Eastern Research Group

Morrisville, NC, United States

Eastern Research Group

Morrisville, NC, United States
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Chaput J.-P.,Eastern Research Group | Saunders T.J.,University of Prince Edward Island | Carson V.,University of Alberta
Obesity Reviews | Year: 2017

Research examining the health effects of physical activity, sedentary behaviour and sleep on different health outcomes has largely been conducted independently or in isolation of the other behaviours. However, the fact that time is finite (i.e. 24 h) suggests that the debate on whether or not the influence of a single behaviour is independent of another one is conceptually incorrect. Time spent in one behaviour should naturally depend on the composition of the rest of the day. Recent evidence using more appropriate analytical approaches to deal with this methodological issue shows that the combination of sleep, movement and non-movement behaviours matters and all components of the 24-h movement continuum should be targeted to enhance health and prevent childhood obesity. The objective of this review is to discuss research investigating how combinations of physical activity, sedentary behaviour and sleep are related to childhood obesity. Emerging statistical approaches (e.g. compositional data analysis) that can provide a good understanding of the best ‘cocktail’ of behaviours associated with lower adiposity and improved health are also discussed. Finally, future research directions are provided. Collectively, it becomes clearer that guidelines and public health interventions should target all movement behaviours synergistically to optimize health of children and youth around the world. © 2017 World Obesity Federation


Traversy G.,Eastern Research Group | Chaput J.-P.,Eastern Research Group
Current obesity reports | Year: 2015

Recreational alcohol intake is a widespread activity globally and alcohol energy (7 kcal/g) can be a contributing factor to weight gain if not compensated for. Given that both excessive alcohol intake and obesity are of public health interest, the present paper provides an update on the association between alcohol consumption and body weight. In general, recent prospective studies show that light-to-moderate alcohol intake is not associated with adiposity gain while heavy drinking is more consistently related to weight gain. Experimental evidence is also mixed and suggests that moderate intake of alcohol does not lead to weight gain over short follow-up periods. However, many factors can explain the conflicting findings and a better characterization of individuals more likely to gain weight as a result of alcohol consumption is needed. In particular, individuals who frequently drink moderate amounts of alcohol may enjoy a healthier lifestyle in general that may protect them from weight gain. In conclusion, despite the important limitations of current studies, it is reasonable to say that alcohol intake may be a risk factor for obesity in some individuals, likely based on a multitude of factors, some of which are discussed herein.


BACKGROUND:: Patient-centered medical home (PCMH) has gained prominence as a promising model to encourage improved primary care delivery. There is a paucity of studies that evaluate the impact of payment models in the PCMH. OBJECTIVES:: We sought to examine whether coupling coordinated, team-based care transformation plan with a novel reimbursement model affects outcomes related to expenditures and utilization. RESEARCH DESIGN:: Interrupted time-series model with a difference-in-differences approach to assess differences between intervention and control groups, across time periods attributable to PCMH transformation and/or payment change. RESULTS:: Although results were modest and mixed overall, PCMH with payment reform is associated with a reduction of $1.04 (P=0.0347) per member per month (PMPM) in pharmacy expenditures. Patients with hypertension, hyperlipidemia, diabetes, and coronary atherosclerosis enrolled in PCMH without payment reform experienced reductions in emergency department visits of 2.16 (P<0.0001), 2.42 (P<0.0001), 3.98 (P<0.0001), and 3.61 (P<0.0001) per 1000 per month. Modest increases in inpatient admission were seen among these patients in PCMH either with or without payment reform. Patients 65 and older enrolled in PMCH without payment reform experienced reductions in pharmacy expenditures $2.35 (P=0.0077) PMPM with a parallel reduction in pharmacy standardized cost of $2.81 (P=0.0174) PMPM indicative of a reduction in the intensity of drug utilization. CONCLUSIONS:: We conclude that PCMH implementation coupled with an innovative payment arrangement generated mixed results with modest improvements with respect to pharmacy expenditures, but no overall financial improvement. However, we did see improvement within specific groups, especially older patients and those with chronic conditions. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.


Kanagasabai T.,York University | Chaput J.-P.,Eastern Research Group
Sleep Health | Year: 2017

Objectives To identify the sleep duration associated with the lowest cardiometabolic risk score in adults and to determine if the association varies by subgroups (eg, sex, age groups, ethnicity, and smoking status). Design Cross-sectional data from the 2005–2012 National Health and Nutrition Examination Survey. Setting Non-institutionalized civil sample from the United States. Participants Age ≥20 y (N = 8827) with sleep and cardiometabolic health data. Interventions N/A. Measurements Sleep duration from the Sleep Disorders Questionnaire was categorized as ≤3, 4, 5, 6, 7, 8, 9, and ≥10 h per night. HDL cholesterol (HDL) and waist circumference (WC) were stratified by sex first, while fasting insulin, fasting plasma glucose (Glu), triglycerides (TG), body max index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were standardized without stratifications. The standardized scores were summed for each participant using the following formula: −zHDL + zInsulin + zGlu + zTG + (zBMI + zWC)/2 + (zSBP + zDBP)/2. Results Seven hours of sleep was associated with the lowest cardiometabolic risk score (−0.30 (95% CI: −0.43, −0.18)), which remained similar after adjusting for age, sex, ethnicity, education, family income, alcohol intake and smoking status. However, 8 hours of sleep was associated with the lowest score in non-Hispanic Blacks. Conclusions This study supports recent sleep duration recommendations in adults, and provides evidence that in general 7 hours of sleep per night is associated with optimal cardiometabolic health of adults. Longitudinal studies using objective measures of sleep would help further clarify this association. © 2017 National Sleep Foundation.


Tremblay A.,Laval University | Chaput J.-P.,Eastern Research Group
Physiology and Behavior | Year: 2012

The obesity epidemic that is prevailing in most countries of the world is generally attributed to the increased amount of opportunities to be in positive energy balance in a context of modernity. This obviously refers not only to sedentariness and unhealthy eating that may dominate life habits of many individuals but also to unsuspected non-caloric factors which produce discrete allostatic changes in the body. In this paper, the focus is put on the impact of some of these factors with the preoccupation to document the allostatic burden of weight loss. Thus, beyond the fact that modernity favors opportunities to eat much and not to be active, the proposed conceptual integration leads to the conclusion that a modern lifestyle makes weight loss more difficult for obese individuals. In addition to the natural effects of weight loss favoring resistance to lose fat, a lifestyle promoting shorter sleep duration and more cognitive demand produces allostatic changes that may interfere with weight loss. The case of persistent organic pollutants (POPs) is also discussed as an example of the potential detrimental effects of a contaminated environment on metabolic processes involved in the control of energy expenditure. Taken together, these observations suggest that weight loss is more than ever a search for compromise between its metabolic benefits and its allostatic effects promoting body weight regain. © 2011 Elsevier Inc.


Chaput J.-P.,Eastern Research Group | Doucet E.,University of Ottawa | Tremblay A.,Laval University
Obesity Reviews | Year: 2012

Obesity is characterized by the accumulation of excess body fat and can be conceptualized as the physical manifestation of chronic energy excess. An important challenge of today's world is that our so-called obesogenic environment is conducive to the consumption of energy and unfavourable to the expenditure of energy. The modern, computer-dependent, sleep-deprived, physically inactive humans live chronically stressed in a society of food abundance. From a physiological standpoint, the excess weight gain observed in prone individuals is perceived as a normal consequence to a changed environment rather than a pathological process. In other words, weight gain is a sign of our contemporary way of living or a 'collateral damage' in the physiological struggle against modernity. Additionally, substantial body fat loss can complicate appetite control, decrease energy expenditure to a greater extent than predicted, increase the proneness to hypoglycaemia and its related risk towards depressive symptoms, increase the plasma and tissue levels of persistent organic pollutants that promote hormone disruption and metabolic complications, all of which are adaptations that can increase the risk of weight regain. In contrast, body fat gain generally provides the opposite adaptations, emphasizing that obesity may realistically be perceived as an a priori biological adaptation for most individuals. Accordingly, prevention and treatment strategies for obesity should ideally target the main drivers or root causes of body fat gain in order to be able to improve the health of the population. © 2012 The Authors. obesity reviews © 2012 International Association for the Study of Obesity.


Thivel D.,Clermont University | Thivel D.,Eastern Research Group | Chaput J.-P.,Eastern Research Group | Chaput J.-P.,University of Ottawa
Sports Medicine | Year: 2014

The effect of physical activity on energy balance is not restricted to its induced energy expenditure but also affects the control of energy intake and appetite. Although it is now clear that physical exercise affects subsequent energy intake and appetite, the mechanisms involved remain uncertain. Most previous studies have assessed both post-exercise energy intake and appetite but mainly focussed their analyses on food consumption, and it remains unclear whether changes in appetite provide an accurate reflection of changes in energy intake. This brief review aims to analyse conjointly the effective energy intake and appetite sensation responses to acute exercise in children and adolescents to examine whether or not these responses to exercise are coupled. After an overview of the available literature, we conclude that acute exercise has an uncoupling effect on energy intake and appetite sensations in both lean and overweight/obese youth. Although methodological issues between studies can be highlighted, lack of consideration of inter-individual variability in terms of energy intake and appetite could be one of the main explanations for such a conclusion. It now appears necessary to further consider the impact of acute exercise and then chronic physical activity on an individual basis in the regulation of energy balance to prescribe successful weight loss programmes. © 2014 Springer International Publishing Switzerland.


Shields M.,Health Information and Research Division | Tremblay M.S.,Eastern Research Group
International Journal of Pediatric Obesity | Year: 2010

Objective. This article compares prevalence estimates of excess weight among Canadian children and youth according to three sets of body mass index (BMI) reference cut-points. The cut-points are based on growth curves generated by the World Health Organization (WHO), the International Obesity Task Force (IOTF), and the US Centers for Disease Control (CDC). A secondary objective is to compare estimates by method of data collection. Methods. Prevalence estimates of overweight and obesity were produced for 2- to 17-year-olds using the three sets of BMI cut-points. Estimates are based on data from 8 661 respondents from the 2004 Canadian Community Health Survey and 1 840 respondents from the 1978/79 Canada Health Survey. In both surveys, the height and weight of children were measured. Results. The 2004 prevalence estimate for the combined overweight/obese category is higher (35%) when based on the WHO cut-points compared with the IOTF (26%) or CDC (28%) cut-points. Estimates of the prevalence of obesity are similar based on WHO and CDC cut-points (13%), but lower when based on IOTF cut-points (8%). Absolute differences in excess weight estimates between 1978/79 and 2004 are similar based on the three sets of cut-points, but the relative increase is greater when based on the IOTF cut-points. Estimates vary substantially by method of data collection. Conclusion. When interpreting prevalence estimates of overweight and obesity for children and youth, it is important to consider the definitions used and the method of data collection. © 2010 Informa UK Ltd.


Chaput J.-P.,Eastern Research Group
Physiology & behavior | Year: 2014

There is increasing evidence showing that sleep has an influence on eating behaviors. Short sleep duration, poor sleep quality, and later bedtimes are all associated with increased food intake, poor diet quality, and excess body weight. Insufficient sleep seems to facilitate the ingestion of calories when exposed to the modern obesogenic environment of readily accessible food. Lack of sleep has been shown to increase snacking, the number of meals consumed per day, and the preference for energy-rich foods. Proposed mechanisms by which insufficient sleep may increase caloric consumption include: (1) more time and opportunities for eating, (2) psychological distress, (3) greater sensitivity to food reward, (4) disinhibited eating, (5) more energy needed to sustain extended wakefulness, and (6) changes in appetite hormones. Globally, excess energy intake associated with not getting adequate sleep seems to be preferentially driven by hedonic rather than homeostatic factors. Moreover, the consumption of certain types of foods which impact the availability of tryptophan as well as the synthesis of serotonin and melatonin may aid in promoting sleep. In summary, multiple connections exist between sleep patterns, eating behavior and energy balance. Sleep should not be overlooked in obesity research and should be included as part of the lifestyle package that traditionally has focused on diet and physical activity. © 2013.


Chaput J.-P.,Eastern Research Group | Tremblay A.,Laval University
Obesity Facts | Year: 2012

Objective: To verify whether sleep quantity and quality at baseline predict the magnitude of fat loss in adults subjected to moderate caloric restriction. Methods: A total of 123 overweight and obese men and women (age, 41.1 ± 6.0 years; BMI, 33.2 ± 3.6 kg/m2 (mean ± SD)) underwent a weight loss intervention consisting of a targeted 600-700 kcal/day decrease in energy intake supervised by a dietician. The length of the intervention varied between 15 and 24 weeks. Body fat mass (dual-energy X-ray absorptiometry), sleep quality (total Pittsburgh Sleep Quality Index score) and sleep duration (h/night, self-reported from the Pittsburgh Sleep Quality Index) were assessed at both baseline and at the end of the weight loss program. Results: The mean weight loss over the dietary intervention was 4.5 ± 3.9 kg, 76% of which came from fat stores. Using a multiple linear regression analysis, we observed a significant positive relationship between sleep duration and the loss of body fat, both in absolute (adjusted β = 0.72 kg/h; p < 0.05) as well as in relative terms (adjusted β = 0.77%/h; p < 0.01), after adjusting for age, sex, baseline BMI, length of the intervention, and change in total energy intake. Furthermore, we observed that a better sleep quality at baseline was associated with greater fat mass loss. Conclusion: This study provides evidence that sleeping habits can influence the success of a weight loss intervention and should be taken into consideration when one decides to start a diet. Copyright © 2012 S. Karger GmbH, Freiburg.

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