text:
Do obese but metabolically normal women differ in intra-abdominal fat and physical activity levels from those with the expected metabolic abnormalities? A cross-sectional study.
ABSTRACT Obesity remains a major public health problem, associated with a cluster of metabolic abnormalities. However, individuals exist who are very obese but have normal metabolic parameters. The aim of this study was to determine to what extent differences in metabolic health in very obese women are explained by differences in body fat distribution, insulin resistance and level of physical activity.
This was a cross-sectional pilot study of 39 obese women (age: 28-64 yrs, BMI: 31-67 kg/m2) recruited from community settings. Women were defined as 'metabolically normal' on the basis of blood glucose, lipids and blood pressure. Magnetic Resonance Imaging was used to determine body fat distribution. Detailed lifestyle and metabolic profiles of participants were obtained.
Women with a healthy metabolic profile had lower intra-abdominal fat volume (geometric mean 4.78 l [95% CIs 3.99-5.73] vs 6.96 l [5.82-8.32]) and less insulin resistance (HOMA 3.41 [2.62-4.44] vs 6.67 [5.02-8.86]) than those with an abnormality. The groups did not differ in abdominal subcutaneous fat volume (19.6 l [16.9-22.7] vs 20.6 [17.6-23.9]). A higher proportion of those with a healthy compared to a less healthy metabolic profile met current physical activity guidelines (70% [95% CIs 55.8-84.2] vs 25% [11.6-38.4]). Intra-abdominal fat, insulin resistance and physical activity make independent contributions to metabolic status in very obese women, but explain only around a third of the variance.
A sub-group of women exists who are metabolically normal despite being very obese. Differences in fat distribution, insulin resistance, and physical activity level are associated with metabolic differences in these women, but account only partially for these differences. Future work should focus on strategies to identify those obese individuals most at risk of the negative metabolic consequences of obesity and on identifying other factors that contribute to metabolic status in obese individuals.
- [Show abstract] [Hide abstract]
ABSTRACT: Obesity is associated with increased risk of developing metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) leading to higher all-cause mortality. However accumulating evidence suggests that not all obese subjects are at increased cardiometabolic risk and that the "metabolically healthy obese" (MHO) phenotype may exist in the absence of metabolic abnormalities. Despite the knowledge of the existence of obese metabolic phenotypes for some time now there is no standard set of criteria to define metabolic health, thus impacting on the accurate estimation of the prevalence of the MHO phenotype and making comparability between studies difficult. Furthermore prospective studies tracking the development of cardiometabolic disease and mortality in MHO have also produced conflicting results. Limited data regards the determinants of the MHO phenotype exist, particularly in relation to dietary and lifestyle behaviours. In light of the current obesity epidemic it is clear that current "one size fits all" approaches to tackle obesity are largely unsuccessful. Whether dietary, lifestyle and/or therapeutic interventions based on stratification of obese individuals according to their metabolic health phenotype are more effective remains to be seen, with limited and conflicting data available so far. This review will present the current state of the art including the epidemiology of MHO and its definitions, what factors may be important in determining metabolic health status and finally, some potential implications of the MHO phenotype in the context of obesity diagnosis, interventions and treatment.Reviews in Endocrine and Metabolic Disorders 08/2013; · 4.58 Impact Factor
Article: Dietary and lifestyle characteristics associated with normal-weight obesity: the National FINRISK 2007 Study.[Show abstract] [Hide abstract]
ABSTRACT: The aim of the present study was to compare the lifestyle (leisure-time physical activity, smoking habits and alcohol consumption) and dietary (energy-yielding nutrients, dietary fibre and foods) factors of Finns with a new syndrome called normal-weight obesity (NWO) with those of lean and overweight Finns. The representative population-based study included 4786 participants (25-74 years) from the National FINRISK 2007 Study with a health examination and questionnaires. Food intake was assessed using a validated FFQ. NWO was defined to include those with a normal BMI ( < 25 kg/m2) but excessive body fat (for men ≥ 20 % and for women ≥ 30 %) according to WHO definitions. The proportion of participants with a normal BMI was 28 % in men and 42 % in women. Of these, 34 % of the men and 45 % of the women had the NWO syndrome (among all the participants, 10 and 19 %, respectively). The waist circumference of the NWO participants was between that of the lean and overweight participants. Some potential risk factors, such as physical inactivity, (ex)-smoking and alcohol consumption, were related to NWO. In general, the intakes of energy-yielding nutrients were not associated with NWO. Instead, some healthy dietary factors (e.g. low intakes of meat and soft drinks) as well as unhealthy factors (e.g. low intakes of root vegetables, cereals and fish and high intake of confectionery) were related to NWO. The findings might explain why the NWO participants were of normal weight, but had an excessive body fat percentage. In conclusion, the proportion of normal-weight participants with an excessive body fat percentage was surprisingly high. The identification of NWO people may be of importance because although they appear lean, they have some unhealthy lifestyle and dietary habits related to obesity and overall health.The British journal of nutrition 11/2013; · 3.45 Impact Factor
Article: Evaluation of Pre- and Postoperative Physical Activity Participation in Laparoscopic Gastric Banding Patients.[Show abstract] [Hide abstract]
ABSTRACT: Weight loss outcomes following laparoscopic adjustable gastric banding (LAGB) are widely variable, and physical activity (PA) participation improves these results. The purpose of this study was to retrospectively describe PA behaviors before and after LAGB and to evaluate the impact of PA on weight loss outcomes. Participants were 172 individuals (145 females, mean age 43.3 ± 12.0 years, mean body mass index [BMI] 43.8 ± 5.1 kg/m(2)) who underwent LAGB at a university medical center. Height, weight, presence of comorbidities, and PA participation were assessed prior to and 3, 6, and 12 months after surgery. Those who reported engaging in ≥150 min of weekly moderate-to-vigorous PA (MVPA) were considered active. Less than 40 % of participants were active prior to surgery, while 31 % of those who were inactive before surgery became active at 6 months of follow-up. Unlike previous reports on gastric bypass patients, there was no statistically significant (p > 0.05) relationship between postoperative PA status and weight loss outcomes at 3, 6, or 12 months in LAGB patients. Interestingly, participants who reported ≥150 min of MVPA prior to surgery achieved approximately 10 % greater excess weight loss (p < 0.05) and a 2.4-kg/m(2) greater decrease in BMI (p < 0.05) at 1 year post-LAGB compared to those who were inactive preoperatively. In our sample, higher levels of preoperative PA participation were associated with improved weight loss outcomes following LAGB. We posit that higher preoperative volumes are indicative of habitual exercise and that those who report being active prior to surgery are likely to maintain these behaviors throughout follow-up.Obesity Surgery 05/2014; · 3.10 Impact Factor
Page 1
RESEARCH ARTICLEOpen Access
Do obese but metabolically normal women differ
in intra-abdominal fat and physical activity levels
from those with the expected metabolic
abnormalities? A cross-sectional study
Louise Hayes1*, Mark S Pearce1, Michael J Firbank2, Mark Walker3, Roy Taylor3, Nigel C Unwin4
Background: Obesity remains a major public health problem, associated with a cluster of metabolic abnormalities.
However, individuals exist who are very obese but have normal metabolic parameters. The aim of this study was to
determine to what extent differences in metabolic health in very obese women are explained by differences in
body fat distribution, insulin resistance and level of physical activity.
Methods: This was a cross-sectional pilot study of 39 obese women (age: 28-64 yrs, BMI: 31-67 kg/m2) recruited
from community settings. Women were defined as 'metabolically normal' on the basis of blood glucose, lipids and
blood pressure. Magnetic Resonance Imaging was used to determine body fat distribution. Detailed lifestyle and
metabolic profiles of participants were obtained.
Results: Women with a healthy metabolic profile had lower intra-abdominal fat volume (geometric mean 4.78 l
[95% CIs 3.99-5.73] vs 6.96 l [5.82-8.32]) and less insulin resistance (HOMA 3.41 [2.62-4.44] vs 6.67 [5.02-8.86]) than
those with an abnormality. The groups did not differ in abdominal subcutaneous fat volume (19.6 l [16.9-22.7] vs
20.6 [17.6-23.9]). A higher proportion of those with a healthy compared to a less healthy metabolic profile met
current physical activity guidelines (70% [95% CIs 55.8-84.2] vs 25% [11.6-38.4]). Intra-abdominal fat, insulin
resistance and physical activity make independent contributions to metabolic status in very obese women, but
explain only around a third of the variance.
Conclusion: A sub-group of women exists who are metabolically normal despite being very obese. Differences in
fat distribution, insulin resistance, and physical activity level are associated with metabolic differences in these
women, but account only partially for these differences. Future work should focus on strategies to identify those
obese individuals most at risk of the negative metabolic consequences of obesity and on identifying other factors
that contribute to metabolic status in obese individuals.
The health consequences of obesity are well established.
Obese individuals are at greater risk of cardiovascular
disease [1,2], largely through the association of obesity
with dyslipidaemia, hypertension, glucose intolerance
and diabetes [3]. It is well known that individuals who
are not obese can develop these metabolic abnormalities
[4,5]. What has been less widely appreciated until
recently is that a subset of obese individuals remains
free of any of these metabolic abnormalities. Current
data suggest that 20-30% of obese individuals appear to
maintain a favourable metabolic profile, more usually
associated with lean individuals [6,7]. Such individuals
have been termed 'metabolically normal obese' [8],
'metabolically healthy but obese' [9], 'obese metabolically
normal' [10] or described as having metabolically benign
obesity [11] or uncomplicated obesity [12]
* Correspondence: firstname.lastname@example.com
1Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne,
Full list of author information is available at the end of the article
Hayes et al. BMC Public Health 2010, 10:723
© 2010 Hayes et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Page 2
The mechanisms through which obesity exerts its
effect on metabolic disorders remain to be fully
explained, but considerable interest has focused on the
role of body fat distribution. Vague first identified
android (upper-body or abdominal) obesity as being
associated with diabetes and atherosclerosis over
50 years ago [13]. Individuals with higher levels of cen-
tral adiposity are at greater risk of developing lipid and
glucose abnormalities than those with fat distributed
more peripherally [14,15]. Compelling evidence now
exists to suggest that excess intra-abdominal (visceral)
fat in particular confers an increased risk of developing
a metabolic disorder [16,17].
An increasing body of work exists to suggest that poor
metabolic health associated with obesity is mediated by
physical activity. Several studies have demonstrated that
higher physical activity and/or cardiorespiratory fitness
is associated with more favourable metabolic health
even among obese individuals [7,18-22].
Several recent studies have identified factors that are
associated with high insulin sensitivity and a favourable
metabolic profile in obese individuals. Although stan-
dard criteria to define the metabolically healthy obese
(MHO) individual are lacking, studies have suggested
that both lower intra-abdominal fat (IAF) [8,23] and
higher physical activity level [24] are associated with a
more healthy metabolic profile in obese individuals.
However, data on the association of directly measured
IAF and other cardiovascular risk factors with metabolic
health in the very obese (BMI ≥ 35) are scarce. Most
work in this field has focused on the overweight and
modestly obese (BMI 25-34) [11,25].
This paper presents a pilot study that arose from the
clinical observation that a substantial minority of indivi-
duals referred to a metabolic clinic for the management
of severe obesity had a healthy metabolic profile. Our
aim was to determine to what extent differences in
metabolic health in very obese (class II and class III obe-
sity) women are explained by differences in body fat dis-
tribution, insulin resistance and level of physical activity.
Participants in this study were 39 very obese women
(median BMI 39.6 kg/m2), aged 28-64 years and of Cau-
casian origin. The women were recruited from a num-
ber of sources, including an obesity clinic, dieticians and
from responding to a press release. Participants were
defined as 'metabolically healthy' (MHO) if they had a
fasting plasma glucose less than 6.1 mmol/l-1, a 2-hour
post 75 g glucose challenge plasma glucose less than 7.8
mmol/l-1, fasting triglycerides less than 2.2 mmol/l-1,
HDL cholesterol greater than 1.1 mmol/l-1and blood
pressure < 160/95 mmHg (n = 20). Participants not
meeting these criteria were defined as 'metabolically
abnormal' (MetAb). At the time this study was planned
there was a lack of consensus on appropriate cut points
for metabolic abnormalities, and for example, no inter-
nationally agreed definition of the metabolic syndrome.
Our approach to defining MHO was therefore some-
what pragmatic, combining WHO cut points for glucose
with cut points recommended locally and used in care
for people with diabetes and treatment within the obe-
sity service for lipids and blood pressure. Nineteen
women (9 MHO and 10 MetAb) were postmenopausal;
four (1 MHO; 3 MetAb) were currently using HRT.
Ethical approval for the study was obtained from the
Joint Ethics Committee of Newcastle and North
Tyneside Health Authority and the Newcastle Universi-
ties. Participants provided written consent for their
Assessment of body fat distribution
Body fat was assessed using magnetic resonance imaging
(MRI). Images were acquired on a Philips Intera 1.5 T
MRI system and rapid T1-weighted spin-echo sequence
with repetition time = 36 ms, echo time = 14 ms, flip
angle 120°, field of view = 60 cm, 256 × 256 matrix and
phase-conjugate symmetry. Participants were scanned
from the lower sternum to the mid thigh, by acquiring
10 mm thick transverse images with 30 mm gaps
between slices, as they lay in a supine position.
The volume of IAF and SCF fat compartments were
determined based on the method of Thomas [26]. The
MR images were transferred from the scanner to a PC
for analysis with custom written software. Fat appears as
a bright, high-intensity signal against a lower signal
from other tissues. Total fat content was determined in
the following fashion for each slice in the image. To
automatically locate the outside of the torso, the soft-
ware examines pixels starting at the posterior left of the
image, and moving diagonally inwards, until two adja-
cent pixels brighter than 1/3 of the maximum signal
intensity are found. A threshold value is determined
from the sharpest edge in a 5 × 5 pixel neighbourhood
of this point, and a contour around the torso automati-
cally generated using this threshold. The mean (Mc)
and standard deviation (SDc) of the pixels along this
contour are determined and a final threshold Tfis set as
Tf= Mc- SDc.
A new contour around the outside of the torso is
automatically generated using this threshold, and those
pixels with an intensity brighter than Tfare designated
as fat. The images were manually checked, and the con-
tour, and/or threshold level could be adjusted as neces-
sary. Each slice was reviewed manually to delete
unwanted voxels associated with, for example, bone
marrow and some stomach contents which give high
Hayes et al. BMC Public Health 2010, 10:723
Page 2 of 9
Page 3
intensity signals in the images. The total fat volume was
then determined by multiplying the number of pixels
brighter than the threshold Tfby the pixel size and sum
of slice thickness and slice gap.
Abdominal adipose tissue was defined as fat found in
the slices from the femoral heads to the top of the liver
or base of the lungs. Subcutaneous fat in this region was
identified as SCF. Fat that was within the peritoneum
was identified as IAF. To determine the IAF content, a
region encompassing the viscera was drawn manually by
an operator using a computer mouse. The IAF volume
was determined by multiplying the number of pixels
brighter than the threshold Tfin this region by the pixel
size and sum of slice thickness and slice gap. The sub-
cutaneous fat volume was determined by subtracting the
intra-abdominal fat volume from the total fat volume. A
measure of thigh fat was made by calculating the fat
area in one slice of one leg taken 80 mm (2 slices)
below the femoral heads slice.
Anthropometric measurements
Height was measured without shoes to the nearest
5 mm, with the head positioned so that the eye and the
external auditory meatus were level. Weight was mea-
sured to the nearest 100 g with the subject lightly
clothed. Waist circumference was measured, with the
waist unclothed and hip circumference over the subject's
underwear, to the nearest centimetre at the midpoint
between the lower costal margin and the superior iliac
crest, and the hips over the greater trochanters. Sagittal
diameter was measured using an abdominal caliper as
the distance between the highest point of the abdomen
and the examination table with the participant lying
supine. Body Mass Index (BMI) was calculated as weight
Biochemical measurements
Participants attended for screening after an overnight
fast. Participants followed their usual diet and physical
activity pattern prior to screening. Fasting blood samples
were taken on arrival at the clinic. Participants then
took a standard oral glucose tolerance test. A venous
blood was taken after 30 minutes and 2 hours. Plasma
was separated by centrifugation within an hour (after
refrigeration of the sample). Serum insulin levels were
measured by an enzyme linked immunosorbent assay
(ELISA; Dako Ltd, Ely, UK). Plasma glucose concentra-
tions were measured on a Yellow Springs Analyser (YSI
Stat Plus 2300; Yellow Springs Instruments, Farnbor-
ough, UK). Insulin resistance (HOMA-IR) was estimated
using the Homeostasis Model Assessment, based on
fasting insulin and glucose [27].
Serum triglycerides were measured by a lipase/glycerol
kinase method on a Cobas Bio centrifugal analyser
(Roche Products Ltd, Welwyn, UK) using a commercial
kit (Sigma Diagnostics, Poole, UK). Serum HDL
cholesterol was estimated by measuring the supernatant
cholesterol concentration after precipitation of apolipo-
protein B containing lipoproteins with heparin and
manganese. LDL cholesterol was estimated using the
Friedwald formula. Non-esterfied fatty acid (NEFA) was
measured by a WAKO cabas analyser.
Blood pressure
Blood pressure was measured twice in the right arm
using an automated blood pressure monitor (Omron
M5-I) and a large cuff (for arm circumference 32-42
cm). The mean measurement was used in analysis.
Physical activity
Current level of physical activity was assessed by an
interviewer-administered questionnaire, based on the
Modifiable Activity Questionnaire [28], and by the use
of a pedometer (Yamax Digiwalker SW-200). The Modi-
fiable Activity Questionnaire collects information on lei-
sure time, occupational and transportation (walking or
cycling) physical activity. The amount of leisure time,
occupational and transportation physical activity under-
taken was recorded and assigned a metabolic equivalent
score (MET; 1 MET = 3.5 ml O2uptake per kg/min)
according to the Compendium of Physical Activities
[29]. The reported daily average time spent in leisure
time activities, occupational activities (including sitting)
and walking or cycling for transport was summed and
total energy expenditure was computed assuming that
time not reported (i.e. 24 hours minus the sum of the
hours reported) was spent at rest and assigned a MET
score of 1. In addition participants were categorised
according to whether or not they met the current UK
recommendation for the level of physical activity
required to provide health benefits (at least 30 minutes
of moderate activity on at least 5 occasions per week
Participants wore the pedometer for four days
(1 weekend day and 3 weekdays). A daily mean number
of steps walked was calculated.
Statistical analyses
All data analyses were performed using SPSS version
11.0. Measures of central tendency and variability are
presented for anthropometric and biochemical data.
Variables were log transformed where appropriate and
geometric means with 95% confidence intervals are pre-
sented. Where variable distributions were not normal-
ised by log transformation medians and inter-quartile
ranges are presented. Independent samples t-tests or
Mann-Whitney tests were used to compare means or
medians between cases and controls as appropriate.
Hayes et al. BMC Public Health 2010, 10:723
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Page 4
Pearson correlations were calculated to evaluate the
relationship between IAF and SCF and glucose, lipids
and blood pressure. Multivariable logistic regression was
used to identify determinants of MHO status. Odds
ratios (OR) and corresponding 95% confidence intervals
(CIs) are reported. The amount of variance explained by
independent variables in logistic regression analysis was
calculated as the difference in deviance between the null
model and the model with the independent variable
divided by the deviance in the null model [31]. A p
value < 0.05 was considered statistically significant.
Body fat distribution and metabolic status
Twenty participants were classified as MHO, the
remaining 19 as MetAb. Participant characteristics are
shown in table 1. The MHO group differed significantly
from the MetAb group on each of the criteria upon
which participants were defined as MHO or MetAb
except systolic blood pressure (p = 0.193). A fairly large
(2.4 kg/m2) non-significant difference in BMI between
the MHO and MetAb groups was found (Figure 1).
Analyses were repeated with adjustment for BMI. This
did not affect the results of the analyses and the unad-
justed results are presented here. The MHO group had
significantly less IAF than the MetAb (4.8 l vs 6.9 l; p =
0.006). The groups did not differ significantly in age.
The MHO group had significantly lower insulin resis-
tance, as estimated by HOMA (3.41 vs 6.67; p = 0.002)
(Figure 2). The 2 groups did not differ significantly in
abdominal SCF, thigh fat:IAF or waist:hip ratio (WHR).
Correlations between IAF and SCF and glucose, lipids,
blood pressure and HOMA-IR are shown in table 2. IAF
and SCF were significantly correlated with each other (r =
0.57, p < 0.001). IAF, but not SCF was significantly and
positively correlated with postload glucose (r = 0.31) and
systolic blood pressure (r = 0.35) and negatively with HDL
(r = -0.34). The correlation between IAF and triglycerides
approached statistical significance (r = 0.31, p = 0.054),
but there was no evidence of a correlation between SCF
and triglycerides. Both IAF and SCF were significantly cor-
related with diastolic blood pressure (r = 0.31 and r = 0.41
for IAF and SCF respectively). HOMA estimated insulin
resistance was not significantly correlated with either IAF
or SCF.
Physical activity
Physical activity questionnaire data and pedometer data
are summarised in table 3. The MHO group recorded a
higher mean number of steps walked per day (6548 vs
5427 in the MetAbs) but this difference was not statisti-
cally significant (p = 0.252) and the inclusion of ped-
ometer recorded steps per day in the logistic regression
model did not contribute to the explanatory power of
the model. MHOs reported greater daily energy expen-
diture in leisure time activities than the MetAbs, both
Table 1 Participant characteristics
MHO MetAb
n20 19p
Central tendencyVariabilityCentral tendency Variability
Fasting glucose (mmol/l-1)a
2-hour glucose (mmol/l-1)b
Triglycerides (mmol/l-1)c
HDL cholesterol (mmol/l-1)
Systolic BP (mmHg)b
DiastolicBP (mmHg)b
Weight (kg)a
Body Mass Index (kg/m2)a
Age (yrs)c
aMedian (interquartile range), Mann-Whitney test for difference;bGeometric mean (95% confidence intervals);cMean (SD)
Figure 1 Comparison of MRI determined intra-abdominal fat
(IAF) and BMI in metabolically normal (MHO n = 20) and those
with any metabolic abnormality (MetAb n = 19). Geometric
mean presented for IAF; median IQR for BMI. The symbol * indicates
the groups are significantly different from each other (p<0.01)
Hayes et al. BMC Public Health 2010, 10:723
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Page 5
over the longer term (past year) and in the preceding
week, but these differences were not statistically signifi-
cant. Total energy expenditure for the 2 groups was
very similar for past year (slightly higher in MHOs) and
past week (slightly higher in MetAbs).
Although the groups did not differ significantly in
terms of their self-reported total energy expenditure
there was a significant difference between the groups in
the proportion of participants reporting meeting current
guidelines for the level of physical activity required to
have an impact on health. Seventy per cent of the MHO
group reported participating in at least 30 minutes of
moderate physical activity on at least 5 occasions per
week (the current UK Government guideline [30]),
compared to 25% of the MetAb group (p = 0.010).
Contribution of body fat distribution and physical activity
to metabolic status
In logistic regression analysis, a greater volume of IAF
was associated with higher risk of having a metabolic
abnormality (OR per litre increase in IAF = 1.48, 95%
CIs 1.07-2.05, p = 0.018). Subcutaneous abdominal fat,
thigh fat and total abdominal fat were not associated
with MHO status. Controlling for the effect of SCF, SCF
and BMI or SCF, BMI and waist circumference did not
affect the relationship between IAF volume and MHO
status (table 4). HOMA-estimated insulin resistance was
strongly significantly associated with an increased likeli-
hood of being MetAb (OR = 6.66, 95% CIs 1.57-28.16,
p = 0.01). When the effect of HOMA was controlled for
IAF was still significantly associated with metabolic sta-
tus (p = 0.046). IAF explained 14.5% of the variance in
MHO status. HOMA explained an additional 15%. An
interaction between IAF and HOMA was also found,
(OR = 1.31, 95% CIs 1.11-1.56) which explained slightly
more (32% for main effects plus interaction) of the var-
iance than IAF and HOMA together.
Meeting current UK Government guidelines for physi-
cal activity participation was negatively associated with
being MetAb (OR for meeting the guidelines = 0.14,
95% CIs 0.04-0.58, p-0.006) and explained 15.2% of the
variance. When IAF and physical activity were included
in the same model the effect of both was attenuated
only slightly. When HOMA was added to the model
HOMA and physical activity remained independent
predictors, together explaining 38.2% of the variance,
but IAF was no longer a statistically significant predictor
(p = 0.077), although it did contribute to the explana-
tory power of the model.
We have demonstrated in this study of very obese women
that lower intra-abdominal fat volume, less insulin resis-
tance and higher level of physical activity are factors that
influence metabolic function beneficially. The results of
multivariable modelling suggest that each makes an inde-
pendent contribution to the risk of having a metabolic
abnormality, suggesting that the impact of physical activity
on metabolic health is independent of its effect on IAF
and that IAF itself makes an independent contribution
and does not only operate via insulin resistance. Our
Figure 2 Comparison of abdominal subcutaneous fat (SCF),
thigh fat:IAF, waist:hip ratio (WHR) and HOMA-IR in
metabolically normal (MHO n = 20) and those with any
metabolic abnormality (MetAb n = 19. All values are geometric
means with 95% CI, except WHR (mean; 95% CI). The symbol *
indicates the groups are significantly different from each other
(p < 0.01)
Table 2 Correlations of fat volumes with fasting and
postload glucose, triglycerides, HDL, blood pressure and
Fasting glucose (mmol/l-1)
2-hour glucose (mmol/l-1)
Triglycerides (mmol/l-1)
HDL cholesterol (mmol/l-1)
SBP (mmHg)
DBP (mmHg)
†p < 0.05
Hayes et al. BMC Public Health 2010, 10:723
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Page 6
findings support a growing body of evidence that indivi-
duals exist who are very obese (in this study median BMI
of 39.6) but remain metabolically normal.
However, together IAF, HOMA-IR and meeting cur-
rent guidelines for participation in physical activity
accounted for only a little over a third of the risk of
having a glucose, lipid or blood pressure abnormality in
this group of women. Much of the variance in metabolic
status in these women remains unexplained by the vari-
ables considered here.
In contrast to other studies [15,32,33] we did not find
an association between abdominal SCF and presence of
a metabolic abnormality. Although the MHO and
MetAb groups did not differ in volume of total abdom-
inal SCF, differences may exist in deep and superficial
subcutaneous fat depots, which were not examined in
this study. Alternatively, in this very obese population
SCF may play a less important role in the metabolic
complications of adiposity than in less obese groups.
Characteristics of IAF that support its importance in
terms of metabolic health, including the lower sensitivity
of IAF to the anti-lipolytic effect of insulin, greater sensi-
tivity to the lipolytic effect of catecholamines and role as
a source of cytokines have been well documented [5,34].
It has also been suggested that an excess of IAF may
act as a marker for an impairment in an individual's
ability to store fat in the subcutaneous depot or to uti-
lise it efficiently within mitochondria [35]. This suggests
that the MHO women in this study are better able to
store fat appropriately than those with a metabolic
abnormality who store excess energy as IAF, and also
potentially in skeletal muscle and the liver.
Insulin resistance, as estimated by HOMA, was an
independent predictor of metabolic status, and explained
a comparable amount of the variance to IAF. It should
be noted, however, that it was to be expected that the
MHO women would have lower HOMA values as nor-
mal glycaemic control, a component of HOMA, was
part of the definition of MHO.
It was surprising that neither IAF nor SCF were signif-
icantly correlated with insulin resistance in this study.
This could be attributed to the use of HOMA-IR as a
proxy for insulin resistance in this study. Although
HOMA-IR and the euglycaemic hyperinsulinaemic glu-
cose clamp procedure have a good correlation in larger
studies (0.6-0.88) [36] HOMA-IR may have less utility
in a small study. Furthermore, HOMA-IR is closely cor-
related with fasting insulin and other investigators have
reported no association or a weak association between
fasting insulin and/or glucose and IAF [37,38] even
when a significant relationship between glucose disposal
and IAF exists [37].
The participants in this study, and especially those
with normal metabolic function, reported higher levels
of physical activity than have been reported in other stu-
dies, including, for example, the Health Survey for Eng-
land 2008, which reported only 19% of obese women
meet the current guideline [39]. The difficulties asso-
ciated with collecting data on physical activity level have
long been acknowledged [40]. However, there is no rea-
son to believe that the MHO and MetAb groups would
have reported their physical activity habits systematically
differently, and as the focus of the study was on differ-
ences between the two groups, this does not present a
major threat to the validity of these data. Nevertheless it
would be desirable in future work to have a more
sophisticated measure of physical activity using an accel-
erometer and/or heart rate monitoring to provide more
precise information on how energy expenditure and
physical activity duration and intensity differ between
those who maintain normal metabolic function and
those who develop an abnormality.
Table 3 Self-reported and pedometer recorded physical activity
n20 19p
Steps per day (pedometer)a
DEE Past year leisure (Kcal)b
DEE Past week leisure (Kcal)b
DEE Past year occupational (Kcal)b
DEE Past week occupational (Kcal)b
Total DEE Past year (Kcal)a
Total DEE Past week (Kcal)a
[11.6-38.4] Moderate activity × 5 per week70.025.0 0.010
DEE = Daily Energy Expenditure;aMean (SD), independent samples t-test for difference between MENO and MetAB;bGeometric mean (95% confidence intervals [CIs])
Hayes et al. BMC Public Health 2010, 10:723
Page 6 of 9
Page 7
Our results could have important public health and
clinical significance. Despite widespread awareness of
the negative consequences of excess adiposity and
efforts to redress or at least halt the rise in obesity, its
prevalence continues to increase. Not all obese indivi-
duals have the glucose, lipid and blood pressure
abnormalities usually associated with obesity. This sug-
gests that there is a need for a different approach to the
problem, which focuses on those most at risk of devel-
oping the ill health consequences of obesity and who
should be targeted for intervention. The findings of this
pilot study suggest that IAF accumulation, insulin
resistance and lack of physical activity each have an
independent role to play in identifying those most at
risk of the negative metabolic health consequences of
obesity. Future work should focus on strategies to iden-
tify individuals most likely to benefit from intervention,
for example, by encouraging the routine use of estab-
lished simple methods, including the measurement of
waist circumference and the use of dual energy X-ray
absorptiometry (DXA) where available, to identify those
likely to have high levels of IAF. In addition work is
needed to identify factors that drive deposition of fat in
the visceral depot. Many determinants of IAF accumula-
tion have been proposed, including genes [41], smoking
[42] and psychological stress [43], but the contribution
of these putative determinants has yet to be fully
It has been suggested that some of the previous
research linking obesity to poor health and mortality
has failed to take account adequately of physical activity
or physical fitness [44] and the relative contributions of
fitness and fatness to the development of CVD and its
associated risk factors is still debated [45]. Data from
this study support an increasing body of work that phy-
sical activity is important in terms of being metabolically
healthy, independently of adiposity [44]. This supports a
move away from a focus primarily on weight loss to
reduce CVD and diabetes risk and towards promoting
increased physical activity and cardiorespiratory fitness
[46] both for the beneficial effects on health it confers
independently of weight loss and its role as an impor-
tant weight management tool.
As discussed above, the factors that we identify
explain only a relatively small amount of the risk of hav-
ing a metabolic abnormality in these very obese women.
Future work should focus on identifying other contribu-
tory factors. One putative risk factor for poor metabolic
health is accumulation of fat in the liver. High liver fat
content leads to raised very low density lipoprotein
levels and is associated with dysglycaemia [47,48]. The
possibility that the women who had a metabolic
abnormality in this study had high liver fat content is
consistent with the suggestion that these women are
impaired in their ability to store fat appropriately in the
subcutaneous depot. In addition an association between
liver fat and habitual physical activity has been observed,
which is consistent with our findings [49]. Other factors
worthy of consideration include aspects of diet [50] and
duration of or age at onset of obesity [8].
Strengths of this study include the detailed metabolic
assessments and the accurate assessment of body fat dis-
tribution that were undertaken on each of the partici-
pants. The small number of participants in this study,
which arose from clinical observations and is intended
as a pilot study to inform future work, and the relatively
Table 4 Logistic regression analysis to identify
determinants of being MetAb
OR95% CIsp
Univariate analysis
All abdominal fat
Thigh fat
Physically active†
Multivariable analysis
IAF, SCF, BMI + waist
IAF + Physically active
0.028Physically active
IAF + HOMA-IR + Physically active
Physically active
†Defined as self-reporting being moderately active for 30 min at least 5 times
per week
Hayes et al. BMC Public Health 2010, 10:723
Page 7 of 9
Page 8
weak measures of physical activity and insulin resistance
that were used for pragmatic reasons mean that the
strength of reported associations may have been under-
estimated, but nevertheless the substantial amount of
variance in metabolic status that remains unexplained
suggests that other factors remain to be identified.
In summary, our results confirm that individuals exist
who are obese but do not appear to suffer the negative
metabolic consequences of obesity. Lower levels of
intra-abdominal fat, less insulin resistance and higher
levels of physical activity are all associated with better
metabolic health even in very obese individuals. These
findings could be used to guide strategies to identify
those obese individuals most at risk of the negative
metabolic consequences of obesity. Intra-abdominal fat,
insulin resistance and physical activity together account
for only around a third of the risk of having a metabolic
abnormality in obese women. Future work should aim
to identify other contributory factors.
This work was funded by a grant from the Newcastle Healthcare Charity.
The authors wish to thank the participants for the time and effort they put
into the study. We also wish to acknowledge the contribution made by
Philip English (radiographer), Elaine Farrell (phlebotomist), Pauline Collins,
Jean Gerrard, Jan Gebbie, Wendy Hicks (SWiMS), Kate Hesketh (dietician) and
Heather Gilbert (laboratory technician).
Author details
1Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne,
UK.2Institute for Ageing and Health, Newcastle University, Newcastle-upon-
Tyne, UK.3Institute of Cellular Medicine, Newcastle University, Newcastle-
upon-Tyne, UK.4Faculty of Medical Sciences, University of the West Indies,
Bridgetown, Barbados.
Authors' contributions
LH was involved in the study design and was responsible for data collection
and analysis and drafting of the manuscript. MP provided statistical advice
and contributed to the drafting and revision of the manuscript. MF
developed and validated the method for measuring abdominal fat using
MRI and commented on drafts of the manuscript. MW was jointly
responsible for the idea for the study and its design and has contributed to
the development of this manuscript. RT was involved in guiding the data
collection methods and analysis for the study and has contributed to the
development of this manuscript. NU was jointly responsible for the idea for
the study and its design, was involved in data analysis and has contributed
to the development of this manuscript. All authors read and approved the
final version of the manuscript for publication.
Competing interests
The authors declare that they have no competing interests.
Received: 22 June 2010 Accepted: 24 November 2010
Published: 24 November 2010
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Pre-publication history
The pre-publication history for this paper can be accessed here:
Cite this article as: Hayes et al.: Do obese but metabolically normal
women differ in intra-abdominal fat and physical activity levels from
those with the expected metabolic abnormalities? A cross-sectional
study. BMC Public Health 2010 10:723.
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Hayes et al. BMC Public Health 2010, 10:723
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text:
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The Cambridge drugs company at the heart of an international take over row is warning that uncertainty over its future could interfere with vital research into life saving treatments.
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subset: commoncrawl


text:
Gary Stein | November 19, 2010 | Comments
A few thoughts on socializing e-mail, taking a stand on net neutrality, and the rising challenge of self-branding.
Occasionally, when I start writing this column, I'll have a really specific topic in mind that, unfortunately, just doesn't have enough weight to generate enough words to fill up a page. I suppose this is a by-product of doing lots of blog posts and status updates - you get to thinking in small chunks. When this happens, I usually end up with a few paragraphs about a topic that just sit in a notebook. This week, I thought I'd pull a few of those proto-columns out of the notebook and assemble them here, in one place, in no particular order.
Socializing E-mail: "Liking" Will Rule
E-mail has long been the core task consumers engage in online. Certainly we're seeing a rise in watching video and playing games, but, mostly, e-mail remains a core activity. That means that the companies that offer e-mail are in a prime position to own a large chunk of consumer digital time and attention. Yahoo, Google, and AOL have managed to keep e-mail at the core of the experience, and build out more services from there.
Now along come the social powerhouses. Social media represents a chance to offer a very particular kind of e-mail. LinkedIn has long used the ability to message other users as a way to upsell paid services on the site. Facebook, this week, announced its particular take on e-mail, which is an integrated inbox, pulling together e-mails, Facebook messages, and text messages.
E-mail and social media are set to converge at some point in the near future. Both have contact lists at their core, and both are about sharing information. Really, what we're talking about is a rearranging of the way that messages are displayed. E-mail has always been chronological (latest message on top). Social technologies will change this so that messages from people you care about appear on top.
This means that now (more than ever) brands have to make sure that people care about them, not just have opted in to their database. Social is going to disrupt e-mail marketing because it will require the consumer to have engaged in an action that signifies to the e-mail client that he cares about messages from a particular source. Think about it: Gmail has no idea that you opted in to an e-mail list, but Facebook knows if you have "liked" a brand. That liked brand gets to the top of the list.
E-mail has long been a new form of direct marketing. Now, it is a new form of relationship marketing.
Net Neutrality: Time to Take a Stand
Net neutrality is a bit of a wonky concept that has been fairly far under the radar of most brands and advertisers, but it is high time we pay attention. Essentially, Net neutrality refers to a particular state of the Internet where all traffic is treated equally. Visiting a blog set up by some kid in Parsippany, NJ, travels across the same wires at the same speed as a page created by a powerful media company. Packets are packets.
But there is a creeping idea that the companies that create content and the companies that carry content can align themselves so that the packets of the powerful media company get delivered sooner, quicker, and more reliably than the kid from New Jersey. This (in my view, of course) is a bad idea.
Open and free access to any site, service, application, or idea is the absolute lifeblood of this new media. That kid may have a stellar idea that will transform the world. If we enter a space where only established stuff from established and powerful brands makes it to our screens, then we narrow our future. Net neutrality ensures that the Internet operates as a marketplace of ideas and a thoroughfare of innovation. That innovation appeals to the marketing world because it creates new opportunities for us to connect with consumers and do business. We can't cut down on the ability for us to discover blogs, Facebook, Twitter, or any other new experience. It will only lead us back to being reliant upon a handful of large companies and the options that they decide to allow us.
Today, take a minute to read the Wikipedia page about Net neutrality to better understand the concept. Come to your own opinion about this topic, and be prepared to confront the issue, maybe in the very near future.
The Rising Challenge of Self-Branding
One of the things that new media channels have allowed for is the rise of self-branding and promotion. I've certainly engaged in it, specifically using Twitter to connect with people and communicate ideas. I also just did my own little URL hack: http://garyste.in. I like the idea that I can now tell people that, if they want to find me, they can just put my name into a browser (along with that dot). The rush to the online, social, self-publishing channel by so many people has put us into a very odd space: a surfeit of talent, ability, and insight. There are too many smart people out there, in nearly every category.
The problem with this is the same as any market where supply outpaces demand: real value of an individual item drops. And when that happens, there tends to be two things that happen: one group of products just decides to roll with the low value and drop the quality. Another group tries very hard to make their particular offering better.
I realize that I am one point of light in this vast galaxy, so I'll try not to be too personal and instead talk about how I have gone about winnowing down the number of sources I pay attention to.
Here's my new rule: I pay attention to practitioners, not pundits.
With precious few exceptions, I only follow and read the people who are in the actual trenches, doing the job. These voices hold the most authenticity for me, and make me interested in sharing ideas. These people are truly embracing the inherent altruism of the medium and sharing for the sake of sharing. I appreciate that and find it totally worthwhile.
Thanks for reading a few of these scattered fragments of columns.
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Gary Stein is SVP, strategy and planning in iCrossing's San Francisco office. He has been working in marketing for more than a decade. Gary lives in San Francisco with his family. Follow him on Twitter: @garyst3in. The opinions expressed in Gary's columns are his alone.
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Atlantic property is an ancient mansion family home located in the heart of ESSAOUIRA Medina. Atlantic Property will... More Info »
Riad Lunetoile is perfectly located in the centre of the medina and offers elegance, privacy and personal attention... More Info »
Essaouira Hostel is perhaps the nicest hostel you will ever stay in! Welcome to Hotel California\'; you can check in... More Info »
Riad El Pacha or governor Riad is built in the 18th century to be the palace of the governor of Essaouira in that... More Info »
Geraldine and Christophe invite you to visit Essaouira and to be hosted in their house, La Maison du Vent. We have... More Info »
Surf Lounge is a beautiful riad in the heart of the medina, a 2 min from the famous Skala (coastal fortification)... More Info »
Property Features In addition to a restaurant, Riad Zelaka features complimentary wireless Internet access. Other... More Info »
Surrounded by argan trees, where cars are replaced by donkeys, horses and camels you can calm down and enjoy a... More Info »
Deep in the heart of the Old City of Essaouira, hidden away in a little street, Riad l'Ayel d'Essaouira invites... More Info »
Located in Essaouira old Medina just a 10-minute walk from Essaouira Beach, Mogador Location Vacances offers... More Info »
The rooms and suites open on a light-filled interior patio with pretty tiles. Some of them are located on a mezzanine... More Info »
After a day of sightseeing in and around the medina, enjoy an afternoon relaxing on the terrace of the riad. The... More Info »
Riad Etoile de Mogador is a old typically Moroccan residence, located in the fabulous Medina of Essaouira, only 200 m... More Info »
Dar Mounia has geographical position within the old Medina, and 200m far from the beach and the old port of the city!... More Info »
The house is built on three floors, plus the roof terrace. There are three double bedrooms and one twin bedroom... More Info »
Comfortable Villa Town in a quiet area guarded day and night. It's a very quiet and residential area, but also very... More Info »
Situated at the back of Essaouira's fortified medina with the food markets pretty much on your door step ,GREEN MILK... More Info »
The Riad Ben Atar is a family –run guest conveniently located in the heart of Essaouira's busting medina. We... More Info »
Les Terrasses d'Essaouira, a luxury hotel which conjugates comfort and refinement and is a tribute to the Moroccan... More Info »
Jimi Hendrix Hotel is located at Diabat, 2 km from Essaouira. Our Hotel is a very typical riad with the classical... More Info »
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Was very pleased with all aspects of the sale.
Felt salesperson, Chris B., did a great job.
Read the full review
All staff were a pleasure to deal with being personable and professional. Price negotiations were not intimidating but rather friendly and professional. Good honest people on the staff. Impressed with the sales person, sales manager, finance manager and receptionist.
Read the full review
Our buying experience at Randy Reed was easily the most pleasant one we have had. Our salesman Jeremy did a great job explaining the vehicle and facilitating the deal. We could not have asked for anything more.
Read the full review
I was quoted a great price online and they made the whole process smooth and easy.
Best experience I have had and I never felt like they treated me different being a single mom.
They even are giving me all of my oil changes for free for as long as I own my car!!!
Read the full review
The following reviews are over two years old - their ratings are not used to calculate the dealer's current aggregated ratings.
I just purchased a used Buick from Randy Reed and it was the easiest process I have ever gone through in terms of a car purchase.
The salesman, Chris, was top notch and the finance manager was awesome as well.
Everyone was kind and very eager to please us.
On top of that, 4 free oil changes per year...
Read the full review


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Notre Dame Collaborating with Five Partners to Build Nation's Top Turbine Engine Component Research and Testing Facility
nwelding • Date: June 26, 2014
The University of Notre Dame and five public and private partners announced Thursday (June 26) a $36 million project that will be the nation's foremost research and test facility for advancing the technology used in the massive gas turbine engines used by commercial and military aircraft, power plants and the oil and gas industry.>Full Story
Fernando To Receive Honorary Doctorate from Grenoble
nwelding • Date: February 27, 2014
Harindra Joseph Fernando, the Wayne and Diana Murdy Family Professor of Civil & Environmental Engineering & Earth Sciences, has been selected to receive an honorary doctorate from the Université de Grenoble [Université Joseph Fourier] in France. The presentation will take place as part of the Honoris Causa Ceremony on March 20, 2014, in Grenoble. The université is home to the Laboratoire Des Ecoulements Geophysiques et Industriels (LEGI) that hosts the largest and most sophisticated rotating platform in the world for studies on Coriolis forces in environmental and geophysical flows that arise due to the rotation of the Earth.>Full Story
Notre Dame a Partner in Two Manufacturing Innovation Institutes Awarded by President Barack Obama
ndavis • Date: February 26, 2014
The University of Notre Dame has been selected as a research partner in both of the advanced manufacturing institutes named Tuesday (Feb. 25) by President Barack Obama to receive government and private sector funding to help revolutionize manufacturing in the United States. Notre Dame is one of only two universities to be named a partner in both institutes.>Full Story
ASME 2013 Fellows: Karel Matous and James P. Schmiedeler
ndavis • Date: December 11, 2013
The ASME Board of Governors confers the Fellow grade of membership on worthy candidates to recognize their outstanding engineering achievements. Nominated by their peers, these 2012-2013 Fellows have had 10 or more years of active practice and at least 10 years of active corporate membership in ASME.>Full Story
Kai Cao awarded a two-year predoctoral research fellowship by the American Heart Association (AHA)
ndavis • Date: December 11, 2013
Kai Cao, a graduate student in the Department of Aerospace and Mechanical Engineering at the University of Notre Dame, has been awarded a two-year predoctoral research fellowship by the American Heart Association (AHA) for his project on "Computational and in vitro hemodynamic characterizations of tricuspid and bicuspid aortic valve ascending aortas". This award helps students initiate careers in cardiovascular and stroke research by providing research assistance and training. Cao is one of 30 candidates among 134 applicants awarded by the AHA Midwest Affiliate.>Full Story


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- Bon Vin
A Wine Shop & Bar
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Caffeine Kick
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Giving Wine a New Flavor
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Typically Irish
- Enoteca Style
A California Fusion Wine Bar
- Enoteca del Fornaio
An Authentic Italian Wine Bar
- Fifty-Seven Degrees
San Diego's Largest Wine Retailer
- Gaffney's Wine Bar
A Tasteful Evening
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Driven By Wine
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Hidden Gem in Old Town
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Wine Near Balboa Park
- Live Wire
Electrifying Dive Bar
- Splash Wine Lounge
Serving Wine by the Splash
- Syrah Wine Parlor
Upscale Enchantment
- Toast Enoteca & Cucina
- Top of the Park Restaurant
Penthouse Restaurant
- Turquoise (The)
A Bit Of Europe In San Diego
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A Wine Bar & Cafe
- Wine Encounter (The)
Do Wine!
- Wine Lover (The)
Seduce Your Senses
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Wine and Dine
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Find records of Dorcas Munson
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Biography & Family History Add details
Dorcas Munson (1720 - 1761) was born on November 18, 1720 at New Haven, New Haven, Connecticut,. She was born into the Munson family.
Dorcas had no-known relationships. Dorcas died on September 22, 1761 at New Haven, New Haven, Ct, at age 40.
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Driver seriously injured after crash near Dumfries
A man has been seriously injured after his van crashed on the outskirts of Dumfries.
It's believed that the van skidded and rolled over before hitting some trees. The incident happened just before 4 o'clock on Saturday afternoon on a roundabout near the Garroch Business Park on the road that links the A75 with the A711 on the western edge of the town.
Police are asking for anyone who might have seen anything to come forward.
– Dumfries and Galloway Police Spokesman
"Officers are investigating a serious road traffic Crash at Garroch Loaning, Dumfries involving a small white Citroen car derived van. Police are appealing for any witnesses who may have seen this vehicle in the vicinity of this area prior to the road traffic collision occurring to contact them on 0845 600 5701."
The driver who is thought to be local was taken to Dumfries and Galloway Royal Infirmary with serious injuries.


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A daily guide to what's happening in the Catholic Church
Topic: First World War
Morning Catholic must-reads: 29/08/14
The fight to honour Ireland's heroes of the First World War
On at least 44 days more than 100 Irishmen were killed during the Great War, but they are only now being recognised
Why Catholicism's credibility survived the Great War
The rather gloomy outlook of the Church meant that it was better equipped than most faiths to cope with the horrors of the First World War
Pope Francis in emotional plea for peace
Pope speaks of children 'deprived of hope' in unscripted remarks to faithful
D-Day landings: Pope pays tribute to 'heavy sacrifice' of soldiers
In message to French bishops Pope remembers soldiers who fought Nazism
From the First World War to Syria, the unending heroism of the Catholic priest
Like Fr van der Lugt, Fr William Doyle made the ultimate sacrifice
A peacemaker betrayed
When Pope Benedict XV tried to end the First World War British Catholics shunned him, says Fr Ashley Beck
Who was to blame for the First World War?
A new book looks at the many culprits who caused the catastrophe
When Christ lay dying on the battlefield
Nick Dunne visits a humble roadside shrine near the trenches of Passchendaele built to house an extraordinary image of Christ crucified
Downton Abbey is a fantasy of the past. That's why we love it
In it we watch the only aristocrats on earth who seemingly never care about money


text:
Great advice i got today
View Single Post
Hall Of Fame
Join Date: Nov 2008
Posts: 2,470
Originally Posted by
Ha!! You and I had the same weekends!! My girl who is 8 lost in the finals to a 12 year old who literally never swung at a ball! She was tall and long armed and blocked everything back. It was on clay so my girl was working her tail off but just could not break through.
And this was the g12s so prepare for a long spell of it.
Originally Posted by
I would love to see her play. I left that tournament so proud. My girl gave up a foot in height, 30-50 lbs to every opponent. She played one entire set with a bloody nose, never even let me or any adult know it was bleeding as her court was in the middle of a row of courts. All I could see is she kept going to the water fountain and washing it. Never gave up, ended the match with a shirt covered in blood, got to the finals and lost to one of the tallest, long armed, pushing freaks of a girl I have ever laid eyes on!
But she gained a ton of valuable experience.
Opponent was older...
Opponent was taller...
Opponent was bigger
Opponent had long arms...
Opponent was a pusher...
Opponent was a freak...
Oh, and your player couldn't break through because of the clay and was injured...
Careful TCF... sounds an awful lot like all of the excuses you used to get on Brad about after a loss.
Pro Kennex 7G, Head Rip Control 17 @ 58lbs, rubber band dampener, Tourna Grip.
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Savoir Bugle Bead Pleat Front Top
- In Stock
2 reviews
- Delivery
- Next day delivery available
Savoir Bugle Bead Pleat Front Top
Decadent embellishment gives this Savoir top a luxurious feel - lifting your new season looks to new heights.
Transforming the iconic tee into the perfect smart-casual piece, this top is a versatile pick that you can style with ease from day-to-night. Bugle bead embellishment compliments your feminine style and draws attention to your décolletage for flattering appeal. A front pleat streamlines this T-shirt's look and helps sleek your silhouette.
Wear this top with Savoir capri pants and a pair of Shoe Box wedges for a daytime look you'll love wearing.
Useful info:
- Smart top by Savoir
- Bugle bead embellishment to front
- Pleat feature to front
Savoir Check Hood Waxed Coat
This waxed jacket by Savoir keeps you warm, dry and ever-so-chic as the cold season approaches.
The iconic wax jacket gets a makeover for the new season - a checked hood detail and parka-inspired tailoring gives this a contemporary twist. A drawstring waist cinches your waist and creates an elegant silhouette, while the front pockets are a charming detail.
Wear this jacket with Savoir jeans and Shoe Box pumps for a casual look you'll feel your best in.
Useful info:
- Waxed coat by Savoir
- Check detail hood
- Pocket detailing to front
- Drawstring waist fastening
- Zip and popper fastening to front
- Worn length: 34 inches
Tunic dress with sequin and velvet detail. Length: 38 inch.Colour: Khaki. Shell: Polyester. Lining: Polyester. Hand wash only.
Savoir Short Sleeve Pinch Detail Top
This short sleeve pinch detail top by Savoir adds a contemporary twist to your casual wardrobe.
With a loose fit and long line design, this top creates a sleek silhouette - flattering your figure and giving you a new season confidence boost. A playful pinch detail draws attention to your décolletage and adds a sprinkle of surprise to your day-to-day style.
Wear this top with Savoir skinny jeans and leather brogues for a classy daytime outfit.
Useful info:
- Top by Savoir
- Pinch detail
- Longline design
- Short sleeves
Savoir Stitch Tunic
- Low stock, selling fast
17 reviews
- Delivery
Savoir Knitted Tunic Top
This stitch knit tunic by Savoir is the ideal layer on chilly spring days.
Featuring a stitched knit, this top is given detail and impact, while the ribbed hem and cuffs add a little texture. Available in two colours, this tunic top is classic in black and zesty in lime.
Wear this tunic with a pair of Savoir jeans and flat ballerina style pumps for a cool and casual off-duty outfit.
Useful info:
- Tunic top by Savoir
- Stitch knit detail
- Scoop V neck
- Ribbed cuffs and hem
Savoir Supersoft Boat Neck Tunic
- Low stock, selling fast
63 reviews
- Delivery
Savoir Supersoft Tunic Dress
This tunic dress by Savoir is the perfect transitional pick for the seasons ahead.
Keeping you warm as we head into spring, this dress features three-quarter sleeves that flatter your arms, while the tunic length provides plenty of coverage. Available in a range of colours this piece will put a spring in your step with stripes, brighten up your wardrobe in green and pink or keep it classic in black, charcoal and oatmeal. Button detailing to the shoulders and two front pockets is a playful finish.
Wear this tunic with a pair of black leggings and ballet pumps for a casual yet chic style.
Useful info:
- Tunic dress by Savoir
- Three-quarter sleeves
- Boat neckline design
- Two front pockets with buttons
- Double button detailing to shoulders
- Length: 30 inches
Savoir Short Sleeved Cotton T-shirt with Scoop Neck
Keeping your look smart yet casual this T-shirt by Savoir is the perfect pick for spring days.
Featuring cotton rich fabric this tee is soft, lightweight and breathable for comfortable all day wear. Available in a range of darker colours this top is the ideal transitional piece. The scoop neck softens the classic tee shape, while the quarter sleeves flatter your upper arms.
Wear this T-shirt over a pair of Savoir jeans with toe post sandals. Add the Savoir waterfall jersey cardigan on cooler days.
Useful info:
- T-shirt by Savoir
- Short sleeves
- Scoop neck
Savoir Three-quarter Sleeve Knitted Dress
When it comes to pulling together a chic autumn and winter wardrobe, a knitted dress is always top of the list.
This Savoir knitted dress has longer sleeves and makes the perfect transitional piece. In a cotton rich fabric this dress keeps you comfortable and stylish for all day wear. The simple shape of this dress flatters for a look that's fashion forward and fuss-free. In a range of colours, you'll find a favourite for day wear, the office and for pared down evening.
Wear this knitted dress by Savoir with coloured heels, tights and a matching tote bag. Wear with leggings and boots for instant autumn style.
Useful info:
- Knitted dress by Savoir
- Long sleeves; round neck
- Length: 36 inches
Savoir V-neck Stud Detail Shirt
- Low stock, selling fast
11 reviews
- Delivery
Savoir V-neck Ladies Shirt with Stud Embellishment
This long sleeve shirt by Savoir gives the masculine classic a fresh, feminine update for summer.
Available in three colours, this blouse is classic 9-5 in white, zesty in lime and transitional in navy. The full length sleeves give you plenty of coverage this season, while the V-neck gives the traditional cut a womanly edge. Stud details add attitude to this piece for a statement finish.
Wear this shirt with a pair of Confident Curve black skinny jeans and wedge sandals for an off-duty look. Opt for smart black trousers and court shoes for an office-ready style.
Useful info:
- Ladies shirt by Savoir
- Full length sleeves
- Stud detailing
- Fixed placket
- Front pocket
Savoir Smocked Neck Top.Colours: Cerise, Chocolate, Lime. 95% viscose, 5% elastane. Machine washable.
Savoir Supersoft Tall Tunic Dress
This tall tunic dress by Savoir is the perfect transitional pick for the seasons ahead. In a tall fit, this dress is designed to give your taller frame plenty of coverage.
Keeping you warm as we head into spring, this dress features three-quarter sleeves that flatter your arms. Available in a range of colours this piece will put a spring in your step with stripes, brighten up your wardrobe in green and pink or keep it classic in black, charcoal and oatmeal. Button detailing to the shoulders and two front pockets is a playful touch that shows off your fun side.
Wear this tall tunic with a pair of black leggings and ballet pumps for a casual yet chic style.
Useful info:
- Tunic dress by Savoir
- Designed for a tall fit
- Three-quarter sleeves
- Boat neckline design
- Two front pockets with buttons
- Double button detailing to shoulders
Savoir Pleat Front T-shirt.Colour: Black, Coral, Green. Polyester. Machine washable.


text:
John Newcom
Outdoors Columnist
---- — It seems as if spring has decided it should try and show up this year. I guess it has decided winter has overrun its time and the warmer weather is trying to break back into our days. I hope spring finds a good foothold as I think we all deserve better weather.
It is time again when the deer harvest numbers come out from the 2013 hunting season. As everyone is saying it is not a surprise that deer harvest numbers are down from the previous record setting season. The problems faced by the deer population included a bout with EHD (epizootic hemorrhagic disease) and new hunting rules that have been put in place to lower the size of the deer population. A previous record setting antlerless deer harvest helped lower the amount of deer available for this past season. Shooting does means no fawns, so fewer deer next season. It is a sound reasonable solution for controlling the deer population.
The weather that we all faced during the 2013 hunting season may have had an affect on the harvest numbers too. I think we saw everything from very warm weather with tornados to subfreezing temperatures with snow and ice. I have to say the weather was all over the place the entire late fall and winter season. I think this weather had an affect on a lot of hunters and that is OK. I believe that if the weather is unsafe then you should not be out in it. Hunting is a sport that we all love but it is good to know when you should just stay home. It is not cool to risk your safety or the safety of friends and family over killing a deer. There are lots of days for hunting, so if it is bad, wait for a better day. I think many outdoorsmen did just that and in doing that some failed to harvest a deer or a second deer this past season.
The season still was in the top 10 highest deer harvested. It was a good year and you just have to take a look in the fields as you drive in the country to see that there are still plenty of deer. I have seen many groups of deer in fields finding food to eat and probably getting into the sun when it is out too. I think everyone has been pleased with days of sunshine even if the temperatures have been below average. You can tell by how warm the sunshine feels that better weather is close at hand. I am sure that man and animal alike are ready for nicer weather.
The nice thing to think about is that in a month or so you should be starting to find mushrooms. I hope we are finding them then and I have heard that lots of snow makes for a better mushroom season. I guess we will have tons of mushrooms this spring if that is correct. Stay warm and be safe outdoors!
John Newcom is an outdoors columnist for the Pharos-Tribune. He can be reached through the sports department at 574-732-5180 or firstname.lastname@example.com.


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Added Dec 28, 2011
Euxton, United K...
Denim skirt
Jan 7, 2012, 07.30 PMby janul
wow, I´m in awe at the topstitching!
Jan 7, 2012, 08.56 AMby nikkishell
Awesome attention to detail! Love the button.
Jan 5, 2012, 12.06 PMby iin
Very well made…And look great on you.
Dec 29, 2011, 11.10 PMby Laura Bolčina
Wow, looks like bought! Well done!
Dec 29, 2011, 08.55 AMby Ralf Schmitz
chapeau for your details and your perfection!
Dec 29, 2011, 03.26 AMby nookie
detailing is soooo good!
Dec 29, 2011, 12.48 AMby deChez
Kudos to you…that looks great!
Dec 28, 2011, 11.19 PMby aurorabella
Perfect stictching! GREAT job.
Dec 28, 2011, 09.51 PMby assets
I admire your stitching so neat.
Dec 28, 2011, 07.02 PMby turtlegirl00
wow! excellent!!!!
Dec 28, 2011, 06.59 PMby spulford
The details are inspired, and the topstitching is perrrrfect.
Dec 28, 2011, 04.35 PMby patti-r
Awesome Stitching Details!!
Add to Favorites 6 people added it
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The hotel was bad even for a cheap hotel. there was even a prostitute loitering outside one night. the reception people were very nice and helpful. but the rooms, shared facilities and general atmoshpere where dismal.
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"Wow! I listed my RV on a Weds and was excited to see several responses within a few days. I sold it in less than a week. I found the posting of the ad to be a very easy process and will highly recommend this site to friends and family looking to sell or purchase an RV! Thank you RVT!!"
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