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  • 1.
    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
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    “…or else I close my ears” How women with obesity want to be approached and treated regarding gestational weight management: A qualitative interview study.2019Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, nr 9, s. 1-17Artikkel i tidsskrift (Fagfellevurdert)
    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. 

  • 2. 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.2016Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 12, artikkel-id e0167731Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 3.
    Christenson, Anne
    et al.
    Karolinska institutet.
    Johansson, Eva
    Karolinska institutet.
    Reynisdottir, Signy
    Karolinska institutet.
    Torgerson, Jarl
    Göteborgs universitet.
    Hemmingsson, Erik
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Shame and avoidance as barriers in midwives’ communication about body weight with pregnant women: A qualitative interview study2018Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 63, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 4. 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.2017Inngår i: Clinical Obesity, ISSN 1758-8103, E-ISSN 1758-8111, Vol. 7, nr 1, s. 1-10Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 5. 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.2015Inngår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 12, artikkel-id e0145273Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 6.
    Dreber, Helena
    et al.
    Karolinska University Hospital.
    Thorell, Anders
    Karolinska Institutet.
    Torgerson, Jarl
    Karolinska University Hospital.
    Reynisdottir, Signy
    Karolinska University Hospital.
    Hemmingsson, Erik
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Weight loss, adverse events, and loss to follow-up after gastric bypass in young versus older adults: A Scandinavian Obesity Surgery Registry study.2018Inngår i: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 14, nr 9, s. 1319-1326, artikkel-id S1550-7289(18)30324-1Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 7.
    Ekblom Bak, Elin
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Ekblom, Björn
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Söderling, Jonas
    Karolinska institutet.
    Börjesson, Mats
    University of Gothenburg.
    Blom, Victoria
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Forskningsgruppen för idrottspsykologi.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Hemmingsson, Erik
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Andersson, Gunnar
    HPI Health Profile Institute, Danderyd.
    Wallin, Peter
    HPI Health Profile Institute, Danderyd.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Sex- and age-specific associations between cardiorespiratory fitness, CVD morbidity and all-cause mortality in 266.109 adults.2019Inngår i: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 127, artikkel-id 105799Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 8.
    Ekblom Bak, Elin
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Andersson, Gunnar
    HPI Health Profile Institute.
    Wallin, Peter
    HPI Health Profile Institute.
    Söderling, Jonas
    Karolinska Institutet.
    Hemmingsson, Erik
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap. Karolinska Institutet.
    Ekblom, Björn
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Decline in cardiorespiratory fitness in the Swedish working force between 1995 and 2017.2019Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 29, nr 2, s. 232-239Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9. 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.2010Inngår i: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 30, nr 5, s. 354-9Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 10.
    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.2014Inngår i: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, nr 9, s. 769-79Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 11.
    Hemmingsson, Erik
    Karolinska institutet.
    Does medically induced weight loss improve obstructive sleep apnoea in the obese: review of randomized trials.2011Inngår i: Clinical Obesity, ISSN 1758-8103, E-ISSN 1758-8111, Vol. 1, nr 1, s. 26-30Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 12.
    Hemmingsson, Erik
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap. Karolinska insitutet.
    Early Childhood Obesity Risk Factors: Socioeconomic Adversity, Family Dysfunction, Offspring Distress, and Junk Food Self-Medication.2018Inngår i: Current Obesity Reports, E-ISSN 2162-4968, Vol. 7, nr 2, s. 204-209Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 13.
    Hemmingsson, Erik
    Karolinska institutet.
    Prognosis in obesity: obstacles must be removed to prevent obesity through increased physical activity.2005Inngår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 331, nr 7514Artikkel i tidsskrift (Annet vitenskapelig)
  • 14.
    Hemmingsson, Erik
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap.
    Slutbantat: förstå din kropp och få en vikt som håller livet ut2018Bok (Annet (populærvitenskap, debatt, mm))
    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.

  • 15.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Ekelund, U
    Is the association between physical activity and body mass index obesity dependent?2007Inngår i: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 31, nr 4, s. 663-8Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 16.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Ekelund, Ulf
    Udden, Joanna
    Bicycling but not walking is independently associated with fasting insulin in abdominally obese women.2011Inngår i: Journal of Physical Activity and Health, ISSN 1543-3080, E-ISSN 1543-5474, Vol. 8, nr 6, s. 820-3Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 17.
    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.2008Inngår i: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 16, nr 6, s. 1731-8Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 18.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Johansson, K
    Reynisdottir, S
    Effects of childhood abuse on adult obesity: a systematic review and meta-analysis.2014Inngår i: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 15, nr 11, s. 882-93Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 19.
    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.2012Inngår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 96, nr 5, s. 953-61Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 20.
    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.2011Inngår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 93, nr 2, s. 474-474Artikkel i tidsskrift (Fagfellevurdert)
  • 21.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Rössner, Stephan
    [Physical activity in the treatment of obesity. Obesity--a chronic disease requiring life-long physical activity].2004Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, nr 20, s. 1790-7Artikkel i tidsskrift (Annet vitenskapelig)
  • 22.
    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.2009Inngår i: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 33, nr 6, s. 645-52Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 23.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Uddén, Joanna
    Neovius, Martin
    No apparent progress in bioelectrical impedance accuracy: validation against metabolic risk and DXA.2009Inngår i: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 17, nr 1, s. 183-7Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 24.
    Hemmingsson, Erik
    et al.
    Karolinska institutet.
    Uddén, Joanna
    Rössner, Stephan
    Diet and physical activity interventions in severely obese adults.2011Inngår i: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 305, nr 6, s. 563-564Artikkel i tidsskrift (Fagfellevurdert)
  • 25. 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.2014Inngår i: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 38, nr 2, s. 279-84Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 26. 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.2011Inngår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 342, artikkel-id d3017Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 27. 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.2014Inngår i: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 99, nr 1, s. 14-23Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 28. 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.2009Inngår i: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 339, artikkel-id b4609Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 29. Juul, Filippa
    et al.
    Hemmingsson, Erik
    Karolinska institutet.
    Trends in consumption of ultra-processed foods and obesity in Sweden between 1960 and 2010.2015Inngår i: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, nr 17, s. 3096-107Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 30.
    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.2009Inngår i: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 16, nr 1, s. 80-4Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 31. 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.2002Inngår i: International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, Vol. 26, nr 5Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 32. Neovius, Martin
    et al.
    Hemmingsson, Erik
    Karolinska institutet.
    Freyschuss, Bo
    Uddén, Joanna
    Bioelectrical impedance underestimates total and truncal fatness in abdominally obese women.2006Inngår i: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 14, nr 10, s. 1731-8Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 33. Neovius, Martin
    et al.
    Uddén, Joanna
    Hemmingsson, Erik
    Karolinska institutet.
    Assessment of change in body fat percentage with DXA and eight-electrode BIA in centrally obese women.2007Inngår i: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 39, nr 12, s. 2199-203Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: To compare estimates of change in percent body fat (Delta%BF) between DXA and BIA8 in abdominally obese women.

    METHODS: Six-month longitudinal study of 106 women (baseline: age 48.2 +/- 7.6 yr; BMI 30.4 +/- 2.9 kg.m; %BFDXA 45.8 +/- 3.6%) participating in an exercise-oriented behavior-change program (walking and bicycling). Fatness was measured by DXA and Tanita BC-418 (BIA8). Agreement between methods was assessed, and regression analysis was used to find predictors of the deviation between methods for estimating changes in fat mass percentage.

    RESULTS: The methods differed significantly, both at baseline and follow-up (-5.0 and -4.4%BF, respectively; both P < 0.001). The mean Delta%BF was -1.1 +/- 2.5%BFDXA and -0.5 +/- 2.2%BFBIA8 (mean difference between methods 0.6 +/- 1.8%BF; P < 0.001; 95% limits of agreement -3.0 to 4.2%BF), with a range of -14.8 to 3.3%BFDXA and -9.4 to 3.5%BFBIA8. Approximately 49% of the variation in the difference between methods was explained by variations in age (beta = -0.05; P = 0.006), DeltaBMI (beta = 0.98; P < 0.001), and Delta%BFDXA (beta = -0.71; P < 0.001), indicating that the larger the change, the greater the discrepancy between methods.

    CONCLUSION: The difference between methods regarding Delta%BF was statistically significant, but it was of small magnitude. However, with increasing Delta%BF, increasing discrepancies were observed, implying that the BIA equipment may have limited validity for detecting larger fat losses. Both clinicians and researchers may benefit from awareness of this potential limitation.

  • 34.
    Olsson, Sven Johan Gustav
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Börjesson, Mats
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Ekblom Bak, Elin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Hemmingsson, Erik
    Karolinska Institutet.
    Hellénius, Mai-Lis
    Karolinska Institutet.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Effects of the Swedish physical activity on prescription model on health-related quality of life in overweight older adults: a randomised controlled trial2015Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, artikkel-id 687Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    The effects of physical activity on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear. We therefore aimed to explore the effects of the Swedish PAP model on HRQoL in overweight older adults.

    Methods

    Participants were recruited from a cohort of men and women born between 1937 and 1938, and living in Stockholm County. Inclusion criteria were; insufficiently physically active, i.e. <30 min of at least moderate intensity physical activity (PA) per day; body mass index >25 kg/m 2 ; and waist circumference ≥102 cm (men) or ≥88 cm (women). Altogether, 101 individuals, aged 67 years, were randomly assigned to two parallel groups: intervention group (n = 47) receiving individualised PAP or control group (n = 54). The 36-item Short Form Health Survey (SF-36) was administered before and after the six months intervention. Main outcomes were the SF-36 physical component summary (PCS) and mental component summary (MCS) scores. Intention to treat analysis was utilised. Regression analysis was performed to assess whether changes in PA and body weight affected changes in HRQoL.

    Results

    At the six months follow-up, regarding the MCS score, the intervention group had improved significantly more (median: 4.4 [interquartile range (IQR): −2.4 to 23.3]) vs (median: 0.0 [IQR: −4.0 to 4.9]); p < 0.05) and a higher proportion of participants had attained relevant improvements (OR 2.43 (95 % CI 1.00–5.88) p < 0.05) compared to the controls. A within group improvement in the PCS score (median: 3.8 [IQR: −1.9 to 19.5] p < 0.05) was found in the intervention group. Changes in PA and body weight had a small, but significant, mediating effect on the changes in HRQoL.

    Conclusions

    PAP had a positive effect on HRQoL, measured by the SF-36 MCS, but no significant between group effect was seen on the PCS in overweight older adults. These effects were, to some extent, mediated by changes in PA and body weight. Our findings support clinical use of the Swedish PAP model.

    Trial registration

    ClinicalTrials.gov NCT02320760.

  • 35. Rössner, S
    et al.
    Hammarstrand, M
    Hemmingsson, Erik
    Karolinska institutet.
    Neovius, M
    Johansson, K
    Long-term weight loss and weight-loss maintenance strategies.2008Inngår i: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 9, nr 6, s. 624-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    It has been suggested that about 20% of subjects undergoing weight-loss programmes can achieve a certain degree of long-term success. At present, surgery remains the only method resulting in long-term sustained weight loss, but access remains restricted. Hence it is important to analyse, in addition to pharmacotherapy, the methods to improve the effects of diet, exercise and behavioural modification. Since these techniques are less spectacular than others, there is a risk that their potential will be overlooked, in spite of the fact that they remain the main alternative for most subjects undergoing weight-loss therapy. This review summarizes realistic treatment alternatives and also provides data from a day care treatment, a strategy not much reported in the literature. This is a standard treatment modality for diabetes but less common in obesity treatment.

  • 36.
    Salier Eriksson, Jane
    et al.
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, FoU-gruppen för rörelse, hälsa och miljö.
    Ekblom, Björn
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet, Björn Ekbloms forskningsgrupp.
    Kallings, Lena
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Hemmingsson, Erik
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Andersson, Gunnar
    HPI Health Profile Institute.
    Wallin, Peter
    HPI Health Profile Institute.
    Ekblom, Örjan
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Ekblom Bak, Elin
    Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, Åstrandlaboratoriet.
    Active commuting in Swedish workers between 1998 and 2015 - trends, characteristics and cardiovascular disease risk.2019Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Trend analyses of active commuting and potential variations in trends and association with cardiovascular disease (CVD) risk within sub-groups are unknown.

    OBJECTIVES: To a) describe trends in active commuting between 1998 to 2015 and b) to study the association between different amounts of active commuting and the incidence risk of CVD in a large sample of Swedish workers, and analyses of potential variations across sub-groups of socio-demographics, physical activity and BMI.

    METHODS: A total of 318,309 participants (47% women, 18-74 years) who participated in a nationwide occupational health service screening between 1998 and 2015 were included. Commuting habits were self-reported, and data on first-time CVD events were derived from national registers.

    RESULTS: Self-reported passive commuters decreased between 1998 and 2015 (64% to 56%), transferring to an increase in mainly moderate/high-dose active commuters (12% to 19%). Changes were seen in all subgroups. The characteristics and life-style habits of the typical passive and active commuter changed little over the study period. Low- and moderate/high-dose active commuters had significantly decreased risks for a first time CVD during follow-up. This was accentuated in men, middle-aged and in participants with light physical work situations, irregular exercise habits, being overweight/obese and with low fitness.

    CONCLUSION: Increases in active commuting were observed between 1998 and 2015, however still leaving a majority who do not actively commute. As active commuting, regardless dose, is associated with a lower CVD risk, encouraging more people to actively commute may provide an easily accessible and time-efficient possibility to increase physical activity and health in the general population.

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