Ti le Associa ion be ween pe sonal backg ound and obesi y in adul s om he Basque
Coun y (Spain)
Au ho s
Ma ía Eugenia Ibáñez-Zamacona1,2, Aline Jelenko ic2, Es he Reba o2
1Depa men o Pha macy and Food Science, Facul y o Pha macy, Uni e si y o he
Basque Coun y (UPV/EHU), Bilbao, Spain.
2Depa men o Gene ics, Physical An h opology and Animal Physiology, Facul y o
Science and Technology, Uni e si y o he Basque Coun y (UPV/EHU), Bilbao, Spain.
Co esponding au ho : Es he Reba o
Depa men o Gene ics, Physical An h opology and Animal Physiology, Facul y o
Science and Technology, Uni e si y o he Basque Coun y (UPV/EHU), Bilbao, Spain.
Email: es he . eba[email p o ec ed]
Running i le Associa ion be ween pe sonal backg ound and obesi y
Núme o de Tablas y Figu as 4 Tablas
This is he accep ed manusc ip o he a icle ha appea ed in inal o m in Re is a Española de An opología Física 46 : 29-39
(2022), which has been published in inal o m a h ps://sea .es/index.php/ e is a- ea /235- olumen-46-2022. © 2022 Sociedad
Española de An opología Física unde CC BY-NC-ND license (h p://c ea i ecommons.o g/licenses/by-nc-nd/4.0/)
Abs ac
Obesi y is a complex pheno ype in ol ing an excessi e amoun o body a ha may
impai heal h. Bo h genes and en i onmen a e in ol ed in he de elopmen o obesi y,
wi h amily his o y being conside ed an impo an isk ac o . The aim o his s udy was
o de e mine he deg ee o associa ion o amily his o y o obesi y, obesi y- ela ed
diseases and physical heal h pe cep ion wi h di e en obesi y indica o s, in a sample o
adul popula ion li ing in he Basque Coun y (Spain). The s udy was conduc ed on 521
indi iduals (318 women and 203 men), aged om 19 o 70 yea s. Body mass index,
wais ci cum e ence, wais -hip a io and he pe cen age o a mass we e aken in o
accoun as obesi y indica o s. Mul iple logis ic eg essions we e used o assess he
ela ionship be ween he ou obesi y indica o s and he pe sonal backg ound a iables.
The s eng h o he associa ion be ween pai s o a iables was exp essed in e ms o
Odds Ra ios. The esul s con i med a posi i e and signi ican associa ion be ween
pe sonal backg ound and di e en obesi y indica o s, al hough he magni ude o he
associa ions was di e en o each obesi y measu e. A amily his o y o obesi y,
especially ha ing obese i s -deg ee ela i es, was a clea isk ac o o obesi y
de elopmen (o e all, abdominal and excess o a ); howe e , a dis ibu ion was
associa ed wi h obesi y- ela ed diseases. A bad pe cep ion o physical heal h condi ion
was s ongly ela ed wi h all indica o s o obesi y, especially wi h body mass index and
excess o a ness.
Key wo ds Family his o y o obesi y, Obesi y- ela ed diseases, Physical heal h
pe cep ion, Obesi y indica o s
Resumen
La obesidad es un eno ipo complejo que conlle a una can idad excesi a de g asa
co po al que puede pe judica la salud. Tan o los genes como el ambien e es án
implicados en el desa ollo de la obesidad, conside ándose a los an eceden es amilia es
como un impo an e ac o de iesgo. El obje i o de es e es udio ue de e mina el g ado
de asociación de los an eceden es amilia es de obesidad, las en e medades elacionadas
con la obesidad y la pe cepción de salud ísica con di e en es indicado es de obesidad,
en una mues a de población adul a esiden e en el País Vasco (España). El es udio se
ealizó en 521 indi iduos (318 muje es y 203 homb es) de en e 19 y 70 años. Como
indicado es de obesidad se conside a on el índice de masa co po al, el pe íme o de la
cin u a, la elación cin u a-cade a y el po cen aje de masa g asa. Se usa on eg esiones
logís icas múl iples pa a e alua la elación en e los pa es de a iables; el g ado de
asociación se exp esó en é minos de Odds Ra ios. Los esul ados con i man una
asociación posi i a y signi ica i a en e los an eceden es pe sonales y la obesidad,
aunque los alo es de las asociaciones ue on di e en es pa a cada indicado . Los
an eceden es amilia es de obesidad, especialmen e ene amilia es obesos de p ime
g ado, suponen un ac o de iesgo pa a la obesidad (gene al, abdominal y exceso de
g asa), aunque la dis ibución de g asa no se asoció con es a a iable, sino con las
en e medades elacionadas con la obesidad. Una mala pe cepción del es ado de salud se
asoció con odos los indicado es de obesidad, especialmen e con el índice de masa
co po al y el exceso de adiposidad.
Palab as cla e His o ia amilia de obesidad, En e medades elacionadas con la
obesidad, Pe cepción de la salud ísica, Indicado es de obesidad.
In oduc ion
Obesi y, de ined as an excessi e accumula ion o body a ha may impai heal h
(WHO, 2000), is a complex pheno ype a ec ed by beha iou al and en i onmen al
ac o s, bu also by gene ic and epigene ic ones (Thake , 2017; Rohde e al., 2019; Diels
Vandem Be ge and Wan Hul, 2020). Common obesi y is a widesp ead condi ion in
wes e nized coun ies; howe e , i s incidence is a iable be ween and wi hin
popula ions (Reba o, 2021). Gene ic p o ile (including amily backg ound), sex, age,
and en i onmen al ac o s such as li es yle, socioeconomic s a us (SES) o
psychological ci cums ances, among o he s, a e conside ed key elemen s in obesi y
de elopmen , as hey a e in ol ed in ene gy balance and a s o e/s o age.
A subs an ial gene ic con ibu ion o obesi y isk has been demons a ed by di e en
he i abili y s udies based on nuclea amilies and wins, wi h he i abili ies (h2) o Body
Mass Index (BMI) anging om 47% o 90% in win s udies and 20% o 50% in amily
ones (Elks e al. 2012; Feng, 2016). In addi ion, nea 80 genome-wide linkage s udies
ha e iden i ied mo e han 300 ch omosomal loci wi h sugges i e e idence o linkage o
obesi y ai s (see e iew by Loos and Yeo, 2022). Family his o y hus seems o con e
a p edisposi ion o obesi y, al hough he in e ac ion be ween genes and en i onmen
mus be aken in o accoun ; some imes he li es yle o pa en s can be jus as impo an
as hei gene ics in “passing on” he isk o obesi y o hei child en (Bah eynian e al.,
2017).
Obesi y is associa ed wi h se e al como bidi ies, such as ype 2 diabe es, ca dio ascula
disease, kidney diseases, cance in a leas 13 ana omical loca ions, musculoskele al
diso de s and in ec ions (A ge inos e al., 2019; Sawadogo e al., 2021; Ki imäki e al.,
2022); in his la e case, as e idenced du ing he ecen COVID pandemic (Ba e o
Pa a idino e al., 2022). In addi ion, people wi h obesi y may expe ience disc imina ion
(so-called "obesi y o weigh s igma"), which has an impac on hei psychological and
physical heal h, as well as on hei sel -es eem and pe cep ion o bo h hei body image
and heal h s a us (Puhl and Heue 2010; La ne and S e ano, 2016; Ibáñez-Zamacona,
Po eda and Reba o, 2020, 2021).
The aim o his s udy was o de e mine he deg ee o associa ion o he pe sonal
backg ound ( amily his o y o obesi y, obesi y- ela ed diseases and physical heal h
pe cep ion) wi h di e en obesi y indica o s, in adul s o bo h sexes li ing in he Basque
Coun y (Spain).
Ma e ial and me hods
Sample
The s udy was conduc ed on 521 indi iduals (318 women and 203 men), aged om 19
o 70 yea s, li ing in he Basque Coun y (Spain). A la ge pe cen age o he sample
(77.7%) was bo n in he Basque Coun y, as we e hei pa en s (52%); he es a e om
o he Spanish egions, mainly Cas ile and Leon (20.8%). In e ms o socioeconomic
s a us (SES), and based on educa ional and p o essional le els, he sample was
conside ed o be middle class ( o de ails see Ibáñez Pé ez-Zamacona, 2017). Bo h
indi iduals wi h and wi hou obesi y we e well ep esen ed (case-con ol s udy design).
In acco dance wi h he Helsinki Decla a ion, w i en in o med consen was ob ained
om all pa icipan s in he s udy. The esea ch was app o ed by he E hics Commi ee
o Resea ch In ol ing Human Beings o he Uni e si y o he Basque Coun y
(UPV/EHU).
Obesi y indica o s and pe sonal backg ound
Heigh , body weigh , wais and hip ci cum e ences (WC, HC), and ou skin olds
(biceps, iceps, subscapula and sup ailiac) we e aken ollowing s anda d c i e ia
(Lohman, Roche and Ma o ell, 1988) by ained pe sonnel (M.E.I.). Fou obesi y
indica o s we e conside ed: BMI (kg/m2) as an index o o e all obesi y, wais
ci cum e ence (WC, cm) as an es ima o o abdominal a (i.e. in e nal a deposi s),
wais -hip a io (WHR=WC/HC) as a measu e o a dis ibu ion, and a mass
pe cen age (FM%) as an e alua o o adiposi y. FM% was calcula ed by using Si i's
(1961) equa ion based on body densi y (D) ob ained om he gene al equa ion o
Du nin and Wome sley (1974), aking in o accoun sex and age. Fo he i s h ee
obesi y indica o s, he cu -o poin s we e he es ablished by he WHO (2000, 2011),
and o FM% he c i e ia o he Spanish Socie y o he S udy o Obesi y (Campillo e
al., 2000). Based on hese cu -o poin s, he obesi y indica o s we e dicho omised o
s a is ical ea men as ollows:
a) Obesi y (BMI≥30 kg/m2) s. non-obesi y (BMI<30 kg/m2); b) Abdominal obesi y
(WC>88 cm in women and >102 cm in men) s. no abdominal obesi y (WC≤ 88 cm in
women, and ≤102 cm in men); c) Cen al a dis ibu ion (WHR≥0.85 in women, and
≥0.90 in men) s. pe iphe al a dis ibu ion (WHR <0.85 in women, and <0.90 in men);
d) Excess o a (FM% >33% in women, and >25% in men) s. no excess a ness (FM%
be ween 20-33% in women, and be ween 12-25% in men).
Pe sonal backg ound was collec ed by means o pe sonal in e iew (M.E.I.), and
included h ee a iables wi h di e en ca ego ies each (eigh in o al):
1) Family his o y o obesi y ha indica es i he pa icipan has any ela i e wi h obesi y
and i s deg ee o ela edness. Ca ego ies: No, 1s deg ee, 2nd deg ee.
2) Obesi y- ela ed diseases ha indica e i he pa icipan has o does no ha e any ype
o obesi y- ela ed disease, namely, ype 2 Diabe es, hype ension, hype choles e olemia,
ca dio ascula and/o espi a o y diseases. Ca ego ies: No, Yes.
3) Physical heal h pe cep ion ha indica es how he pa icipan pe cei es his/he
physical heal h condi ion. Ca ego ies: Good, Regula , Bad.
Da a analysis
The numbe and pe cen age (%) o indi iduals wi h o e all obesi y (BMI≥30 kg/m2) as
well as BMI mean (M) and s anda d de ia ion (SD) we e calcula ed o each ca ego y
o he h ee quali a i e a iables (pe sonal backg ound), sepa a ely o sex and wo age
g oups (<45 yea s and ≥45 yea s). Da a we e es ed o no mali y and homoscedas ici y
using he Kolmogo o -Smi no es (n>50), o he Shapi o-Wilk es (n≤50) and he
Le ene es . Mul iple logis ic eg essions we e used o assess he ela ionship be ween
he ou obesi y indica o s (dependen a iables) and he backg ound a iables
(independen ones). Age, sex and socioeconomic s a us (SES) we e used as co a ia es
o con ol o po en ial con ounding e ec s. The s eng h o he associa ion be ween
pai s o a iables was exp essed in e ms o Odds Ra ios (OR), which measu es he
e ec size. Bon e oni co ec ion o mul iple compa isons was calcula ed (p< 0.0007),
bu he signi icance h eshold was se a p<0.05, due o he sample size and he
con ic ion ha his co ec ion is oo conse a i e.
Resul s
Tables 1 o 3 show he desc ip i e s a is ics o he h ee pe sonal backg ound a iables
in women and men and in bo h age g oups, in addi ion o he co esponding BMI mean
and SD. All indi iduals whose i s -deg ee ela i es we e obese had a highe equency
o obesi y han in he o he wo ca ego ies conside ed o amily his o y o obesi y
(Table 1). Rega ding sex and age, obesi y pe cen ages we e lowe in women (58.3%)
han in men (60.6%) in he oldes age g oup, as well as in he <45 yea s g oup (34% and
40% and in women and men, espec i ely). In indi iduals o e 45 yea s o age wi h
obese second-deg ee ela i es, i is also wo h no ing he high equency o obesi y
(50% in women and 30% in men). The mean BMI was highe in indi iduals whose
i s -deg ee ela i es we e obese, wi h alues o 32.5 and 32.7 o women and men in
he age g oup ≥45 yea s, and o 29.6 (women) and 30.9 (men) o hose unde 45 yea s
o age (Table 1).
As shown in Table 2, 50% o women and 60% o men unde 45 yea s o age who had
some ype o obesi y- ela ed disease we e obese; o he same ca ego y, bu in he age
g oup ≥45 yea s, he pe cen ages o obesi y we e also high, especially in women
(69.8%). Among he indi iduals o e 45 yea s o age who did no epo obesi y- ela ed
diseases, i is wo h no ing a signi ican pe cen age o obese (35.2% o women and
33.3% o men). BMI alues we e e y high in indi iduals who epo ed ha ing some
ype o obesi y- ela ed disease, wi h alues anging om 40.2 ( he maximum) o 31.3
( he minimum), compa ed o hose who epo ed none, whose BMI anged om 26.4 o
29 (Table 2).
Table 3 shows ha a la ge pe cen age o women and men ha epo ed o ha e a bad
physical heal h pe cep ion we e obese (54.8% o women and 64.7% o men <45 yea s,
and 74.4% o women and 68.4% o men ≥45 yea s); in his ca ego y BMI was highe
han in he o he wo ca ego ies, wi h BMI anging om 33.6 o 35.8 (women) and 37.5
o 34.0 (men), depending on he age g oup. The e we e also high equencies o obesi y
among women and men olde han 45 yea s who had a good (28.6% o 38.7%) o
egula (37.5% o 40.8%) pe cep ion o hei physical heal h (Table 3).
Indi iduals wi h obese i s -deg ee ela i es had be ween 2.19 and 3.96 imes mo e isk
o be obese compa ed wi h hose who did no ha e obese ela i es (Table 4); he
associa ions be ween his a iable ( amily his o y o obesi y) and h ee obesi y
indica o s we e highly signi ican (p<0.001 o BMI and WC; p<0.01 o FM%). Based
on BMI and wais ci cum e ence (WC), he isk o obesi y was almos 2 old highe in
Indi iduals ha ing obesi y- ela ed diseases (p<0.05 o bo h indica o s) han in hose
ee o diseases (Table 4). The isk was 3.44 old highe in indi iduals wi h cen al a
dis ibu ion (WHR) compa ed wi h subjec s ee o diseases (p<0.001). A bad
pe cep ion o he physical heal h was signi ican ly associa ed wi h all obesi y indica o s.
Among hem, he one based on FM% had he highe associa ion (OR=10.42, p<0.001),
whe eas he one based on WHR had he lowes one (OR=2.64, p<0.01).
Discussion
Acco ding o he ob ained esul s, and in line wi h o he s udies (e.g. Neu zling, Taddei
and Gigan e, 2003; Ochoa e al., 2007; Fipps e al., 2022), a amily his o y o obesi y
(i.e. close ela i es wi h obesi y) can be conside ed a isk ac o o he de elopmen o
obesi y in he s udied sample. In gene al, and i espec i e o sex and age, indi iduals
whose i s -deg ee ela i es we e obese we e mo e likely o be obese; ha ing obese
second-deg ee ela i es was also associa ed wi h a highe isk, al hough only in he
olde age g oup and especially in women. Howe e , a conside able p opo ion o obese
women and men (mainly o e 45 yea s o age) did no ha e a amily his o y o obesi y;
his can indica es ha “genes a e no always des iny” (Vee man, 2011; Kim, 2019).
Th ee o he ou obesi y indica o s s udied we e signi ican ly associa ed wi h ha ing
obese i s -deg ee ela i es; hese indi iduals we e be ween 2.19 and 3.62 imes mo e
likely o be obese. This ela ionship ypically illus a es wo unde lying p ocesses. On
one side, amilial clus e ing o obesi y has a clea gene ic componen (Ukkola and
Boucha d 2001; Xia and G an , 2013), so ha obesi y- ela ed genes a e ansmi ed
om obese pa en s o i s o sp ing con ibu ing o he isk o obesi y in childhood,
adolescence and e en in adul hood (Wannaiampikul e al., 2015; Singh, Kuma , and
Mahalingam, 2017; Thapaliya e al., 2021). On he o he hand, pa en s also ansmi
hei en i onmen al expe iences (Bi ch and Fishe , 1998; Huang, Jasimah and
Jena abadi, 2017; Eas e al., 2019), which may modula e child en beha iou s and
a i udes ha in luence obesi y de elopmen . Fo example, ea ing pa e ns and ood
Du nin J.V., Wome sley J. (1974). Body a assessed om o al body densi y and i s
es ima ion om skin old hickness: Measu emen s on 481 men and women aged om
16 o 72 yea s. B J Nu 32: 77-97. h ps://doi:10.1079/bjn19740060
Eas P., Delke E., Blanco E., Bu owsR., Lozo B., Gahagan S. (2019). Home and
Family en i onmen ela ed o de elopmen o obesi y: A 21-Yea Longi udinal S udy .
Child Obes 15 (3): 156-166. doi: 10.1089/chi.2018.0222
Elks C., Den Hoed M., Zhao J., Sha p S., Wa eham N., Loos R., Ong K. (2012).
Va iabili y in he he i abili y o body mass index: A sys ema ic e iew and me a-
eg ession. F on Endoc inol 3: 29-45. doi: 10.3389/ endo.2012.00029
Eps ein L.H., Saelens B.H. (2000). Beha io al economics o obesi y: Food in ake and
ene gy expendi u e. In W.K. Bickel and R.E. Vuchinich (Eds.). Re aming heal h
beha io change wi h beha io al economics: 293-311. Law ence E lbaum Associa es
Publishe s.
Feng R. (2016). How much do we know abou he he i abili y o BMI? Am J Clin Nu
104(2): 243-244. h ps://doi.o g/10.3945/ajcn.116.139451
Fipps D.C., Holde S.M., Schmalz D.L., Sco J. (2022). Family his o y o obesi y and
he in luence on physical ac i i y and die a y adhe ence a e ba ia ic su ge y. J
Pe iope P ac 32(9): 230-233. doi: 10.1177/17504589211015615
Fishe A., an Jaa s eld C., Llewellyn C., Wa dle J. (2010). En i onmen al in luences
on child en's physical ac i i y: Quan i a i e es ima es using a win design. PloS ONE
5(4): e10110. doi: 10.1371/jou nal.pone.0010110
Fishe J., Bi ch L. (1999). Res ic ing access o oods and child en's ea ing. Appe i e
32(3): 405-419. doi: 10.1006/appe.1999.0231
F anks P., Ra ussin E., Hanson R., Ha pe I., Allison D., Knowle W., Ta a anni P.,
Salbe A. (2005). Habi ual physical ac i i y in child en: The ole o genes and he
en i onmen . Am J Clin Nu 82(4): 901-908. doi: 10.1093/ajcn/82.4.901
F uh S.M. (2017). Obesi y: Risk ac o s, complica ions, and s a egies o sus ainable
long- e m weigh managemen . J Am Acad Nu se P ac 29: S3-S14 S3. doi:
10.1002/2327-6924.12510
F uh S.M., Nadglowski J., Hall H., Da is S., C ook E., Zlomke K. (2016). Obesi y
s igma and bias. J Nu se P ac 12(7): 425-432. doi: 10.1016/j.nu p a.2016.05.013
Ful on M, S ini asan VN (2022). Obesi y, s igma and disc imina ion. In: S a Pea ls
[In e ne ]. T easu e Island (FL): S a Pea ls Publishing. A ailable om:
h ps://www.ncbi.nlm.nih.go /books/NBK554571/ accessed 2 No embe 2022.
Gaesse G.A., Angadi, S.S. (2021). Obesi y ea men : Weigh loss e sus inc easing
i ness and physical ac i i y o educing heal h isks. iScience 24: 102995.
h ps://doi.o g/10.1016/j.isci.
Huang H., Jasimah C.W., Jena abadi H.S. (2017). Family en i onmen and childhood
obesi y: A New F amewo k wi h S uc u al Equa ion Modeling. In J En i on Res
Public Heal h 14: 181. doi:10.3390/ije ph14020181
Huppe z C., Ba els M., an Beijs e eld C., Boomsma D., Hudziak J., De Geus E.
(2012). E ec o sha ed en i onmen al ac o s on exe cise beha io om age 7 o 12
yea s. Med Sci Spo s Exce 44(10): 2025-2032. doi: 10.1249/MSS.0b013e31825d358e
Ibáñez M.E., Po eda A., Reba o E. (2021). Ideal body image o he opposi e sex and i s
associa ion wi h Body Mass Index. J Biosoc Sci 2021: 1-9. doi:
10.1017/S0021932021000705.
Ibáñez M.E., Po eda A., Reba o, E. (2020). Body image in ela ion o nu i ional s a us
in adul s om he Basque Coun y (Spain). J Biosoc Sci 52(2): 272-285.
doi:10.1017/S0021932019000439
Ibáñez Pé ez-Zamacona M.E. (2017). Bioan h opology o obesi y in a popula ion o he
Au onomous Communi y o he Basque Coun y. PhD Thesis, Uni e si y o he Basque
Coun y, Spain.
Jago R., Fox K.R., Page A.S., B ockman R., Thompson J.L. (2010). Pa en and child
physical ac i i y ac i i y and seden a y ime: Do ac i e pa en s os e ac i e child en?
BMC Public Heal h 10: 194. h p://www.biomedcen al.com/1471-2458/10/194
Jung C., Fische N., F i zenwange M., Thude H., Ba z D., Figulla H. (2009). Social
and beha iou al aspec s and hei consequences in obese eenage s: Impo ance o
amily’s his o y. Nu Hosp 24(6): 693-700. PMID: 20049373
Kim J. (2019). A e genes des iny? Explo ing he ole o in au e ine en i onmen in
mode a ing gene ic in luences on body mass. Am J Hum Biol 32: e23354.
h ps://doi.o g/10.1002/ajhb.23354
Ki imäki M., S andbe g, T., Pen i, J., Nybe g, S.T., F ank, P., Jokela M. e al. (2022).
Body-mass index and isk o obesi y- ela ed complex mul imo bidi y: an obse a ional
mul icoho s udy. Lance Diabe es Endoc inol 10: 253-263. h ps://doi.o g/10.1016/
S2213-8587(22)00033-X
La sen L.T. (2022). No me ely he absence o disease: A genealogy o he WHO’s
posi i e heal h de ini ion His o y o he Human Sciences. 35 (1): 111-131. doi:
10.1177/0952695121995355
La ne J.D., S e ano E.C. (2016). Obesi y s igma iza ion and he impo ance o he
esea ch o AJ S unka d. Cu Obes Rep 5(1): 121-125. doi: 10.1007/s13679-016-0198-
7
La allee K.L., Zhang X.C., Schneide S., Ma g a J. (2021). Obesi y and Men al
Heal h: A longi udinal, c oss-cul u al examina ion in Ge many and China. F on
Psychol 12: 712567. h ps://doi.o g/10.3389/ psyg.2021.712567
Lohman T., Roche A., Ma o ell R. (1988). An h opome ic s anda diza ion e e ence
manual. Human Kine ics Books, Champaign, IL, USA, 177 pages.
Loos R.J., Yeo G.S.H. (2022) The gene ics o obesi y: om disco e y o biology. NA
Re Gene 23: 120-133. h ps://doi.o g/10.1038/s41576-021-00414-z
Ma ínez-La ad M.T., Co ba ón Anchuelo A., Del P ado N., Iba a Rueda J.M., Gab iel,
R., Se ano-Ríos M. (2014). P o ile o Indi iduals Who A e Me abolically Heal hy
Obese Using Di e en De ini ion C i e ia. A Popula ion-Based Analysis in he Spanish
Popula ion. PloS ONE 9: e106641. doi: 10.1371/jou nal.pone.0106641
Neu zling M.B., Taddei J.A.A.C., Gigan e D.P. (2003). Risk ac o s o obesi y among
B azilian adolescen s: A case–con ol s udy. Public Heal h Nu 6(08): 743-749. doi:
10.1079/phn2003490
Ochoa M.C., Mo eno-Aliaga M.J., Ma ínez-González M.A., Ma ínez J.A., Ma í A.,
GENOI Membe s (2007). P edic o ac o s o childhood obesi y in a Spanish case-
con ol s udy. Nu i ion 23(5): 379-384. doi: 10.1016/j.nu .2007.02.004
Okosun I.S., Choi S., Ma amo os T., De e G.E. (2001). Obesi y is associa ed wi h
educed sel - a ed gene al heal h s a us: E idence om a ep esen a i e sample o whi e,
black, and Hispanic Ame icans. P e Med 32(5): 429-436. doi:
10.1006/pmed.2001.0840
Palmei a C.S., Mon ei o Ga ido L.M., Lima M. de L., Cos a Guima ães A., Teixei a
Ladeia A.M. (2016). Pe cep ions abou he heal h condi ion o people wi h obesi y. Re
Rene 17(5): 724-731. doi: 10.15253/2175-6783.2016000500019
Pe ei a-Mi anda E., Cos a P., Quei oz V., Pe ei a-San os M., San ana, M. (2017).
O e weigh and obesi y associa ed wi h highe dep ession p e alence in adul s: A
sys ema ic e iew and me a-analysis. J Am Coll Nu 36 (3): 223-233. doi:
10.1080/07315724.2016.1261053
Phillips C.M. (2017). Me abolically heal hy obesi y ac oss he li e cou se: epidemiology,
de e minan s, and implica ions. Ann NY Acad Sci 1391:85-100. doi:
10.1111/nyas.13230
P ospe , M.H., Moczulski, V.L., Qu eshi, A. (2009). Obesi y as a p edic o o sel - a ed
heal h. Am J Heal h Beha 33 (3): 319-329. doi: 10.5993/ajhb.33.3.10
Puhl R.M., Heue C.A. (2010). Obesi y s igma: Impo an conside a ions o public
heal h. Am J Public Heal h 100: 1019-1028. doi: 10.2105/AJPH.2009.159491
Quick V. (2018). Clus e ing o obesi y- ela ed isk beha io s among amilies wi h
p eschool child en using a socioecological app oach: C oss-sec ional s udy. JMIR
Pedia Pa en 1(1): e10320. doi: 10.2196/10320
Reba o E. (2021). In a-popula ion and in e -popula ion a iabili y o body composi ion
In: Bioelec ical impedance analysis o body composi ion. Applica ions in spo s
science. Chap e I. Body Composi ion, pp: 19-30. Ma ini, E. & Toselli, S. (Eds.),
Caglia i: UNICAP ess/dida ica. ISBN: 9788833120324, e-ISBN: 9788833120331, doi:
h ps://doi.o g/10.13125/unicap ess.978-88-3312-033-1
Robinson E., Haynes A., Su in A., Daly M. (2020). Sel -pe cep ion o o e weigh and
obesi y: A e iew o men al and physical heal h ou comes Obes Sci P ac 6: 552-561.
doi: 10.1002/osp4.424
Rohde K., Kelle M., la Cou Poulsen L., Blühe M., Ko acs P., Bö che Y. (2019).
Gene ics and epigene ics in obesi y. Me ab 92: 37-50. doi:
10.1016/j.me abol.2018.10.007.
Sawadogo W., Tsegaye M., Gizaw A., Ade a T. (2021). O e weigh and obesi y as isk
ac o s o COVID-19- associa ed hospi alisa ions and dea h: sys ema ic e iew and
me a-analysis. BMJ Nu Heal h 0: e000375. doi:10.1136/bmjnph-2021-000375
Sil en oinen K., Jelenko ic A., Sund R., Hu Y.M., Yokoyama Y., Honda C.,
Hjelmbo g J ., Mölle S., Ooki S., Aal onen S. e al. (2016). Gene ic and en i onmen al
e ec s on body mass index om in ancy o he onse o adul hood: an indi idual-based
pooled analysis o 45 win coho s pa icipa ing in he COllabo a i e p ojec o
De elopmen o An h opome ical measu es in Twins (CODATwins) s udy. Am J Clin
Nu 104: 371-379. doi: 10.3945/ajcn.116.130252
Sil en oinen K., Rokholm B., Kap io J., Sø ensen T.I.A. (2010). The gene ic and
en i onmen al in luences on childhood obesi y: a sys ema ic e iew o win and
adop ion s udies. In J Obes 34: 29-40. doi: 10.1038/ijo.2009.177.
Simmonds M., Llewellyn A., Owen C G., Woolaco N. (2016). P edic ing adul obesi y
om childhood obesi y: a sys ema ic e iew and me a-analysis. Obes Re 17: 95-107.
doi: 10.1111/ob .12334
Singh R., Kuma P., Mahalingam K. (2017). Molecula gene ics o human obesi y: A
comp ehensi e e iew. C R Biol 340(2): 87-108. doi: 10.1016/j.c i.2016.11.007
Si i W. (1961). Body composi ion om luid spaces and densi y analysis o me hods. In
B ozek J and Henschel A (eds) Techniques o Measu ing Body Composi ion. Na ional
Academic P ess: Washing on DC, USA, pp. 223–244.
Thake V.V. (2017). Gene ic and epigene ic causes o obesi y. Adolesc Med S a e A
Re 28(2): 379-405. PMID: 30416642; PMCID: PMC6226269.
Thapaliya G., Chen L., Jansen E., Smi h K.R., Sadle J.R., Benson L., Papan oni A.,
Ca nell S. (2021). Familial Obesi y Risk and Cu en Excess Weigh In luence B ain
S uc u e in Adolescen s. Obesi y 29: 184-193. doi:10.1002/oby.23042
Ukkola O., Boucha d C. (2001). Clus e ing o me abolic abno mali ies in obese
indi iduals: The ole o gene ic ac o s. Ann Med 33(2): 79-90. doi:
10.3109/07853890109002062
Vee man J.L. (2011). On he u ili y o sc eening o genes ha makey a . PloS Med
8(11): e1001114. doi:10.1371/jou nal.pmed.1001114
Wannaiampikul S., Phon a B., Tung ongchi A., Limwongse C., Chong i iyaphan,N.,
San ip abhob J., Tung ongchi R. (2015). Gene ic a ian sc eening o MC3R and
MC4R genes in ea ly-onse obese child en and hei ela i es among a Thai popula ion:
Family-based s udy. Gene Mol Res 14(4): 18090-18102. doi:
10.4238/2015.Decembe .22.35
Webbe L., Di aje a D., Ma sh T., McPhe son K., B own M., Galea G., B eda J. (2014).
The u u e bu den o obesi y- ela ed diseases in he 53 WHO Eu opean-Region
coun ies and he impac o e ec i e in e en ions: a modelling s udy. BMJ Open 4:
e004787. doi:10.1136/bmjopen-2014-004787
WHO (2000). Obesi y: P e en ing and Managing he Global Epidemic. Repo o a
WHO consul a ion. Technical Repo Se ies 894. Wo ld Heal h O ganiza ion, Gene a.
WHO (2011). Wais ci cum e ence and wais –hip a io. Repo o a WHO expe
consul a ion (pp. 8-11). Wo ld Heal h O ganiza ion, Gene a.
Xia Q., G an S.F.A. (2013). The gene ics o human obesi y. Ann NY Acad Sci 1281:
178-190. doi: 10.1111/nyas.12020
