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PURPOSE This study examined worker characteristics and behaviors, and the perceived importance of job-related tasks associated with the willingness to perform a proposed probation officer physical ability test (PROPAT). METHODS North Carolina probation officers (N = 1,213; 46.2% female; 39.8 ± 10.1 years; 30.7 ± 6.6 kg/m2) completed a survey including demographics, health history, and job-related tasks. A multivariable logistic regression model estimated the odds of being willing to perform the PROPAT. Adjusted odds ratios (ORadjusted) with 95% confidence intervals (CI) were calculated, with those excluding 1.00 deemed statistically significant. RESULTS The majority (72%) of probation officers were willing to perform the PROPAT. Being male (compared to female) (ORadjusted = 1.50; 95%CI = 1.12-2.02), having moderate (ORadjusted = 1.51; 95%CI = 1.10-2.08) and high physical activity status (ORadjusted = 2.89; 95%CI = 1.97-4.28) (compared to low) increased the odds of being willing to perform the PROPAT. Additionally, reporting a greater importance of tasks including running to pursue a suspect (TASKRUN; 1-unit-increase; ORadjusted = 1.25; 95%CI = 1.10-1.43) and dragging an unresisting person (TASKDRAG; 1-unit-increase; ORadjusted = 1.16; 95%CI = 1.01-1.32) increased the odds of being willing to perform the PROPAT. Increasing age (1-year increase; ORadjusted = 0.96; 95% CI = 0.94-0.98), class II (ORadjusted = 0.45; 95%CI = 0.28-0.71) and class III obesity (compared to normal weight; ORadjusted = 0.55; 95% CI = 0.32-0.93), and a previous musculoskeletal injury (ORadjusted = 0.57; 95%CI = 0.35-0.93) all decreased the odds of being willing to perform the PROPAT. CONCLUSIONS These results suggest being older, previously injured, obese (BMI ≥ 35 kg/m2), and less active is associated with being less willing to participate in the PROPAT, while males and reporting a higher importance of the TASKRUN and TASKDRAG activities is associated with being more willing to participate in the PROPAT. Departments can use these findings to identify feasible strategies (e.g., education, physical training) to improve the implementation of physical employment standards.

Objective To assess the risk factors associated with cesarean delivery in women with class III obesity (body mass index [BMI, calculated as weight in kilograms divided by height in meters squared] 40 or higher) who are undergoing induction of labor. Methods This was a retrospective cohort of obese women with a BMI of 40 or higher and singleton pregnancy of 34 weeks of gestation or longer who underwent induction of labor at two large teaching institutions from January 2013 to December 2015. The primary outcome was cesarean delivery. Secondary outcomes included maternal and neonatal composite morbidity. We then assessed the applicability of using a previously developed calculator to predict the risk of cesarean delivery. The area under the receiver operating characteristic (ROC) curve was used as a measure of the ability of the calculator to discriminate between women who underwent cesarean compared with vaginal delivery. Results There were 485 women with class III obesity who underwent induction during the study period. Of the 428 women who met inclusion criteria, 81.8% had a BMI of 40-50, 14.5% had a BMI of 50-60, and 3.7% had a BMI higher than 60. The overall cesarean delivery rate was 49.1% (46% with BMI 40-50, 63% with BMI 50-60, and 69% with BMI higher than 60, P=.012). Of the 428 women studied, 77.6% were black and 55% were nulliparous. Nulliparity, height, initial cervical dilation, and modified Bishop score were associated with a higher rate of cesarean delivery in multivariable models. Maternal and neonatal composite morbidity was higher in obese women who underwent cesarean delivery, compared with those who delivered vaginally. The performance of a previously developed induction calculator applied to this cohort had an area under the ROC curve of 75% (95% CI 0.70-0.79). Conclusions In women with class III obesity who underwent labor induction, the cesarean delivery rate approaches 50%. Nulliparity, height, and unfavorable cervical examination were the most significant risk factors for cesarean delivery. This information can be used to augment counseling for the obese patient who is undergoing induction.

Objective Obese women have higher cervical cancer incidence and mortality than their counterparts, possibly related to nonadherence to screening recommendations. We assessed the association of body mass index with adherence to cervical cancer screening recommendations in Hispanic women living in Puerto Rico, a minority population with the highest incidence of cervical cancer in the United States. Materials and methods We included 536 Hispanic women aged 21 to 64 years enrolled in a population-based study of human papillomavirus (HPV) infection. Demographic and clinical characteristics and risky behaviors were collected using structured interviews. Weight and height were measured to classify body mass index as underweight, normal, overweight, and obesity (class I, class II, class III). Adherence to cervical cancer screening recommendations was self-reported. Logistic regression models were fit to estimate the odds ratio with 95% CI after adjusting for covariates. Results Nearly one third (29.7%) of women were overweight and 43.5% were obese (class I: 22.6%, class II: 11.0%, class III: 9.9%). Overall adherence to cervical cancer screening within the past 3 years was 78.5%, being lowest among women with class III obesity (60.4%). After multivariable adjustment, only women with class III obesity had significantly higher odds (odds ratio = 2.5, 95% CI: 1.2-5.1) of reporting nonadherence to cervical cancer screening compared with normal weight women. Conclusions Adherence to cervical cancer screening in this population was below the Healthy People 2020 target of 93%, especially for women with morbid obesity. These findings highlight the importance of adequate interventions to decrease cervical cancer screening disparities in these women.

To evaluate the efficacy of incisional negative pressure wound therapy in the prevention of postoperative wound morbidity in women with class III obesity undergoing cesarean delivery.In an open label randomized controlled trial, women admitted for delivery with class III obesity (body mass index 40 or higher) measured within 2 weeks of admission for delivery were offered participation in the study. They were consented either in the outpatient maternal-fetal medicine specialty clinic, during admission to labor and delivery and before a decision to perform cesarean delivery, or in the preoperative area of the hospital before scheduled cesarean delivery. Exclusion criteria included anticoagulation therapy, human immunodeficiency virus infection, and silver or acrylic allergy. Those who ultimately underwent cesarean delivery were randomized to standard surgical dressing or incisional negative pressure wound therapy dressing. The primary outcome was wound morbidity. Preplanned secondary outcomes included characteristics of composite wound morbidity, and hospital, emergency room, and clinic utilization. The sample size estimate required randomization of 440 women to detect a 50% decrease in composite outcome.Between January 1, 2015, and July 31, 2016, 850 women were screened and 677 women with class III obesity were enrolled. Of these, 441 underwent cesarean delivery and were subsequently randomized (219 to standard dressing and 222 to incisional negative pressure wound therapy). The primary outcome, overall composite wound morbidity rate, was 18%. This was not different between the two cohorts (incisional negative pressure wound therapy 17% vs standard dressing 19%, relative risk 0.9 [95% CI 0.5-1.4]).Prophylactic incisional negative pressure wound therapy use did not reduce postoperative wound morbidity when compared with a standard surgical dressing in women with class III obesity.ClinicalTrials.gov, NCT02289157.

Purpose Obesity is a major public health concern in the United States, affecting nearly 79 million people. There have been promising results performing microvascular breast reconstruction in patients with obesity; however, the definition of obesity is often poorly defined or does not extend above a body mass index (BMI) of 35. Our goal was to examine outcomes of microvascular breast reconstruction in this questionably more risky population. Methods A retrospective review from 2013 to 2016 was performed of 2 surgeons' experience with abdominally based microvascular breast reconstructions. Women were categorized by BMI into the following groups: normal (18.5-24.9 kg/m), overweight (25.1-29.0 kg/m), class I (30.0-34.9 kg/m), class II (35.0-39.9 kg/m), and class III (>40 kg/m). Demographics included history of tobacco use, breast cancer diagnosis, adjuvant care, and comorbidities. Complications evaluated included donor site (delayed wound healing, fat necrosis, dehiscence, infection, abdominal hernia/bulge, and seroma), recipient site (delayed wound healing and fat necrosis), and need for reoperation. Statistical analyses were performed using analysis of variance and χ test. Results A total of 90 women (117 breasts) underwent microsurgical breast reconstruction using abdominal tissue. Twenty-seven women (48 breasts) met criteria for class II and class III obesity (BMI 35-53). Mean follow-up was 24 months. No statistically significant difference was found in demographics among all groups. There was a trend toward variability in overall complications across the BMI groups (P = 0.149). Donor site complications had a significant variation across the different BMI groups (P = 0.016). The rate of donor site complications was similar in class II (8/14) and class III (7/13) obese women. Recipient site complications were similar across the BMI groups. Conclusions We found obese women to have a higher rate of abdominal donor site complications; however, this risk seems to level off at class I or II obesity. We have modified our surgical technique of managing the abdominal donor site to optimize our outcomes in the morbidly obese patient population.

BACKGROUND Childhood obesity has increased markedly during the past decades; however, data on the prevalence of severe obesity in children and adolescents are limited. The present study examined the prevalence of severe obesity and its association with elevated blood pressure (BP) among children and adolescents in Shandong, China. PATIENTS AND METHODS A total of 44 630 (22 404 boys and 22 226 girls) students aged 7-18 years participated in the study. BMI cut-off points recommended by the International Obesity Task Force were used to define class I-III obesity. Relatively high BP status was defined as systolic BP and/or diastolic BP of at least 95th percentile for age and sex. RESULTS The prevalence rates of class I, class II, and class III obesity were 6.67, 1.47, and 0.42% for boys and 2.88, 0.64, and 0.18% for girls, respectively; boys had a higher prevalence than girls (P

The AspireAssist System (AspireAssist) is an endoscopic weight loss device that is comprised of an endoscopically placed percutaneous gastrostomy tube and an external device to facilitate drainage of about 30% of the calories consumed in a meal, in conjunction with lifestyle (diet and exercise) counseling.In this 52-week clinical trial, 207 participants with a body-mass index (BMI) of 35.0-55.0 kg/mAt 52 weeks, participants in the AspireAssist group, on a modified intent-to-treat basis, had lost a mean (±s.d.) of 31.5±26.7% of their excess body weight (12.1±9.6% total body weight), whereas those in the Lifestyle Counseling group had lost a mean of 9.8±15.5% of their excess body weight (3.5±6.0% total body weight) (P0.001). A total of 58.6% of participants in the AspireAssist group and 15.3% of participants in the Lifestyle Counseling group lost at least 25% of their excess body weight (P0.001). The most frequently reported adverse events were abdominal pain and discomfort in the perioperative period and peristomal granulation tissue and peristomal irritation in the postoperative period. Serious adverse events were reported in 3.6% of participants in the AspireAssist group.The AspireAssist System was associated with greater weight loss than Lifestyle Counseling alone.

Background:. Postmastectomy reconstruction in obese patients has a significant risk of complications and poor outcomes after implant-based and autologous methods. Here we present 22 consecutive patients with Class III obesity [body mass index (BMI) > 40 kg/m2] who underwent reconstruction with a muscle-sparing latissimus dorsi (MSLD) flap. Methods:. A chart review of a single surgeon experience with 22 consecutive patients with Class III obesity who underwent postmastectomy reconstruction with an MSLD flap was performed. Demographics, operative details, outcomes, and complications were evaluated. Results:. Twenty-two patients underwent 29 mastectomy and MSLD reconstructions. There were no flap failures. The average BMI was 47.2 kg/m2, including 12 patients with BMI > 50 kg/m2. Seven breasts demonstrated partial nipple and or mastectomy flap necrosis. There was 1 (3.4%) donor site dehiscence that healed with outpatient wound care and 1 (3.4%) seroma that required multiple aspirations in the office. The average operative times were 178 and 420 minutes for unilateral and bilateral mastectomy and immediate reconstructions, respectively. The average hospital length of stay was 0.56 and 1.3 days for unilateral and bilateral surgeries, respectively. Conclusions:. These results demonstrate the utility of the MSLD flap in reconstructing the very obese. Operative times and lengths of stay compare favorably with conventional latissimus dorsi flap and abdominal-based microvascular free tissue transfer reconstructions. While our complication rates were higher than historically seen for patients with normal BMIs, there were no instances of flap failure, making this a viable reconstructive option for these very high-risk patients.

Key Points 1. The body mass index is not an adequate measure of obesity in patients with cirrhosis. It is necessary to account for the contributions of ascites and fluid overload in addition to the distribution of adipose tissue. The interpretation of the literature on the effects of the body mass index on posttransplant outcomes is difficult if adjustments are not made for these factors. 2. Survival after liver transplantation has improved over the years and appears unaffected by obesity (even class III obesity) before transplantation. 3. Obesity is even more common after liver transplantation. Weight increases occur, with the greatest gains occurring within the first 6 months of transplant. Education and lifestyle management for the prevention of weight gain are the first measures in the posttransplant management of obesity. 4. Further investigation of bariatric surgery before, during, and after transplantation is needed. 5. Metabolic syndrome and its individual components are common after liver transplantation and are associated with increased risks of cardiovascular disease, cardiovascular death, liver-related deaths, and overall mortality. 6. Recurrent or de novo steatosis in the allograft is not uncommon and is a risk for steatohepatitis and progression to cirrhosis with graft loss. Liver Transpl 16:S65-S71, 2010. © 2010 AASLD.

INTRODUCTION:Optimal timing of third trimester (3rd tri) ultrasound in the obese population is unclear. Later scans are technically difficult while earlier scans may not reflect clinical changes closer to term. We compared the accuracy of early versus late 3rd tri ultrasounds in predicting actual bi

This study examined impact of obesity on outcomes after abdominal aortic aneurysm repair.Data were obtained from the Veterans Affairs National Surgical Quality Improvement Program. Body mass index (BMI) was categorized according to National Institutes of Health guidelines. Multivariate regression adjusted for 40 other risk factors to analyze trends in complications and death within 30 days.We identified 2,201 patients undergoing 1,185 open and 1,016 endovascular aneurysm repairs (EVAR) for abdominal aortic aneurysms from January 2004 through December 2005. BMI distribution was identical in both groups and reflected national population statistics: approximately 30% were normal (BMI 18.5 to 24.9), 40% were overweight (25.0 to 29.9), and 30% were obese class I (30.0 to 34.9), II (35.0 to 39.9), or III (/=40.0). After open repair, obesity of any class was independently predictive of wound complications (adjusted odds ratio = 2.4; 95% CI, 1.5 to 5.3; p = 0.002). Class III obesity was also an independent predictor or renal complications (adjusted odds rato = 6.3; 95% CI, 2.2 to 18.0; p0.0001) and cardiac complications (adjusted odds ratio = 4.5; 95% CI, 1.1 to 22.9; p = 0.045. After EVAR, obesity (any class) was predictive of wound complications (adjusted odds ratio = 3.1; 95% CI, 1.1 to 8.1; p = 0.026), but not predictive of other complications or death. Between the two types of operation, there were fewer complications and deaths after EVAR compared with open repair across all BMI categories, but outcomes were most disparate among the obese.Obesity is an independent risk factor that surgeons should consider during patient selection and operative planning for abdominal aortic aneurysm repair. Obese patients appear to particularly benefit from successful EVAR over open repair, but if open repair is required, special attention should be paid to cardiac risk, perioperative renal protection, and aggresive wound infection prevention measures.

Obesity is increasing in prevalence among pregnant women across the United States. At the University of Alabama, between 1980 and 1999, the frequency of obesity at the first prenatal visit doubled from 16% to 36%, and the frequency of weight over 300 pounds increased 10-fold from 0.5% to 4.9%. In the state of Utah in 2001, 37.8% of white women, 44.2% of black women, 43.8% of Latinas, and 61.1% of Native American women were obese at the time of delivery. The definition of obesity in pregnancy is a matter of debate. The American College of Obstetricians and Gynecologists (ACOG) recommends using height and weight measured at the first prenatal visit to calculate the body mass index (BMI). Based on World Health Organization criteria, obesity is present when the BMI is 30 or above, and obesity may be further categorized by BMI into Class I (30 to 34.9), Class II (35 to 39.9), and Class III obesity (Z40). Morbid obesity corresponds to a BMI greater than 35 to 40 kg/m. Obesity complicates obstetric management, and has been associated with gestational hypertension, preeclampsia, gestational diabetes, and cesarean section.7–13 During the active phase of labor, the cervix dilates more slowly in obese women, and failure to progress is more common, even in patients with spontaneous onset of labor. Obesity increases the risk of emergency cesarean delivery in most but not all cohort studies that have evaluated the topic.16–18 For women who deliver by cesarean section, operative and postoperative complications include operative time greater than 2 hours, excessive blood loss, wound infection and endomyometritis, and increased length of hospital stay. Obesity also impacts anesthetic management. Excessive body fat can obscure anatomic landmarks, complicating epidural and intravenous

Rationale: Obesity is considered a relative contraindication to pancreas transplantation due to increased risks of wound-related complications. Robotic surgeries have never been applied for pancreas transplantation in obese recipients though robotic kidney transplantation did and already proved its value in reducing wound-related complications in obese recipients. Patient concerns & Diagnoses: We performed the first robotic pancreas after kidney transplantation for a 34-year-old Hispanic type 1 diabetic male with class III obesity (BMI = 41 kg/m2). Interventions: The pancreas graft was procured and benched in the standard fashion. Methylene blue was used to detect any vascular leaks. The operation was completed via two 12-mm ports (camera, laparoscopic bed-side assistance), two 8-mm ports for robotic arms, and a 7-cm epigastric incision for hand port. The portal vein and arterial Y-graft of the pancreas were anastomosed to the recipient's left external iliac vein and artery, respectively. Duodenum-bladder drainage was performed with a circular stapler. Outcomes: Duration of warm and cold ischemia was: 45 minutes and 7 hours, respectively. The patient was discharged uneventfully without wound-related complications. Excellent metabolic control was achieved with hemoglobin A1c lowering from 9% before transplantation to 4.4% on day 120. The patient remained in nondiabetic status in 1-year follow-up. Lessons: In conclusion, robotic pancreas transplantation is feasible in patients with morbid obesity.

Background Recent literature suggests that obesity is protective in critically illness. This study addresses the effect of BMI on outcomes after emergency abdominal surgery (EAS). Methods Retrospective, ACS-NSQIP analysis. All patients that underwent EAS were included. The study population was divided into five groups based on BMI; regression models were used to evaluate the role of obesity in morbidity and mortality. Results 101,078 patients underwent EAS; morbidity and mortality were 19.5% and 4.5%, respectively. Adjusted mortality was higher in underweight patients (AOR 1.92), but significantly lower in all obesity groups (AOR's 0.73, 0.66, 0.70, 0.70 respectively). Underweight and class III obesity was associated with increased complications (AOR 1.47 and 1.30), while mild obesity was protective (AOR 0.92). Conclusions Underweight patients undergoing EAS have increased morbidity and mortality. Although class III obesity is associated with increased morbidity, overweight and class I obesity were protective. All grades of obesity may be protective against mortality after EAS relative to normal weight patients.

INTRODUCTION: Morbidly obese patients are denied access to kidney transplantation (KT) due to increased risk of complications. Surgical site infection risk in such patients increases to 40% from 5% in normal weight recipients, which is directly correlated with worse outcomes. The robot-assisted approach to kidney transplantation in patients with class III obesity (BMI 40 kg/m) was designed to reduce wound complications.

To the Editor: To date, there are more than 20 published reports, with that by Jin et al1 being the latest, that describe the relationship of body mass index/obesity with postoperative CABG mortality. Almost all studies report the fact that risk of mortality is high in underweight patients and decreases as an inverse function of BMI, until the threshold of class III obesity is reached, where the risk becomes high again. Gurm et al2 recently showed that a similar trend prevails in patients undergoing PTCA. This takes the perspective away from the surgical procedure and puts the focus on finding confounding factors related to obesity that might be at the …