiovascular disease in adults. In an analysis of nationally representative, cross-sectional data from 2838 children and adolescents aged 6 through 19 years, Trasande and colleagues found that higher urinary BPA levels were associated with obesity in children and adolescents.

Three articles in this issue report findings on health outcomes and health care utilization after surgical therapy for obesity. In a 6-year follow-up of 418 severely obese patients who underwent gastric bypass surgery and 738 severely obese patients who did not, Adams and colleagues found that surgery was associated with higher rates of type 2 diabetes remission and lower risks of cardiovascular and other adverse health outcomes. Neovius and colleagues analyzed data from 2010 adults who underwent bariatric surgery and 2037 contemporaneously matched controls who received conventional medical treatment of obesity between 1987 and 2001 and found that compared with controls, surgery patients used more inpatient and nonprimary outpatient care during the first 6 years after surgery but not thereafter and that they had lower drug costs from year 7 through year 20 of follow-up. Dixon and colleagues randomly assigned 60 obese individuals with moderate to severe obstructive sleep apnea to receive bariatric surgery (laparoscopic adjustable gastric band) or to a conventional weight loss program and found that surgery did not result in a greater reduction in the apnea-hypopnea index despite significantly greater weight loss. In an editorial, Courcoulas discusses progress toward an evidence-based approach to the surgical treatment of severe obesity.

ArticleArticleArticleArticle  AND AUTHOR VIDEO INTERVIEW

Increased body mass index (BMI) is strongly associated with diabetes risk at a population level, yet many obese individuals remain metabolically healthy. Neeland and colleagues examined the aJAMA_v308_n9ssociation between adiposity phenotype—assessed by dual-energy x-ray absorptiometry and magnetic resonance imaging—and risk of incident diabetes in 732 obese individuals participating in a multiethnic, population-based prospective cohort study. The authors found that a dysfunctional adiposity phenotype characterized by excess visceral fat and insulin resistance was independently associated with incident prediabetes and type 2 diabetes, whereas general adiposity was not.

Studies are providing new insights into the mechanisms underlying obesity-associated morbidities.

Government's role in preventing excess calorie consumption

Next generation of obesity research

Article AND AUTHOR AUDIO INTERVIEW

FDA approval of obesity drugs

Cardiovascular risk assessment of new obesity drugs

“I firmly believe that exposure to palettes of flavors and feeding behaviors entrained in early life are critical to developing the ability to experience foods in a healthful fashion.” From “Food for Thought.”

Progress in obesity research

Drs Livingston and Zylke summarize and comment on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about bariatric surgery.