Gymnastik- och idrottshögskolan, GIH

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  • 1.
    Blom, Victoria
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Sport Psychology research group. Karolinska institutet.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Wallin, Peter
    HPI Health Profile Institute AB, Stockholm, Sweden.
    Andersson, Gunnar
    HPI Health Profile Institute AB, Stockholm, Sweden.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Söderling, Jonas
    Karolinska institutet.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Self-Reported General Health, Overall and Work-Related Stress, Loneliness, and Sleeping Problems in 335,625 Swedish Adults from 2000 to 2016.2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 2, article id E511Article in journal (Refereed)
    Abstract [en]

    The prevalence of poor health, in particular stress-related mental ill-health, is increasing over time and birth cohorts. As rapid societal changes have occurred in the last decade and still are occurring, there is an interest in investigating the trends in health-related factors. The aim of the present study was to investigate trends in self-reported general health, overall stress, work-related stress, feelings of loneliness, and sleeping problems in 335,625 Swedish adults across categories of gender, geographic regions, length of education, and age from 2000 to 2016. On population level, sleeping problems and poor general health have increased markedly and significantly, while experiences of work stress decreased between 2000 and 2016 (p < 0.05). Overall stress and level of loneliness were unchanged (p > 0.05). The risk of having ≥3 symptoms (any of poor or very poor general health, often or very often perceived overall stress, loneliness, or sleeping problems) has increased significantly from 2000 to 2016 (ß = 1034 (1027-1040)). This increase was significantly higher in young (ß = 1052 (1038-1065)) and individuals with lower education (ß = 1056 (1037-1076)) compared to older and high length of education.

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  • 2.
    Blom, Victoria
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Lönn, Amanda
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska University Hospital, Solna, Sweden.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Väisänen, Daniel
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Andersson, Gunnar
    HPI Health Profile Institute, Danderyd, Sweden.
    Wallin, Peter
    HPI Health Profile Institute, Danderyd, Sweden.
    Stenling, Andreas
    Umeå University, Umeå, Sweden; University of Agder, Kristiansand, Norway.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Lindwall, Magnus
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. University of Gothenburg, Gothenburg, Sweden.
    Salier Eriksson, Jane
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Holmlund, Tobias
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Karolinska Institute, Stockholm, Sweden.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Lifestyle Habits and Mental Health in Light of the Two COVID-19 Pandemic Waves in Sweden, 20202021In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 18, no 6, article id 3313Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic has become a public health emergency of international concern, which may have affected lifestyle habits and mental health. Based on national health profile assessments, this study investigated perceived changes of lifestyle habits in response to the COVID-19 pandemic and associations between perceived lifestyle changes and mental health in Swedish working adults. Among 5599 individuals (50% women, 46.3 years), the majority reported no change (sitting 77%, daily physical activity 71%, exercise 69%, diet 87%, alcohol 90%, and smoking 97%) due to the pandemic. Changes were more pronounced during the first wave (April–June) compared to the second (October–December). Women, individuals &lt;60 years, those with a university degree, white-collar workers, and those with unhealthy lifestyle habits at baseline had higher odds of changing lifestyle habits compared to their counterparts. Negative changes in lifestyle habits and more time in a mentally passive state sitting at home were associated with higher odds of mental ill-health (including health anxiety regarding one’s own and relatives’ health, generalized anxiety and depression symptoms, and concerns regarding employment and economy). The results emphasize the need to support healthy lifestyle habits to strengthen the resilience in vulnerable groups of individuals to future viral pandemics and prevent health inequalities in society.

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  • 3.
    Christenson, Anne
    et al.
    Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
    Johansson, Eva
    Karolinska Institutet, Stockholm, Sweden.
    Reynisdottir, Signy
    Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.
    Torgerson, Jarl
    Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    “…or else I close my ears” How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study.2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 9, p. 1-17Article in journal (Refereed)
    Abstract [en]

    Introduction: The importance of helping pregnant women maintain a healthy lifestyle and prevent excessive gestational weight gain is well recognized, but pregnant women do not always perceive communication about body weight as respectful or helpful. Furthermore, fear of inducing shame or guilt can prohibit some midwives from talking about body weight, especially if the woman has obesity. We aimed to explore what women of reproductive age with obesity regard to be the most important and relevant aspects when discussing gestational weight management. Methods: Qualitative interview study using focus groups and individual semi-structured interviews with 17 women of reproductive age (19–39 y) with obesity. Thematic analysis was used to analyze the data. Results: We identified three themes: 1) Importance of obtaining vital medical information; 2) A wish to feel understood and treated with respect; 3) Midwives’ approach is crucial in sensitive key situations, which include bringing up the subject of body weight, weighing, providing weight-related information, coaching lifestyle modification, dealing with emotional reactions and ending a conversation. Conclusions: A majority of the interviewed women wished to receive information about risks about obesity and gestational weight gain, and recommendations on weight management. However, the risk of midwives offending someone by raising the topic may be increased if the pregnant woman believe that gestational weight gain is uncontrollable by the individual. Also, several situations during maternity care meetings can be stigmatizing and make women less receptive to advice or support. Women suggest that a good working alliance is likely to be achieved if midwives have knowledge about the causes of obesity, take interest in the patients’ background, have a non-judgmental approach and refrain from giving unsolicited advice. 

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  • 4. Christenson, Anne
    et al.
    Johansson, Eva
    Reynisdottir, Signy
    Torgerson, Jarl
    Hemmingsson, Erik
    Karolinska institutet.
    Women's Perceived Reasons for Their Excessive Postpartum Weight Retention: A Qualitative Interview Study.2016In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 12, article id e0167731Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Obesity in Sweden has doubled to 14% over the last 20 years. New strategies for treatment and prevention are needed. Excessive gestational weight gain has been found to contribute substantially to obesity, and there is a consistent association between postpartum weight retention and obesity later in life. We aimed to explore what factors women perceive as reasons for having substantial postpartum weight retention, to identify areas for new and improved interventions.

    METHODS: Qualitative interview study (semi-structured) using an emergent design. Fifteen women, with a postpartum weight retention ≥ 10 kg, were interviewed by a trained cognitive therapist. Eight women had pre-pregnancy BMI below 30 kg/m2. Interviews were transcribed verbatim and data analysed using inductive manifest content analysis. Salient text passages were extracted, shortened, coded and clustered into categories.

    RESULTS: Participants reported no knowledge of current gestational weight gain recommendations or of risks for adverse pregnancy outcomes with excessive weight gain or postpartum weight retention. Excessive eating emerged as a common strategy to provide relief of psychological, emotional and physical discomfort, such as depression and morning sickness. Women perceived medical staff as being unconcerned about weight, and postpartum weight loss support was scarce or absent. Some women reported eating more due to a belief that breastfeeding would automatically lead to weight loss.

    CONCLUSION: There is a need to raise awareness about risks with unhealthy gestational weight development and postpartum weight retention in women of childbearing age. The common strategy to cope with psychological, emotional or physical discomfort by eating is an important factor to target with intervention. The postpartum year is a neglected period where additional follow-up on weight and weight loss support is strongly indicated.

  • 5.
    Christenson, Anne
    et al.
    Stockholm Hlth Serv, Stockholm, Sweden; Karolinska Inst, Stockholm, Sweden..
    Torgerson, Jarl
    Univ Gothenburg, Gothenburg, Sweden..
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Attitudes and beliefs in Swedish midwives and obstetricians towards obesity and gestational weight management2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 755Article in journal (Refereed)
    Abstract [en]

    Background Gestational weight interventions are important in maternity care to counteract adverse pregnancy events. However, qualitative findings indicate potential obstacles in the implementation of interventions due to the sensitivity of the subject and existing obesity stigma. Pregnant women have reported disrespectful or unhelpful communication, while some midwives seem to avoid the topic, as not to upset women. This descriptive study aimed to provide knowledge about maternity care providers' beliefs about obesity, and their attitudes towards gestational weight management. Method A web survey was emailed to Swedish maternity care clinics. Existing questionnaires, "Beliefs About Obese People" (BAOP), "Perceived weight bias in health care" and "Attitudes toward obese patients" was used, supplemented with questions formulated for this study. An open free-text question allowed participants to provide a deeper and more nuanced picture of the topic. Results 274 respondents (75% midwives and 25% obstetricians) participated. One third of respondents found obesity to be a more sensitive topic than smoking or alcohol habits, and 17% of midwives agreed to the statement: "I sometimes avoid talking about weight so as not to make the pregnant woman worried or ashamed". Having had training in motivational interviewing seemed positively associated with midwives' inclination to talk about body weight, especially with women with obesity (p = .001), whereas years of working experience were not associated. Having received obesity education increased confidence in providing adequate information, but still only 46% felt they had enough knowledge to provide diet and exercise advice to pregnant women with obesity. Qualitative data revealed great empathy for women with obesity, and a wish to have more obesity education and access to other professionals. Conclusion Swedish maternity care staff displayed empathy for women with obesity and found gestational weight interventions important, but almost one fifth of midwives sometimes avoid the subject of body weight for fear of upsetting women. Education about obesity facts, training in person-centered communication, i.e. motivational interviewing, and access to dieticians may facilitate gestational weight management implementation.

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  • 6.
    Christenson, Anne
    et al.
    Karolinska institutet.
    Johansson, Eva
    Karolinska institutet.
    Reynisdottir, Signy
    Karolinska institutet.
    Torgerson, Jarl
    Göteborgs universitet.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Shame and avoidance as barriers in midwives’ communication about body weight with pregnant women: A qualitative interview study2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 63, p. 1-7Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Excessive gestational weight gain, regardless of initial BMI, is associated with perinatal risks for both mother and offspring and contributes to obesity in women. Studies report that healthcare professionals find it difficult to communicate about weight and pregnant women perceive healthcare professionals as unconcerned, leaving many women uninformed about weight recommendations and risks. We aimed to explore how midwives approach communication about gestational weight gain recommendations, and to characterize communication barriers and facilitators.

    METHODS:

    Seventeen midwives from different areas in Sweden were interviewed by a therapist using semi-structured interviews. Interviews were transcribed verbatim and analysed by three researchers using latent content analysis. Recurrent themes were identified and formulated.

    RESULTS:

    The main theme identified in the latent part of the analysis was "midwives use avoidant behaviours to cope with fear of inflicting worries, shame or feelings of guilt in pregnant women". Avoidant behaviours include: adjusting weight recommendations, toning down risks and avoid talking about weight. Subthemes identified were (I) Conflicting responsibilities in midwives' professional identity (II) Perceived deficiencies in the working situation.

    CONCLUSION:

    Midwives' empathy and awareness of weight stigma strongly affects communication about weight with pregnant women, and midwives' use of avoidant behaviours constitutes salient information barriers. More research is needed on whether gestational weightguidelines and weighing routines for all women, resources for extra visits, training in specific communication skills and backup access to other professions can facilitate for midwives to initiate and communicate about healthy gestational weight development, enabling more pregnant women to make well-informed lifestyle choices.

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  • 7. Dreber, H
    et al.
    Reynisdottir, S
    Angelin, B
    Tynelius, P
    Rasmussen, F
    Hemmingsson, Erik
    Karolinska institutet.
    Mental distress in treatment seeking young adults (18-25 years) with severe obesity compared with population controls of different body mass index levels: cohort study.2017In: Clinical Obesity, ISSN 1758-8103, E-ISSN 1758-8111, Vol. 7, no 1, p. 1-10Article in journal (Refereed)
    Abstract [en]

    Young adults (18-25) with severe obesity constitute a challenging patient group, and there is limited evidence about their mental health status compared to population controls. Mental distress in treatment seeking young adults with severe obesity (n = 121, mean body mass index [BMI] = 39.8 kg m(-2) ) was compared with matched (1:3 for age, gender and socioeconomic status) population controls of normal weight (n = 363, mean BMI = 22.4 kg m(-2) ), as well as unmatched population controls with class I obesity (n = 105, mean BMI = 32.1 kg m(-2) ) or severe obesity (n = 41, mean BMI = 39.7 kg m(-2) ). Mental distress was measured by the General Health Questionnaire-12 (GHQ-12), and we quantified physician-diagnosed depression, present anxiety and suicide attempts. Poisson regression and linear regression analysis were used for analysing differences in mental distress between groups. Treatment seekers experienced more mental distress than normal weight controls as measured by continuous (adjusted mean: 3.9 vs. 2.2 points, P <0.001) and categorical (cut-off for mental distress ≥3 points, RR: 1.76, P <0.001) GHQ-12 scores, depression (RR: 2.18, P < 0.001), anxiety (RR: 1.97, P < 0.001) and suicide attempts (RR: 2.04; P = 0.034). Treatment seekers also experienced more mental distress as measured by continuous GHQ-12 than controls with class I obesity (adjusted mean: 2.3 points) or severe obesity (adjusted mean: 2.1; both, P < 0.001). Young adult treatment seekers with severe obesity constitute a risk group for mental distress compared to population controls of different BMI levels.

  • 8. Dreber, Helena
    et al.
    Reynisdottir, Signy
    Angelin, Bo
    Hemmingsson, Erik
    Karolinska institutet.
    Who is the Treatment-Seeking Young Adult with Severe Obesity: A Comprehensive Characterization with Emphasis on Mental Health.2015In: PLOS ONE, E-ISSN 1932-6203, Vol. 10, no 12, article id e0145273Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To characterize treatment-seeking young adults (16-25 years) with severe obesity, particularly mental health problems.

    STUDY DESIGN AND PARTICIPANTS: Cross-sectional study of 165 participants (132 women, 33 men) with BMI ≥35 kg/m2 or ≥30 kg/m2 with comorbidities, enrolling in a multidisciplinary obesity treatment program.

    METHOD: Data collection at admission of present and life-time health issues including symptomatology of anxiety, depression (Hospital Anxiety and Depression Scale) and attention-deficit/hyperactivity disorder (Adult ADHD Self-Report scale); self-esteem (Rosenberg Self-Esteem Scale), suicide attempts, health-related quality of life (Short Form-36 Health Survey), psychosocial functioning related to obesity (Obesity-related Problems Scale), cardiorespiratory fitness (Astrand's bicycle ergometer test), somatic and psychiatric co-morbidities, cardiometabolic risk factors, and micronutritional status. We used multiple regression analysis to identify variables independently associated with present anxiety and depressive symptomatology.

    RESULTS: Mean body mass index was 39.2 kg/m2 (SD = 5.2). We found evidence of poor mental health, including present psychiatric diagnoses (29%), symptomatology of anxiety (47%), depression (27%) and attention-deficit/hyperactivity disorder (37%); low self-esteem (42%), attempted suicide (12%), and low quality of life (physical component score = 46, SD = 11.2; mental component score = 36, SD = 13.9, P<0.001 for difference). Variables independently associated with present anxiety symptomatology (R2 = 0.33, P<0.001) included low self-esteem (P<0.001) and pain (P = 0.003), whereas present depressive symptomatology (R2 = 0.38, P<0.001) was independently associated with low self-esteem (P<0.001), low cardiorespiratory fitness (P = 0.009) and obesity-related problems (P = 0.018). The prevalence of type 2 diabetes was 3%, and hypertension 2%. Insulin resistance was present in 82%, lipid abnormality in 62%, and poor cardiorespiratory fitness in 92%. Forty-eight percent had at least one micronutritional deficiency, vitamin D being the most common (35%).

    CONCLUSION: A wide range of health issues, including quite severe mental health problems, was prevalent in treatment-seeking young adults with severe obesity. These are likely to constitute a major treatment challenge, including options relating to bariatric surgery.

  • 9.
    Dreber, Helena
    et al.
    Obesity Center, Karolinska University Hospital, Stockholm, Sweden.
    Thorell, Anders
    Department of Clinical Science, Karolinska Institutet, Danderyds Hospital and Department of Surgery, Ersta Hospital, Stockholm, Sweden..
    Reynisdottir, Signy
    Obesity Center, Karolinska University Hospital, Stockholm, Sweden.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Health-Related Quality of Life 5 Years After Roux-en-Y Gastric Bypass in Young (18-25 Years) Versus Older (≥ 26 Years) Adults: a Scandinavian Obesity Surgery Registry Study.2019In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 29, no 2, p. 434-443Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To compare changes in health-related quality of life (HRQoL) in young (18-25 years) versus older (≥ 26 years) adults up to 5 years after Roux-en-Y gastric bypass (RYGB).

    METHODS: Data on Short Form-36 (SF-36) and obesity-related problems scale (OP) at baseline and 1, 2, and 5 years after RYGB were extracted from the Scandinavian Obesity Surgery Registry. Within-group changes and the effect of age group on 5-year changes in SF-36 and OP were analyzed. Effects sizes (ESs) were calculated.

    RESULTS: A total of 2542 young and 12,425 older adults were included at baseline, and 138 young (20.7% of those eligible) and 1021 older (31.8%) adults were followed-up 5 years post-RYGB. At this time, average to large improvements (ES ≥ 0.5) were observed in physical functioning, physical component score and OP in young adults, and in physical functioning, role physical, general health, physical component score, and OP in older adults (all, p ≤ 0.001). Both age groups displayed negligible to weak (ES < 0.5) or no improvements in mental HRQoL (all, p < 0.55). Older adults displayed greater 5-year improvements than their young counterparts in role physical, general health, vitality, social functioning, physical component score, and obesity-related problems scale (all, p < 0.05).

    CONCLUSIONS: Both young and older adults displayed improvements in OP and physical HRQoL 5 years post-RYGB compared to baseline, while mental HRQoL did not improve to the same extent. Greater HRQoL-improvements could be expected in older patients why future research on HRQoL post-RYGB should stratify data on age groups.

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  • 10.
    Dreber, Helena
    et al.
    Karolinska University Hospital.
    Thorell, Anders
    Karolinska Institutet.
    Torgerson, Jarl
    Karolinska University Hospital.
    Reynisdottir, Signy
    Karolinska University Hospital.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Weight loss, adverse events, and loss to follow-up after gastric bypass in young versus older adults: A Scandinavian Obesity Surgery Registry study.2018In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 14, no 9, p. 1319-1326, article id S1550-7289(18)30324-1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Young adults display particularly poor weight loss in behavioral obesity treatment; nonetheless, they have seldom been included in bariatric research.

    OBJECTIVES: To compare weight loss, adverse events, and loss to follow-up in young (18-25 yr) versus older (≥26 yr) adults up to 5 years after Roux-en-Y gastric bypass.

    SETTING: Nationwide, register-based study, Sweden.

    METHODS: Prospective registry data (Scandinavian Obesity Surgery Register) were analyzed in young (22.2 yr [standard deviation (SD): 2.1], 81.6% women, mean body mass index 43.7 kg/m2 [SD: 5.4]) and older (42.6 years [SD: 9.6], 82.0% women, mean body mass index 43.4 kg/m2 [SD: 5.0]) adults undergoing Roux-en-Y gastric bypass. Groups were matched for body mass index, sex, and year of surgery. Regression analyses and mixed models were used to compare outcomes between groups.

    RESULTS: A total of 369 young (37.0% of eligible) and 2210 older (46.1%) adults attended the 5-year follow-up. At this time, weight loss was 31.8% in young and 28.2% in older adults (P < .001), with a serious adverse event (Clavien-Dindo ≥3b) being reported in 52 (14.1%) young and 153 (6.9%) older adults (odds ratio = 2.06, 95% confidence interval: 1.45-2.92, P < .001). Loss to follow-up was higher in young versus older adults throughout the study period (range of relative risk = 1.16-1.89, P < .001).

    CONCLUSIONS: While young adults displayed at least equal weight loss as older adults, rates of adverse events were approximately doubled, and loss to follow-up rates were higher. Future studies on the significance of and the etiology behind the higher incidence of serious adverse events are needed. Intensified clinical contact post Roux-en-Y gastric bypass should have the potential to further improve outcomes in young adults.

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  • 11.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Söderling, J
    Börjesson, M
    Blom, Victoria
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Sport Psychology research group.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Andersson, G
    Wallin, P
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Sex- and age-specific associations between cardiorespiratory fitness, CVD morbidity and all-cause mortality in 316.137 Swedish adults2019Conference paper (Other academic)
  • 12.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Söderling, Jonas
    Karolinska institutet.
    Börjesson, Mats
    University of Gothenburg.
    Blom, Victoria
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Sport Psychology research group.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Andersson, Gunnar
    HPI Health Profile Institute, Danderyd.
    Wallin, Peter
    HPI Health Profile Institute, Danderyd.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Sex- and age-specific associations between cardiorespiratory fitness, CVD morbidity and all-cause mortality in 266.109 adults.2019In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 127, article id 105799Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate sex- and age-specific associations between cardiorespiratory fitness, all-cause and cause-specific mortality, and cardiovascular disease (CVD) morbidity. 266.109 participants (47% women, 18-74 years) free from CVD, participating in occupational health service screenings in 1995-2015 were included. CRF was assessed as estimated maximal oxygen consumption (estVO2max) using a submaximal cycle test. Incident cases of first-time CVD event and death from any cause were ascertained through national registers. There were 4244 CVD events and 2750 cases of all-cause mortality during mean 7.6 years follow-up. Male gender, higher age and lower estVO2max were associated with higher all-cause mortality and CVD morbidity incidence rates. Risk reductions with increasing estVO2max were present in all age-groups of men and women. No obvious levelling off in risk was identified in the total cohort. However, women and older age-groups showed no further reduction in higher aggregated estVO2max levels. CVD specific mortality was more associated with estVO2max compared to tumor specific mortality. The risk for all-cause mortality and CVD morbidity decreased by 2.3% and 2.6% per increase in 1 ml·min-1·kg-1 with no significant sex-differences but more pronounced in the three lower estVO2max categories for all-cause mortality (9.1%, 3.8% and 3.3%, respectively). High compared to lower levels of estVO2max was not related to a significantly elevated mortality or morbidity. In this large cohort study, CVD morbidity and all-cause mortality were inversely related to estVO2max in both men and women of all age-groups. Increasing cardiorespiratory fitness is a clear public health priority.

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  • 13.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Andersson, Gunnar
    HPI Health Profile Institute.
    Wallin, Peter
    HPI Health Profile Institute.
    Söderling, Jonas
    Karolinska Institutet.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska Institutet.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Decline in cardiorespiratory fitness in the Swedish working force between 1995 and 2017.2019In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 29, no 2, p. 232-239Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Long-term trend analyses of cardiorespiratory fitness (VO2 max) in the general population are limited.

    OBJECTIVES: To describe trends in VO2 max from 1995 to 2017 in the Swedish working force and to study developments across categories of sex, age, education, and geographic regions.

    METHODS: 354.277 participants (44% women, 18-74 years) who participated in a nationwide occupational health service screening between 1995 and 2017 were included. Changes in standardized mean values of absolute (L·min-1 ) and relative (ml·min-1 ·kg-1 ) VO2 max, and the proportion with low (<32) relative VO2 max are reported. VO2 max was estimated using a submaximal cycle test.

    RESULTS: Absolute VO2 max decreased by -6.7% (-0.19 L·min-1 ) in the total population. Relative VO2 max decreased by -10.8% (-4.2 ml·min-1 ·kg-1 ) with approximately one-third explained by a simultaneous increase in body mass. Decreases in absolute fitness were more pronounced in men vs. women (8.7% vs. 5.3%), in younger vs. older (6.5% vs 2.3%), in short (11.4%) vs. long (4.5%) education, and in rural vs. urban regions (6.5% vs 3.5%), all p<0.001. The proportions with low VO2 max increased from 27% to 46% (p<0.001).

    CONCLUSION: Between 1995 and 2017, there was a steady and pronounced decline in mean cardiorespiratory fitness in Swedish adults. Male gender, young age, short education and living in a rural area were predictive of greater reductions. The proportion with low cardiorespiratory fitness almost doubled. Given the strong associations between cardiorespiratory fitness and multiple morbidities and mortality, preventing further decreases is a clear public health priority, especially for vulnerable groups. This article is protected by copyright. All rights reserved.

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  • 14.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Stenling, Andreas
    Umeå University, Umeå, Sweden.
    Salier Eriksson, Jane
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, The Research Unit for Movement, Health and Environment.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Andersson, Gunnar
    HPI Health Profile Institute, Danderyd, Sweden.
    Wallin, Peter
    HPI Health Profile Institute, Danderyd, Sweden.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Lindwall, Magnus
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Latent profile analysis patterns of exercise, sitting and fitness in adults - Associations with metabolic risk factors, perceived health, and perceived symptoms.2020In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 4, article id e0232210Article in journal (Refereed)
    Abstract [en]

    AIM: To identify and describe the characteristics of naturally occurring patterns of exercise, sitting in leisure time and at work and cardiorespiratory fitness, and the association of such profiles with metabolic risk factors, perceived health, and perceived symptoms.

    METHODS: 64,970 participants (42% women, 18-75 years) participating in an occupational health service screening in 2014-2018 were included. Exercise and sitting were self-reported. Cardiorespiratory fitness was estimated using a submaximal cycle test. Latent profile analysis was used to identify profiles. BMI and blood pressure were assessed through physical examination. Perceived back/neck pain, overall stress, global health, and sleeping problems were self-reported.

    RESULTS: Six profiles based on exercise, sitting in leisure time and at work and cardiorespiratory fitness were identified and labelled; Profile 1 "Inactive, low fit and average sitting in leisure, with less sitting at work"; Profile 2 "Inactive, low fit and sedentary"; Profile 3 "Active and average fit, with less sitting at work"; Profile 4 "Active, average fit and sedentary in leisure, with a sedentary work" (the most common profile, 35% of the population); Profile 5 "Active and fit, with a sedentary work"; Profile 6 "Active and fit, with less sitting at work". Some pairwise similarities were found between profiles (1 and 2, 3 and 4, 5 and 6), mainly based on similar levels of exercise, leisure time sitting and fitness, which translated into similar dose-response associations with the outcomes. In general, profile 1 and 2 demonstrated most adverse metabolic and perceived health, profile 4 had a more beneficial health than profile 3, as did profile 6 compared to profile 5.

    CONCLUSIONS: The present results implies a large variation in exercise, sitting, and fitness when studying naturally occurring patterns, and emphasize the possibility to target exercise, sitting time, and/or fitness in health enhancing promotion intervention and strategies.

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  • 15.
    Ekblom Bak, Elin
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Väisänen, Daniel
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Blom, Victoria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Andersson, Gunnar
    HPI Health Profile Institute, Sweden.
    Wallin, Peter
    HPI Health Profile Institute, Sweden.
    Salier Eriksson, Jane
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Holmlund, Tobias
    Karolinska Institute, Stockholm, Sweden.
    Lindwall, Magnus
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. University of Gothenburg, Sweden.
    Stenling, Andreas
    Umeå University, Sweden; University of Agder, Kristiansand, Norway.
    Lönn, Amanda
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health. Women's Health and Allied Health Professionals Theme Medical Unit Occupational Therapy and Physiotherapy, Stockholm, Sweden.
    Cardiorespiratory fitness and lifestyle on severe COVID-19 risk in 279,455 adults: a case control study.2021In: International Journal of Behavioral Nutrition and Physical Activity, E-ISSN 1479-5868, Vol. 18, no 1, article id 135Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The impact of cardiorespiratory fitness (CRF) and other lifestyle-related factors on severe COVID-19 risk is understudied. The present study aims to investigate lifestyle-related and socioeconomic factors as possible predictors of COVID-19, with special focus on CRF, and to further study whether these factors may attenuate obesity- and hypertension-related risks, as well as mediate associations between socioeconomic factors and severe COVID-19 risk.

    METHODS: Out of initially 407,131 participants who participated in nationwide occupational health service screening between 1992 and 2020, n = 857 cases (70% men, mean age 49.9 years) of severe COVID-19 were identified. CRF was estimated using a sub-maximum cycle test, and other lifestyle variables were self-reported. Analyses were performed including both unmatched, n = 278,598, and sex-and age-matched, n = 3426, controls. Severe COVID-19 included hospitalization, intensive care or death due to COVID-19.

    RESULTS: Patients with more severe COVID-19 had significantly lower CRF, higher BMI, a greater presence of comorbidities and were more often daily smokers. In matched analyses, there was a graded decrease in odds for severe COVID-19 with each ml in CRF (OR = 0.98, 95% CI 0.970 to 0.998), and a two-fold increase in odds between the lowest and highest (< 32 vs. ≥ 46 ml·min-1·kg-1) CRF group. Higher BMI (per unit increase, OR = 1.09, 1.06 to 1.12), larger waist circumference (per cm, OR = 1.04, 1.02 to 1.06), daily smoking (OR = 0.60, 0.41 to 0.89) and high overall stress (OR = 1.36, 1.001 to 1.84) also remained significantly associated with severe COVID-19 risk. Obesity- and blood pressure-related risks were attenuated by adjustment for CRF and lifestyle variables. Mediation through CRF, BMI and smoking accounted for 9% to 54% of the associations between low education, low income and blue collar/low skilled occupations and severe COVID-19 risk. The results were consistent using either matched or unmatched controls.

    CONCLUSIONS: Both lifestyle-related and socioeconomic factors were associated with risk of severe COVID-19. However, higher CRF attenuated the risk associated with obesity and high blood pressure, and mediated the risk associated with various socioeconomic factors. This emphasises the importance of interventions to maintain or increase CRF in the general population to strengthen the resilience to severe COVID-19, especially in high-risk individuals.

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  • 16.
    Elinder, Liselotte Schäfer
    et al.
    Karolinska Institutet, Stockholm, Sweden; Region Stockholm, Stockholm, Sweden..
    Wiklund, Camilla
    Karolinska Institutet, Stockholm, Sweden..
    Norman, Åsa
    Karolinska Institutet, Stockholm, Sweden..
    Stattin, Nouha Saleh
    Region Stockholm, Stockholm, Sweden; Karolinska Institutet, Huddinge, Sweden..
    Andermo, Susanne
    Karolinska Institutet, Stockholm, Sweden..
    Patterson, Emma
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Cook, Clayton
    University of Minnesota, Minneapolis, MN, USA..
    Raposo, Sara
    Karolinska Institutet, Stockholm, Sweden; Region Stockholm, Stockholm, Sweden.
    Kwak, Lydia
    Karolinska Institutet, Stockholm, Sweden..
    IMplementation and evaluation of the school-based family support PRogram a Healthy School Start to promote child health and prevent OVErweight and obesity (IMPROVE) - study protocol for a cluster-randomized trial.2021In: BMC Public Health, E-ISSN 1471-2458, Vol. 21, no 1, article id 1630Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: IMPROVE aims to conduct a hybrid type 3 evaluation design to test the effectiveness of bundled implementation strategies on intervention fidelity of the Healthy School Start (HSS) program, while simultaneously monitoring effects on health outcomes of children and parents. The HSS is a 4-component family support program for children starting school (5-7 years of age) promoting healthy dietary habits and physical activity in the home environment to prevent childhood obesity and parents' risk of developing type 2 diabetes.

    METHODS: IMPROVE is a cluster-randomized controlled trial with two arms to evaluate and compare the effects of two different bundles of implementation strategies on intervention fidelity expressed as adherence and responsiveness at 12 and 24 months (primary outcomes). Thirty schools in two municipalities will participate in the study reaching about 1400 families per school year. In stakeholder workshops, key implementation determinants were identified according to the domains of the Consolidated Framework for Implementation Research. Through a consensus process with stakeholders, two bundles of implementation strategies were tailored to address context-specific determinants. Schools randomly assigned to group 1 will receive bundle 1 (Basic) and group 2 will receive bundle 1 + 2 (Enhanced). Bundle 2 consists of external facilitation, fidelity monitoring and feedback strategies. Secondary outcomes will include change in acceptability, appropriateness, feasibility, and organisational readiness as perceived by school staff. In addition, child weight status and diet, and parents' feeding practices and risk of type 2 diabetes will be monitored. Linear and ordinal regression analysis will be used to test the effect on the primary and secondary outcomes, taking clustering and covariates into consideration where needed. Process evaluation will be conducted through key stakeholder interviews to investigate experiences of the program and perceptions on sustainability.

    DISCUSSION: This systematic approach to investigating the effectiveness of two different bundles of implementation strategies tailored to context-specific determinants on the fidelity of the HSS intervention will provide new insight into feasible implementation strategies and external support needed for the HSS to be effective and sustainable. Results will help inform how to bridge the gap between the research on school-based health programs and routine practice in schools.

    TRIAL REGISTRATION: Registered prospectively at ClinicalTrials.gov ID: NCT04984421 , registered July 30, 2021.

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  • 17. Eriksson, Michael
    et al.
    Uddén, Joanna
    Hemmingsson, Erik
    Karolinska institutet.
    Agewall, Stefan
    Impact of physical activity and body composition on heart function and morphology in middle-aged, abdominally obese women.2010In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 30, no 5, p. 354-9Article in journal (Refereed)
    Abstract [en]

    Several studies have shown training induced morphological changes in the heart. Our aim was to assess how frequent, low-intensity exercise (walking and cycling) influences heart function and morphology in abdominally obese women. Fifty women with abdominal obesity (mean age 47.0 +/- 7.5 years, waist circumference (WC) 103.2 +/- 7.8 cm), free of cardiovascular problems were recruited. They were equipped with a bicycle and pedometers and instructed to start commuting in a physically active way for 6 months. Evaluation of cardiac function and morphology was performed using echocardiography (ECHO) before and after 6 months of training. The subjects increased significantly their daily physical activity. After 6 months, there was a significant decrease in WC (from 103.3 +/- 7.9 to 100.8 +/- 8.4 cm, P = 0.0003), in systolic and diastolic blood pressure (126.8 +/- 15.2 to 120.4 +/- 14.5 mmHg, P = 0.0001, and 79.8 +/- 7.8 to 77.8 +/- 8.4 mmHg, P = 0.0006, respectively). ECHO showed an increase in the right ventricular (RV) systolic longitudinal function expressed as tricuspid annular motion from 22.00 +/- 3.30 to 23.05 +/- 3.59 mm, P = 0.015; and a similar trend in left ventricular (LV) mitral annular motion, which increased from 13.09 +/- 1.53 to 13.39 +/- 1.47 mm, P = 0.070. Cycling was associated with reductions in LV systolic and RV diastolic dimensions, whereas walking was not associated with any changes in the ECHO-variables. A reduction in WC by frequent, low-intensity exercise in abdominally obese women is associated with decrease in blood pressure and improved longitudinal RV systolic function.

  • 18.
    Hemmingsson, Erik
    Karolinska institutet.
    A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention.2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no 9, p. 769-79Article in journal (Refereed)
    Abstract [en]

    The lack of significant treatment and prevention progress highlights the need for a more expanded strategy. Given the robust association between socioeconomic factors and obesity, combined with new insights into how socioeconomic disadvantage affects both behaviour and biology, a new causal model is proposed. The model posits that psychological and emotional distress is a fundamental link between socioeconomic disadvantage and weight gain. At particular risk are children growing up in a disharmonious family environment, mainly caused by parental socioeconomic disadvantage, where they are exposed to parental frustrations, relationship discord, a lack of support and cohesion, negative belief systems, unmet emotional needs and general insecurity. Without adequate resilience, such experiences increase the risk of psychological and emotional distress, including low self-esteem and self-worth, negative emotions, negative self-belief, powerlessness, depression, anxiety, insecurity and a heightened sensitivity to stress. These inner disturbances eventually cause a psycho-emotional overload, triggering a cascade of weight gain-inducing effects including maladaptive coping strategies such as eating to suppress negative emotions, chronic stress, appetite up-regulation, low-grade inflammation and possibly reduced basal metabolism. Over time, this causes obesity, circular causality and further weight gain. Tackling these proposed root causes of weight gain could potentially improve both treatment and prevention outcomes.

  • 19.
    Hemmingsson, Erik
    Karolinska institutet.
    Does medically induced weight loss improve obstructive sleep apnoea in the obese: review of randomized trials.2011In: Clinical Obesity, ISSN 1758-8103, E-ISSN 1758-8111, Vol. 1, no 1, p. 26-30Article in journal (Refereed)
    Abstract [en]

    Obstructive sleep apnoea is characterized by repeated periods of breathing cessation during sleep. Obstructive sleep apnoea is both common and underdiagnosed in the obese. A recent study found that as many as 86% of older obese type 2 diabetics had obstructive sleep apnoea. Obesity is independently associated with developing obstructive sleep apnoea, and the reverse may also occur. The prevalence of obstructive sleep apnoea is therefore expected to rise in the wake of the obesity epidemic. The number of partial (hypopnoea) or complete (apnoea) airway obstructions per hour (apnoea-hypopnoea index) is used to classify obstructive sleep apnoea as mild (5-14 events per hour), moderate (15-30) or severe (>30). Severe obstructive sleep apnoea is associated with a two to sixfold increase in all-cause mortality; the impact of mild and moderate obstructive sleep apnoea is less clear. Until recently, the evidence supporting a beneficial effect of weight loss on obstructive sleep apnoea has been limited by a lack of randomized trials. In 2009, at least three randomized controlled trials evaluated whether medically induced weight loss improves obstructive sleep apnoea. The treatment effect ranged from 42% to 62% improvement, although the highest estimate was seen in a very short duration study (9 weeks). Patients who either lost 10-15 kg or more, or had severe obstructive sleep apnoea at baseline, benefited most from treatment.

  • 20.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences. Karolinska insitutet.
    Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family Dysfunction, Offspring Distress, and Junk Food Self-Medication.2018In: Current Obesity Reports, E-ISSN 2162-4968, Vol. 7, no 2, p. 204-209Article in journal (Refereed)
    Abstract [en]

    PURPOSE OF REVIEW: To explore the sequence and interaction of infancy and early childhood risk factors, particularly relating to disturbances in the social environment, and how the consequences of such exposures can promote weight gain and obesity.

    RECENT FINDINGS: This review will argue that socioeconomic adversity is a key upstream catalyst that sets the stage for critical midstream risk factors such as family strain and dysfunction, offspring insecurity, stress, emotional turmoil, low self-esteem, and poor mental health. These midstream risk factors, particularly stress and emotional turmoil, create a more or less perfect foil for calorie-dense junk food self-medication and subtle addiction, to alleviate uncomfortable psychological and emotional states. Disturbances in the social environment during infancy and early childhood appear to play a critical role in weight gain and obesity, through such mechanisms as insecurity, stress, and emotional turmoil, eventually leading to junk food self-medication and subtle addiction.

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  • 21.
    Hemmingsson, Erik
    Karolinska institutet.
    Prognosis in obesity: obstacles must be removed to prevent obesity through increased physical activity.2005In: The BMJ, E-ISSN 1756-1833, Vol. 331, no 7514Article in journal (Other academic)
  • 22.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Slutbantat: förstå din kropp och få en vikt som håller livet ut2018Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Förlagets text:

    Har du också kämpat med vikten i många år? Ibland har det kanske gått åt det håll du vill, men ofta hamnar du förr eller senare tillbaka till ursprungsläget med några eller många kilo fler än du önskar. Självrannsakan och en känsla av misslyckande ligger nära till hands men Erik Hemmingsson, med över tjugo års erfarenhet av forskning på övervikt, menar att det är inte din karaktär det är fel på. Vi föds med olika fysiologiska förutsättningar, vissa har lätt att gå upp i vikt medan andra kan äta i princip vad som helst och ändå håller sig trådsmala genom hela livet. Kroppen motarbetar dessutom viktminskning på olika sätt, och forskning visar att övervikt är starkt kopplat till vårt inre. Visste du att övervikt kan bero på hur du hade det när du var liten, i vilket område du är född, om du har stressat mycket under ditt liv, vilka föräldrar du växte upp med eller om du haft svåra livshändelser? Allt detta påverkar vad vi äter, hur vi äter och inte minst varför vi äter.Vi behöver alla lära oss mer om vår aptit och mättnad, som många aldrig riktigt lärt sig lyssna på, och som heller inte fungerar speciellt bra hos många överviktiga. I Slutbantat finns verktygslådan där du få olika verktyg att förstå dig själv och ditt ätbeteende bättre men också hållbara strategier och en genomgång av vilken mat som du ska satsa på.

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  • 23.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    The unparalleled rise of obesity in China: a call to action.2021In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 45, p. 921-922Article in journal (Other academic)
  • 24.
    Hemmingsson, Erik
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Andersson, Gunnar
    Health Profile Institute, Stockholm, Sweden.
    Wallin, Peter
    Health Profile Institute, Stockholm, Sweden.
    Söderling, Jonas
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Blom, Victoria
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Sport Psychology research group.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group. Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Prevalence and time trends of overweight, obesity and severe obesity in 447,925 Swedish adults, 1995–20172021In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 49, no 4, p. 377-383Article in journal (Refereed)
    Abstract [en]

    Aims: The purpose of this research was to describe the current prevalence and historic trends in overweight, obesity and severe obesity in Sweden. Methods: Data on BMI, age, gender, education and geographic region were obtained in n=447,925 Swedish adults through a nationwide screening test (1995?2017). To account for sampling variations, we quantified prevalence estimates and time trends using standardized values (direct method) to all 18?74-year-old Swedes, using nationwide databases. Rates of overweight (BMI ?25 kg/m2), obesity (BMI ?30 kg/m2) and severe obesity (BMI ?35 kg/m2) were calculated across gender, age, education and geographic categories. Years were grouped into two-year sampling periods (except the first period where we used three years) for increased power. We used multivariable logistic regression to quantify independent associations between age, gender, education and region with obesity development and current prevalence rates. Results: In 2016/17 the unstandardized prevalence of overweight, obesity and severe obesity were 55.1%, 16.6% and 4.2%, respectively. Factors associated with a higher obesity prevalence were male gender, older age, lower education and residing in a rural region (all P<0.001). Between 1995 and 2017 the prevalence of severe obesity increased by 153%, compared to obesity (+86%) and overweight (+23%). While there were similar increases in obesity across gender and age groups, people with low education (vs high) and rural areas (vs urban) had a higher prevalence increase (both P<0.001). Conclusions: Rates of overweight, obesity and severe obesity have increased markedly in Swedish adults since 1995. Priority groups for prevention efforts include individuals with low education and those living in rural areas.

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  • 25.
    Hemmingsson, Erik
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences.
    Ekblom, Örjan
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Kallings, Lena
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Andersson, Gunnar
    Wallin, Peter
    Söderling, Jonas
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Björn Ekblom's research group.
    Blom, Victoria
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Sport Psychology research group.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Sport and Health Sciences, Åstrand Laboratory of Work Physiology.
    Objectively measured prevalence and time trends of obesity and severe obesity in 447 925 Swedish adults, 1995-20172019Conference paper (Other academic)
  • 26.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Ekelund, U
    Is the association between physical activity and body mass index obesity dependent?2007In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 31, no 4, p. 663-8Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Most studies indicate an inverse relationship between physical activity (PA) and body mass index (BMI). However, the impact of obesity on this relationship is unclear.

    OBJECTIVE: To scrutinize the BMI/PA relationship by analysing multiple categories of PA from a sample with a wide BMI range.

    DESIGN: PA was measured with accelerometry for 7 consecutive days during free-living conditions in 85 severely obese outpatients (mean BMI 42.7 kg/m(2) (s.d. 6.1); age 43.0 year (12.6)) and 193 control subjects (24.0 kg/m(2) (3.5); 41.6 year (13.0)). Six categories of PA were calculated from the accelerometer data (min/day of sedentary time, min/day of light PA, min/day of moderate PA, min/day of vigorous PA, activity counts/day and steps/day). Participants were stratified in obese and non-obese subgroups (BMI=30 kg/m(2) as cutoff). Associations between BMI and PA were examined in the total sample, and in subgroups. The impact of sex and age on the BMI/PA association was tested.

    RESULTS: In the total sample, the association between BMI and PA was significant in all PA categories except for time spent sedentary (P=0.68). However, in subgroup analyses, the association between BMI and PA in non-obese was only significant for activity counts/day (r=-0.16, P<0.05) and vigorous intensity PA (r=-0.15, P=0.05). After adjustment for age, vigorous PA remained significantly associated with BMI in the non-obese (r=-0.17, P<0.05). In obese individuals, significant associations between BMI and PA were found for all six PA categories (age adjusted), sedentary time (r=0.26, P=0.05), light PA (r=-0.30, P<0.01), moderate PA (r=-0.35, P<0.01), vigorous PA (r=-0.39, P<0.001), activity counts/day (r=-0.50, P<0.001) and steps/day (r=-0.54, P<0.001).

    CONCLUSION: The association between PA and BMI was weak in non-obese individuals. In contrast, BMI was highly significantly associated with PA in obese individuals. Longitudinal studies are needed to tease out the direction of association between PA and BMI across BMI categories, as the cross-sectional associations seem to be dependent on obesity status.

  • 27.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Ekelund, Ulf
    Udden, Joanna
    Bicycling but not walking is independently associated with fasting insulin in abdominally obese women.2011In: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 8, no 6, p. 820-3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The impact of walking and bicycling on insulin resistance (IR) in women with abdominal obesity is unclear.

    METHODS: Pooled analysis of data from a randomized trial on physically active commuting (bicycling + walking vs walking only) in women with abdominal obesity [n = 98; age:47.3 ± 7.6 yrs; waist circumference (WC):103.1 ± 7.8 cm]. Bicycling and walking data were collected during 7 consecutive days by trip meters (Trelock FC-410) and pedometers (Yamax digiwalker SW-200) at baseline, 2, 4, and 6 months. Owing to a skew distribution we analyzed bicycling as a binary dummy variable with a 10 km/week cut-off. Fasting serum insulin and homeostatic model assessment - insulin resistance (HOMA-IR) were assessed at baseline and 6 months, as were body mass index (BMI), WC, and dual x-ray absorptiometry (DXA)-assessed % whole-body fat.

    RESULTS: Increased bicycling by 10 km/wk was associated with reductions in fasting serum insulin at follow-up independent of age, treatment allocation, baseline phenotype, Δ walking, and Δ % body fat (β = -10.9, P = .042), but not HOMA-IR (β = -2.0, P = .13). Increased walking was not associated with fasting serum insulin (P = .33) or HOMA-IR (P = .44) at follow-up, after adjustment for the same covariates and Δ bicycling.

    CONCLUSION: Increased bicycling but not walking was associated with reduced insulin levels at follow-up. Bicycling may be more effective than walking for reducing insulin levels in abdominally obese women.

  • 28.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Hellénius, Mai-Lis
    Ekelund, Ulf
    Bergström, Jakob
    Rössner, Stephan
    Impact of social support intensity on walking in the severely obese: a randomized clinical trial.2008In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 16, no 6, p. 1731-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: There are few established methods for promoting physical activity (PA) in the severely obese. Because social support is a potential method for promoting PA, we compared mean steps/day during 18 weeks in severely obese outpatients receiving either standard support (SS) or added support (AS).

    METHODS AND PROCEDURES: Eighty severely obese outpatients from an obesity clinic were invited; 66 provided written consent, 55 were randomized, and 42 were included in final analyses (9 men, 33 women; age 44.4 +/- 13.1 years; BMI 41.9 +/- 5.5 kg/m(2)). All participants received a pedometer and a walking promotion booklet. In addition to SS, the AS group received ten 2-h group counseling sessions aimed at increasing weekly accumulated steps, every second week during the study. Each participant was asked to complete a 7-day walking diary every second week (10 observations).

    RESULTS: Baseline steps/day was 6,912 for the AS group and 5,311 for the SS group (P = 0.023). Data at 18 weeks showed that the AS group recorded 10,136 steps/day and the SS group 6,118 steps/day (P = 0.024). There was no allocation x time interaction (P = 0.46). During the follow-up period as a whole, the AS group recorded 1,794 more steps/day than the SS group (P = 0.0074).

    DISCUSSION: The AS group recorded more steps/day than the SS group, reaching a mean level of approximately 10,000 steps/day. However, the nonsignificant interaction between allocation x time suggests that this difference was present already at baseline and did not increase during follow-up.

  • 29.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Johansson, K
    Reynisdottir, S
    Effects of childhood abuse on adult obesity: a systematic review and meta-analysis.2014In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, no 11, p. 882-93Article in journal (Refereed)
    Abstract [en]

    Controversy exists surrounding the role of childhood abuse in obesity development. This is a meta-analysis of observational studies on the role of childhood abuse in adult obesity. Systematic searches of PubMed, PsycInfo, Medline and CINAHL resulted in 23 cohort studies (4 prospective, 19 retrospective) with n=112,708 participants, containing four abuse types (physical, emotional, sexual, general). Four studies reported dose-response effects. A random effects model was used to quantify effect sizes, meta-regression/subgroup analysis for identifying potential moderating variables and Egger's test for publication bias. Adults who reported childhood abuse were significantly more likely to be obese (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.24-1.45, P<0.001). All four types of abuse were significantly associated with adult obesity: physical (OR: 1.28, 95% CI: 1.13-1.46), emotional (OR: 1.36, 95% CI: 1.08-1.71), sexual (OR: 1.31, 95% CI: 1.13-1.53) and general abuse (OR: 1.45, 95% CI: 1.25-1.69). Severe abuse (OR: 1.50, 95% CI: 1.27-1.77) was significantly more associated with adult obesity (P=0.043) compared with light/moderate abuse (OR: 1.13, 95% CI: 0.91-1.41). We found no significant effects of study design (prospective vs. retrospective, P=0.07), age (P=0.96) or gender (P=0.92). Publication bias was evident (Egger's test P=0.007), but effect sizes remained statistically significant in sensitivity analyses. Childhood abuse was clearly associated with being obese as an adult, including a positive dose-response association. This suggests that adverse life experiences during childhood plays a major role in obesity development, potentially by inducing mental and emotional perturbations, maladaptive coping responses, stress, inflammation and metabolic disturbances.

  • 30.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Johansson, Kari
    Eriksson, Jonas
    Sundström, Johan
    Neovius, Martin
    Marcus, Claude
    Weight loss and dropout during a commercial weight-loss program including a very-low-calorie diet, a low-calorie diet, or restricted normal food: observational cohort study.2012In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, no 5, p. 953-61Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The effectiveness of commercial weight-loss programs consisting of very-low-calorie diets (VLCDs) and low-calorie diets (LCDs) is unclear.

    OBJECTIVE: The aim of the study was to quantify weight loss and dropout during a commercial weight-loss program in Sweden (Itrim; cost: $1300/€1000; all participants paid their own fee).

    DESIGN: This observational cohort study linked commercial weight-loss data with National Health Care Registers. Weight loss was induced with a 500-kcal liquid-formula VLCD [n = 3773; BMI (in kg/m(2)): 34 ± 5 (mean ± SD); 80% women; 45 ± 12 y of age (mean ± SD)], a 1200-1500-kcal formula and food-combination LCD (n = 4588; BMI: 30 ± 4; 86% women; 50 ± 11 y of age), and a 1500-1800-kcal/d restricted normal-food diet (n = 676; BMI: 29 ± 5; 81% women; 51 ± 12 y of age). Maintenance strategies included exercise and a calorie-restricted diet. Weight loss was analyzed by using an intention-to-treat analysis (baseline substitution).

    RESULTS: After 1 y, mean (±SD) weight changes were -11.4 ± 9.1 kg with the VLCD (18% dropout), -6.8 ± 6.4 kg with the LCD (23% dropout), and -5.1 ± 5.9 kg with the restricted normal-food diet (26% dropout). In an adjusted analysis, the VLCD group lost 2.8 kg (95% CI: 2.5, 3.2) and 3.8 kg (95% CI: 3.2, 4.5) more than did the LCD and restricted normal-food groups, respectively. A high baseline BMI and rapid initial weight loss were both independently associated with greater 1-y weight loss (P < 0.001). Younger age and low initial weight loss predicted an increased dropout rate (P < 0.001). Treatment of depression (OR: 1.4; 95% CI: 1.1, 1.9) and psychosis (OR: 2.6; 95% CI: 1.1, 6.3) were associated with an increased dropout rate in the VLCD group.

    CONCLUSION: A commercial weight-loss program, particularly one using a VLCD, was effective at reducing body weight in self-selected, self-paying adults.

  • 31.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Johansson, Kari
    Neovius, Martin
    Randomized controlled trial on weight loss in obstructive sleep apnea: inappropriate analysis limits main conclusion.2011In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 93, no 2, p. 474-474Article in journal (Refereed)
  • 32.
    Hemmingsson, Erik
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nordenfelt, Anja
    Mamma United, Stockholm, Sweden..
    Oljans, Emma
    Swedish School of Sport and Health Sciences, GIH, Department of Movement, Culture and Society. SWEDESD: Research and learning for sustainable development and global health, Department of Women’s and Children’s Health, Uppsala University, Sweden..
    Mamma United: evaluation of a 12-week support program that promotes integration, autonomy, health and well-being for immigrant mothers and their families living in socially deprived areas2023In: SIHI Sweden Conference 2023, Exploring Community Engagement for Social Innovation in Health, 2023Conference paper (Other academic)
  • 33.
    Hemmingsson, Erik
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Nowicka, Paulina
    Department of Food Studies, Nutrition, and Dietetics, Uppsala University, Uppsala, Sweden..
    Ulijaszek, Stanley
    Unit for Biocultural Variation and Obesity, School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK..
    Sørensen, Thorkild I A
    Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark..
    The social origins of obesity within and across generations.2023In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 24, no 1, article id e13514Article in journal (Refereed)
    Abstract [en]

    We propose a model for obesity development that traces a considerable part of its origins to the social domain (mainly different forms of prolonged social adversity), both within and across generations, working in tandem with a genetic predisposition. To facilitate overview of social pathways, we place particular focus on three areas that form a cascading sequence: (A) social adversity within the family (parents having a low education, a low social position, poverty and financial insecurity; offspring being exposed to gestational stress, unmet social and emotional needs, abuse, maltreatment and other negative life events, social deprivation and relationship discord); (B) increasing levels of insecurity, negative emotions, chronic stress, and a disruption of energy homeostasis; and (C) weight gain and obesity, eliciting further social stress and weight stigma in both generations. Social adversity, when combined with genetic predisposition, thereby substantially contributes to highly effective transmission of obesity from parents to offspring, as well as to obesity development within current generations. Prevention efforts may benefit from mitigating multiple types of social adversity in individuals, families, and communities, notably poverty and financial strain, and by improving education levels.

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  • 34.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Rössner, Stephan
    [Physical activity in the treatment of obesity. Obesity--a chronic disease requiring life-long physical activity].2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 20, p. 1790-7Article in journal (Other academic)
  • 35.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Uddén, J
    Neovius, M
    Ekelund, U
    Rössner, S
    Increased physical activity in abdominally obese women through support for changed commuting habits: a randomized clinical trial.2009In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 33, no 6, p. 645-52Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Abdominally obese women can reduce their health risk through regular physical activity. There is, however, little evidence on the effectiveness of interventions that promote physical activity long-term, such as cycling and walking to and from work.

    METHODS: This intervention focused on physically active commuting (cycling and walking) in middle-aged (30-60 years), abdominally obese (waist circumference > or = 88 cm) women (n=120), recruited by newspaper advertisement. The intervention group was a moderate-intensity programme with physician meetings, physical activity prescriptions, group counselling and bicycles. The control group was a low-intensity group support programme with pedometers. We used a randomized, controlled, 2-armed design with 18 months duration and intention-to-treat analysis (data collection 2005-2006). Treatment success was defined as bicycling > or = 2 km/d (primary) or walking 10,000 steps per day (secondary).

    RESULTS: At baseline, mean (s.d.) age was 48.2 years (7.4), waist circumference 103.8 cm (7.8), walking 8471 steps per day (2646), bicycling 0 km per day. Attrition at 18 months was 10% for the intervention group and 25% in the control group (P=0.03). The intervention group was more likely to achieve treatment success for cycling than controls: 38.7 vs 8.9% (odds ratio (OR)=7.8 (95% confidence interval=4.0 to 15.0, P<0.001)), but with no difference for compliance with the walking recommendation: 45.7 vs 39.3% (OR=1.2 (95% CI=0.7 to 2.0, P=0.50)). Commuting by car and public transport were reduced by 34% (P<0.01) and 37% (P<0.001), respectively, with no differences between groups. Both groups attained similar waist reductions (-2.1 and -2.6 cm, P=0.72).

    CONCLUSIONS: Abdominally obese women can increase PA long-term through moderate-intensity behavioural support aimed at changing commuting habits.

  • 36.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Uddén, Joanna
    Neovius, Martin
    No apparent progress in bioelectrical impedance accuracy: validation against metabolic risk and DXA.2009In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 17, no 1, p. 183-7Article in journal (Refereed)
    Abstract [en]

    Bioelectrical impedance (BIA) is quick, easy, and safe when quantifying fat and lean tissue. New BIA models (Tanita BC-418 MA, abbreviated BIA(8)) can perform segmental body composition analysis, e.g., estimate %trunkal fatness (%TF). It is not known, however, whether new BIA models can detect metabolic risk factors (MRFs) better than older models (Tanita TBF-300, abbreviated BIA(4)). We therefore tested the correlation between MRF and percentage whole-body fat (%BF) from BIA(4) and BIA(8) and compared these with the correlation between MRF and dual-energy X-ray absorptiometry (DXA, used as gold standard), BMI and waist circumference (WC). The sample consisted of 136 abdominally obese (WC >or= 88 cm), middle-aged (30-60 years) women. MRF included fasting blood glucose and insulin; high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides; high sensitive C-reactive protein, plasminogen activator inhibitor-1 (PAI-1), and fibrinogen; and alanine transaminase (ALT) liver enzyme. We found that similar to DXA, but in contrast to BMI, neither %BF BIA(4) nor %BF BIA(8) correlated with blood lipids or ALT. In the segmental analysis of %TF, BIA(8) only correlated with inflammatory markers, but not insulin, blood lipids, or ALT liver enzyme (in contrast to WC and %TF DXA). %TF DXA was associated with homeostatic model assessment insulin resistance (HOMA-IR) independently of WC (P = 0.03), whereas %TF BIA(8) was not (P = 0.53). Receiver-operating characteristic (ROC) curves confirmed that %TF BIA(8) did not differ from chance in the detection of insulin resistance (P = 0.26). BIA estimates of fatness were, at best, weakly correlated with obesity-related risk factors in abdominally obese women, even the new eight-electrode model. Our data support the continued use of WC and BMI.

  • 37.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Uddén, Joanna
    Rössner, Stephan
    Diet and physical activity interventions in severely obese adults.2011In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 305, no 6, p. 563-564Article in journal (Refereed)
  • 38.
    Hemmingsson, Erik
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Väisänen, Daniel
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Andersson, Gunnar
    HPI Health Profile Institute, Sweden.
    Wallin, Peter
    HPI Health Profile Institute, Sweden.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Combinations of BMI and cardiorespiratory fitness categories: trends between 1995 and 2020 and associations with CVD incidence and mortality and all-cause mortality in 471 216 adults.2022In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 29, no 6, p. 959-967Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe time trends in combinations of cardiorespiratory fitness (CRF) and body mass index (BMI) status, and to analyse their associations with cardiovascular disease (CVD) incidence and mortality and all-cause mortality.

    METHODS AND RESULTS: Prospective cohort study with data from occupational health screenings in Swedish employees, including n = 471 216 (aged 18-74 years) between 1995 and 2020, and n = 169 989 in risk analyses. Cardiorespiratory fitness was estimated from a submaximal cycle test. High CRF was defined as top quartile, and low CRF as bottom quartile. Body mass index was used to define normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obesity (≥30 kg/m2). Outcome data (CVD incidence and mortality, all-cause mortality) were obtained from national registers. From 1995 to 2020, the combination of obesity + low CRF increased from 2.1% to 5.3% (relative increase 154%) whereas the combination of normal weight + high CRF decreased from 13.2% to 9.3% (-30%) (both P < 0.001). Negative changes were more pronounced in men, younger ages, and non-university educated. At the end of the period, prevalence of obesity + low CRF were higher in men vs. women (3.1% vs. 2.2%), older vs. younger (3.7% vs. 1.7%), and in non-university vs. university educated (5.0% vs. 0.3%), all P-value <0.001. Having a high CRF attenuated the risk of all three outcomes in all BMI categories, especially in individuals with obesity (hazard ratio 3.90 vs. 6.67 for CVD mortality). Both a low BMI and a high CRF prolonged age of onset for all three outcomes.

    CONCLUSIONS: The combination of obesity with low CRF has increased markedly since the mid-90s, with clear implications for increased CVD morbidity and mortality, and all-cause mortality.

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  • 39.
    Hemmingsson, Erik
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Wolter, Stina
    Kriget mot kroppen2022Book (Other (popular science, discussion, etc.))
    Abstract [sv]

    Alldeles för många tvingas idag leva med vikthets och fettfobi i en dietkultur som stjälper mer än hjälper. Överviktsforskaren Erik Hemmingsson och konstnären Stina Wollter delar här chockerande vittnesmål om viktmobbning, både från samhället i stort och från sjukvården. De skärskådar en värld som tycks vara besatt av hälsa, men som varken gör människor lättare, friskare eller gladare.

    Vad menas egentligen med hälsa? Är BMI ett bra verktyg? Vad säger aktuell forskning?

    Författarna visar vägen mot en hälsosammare värld genom att ifrågasätta gamla sanningar och lyfta fram nya. Genom att utgå från vad just din kropp behöver och mår bra av istället för vad du väger, kan du uppnå bättre hälsa. Men framför allt, det är dags att sluta fred med kroppen! [Text från förlaget]

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  • 40.
    Holmlund, Tobias
    et al.
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Blom, Victoria
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Ekblom, Björn
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Andersson, Gunnar
    HPI Health Profile Institute, Sweden.
    Wallin, Peter
    HPI Health Profile Institute, Sweden.
    Ekblom Bak, Elin
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Change in cardiorespiratory fitness on self-rated health: prospective cohort study in 98 718 Swedish adults.2023In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 51, no 4, p. 542-551Article in journal (Refereed)
    Abstract [en]

    Aim: To study how change in cardiorespiratory fitness over time is associated with the development of poor self-rated health in healthy Swedish adults, and whether this association varies with sex, age, body mass index and cardiorespiratory fitness at baseline. A secondary aim was to study the influence of other predictors of self-rated health. Methods: A total of 98,718 participants (45% women, mean age 42.2 years) with two assessments from occupational health service screenings between 1988 and 2019 (mean duration 4.3 years), with good self-rated health at baseline were included. Cardiorespiratory fitness was assessed as estimated maximal oxygen consumption using submaximal cycle testing. Change in cardiorespiratory fitness was expressed as percentage annual change. Poor self-rated health at follow-up was defined as percieving self-rated health as 'poor' or 'very poor'. Results: A large decrease in cardiorespiratory fitness (⩾-3%) was associated with a 34% higher risk of poor self-rated health compared to maintainers (-1 to +1%) after multi-adjustment including change in body mass index, back/neck pain, stress, exercise habits and sleep quality or sleep problems. The associations for decreasers were stronger with longer follow-up time (>10 years). Preserving, or changing to, risk level for body mass index, back/neck pain, stress, exercise and sleep quality/problems were associated with a higher risk of poor self-rated health. Conclusions: Preserving or increasing cardiorespiratory fitness is associated with a lower risk of poor self-rated health, independently of change in other health-related variables, which may act as a protection against future poor self-rated health. This is of high clinical value, and strategies for maintaining or improving cardiorespiratory fitness have the potential to influence both disease and mortality.

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  • 41.
    Jayawickrama, Ravisha S.
    et al.
    School of Population Health, Curtin University, Western Australia, Australia..
    Hill, Briony
    O'Connor, Moira
    School of Population Health, Curtin University, Western Australia, Australia..
    Flint, Stuart W.
    School of Psychology, University of Leeds, Yorkshire, United Kingdom..
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Lawrence, Blake J.
    School of Population Health, Curtin University, Western Australia, Australia..
    Assessing explicit weight bias among Australian health care students: Suitability of the Beliefs About Obese Persons Scale (BAOP) and the Antifat Attitudes Questionnaire (AFA).2023In: Stigma and Health, ISSN 2376-6972Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to examine the suitability of the Beliefs About Obese Persons Scale (BAOP) and Antifat Attitudes Questionnaire (AFA) among Australian health care students. Specifically, we explored the factor structures of the two scales, their psychometric properties including internal consistency and convergent validity, and whether they were impacted by social desirability bias. Students studying health care courses at Australian universities (N = 900) responded to an online survey and completed the BAOP, AFA, 13-item Short Form Marlowe–Crowne Social Desirability Scale (MCSDS), Empathy for Obese Patients, and Confidence in Clinical Interaction With Obese Patients scales. Confirmatory factor analyses, Pearson’s correlations, and linear regressions were conducted to examine the factor structures of the BAOP and AFA, examine their convergent validity, and whether scores on these scales were associated with socially desirable responding. Confirmatory factor analyses confirmed the originally proposed factor structures of the BAOP (one factor) and AFA (three factors) and supported a relatively good model fit. Support for convergent validity of the two measures was shown when correlated with each other and the Empathy for Obese Patients and Confidence in Clinical Interaction With Obese Patients scales. The BAOP was not associated with socially desirable responding (p > .5). In contrast, all subscales of the AFA were associated with socially desirable responding (p < .5); as AFA scores increased, participants were less likely to respond in a socially desirable manner. The BAOP and AFA are considerably suitable measures to assess explicit weight bias among Australian health care students.Our findings indicate that the Beliefs About Obese Persons Scale (BAOP) and Antifat Attitudes Questionnaire (AFA) are considerably suitable measures to assess explicit weight bias among Australian health care students. Our findings support the continued assessment of explicit weight bias among health care students in order to quantify this construct within this population. Quantifying the extent to which explicit weight bias is present among health care students may assist in the development of novel weight bias reduction interventions to reduce students’ exhibited weight bias, with the goal of enabling future health care professionals to provide equitable treatment to people living with overweight. 

  • 42.
    Jayawickrama, Ravisha S
    et al.
    School of Population Health, Curtin University, Western Australia, Australia.
    O'Connor, Moira
    School of Population Health, Curtin University, Western Australia, Australia.
    Flint, Stuart W
    School of Psychology, University of Leeds, Yorkshire, United Kingdom..
    Hemmingsson, Erik
    Swedish School of Sport and Health Sciences, GIH, Department of Physical Activity and Health.
    Lawrence, Blake J
    School of Population Health, Curtin University, Western Australia, Australia.
    Explicit and implicit weight bias among health care students: a cross-sectional study of 39 Australian universities.2023In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 58, article id 101894Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Weight bias exhibited by health care students may continue into their future practice, compromising the provision of care that people living with overweight or obesity receive. This highlights the need to comprehensively examine the extent to which weight bias is present among health care students and the factors that may be associated with students' weight bias.

    METHODS: In this cross-sectional study, Australian university students enrolled in health care courses were invited via social media advertisements, snowball and convenience sampling, and by making direct contact with universities to complete an online survey. Students provided demographic information including discipline of study, perceived weight status, and state of residence. Students then completed several measures which assessed their explicit and implicit weight bias, and empathy. Descriptive statistics established the presence of explicit and implicit weight bias, and ANCOVAs, ANOVA, and multiple regression analyses were conducted to examine the potential factors associated with students' exhibited weight bias.

    FINDINGS: Between March 08, 2022, and March 15, 2022, 900 eligible health care students attending 39 Australian universities participated in the study. Students reported varying levels of explicit and implicit weight bias, with minimal differences between disciplines on most outcome measures. Students who identified as men (vs. women) exhibited higher of both explicit and implicit bias (Beliefs About Obese Persons (BAOP): p = 0.0002, Antifat Attitudes Questionnaire (AFA)-Dislike: p = 0.019, AFA Willpower p < 0.0001, Empathy for Obese Patients: p = 0.0011, Implicit Association Test: p = 0.022), and students who displayed greater (vs. less) empathic concern exhibited lower levels of explicit bias (BAOP, AFA Dislike and Willpower, and Empathy for Obese Patients: p < 0.0001). Having witnessed the enactment of weight stigma sporadically (vs. regularly) by role models was associated with greater attribution of the causes of obesity to willpower (a few times a month vs. daily: p = 0.020, a few times a year vs. daily: p = 0.022), and less time spent with people living with overweight or obesity outside of study was associated with more dislike (a few times a month vs. daily: p = 0.0048, once a month vs. daily: p = 0.0002) and less fear of fat (once a month vs. daily: p = 0.036, and once a month vs. a few times a week: p = 0.0028).

    INTERPRETATION: Results demonstrate the presence of both explicit and implicit weight bias among Australian health care students. Several characteristics and experiences of students were associated with their weight bias. Validity of the exhibited weight bias should be established in practical interactions with people living with overweight or obesity and novel interventions should be developed to ameliorate weight bias.

    FUNDING: Research Training Program (RTP) Scholarship, Australian Government, Department of Education.

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  • 43. Johansson, K
    et al.
    Sundström, J
    Marcus, C
    Hemmingsson, Erik
    Karolinska institutet.
    Neovius, M
    Risk of symptomatic gallstones and cholecystectomy after a very-low-calorie diet or low-calorie diet in a commercial weight loss program: 1-year matched cohort study.2014In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 38, no 2, p. 279-84Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Concern exists regarding gallstones as an adverse event of very-low-calorie diets (VLCDs; <800 kcal per day).

    OBJECTIVE: To assess the risk of symptomatic gallstones requiring hospital care and/or cholecystectomy in a commercial weight loss program using VLCD or low-calorie diet (LCD).

    DESIGN: A 1-year matched cohort study of consecutively enrolled adults in a commercial weight loss program conducted at 28 Swedish centers between 2006 and 2009. A 3-month weight loss phase of VLCD (500 kcal per day) or LCD (1200-1500 kcal per day) was followed by a 9-month weight maintenance phase. Matching (1:1) was performed by age, sex, body mass index, waist circumference and gallstone history (n=3320:3320). Gallstone and cholecystectomy data were retrieved from the Swedish National Patient Register.

    RESULTS: One-year weight loss was greater in the VLCD than in the LCD group (-11.1 versus -8.1 kg; adjusted difference, -2.8 kg, 95% CI -3.1 to -2.4; P<0.001). During 6361 person-years, 48 and 14 gallstones requiring hospital care occurred in the VLCD and LCD groups, respectively, (152 versus 44/10 000 person-years; hazard ratio, 3.4, 95% CI 1.8-6.3; P<0.001; number-needed-to-harm, 92, 95% CI 63-168; P<0.001). Of the 62 gallstone events, 38 (61%) resulted in cholecystectomy (29 versus 9; hazard ratio, 3.2, 95% CI 1.5-6.8; P=0.003; number-needed-to-harm, 151, 95% CI 94-377; P<0.001). Adjusting for 3-month weight loss attenuated the hazard ratios, but the risk remained higher with VLCD than LCD for gallstones (2.5, 95% CI 1.3-5.1; P=0.009) and became borderline for cholecystectomy (2.2, 95% CI 0.9-5.2; P=0.08).

    CONCLUSION: The risk of symptomatic gallstones requiring hospitalization or cholecystectomy, albeit low, was 3-fold greater with VLCD than LCD during the 1-year commercial weight loss program.

  • 44. Johansson, Kari
    et al.
    Hemmingsson, Erik
    Karolinska institutet.
    Harlid, Richard
    Trolle Lagerros, Ylva
    Granath, Fredrik
    Rössner, Stephan
    Neovius, Martin
    Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational follow-up study.2011In: The BMJ, E-ISSN 1756-1833, Vol. 342, article id d3017Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine whether initial improvements in obstructive sleep apnoea after a very low energy diet were maintained after one year in patients with moderate to severe obstructive sleep apnoea.

    DESIGN: Single centre, prospective observational follow-up study.

    SETTING: Outpatient obesity clinic in a university hospital in Stockholm, Sweden.

    PARTICIPANTS: 63 men aged 30-65 with body mass index (BMI) 30-40 and moderate to severe obstructive sleep apnoea defined as an apnoea-hypopnoea index ≥ 15 (events/hour), all treated with continuous positive airway pressure.

    INTERVENTION: A one year weight loss programme, consisting of an initial very low energy diet for nine weeks (seven weeks of 2.3 MJ/day and two weeks of gradual introduction of normal food) followed by a weight loss maintenance programme.

    MAIN OUTCOME MEASURE: Apnoea-hypopnoea index, the main index for severity of obstructive sleep apnoea. Data from all patients were analysed (baseline carried forward for missing data).

    RESULTS: Of 63 eligible patients, 58 completed the very low energy diet period and started the weight maintenance programme and 44 completed the full programme; 49 had complete measurements at one year. At baseline the mean apnoea-hypopnoea index was 36 events/hour. After the very low energy diet period, apnoea-hypopnoea index was improved by -21 events/hour (95% confidence interval -17 to -25) and weight by -18 kg (-16 to -19; both P<0.001). After one year the apnoea-hypopnoea index had improved by -17 events/hour (-13 to -21) and body weight by -12 kg (-10 to -14) compared with baseline (both P<0.001). Patients with severe obstructive sleep apnoea at baseline had greater improvements in apnoea-hypopnoea index (-25 events/hour) compared with patients with moderate disease (-7 events/hour, P<0.001). At one year, 30/63 (48%, 95% confidence interval 35% to 60%) no longer required continuous positive airway pressure and 6/63 (10%, 2% to 17%) had total remission of obstructive sleep apnoea (apnoea-hypopnoea index <5 events/hour). There was a dose-response association between weight loss and apnoea-hypopnoea index at follow-up (β = 0.50 events/kg, 0.11 to 0.88; P = 0.013).

    CONCLUSION: Initial improvements in obstructive sleep apnoea after treatment with a very low energy diet can be maintained after one year in obese men with moderate to severe disease. Those who lose the most weight or have severe sleep apnoea at baseline benefit most. Trial registration Current Controlled Trials 70090382.

  • 45. Johansson, Kari
    et al.
    Neovius, Martin
    Hemmingsson, Erik
    Karolinska institutet.
    Effects of anti-obesity drugs, diet, and exercise on weight-loss maintenance after a very-low-calorie diet or low-calorie diet: a systematic review and meta-analysis of randomized controlled trials.2014In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 99, no 1, p. 14-23Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Weight-loss maintenance remains a major challenge in obesity treatment.

    OBJECTIVE: The objective was to evaluate the effects of anti-obesity drugs, diet, or exercise on weight-loss maintenance after an initial very-low-calorie diet (VLCD)/low-calorie diet (LCD) period (<1000 kcal/d).

    DESIGN: We conducted a systematic review by using MEDLINE, the Cochrane Controlled Trial Register, and EMBASE from January 1981 to February 2013. We included randomized controlled trials that evaluated weight-loss maintenance strategies after a VLCD/LCD period. Two authors performed independent data extraction by using a predefined data template. All pooled analyses were based on random-effects models.

    RESULTS: Twenty studies with a total of 27 intervention arms and 3017 participants were included with the following treatment categories: anti-obesity drugs (3 arms; n = 658), meal replacements (4 arms; n = 322), high-protein diets (6 arms; n = 865), dietary supplements (6 arms; n = 261), other diets (3 arms; n = 564), and exercise (5 arms; n = 347). During the VLCD/LCD period, the pooled mean weight change was -12.3 kg (median duration: 8 wk; range 3-16 wk). Compared with controls, anti-obesity drugs improved weight-loss maintenance by 3.5 kg [95% CI: 1.5, 5.5 kg; median duration: 18 mo (12-36 mo)], meal replacements by 3.9 kg [95% CI: 2.8, 5.0 kg; median duration: 12 mo (10-26 mo)], and high-protein diets by 1.5 kg [95% CI: 0.8, 2.1 kg; median duration: 5 mo (3-12 mo)]. Exercise [0.8 kg; 95% CI: -1.2, 2.8 kg; median duration: 10 mo (6-12 mo)] and dietary supplements [0.0 kg; 95% CI: -1.4, 1.4 kg; median duration: 3 mo (3-14 mo)] did not significantly improve weight-loss maintenance compared with control.

    CONCLUSION: Anti-obesity drugs, meal replacements, and high-protein diets were associated with improved weight-loss maintenance after a VLCD/LCD period, whereas no significant improvements were seen for dietary supplements and exercise.

  • 46. Johansson, Kari
    et al.
    Neovius, Martin
    Lagerros, Ylva Trolle
    Harlid, Richard
    Rössner, Stephan
    Granath, Fredrik
    Hemmingsson, Erik
    Karolinska institutet.
    Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial.2009In: The BMJ, E-ISSN 1756-1833, Vol. 339, article id b4609Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the effect of weight loss induced by a very low energy diet on moderate and severe obstructive sleep apnoea in obese men. Design Single centre, two arm, parallel, randomised, controlled, open label trial. Blocked randomisation procedure used for treatment allocation. Setting Outpatient obesity clinic in a university hospital in Stockholm, Sweden. Participants 63 obese men (body mass index 30-40, age 30-65 years) with moderate to severe obstructive sleep apnoea (apnoea-hypopnoea index (AHI) >or=15), treated with continuous positive airway pressure.

    INTERVENTIONS: The intervention group received a liquid very low energy diet (2.3 MJ/day) for seven weeks to promote weight loss, followed by two weeks of gradual introduction of normal food, reaching 6.3 MJ/day at week 9. The control group adhered to their usual diet during the nine weeks of follow-up.

    MAIN OUTCOME MEASURE: AHI, the major disease severity index for obstructive sleep apnoea. Data from all randomised patients were included in an intention to treat analysis (baseline carried forward for missing data). Results Of the 63 eligible patients, 30 were randomised to intervention and 33 to control. Two patients in the control group were dissatisfied with allocation and immediately discontinued. All other patients completed the trial. Both groups had a mean AHI of 37 events/h (SD 15) at baseline. At week 9, the intervention group's mean body weight was 20 kg (95% confidence interval 18 to 21) lower than that of the control group, while its mean AHI was 23 events/h (15 to 30) lower. In the intervention group, five of 30 (17%) were disease free after the energy restricted diet (AHI <5), with 15 of 30 (50%) having mild disease (AHI 5-14.9), whereas the AHI of all patients in the control group except one remained at 15 or higher. In a subgroup analysis of the intervention group, baseline AHI significantly modified the effectiveness of treatment, with a greater improvement in AHI in patients with severe obstructive sleep apnoea (AHI >30) at baseline compared with those with moderate (AHI 15-30) sleep apnoea (AHI -38 v -12, P<0.001), despite similar weight loss (-19.2 v -18.2 kg, P=0.55). Conclusion Treatment with a low energy diet improved obstructive sleep apnoea in obese men, with the greatest effect in patients with severe disease. Long term treatment studies are needed to validate weight loss as a primary treatment strategy for obstructive sleep apnoea.

    TRIAL REGISTRATION: Current Controlled Trials ISRCTN70090382.

  • 47. Juul, Filippa
    et al.
    Hemmingsson, Erik
    Karolinska institutet.
    Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010.2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 17, p. 3096-107Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how consumption of ultra-processed foods has changed in Sweden in relation to obesity.

    DESIGN: Nationwide ecological analysis of changes in processed foods along with corresponding changes in obesity. Trends in per capita food consumption during 1960-2010 were investigated using data from the Swedish Board of Agriculture. Food items were classified as group 1 (unprocessed/minimally processed), group 2 (processed culinary ingredients) or group 3 (3·1, processed food products; and 3·2, ultra-processed products). Obesity prevalence data were pooled from the peer-reviewed literature, Statistics Sweden and the WHO Global Health Observatory.

    SETTING: Nationwide analysis in Sweden, 1960-2010.

    SUBJECTS: Swedish nationals aged 18 years and older.

    RESULTS: During the study period consumption of group 1 foods (minimal processing) decreased by 2 %, while consumption of group 2 foods (processed ingredients) decreased by 34 %. Consumption of group 3·1 foods (processed food products) increased by 116 % and group 3·2 foods (ultra-processed products) increased by 142 %. Among ultra-processed products, there were particularly large increases in soda (315 %; 22 v. 92 litres/capita per annum) and snack foods such as crisps and candies (367 %; 7 v. 34 kg/capita per annum). In parallel to these changes in ultra-processed products, rates of adult obesity increased from 5 % in 1980 to over 11 % in 2010.

    CONCLUSIONS: The consumption of ultra-processed products (i.e. foods with low nutritional value but high energy density) has increased dramatically in Sweden since 1960, which mirrors the increased prevalence of obesity. Future research should clarify the potential causal role of ultra-processed products in weight gain and obesity.

  • 48.
    Kallings, Lena V
    et al.
    Karolinska institutet.
    Sierra Johnson, Justo
    Fisher, Rachel M
    Faire, Ulf de
    Ståhle, Agneta
    Hemmingsson, Erik
    Karolinska institutet.
    Hellénius, Mai-Lis
    Beneficial effects of individualized physical activity on prescription on body composition and cardiometabolic risk factors: results from a randomized controlled trial.2009In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 16, no 1, p. 80-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Insufficient physical activity (PA), overweight and abdominal obesity are increasing global public health problems.

    DESIGN: Randomized controlled 6-month intervention study.

    METHODS: One hundred and one 68-year-old individuals (57% female) with low PA, overweight (BMI 25-40 kg/m) and abdominal obesity (waist circumference >88 cm in women and >102 cm in men), were randomized to PA on prescription (PAP) or a minimal intervention. PA measured by several methods, anthropometric parameters, body composition and cardiometabolic risk factors were measured at baseline and after intervention.

    RESULTS: Favourable changes in anthropometrics, body composition, S-glucose, glycosolated haemoglobin (HbA1c), blood lipids and apolipoproteins were seen in the PAP group. In the control group, however, some positive changes were also noted. Bodyweight, neck circumference, fat mass, S-cholesterol and HbA1c decreased significantly more in the PAP group.

    CONCLUSION: Individualized PAP improves body composition and cardiometabolic risk factors in sedentary older overweight individuals. PAP might be useful in clinical practice to counteract the epidemic of sedentary lifestyle and concomitant cardiometabolic disorders.

  • 49. Linné, Y
    et al.
    Hemmingsson, Erik
    Karolinska institutet.
    Adolfsson, B
    Ramsten, J
    Rössner, S
    Patient expectations of obesity treatment-the experience from a day-care unit.2002In: International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, Vol. 26, no 5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Unrealistic patient weight loss expectations in treatment of obesity may hamper the modest success which can actually be achieved.

    SETTING: Academic Obesity Unit Day Care Centre.

    OBJECTIVE: Description of weight loss expectations and weight loss concerns by questionnaire analyses.

    RESULTS: Patients were severely obese, with a median initial body mass index (BMI) of 40.7 kg/m(2). Weight loss expectations were generally unrealistic, with women hoping for a loss up to 42%, and men for 29% of their baseline weight (P<0.001). No effects of age on actual weight loss or weight loss expectations were observed.

    CONCLUSION: Gender differences in weight loss expectations may be important to acknowledge in future development of obesity treatment programmes. Realistic treatment outcome should be described early in a programme to facilitate compliance.

  • 50. Neovius, Martin
    et al.
    Hemmingsson, Erik
    Karolinska institutet.
    Freyschuss, Bo
    Uddén, Joanna
    Bioelectrical impedance underestimates total and truncal fatness in abdominally obese women.2006In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 14, no 10, p. 1731-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare estimates of total and truncal fatness from eight-electrode bioelectrical impedance analysis equipment (BIA(8)) with those from DXA in centrally obese women. The secondary aim was to examine BMI and waist circumference (WC) as proxy measures for percentage total body fat (%TBF) and truncal body fat percentage (tr%BF).

    RESEARCH METHODS AND PROCEDURES: This was a cross-sectional study of 136 women (age, 48.1 +/- 7.7 years; BMI, 30.4 +/- 2.9 kg/m(2); %TBF(DXA), 46.0 +/- 3.7%; WC, 104 +/- 8 cm). Fatness was measured by DXA and Tanita BC-418 equipment (Tanita Corp., Tokyo, Japan). Agreement among methods was assessed by Bland-Altman plots, and regression analysis was used to evaluate anthropometric measures as proxies for total and abdominal fatness.

    RESULTS: The percentage of overweight subjects was 41.9%, whereas 55.9% of the subjects were obese, as defined by BMI, and all subjects had a WC exceeding the World Health Organization cut-off point for abdominal obesity. Compared with DXA, the BIA(8) equipment significantly underestimated total %BF (-5.0; -3.6 to -8.5 [mean; 95% confidence interval]), fat mass (-3.6; -3.9 to -3.2), and tr%BF (-8.5; -9.1 to -7.9). The discrepancies between the methods increased with increasing adiposity for both %TBF and tr%BF (both p < 0.001). Variation in BMI explained 28% of the variation in %TBF(DXA) and 51% of %TBF(BIA8). Using WC as a proxy for truncal adiposity, it explained only 18% of tr%BF(DXA) variance and 27% of tr%BF(BIA8) variance. The corresponding figures for truncal fat mass were 49% and 35%, respectively. No significant age effects were observed in any of the regressions.

    DISCUSSION: BIA(8) underestimated both total and truncal fatness, compared with DXA, with higher dispersion for tr%BF than %TBF. The discrepancies increased with degree of adiposity, suggesting that the accuracy of BIA is negatively affected by obesity.

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