• Comparison of Self-reported and Measured Pre-pregnancy Weight: Implications for Gestational Weight Gain Counseling

      Bannon, Annika L.; Waring, Molly E.; Leung, Katherine; Masiero, Jessica; Stone, Julie M.; Scannell, Elizabeth C.; Moore Simas, Tiffany A. (2017-02-02)
      Objectives: To examine clinical and demographic characteristics associated with availability of self-reported and measured pre-pregnancy weight, differences in these parameters, and characteristics associated with self-report accuracy. Methods: Retrospective cohort of 7483 women who delivered at a large academic medical center between 2011 and 2014. Measured pre-pregnancy weights recorded within a year of conception and self-reported pre-pregnancy weights reported anytime during pregnancy were abstracted from electronic medical records. Difference in weights was calculated as self-reported minus measured pre-pregnancy weight. Logistic and linear regression models estimated associations between demographic and clinical characteristics, and presence of self-reported and measured weights, and weight differences. Results: 42.2% of women had both self-reported and measured pre-pregnancy weight, 49.7% had only self-reported, and 2.8% had only measured. Compared to white women, black women and women of other races/ethnicities were less likely to have self-reported weight, and black, Asian, and Hispanic women, and women of other races/ethnicities were less likely to have measured weights. For 85%, pre-pregnancy BMI categorized by self-reported and measured weights were concordant. Primiparas and multiparas were more likely to underreport their weight compared to nulliparas (b = -1.32 lbs, 95% CI -2.24 to -0.41 lbs and b = -2.74 lbs, 95% CI -3.82 to -1.67 lbs, respectively). Discussion: Utilization of self-reported or measured pre-pregnancy weight for pre-pregnancy BMI classification results in identical categorization for the majority of women. Providers may wish to account for underreporting for patients with a BMI close to category cutoff by recommending a range of gestational weight gain that falls within recommendations for both categories where feasible.
    • Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study

      Nguyen, U-S D. T.; Hillstrom, H. J.; Li, Wenjun; Dufour, A. B.; Kiel, Douglas P.; Procter-Gray, Elizabeth; Gagnon, M. M.; Hannan, Marian T. (2010-01-01)
      OBJECTIVE: To examine potential risk factors for hallux valgus in community-dwelling elders. METHOD: Data from 600 MOBILIZE Boston Study participants (386 women and 214 men) were analyzed. Hallux valgus was defined as >15 degrees angular deviation of the hallux with respect to the first metatarsal bone toward the lesser toes. Associations of hallux valgus with age, body mass index (BMI), race, education, pes planus, foot pain, and in women, history of high heel shoe use, were assessed using sex-specific Poisson regression with robust variance estimation for risk ratios (RR) and 95% confidence intervals (CI). RESULTS: Hallux valgus was present in 58% of women and 25% of men. Higher BMI was inversely associated with presence of hallux valgus in women (P trend=0.001), with the strongest inverse association observed in those with BMI of 30.0 or more compared to those with normal BMI (RR=0.7, 95% CI: 0.5, 0.9). Women, who usually wore high-heeled shoes during ages 20-64 years compared to those who did not, had increased likelihood of hallux valgus (RR=1.2, 95% CI: 1.0, 1.5). Among men, those with BMI between 25.0 and 29.9 had increased likelihood of hallux valgus compared to those with normal BMI (RR=1.9, 95% CI: 1.0, 3.5). Men with pes planus were more likely to have hallux valgus (RR=2.1, 95% CI: 1.3, 3.3) compared to men without pes planus. CONCLUSION: In women, hallux valgus was associated with lower BMI and high heel use during ages 20-64, while in men, associations were observed with higher BMI and pes planus. Our results suggest that the etiologic mechanisms for hallux valgus may differ between men and women. Elsevier Ltd. All rights reserved.
    • Food Insecurity and Obesity: Exploring the Role of Social Support

      Ashe, Karen M.; Lapane, Kate L. (2017-11-28)
      BACKGROUND: Women are disproportionately affected by both obesity and food insecurity. Food insecurity occurs when there is limited ability to acquire adequate foods. It is unknown whether social support can reduce the effect of food insecurity on increased obesity. This study seeks to determine whether social support modifies the relationship between food insecurity and obesity. METHODS: We conducted a cross-sectional study in a nationally representative sample of 4672 women aged > /=40 years using National Health and Nutrition Examination Survey (2003-2008). Individual food insecurity was assessed based on the U.S. Department of Agriculture 18-item validated household food security scale. Women were categorized as fully food secure (0 affirmative responses) or food insecure (1-10 affirmative responses). Obesity was defined as body mass index > /=30 kg/m(2). Outcomes were analyzed by multivariable logistic regression. RESULTS: Fourteen percent were food insecure. Women with food insecurity had 1.4 the odds of obesity as those who were fully food secure, adjusting for race/ethnicity and health status (95% confidence interval [CI] 1.22-1.62). Food-insecure women were 80% less likely to report strong social support than women who were fully food secure (95% CI 0.11-0.36). Social support as measured in this study did not modify the association between food insecurity and obesity. CONCLUSIONS: Women reporting food insecurity reported lower levels of social support and were more likely to experience obesity. Interventions to reduce obesity in women who are food insecure must consider the limited resources available to these women.
    • Home Matters: Adolescents Drink More Sugar-Sweetened Beverages When Available at Home

      Haughton, Christina; Waring, Molly E.; Wang, Monica L.; Rosal, Milagros C.; Pbert, Lori; Lemon, Stephenie C. (2018-07-18)
      OBJECTIVES: To examine the association between sugar-sweetened beverage availability at home and sugar-sweetened beverage consumption, and to evaluate whether this association was consistent across school and school neighborhood sugar-sweetened beverage availability. STUDY DESIGN: Secondary data analyses were performed from the 2014 cross-sectional, Internet-based Family Life, Activity, Sun, Health, and Eating (FLASHE) study of 1494 adolescents (age 12-17 years). Ordinal logistic regression analyses were conducted to examine the association between sugar-sweetened beverage availability in the home and adolescents' frequency of sugar-sweetened beverage consumption (nondaily, < 1; daily, 1- < 2; daily, > /=2), adjusting for adolescent age, sex, race, and body mass index and parent marital status and housing insecurity. Stratified ordinal logistic regression analyses were used to examine the associations by school and school neighborhood sugar-sweetened beverage availability. RESULTS: One-third (32.6%) of adolescents were nondaily consumers of sugar-sweetened beverages, 33.9% consumed 1- < 2 sugar-sweetened beverages daily, and 33.5% consumed > /=2 sugar-sweetened beverages daily. Almost one-half (44.4%) reported that sugar-sweetened beverages were often or always available in the home. Frequency of sugar-sweetened beverage availability at home was associated with greater sugar-sweetened beverage consumption (OR, 2.88; 95% CI, 2.86-2.89 for rarely/sometimes available at home; OR. 5.62; 95% CI, 5.60-5.64 for often/always available at home). Similar associations were found regardless of the availability of sugar-sweetened beverages in the adolescent's school or school neighborhood. CONCLUSIONS: Sugar-sweetened beverage availability in the home was associated with adolescent sugar-sweetened beverage consumption, regardless of sugar-sweetened beverage availability in other settings, and may be a key target for obesity prevention efforts.
    • Impact of Body Mass Index and Weight Change on Risk of Recurrence in Patients Treated for Endometrial Adenocarcinoma

      DeGregorio, Geneva A.; Leung, Katherine; Bradford, Leslie S. (2017-05-16)
      Background: Obesity is a well-documented risk factor for EAC, but the relationship between obesity and disease recurrence is controversial. Additionally, body weight is an inherently dynamic variable and no studies have examined the relationship between interval weight change and risk of EAC recurrence. Objectives: To identify if there is a relationship between body mass index (BMI) or interval weight change and the risk of disease recurrence among women treated for EAC. Methods: We conducted a retrospective chart review of 337 women diagnosed and treated surgically for EAC at UMass Memorial Medical Center from 2010 to 2015. The effect of BMI on risk of disease recurrence was assessed by Cox proportional hazards model adjusting for age, FIGO stage, myometrial invasion, lymphovascular space involvement and status of adjuvant therapy. The effect of interval weight change on EAC recurrence was assessed using logistic regression, adjusting for BMI and recurrence free interval. Results: Among 337 women diagnosed with EAC, mean BMI at diagnosis was 35.9 pounds (SD: 8.9), mean weight at diagnosis was 201.5 pounds (SD: 52.7) and mean interval weight change was -8.1 pounds (SD: 18.8). At time of data extraction there were 19 patients (5.7%) with disease recurrence. The hazard ratio for recurrence in women with BMI >50 was 11.4 [95%CI: 1.54-84.05] times that of women with BMI(p=0.02). Women who maintained or gained weight following primary surgical resection had no increased risk of recurrence compared to those who lost weight [OR: 1.02, 95%CI: 0.27-3.82] (p=0.97). Conclusion: Women with extreme obesity at diagnosis are more likely to have disease recurrence following primary surgical treatment for endometrial adenocarcinoma. However, women who lose weight following primary surgical treatment of EAC are just as likely to have disease recurrence as those who maintain or gain weight.
    • Physical impairment and body weight history in postmenopausal women: the Women's Health Initiative

      Wanigatunga, Amal A.; Sourdet, Sandrine S.; Lamonte, Michael J.; Waring, Molly E.; Nassir, Rami; Garcia, Lorena; Bea, Jennifer W.; Seguin, Rebecca A.; Ockene, Judith K.; Sarto, Gloria E.; et al. (2016-06-08)
      OBJECTIVE: To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women. DESIGN: BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association between BMI at age 18 years and BMI transitions over adulthood on severe physical impairment (SPI), defined as scoring < 60 on the Physical Functioning subscale of the Rand thirty-six-item Short-Form Health Survey. SETTING: Participants were part of the Women's Health Initiative Observational Study (WHI OS), where participants' health was followed over time via questionnaires and clinical assessments. SUBJECTS: Postmenopausal women (n 76 016; mean age 63.5 (sd 7.3) years). RESULTS: Women with overweight (BMI=25.0-29.9 kg/m2) or obesity (BMI > /=30.0 kg/m2) at 18 years had greater odds (OR (95 % CI)) of SPI (1.51 (1.35, 1.69) and 2.14 (1.72, 2.65), respectively) than normal-weight (BMI=18.5-24.9 kg/m2) counterparts. Transitions from normal weight to overweight/obese or to underweight (BMI < 18.5 kg/m2) were associated with greater odds of SPI (1.97 (1.84, 2.11) and 1.35 (1.06, 1.71), respectively) compared with weight stability. Shifting from underweight to overweight/obese also had increased odds of SPI (1.52 (1.11, 2.09)). Overweight/obese to normal BMI transitions resulted in a reduced SPI odds (0.52 (0.39, 0.71)). CONCLUSIONS: Higher weight history and transitions into higher weight classes were associated with higher likelihood of SPI, while transitioning into lower weight classes for those with overweight/obesity was protective among postmenopausal women.