Obesity among children and adults has reached epidemic proportions in the United States. This condition has proven difficult to treat effectively, especially in terms of sustainable weight loss. The project described in this report embarked on multidimensional, community-based efforts to prompt a national discussion of the obesity issue and the…
Táki Athanássios Cordas
Full Text Available Great population studies do not confirm the hypothesis that atypical personality of obese would exist. Obeses in the generalpopulation do not present more psychological disturbs thanthe ones that are not obeses. Obeses adolescents and adultsare discriminated in their academic and professional lifes. Thissocial, cultural, economic and affective impoverishment seemsto be directly related to the gravity of their obesity, what means,higher the ICM (Index of Corporal Mass, bigger are thepsychological problems. This abandonment contributes to thebig risk of unchain psychiatric pictures as depression, anxyetdisturbs, drugs and alcoholic excessive consumption andalimentary disturbs. Obeses of the general population do notpresent more psychological or psychiatric symptoms than theclinical population of obeses (obeses under treatment, presentmore clinical and psychiatric problems, mainly compulsoryalimentary standards. Some studies indicate that there is alinear relation between the ICM and the highest frequency ofalimentary compulsory behavior or bulimic episode. Thepsychiatric patients negative body perception added to theirother negative perceptions about their performance in searchingsocial interaction increase the trend to the isolation. Thepsychiatric picture presence in the bariatric surgery preoperatoryin a III degree overweight pacient has not to be facedas absolute surgery counter indication since such procedurecan be the difference between giving a better life quality orwaiting for a potentially lethal complication. We cannot forgetthat the obesity itself, due to the common associatedcomorbidyties, loads a great lethality potential. The surgerycounter-indication could be relative, it depending on how muchthe psychiatric disturbs interfere on the treatment andconditioned to the rigorous psychiatric control in the anteriorand post surgical period.
Simona Ianosi Edith
Full Text Available Obesity is a disease with severe health consequences and increased risk of mortality. The most commonly used criteria to assess the presence and the severity of obesity are body mass index, waist circumference, waist-to-height ratio and the presence of the health conditions caused or worsened by obesity. Worldwide obesity has more than doubled in the last 4 decades. Obesity is the second of the leading preventable causes of death worldwide (after smoking. Obesity has a plurifactorial pathogenesis. The central perturbation consists in the imbalance between calories intake and calories consumption (by inappropriate diet and sedentary lifestyle. Identification of all the ethiological factors is important for treatment and prophylaxis. Weight loss benefits are multiple and important: improvement in glicemic control and in plasma lipid levels, blood presure control, obstructiv sleep apneea reduction, improvement in management of daily activities and profesional performances, increase quality of life, reduction in mortality. Overweight or obese patient will complete a diagnostic and a treatment program. Treatment of obesity claims a targeted multidimensional therapy: weight and lifestyle management, diet, sustained physical activity in daily life, exercise, decrease life stressors, smoking cessation, drug therapy, bariatric surgery psichological, familial and social suport. Weight loss program must be carefully planned, adapted to the patient’s abilities and comorbidities and supervised by a nutritionist and a physiotherapist.
Steinbeck, Katharine S; Lister, Natalie B; Gow, Megan L; Baur, Louise A
The increased prevalence of adolescent obesity and associated short-term and long-term complications emphasize the need for effective treatment. In this Review, we aim to describe the evidence for, and elements of, behaviour management and adjunctive therapies and highlight the opportunities and challenges presented by obesity management in adolescence. The broad principles of treatment include management of obesity-associated complications; a developmentally appropriate approach; long-term behaviour modification (dietary change, increased physical activity, decreased sedentary behaviours and improved sleep patterns); long-term weight maintenance strategies; and consideration of the use of pharmacotherapy, more intensive dietary therapies and bariatric surgery. Bariatric surgery should be considered in those with severe obesity and be undertaken by skilled bariatric surgeons affiliated with teams experienced in the medical and psychosocial management of adolescents. Adolescent obesity management strategies are more reliant on active participation than those for childhood obesity and should recognize the emerging autonomy of the patient. The challenges in adolescent obesity relate primarily to the often competing demands of developing autonomy and not yet having attained neurocognitive maturity.
Bult, Mariëlle J F; van Dalen, Thijs; Muller, Alex F
More than half of the European population are overweight (body mass index (BMI) > 25 and or = 30 kg/m2). Being overweight and obesity are becoming endemic, particularly because of increasing nourishment and a decrease in physical exercise. Insulin resistance, type 2 diabetes, dyslipidemia, hypertension, cholelithiasis, certain forms of cancer, steatosis hepatis, gastroesophageal reflux, obstructive sleep apnea, degenerative joint disease, gout, lower back pain, and polycystic ovary syndrome are all associated with overweight and obesity. The endemic extent of overweight and obesity with its associated comorbidities has led to the development of therapies aimed at weight loss. The long-term effects of diet, exercise, and medical therapy on weight are relatively poor. With respect to durable weight reduction, bariatric surgery is the most effective long-term treatment for obesity with the greatest chances for amelioration and even resolution of obesity-associated complications. Recent evidence shows that bariatric surgery for severe obesity is associated with decreased overall mortality. However, serious complications can occur and therefore a careful selection of patients is of utmost importance. Bariatric surgery should at least be considered for all patients with a BMI of more than 40 kg/m2 and for those with a BMI of more than 35 kg/m2 with concomitant obesity-related conditions after failure of conventional treatment. The importance of weight loss and results of conventional treatment will be discussed first. Currently used operative treatments for obesity and their effectiveness and complications are described. Proposed criteria for bariatric surgery are given. Also, some attention is devoted to more basic insights that bariatric surgery has provided. Finally we deal with unsolved questions and future directions for research.
Marcio C. Mancini
Full Text Available Pharmacological treatment of obesity is an area of sudden changes,development of new drugs and treatment propositions. This articlepresents information on physiological agents that are currentlybeing used as well as drugs that were widely used but are nomore available.
Full Text Available In the last few years, obesity has become a global epidemic. Consequently, worldwide costs associated with managing obesity and obesity-related comorbidities are huge. Numerous studies have focused on discerning the appropriate proper treatment of weight related problems such as overweight and obesity. Moreover, many clinical trials have been conducted for many years in order to introduce effective anti-obesity drugs. The aim of the present review is to provide an overview of current and future pharmacotherapy for obesity, and to provide the reader with a determination of the concentration and composition of long and short term anti-obesity drugs, doing so by placing emphasis on pharmacotherapy and up-to-day solutions. It should be noted that, currently, the worldwide pharmacotherapy is represented by phendimetrazine, benzphetamine and diethylpropion, as well as by orlistat, lorcaserin, phentermine/topiramate, naltrexone/bupropion and liraglutide. In our paper, individual cases of patients’ needs are thoroughly illustrated by way of examples. Medical prescriptions and contraindications are also described.
Gomis Barbará, R
The pharmacological treatment of obesity should be considered when cannot be achieved a 10% weight loss with diet therapy and physical activity. The drugs effective in obesity treatment may act by different mechanisms such as reduction in food intake, inhibition of fat absorption, increase of thermogenesis and stimulation of adipocyte apoptosis. At present, we only have two marketed drugs for obesity treatment. Sibutramine is an inhibitor of norepinephrine, dopamine and serotonina reuptake which inhibits food intake and increases thermogenesis. Sibutramine administration for a year can induce a weight loss of 4-7%. Its main side effects are hypertension, headache, insomnia and constipation. Orlistat is an inhibitor of pancreatic lipase which is able to block the absorption of 30% of ingested fat. Its administration induces weight loss and reduction of ulterior weight regain. Also, this drug improves hypertension dyslipdaemia and helps to prevent diabetes in 52% of cases when administered over four years. The increase in frequency of stools and interference with vitamin absorption are its main side effects. Glucagon-like peptide 1, which increases insulin sensitivity and satiety, adiponectin and PPAR-gamma agonists which reduce insulin resistance and modulates adipocyte generation are the basis for future therapeutic approaches of obesity. Phosphatase inhibitors induce PPAR-gamma phosphorylation and UCP-1 expression leading to an increase in thermogenesis and reduction in appetite.
Ana Maria Pita Lottenberg
Full Text Available The fast global increased prevalence of obesity has been classifiedas an epidemics by the World Health Organization. The etiology ofobesity is very complex and involves genetic and environmentalfactors. One of the main factors that trigger obesity is sedentarylife, as well as the great availability of fat-rich foods that present ahigh energy density. According to the NHANES II, although thepopulation has decreased the ingestion of fat, the total consumptionof food has increased. The main factors that influence in choice offood are flavor, followed by cost, convenience and, finally, itsnutritional value. The dietary treatment of obesity should haverealistic goals concerning weight loss rate and amount. It issuggested to prescribe a balanced low-calorie diet, emphasizingmostly the quality of foods by using the food pyramid. Therefore,patients may learn the appropriate criteria to select food and makehealthy choices. The dietary treatment of obesity also includesthe use of behavioral techniques directed at dietary education,thus resulting in choice of healthy foods with adequate energyvalue.
Crocker, Melissa K.; Yanovski, Jack A.
This paper reviews factors that contribute to excessive weight gain in children and outlines current knowledge regarding approaches for treating pediatric obesity. Virtually all of the known genetic causes of obesity primarily increase energy intake. Genes regulating the leptin signaling pathway are particularly important for human energy homeostasis. Obesity is a chronic disorder that requires long-term strategies for management. The foundation for all treatments for pediatric obesity remain...
Full Text Available Prevalence of pediatric obesity continues to rise worldwide. Increasing the number of health care practitioners as well as pediatricians with expertise in obesity treatment is necessary. Because many obese patients suffer obesity-associated cardiovascular, metabolic and other health complications that could increase the severity of obesity, it is fundamental not only to identify the child prone to obesity as early as possible, but to recognize, treat and monitor obesity-related diseases during adolescence. This short review outlines the treatment of pediatric obesity that may have applications in the primary care setting. It examines current information on eating behavior, sedentary behavior, and details studies of multidisciplinary, behavior-based, obesity treatment programs. We also report the less common and more aggressive forms of treatment, such as medication and bariatric surgery. We emphasize that health care providers have the potential to improve outcomes by performing early identification, helping families create the best possible home environment, and by providing structured guidance to obese children and their families.
Full Text Available The markedly high prevalence of obesity contributes to the increased incidence of chronic diseases, such as diabetes, hypertension, sleep apnea, and heart disease. Because of high prevalence of obesity in almost all countries, it has been the focus of many researches throughout the world during the recent decades. Along with increasing researches, new concepts and controversies have been emerged. The existing controversies on the topic are so deep that some researches argue on absolutely philosophical questions such as “Is obesity a disease?” or “Is it correct to treat obesity?” These questions are based on a few theories and real data that explain obesity as a biological adaptation and also the final results of weight loss programs. Many people attempt to lose weight by diet therapy, physical activity and lifestyle modifications. Importantly, weight loss strategies in the long term are ineffective and may have unintended consequences including decreasing energy expenditure, complicated appetite control, eating disorders, reducing self-esteem, increasing the plasma and tissue levels of persistent organic pollutants that promote metabolic complications, and consequently, higher risk of repeated cycles of weight loss and weight regain. In this review, major paradoxes and controversies on obesity including classic obesity paradox, pre-obesity; fat-but-fit theory, and healthy obesity are explained. In addition, the relevant strategies like “Health at Every Size” that emphasize on promotion of global health behaviors rather than weight loss programs are explained.
Overweight and obesity are increasing worldwide. This has major adverse consequences for health in general and fertility in women in particular. With the increasing number of women in reproductive age being obese, there is also an increasing need for fertility treatment. And with more pregnant women
Buri, Caroline; Laederach, Kurt
The treatment of obesity is complex due to the multifactorial etiology. A modern therapy concept must therefore be tailored to the individual needs and problems and depends on various factors such as degree of obesity, the presence of physical complications, psychological co-morbidities, any treatment measures the patient underwent up to now as well as on motivational factors. Before deciding on a therapeutic measure a structured multidisciplinary cooperation is essential including psychosomatic medicine/psychiatry/psychotherapy, endocrinology, sports medicine, nutritional medicine and surgery as well. The treatment must be carried out in a multidisciplinary team and includes an adequate therapy of comorbidities and sometimes a psychopharmacological support. The success of a conservative treatment of obesity is remarkable and long-lasting and can be straightforwardly compared to bariatric surgery in financial as well as ethical terms, although for patients and their physicians the latter often carries the allure of quick success.
Portie Felix, Antonio; Navarro Sanchez, Gustavo; Hernandez Solar, Abel; Grass Baldoquin, Jorge Alberto; Domloge Fernandez, Joana
The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)
Obesity in our country is a growing concern. There are several different options for weight loss; however, individuals must be self-motivated and amendable to change in order to achieve success with their weight loss goals. Several strategies used by professionals in the US today to treat overweight and obesity, include diet therapy, exercise, behavior modification, pharmacotherapy, and surgery. The focus of the American Dietetic Association (ADA) Weight Management Position Statement is no longer just on weight loss but now on weight management. Reaching one's ideal body weight is recommended but not often realistic. Frequently, the goal of treatment shifts to maintenance of ones current weight or attempts at moderate weight loss. Lifestyle modification or behavioral modification interventions rely on analyzing behavior to identify events that are associated with appropriate vs. inappropriate eating, exercise, or thinking habits. Certain primary strategies that have been found to be useful for helping people change their behaviors so that they can lose weight and maintain their weight loss, include self-monitoring, stimulus control, cognitive restructuring, stress management, social support, physical activity, and relapse prevention. Weight loss programs should strive to combine a nutritionally balanced dietary regimen with exercise and lifestyle modifications at the lowest possible cost. There are several different methods used for dietary modifications; low calorie diets, very low calorie diets, fasting, formula diets and meal replacement programs, and popular diets. Bariatric surgery is gaining popularity as it has been an effective way to treat obesity. Following gastric bypass surgery, the patients must be prepared to modify their eating behaviors and dietary selections to assist with weight loss and prevent potential complications. Patients should be educated on the dietary guidelines extensively prior to surgery and again post-operatively.
J.E. de Niet (Judith)
textabstractObesity has become a global epidemic among all age groups. A number of countries have even experienced a notable shift from under- to over nutrition in youngsters or a double burden of both malnutrition and obesity. The World Health Organization (WHO) defines overweight and obesity as
Full Text Available Abstract Background Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment. Methods Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment. Results Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group. Conclusion A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.
Staniford, Leanne J.; Breckon, Jeff D.; Copeland, Robert J.
Childhood obesity trends have increased dramatically over the past three decade's. The purpose of this quantitative systematic review is to provide an update of the evidence, illustrating the efficacy of childhood obesity treatment, considering whether treatment fidelity has been measured and/or reported and whether this related to the treatment…
Xu, Shumei; Xue, Ying
, and mitochondrial uncoupling proteins, are known to affect body weight. These molecules serve as potential targets for the pharmacological manipulation of obesity. Sibutramine and orlistat are primariliy used for the treatment of adult obesity, which produces modest weight loss, of 3-8% compared to placebo. For children and obese adolescents, metformin is used in the case of insulin resistance and hyperinsulinemia. Octreotide is used for hypothalamic obesity. Bariatric surgery is performed for the treatment of severe childhood obesity. The causes, symptoms, prevention and treatment of pediatric obesity are described in the present review.
Torekov, S S; Madsbad, S; Holst, Jens Juul
Obesity is common and associated with a high rate of morbidity and mortality; therefore, treatment is of great interest. At present, bariatric surgery is the only truly successful treatment of severe obesity. Mimicking one of the effects of bariatric surgery, namely the increased secretion...... of glucagon-like peptide (GLP)-1, by artificially increasing the levels of GLP-1 might prove successful as obesity treatment. Recent studies have shown that GLP-1 is a physiological regulator of appetite and food intake. The effect on food intake and satiety is preserved in obese subjects and GLP-1 may...... therefore have a therapeutic potential. The GLP-1 analogues result in a moderate average weight loss, which is clinically relevant in relation to reducing the risk of type 2 diabetes and cardiovascular disease. Inspired by the hormone profile after gastric bypass, a future strategy in obesity drug...
Wesp, Julie A; Farrell, Timothy M
Epidemiological studies have demonstrated that obesity is frequently associated with esophageal motility disorders. Morbid obesity and achalasia may coexist in the same patient. The management of the morbidly obese patient with achalasia is complex and the most effective treatment remains controversial. The aim of this study is to review the pathophysiology, clinical presentation, diagnostic evaluation, and treatment of achalasia in morbidly obese patients. PubMed search from January 1990 to July 2017, including the following terms: achalasia, morbid obesity, bariatric, and treatment. Achalasia in the setting of morbid obesity may be successfully treated by endoscopic or surgical methods. Surgeons may choose to add a bariatric procedure, with various strategies present in the literature. A review of the present literature suggests that the preferred approach to achalasia in the morbidly obese patient is to address both disease processes simultaneously with a laparoscopic Heller myotomy and a Roux-en-Y gastric bypass. Roux-en-Y gastric bypass is cited by most experts as the bariatric procedure of choice, given its antireflux benefits. A well-powered study, comparing the various approaches to the treatment of achalasia in the setting of morbid obesity, is required to establish a consensus.
Togashi, Kenji; Iguchi, Kosei; Masuda, Hidenari
The prevalence of childhood obesity and its comorbidities is high in Japan. Increasing prevalence of obesity among children emphasizes the importance of focusing on primary prevention to avoid health complications later in life. We emphasize the prevention of obesity by recommending breast-feeding of infants for at least 6 months and advocating that schools provide for 60 min of moderate to vigorous daily exercise in all grades. Treatment interventions include behavioral therapy, reduction in sedentary behavior, and dietary and exercise education. After dietary treatment combined with exercise treatment, the areas of subcutaneous and visceral fat decreased significantly. These data suggest that dietary treatment combined with exercise treatment in obese children normalizes the distribution of abdominal fat and reduces the risk factors for chronic disease.
Martinussen, Christoffer; Bojsen-Møller, Kirstine Nyvold; Svane, Maria Saur
INTRODUCTION: The increasing prevalence of obesity represents a huge threat to public health and the current pharmacological treatment options are limited. Bariatric surgery is by far the most effective treatment for severe obesity, highlighting the urgent need for new and improved drug therapies....... Areas covered: Based on the physiological regulation of energy homeostasis, pharmacological strategies to treat obesity are evaluated with focus on drugs in phase 2 and 3 clinical development. The potential impact of these drugs on current treatment standards and the barriers for development...... are discussed and set in a historical perspective of previous antiobesity medications. Expert opinion: The radical effects of bariatric surgery have extended our understanding of the mechanisms controlling appetite and boosted the search for new drug targets in obesity treatment. Accordingly, several compounds...
Ionică Floriana Elvira
Full Text Available Background and Aims: In the last three decades, obesity and its related co morbidities has quickly increased. Sometime, obesity was viewed as a serious health issue in developed countries alone, but now is recognized as a worldwide epidemic, and its associated costs are enormous. Obesity is related with various diseases, like hypertension, type 2 diabetes mellitus (T2DM, dyslipidemia, chronic cardiovascular diseases, respiratory conditions, alongside chronic liver diseases, including nonalcoholic fatty liver disease (NAFLD and non-alcoholic steatohepatitis (NASH. This review purpose is to provide data on the current anti-obesity drugs, also available and in the development. Material and Methods: We searched MEDLINE from 2006 to the present to collect information on the anti-obesity pharmacotherapy. Results and Conclusions: In the patients with obesity related comorbidities, there may be an adaptation of the anti-obesity pharmacotherapy to the patients’ needs, in respect to the improvements of the cardiometabolic parameters. Although their efficacy was proven, the anti-obesity pharmacotherapies have presented adverse events that require a careful monitoring during treatment. The main obstacle for approve new drugs seems to be the ratio between the risks and the benefits, because of a long-time background of perilous anti-obesity drugs.
Holm, Jens-Christian; Gamborg, Michael; Bille, Dorthe S
Clinically-relevant protocols for the treatment of childhood obesity are lacking. This study report results for a clinic-based structured treatment program for chronic childhood obesity.......Clinically-relevant protocols for the treatment of childhood obesity are lacking. This study report results for a clinic-based structured treatment program for chronic childhood obesity....
Full Text Available The perspectives in the pharmacological treatment of obesitycan be classified in two classes: drugs already in the market,in advanced clinical trial or in final approval, or drugs in earlydevelopment. Among the first class are antiepileptic drugslike topiramate (although it was studied for obesity treatmentit was descontinued for this indication because of the highdrop-out rate in clinical trials and zonisamide (with someshort term studies in obese adults; antidepressives likebupropion (that leads to weight reduction and also diminishesthe weight gain associated to smoking cessation andradafaxine (a bupropion metabolite, without reported trials inobese subjects; glucagon-like peptide-1 analogues like exenatide(exendin-4, pramlintide and liraglutide (with studiesin type 2 diabetic obese subjects and the selective blockerof the cannabinoid-1 receptor, rimonabant, with a large bodyof studies (Rimonabant in Obesity, RIO-Europe, RIO-NorthAmerica, RIO-Lipids and RIO-Diabetes, involving more than6.600 patients with obesity, with and without diabetes, beingan important perspective of treatment for obesity andmetabolic syndrome. In early phase of development, we canreport some energy balance modulators like neuropeptide Yantagonists, melanocortin agonists, leptine and its analoguesand ciliary neurotrophic factor (axokine; termogenic agentslike agonists of the beta-3 adrenergic receptor, uncouplingagents of the mithocondrial membrane and peripheralmodulators of the energy balance (cholecystokinine.
Full Text Available Obesity now presents one of the biggest health problems of our times. Diet and exercise are best for both prevention and treatment; unfortunately, both require much discipline and are difficult to maintain. Medications offer a possible adjunct, but their effect is modest, they are limited by side effects, and the weight loss lasts only as long as the drug is being taken, since as soon as treatment is stopped, the weight is regained. Sibutramine, a sympathomimetic medication which was available for long-term treatment, is the most recent of the drugs to be withdrawn from the market due to side effects; in this case it was an increased risk of cardiovascular events. This paper reviews those medications which are available for treatment of obesity, including many of those recently taken off the market. It also discusses some of the newer treatments that are currently being investigated.
Maria Catena Quattropani; Teresa Buccheri
Objective: This work focuses on clinical psychologist’ presence within childhood obesity prevention programmes in several countries. Method: The Authors collected articles considering psychological, biological and social aspects linked to childhood obesity. Results: Studies reveal that childhood obesity prevention programmes are based on biological, medical and educational aspects; clinical psychologists up until now have been engaged almost exclusively in the treatment of obesity. Conclusion...
Overeating and physical inactivity are of great importance in the etiology of obesity. Psychological factors are often found in the background of life style. Chronic stress can contribute to physical inactivity and behaviors that hinder the keeping of a diet (e.g., irregular eating pattern, emotional eating). Results of randomized controlled trials show that relaxation can reduce emotional eating, improve cognitive restraint, and thereby reduce weight. However, stress management is more than relaxation. It consists of adaptive emotion-focused and problem-focused coping strategies and skills to improve relationships. Deflection skills may help in replacing emotional eating with other behaviors. Cognitive restructuring, saying no, and problem solving help to prevent or manage conflicts and difficulties otherwise would result in overeating due to distress. Developing stress management skills may result in greater compliance with the treatment. The techniques presented in the study can be easily applied by general practitioners or specialists, and provide tools for optimizing obesity treatment.
Lenders, C M; Gorman, K; Lim-Miller, A; Puklin, S; Pratt, J
Pediatric obesity is a major public health threat. Obese children and adolescents are at increased risk for many medical and surgical conditions. These conditions may affect their quality of life and life expectancy. The rapidly progressive nature of type 2 diabetes mellitus within the first 5 years of obesity diagnosis is particularly concerning. Because health risk increases with degree of obesity, adolescents who may be eligible for more aggressive obesity treatment should be identified and counseled. Published by Elsevier Inc.
Lund, Thomas Bøker; Sandøe, Peter; Lassen, Jesper
The aim of this study was to investigate the Danish public’s support for publicly funded obesity treatment and prevention. It was also examined whether levels of support could be explained by dislike of obese people and / or the belief that those who are obese are personally responsible......, the perceived controllability of obesity, self-reported BMI, and additional attitudinal and sociodemographic characteristics. Public funding of some obesity treatments, such as weight-loss surgery, attracted only limited public support. A majority of the Danish public did support ‘softer’ treatment...... interventions and preventive initiatives. Attitudes to the treatment of obesity were clearly best predicted by the belief that individuals are personally responsible for their own obesity. Dislike of obese persons had no direct effect on the preference for collective treatment initiatives and only a small...
Most, Sebastian W; Højgaard, Birgitte; Teilmann, Grete Katrine
BACKGROUND: Treating severe childhood obesity has proven difficult with inconsistent treatment results. This study reports the results of the implementation of a childhood obesity chronic care treatment protocol. METHODS: Patients aged 5 to 18 years with a body mass index (BMI) above the 99th......, but independent of baseline BMI SDS, age, co-morbidity, SES, pubertal stage, place of referral, hours of treatment per year, and mean visit interval time. CONCLUSIONS: The systematic use of the TCOCT protocol reduced the degree of childhood obesity with acceptable retention rates with a modest time...... percentile for sex and age were eligible for inclusion. At baseline patients' height, weight, and tanner stages were measured, as well as parents' socioeconomic status (SES) and family structure. Parental weight and height were self-reported. An individualised treatment plan including numerous advices...
Obesity is commonly encountered in veterinary patients. Although there are various published dietary approaches to achieving weight loss, successful long-term prevention of weight regain has proven elusive. Adding environmental and behavioral treatment strategies to a weight loss plan may help the veterinary team, the pet, and the pet owner maximize the effectiveness of the program. Because the owner directly affects the environment and behavior of the pet undergoing a weight loss plan, treatment strategies with an emphasis on owner involvement is the focus of this review. Veterinary use of the 5 A's behavioral counseling approach with the pet owner is discussed. Copyright © 2016 Elsevier Inc. All rights reserved.
Andris, Deborah A
In the United States, obesity has reached epidemic proportions. Serious medical complications, impaired quality of life, and premature mortality are all associated with obesity. Medical conditions such as type 2 diabetes mellitus, hypertension, hyperlipidemia, or sleep apnea can improve or be cured with weight loss. Medical treatment programs focused on diet, behavior modification, and/or pharmacologic intervention have met with limited long-term success. Although surgical treatments for obesity have become popular in recent years, they should only be used as a last resort for weight loss. Not all patients can be considered appropriate candidates for surgery; therefore, guidelines based on criteria from the National Institutes of Health should be used preoperatively to help identify suitable persons. Most individuals who opt for weight-loss surgery have usually struggled for many years with losing weight and keeping it off, but surgery alone will not ensure successful weight loss. Patient education is imperative for long-term success. Moreover, any such educational regimen should include information on diet, vitamin and mineral supplementation, and lifestyle changes, as well as expected weight-loss results and improvements in comorbid conditions. Patients must be willing to commit to a long-term follow-up program intended to promote successful weight loss and weight maintenance and to prevent metabolic and nutritional complications.
XU, SHUMEI; XUE, YING
Pediatric or childhood obesity is the most prevalent nutritional disorder among children and adolescents worldwide. Approximately 43 million individuals are obese, 21?24% children and adolescents are overweight, and 16?18% of individuals have abdominal obesity. The prevalence of obesity is highest among specific ethnic groups. Obesity increases the risk of heart diseases in children and adults. Childhood obesity predisposes the individual to insulin resistance and type 2 diabetes, hypertensio...
Verheijden, M.W.; Bakx, J.C.; Weel, van C.; Koelen, M.A.; Staveren, van W.A.
Social support is important to achieve beneficial changes in risk factors for disease, such as overweight and obesity. This paper presents the theoretical and practical framework for social support, and the mechanisms by which social support affects body weight. The theoretical and practical
Verheijden, M.W.; Bakx, J.C.; Weel, C. van; Koelen, M.A.; Staveren, W.A. van
Social support is important to achieve beneficial changes in risk factors for disease, such as overweight and obesity. This paper presents the theoretical and practical framework for social support, and the mechanisms by which social support affects body weight. The theoretical and practical
Olszewski, Pawel K; Klockars, Anica; Levine, Allen S
Laboratory animal experiments have consistently shown that oxytocin causes early termination of food intake, thereby promoting a decrease in body weight in a long term. Recent studies have also assessed some of oxytocin's effects on appetite and energy balance in humans. The present study examines the findings of the key basic research and of the few clinical studies published thus far in the context of potential benefits and challenges stemming from the use of oxytocin in obese patients. Basic research indicates the involvement of oxytocin in satiety, processing, in reducing a drive to eat for pleasure and because of psychosocial factors. Although the results of clinical studies are very scarce, they suggest that oxytocin administered intranasally in humans decreases energy-induced and reward-induced eating, supports cognitive control of food choices, and improves glucose homeostasis, and its effectiveness may be BMI dependent. Despite the wealth of basic research showing broad anorexigenic effects of oxytocin, clinical studies on oxytocin's therapeutic potential in obesity, are still in their infancy. Future implementation of oxytocin-based pharmacological strategies in controlling energy balance will likely depend on our ability to integrate diverse behavioral and metabolic effects of oxytocin in obesity treatment regimens.
Noordin, M. Hazim M.; Ahmad, Hartini; Baharin, Shamsuddin
Malaysia is ranked as a country with the most obese population in the Southeast Asia region, and placed sixth in the Asia Pacific. Obesity does not only influence the persons' mobility and quality of health, but could also link to medical leaves and absenteeism affecting the overall workforce productivity and efficiency. Routine physical activity is essential for good health and it is particularly important for those who are trying to lose weight or to maintain a healthy weight. However, it is disheartening to note that only 32.6 percent Malaysians above the age of 15 are involved in physical exercise or vigorous sports. There is an emergence of many types of hydrotherapy system, which are either active or passive and these can be at hospital settings, public places or in individual homes. Such hydrotherapy, if properly programmed can promote the physical activity amongst the obese in Malaysia. Current research on the use of active and passive hydrotherapy for obesity treatment was carried out. Subjects of both sexes and diverse age ranges, immersed themselves in a heated pool within hospital setting and in a bath tubs with high energy turbulent movement of medium temperature water. These hydrotherapy sessions provide a form of physical exercise in water as compared to on the land exercise. The findings of the hydrotherapy sessions have shown encouraging results. Quantitative data was analysed, with the help of descriptive statistics and paired sample t-test. Qualitative data was analysed manually with help of thematic analysis and specialised qualitative assessment software. This study reveals that hydrotherapy has improved patient's mobility, flexibility and exercise capability. Results reveal the reduction in the weight of subjects, with both quantitative and qualitative data results show that Hydrotherapy improved the quality of life in term of body pain reduction and general health improvement. Therefore, it can be concluded that the hydrotherapy can be seen
KARADAYI, BILGEHAN; KOCKAYA, GUVENC; YENILMEZ, FATMA BETUL; SENER, OLGUN; BEYAN, ASLIHAN
Obesity is defined by the World Health Organization (WHO) as “abnormal or excess fat accumulation that may impair health.” To define obesity, the patient’s body weight in kilograms is divided by the square of height in meters to calculate the body mass index (BMI). In Turkey, it has been reported that 34.8% of the population are overweight, 44.2% are of normal weight, and 3.9% are lean in 2012. With respect to gender, 20.9% and 30.4% of the women are obese and overweight, respectively. The ai...
Halpern, A; Mancini, M C
The information presented in this article provides an overview of physiological agents, therapeutics in current use, and medications that have been extensively used in the past but are no longer available, or are not classically considered as anti-obesity drugs. The authors present an extensive review on the criteria for anti-obesity management efficacy, on physiological mechanisms that regulate central and/or peripheral action energetic homeostasis (nutrients, monoamines and peptides), and on beta-phenethylamine pharmacological-derivative agents (fenfluramine, dexfenfluramine, phentermine, diethylpropion, fenproporex and sibutramine), tricyclic derivatives (mazindol), phenylpropanolamine derivatives (ephedrine, phenylpropanolamine), a phenylpropanolamine oxy-tri-fluor-phenyl derivative (fluoxetine), a naftilamine derivative (sertraline) and a lipstatine derivative (orlistat). An analysis of all clinical trials longer than 10 weeks in duration is also presented for medications used in the management of obesity.
Jorsal, T; Rungby, J; Knop, F K
for treatment of diabetes and obesity. This review will outline the physiology and pharmacological potential of amylin and GLP-1, respectively, and focus on innovative peptide drug development leading to drugs acting on two or more distinct receptors, such as an amylin and GLP-1 peptide hybrid, potentially...... producing a more effective treatment strategy to combat the rapidly increasing global obesity....
Full Text Available Most of the available non-invasive medical therapies for obesity are non-efficient in a long-term evaluation; therefore there is a constant need for new methods of treatment. Research on calorie restriction has led to the discovery of sirtuins (silent information regulators, SIRTs, enzymes regulating different cellular pathways that may constitute potential targets in the treatment of obesity. This review paper presents the role of SIRTs in the regulation of glucose and lipid metabolism as well as in the differentiation of adipocytes. How disturbances of SIRTs’ expression and activity may lead to the development of obesity and related complications is discussed. A special emphasis is placed on polymorphisms in genes encoding SIRTs and their possible association with susceptibility to obesity and metabolic complications, as well as on data regarding altered expression of SIRTs in human obesity. Finally, the therapeutic potential of SIRTs-targeted strategies in the treatment of obesity and related disorders is discussed.
Legro, Richard S.
There appears to be an epidemic of both obesity and polycystic ovary syndrome (PCOS) in the world today. However, obesity per se is not a part of the phenotype in many parts of the world. Obesity is likely not a cause of PCOS, as the high prevalence of PCOS among relatively thin populations demonstrates. However, obesity does exacerbate many aspects of the phenotype, especially cardiovascular risk factors such as glucose intolerance and dyslipidemia. It is also associated with a poor response to infertility treatment and likely an increased risk for pregnancy complications in those women who do conceive. Although most treatments of obesity, with the exception of bariatric surgery, achieve modest reductions in weight and improvements in the PCOS phenotype, encouraging weight loss in the obese patient remains one of the front-line therapies. However, further studies are needed to identify the best treatments, and the role of lifestyle therapies in women of normal weight with PCOS is uncertain. PMID:23074008
Michelini, Ilaria; Falchi, Anna Giulia; Muggia, Chiara; Grecchi, Ilaria; Montagna, Elisabetta; De Silvestri, Annalisa; Tinelli, Carmine
Diet attrition and failure of long term treatment are very frequent in obese patients. This study aimed to identify pre-treatment variables determining dropout and to customise the characteristics of those most likely to abandon the program before treatment, thus making it possible to modify the therapy to increase compliance. A total of 146 outpatients were consecutively enrolled; 73 patients followed a prescriptive diet while 73 followed a novel brief group Cognitive Behavioural Treatment (CBT) in addition to prescriptive diet. The two interventions lasted for six months. Anthropometric, demographic, psychological parameters and feeding behaviour were assessed, the last two with the Italian instrument VCAO Ansisa; than, a semi-structured interview was performed on motivation to lose weight. To identify the baseline dropout risk factors among these parameters, univariate and multivariate logistic models were used. Comparison of the results in the two different treatments showed a higher attrition rate in CBT group, despite no statistically significant difference between the two treatment arms (P = 0.127). Dropout patients did not differ significantly from those who did not dropout with regards to sex, age, Body Mass Index (BMI), history of cycling, education, work and marriage. Regardless of weight loss, the most important factor that determines the dropout appears to be a high level of stress revealed by General Health Questionnaire-28 items (GHQ-28) score within VCAO test. The identification of hindering factors during the assessment is fundamental to reduce the dropout risk. For subjects at risk, it would be useful to dedicate a stress management program before beginning a dietary restriction.
Lee, Darrin J; Elias, Gavin J B; Lozano, Andres M
Eating disorders and obesity adversely affect individuals both medically and psychologically, leading to reduced life expectancy and poor quality of life. While there exist a number of treatments for anorexia, morbid obesity and bulimia, many patients do not respond favorably to current behavioral, medical or bariatric surgical management. Neuromodulation has been postulated as a potential treatment for eating disorders and obesity. In particular, deep brain stimulation and transcranial non-invasive brain stimulation have been studied for these indications across a variety of brain targets. Here, we review the neurobiology behind eating and eating disorders as well as the current status of preclinical and clinical neuromodulation trials for eating disorders and obesity.
Edio Luiz Petroski; Ludmila Dalben Soares
In the last few years, there has been considerable interest in the effects of excessive weight gain during childhood, due to the fact that the development of fat tissue in this period is a determinant of adult body composition. The objective of this study was to investigate the prevalence of infant obesity, to identify possible etiological factors, and to highlight treatments that have been used to reduce and/or prevent child obesity. Results have shown that obesity has increased more than an...
Ness-Abramof, Rosane; Apovian, Caroline M
The prevalence of obesity has risen sharply during the last 4 decades imposing a serious health burden to modern society. Obesity is known to cause and exacerbate many chronic diseases such as diabetes, hypertension, dyslipidemia, coronary heart disease, stroke, obstructive sleep apnea and certain cancers, among many others. The rise in obesity prevalence is mainly caused by overconsumption of energy, coupled to a sedentary life in susceptible individuals. Weight homeostasis is paramount for survival and its control is coordinated by neural and endocrine signals emanating from the fat tissue, digestive system and brain. During thousands of years humans were challenged by nutrient deprivation, developing an efficient mechanism to store energy. It explains the difficulty in losing weight, making obesity prevention the main effective health approach to halt the obesity epidemic.
Obesity and being overweight have become significant global health concerns, and may actually be ... increased intake of energy-dense foods that are high in saturated fat, and a decrease in .... Journal of American Medical Association. 2015 ...
Walmir Ferreira Coutinho
Binge eating is a frequent disorder among obese patient, specialythose undergoing weight loss treatment. Binge eating disorder(BED) is a newly defined diagnostic category, usually associatedwith psychopathology and overweight. Several clinical trialsinvolving psychoterapeutical interventions have shown thatcognitive beahavior therapy and interpersonal therapy can beeffective for the treatment of obese patients with BED.Pharmacotherapy can be also an useful tool for the control ofbinge eating,...
Zhang, W-L; Zhu, L; Jiang, J-G
Obesity is considered as a chronic disease that can induce a series of comorbidities and complications. Chinese medicine has long clinical experiences in the treatment of obesity. This review summarizes the natural products from traditional Chinese medicine (TCM) that are reported to have anti-obesity effects in the past two decades. Botanic TCM comprises 90% of total Chinese crude drugs, and generally contains various active ingredients, in which the effective anti-obesity ingredients identified can be divided into saponins, polysaccharides, alkaloids, polyphenols and others. Astragaloside IV, glycyrrhizin, macrostemonoside A, berberine, betaine, capsaicin, matrine, methyl piperate, piperine, rutaecarpine, asimilobine, epigallocatechingallate, magnolol, resveratrol, soybean-isoflavone, α-linolenic acid, emodin, geniposide, phillyrin, salidroside and ursolic acid are specified in this review, and their sources, models, efficacy are described. It is concluded that the mechanisms of these components for the treatment of obesity include: (i) suppression of appetite, increase of satiety, reduction of energy intake; (ii) reduction in the digestion and absorption of exogenous lipid; (iii) attenuation of the synthesis of endogenous lipid; (iv) promotion of the oxidation and expenditure of lipid and (v) improvement of lipid metabolism disorder. Authors believe that the effective compounds from TCM will provide an alternative and hopeful way for the treatment of obesity. © 2014 World Obesity.
Korossy, Anna; Blázovics, Anna
Obesity is an increasing problem all over the world as the lifestyle changes and fast food chains gain popularity. In India, 31% of men and 29% of women are overweight, which is a growing trend over the last 11 years. Obesity increases the risk of many diseases such as cardiovascular diseases, reflux disease, gastrointestinal tumors, and sleep apnea. Obesity without complications can also cause serious complications during surgery. In Ayurveda the formation of diseases depends on the balance of the three doshas - vata, pitta, kapha. The rate of three doshas varies depending on the body constitution of the indvidual. Studies of an Indian research group have shown that Ayurvedic body type classification may be associated with genes of inflammation and oxidative stress factors, the rate of DNA methylation and development of cardiovascular diseases. Orv. Hetil., 2016, 157(34), 1349-1352.
Robert H. Lustig
Full Text Available Obesity is a common complication after craniopharyngioma therapy, occurring in up to 75% of survivors. Its weight gain is unlike that of normal obesity, in that it occurs even with caloric restriction, and attempts at lifestyle modification are useless to prevent or treat the obesity. The pathogenesis of this condition involves the inability to transduce afferent hormonal signals of adiposity, in effect mimicking a state of CNS starvation. Efferent sympathetic activity drops, resulting in malaise and reduced energy expenditure, and vagal activity increases, resulting in increased insulin secretion and adipogenesis. Lifestyle intervention is essentially useless in this syndrome, termed hypothalamic obesity. Pharmacologic treatment is also difficult, consisting of adrenergics to mimic sympathetic activity, or suppression of insulin secretion with octreotide, or both. Recently, bariatric surgery (Roux-en-Y gastric bypass, laparoscopic gastric banding, truncal vagotomy have also been attempted with variable results. Early and intensive management is required to mitigate the obesity and its negative consequences.
Pulgaron, Elizabeth R.; Delamater, Alan M.
The incidence of overweight and obesity among children has increased dramatically in recent decades, with about one-third of children in the U.S. currently being either overweight or obese. Being overweight in early childhood increases risk for later obesity. There is evidence for the efficacy of family-based behavioral treatment to control weight and improve health outcomes. Obesity-related health risks have been documented, including metabolic syndrome. There is also increasing incidence of type 2 diabetes (T2D) among youth in recent years, with obesity and family history of T2D generally present. Lower income and ethnic minority status are associated with both obesity and T2D in youth. Most youth with T2D do not achieve optimal glycemic control, and are at high risk for later health complications. Obesity and T2D represent significant public health issues with potentially great personal and societal cost. Research addressing the prevention of obesity and T2D among youth is urgently needed. PMID:24919749
Chen, H C; Farese, R V
Because triglycerides are considered essential for survival and their synthesis has been thought to occur through a single mechanism, inhibiting triglyceride synthesis has been largely unexplored as a possible target for obesity treatment. However, recent studies indicate that mice lacking acyl CoA:diacylglycerol acyltransferase (DGAT), a key enzyme in triglyceride synthesis, are viable and resistant to diet-induced obesity. Unexpectedly, this resistance is caused by a mechanism involving increased energy expenditure. These findings suggest that inhibiting specific components of triglyceride synthesis, such as DGAT, is feasible and may represent a novel approach to treating obesity.
Lee, Darrin J.; Elias, Gavin J.B.; Lozano, Andres M.
Eating disorders and obesity adversely affect individuals both medically and psychologically, leading to reduced life expectancy and poor quality of life. While there exist a number of treatments for anorexia, morbid obesity and bulimia, many patients do not respond favorably to current behavioral, medical or bariatric surgical management. Neuromodulation has been postulated as a potential treatment for eating disorders and obesity. In particular, deep brain stimulation and transcranial non-invasive brain stimulation have been studied for these indications across a variety of brain targets. Here, we review the neurobiology behind eating and eating disorders as well as the current status of preclinical and clinical neuromodulation trials for eating disorders and obesity. PMID:29399320
Câmara, Niels Olsen Saraiva; Iseki, Kunitoshi; Kramer, Holly; Liu, Zhi-Hong; Sharma, Kumar
The theme of World Kidney Day 2017 is 'kidney disease and obesity: healthy lifestyle for healthy kidneys'. To mark this event, Nature Reviews Nephrology invited five leading researchers to describe changes in the epidemiology of obesity-related kidney disease, advances in current understanding of the mechanisms and current approaches to the management of affected patients. The researchers also highlight new advances that could lead to the development of novel treatments and identify areas in which further basic and clinical studies are needed.
Legro, Richard S
There appears to be an epidemic of both obesity and polycystic ovary syndrome (PCOS) in the world today. However, obesity per se is not a part of the phenotype in many parts of the world. Obesity is likely not a cause of PCOS, as the high prevalence of PCOS among relatively thin populations demonstrates. However, obesity does exacerbate many aspects of the phenotype, especially cardiovascular risk factors such as glucose intolerance and dyslipidemia. It is also associated with a poor response to infertility treatment and likely an increased risk for pregnancy complications in those women who do conceive. Although most treatments of obesity, with the exception of bariatric surgery, achieve modest reductions in weight and improvements in the PCOS phenotype, encouraging weight loss in the obese patient remains one of the front-line therapies. However, further studies are needed to identify the best treatments, and the role of lifestyle therapies in women of normal weight with PCOS is uncertain. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Full Text Available ABSTRACT Obesity is a wide-spread condition directly or indirectly connected with an increase in the prevalence of a variety of human diseases. It affects over 50% of the western overall population. In 2017, a thorough analysis of 204 studies on obesity and cancer revealed that the condition increases the risk of the following types of cancer: stomach, colon, rectal, bile duct, pancreatic, esophagus, breast, endometrial, ovarian, kidney and multiple myeloma. The first study aiming at establishing a connection between obesity and the rate of induced orthodontic tooth movement was conducted by Saloom et al; however, it could not effectively nor significantly reveal any direct influence or effect. Despite being identified during the first week, differences could not be explained and treatment time remained unchanged. In spite of lack of studies in the literature on the connection between obesity and the rate of induced tooth movement, in clinical practice, courses or specialized training, we should not have protocols changed nor adopt any measures or expect significant differences between normal-weight and obese individuals. It should be emphasized that unsuccessful cases or cases of root resorption associated with treatment should not be assigned to obesity, since scientific data is insufficient to do so.
Skow, M A; Bergmann, N C; Knop, F K
, whereas GIP seems to affect lipid metabolism. The introduction of selective GLP-1 receptor (GLP-1R) agonists for the treatment of type 2 diabetes and obesity has increased the scientific and clinical interest in incretins. Combining the body weight-lowering and glucose-lowering effects of GLP-1...... with a more potent improvement of β cell function through additional GIP action could potentially offer a more effective treatment of diabetes and obesity, with fewer adverse effects than selective GLP-1R agonists; therefore, new drugs designed to co-activate both the GIP receptor (GIPR) and the GLP-1R...
Khan, Abraham; Kim, Aram; Sanossian, Cassandra; Francois, Fritz
Gastroesophageal reflux disease (GERD) is a frequently encountered disorder. Obesity is an important risk factor for GERD, and there are several pathophysiologic mechanisms linking the two conditions. For obese patients with GERD, much of the treatment effort is focused on weight loss and its consistent benefit to symptoms, while there is a relative lack of evidence regarding outcomes after novel or even standard medical therapy is offered to this population. Physicians are hesitant to recommend operative anti-reflux therapy to obese patients due to the potentially higher risks and decreased efficacy, and these patients instead are often considered for bariatric surgery. Bariatric surgical approaches are broadening, and each technique has emerging evidence regarding its effect on both the risk and outcome of GERD. Furthermore, combined anti-reflux and bariatric options are now being offered to obese patients with GERD. However, currently Roux-en-Y gastric bypass remains the most effective surgical treatment option in this population, due to its consistent benefits in both weight loss and GERD itself. This article aims to review the impact of both conservative and aggressive approaches of obesity treatment on GERD.
Hu, Jia; Zhu, Chao; Huang, Mao
Being a great threaten for human health, obesity has become a pandemic chronic disease. There have been several therapeutic treatments for this social health issue, including diet and exercise therapy, medication and surgery, among which the diet is still the most common way. However, none of these therapeutic measures available is ideal, making it necessary to find an effective medical treatment. The endocannabinoid system, which is well known for its contributions in certain mental processes such as relaxation, amelioration of pain and anxiety, and sedation initiation, has been recently reported to play an essential role in regulating appetite and metabolism to maintain energy balance, leading to the belief that endocannabinoid system is closely related to obesity. This new discovery deepens our understanding of obesity, and provides us with a new direction for clinical obesity treatment. Rimonabant is an antagonist for CB1, and has entered the market in some countries. However, although effective as an anti-obesity drug, rimonabant also causes obviously adverse side-effects, thus is being doubted and denied for medical usage.
Lucy F. Faulconbridge
Full Text Available Background. Obese individuals who suffer from major depressive disorder are routinely screened out of weight loss trials. Treatments targeting obesity and depression concurrently have not been tested. Purpose. To test the short-term efficacy of a treatment that combined behavioral weight management and cognitive behavioral therapy (CBT for obese adults with depression. Methods. Twelve obese females diagnosed with major depressive disorder received weekly group behavioral weight management, combined with CBT for depression, for 16 weeks. Weight, symptoms of depression, and cardiovascular disease (CVD risk factors were measured at baseline and week 16. Results. Participants lost 11.4% of initial weight and achieved significant improvements in symptoms of depression and CVD risk factors. Conclusions. Obese individuals suffering from major depressive disorder can lose weight and achieve improvements in symptoms of depression and CVD risk factors with 16 weeks of combined treatment. A larger randomized controlled trial is needed to establish the efficacy of this treatment.
Tschöp, Matthias H; Finan, Brian; Clemmensen, Christoffer
Many complex diseases have historically proven to be defiant to the best mono-therapeutic approaches. Several examples of combination therapies have largely overcome such challenges, notably for the treatment of severe hypertension and tuberculosis. Obesity and its consequences, such as type 2...... diabetes, have proven to be equally resistant to therapeutic approaches based on single medicines. Proper management of type 2 diabetes often requires adjunctive medications, and the recent registration of a few compound mixtures has set the precedent for combinatorial treatment of obesity. On the other...... to reverse obesity and type 2 diabetes. Here, we summarize the discovery, pre-clinical validation, and first clinical test of such peptide hormone poly-agonist drug candidates....
Trier, C; Fonvig, Cilius Esmann; Bøjsøe, C
. There were no associations between the baseline intake of sweetened beverages, candy, snacks, and/or fast food and BMI SDS at baseline or the change in BMI SDS during treatment. CONCLUSIONS: The intake of sweetened beverages, candy, snacks or fast food when entering a childhood obesity treatment program......BACKGROUND: Increased consumption of sweetened beverages has previously been linked to the degree of childhood obesity. OBJECTIVE: The aim of the present study was to assess whether the intake of sweetened beverages, candy, snacks or fast food at baseline in a multidisciplinary childhood obesity...... treatment program was associated with the baseline degree of obesity or the treatment effect. METHODS: This prospective study included 1349 overweight and obese children (body mass index standard deviation scores (BMI SDS) ≥ 1.64) enrolled in treatment at The Children's Obesity Clinic, Copenhagen University...
Full Text Available Scott S Um1, Wendelin Slusser2, Daniel A DeUgarte11Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 2Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USAAbstract: Adolescent obesity is a growing health concern that can have immense physical and psychological impact. Treatment of morbidly obese adolescents should include a multidisciplinary team to address medical comorbidities, diet, physical activity, mental health, and behavior modification. Anti-obesity pharmacologic agents have a limited role in the treatment of adolescents because of concerns with side effects, safety, and efficacy. Orlistat (GlaxoSmithKline, Moon Township, PA is the only approved medication for weight-loss in adolescents. However, it is associated with gastrointestinal side effects and its long-term efficacy is unknown. Bariatric surgery is the most effective therapy to treat morbid obesity. However, adolescents must meet rigorous criteria and have appropriate cognitive, psychological, and social clearance before being considered for surgical intervention. Gastric bypass remains the gold standard bariatric operation. The adjustable gastric band is not FDA-approved for use in patients under 18 years of age. Sleeve gastrectomy is a promising procedure for adolescents because it avoids an intestinal bypass and the implantation of a foreign body. Prospective longitudinal assessment of bariatric surgery procedures is required to determine long-term outcomes. In this manuscript, we review the treatment options, efficacy, and impact on quality of life for morbidly obese adolescents.Keywords: bariatric surgery, morbid obesity, weight loss, adolescent
Gilles, Allyson; Cassano, Michael; Shepherd, Elizabeth J.; Higgins, Diana; Hecker, Jeffrey E.; Nangle, Douglas W.
The current meta-analysis reviews research on the treatment of pediatric obesity focusing on studies that have been published since 1994. Eleven studies (22 comparisons, 115 effect sizes, N = 447) were included in the present meta-analysis. Results indicated that comprehensive behavioral interventions may be improved in at least two ways:…
Andersson, B.; Seidell, J; Terning, K; Björntorp, P
Obese women (n = 104) were treated with an energy reduced diet (1100 kcal d-1) in a strictly standardized outpatient regime. Body composition, regional adipose tissue distribution, regional fat cell sizes and metabolic variables were followed before treatment, after 5% weight loss and at the stage
Obesity prevalence is growing as well as its severity with increasing morbidity and mortality. This "globesity" also affects developing countries where under nutrition and stunting frequently coexist with overweight and obesity. One third of obese adults began to be so in the pediatric ages. There are two main types of prevention: general one representing greater actions from health authorities and the individual one carried out by the pediatrician and the patient at risk. Once the state of obesity is reached (relative body mass index, rBMI >121%) the longer lasting care becomes more complex and frequently unsuccessful. The treatment of obesity is aimed to care for the present and silent disorders and for preventing its further tracking to adulthood. Identification of pediatric population at risk which is the one with an rBMI of 111%-120% plus other risk factors. Specific individual actions include reduction of food intake, increase of energy expenditure, involvement of parents, and the child-adolescent himself in the prevention. Therapy is based on some principles plus the important medical and emotional approach. A Cochrane study based on only 10 appropriate studies showed a predominant poor efficacy of the undergone preventive action. Treatment guides are presented after our own experience with a group of 400 kids with an average follow-up of 7 years and other individual prevention studies. Involving motivated pediatricians with a minimum of time for visits and better follow-up in the frame of a general national preventive programme could be a rational outcome. Treatment of obesity should never be postponed whatever the clinical care is.
Eichen, Dawn M; Matheson, Brittany E; Appleton-Knapp, Sara L; Boutelle, Kerri N
Recent research has highlighted executive function and neurocognitive deficits among individuals with eating and weight disorders, identifying a potential target for treatment. Treatments targeting executive function for eating and weight disorders are emerging. This review aims to summarize the recent literature evaluating neurocognitive/executive function-oriented treatments for eating and weight disorders and highlights additional work needed in this area. Cognitive remediation therapy (CRT) for anorexia nervosa has been the most extensively studied neurocognitive treatment for eating disorders. Results demonstrate that CRT improves executive function and may aid in the reduction of eating disorder symptomatology. Computer training programs targeting modifying attention and increasing inhibition are targeting reduction of binge eating and weight loss with modest success. Neurocognitive treatments are emerging and show initial promise for eating and weight disorders. Further research is necessary to determine whether these treatments can be used as stand-alone treatments or whether they need to be used as an adjunct to or in conjunction with other evidence-based treatments to improve outcomes.
Full Text Available Over the last decade, investigators have paid increasing attention to the effects of resistance training (RT on several metabolic syndrome variables. Evidence suggests that skeletal muscle is responsible for up to 40% of individuals' total body weight and may be influential in modifying metabolic risk factors via muscle mass development. Due to the metabolic consequences of reduced muscle mass, it is understood that normal aging and/or decreased physical activity may lead to a higher prevalence of metabolic disorders. The purpose of this review is to (1 evaluate the potential clinical effectiveness and biological mechanisms of RT in the treatment of obesity and (2 provide up-to-date evidence relating to the impact of RT in reducing major cardiovascular disease risk factors (including dyslipidaemia and type 2 diabetes. A further aim of this paper is to provide clinicians with recommendations for facilitating the use of RT as therapy in obesity and obesity-related metabolic disorders.
Trier, C; Fonvig, C E; Bøjsøe, C; Mollerup, P M; Gamborg, M; Pedersen, O; Hansen, T; Holm, J-C
Increased consumption of sweetened beverages has previously been linked to the degree of childhood obesity. The aim of the present study was to assess whether the intake of sweetened beverages, candy, snacks or fast food at baseline in a multidisciplinary childhood obesity treatment program was associated with the baseline degree of obesity or the treatment effect. This prospective study included 1349 overweight and obese children (body mass index standard deviation scores (BMI SDS) ≥ 1.64) enrolled in treatment at The Children's Obesity Clinic, Copenhagen University Hospital Holbaek. The children were evaluated at baseline and after up to 5.9 years of treatment (median 1.3 years). Both boys and girls decreased their BMI SDS during treatment with a mean decrease in boys of 0.35 (p fast food and BMI SDS at baseline or the change in BMI SDS during treatment. The intake of sweetened beverages, candy, snacks or fast food when entering a childhood obesity treatment program was not associated with the degree of obesity at baseline or the degree of weight loss during treatment. © 2016 World Obesity Federation.
Walsh, Stephanie M; Palmer, Wendy; Welsh, Jean A; Vos, Miriam B
Despite the well-documented need for multidisciplinary pediatric obesity treatment programs, few programs exist and best practices are not clearly defined. We describe the design and initial quality-related outcomes of the Strong4Life multidisciplinary pediatric obesity treatment program along with some challenges and solutions implemented over the first 2 years. The purpose of this report is to inform others interested in designing similar programs. The Strong4Life Clinic obesity program was designed to provide children with the medical care, as well as the behavior change guidance and support needed to reverse their obesity and/or minimize the related health risks. This low-intensity program is designed to provide approximately 6 hours of care over 12 months from a medical provider, psychologist, registered dietitian nutritionist, exercise physiologist, and nurse. Between August 2011 and February 2014, the Strong4Life clinic served 781 high-risk (mean sex- and age-adjusted body mass index [BMI] percentile 98.8) and racially/ethnically diverse (45% non-Hispanic black and 24% Hispanic) patients. Of the 781 patients seen, 66% returned for at least 1 visit. Nearly all returning Strong4Life patients stabilized or improved their BMI (90% of those who participated 6 months, but longer follow-up and assessment of comorbidities are needed. © 2014 American Society for Parenteral and Enteral Nutrition.
Grønbæk, Helle Nergaard; Madsen, Svend Aage Lykke; Michaelsen, Kim F.
INTRODUCTION: The objective of this study was to assess the impacts of a family-based childhood obesity treatment on anthropometry and predictors of dropout and successful weight loss. MATERIALS AND METHODS: The 18-month treatment consisted of a intensive period (IP) including physical exercise...... had limited education and in immigrant families. CONCLUSIONS: This treatment with a psychological approach is feasible and results in significant weight loss during the programme. Future research should focus on how to improve the results of families with limited education and immigrants with non...
Boutelle, Kerri N; Norman, Gregory J; Rock, Cheryl L; Rhee, Kyung E; Crow, Scott J
Clinic-based programs for childhood obesity are not available to a large proportion of the population. The purpose of this study was to evaluate the efficacy of a guided self-help treatment of pediatric obesity (GSH-PO) compared with a delayed treatment control and to evaluate the impact of GSH-PO 6-months posttreatment. Fifty overweight or obese 8- to 12-year-old children and their parents were randomly assigned to immediate treatment or to delayed treatment. The GSH-PO includes 12 visits over 5 months and addresses key components included in more intensive clinic-based programs. Children and parents in the immediate treatment arm were assessed at time 1 (T1), participated in GSH-PO between T1 and T2, and completed their 6-month posttreatment assessment at T3. Children and parents in the delayed treatment arm were assessed at T1, participated in GSH-PO between T2 and T3, and completed their 6-month posttreatment assessment at T4. The main outcome measures were BMI, BMI z score, and percentage overweight (%OW). Children in the immediate treatment GSH-PO arm decreased their BMI significantly more than did the delayed treatment arm (BMI group × time = -1.39; P < .001). Similar results were found for BMI z score and %OW. At the 6-month posttreatment assessment, changes resulting from GSH-PO were maintained for BMI z score and %OW but not BMI (BMI time effect = -0.06, not significant; BMI z score time effect = -0.10, P < .001; %OW time effect = -4.86, P < .05). The GSH-PO showed initial efficacy in decreasing BMI for children in this study. Additional efficacy and translational studies are needed to additionally evaluate GSH-PO.
Sallam, Hanaa S; Chen, Jiande D Z
Obesity is one of the most prevalent health problems in the United States. Current therapeutic strategies for the treatment of obesity are unsatisfactory. We hypothesized the use of colon electrical stimulation (CES) to treat obesity by inhibiting upper gastrointestinal motility. In this preliminary study, we aimed at studying the effects of CES on gastric emptying of solid, intestinal motility, and food intake in dogs. Six dogs, equipped with serosal colon electrodes and a jejunal cannula, were randomly assigned to receive sham-CES or CES during the assessment of: (i) gastric emptying of solids, (ii) postprandial intestinal motility, (iii) autonomic functions, and (iv) food intake. We found that (i) CES delayed gastric emptying of solids by 77%. Guanethidine partially blocked the inhibitory effect of CES on solid gastric emptying; (ii) CES significantly reduced intestinal contractility and the effect lasted throughout the recovery period; (iii) CES decreased vagal activity in both fasting and fed states, increased the sympathovagal balance and marginally increased sympathetic activity in the fasting state; (iv) CES resulted in a reduction of 61% in food intake. CES reduces food intake in healthy dogs and the anorexigenic effect may be attributed to its inhibitory effects on gastric emptying and intestinal motility, mediated via the autonomic mechanisms. Further studies are warranted to investigate the therapeutic potential of CES for obesity.
Xu, Tianhua; Sheng, Zitong; Yao, Li
In light of the rapid increase in the number of obesity incidences worldwide, obesity has become an independent risk factor for chronic kidney disease. Obesity-related glomerulopathy (ORG) is characterized by glomerulomegaly in the presence or absence of focal and segmental glomerulosclerosis lesions. IgM and complement 3 (C3) nonspecifically deposit in lesions without immune-complex-type deposits during ORG immunofluorescence. ORG-associated glomerulomegaly and focal and segmental glomerulosclerosis can superimpose on other renal pathologies. The mechanisms under ORG are complex, especially hemodynamic changes, inflammation, oxidative stress, apoptosis, and reduced functioning nephrons. These mechanisms synergize with obesity to induce end-stage renal disease. A slow increase of subnephrotic proteinuria ( < 3.5 g/d) is the most common clinical manifestation of ORG. Several treatment methods for ORG have been developed. Of these methods, renin-angiotensin-aldosterone system blockade and weight loss are proven effective. Targeting mitochondria may offer a novel strategy for ORG therapy. Nevertheless, more research is needed to further understand ORG.
Meijneke, Ruud W. H.; Schouten-van Meeteren, Antoinette Y. N.; de Boer, Nienke Y.; van Zundert, Suzanne; van Trotsenburg, Paul A. S.; Stoelinga, Femke; van Santen, Hanneke M.
Abstract Hypothalamic obesity after treatment for craniopharyngioma is a well-recognized, severe problem. Treatment of hypothalamic obesity is difficult and often frustrating for the patient, the parents and the professional care-giver. Because hypothalamic obesity is caused by an underlying medical
Marcio C. Mancini
Full Text Available Obesity is a chronic disease associated with excess morbidity and mortality. Clinical treatment, however, currently offers disappointing results, with very high rates of weight loss failure or weight regain cycles, and only two drugs (orlistat and sibutramine approved for long-term use. Drugs combinations can be an option for its treatment but, although widely used in clinical practice, very few data are available in literature for its validation. Our review focuses on the rationale for their use, with advantages and disadvantages; on combinations often used, with or without studies; and on new perspectives of combinations being studied mainly by the pharmaceutical industry.
Rosen, L W
In a pilot study utilizing self-control techniques for the purpose of modifying the cue-reactive eating habits of obese patients, three subjects maintained a continuous weight loss throughout the first year of treatment. Techniques included goal setting, self-monitoring, brief delay and self-confrontation prior to eating unauthorized food and direct observation of oneself in a mirror when eating unauthorized food. All patients are expected to remain in treatment for the foreseeable future with no termination of the program despite apparent success with regard to control of their feeding disturbance. The rationale for this approach is discussed.
Walmir Ferreira Coutinho
Full Text Available Binge eating is a frequent disorder among obese patient, specialythose undergoing weight loss treatment. Binge eating disorder(BED is a newly defined diagnostic category, usually associatedwith psychopathology and overweight. Several clinical trialsinvolving psychoterapeutical interventions have shown thatcognitive beahavior therapy and interpersonal therapy can beeffective for the treatment of obese patients with BED.Pharmacotherapy can be also an useful tool for the control ofbinge eating, as part of a multidimensional therapeutic approach,associated to psychotherapy and eating behavior modification.Although the investigation of pharmacological agents for thetreatment of BED is still in its preliminary stages, somemedications have shown promising results in randomized clinicaltrials. Currently, three main classes of drugs have been evaluatedin randomized controlled trials: antidepressants, anti-obesityagents and anticonvulsants. The most studied drugs were theserotonina selective reuptake inhibitors (SSRIs. Fluoxetine,fluvoxamine, sertralina and citalopram have been shown to causemodest, but significant reduction in the frequency of bingeepisodes and body weight over the short term of the trials. Morerecently, sibutramina and topiramate have been shown tosignificantly reduce the binge eating behavior and the body weightin patients with obesity and binge eating.
Cohen, Gail M.; Irby, Megan B.; Boles, Katie; Jordan, Christine; Skelton, Joseph A.
Pediatric obesity is more prevalent in rural areas, yet rural families may not have access to pediatric obesity treatment programs. Use of new technologies, particularly telemedicine, has proven effective in other behavioral fields, such as psychiatry. This paper reviews the literature on the use of telemedicine in pediatric obesity treatment, and describes one tertiary-care pediatric obesity telemedicine program. We performed a systematic review of the literature from 1990–2011 using the fol...
Full Text Available Introduction: Obesity is a worldwide health problem whose prevalence is on the increase. Many obesity-associated diseases require intensive medical treatment and are the cause of a large proportion of health-related expenditures in Germany. Treatment of obesity includes nutritional, exercise and behaviour therapy, usually in combination. The goal of behaviour therapy for obesity is to bring about a long-term alteration in the eating and exercise habits of overweight and obese individuals. Under certain circumstances, drug treatment may be indicated. Objectives: What is the effectiveness of behaviour therapy for obesity considering approved drugs reduce weight under medical, economic, ethical-social and legal aspects? Methods: A systematic review was conducted using relevant electronic literature databases. Publications chosen according to predefined criteria are evaluated by approved methodical standards of the evidence-based medicine systematically and qualitatively. Results: In total 18 studies, included one HTA and one meta-analysis could be identified according to the predefined inclusion criteria. Three studies compare behaviour therapy to other therapy forms (advice or instruction on nutritional changes, physical activity or a combination of the two, six studies evaluate different forms of behaviour therapy, four studies and four studies compare behaviour therapies mediated by Internet or telephone. Three studies could be identified examining the effect of the combination of behaviour and drug therapy. Furthermore one HTA and one meta-analysis could be included in the evaluation. The behaviour therapy in comparison with other therapy forms reveals a higher effectiveness. In comparison of the different therapeutic approaches of the behaviour therapy intensive behaviour therapy forms and group therapy show a higher effectiveness. Studies related to behaviour therapy based on media support demonstrate a weight reduction both through the
Łuczyński, Włodzimierz; Głowińska-Olszewska, Barbara; Bossowski, Artur
As the available therapies for diabetes and obesity are not effective enough, diabetologists and educators search for new methods to collaborate with patients in order to support their health behaviors. The aim of this review is to discuss perspectives for the development of new empowerment-type therapies in the treatment of diabetes/obesity. Empowerment is a process whereby patients gain the necessary knowledge to influence their own behavior to improve the quality of their lives. It is carried out in five stages: (1) identify the problem, (2) explain the feelings and meanings, (3) build a plan, (4) act, and (5) experience and assess the execution. Although many years have passed since the advent and popularization of the concept of empowerment, the area remains controversial, mainly with regard to the methodology of therapy. Some previous studies have confirmed the positive effect of empowerment on body weight, metabolic control, and quality of life of patients with type 2 diabetes; however, few studies have been conducted in patients with type 1 diabetes. There is still a need to confirm the effectiveness of empowerment in accordance with Evidence Based Medicine by performing long-term observational studies in a large group of patients. In future, empowerment may become part of the standard of care for patients with diabetes and/or obesity.
Dubern, Béatrice; Tounian, Patrice
The increased frequency of extreme forms of obesity in adolescents and the disappointing results of conventional treatments are now leading pediatricians to consider bariatric or cosmetic surgery as the only real long-term effective therapeutic alternative. The two main techniques currently used for bariatric surgery in adolescents are gastric bypass and adjustable gastric banding. Whatever the technique, weight loss is significant with improvement of comorbidities and quality of life. In addition, the complications are identical to those in adults and equally frequent. However, because of the particularities of this age, caution is still required. Adolescence is indeed characterized by specific nutritional needs, but also changes in body image in which surgery could have a negative effect. Currently, all obese teenagers making a request for bariatric surgery should have a comprehensive assessment with global care for at least 6 months. The indication is then discussed on a case-by-case basis by multidisciplinary teams and experts. To date, the type of surgery (gastric banding, gastric sleeve, or bypass) is still widely discussed. Based on experience with adults, we believe that gastric sleeve and bypass should be preferred. In addition, obesity in adolescents almost always involves psychosocial consequences, while somatic complications are rare. Thus, the care of adipo- or gynecomastia, abdominal fat excess, and concealed penis is essential and therefore justifies cosmetic surgery. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Sharma, Prateek; Vakil, Nimish; Monyak, John T; Silberg, Debra G
Obesity is associated with increased risk of gastroesophageal reflux disease (GERD). To evaluate the effect of obesity on symptom resolution in patients with nonerosive reflux disease (NERD) and healing rates in patients with erosive esophagitis (EE). Two post hoc analyses were performed. Analyses included pooled data from randomized, double-blind, multicenter studies of proton pump inhibitors (PPIs) in GERD patients. Analysis 1 included 704 patients with NERD receiving esomeprazole 20 mg, esomeprazole 40 mg, or placebo. Analysis 2 included 11,027 patients with EE receiving esomeprazole 40 mg, omeprazole 20 mg, or lansoprazole 30 mg. For NERD patients, no significant association between baseline heartburn severity and body mass index (BMI) was observed. In EE patients, overweight (BMI 25 to <35 kg/m) and obese (BMI ≥35 kg/m) patients had significantly higher rates of Los Angeles (LA) grade C or D EE than patients with BMI <25 kg/m (P<0.0001). Percentages of PPI-treated patients who achieved heartburn resolution or EE healing within a given LA grade were similar across BMI categories. Heartburn resolution was significantly associated with treatment (esomeprazole vs. placebo), increasing age, and for men versus women (all P≤0.0284). EE healing was significantly associated with PPI treatment (esomeprazole and lansoprazole vs. omeprazole), increasing age, race, presence of a hiatal hernia, and lower LA grade at baseline (all P≤0.0183). In patients with GERD, high BMI was associated with more severe EE at baseline. However, during PPI treatment, BMI is not a significant independent predictor of heartburn resolution or EE healing.
Sun, Xulong; Li, Pengzhou; Yang, Xiangwu; Li, Weizheng; Qiu, Xianjie; Zhu, Shaihong
Obesity has become a major global health problem, epitomized by excess accumulation of body fat resulting from an imbalance between energy intake and expenditure. The treatments for obesity range from modified nutrition and additional physical activity, to drugs or surgery. But the curative effect of each method seems to vary between individuals. With progress in the genetics and epigenetics of obesity, personalization of the clinical management of obesity may be at our doorstep. This review presents an overview of our current understanding of the genetics and epigenetics of obesity and how these findings influence responses to treatments. As bariatric surgery is the most effective long-term treatment for morbid obesity, we pay special attention to the association between genetic factors and clinical outcomes of bariatric surgery. Finally, we discuss the prospects for precision obesity treatment.
Shannon M. Looney
Full Text Available This article provides an overview of research regarding adult behavioral lifestyle intervention for obesity treatment. We first describe two trials using a behavioral lifestyle intervention to induce weight loss in adults, the Diabetes Prevention Program (DPP and the Look AHEAD (Action for Health in Diabetes trial. We then review the three main components of a behavioral lifestyle intervention program: behavior therapy, an energy- and fat-restricted diet, and a moderate- to vigorous-intensity physical activity prescription. Research regarding the influence of dietary prescriptions focusing on macronutrient composition, meal replacements, and more novel dietary approaches (such as reducing dietary variety and energy density on weight loss is examined. Methods to assist with meeting physical activity goals, such as shortening exercise bouts, using a pedometer, and having access to exercise equipment within the home, are reviewed. To assist with improving weight loss outcomes, broadening activity goals to include resistance training and a reduction in sedentary behavior are considered. To increase the accessibility of behavioral lifestyle interventions to treat obesity in the broader population, translation of efficacious interventions such as the DPP, must be undertaken. Translational studies have successfully altered the DPP to reduce treatment intensity and/or used alternative modalities to implement the DPP in primary care, worksite, and church settings; several examples are provided. The use of new methodologies or technologies that provide individualized treatment and real-time feedback, and which may further enhance weight loss in behavioral lifestyle interventions, is also discussed.
Hoek, van E.
Thesis: Young Children and Obesity – Development and Evaluation of Family-oriented Treatment, Esther van Hoek
The prevalence of childhood obesity has increased rapidly during the last decades. Childhood obesity is a multisystem disease with serious consequences such as
Nielsen, Tenna Ruest Haarmark; Gamborg, Michael; Fonvig, Cilius Esmann
Childhood obesity and related co-morbidities are increasing. This intervention study assessed the associations between weight changes and lipidemia in obese children and adolescents.......Childhood obesity and related co-morbidities are increasing. This intervention study assessed the associations between weight changes and lipidemia in obese children and adolescents....
Sun, Xulong; Li, Pengzhou; Yang, Xiangwu; Li, Weizheng; Qiu, Xianjie; Zhu, Shaihong
Abstract Obesity has become a major global health problem, epitomized by excess accumulation of body fat resulting from an imbalance between energy intake and expenditure. The treatments for obesity range from modified nutrition and additional physical activity, to drugs or surgery. But the curative effect of each method seems to vary between individuals. With progress in the genetics and epigenetics of obesity, personalization of the clinical management of obesity may be at our doorstep. Thi...
Dolores M. Wolongevicz
Full Text Available Background. Links between dietary quality and abdominal obesity are poorly understood. Objective. To examine the association between an obesity-specific dietary quality index and abdominal obesity risk in women. Methods. Over 12 years, we followed 288 Framingham Offspring/Spouse Study women, aged 30–69 years, without metabolic syndrome risk factors, cardiovascular disease, cancer, or diabetes at baseline. An 11-nutrient obesity-specific dietary quality index was derived using mean ranks of nutrient intakes from 3-day dietary records. Abdominal obesity (waist circumference >88 cm was assessed during follow-up. Results. Using multiple logistic regression, women with poorer dietary quality were more likely to develop abdominal obesity compared to those with higher dietary quality (OR 1.87; 95% CI, 1.01, 3.47; P for trend =.048 independent of age, physical activity, smoking, and menopausal status. Conclusions. An obesity-specific dietary quality index predicted abdominal obesity in women, suggesting targets for dietary quality assessment, intervention, and treatment to address abdominal adiposity.
Dalton, Bethan; Campbell, Iain C; Schmidt, Ulrike
Psychological interventions are the treatment of choice for most eating disorders; however, significant proportions of patients do not recover with these. Advances in understanding of the neurobiology of eating disorders have led to the development of targeted treatments, such as deep brain stimulation (DBS), noninvasive brain stimulation (NIBS), and neurofeedback. We review the emerging clinical evidence for the use of these interventions in eating disorders and obesity, together with their theoretical rationale. Finally, we reflect on future developments. During the last 20 months, seven case studies/series and seven randomized controlled trials (RCTs) of NIBS or neurofeedback in different eating disorders, obesity, or food craving have appeared. These have largely had promising results. One NIBS trial, using a multisession protocol, was negative. A case series of subcallosal DBS in anorexia nervosa has also shown promise. A search of trial registries identified a further 21 neuromodulation/feedback studies in progress, indicating that neuromodulation/feedback is an area of growing interest. At present, neuromodulation and neurofeedback are largely experimental interventions; however, growing understanding of the mechanisms involved, together with the rising number of studies in this area, means that the clinical utility of these interventions is likely to become clearer soon.
Aureo Ludovico de Paula
Full Text Available Objectives: To demonstrate the preliminary results of a newtechnique named neuroendocrine brake, for surgical treatment ofmorbid obesity. Methods: In November 2003, three patientsunderwent the neuroendocrine brake operation performed by thelaparoscopic approach. The mean age was 46.4 years; all patientswere female. Mean BMI was 42.3 kg/m2. The patients selectedpresented some relative or absolute contraindications to the useof gastrointestinal bypass techniques, including gastric ulcer anda family history of gastric malignancy(1 and chronic anemia (2.All patients had associated diseases, including type II diabetesmellitus (2, hypertension (2, obstructive sleep apnea (1,dyslipidemia (3, cholecystolithiasis (1, gastric ulcer (1 andchronic anemia (2. The laparoscopic technique consisted of anileal interposition at the proximal jejunum and longitudinalgastrectomy. Results: There was no conversion to open surgery orpostoperative complications. Sixteen months later, the meanpercentage of initial body weight loss was 44.6% and the meanBMI was 24.3 kg/m2. Glucose, triglyceride and cholesterol levelswere normalized, and sleep apnea showed remission. Conclusion:In spite of the reduced number of patients and short term followup, the good results suggest that the neuroendocrine brake maybecome an option for surgical treatment of morbid obesity in thenear future.
Nielsen, Louise A; Bøjsøe, Christine; Kloppenborg, Julie T
INTRODUCTION: The aim was to investigate whether a familial predisposition to obesity related cardiovascular complications was associated with the degree of obesity at baseline and/or changes in the degree of obesity during a multidisciplinary childhood obesity treatment program. METHODS: The study...... included 1421 obese children (634 boys) with a median age of 11.5 years (range 3.1-17.9 years), enrolled in treatment for 0.04 to 5.90 years (median 1.3 years) at the Children's Obesity Clinic, Denmark. At baseline, weight and height were measured, body mass index (BMI) standard deviation score (SDS......) calculated, and self-reported information on familial predisposition to obesity, hypertension, type 2 diabetes mellitus (T2DM), thromboembolic events, and dyslipidaemia were obtained. A familial predisposition included events in biological parents, siblings, grandparents, uncles, and aunts. The treatment...
Full Text Available Obesity is a very common global health problem, and it is known to be linked to cardiovascular and cerebrovascular diseases. Western medical treatments for obesity have many drawbacks, including effects on monoamine neurotransmitters and the potential for drug abuse and dependency. The safety of these medications requires improvement. Herbal medicine has been used for treatment of disease for more than 2000 years, and it has proven efficacy. Many studies have confirmed that herbal medicine is effective in the treatment of obesity, but the mechanisms are not clear. This article will discuss the possible effects and mechanisms of herbal medicine treatments for obesity that have been reported in the past decade.
Cunningham, Phillippe B.; Ellis, Deborah A.; Naar-King, Sylvie
Overweight and obesity are increasing dramatically in the United States of America, especially among children. Effective treatment of the multiple risk factors that promote youth obesity requires treatment approaches that are flexible and comprehensive enough to address each of these factors. One such treatment approach is Multisystemic Therapy…
Obesity means having too much body fat. It is different from being overweight, which means weighing too ... what's considered healthy for his or her height. Obesity happens over time when you eat more calories ...
Thilini N Jayasinghe
Full Text Available Obesity has reached epidemic proportions. Despite a better understanding of the underlying pathophysiology and growing treatment options, a significant proportion of obese patients do not respond to treatment. Recently, microbes residing in the human gastrointestinal tract have been found to act as an endocrine organ, whose composition and functionality may contribute to the development of obesity. Therefore, faecal/gut microbiome transplantation (GMT, which involves the transfer of faeces from a healthy donor to a recipient, is increasingly drawing attention as a potential treatment for obesity. Currently the evidence for GMT effectiveness in the treatment of obesity is preliminary. Here, we summarize benefits, procedures, and issues associated with GMT, with a special focus on obesity.
Rosenbaum, Michael; Agurs-Collins, Tanya; Bray, Molly S; Hall, Kevin D; Hopkins, Mark; Laughlin, Maren; MacLean, Paul S; Maruvada, Padma; Savage, Cary R; Small, Dana M; Stoeckel, Luke
The responses to behavioral, pharmacological, or surgical obesity treatments are highly individualized. The Accumulating Data to Optimally Predict obesity Treatment (ADOPT) project provides a framework for how obesity researchers, working collectively, can generate the evidence base needed to guide the development of tailored, and potentially more effective, strategies for obesity treatment. The objective of the ADOPT biological domain subgroup is to create a list of high-priority biological measures for weight-loss studies that will advance the understanding of individual variability in response to adult obesity treatments. This list includes measures of body composition, energy homeostasis (energy intake and output), brain structure and function, and biomarkers, as well as biobanking procedures, which could feasibly be included in most, if not all, studies of obesity treatment. The recommended high-priority measures are selected to balance needs for sensitivity, specificity, and/or comprehensiveness with feasibility to achieve a commonality of usage and increase the breadth and impact of obesity research. The accumulation of data on key biological factors, along with behavioral, psychosocial, and environmental factors, can generate a more precise description of the interplay and synergy among them and their impact on treatment responses, which can ultimately inform the design and delivery of effective, tailored obesity treatments. © 2018 The Obesity Society.
Joana Ribeiro da Silva
Full Text Available Background: Obesity is an increasing worldwide problem associated with a vast number of comorbidities. Decreasing body weight by only 5-10% has been shown to slow and even prevent the onset of obesity-related comorbidities. Between pharmacological therapy and bariatric surgery a great variety of endoscopic techniques are available, the most common being intragastric balloon (IGB. The purpose of this study was to assess the safety, tolerance, and kinetics of IGBs in weight loss. The kinetics of weight loss were evaluated in 2 different contexts and phases: after the IGB's removal and after follow-up that varied between 6 and 12 months. Successful weight loss was defined as ≥10% weight loss after 6-12 months. Methods: The study included 51 patients who had undergone Orbera® IGB placement between September 2014 and February 2016. Inclusion criteria were age between 18 and 65 years; body mass index (BMI 28-35 with severe obesity-related disorders; or BMI 35-40. The IGB was removed 6 months later. All patients were followed for a minimum period of 6-12 months. Results: Of 51 patients, 16 were excluded (7 due to intolerance and 35 patients entered the study, of which 83% were followed for more than 6-12 months. The average weight loss (WL and % excess WL (%EWL after 6 months of treatment were 11.94 kg and 42.16%, respectively. At 6-12 months, after removal of the IGB, the mean WL was 8.25 kg and %EWL was 30.27%. Nineteen patients attained a WL of ≥10% the baseline value at IGB removal and 12 maintained their weight below this threshold during the 6-12 following months. Conclusions: After temporary IGB implantation in overweight or obese individuals, a WL that was ≥10% of weight at baseline was achieved in 54.3% and sustained at 6-12 months in 41.4% of participants. IGBs are an attractive intermediate option between diet and exercise programs and bariatric surgery. In general, IGB placement is a safe and well-tolerated procedure.
Mittendorfer, Bettina; Peterson, Linda R.
Obesity is a risk factor for cardiovascular disease, including coronary artery disease and heart failure, but the mechanisms by which it may cause them are not completely clear. Currently, therapies aimed at obesity-related cardiovascular disease include weight loss strategies and reduction of the other risk factors that are associated with obesity and cardiovascular disease. Other pathways with for potential drug development for obesity-related CVD are also discussed.
Perryman, Mandy; Sidoti,Kara
Mandy L Perryman,1 Kara A Sidoti,2 1Department of Leadership and Counselor Education, University of Mississippi, MS, USA; 2Lynchburg College, Lynchburg, VA, USA Abstract: Rates of obesity in children and adolescents appear to be stabilizing, though the prevalence of extreme obesity in this population remains fairly consistent at 4%. Childhood obesity contributes to serious health complications, such as hypertension, orthopedic problems, hormonal imbalances, and adult obesity. Psychological, ...
Carpaij, Orestes A; van den Berge, Maarten
PURPOSE OF REVIEW: Obesity is a worldwide epidemic with a prevalence that has tripled in the last two decades. Worldwide, more than 1.5 billion adults are overweight and more than 500 million obese. Obesity has been suggested to be a risk factor for the development of more difficult-to-control
Edio Luiz Petroski
Full Text Available In the last few years, there has been considerable interest in the effects of excessive weight gain during childhood, due to the fact that the development of fat tissue in this period is a determinant of adult body composition. The objective of this study was to investigate the prevalence of infant obesity, to identify possible etiological factors, and to highlight treatments that have been used to reduce and/or prevent child obesity. Results have shown that obesity has increased more than any other nutritional problem in both developed and developing countries over the last decade. Etiological factors linked to childhood obesity were early weaning, introduction of inadequate nutrition, and physical inactivity. The treatment of childhood obesity requires a multidisciplinary team consisting of a doctor, nutritionist, psychologist, and physical educator. There are also some general recommendations to be followed: a balanced diet for adequate growth and weight control, and controlled physical exercise together with individual and family emotional support. Parental cooperation is important for the best results. Schools also have a fundamental role in teaching children positive attitudes and behavior towards physical activity and nutrition. RESUMO Nos últimos anos, o interesse sobre os efeitos do ganho de peso excessivo na infância tem aumentado consideravelmente, devido ao fato que o desenvolvimento da celularidade adiposa neste período ser determinante nos padrões de composição corporal de um indivíduo adulto. Este trabalho teve como objetivo investigar a prevalência da obesidade infantil, identificar os possíveis fatores etiológicos além de verifi car quais as intervenções que se destacaram nesta última década como forma de diminuir e/ou prevenir a obesidade em crianças. Os resultados encontrados foram que a obesidade é uma das enfermidades nutricionais que mais têm apresentado aumento de sua prevalência, tanto nos pa
Martínez-Ortega, Antonio Jesús; Aliaga-Verdugo, Alberto; Pereira-Cunill, José Luis; Jiménez-Varo, Ignacio; Romero-Lluch, Ana R; Sobrino-Rodríguez, Salvador; Belda-Laguna, Ovidio; García-Luna, Pedro Pablo
Few effective therapeutic tools are currently available to fight the increasing prevalence of obesity and its associated comorbidities. Bariatric surgery is the only treatment with proven long-term effectiveness, but is associated to a high surgical risk and significant economic costs because of its technical complexity and the characteristics of patients. This is leading to development of new endoscopic procedures with less clinical risks and economic costs, while maintaining the benefits in terms of morbidity and mortality, which could even serve as a bridging element before surgery in cases where this is unavoidable, allowing for preoperative weight loss and control of comorbidities in order to improve anesthetic risks and possible complications. The purpose of this review was to analyze the most relevant and promising endoscopic techniques currently available. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.
Regueras Santos, L; Díaz Moro, A; Iglesias Blázquez, C; Rodríguez Fernández, C; Quiroga González, R; de Paz Fernández, J A; Rodríguez Fernández, L M
Parental obesity is a risk factor for childhood obesity. The aim of this study was to determine if parental obesity influences the adherence and success of obesity treatment in a hospital paediatric endocrinology clinic. An analytical, prospective, longitudinal study was conducted on obese children aged 4-14. An initial body mass index (BMI), and again at 6 months after receiving health, hygiene and dietary recommendations. Success was considered as a decrease of 0.5 in the BMI Z-score, and adherence to attending the 6-month review. Parental BMI was determined to identify overweight. The χ(2) test was used for qualitative variables and the T-Student test for quantitative (significance, p3). More than half (59%) of the children had one or both parents obese (41 fathers and 37 mothers were obese). Treatment was not adhered to by 25 children. Adherence was worse if both parents were obese OR 3.65 (1.3 to 10.5) (P<=.01) and adherence was better if the mother was not obese, although the father was (P=.01). The treatment had significant success in 40 patients. If the mother was the only obese one in the family, the possibility of treatment failure was greater OR 5.6 (1.4 to 22.4) (P<.01) CONCLUSIONS: A high percentage of children with severe obesity have obese parents. The mother has an important influence on adherence and response to treatment for the severely obese child. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.
Aronne, L J
Although still considered more of a cosmetic problem by both the general public and some areas of the medical community, overweight and obesity have reached epidemic proportions worldwide. Overweight and obesity have not only a significant psychological impact but also result in an increased risk for development of numerous chronic and sometimes fatal diseases. The morbidity from obesity-associated disorders increases with higher body mass index and begins within the normal weight range. The costs (direct and indirect) associated with treating obesity and its comorbid conditions are notable and increasing. Obesity rates in patients with schizophrenia are at least as high, if not higher, than in the general population. This article reviews the epidemiology and burden of obesity and its associated comorbid disorders. The guidelines from the National Heart, Lung, and Blood Institute of the National Institutes of Health for diagnosing and treating obesity are also discussed.
van der Baan-Slootweg, Olga; Benninga, Marc A.; Beelen, Anita; van der Palen, Jacobus Adrianus Maria; Tamminga-Smeulders, Christine; Tijssen, Jan G.P.; van Aalderen, Wim M.C.
Importance Severe childhood obesity has become a major health problem, and effective, evidence-based interventions are needed. The relative effectiveness of inpatient compared with ambulatory treatment remains unknown. Objective To determine whether an inpatient treatment program is more effective
Vos, R.C.; Huisman, S.D.; Houdijk, E.C.A.M.; Pijl, H.; Wit, J.M.
Purpose To evaluate the effect of multidisciplinary treatment on obesity and health-related quality of life (HRQOL). Methods Obese children were randomized to a multidisciplinary lifestyle treatment, including medical, nutritional, physical, and psychological counseling during 3 months, (n = 40,
Geller, Jeffrey S; Dube, Eileen T; Cruz, Glavielinys A; Stevens, Jason; Keating Bench, Kara
This is a retrospective cohort study to evaluate a novel group medical visit (GMV) program using an empowerment curriculum as treatment for pediatric obesity in a federally qualified community health center. Biometric and self-reported data were reviewed from 417 overweight or obese children ages 5-18 attending the pediatric obesity empowerment model GMV program (POEM-GMV) at least twice during a 3-year period. Variables were evaluated using paired means t-test. Pearson's correlation test was used to evaluate variables and the BMI z-score. Subanalysis by gender was performed. The average participant was 10.48 ± 2.53 years old and participated for 301 ± 287 days. BMI z-score reduced from 2.99 ± 0.96 to 2.88 ± 0.88 (p pediatric obesity in an underserved community. There were statistically significantly improved outcomes in obesity, especially for boys. Significant improvement was observed in many lifestyle factors associated with obesity. Weight loss most closely correlated with reduced stress levels and sugary beverage consumption. Additional studies are needed to further evaluate the efficacy of POEM-GMV.
... improve or prevent the health problems associated with obesity. Dietary changes, increased physical activity and behavior changes can ... more calories than you burn. And most Americans' diets are too high in calories and are ... factors Obesity usually results from a combination of causes and ...
Nielsen, Tenna Ruest Haarmark; Fonvig, Cilius Esmann; Dahl, Maria
Objective The body mass index (BMI) standard deviation score (SDS) may not adequately reflect changes in fat mass during childhood obesity treatment. This study aimed to investigate associations between BMI SDS, body composition, and fasting plasma lipid concentrations at baseline and during......, and 80% improved their lipid concentrations. Conclusion Reductions in the degree of obesity during multidisciplinary childhood obesity treatment are accompanied by improvements in body composition and fasting plasma lipid concentrations. Even in individuals increasing their BMI SDS, body composition...... childhood obesity treatment. Methods 876 children and adolescents (498 girls) with overweight/obesity, median age 11.2 years (range 1.6±21.7), and median BMI SDS 2.8 (range 1.3±5.7) were enrolled in a multidisciplinary outpatient treatment program and followed for a median of 1.8 years (range 0...
Goswami, Gayotri; Shinkazh, Nataliya; Davis, Nichola
The prevalence of obesity has increased to pandemic levels worldwide and is related to increased risk of morbidity and mortality. Metabolic comorbidities are commonly associated with obesity and include metabolic syndrome, pre-diabetes, and type 2 diabetes. Even if the prevalence of obesity remains stable until 2030, the anticipated numbers of people with diabetes will more than double as a consequence of population aging and urbanization. Weight reduction is integral in the prevention of dia...
Frintner, Mary Pat; Liebhart, Janice L; Lindros, Jeanne; Baker, Alison; Hassink, Sandra G
Little information is available to gauge residents' perceived receipt of comprehensive training and preparedness to manage children with obesity in practice. A national, random sample of 1000 graduating pediatric residents were surveyed in 2013 on childhood overweight/obesity and preparedness to prevent and treat obesity. A composite training measure was created by summing the number of areas (10 possible) where training on overweight/obesity was received. Multivariable logistic regression explored relationships of resident and training characteristics to residents' belief that their own counseling on prevention and treatment of overweight/obesity is very effective (vs somewhat/slightly/not effective). Of 625 survey respondents (63% response), most (68-92%) reported receipt of training in each of 10 assessed areas on overweight/obesity prevention, assessment, and treatment. Most residents did not desire more training in the assessed areas; however, 54% wanted more training in motivational interviewing. About one-fourth believed that their own counseling on the prevention of overweight/obesity (26%) and treatment of obesity (22%) was very effective. Residents who rated their ability to use motivational interviewing as very good/excellent were more likely to rate their counseling on both the prevention and treatment of overweight/obesity as very effective (adjusted odds ratio [aOR] 4.33, 95% confidence interval [CI] 2.63-7.13; and aOR 4.69, 95% CI 2.72-8.07, respectively). Residents who received training in all 10 assessed areas were also more likely to rate their counseling on both prevention and treatment as very effective (aOR 2.58, 95% CI 1.61-4.14; aOR 2.41, 95% CI 1.46-3.97, respectively). Comprehensive training on overweight/obesity and inclusion of training in motivational interviewing may help residents feel better prepared to care for children with overweight/obesity. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights
Manulu, Mangatas S M; Sutanegara, I N Dwi
Obesity has become a worldwide public health problem affecting millions of people. This is a chronic, stigmatized, and costly disease, rarely curable and is increasing in prevalence to a point today where we define obesity as an epidemic disease that not only in developed but also on developing countries. The pathogenesis of obesity is largely unknown, especially about energy regulatory mechanism that involved wide area of neuroendocrinology that is very interesting but very complex and makes internists "refuse" to learn. Obesity occurs through a longstanding imbalance between energy intake and energy expenditure, influenced by a complex biologic system that regulates appetite and adiposity. Obesity influences the pathogenesis of hypertension, type 2 diabetes, dyslipidemia, kidney, heart, and cerebrovascular disease. It is very wise for every internist to learn the pathogenesis and treatment of this worldwide diseases. Until now, the available treatments, including drugs, are palliative and are effective only while the treatment is being actively used; and besides so many side effects reported.
Carol A. Dennison
Full Text Available Maternal obesity is associated with increased risk of pregnancy complications and greater risk of obesity in offspring, but studies designed to examine preconception weight loss are limited. The objective of this study was to determine if a combined dietary [oligofructose (OFS] and pharmacological (sitagliptin preconception intervention could mitigate poor pregnancy outcomes associated with maternal obesity and improve offspring metabolic health and gut microbiota composition. Diet-induced obese female Sprague-Dawley rats were randomized to one of four intervention groups for 8 weeks: (1 Obese-Control (consumed control diet during intervention; (2 Obese-OFS (10% OFS diet; (3 Obese-S (sitagliptin drug; (4 Obese-OFS + S (combination treatment. Two reference groups were also included: (5 Obese-HFS (untreated obese consumed high fat/sucrose diet throughout study; (6 Lean-Control (lean reference group that were never obese and consumed control diet throughout. Offspring consumed control diet until 11 weeks of age followed by HFS diet until 17 weeks of age. The Obese-OFS + S rats lost weight during the intervention phase whereas the OFS and S treatments attenuated weight gain compared with Obese-HFS (p < 0.05. Gestational weight gain was lowest in Obese-OFS + S rats and highest in Obese-HFS rats (p < 0.05. Prepregnancy intervention did not affect reproductive parameters but did affect pregnancy outcomes including litter size. Male Obese-OFS offspring had significantly lower percent body fat than Obese-HFS at 17 weeks. Female Obese-S and Obese-OFS offspring had significantly lower fasting glucose at 17 weeks compared with Obese-Control and Obese-HFS. Clostridium cluster XI was higher in Obese-HFS and Obese-S dams at birth compared with all other groups. Dams with an adverse pregnancy outcome had significantly lower (p = 0.035 Lactobacillus spp. compared with dams with normal or small litters. At weaning, male offspring
Wing, Rena R.; And Others
Assigned 49 obese diabetic patients with obese spouses (diabetic or nondiabetic) to an alone or together (with spouses) treatment condition of behavioral weight control program. Found no significant differences in weight losses of patients at posttreatment or one-year followup, but did find that women did better when treated with their spouses,…
Mead, Emma; Atkinson, Greg; Richter, Bernd; Metzendorf, Maria-Inti; Baur, Louise; Finer, Nicholas; Corpeleijn, Eva; O'Malley, Claire; Ells, Louisa J.
BACKGROUND: Child and adolescent obesity has increased globally, and can be associated with significant short- and long-term health consequences. OBJECTIVES: To assess the efficacy of drug interventions for the treatment of obesity in children and adolescents. SEARCH METHODS: We searched CENTRAL,
Full Text Available Available anti-obesity pharmacotherapy options remain very limited and development of more effective drugs has become a priority. The potential strategies to achieve weight loss are to reduce energy intake by stimulating anorexigenic signals or by blocking orexigenic signals, and to increase energy expenditure. This review will focus on approved obesity medications, as well as potential new pharmacologic treatment options.
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MacLean, Paul S; Rothman, Alexander J; Nicastro, Holly L; Czajkowski, Susan M; Agurs-Collins, Tanya; Rice, Elise L; Courcoulas, Anita P; Ryan, Donna H; Bessesen, Daniel H; Loria, Catherine M
Individual variability in response to multiple modalities of obesity treatment is well documented, yet our understanding of why some individuals respond while others do not is limited. The etiology of this variability is multifactorial; however, at present, we lack a comprehensive evidence base to identify which factors or combination of factors influence treatment response. This paper provides an overview and rationale of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, which aims to advance the understanding of individual variability in response to adult obesity treatment. This project provides an integrated model for how factors in the behavioral, biological, environmental, and psychosocial domains may influence obesity treatment responses and identify a core set of measures to be used consistently across adult weight-loss trials. This paper provides the foundation for four companion papers that describe the core measures in detail. The accumulation of data on factors across the four ADOPT domains can inform the design and delivery of effective, tailored obesity treatments. ADOPT provides a framework for how obesity researchers can collectively generate this evidence base and is a first step in an ongoing process that can be refined as the science advances. © 2018 The Obesity Society.
Kloppenborg, Julie T; Gamborg, Michael; Fonvig, Cilius E
and adolescents from the Children's Obesity Clinic, Holbaek, Denmark. Anthropometrics, pubertal development, socioeconomic status (SES), and fasting concentrations of plasma glucose, serum insulin, serum C-peptide, and whole blood glycosylated hemoglobin (HbA1c) were collected at treatment entry and at follow......OBJECTIVE: To investigate whether children and adolescents exhibiting an impaired glucose metabolism are more obese at treatment entry and less likely to reduce their degree of obesity during treatment. METHODS: The present study is a longitudinal observational study, including children...... mass index (BMI) z-score 2.94 (range 1.34-5.54) were included. The mean BMI z-score reduction was 0.31 (±0.46) after 13 months (range 6-18) of treatment. At treatment entry, patients with impaired estimates of glucose metabolism were more obese than normoglycemic patients. Baseline concentration of C...
Lopez-Nava, Gontrand; Galvão, M P; Bautista-Castaño, I; Fernandez-Corbelle, J P; Trell, M; Lopez, N
Bariatric endoscopic techniques are minimally invasive and induce gastric volume reduction to treat obesity. Aim : To evaluate endoscopic sleeve gastroplasty (Apollo method) using a suturing method directed at the greater curvature, as well as the perioperative care, two year safety and weight loss. Prospective single-center study over 154 patients (108 females) using the endoscopic sleeve gastroplasty procedure under general anesthesia with overnight inpatient observation. Of the154 initial patients, 143 were available for 1-month of follow-up, 133 for 6-month, 64 for 12-month and 28 completed the 24 month assessment. Follow-up was carried out by a multidisciplinary team (nutritionist and psychologist). Outcomes evaluated were: change in BMI; change in body weight (TBWL); % of loss of initial body weight (%TBWL); % of excess body weight loss (%EWL) (segregated in > or 25% %EWL. There were no mayor adverse events intraprocedure or during the 24 months of follow-up . Endoscopic sleeve gastroplasty with regular monitoring by a multidisciplinary team can be considered an effective, safe and well tolerated procedure for obesity treatment, at least for two years of follow-up. As técnicas de endoscopia bariátrica são minimamente invasivas e induzem à redução do volume gástrico para tratar a obesidade. Avaliar a gastroplastia sleeve endoscópica (método Apollo) usando um método de sutura direcionado para a grande curvatura, bem como os cuidados perioperatórios, segurança em dois anos e perda de peso. Estudo prospectivo em um único centro com 154 pacientes (108 mulheres) usando o procedimento endoscópico de gastroplastia sleeve sob anestesia geral com observação do paciente internado durante a noite. Dos 154 pacientes iniciais, 143 estiveram disponíveis para acompanhamento de um mês, 133 durante seis meses, 64 durante 12 meses e 28 completaram a avaliação de 24 meses. O acompanhamento foi realizado por equipe multidisciplinar (nutricionista e psic
Full Text Available Polycystic ovary syndrome (PCOS is a common disorder affecting women of reproductive age and it is associated with increased cardiovascular risk. Obesity plays an important role in the pathogenesis of PCOS, and the majority of patients with PCOS are obese. Over the last 20 years, the prevalence of obesity has dramatically increased, with probable associated increase in PCOS. Weight reduction plays an integral part in the management of women with PCOS. In this paper, current available weight reduction therapies in the management of PCOS are discussed.
Renault, Kristina M; Nørgaard, Kirsten; Nilas, Lisbeth
OBJECTIVE: The objective of the study was to assess physical activity intervention assessed by a pedometer with or without dietary intervention on gestational weight gain (GWG) in obese pregnant women by comparing with a control group. STUDY DESIGN: This study was a randomized controlled trial...... of 425 obese pregnant women comparing 3 groups: (1) PA plus D, physical activity and dietary intervention (n = 142); (2) PA, physical activity intervention (n = 142); and (3) C, a control group receiving standard care (n = 141). All participants routinely in gestational weeks 11-14 had an initial dietary......-up reduced GWG compared with controls in obese pregnant women....
Burch, J; McKenna, C; Palmer, S; Norman, G; Glanville, J; Sculpher, M; Woolacott, N
This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of rimonabant for the treatment of obese or overweight patients based upon a review of the manufacturer's submission to the National Centre for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submission's main evidence came from four randomised controlled trials. Rimonabant resulted in a significantly greater benefit than placebo for all primary weight loss outcomes. At 1 year, rimonabant had a statistically significant beneficial effect on systolic blood pressure, high-density lipoprotein cholesterol, triglycerides and fasting plasma glucose in diabetics and non-diabetics, and glycosylated haemoglobin in diabetics. Improvements were maintained over 2 years with rimonabant; withdrawal of rimonabant at 1 year resulted in a reduction in weight loss until there was no difference from placebo at 2 years. Psychiatric adverse events were experienced by 26% and 14% of rimonabant and placebo patients respectively; figures for symptoms of depression were 9% and 5% respectively. Pairwise comparisons of orlistat, sibutramine and rimonabant showed beneficial effects of rimonabant over orlistat and sibutramine for weight loss outcomes; however, response hurdles imposed on orlistat or sibutramine in clinical practice may not have been applied in the orlistat and sibutramine trials. The manufacturer's Markov cohort model evaluated rimonabant versus orlistat, sibutramine and diet and exercise alone for three base-case populations. The incremental cost-effectiveness ratio (ICER) of rimonabant varied from 10,534 pounds to 13,236 pounds per quality-adjusted life-year (QALY) versus diet and exercise, to 8977 pounds to 12,138 pounds per QALY versus orlistat, to 1463 pounds to 3908 pounds per QALY versus sibutramine. In subgroup analysis there was a wider variation in the ICER estimates although none exceeded 20,000 pounds
Ryder, Justin R; Fox, Claudia K; Kelly, Aaron S
Severe obesity is the only obesity classification increasing in prevalence among children and adolescents. Treatment options that produce meaningful and sustained weight loss and comorbidity resolution are urgently needed. The purpose of this review is to provide a brief overview of the current treatment options for pediatric severe obesity and offer suggestions regarding future opportunities for accelerating the development and evaluation of innovative treatment strategies. At present, there are three treatment options for youth with severe obesity: lifestyle modification therapy, pharmacotherapy, and bariatric surgery. Lifestyle modification therapy can be useful for improving many chronic disease risk factors and comorbid conditions but often fails to achieve clinically meaningful and sustainable weight loss. Pharmacotherapy holds promise as an effective adjunctive treatment but remains in the primordial stages of development in the pediatric population. Bariatric surgery provides robust weight loss and risk factor/comorbidity improvements but is accompanied by higher risks and lower uptake compared to lifestyle modification therapy and pharmacotherapy. New areas worth pursuing include combination pharmacotherapy, device therapy, identification of predictors of response aimed at precision treatment, and interventions in the postbariatric surgical setting to improve long-term outcomes. Treating pediatric severe obesity effectively and safely is extremely challenging. Some progress has been made, but substantially more effort and innovation are needed in the future to combat this serious and ongoing medical and public health issue. © 2018 The Obesity Society.
The comparison of the largest bariatric surgery study (Swedish Obese Subjects, SOS) with almost 4000 surgical and conservatively treated patients and its conservative counterpart, the LookAHEAD study (Action for Help in Diabetes) with more than 5000 obese patients (average BMI 36 kg/m(2)) with type 2 diabetes showed that although both studies resulted in improved cardiovascular risk factors (bodyweight, HbA1c, HDL/LDL, blood pressure, sleep apnoe syndrome) only the SOS study and subsequent obesity surgery studies could verify their primary outcome hypothesis (significant reduction of the incidence of both cardiovascular deaths, non-fatal infarctions and strokes and hospitalization angina). Furthermore the SOS study could demonstrate a decreased mortality compared to the Look-AHEAD study. Despite a high psychological co-morbidity of obesity surgery patients the majority of studies also with follow-ups of more than 5 years demonstrates an improvement in mental functioning and quality of life. In contrast, there seems to be an increased risk for suicide about 3-4 years after the surgical intervention. Thus, while the majority of obesity surgery patients seems to benefit both physically and mentally, there is a minority that risks to take at least psychologically serious damage. © Georg Thieme Verlag KG Stuttgart · New York.
Rodino, Iolanda S; Byrne, Susan; Sanders, Katherine A
Obesity negatively affects reproductive functioning and psychological wellbeing. Distress experienced by infertile women with elevated body mass index (BMI) was investigated. Infertile women (n = 403) were stratified according to World Health Organization (2000) BMI categories (normal, overweight and obese) and infertility category (polycystic ovary syndrome [PCOS] or non-PCOS). Participants anonymously completed a Demographics Questionnaire, International Physical Activity Questionnaire, Depression, Anxiety and Stress Scale, Positive and Negative Affect Schedule, Rosenberg Self Esteem Scale, Fertility Problem Inventory, Clinical Perfectionism Questionnaire and the Eating Disorder Examination Questionnaire. Women in the obese BMI group were no more psychologically vulnerable to general mood (depression, anxiety and stress) or fertility-specific distress than normal or overweight BMI women. Independent of their PCOS status, obese women reported more frequent episodes of binge eating, shape concerns and low self-esteem symptoms associated with disordered eating. Women with PCOS had elevated shape concerns and anxiety independent of their BMI category compared with women who did not have PCOS. Obese infertile women presenting with the characteristics of binge eating, low self-esteem and body shape concerns may represent a vulnerable subgroup that could benefit from accessing targeted psychological interventions as do women with PCOS who have body shape concerns. Copyright © 2015 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
Morgen, Camilla Schmidt; Sørensen, Thorkild I A
A new report provides compelling evidence of the high prevalence of overweight and obesity throughout the world. The prevalence has increased since 1980, but at different rates across ages, times and locations. Studies exploring the causes of these differences could aid development of effective...
Abdus, Salam; Zuvekas, Samuel H
Using data from the 2004 to 2008 Medical Expenditure Panel Survey (MEPS), this study examined the relationship between obesity and the treatment of depression across racial/ethnic subgroups, controlling for depressive symptoms, self-rated mental health, health status, and socioeconomic characteristics. The association between obesity and depression-related medication was significant for white women but not for black or Hispanic women. Similarly, the association between obesity and depression-related ambulatory visits was significant for white women but not for black or Hispanic women. The results for men were, in general, mixed and inconsistent. The significant racial/ethnic differences found in the relationship between obesity and depression treatment among women suggest that social and cultural factors might play important roles in depression treatment among women.
Kaleth, Anthony S; Slaven, James E; Ang, Dennis C
Obesity is a common comorbid condition among patients with fibromyalgia (FM). Our objective was to assess if obesity moderates the treatment benefits of exercise-based motivational interviewing (MI) for FM. This is a secondary data analysis of a completed clinical trial of 198 FM patients who were randomized to receive either MI or attention control (AC). Using body mass index (BMI) to divide participants into obese (BMI≥30 kg/m) and nonobese (BMIFibromyalgia Impact Questionnaire, FIQ). Secondary measures included pain intensity (Brief Pain Inventory), 6-Minute Walk Test, and self-reported physical activity (Community Health Activities Model Program for Seniors). Of the 198 participants, 91 (46%) were nonobese and 107 (54%) were obese. On global FM symptom severity (FIQ), the interaction between treatment arms and obesity status was significant (P=0.02). In the nonobese group, MI was associated with a greater improvement in FIQ than AC. In the obese group, MI participants reported less improvement in FIQ compared with AC. The interaction analysis was also significant for Brief Pain Inventory pain intensity (P=0.01), but not for the walk test and self-reported physical activity. This is the first study to show that obesity negatively affects the treatment efficacy of MI in patients with FM. Our findings suggest that exercise-based MI may be more effective if initiated after weight loss is achieved.
MacLean, Paul S; Higgins, Janine A; Johnson, Ginger C; Fleming-Elder, Brooke K; Peters, John C; Hill, James O
Obesity is reaching epidemic proportions and predisposes afflicted individuals to several comorbidities. For these individuals, losing weight has proven to be an easier feat than maintaining a reduced weight. In obesity-prone rats, we examined if there is a metabolic propensity to regain weight after a period of significant weight loss. Twenty-four-hour energy expenditure (EE), sleeping metabolic rate (SMR), and nonprotein respiratory quotient (NPRQ) were obtained by indirect calorimetry with urinary nitrogen analysis and normalized to fat mass (FM) and fat-free mass (FFM) acquired by dual-energy X-ray absorptiometry. Obesity-prone rats were examined after free access to a high-fat diet for 16 wk to establish the obese state. They were again examined after 2 wk of calorie restriction, which reduced body weight (14%) and FM (32%). Rats were again examined after a further 8 wk of intake-regulated weight maintenance or ad libitum feeding that led to weight regain. Metabolic data were compared with preobese and age-matched controls. Weight loss suppressed EE and SMR beyond what was expected for the change in metabolic mass. This elevated metabolic efficiency persisted throughout weight maintenance but resolved after 8 wk of regain. Adjusted NPRQ values were elevated in weight-maintained and weight-regaining rats, suggesting a preference for carbohydrate utilization. These data support the concept that weight reduction in obesity is accompanied by metabolic adjustments beyond the drive to consume calories that predispose to weight regain, and some aspects of this adjustment persist with prolonged weight maintenance and during weight regain.
Prasad, Chaithra; Batsis, John A; Lopez-Jimenez, Francisco; Clark, Matthew M; Somers, Virend K; Sarr, Michael G; Collazo-Clavell, Maria L
Bariatric surgery (BSx) produces clinically relevant weight loss that translates into improved quality of life, decreased mortality, and reduction in medical comorbidities, including cardiovascular (CV) risk. Little is known about patients' decision-making process to undergo BSx, but risk perception is known to influence medical decision-making. This study examined CV and BSx risk perception in obese subjects undergoing BSx (n = 268) versus those managed medically (MM) (n = 273). This retrospective population-based survey of subjects evaluated for BSx had 148 (55%) and 88 (32%) responders in the BSx and MM groups, respectively. Survey questions assessed risk perceptions and habits prior to weight loss intervention. CV risk was calculated using the Framingham Risk Score (FRS). At baseline, BSx subjects had a greater body mass index and greater prevalence of diabetes and depression. Follow-up mean weight loss was greater in the BSx group. BSx subjects perceived obesity as a greater risk to their overall health than the surgical risk. FRS declined in the BSx group (10 to 5%; p risk had a greater tendency to perceive the risk of BSx as greater than that of obesity. Obese subjects undergoing BSx are more likely than MM subjects to perceive obesity as a greater risk to their health than BSx. MM subjects generally underestimate their CV risk and overestimate the risk of BSx. Active discussion of CV risk using the FRS and the perception of risk associated with bariatric surgery can enhance patients' ability to make an informed decision regarding their management. © The European Society of Cardiology 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Rausch, John Conrad; Perito, Emily Rothbaum; Hametz, Patricia
This study surveyed pediatric primary care providers at a major academic center regarding their attitudes and practices of obesity screening, prevention, and treatment. The authors compared the care providers' reported practices to the 2007 American Medical Association and Centers for Disease Control and Prevention Expert Committee Recommendations to evaluate their adherence to the guidelines and differences based on level of training and specialty. Of 96 providers surveyed, less than half used the currently recommended criteria for identifying children who are overweight (24.7%) and obese (34.4%), with attendings more likely to use the correct criteria than residents (P obesity, the majority felt their counseling was not effective. There was considerable variability in reported practices of lab screening and referral patterns of overweight and obese children. More efforts are needed to standardize providers' approach to overweight and obese children.
Full Text Available Jana Zmolikova,1,2 Dita Pichlerova,3 Petr Bob,1,4 Denisa Schückova,5 Jitka Herlesova,3 Petr Weiss6 1Department of Psychiatry, First Faculty of Medicine, Center for Neuropsychiatric Research of Traumatic Stress, Charles University, 2Department of Clinical Psychology, Na Homolce Hospital, 3OB Clinic, Prague, 4Faculty of Medicine, Central European Institute of Technology, Masaryk University, Brno, 5Iscare Clinical Centre, 6Institute of Sexology, First Faculty of Medicine, Charles University, Prague, Czech Republic Background: Splitting represents a defense mechanism that describes fragmentation of conscious experience that may occur in various psychopathological conditions. The purpose of this study was to examine the relationship of splitting with disturbed cognitive and affective functions related to impulsivity and intimate partnerships in a group of obese patients indicated for bariatric treatment and compare the results with other obese patients and patients with bulimia nervosa. Methods: In this clinical study, we assessed 102 young women. The sample was divided into three subgroups: obese women (N=30, obese women indicated for bariatric treatment (N=48, and patients with bulimia nervosa (N=24. The patients were assessed using Splitting Index and Barratt Impulsivity Scale, and selected information about their intimate partnership was documented for all the participants.Results: The main results of this study indicate significant differences in the relationship of splitting and impulsivity with difficulties in intimate partnerships. These differences discriminate obese patients indicated for bariatric treatment from other obese patients and patients with bulimia nervosa.Conclusion: These findings may have significant implications for treatment of the obese patients indicated for bariatric treatment and their presurgery psychological evaluations. Keywords: splitting, impulsivity, obesity, bulimia nervosa, bariatric treatment
Cinar, Ayse Basak
Abstract: Obesity, diabetes and oral diseases (dental cariesand periodontal diseases), largely preventable chronic diseases, are described as global pandemic due their distribution and severe consequences. WHO has called for a global action for prevention and promotion of these diseases as a vital...... the likelihood of periodontitis which is one of the most common chronic diseases worldwide, described as pandemic, and closely related to DM2. Promoting good oral health is significantly essential for prevention and reducing the negative consequences of periodontal diseases, DM2 and obesity, and to maintain good...
Sri Rahayu Lestari
Full Text Available Objective: To determine body weight gain, expression of Igf-1 and Igf-1 receptor on obese rat model treated with rambutan peel extract (RPE as a physiological response. Methods: Normal and obese rat feed with normal and high calorie diet around 1 2 weeks and continued to treat with ellagic acid, RPE 15, 30 and 60 mg/kg body weight respectively. Physiological responses observed were weight gain and expression of Igf-1 with its receptor. Body weight of rat was weighed once per week. Expression of Igf-1 and igf-1R observed with fluorescence immunohistochemistry. The intensity of Igf-1 and Igf-1R expression was analysis using FSX-BSW software. Results: The lowest weight gain was obtained on obese rat model treated with RPE 30 mg/kg body weight. The expression of Igf-1 and Igf-1R were reduced on obese rat model treated with RPE compared with obese rat model of non treatment (P<0.05. The low expression of Igf-1 and Igf-1R was found on obese rat model treated with ellagic acid and RPE 30 mg/kg body weight. Conclusions: The RPE was effecting to the physiological response on obese rat model. The RPE 30 mg/kg body weight inhibited body weight gain and decreased the expression of Igf-1 and Igf- 1R of obese rat model.
Teoh, Seong Lin; Das, Srijit
Obesity continues to be a major global problem. Various cancers are related to obesity and proper understanding of their aetiology, especially their molecular tumour biology is important for early diagnosis and better treatment. Genes play an important role in the development of obesity. Few genes such as leptin, leptin receptor encoded by the db (diabetes), pro-opiomelanocortin, AgRP and NPY and melanocortin-4 receptors and insulin-induced gene 2 were linked to obesity. MicroRNAs control gene expression via mRNA degradation and protein translation inhibition and influence cell differentiation, cell growth and cell death. Overexpression of miR-143 inhibits tumour growth by suppressing B cell lymphoma 2, extracellular signal-regulated kinase-5 activities and KRAS oncogene. Cancers of the breast, uterus, renal, thyroid and liver are also related to obesity. Any disturbance in the production of sex hormones and insulin, leads to distortion in the balance between cell proliferation, differentiation and apoptosis. The possible mechanism linking obesity to cancer involves alteration in the level of adipokines and sex hormones. These mediators act as biomarkers for cancer progression and act as targets for cancer therapy and prevention. Interestingly, many anti-cancerous drugs are also beneficial in treating obesity and vice versa. We also reviewed the possible link in the mechanism of few drugs which act both on cancer and obesity. The present review may be important for molecular biologists, oncologists and clinicians treating cancers and also pave the way for better therapeutic options.
Kuneš, Jaroslav; Pražienková, V.; Popelová, A.; Mikulášková, Barbora; Zemenová, J.; Maletínská, L.
Roč. 230, č. 2 (2016), R51-R58 ISSN 0022-0795 R&D Projects: GA ČR(CZ) GA15-08679S Institutional support: RVO:67985823 Keywords : prolactin-releasing peptide * lipidization * obesity * GPR10 * anorexigenic * mice Subject RIV: ED - Physiology Impact factor: 4.706, year: 2016
Kuneš, Jaroslav; Pražienková, Veronika; Popelová, Andrea; Mikulášková, Barbora; Zemenová, Jana; Maletínská, Lenka
Roč. 230, č. 2 (2016), R51-R58 ISSN 0022-0795 R&D Projects: GA ČR(CZ) GA15-08679S Institutional support: RVO:61388963 Keywords : prolactin-releasing peptide * lipidization * obesity * GPR10 * anorexigenic * mice Subject RIV: FB - Endocrinology, Diabetology, Metabolism, Nutrition Impact factor: 4.706, year: 2016
Tanagho, Peter A; Shohdy, Kyrillus S
G protein coupled receptor 120 (GPR120) is a class of receptors in the gastrointestinal tract (GIT) that is implicated in nutrient sensing and body weight regulation. Functions of GPR120 are thought to be mediated by the release of a group of hormones known as incretins, such as glucagon like peptide 1 (GLP-1) and gastric inhibitory polypeptide (GIP). We have searched PubMed with the keywords "GPR120","GLP-1" and "obesity". Relevant studies were retrieved and included in the review. Recently, many exogenous compounds have been investigated in their role in the release of GLP-1 and in causing weight loss in obese rats. However, some results question the putative role of GPR120 in metabolic homeostasis. Herein, we evaluate the potential use of GPR120 as a target receptor in obesity and found it to be ubiquitous throughout the GIT, with various functions in each site. In order to find the optimal drug, the role of GPR120 in each site needs to be defined and selectivity of the potential drug needs to be studied to ensure the success of this growing line of obesity management.
Full Text Available B Shariat-Madar1, D Kolte2, A Verlangieri2, Z Shariat-Madar21College of Literature, Science, and the Arts, University of Michigan, Ann Arbor MI, USA; 2School of Pharmacy, Department of Pharmacology, University of Mississippi, University, MS, USAAbstract: Recently, we serendipitously discovered that mice with the deficiency of the enzyme prolylcarboxypeptidase (PRCP have elevated α-melanocyte-stimulating hormone (α-MSH levels which lead to decreased food intake and weight loss. This suggests that PRCP is an endogenous inactivator of α-MSH and an appetite stimulant. Since a modest weight loss can have the most profound influence on reducing cardiovascular risk factors, the inhibitors of PRCP would be emerging as a possible alternative for pharmacotherapy in high-risk patients with obesity and obesity-related disorders. The discovery of a new biological activity of PRCP in the PRCP-deficient mice and studies of α-MSH function indicate the importance and complexity of the hypothalamic pro-opiomelanocortin (POMC system in altering food intake. Identifying a role for PRCP in regulating α-MSH in the brain may be a critical step in enhancing our understanding of how the brain controls food intake and body weight. In light of recent findings, the potential role of PRCP in regulating fuel homeostasis is critically evaluated. Further studies of the role of PRCP in obesity are much needed.Keywords: prolylcarboxypeptidase, melanocyte-stimulating harmone, appetite, weight loss, cardiovascular risk, obesity
Chao, Ariana M; Wadden, Thomas A; Berkowitz, Robert I
Pediatric obesity is a serious public health concern. Five medications have been approved by the Food and Drug Administration (FDA) for chronic weight management in adults with obesity, when used as an adjunct to lifestyle modification. Orlistat is the only FDA-approved medication for pediatric patients aged 12 years and above. Areas covered: This paper summarizes safety and efficacy data from clinical trials of weight loss medications conducted among pediatric samples. Relevant studies were identified through searches in PubMed. Expert opinion: Orlistat, as an adjunct to lifestyle modification, results in modest weight losses and may be beneficial for some pediatric patients with obesity. However, gastrointestinal side effects are common and may limit use. In adults taking orlistat, rare but severe adverse events, including liver and renal events, have been reported. Recent pediatric pharmacokinetic studies of liraglutide have demonstrated similar safety and tolerability profiles as found in adults, with gastrointestinal disorders being the most common adverse events. Clinical trials are needed of liraglutide, as well as other medications for obesity, that systematically evaluate their risks and benefits in pediatric patients.
Strien, T. van
Purpose of the Review: Eating in response to negative emotions (EE) may be an explanatory factor of the weight regain of many dieters. This narrative review presents evidence on possible causes of EE and the association of EE with depression and obesity and discusses implications of these findings
Skelton, Joseph A; Irby, Megan Bennett; Geiger, Ann M
Pediatric obesity treatment programs report high attrition rates, but it is unknown if family experience and satisfaction contributes. This review surveys the literature regarding satisfaction in pediatric obesity and questions used in measurement. A systematic review of the literature was conducted using Medline, PsychINFO, and CINAHL. Studies of satisfaction in pediatric weight management were reviewed, and related studies of obesity were included. Satisfaction survey questions were obtained from the articles or from the authors. Eighteen studies were included; 14 quantitative and 4 qualitative. Only one study linked satisfaction to attrition, and none investigated the association of satisfaction and weight outcomes. Most investigations included satisfaction as a secondary aim or used single-item questions of overall satisfaction; only one assessed satisfaction in noncompleters. Overall, participants expressed high levels of satisfaction with obesity treatment or prevention programs. Surveys focused predominantly on overall satisfaction or specific components of the program. Few in-depth studies of satisfaction with pediatric obesity treatment have been conducted. Increased focus on family satisfaction with obesity treatment may provide an avenue to lower attrition rates and improve outcomes. Enhancing measurement of satisfaction to yield actionable responses could positively influence outcomes, and a framework, via patient-centered care principles, is provided. © 2013 National Association for Healthcare Quality.
Lytle, Leslie A; Nicastro, Holly L; Roberts, Susan B; Evans, Mary; Jakicic, John M; Laposky, Aaron D; Loria, Catherine M
The ability to identify and measure behaviors that are related to weight loss and the prevention of weight regain is crucial to understanding the variability in response to obesity treatment and the development of tailored treatments. The overarching goal of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project is to provide obesity researchers with guidance on a set of constructs and measures that are related to weight control and that span and integrate obesity-related behavioral, biological, environmental, and psychosocial domains. This article describes how the behavioral domain subgroup identified the initial list of high-priority constructs and measures to be included, and it describes practical considerations for assessing the following four behavioral areas: eating, activity, sleep, and self-monitoring of weight. Challenges and considerations for advancing the science related to weight loss and maintenance behaviors are also discussed. Assessing a set of core behavioral measures in combination with those from other ADOPT domains is critical to improve our understanding of individual variability in response to adult obesity treatment. The selection of behavioral measures is based on the current science, although there continues to be much work needed in this field. © 2018 The Obesity Society.
Mollerup, Pernille Maria; Gamborg, Michael Orland; Trier, Cæcilie
BACKGROUND: Due to the pandemic of child and adolescent overweight and obesity, improvements in overweight and obesity treatment availability and accessibility are needed. METHODS: In this prospective study, we investigated if reductions in body mass index (BMI) standard deviation scores (SDS......) and waist circumference (WC) would occur during 1.5 years of community-based overweight and obesity treatment based upon an effective hospital-based overweight and obesity treatment protocol, The Children's Obesity Clinics' Treatment protocol. Height, weight, and WC were measured at all consultations...... was invested per child per year. CONCLUSION: BMI SDS and WC were reduced after 1.5 years of treatment. Hence, this community-based overweight and obesity treatment program may help accommodate the need for improvements in treatment availability and accessibility....
Callaway, C W
Obesity is not a single disease, but a variety of conditions resulting from different mechanisms and associated with various types and degrees of risks. To determine who should lose weight, how much weight should be lost, and how to undertake weight loss, the following types of information are needed: personal-demographic data, developmental patterns, family history, energy balance, body composition/fat distribution, psychological/behavioral measures, endocrine/metabolic measures, complicatio...
Felipe Q. da Luz
Full Text Available Obesity and eating disorders are each associated with severe physical and mental health consequences, and individuals with obesity as well as comorbid eating disorders are at higher risk of these than individuals with either condition alone. Moreover, obesity can contribute to eating disorder behaviors and vice-versa. Here, we comment on the health complications and treatment options for individuals with obesity and comorbid eating disorder behaviors. It appears that in order to improve the healthcare provided to these individuals, there is a need for greater exchange of experiences and specialized knowledge between healthcare professionals working in the obesity field with those working in the field of eating disorders, and vice-versa. Additionally, nutritional and/or behavioral interventions simultaneously addressing weight management and reduction of eating disorder behaviors in individuals with obesity and comorbid eating disorders may be required. Future research investigating the effects of integrated medical, psychological and nutritional treatment programs addressing weight management and eating disorder psychopathology in individuals with obesity and comorbid eating disorder behaviors—such as binge eating—is necessary.
Vuolteenaho, Katriina; Koskinen, Anna; Moilanen, Eeva
Osteoarthritis (OA) is the most common cause of musculoskeletal disability and pain in the world. The current drug treatment for OA is symptom relieving, and there is an urgent need for treatments that could retard, prevent or repair cartilage destruction in OA. Obesity is a major risk factor for OA. Traditionally, it has been thought to contribute to the development of OA by increasing the load on weight-bearing joints. However, this appears to be an over-simplification, because obesity is also linked to OA in the hand and finger joints. Recent studies have shown that adipocytokine leptin is a possible link between obesity and OA: Leptin levels in synovial fluid are increased in obese patients, leptin receptor (Ob-R) is expressed in cartilage, and leptin induces the production of matrix metalloproteinases (MMPs), pro-inflammatory mediators and nitric oxide (NO) in chondrocytes. Furthermore, according to the very recent findings, not only leptin levels in the joint but also leptin sensitivity in the cartilage are enhanced in obese OA patients. The findings supporting leptin as a causative link between obesity and OA offer leptin as a potential target to the development of disease-modifying drugs for osteoarthritis (DMOAD), especially for obese patients. © 2013 Nordic Pharmacological Society. Published by John Wiley & Sons Ltd.
Full Text Available Amit A Joharapurkar, Nirav A Dhanesha, Mukul R Jain Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, India Abstract: Worldwide prevalence of obesity has nearly doubled since 1980. Obesity is the result of interactions among the environmental factors, genetic predisposition, and human behavior. Even modest weight reduction in obese patients provides beneficial health outcomes. For effective weight reduction, a drug should either increase energy expenditure or decrease energy intake without causing serious adverse effects. To overcome lack of efficacy and central nervous system related side effects, exploitation of the peripheral mechanism of anti-obesity action is needed. Inhibition of pathological angiogenesis in adipose tissue is one such peripheral mechanism that has attracted the attention of researchers in this area. Although originally developed as anti-cancer agents, methionine aminopeptidase (MetAP2 inhibitors induce significant and sustained weight reduction. Here, we review preclinical and clinical pharmacology of MetAP2 inhibitors. Beloranib is a prototype MetAP2 inhibitor, and currently in advanced clinical trials for the treatment of obesity. Clinical data of beloranib indicate that MetAP2 inhibitors could be a future treatment option for weight reduction without serious adverse effects. Further clinical data from Phase III trials will add to our growing knowledge of MetAP2 inhibitor potential for anti-obesity therapy. Keywords: angiogenesis, beloranib, body weight, MetAP2, anti-obesity
Meijneke, Ruud W H; Schouten-van Meeteren, Antoinette Y N; de Boer, Nienke Y; van Zundert, Suzanne; van Trotsenburg, Paul A S; Stoelinga, Femke; van Santen, Hanneke M
Hypothalamic obesity after treatment for craniopharyngioma is a well-recognized, severe problem. Treatment of hypothalamic obesity is difficult and often frustrating for the patient, the parents and the professional care-giver. Because hypothalamic obesity is caused by an underlying medical disorder, it is often assumed that regular diet and exercise are not beneficial to reduce the extraordinarily high body mass index, and in fact, lifestyle interventions have been shown to be insufficient in case of extreme hypothalamic obesity. Nevertheless, it is important to realize that also in this situation, informal care delivered by the family and appropriate parenting styles are required to minimize the obesity problem. We present a case in which weight gain in the home situation was considered unstoppable, and a very early mortality due to complications of the severe increasing obesity was considered inevitable. A permissive approach toward food intake became leading with rapid weight increase since a restrictive lifestyle was considered a senseless burden for the child. By admission to our hospital for a longer period of time, weight reduction was realized, and the merely permissive approach could be changed into active purposeful care by adequate information, instruction, guidance and encouragement of the affected child and her parents. This case illustrates that, although this type of obesity has a pathological origin, parental and environmental influences remain of extreme importance.
Tsai, Adam G; Histon, Trina; Donahoo, W Troy; Hashmi, Shahid; Murali, Sameer; Latare, Peggy; Oliver, Lajune; Slovis, Jennifer; Grall, Sarah; Fisher, David; Solomon, Loel
Kaiser Permanente, an integrated health care delivery system in the USA, takes a "whole systems" approach to the chronic disease of obesity that begins with efforts to prevent it by modifying the environment in communities and schools. Aggressive case-finding and substantial investment in intensive lifestyle modification programs target individuals at high risk of diabetes and other weight-related conditions. Kaiser Permanente regions are increasingly standardizing their approach when patients with obesity require treatment intensification using medically supervised diets, prescription medication to treat obesity, or weight loss surgery.
Eg, Marianne; Cortes, Dina; Johansen, Anders
INTRODUCTION: The prevalence of children and adolescents with overweight and obesity has tripled over the past 30 years. One in five children in Denmark is overweight, a condition which is accompanied by serious medical and psychosocial complications. So far, an overview of the Danish treatment...... of departments offered less comprehensive programmes. The final third offered no multidisciplinary treatment programme for the target group. The criteria for referral to the paediatric departments that offered obesity programmes were heterogeneous. FUNDING: Funding for this study was received from Region...... of childhood overweight and obesity has been lacking. METHODS: Telephone interviews with all Danish paediatric departments were conducted in 2014. The results, constituting a baseline, were analysed using the clinical guidelines for overweight and obesity published by the Danish Paediatric Society's Overweight...
Eg, Marianne; Cortes, Dina; Johansen, Anders
INTRODUCTION: The prevalence of children and adolescents with overweight and obesity has tripled over the past 30 years. One in five children in Denmark is overweight, a condition which is accompanied by serious medical and psychosocial complications. So far, an overview of the Danish treatment...... of departments offered less comprehensive programmes. The final third offered no multidisciplinary treatment programme for the target group. The criteria for referral to the paediatric departments that offered obesity programmes were heterogeneous. FUNDING: Funding for this study was received from Region...... of childhood overweight and obesity has been lacking. METHODS: Telephone interviews with all Danish paediatric departments were conducted in 2014. The results, constituting a baseline, were analysed using the clinical guidelines for overweight and obesity published by the Danish Paediatric Society’s Overweight...
Bennett, Elizabeth Anne; Kolko, Rachel; Chia, Lichun; Elliott, Jennifer Padden; Kalarchian, Melissa Ann
Childhood obesity is a serious health issue, associated with medical comorbidity and psychosocial impairment that can persist into adulthood. In the United States, youth with intellectual and developmental disabilities are more likely to be obese than youth without disabilities. A large body of evidence supports the efficacy of family-based treatment of childhood obesity, including diet, physical activity, and behavior modification, but few interventions have been developed and evaluated specifically for this population. We highlight studies on treatment of obesity among youth with intellectual and developmental disabilities, including both residential/educational settings as well as outpatient/hospital settings. All interventions were delivered in-person, and further development of promising approaches and delivery via telenursing may increase access by youth and families. Nursing scientists can assume an important role in overcoming barriers to care for this vulnerable and underserved population. PMID:28349744
Reas, Deborah L; Masheb, Robin M; Grilo, Carlos M
This study examined reasons for seeking treatment reported by obese patients diagnosed with binge eating disorder (BED). Participants were 248 adults (58 men and 190 women) who met DSM criteria for BED. Participants were recruited through advertisements for treatment studies looking for persons who wanted to "stop binge eating and lose weight." Patients' reasons for seeking treatment were examined with respect to demography (gender and age), obesity (BMI and age of onset), features of eating disorders, and associated psychological functioning (depression and self-esteem). Of the 248 participants, 64% reported health concerns and 36% reported appearance concerns as their primary reason for seeking treatment. Reasons for seeking treatment did not differ significantly by gender. Patients seeking treatment because of appearance-related reasons had lower BMIs than those reporting health-related reasons (34.8 vs. 38.5, respectively), but they reported greater body dissatisfaction, more features of eating disorders, and lower self-esteem. Reasons that prompt treatment seeking among obese individuals with BED reflect meaningful patient characteristics and, therefore, warrant assessment and consideration during treatment planning. Further research is needed to determine whether reasons for treatment seeking among different obese patient groups affect treatment outcomes. Copyright 2004 NAASO
Frerichs, Leah M; Araz, Ozgur M; Huang, Terry T-K
Research evidence indicates that obesity has spread through social networks, but lever points for interventions based on overlapping networks are not well studied. The objective of our research was to construct and parameterize a system dynamics model of the social transmission of behaviors through adult and youth influence in order to explore hypotheses and identify plausible lever points for future childhood obesity intervention research. Our objectives were: (1) to assess the sensitivity of childhood overweight and obesity prevalence to peer and adult social transmission rates, and (2) to test the effect of combinations of prevention and treatment interventions on the prevalence of childhood overweight and obesity. To address the first objective, we conducted two-way sensitivity analyses of adult-to-child and child-to-child social transmission in relation to childhood overweight and obesity prevalence. For the second objective, alternative combinations of prevention and treatment interventions were tested by varying model parameters of social transmission and weight loss behavior rates. Our results indicated child overweight and obesity prevalence might be slightly more sensitive to the same relative change in the adult-to-child compared to the child-to-child social transmission rate. In our simulations, alternatives with treatment alone, compared to prevention alone, reduced the prevalence of childhood overweight and obesity more after 10 years (1.2-1.8% and 0.2-1.0% greater reduction when targeted at children and adults respectively). Also, as the impact of adult interventions on children was increased, the rank of six alternatives that included adults became better (i.e., resulting in lower 10 year childhood overweight and obesity prevalence) than alternatives that only involved children. The findings imply that social transmission dynamics should be considered when designing both prevention and treatment intervention approaches. Finally, targeting adults may
Leah M Frerichs
Full Text Available Research evidence indicates that obesity has spread through social networks, but lever points for interventions based on overlapping networks are not well studied. The objective of our research was to construct and parameterize a system dynamics model of the social transmission of behaviors through adult and youth influence in order to explore hypotheses and identify plausible lever points for future childhood obesity intervention research. Our objectives were: (1 to assess the sensitivity of childhood overweight and obesity prevalence to peer and adult social transmission rates, and (2 to test the effect of combinations of prevention and treatment interventions on the prevalence of childhood overweight and obesity. To address the first objective, we conducted two-way sensitivity analyses of adult-to-child and child-to-child social transmission in relation to childhood overweight and obesity prevalence. For the second objective, alternative combinations of prevention and treatment interventions were tested by varying model parameters of social transmission and weight loss behavior rates. Our results indicated child overweight and obesity prevalence might be slightly more sensitive to the same relative change in the adult-to-child compared to the child-to-child social transmission rate. In our simulations, alternatives with treatment alone, compared to prevention alone, reduced the prevalence of childhood overweight and obesity more after 10 years (1.2-1.8% and 0.2-1.0% greater reduction when targeted at children and adults respectively. Also, as the impact of adult interventions on children was increased, the rank of six alternatives that included adults became better (i.e., resulting in lower 10 year childhood overweight and obesity prevalence than alternatives that only involved children. The findings imply that social transmission dynamics should be considered when designing both prevention and treatment intervention approaches. Finally
Carnagarin, Revathy; Gregory, Cynthia; Azzam, Omar; Hillis, Graham S; Schultz, Carl; Watts, Gerald F; Bell, Damon; Matthews, Vance; Schlaich, Markus P
Obesity-related hypertension is commonly characterized by increased sympathetic nerve activity and is therefore acknowledged as a predominantly neurogenic form of hypertension. The sustained sympatho-excitation not only contributes to the rise in blood pressure but also elicits a vicious cycle which facilitates further weight gain and progression of associated co-morbidities. While weight loss and exercise remain at the forefront of therapy for obesity and obesity-related hypertension, the difficulties in achieving and maintaining long-term weight loss with lifestyle measures and the variable blood pressure response to weight loss often necessitate prescription of antihypertensive drug therapy. Remarkably, there are no specific recommendations for pharmacologic treatment for obese patients with arterial hypertension in any of the current guidelines and general principles of antihypertensive treatment are applied. The use of β-blockers and diuretics is commonly discouraged as first- or second-line therapy due to their unfavorable metabolic effects. This review explores evolving therapeutic strategies which based on their interference with pathophysiologic mechanism relevant in the context of obesity may guide optimized treatment of obesity-related hypertension.
Larissa Soares Mariz
Full Text Available Objective.To evaluate the risk factors associated with treatment abandonment by overweight or obese children and adolescents. Methods. A cross-sectional study, conducted in 2011, at the Childhood Obesity Center, in Campina Grande, Brazil, with the records of 208 children and adolescents, between three and 18 years of age, divided into two groups: Group I included those who abandoned treatment, and Group II included those who did not abandon treatment. Results. Non-adherence was significantly associated with higher income (OR=5.8, high maternal education (OR=2.4, white skin color (OR=2.9, and obesity (OR=3.6. Conclusion. Despite the new academic-care approach, the non-adherence to treatment rate was high, and was associated with sociodemographic and nutritional factors.
Soares Mariz, Larissa; Campos Muniz Medeiros, Carla; Cruz Enders, Bertha; Nascimento Kluczynik Vieira, Caroline Evelin; Aires Silva Medeiros, Kaio Keomma; Silva Coura, Alexsandro
To evaluate the risk factors associated with treatment abandonment by overweight or obese children and adolescents. A cross-sectional study, conducted in 2011, at the Childhood Obesity Center, in Campina Grande, Brazil, with the records of 208 children and adolescents, between three and 18 years of age, divided into two groups: Group I included those who abandoned treatment, and Group II included those who did not abandon treatment. Non-adherence was significantly associated with higher income (OR=5.8), high maternal education (OR=2.4), white skin color (OR=2.9), and obesity (OR=3.6). Despite the new academic-care approach, the non-adherence to treatment rate was high, and was associated with sociodemographic and nutritional factors.
Eating habits, weight reduction strategies and long-term treatment resultsin obese men. The "Gustaf" study. Ingalena Andersson Obesity Unit and Health Behaviour Research, Department of Medicine, HuddingeHospital, Karolinska Institute, Stockholm, Sweden. Abdominal male obesity is associated with hypertension, abnormal blood lipidsand diabetes type 11. For development of a weight loss program for such males, 86obese men (BMI 37.7 [4.4] kg/m2) (mean [SD] ) from the wa...
Trier, Cæcilie; Dahl, Maria; Stjernholm, Theresa
during their child's treatment. Conclusion: There is a high prevalence of overweight/obesity among parents of children entering childhood obesity treatment. Family-based childhood obesity treatment with a focus on the child has a positive effect on parental BMI with both mothers and fathers losing weight...... available in 606 mothers and 479 fathers. At baseline, the median BMI of the mothers was 28.1 kg/m2 (range: 16.9-66.6), and the median BMI of the fathers was 28.9 kg/m2 (range: 17.2-48.1). Seventy percent of the mothers and 80% of the fathers were overweight or obese at the time of their child's treatment...... initiation. Both the mothers and fathers lost weight during their child's treatment with a mean decrease in BMI in the mothers of 0.5 (95% CI: 0.2-0.8, p = 0.0006) and in the fathers of 0.4 (95% CI: 0.2-0.6, p = 0.0007). Of the overweight/obese parents, 60% of the mothers and 58% of the fathers lost weight...
Garaulet, Marta; Pérez de Heredia, F
Obesity is the consequence of an imbalance between energy intake and expenditure, food intake being affected by multiple factors -psychological, social, work-related, etc. This revision discusses the role of diet in the behavioural treatment (BT) of obesity, which faces multiple approaches and focuses on patients' behaviour rather than their mere energy intake. Recent literature has been revised that deals with the health benefits of Mediterranean diet in order to assess its suitability for obesity treatment based on BT. BT helps patients to develop skills and techniques in order to adopt proper habits and attain their healthiest weight. Patients learn to establish realistic goals, both as regards weight and behaviour, and to evaluate their progress in modifying eating and exercising habits. The application of the Mediterranean diet in obesity treatment presents various advantages which are based on the principles of this diet -wide variety of food, high carbohydrate content, or high satiating capacity, which prevents specific hunger and ketogenesis-, and has been demonstrated to be effective in reducing body weight. BT based on the Mediterranean diet is a useful tool for obesity treatment. The Mediterranean diet provides the patients with a diet established on widely recognised nutritional benefits, suitable to their social and daily life, and that can be easily followed in the long term, according to the objectives of BT. For these reasons, Mediterranean diet-based BT helps to prolong both the treatment and maintenance periods and therefore contributes to a more stable weight loss.
Altfas Jules R
Full Text Available Abstract Background Bariatric patients showing poor "focus" during treatment more often failed to lose weight or maintain reduced weight. Evaluation of these patients identified a number having attention deficit/hyperactivity disorder (ADHD, evidently a potent factor limiting successful weight control. After searches found no published reports describing comorbid ADHD and obesity, this report was conceived to begin exploring the prevalence and characteristics of these patients. Method Clinical records of 215 patients receiving obesity treatment during 2000 were reviewed. Data collected and analyzed included age, sex, beginning and ending body mass index (BMI, number of clinic visits, months of treatment, and diagnostic category (ADHD, some ADHD symptoms, non-ADHD. DSM-IV criteria were used, except age of onset was modified to Results Whole sample ADHD prevalence was 27.4% (CI:21.1,32.9, but 42.6% (CI: 36.3% to 48.9% for BMI >= 40. Mean weight loss among obese patients with ADHD (OB+ADHD was 2.6 BMI (kg/m2 vs. 4.0 for non-ADHD (NAD (p = 40, OB+ADHD had BMI loss 2.9 vs. 7.0 (NAD (p Conclusions ADHD was highly prevalent among obese patients and highest in those with extreme obesity. Comorbid obesity and ADHD symptoms rendered treatment less successful compared to NAD counterparts. Reasons for the comorbidity are unknown, but may involve brain dopamine or insulin receptor activity. If replicated in further studies, these findings have important implications for treatment of severe and extreme obesity.
van der Baan-Slootweg, Olga; Benninga, Marc A.; Beelen, Anita; van der Palen, Job; Tamminga-Smeulders, Christine; Tijssen, Jan G. P.; van Aalderen, Wim M. C.
Severe childhood obesity has become a major health problem, and effective, evidence-based interventions are needed. The relative effectiveness of inpatient compared with ambulatory treatment remains unknown. To determine whether an inpatient treatment program is more effective than an ambulatory
Kitzmann, Katherine M.; Dalton, William T., III; Buscemi, Joanna
Many family-based treatments for pediatric obesity teach specific parenting practices related to weight management. Although youth in these programs show increases in positive health behaviors and reductions in the extent to which they are overweight, most remain overweight after treatment. A recent trend is to create tailored programs for…
Werrij, Marieke Q.; Mulkens, Sandra; Elgersma, Hermien J.; Ament, Andre J. H. A.; Hospers, Hann J.; Jansen, Anita T. M.
Objective: The treatment of obesity is universally disappointing; although usually some weight loss is reported directly after treatment, eventual relapse to, or even above, former body weight is common. In this study it is tested whether the addition of cognitive therapy to a standard dietetic
The need for effective treatments for pediatric overweight is well known. We evaluated the applicability of an evidence-based treatment in an applied clinic setting that includes children with severe obesity and comorbid medical or psychiatric conditions. Forty-eight overweight children and their fa...
Yaeger-Yarom, Gili; Nemet, Dan; Eliakim, Alon
Despite the childhood obesity epidemic, few obese children receive therapy and relatively few weight management multidisciplinary programs exist. The objective of this study was to examine the patterns and causes for obese children referrals to a tertiary multidisciplinary childhood obesity treatment program. A total of 227 children (10.6 +/- 2.6 years; 108 boys, 119 girls) were evaluated at the beginning of the programs for personal and familial demographic and anthropometric details, the referring agent to the program, and the main reasons for participation and for the child's desire to lose weight. The majority of participants had an obese family member (83%), in particular an obese parent (62%). The majority of patients were self-referred (86.8%), mainly by their mothers (74%). Only a small fraction were referred by healthcare providers (15.4%). The desire to improve appearance (44.5%), social/psychological issues (39.2%) and the will to improve fitness (29.5%) were the main reasons for joining the program. Understanding the motives for participation and referral patterns can improve recruitment and participation of obese children in weight reduction intervention programs.
Manning, Kathryn; Senekal, Marjanne; Harbron, Janetta
Background: Insights into the characteristics of treatment seekers for lifestyle changes and treatment preferences are necessary for intervention planning. Aim: To compile a profile of treatment-seeking obese patients with non-communicable diseases (NCDs) or NCD risk factors and to compare patients who choose group-based (facility-based therapeutic group [FBTG]) versus usual care (individual consultations) treatment. Setting: A primary healthcare facility in Cape Town, South Africa. ...
Jakobsen, Gunn Signe; Småstuen, Milada Cvancarova; Sandbu, Rune; Nordstrand, Njord; Hofsø, Dag; Lindberg, Morten; Hertel, Jens Kristoffer; Hjelmesæth, Jøran
The association of bariatric surgery and specialized medical obesity treatment with beneficial and detrimental outcomes remains uncertain. To compare changes in obesity-related comorbidities in patients with severe obesity (body mass index ≥40 or ≥35 and at least 1 comorbidity) undergoing bariatric surgery or specialized medical treatment. Cohort study with baseline data of exposures from November 2005 through July 2010 and follow-up data from 2006 until death or through December 2015 at a tertiary care outpatient center, Vestfold Hospital Trust, Norway. Consecutive treatment-seeking adult patients (n = 2109) with severe obesity assessed (221 patients excluded and 1888 patients included). Bariatric surgery (n = 932, 92% gastric bypass) or specialized medical treatment (n = 956) including individual or group-based lifestyle intervention programs. Primary outcomes included remission and new onset of hypertension based on drugs dispensed according to the Norwegian Prescription Database. Prespecified secondary outcomes included changes in comorbidities. Adverse events included complications retrieved from the Norwegian Patient Registry and a local laboratory database. Among 1888 patients included in the study, the mean (SD) age was 43.5 (12.3) years (1249 women [66%]; mean [SD] baseline BMI, 44.2 [6.1]; 100% completed follow-up at a median of 6.5 years [range, 0.2-10.1]). Surgically treated patients had a greater likelihood of remission and lesser likelihood for new onset of hypertension (remission: absolute risk [AR], 31.9% vs 12.4%); risk difference [RD], 19.5% [95% CI, 15.8%-23.2%], relative risk [RR], 2.1 [95% CI, 2.0-2.2]; new onset: AR, 3.5% vs 12.2%, RD, 8.7% [95% CI, 6.7%-10.7%], RR, 0.4 [95% CI, 0.3-0.5]; greater likelihood of diabetes remission: AR, 57.5% vs 14.8%; RD, 42.7% [95% CI, 35.8%-49.7%], RR, 3.9 [95% CI, 2.8-5.4]; greater risk of new-onset depression: AR, 8.9% vs 6.5%; RD, 2.4% [95% CI, 1.3%-3.5%], RR, 1.5 [95% CI, 1.4-1.7]; and
Wafa, Sharifah W; Talib, Ruzita A; Hamzaid, Nur H; McColl, John H; Rajikan, Roslee; Ng, Lai O; Ramli, Ayiesah H; Reilly, John J
Few randomized controlled trials (RCTs) of interventions for the treatment of childhood obesity have taken place outside the Western world. To test whether a good practice intervention for the treatment of childhood obesity would have a greater impact on weight status and other outcomes than a control condition in Kuala Lumpur, Malaysia. Assessor-blinded RCT of a treatment intervention in 107 obese 7- to 11-year olds. The intervention was relatively low intensity (8 hours contact over 26 weeks, group based), aiming to change child sedentary behavior, physical activity, and diet using behavior change counselling. Outcomes were measured at baseline and six months after the start of the intervention. Primary outcome was BMI z-score, other outcomes were weight change, health-related quality of life (Peds QL), objectively measured physical activity and sedentary behavior (Actigraph accelerometry over 5 days). The intervention had no significant effect on BMI z score relative to control. Weight gain was reduced significantly in the intervention group compared to the control group (+1.5 kg vs. +3.5 kg, respectively, t-test p < 0.01). Changes in health-related quality of life and objectively measured physical activity and sedentary behavior favored the intervention group. Treatment was associated with reduced rate of weight gain, and improvements in physical activity and quality of life. More substantial benefits may require longer term and more intensive interventions which aim for more substantive lifestyle changes.
Katzmarzyk, P T; Barlow, S; Bouchard, C; Catalano, P M; Hsia, D S; Inge, T H; Lovelady, C; Raynor, H; Redman, L M; Staiano, A E; Spruijt-Metz, D; Symonds, M E; Vickers, M; Wilfley, D; Yanovski, J A
The 2013 Pennington Biomedical Research Center's Scientific Symposium focused on the treatment and management of pediatric obesity and was designed to (i) review recent scientific advances in the prevention, clinical treatment and management of pediatric obesity, (ii) integrate the latest published and unpublished findings and (iii) explore how these advances can be integrated into clinical and public health approaches. The symposium provided an overview of important new advances in the field, which led to several recommendations for incorporating the scientific evidence into practice. The science presented covered a range of topics related to pediatric obesity, including the role of genetic differences, epigenetic events influenced by in utero development, pre-pregnancy maternal obesity status, maternal nutrition and maternal weight gain on developmental programming of adiposity in offspring. Finally, the relative merits of a range of various behavioral approaches targeted at pediatric obesity were covered, together with the specific roles of pharmacotherapy and bariatric surgery in pediatric populations. In summary, pediatric obesity is a very challenging problem that is unprecedented in evolutionary terms; one which has the capacity to negate many of the health benefits that have contributed to the increased longevity observed in the developed world.
Ortega-González, Carlos; Aguilera-Pérez, Jesús Rafael; Arce-Sánchez, Lidia; Barquera-Cervera, Simón; Díaz-Polanco, Araceli; Fernández-Sánchez, Mónica; Ferreira-Hermosillo, Aldo; Martínez-Cruz, Nayeli; Medina-García, Catalina; Molina-Ayala, Mario Antonio; Muñoz-Manrique, Cinthya Guadalupe; Pantoja-Millán, Juan Pablo; Perichart-Perera, Otilia; Pimentel-Nieto, Dian; Reyes-Rodríguez, Eduardo Armando; Romero-Zazueta, Alejandro; Ruiz-Padilla, Claudia Lorena; Vergara-López, Alma; Vidrio-Velázquez, Maricela; Villagordoa-Mesa, Juan; Zúñiga-González, Sergio Antonio
The development of obesity is complex and multifactorial, with genetic, biological, environmental and lifestyle of each individual etiology. The different changes in metabolism of women, amongst other factors, lead to disorganization in the distribution of lipids, which gathered in large quantities within the viscera, increases cardiovascular mortality and it is a major determinant factor of the metabolic syndrome. To homologate and to apply concepts of evidence-based clinical practice in diagnosis and treatment of obesity in women in reproductive age and climacterium. The experts' consensus was done by specialized physicians properly endocrinologists, gynecologists, surgeons, psychologists, nutrition specialists, physical activity and public health, according to their expertise and clinical judgment. The recommendations were based in diagnostic criteria aside from the level of evidence of previously established treatment guidelines, controlled clinical trials and standardized guides for women in reproductive age and climacterium with obesity. The establishment of a nutritional intervention amongst other aspects of lifestyle is the first-line in the treatment of obesity. Current pharmacological treatments offer modest results in efficiency and security in weight reduction so these must go along with real changes in lifestyle in order to obtain better results in the short and long term. The high prevalence of overweight and obesity in our country, especially in women in reproductive age, compels us to pose and work in prevention strategies as well as diverse therapeutic plans favoring safe weight loss and results in the long term.
Full Text Available Paolo Leombruni, Luca Lavagnino, Secondo FassinoDepartment of Neurosciences, Psychiatry Section, University of Torino, Centre for Eating Disorders and Obesity, Torino, ItalyAbstract: Topiramate is an anticonvulsant drug used for the treatment of epilepsy and prophylaxis of migraine. Some authors have proposed its use as a mood stabilizer and have reported its efficacy in reducing impulsiveness and improving mood regulation, possibly via its antagonism to glutamatergic transmission in the lateral hypothalamus, although this indication is still controversial. Weight loss is a side effect consistently reported in the medical literature in patients treated with topiramate. Given its potential role in stabilizing mood and reducing impulse control problems and weight, topiramate has been proposed as a treatment for obese patients with binge eating disorder (BED. The aim of this paper is to review published data on the efficacy and safety of topiramate for the treatment of obese subjects with BED. Although the evidence is preliminary, topiramate appears to be a relatively safe and effective treatment for obese subjects with BED. Limitations of the studies and future directions for research are discussed.Keywords: topiramate, binge eating disorder, obesity
Meyer, Lene; Tjørnhøj-Thomsen, Tine; Lau, Marianne Engelbrecht
Background: Binge eating disorder (BED) has recently been recognized as a diagnosis in the DSM-5 (Diagnostic Manual of Mental Disorders). BED is a severe eating disorder with physical, social and psychological consequences. The prevalence of BED is 2-3% and the majority develop weight problems...... and obesity. Treatment is found effective in reducing eating disorder symptomatology, but rarely leads to weight loss. It is still unknown how the issue of obesity can be addressed in BED treatment without increasing the risk of binge eating relapse. Objectives: The study is an explorative investigation...... of the outcome of a newly developed group based treatment that combines psychotherapy and either weight loss or well-being components for patients with binge eating disorders and obesity. Methods: The study uses a convergent mixed methods design. Qualitative and quantitative data are gathered using in...
Trier, Cæcilie; Dahl, Maria; Stjernholm, Theresa; Nielsen, Tenna R H; Bøjsøe, Christine; Fonvig, Cilius E; Pedersen, Oluf; Hansen, Torben; Holm, Jens-Christian
The aim of this study was to investigate the prevalence of overweight/obesity among parents of children entering childhood obesity treatment and to evaluate changes in the parents' weight statuses during their child's treatment. The study included parents of 1,125 children and adolescents aged 3-22 years, who were enrolled in a multidisciplinary childhood obesity treatment program. At baseline, weight and height of the parents were obtained by self-reported information and parental body mass index (BMI) was calculated. Weight and height of the children were measured in the clinic and BMI standard deviation scores were calculated. Furthermore, anthropometric data from parents of 664 children were obtained by telephone interview after a mean of 2.5 years of treatment (ranging 16 days to 7 years), and changes in parental BMI were analyzed. Data on changes in BMI were available in 606 mothers and 479 fathers. At baseline, the median BMI of the mothers was 28.1 kg/m2 (range: 16.9-66.6), and the median BMI of the fathers was 28.9 kg/m2 (range: 17.2-48.1). Seventy percent of the mothers and 80% of the fathers were overweight or obese at the time of their child's treatment initiation. Both the mothers and fathers lost weight during their child's treatment with a mean decrease in BMI in the mothers of 0.5 (95% CI: 0.2-0.8, p = 0.0006) and in the fathers of 0.4 (95% CI: 0.2-0.6, p = 0.0007). Of the overweight/obese parents, 60% of the mothers and 58% of the fathers lost weight during their child's treatment. There is a high prevalence of overweight/obesity among parents of children entering childhood obesity treatment. Family-based childhood obesity treatment with a focus on the child has a positive effect on parental BMI with both mothers and fathers losing weight. ClinicalTrials.gov NCT00928473.
Wolfe, Bruce M.; Kvach, Elizaveta; Eckel, Robert H.
This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD) as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by non-surgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the co-morbidities, quality of life and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes, inflammation, obstructive sleep apnea and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors following weight loss, it is reasonable to expect a reduction of CVD events and related mortality following weight loss in populations with obesity. The quality of the current evidence is reviewed and future research opportunities and summaries are stated. PMID:27230645
Laskowski, Edward R
The United States is in the midst of a significant public health problem that relates to obesity and inactivity. This epidemic has far-ranging consequences for our workforce and our children and shows no signs of slowing in the near future. Significant research has been performed on the effects of exercise for the reduction of body weight; results of most studies indicate that exercise alone has a small effect on body-weight reduction independent of caloric restriction. However, when combined with dietary restriction, exercise has a synergistic effect and enhances weight loss beyond the effect of diet alone. In addition, exercise has been shown to have significant beneficial effects on cardiovascular and metabolic risk factors independent of actual weight loss, and losing just a small amount of weight can have a significant beneficial effect on these parameters. Genetic factors related to obesity have been found to be positively modified when persons incorporate physical activity into their lifestyle. Sitting time appears to be an independent risk factor for the development of metabolic risk factors; persons who spend more time sitting and watching television have worse metabolic profiles, even if they achieve the recommended amount of physical activity per week, than do those who move about throughout the day. Exercise also is essential for the prevention of weight gain over a life span, although the amount required to prevent weight gain may be closer to twice the amount of exercise recommended by the current Physical Activity Guidelines for Americans (www.health.gov/paguidelines). In many ways, the physiatrist is the most well prepared of all the specialists to address the complex, multidimensional problems of obesity and inactivity. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Cheon, Chunhoo; Jang, Soobin; Park, Jeong-Su; Ko, Youme; Kim, Doh Sun; Lee, Byung Hoon; Song, Hyun Jong; Song, Yun-Kyung; Jang, Bo-Hyoung; Shin, Yong-Cheol; Ko, Seong-Gyu
Obesity is a public health concern in many countries due to its increasing prevalence. Euiiyin-tang is an herbal medicine formula often used as a clinical treatment for obesity. It acts to eliminate humidity and purify the blood, the causes of obesity identified by the theoretical framework of Korean medicine. The purpose of this study is to evaluate the efficacy and safety of Euiiyin-tang in treating obesity. This study is a randomised, double-blinded and placebo-controlled, multicentre trial. It has two parallel arms: the Euiiyin-tang group and the placebo group. A total of 160 obese adult women will be enrolled in the trial. The participants will be randomly divided at a 1:1 ratio at visit 2 (baseline). The participants will be administered Euiiyin-tang or placebo for 12 weeks. The primary endpoint is the change in weight occurring between baseline and post-treatment. The secondary outcomes include average weight reduction, changes in body fat, waist and hip circumferences, body mass index, and lipid profile, and the results of questionnaires such as the Korean version of Obesity-related Quality of Life, the Korean version of Eating Attitudes Test, the Social Readjustment Rating Scale, and the Stress Reaction Inventory. The present study will provide research methodologies for evaluating the efficacy and safety of Euiiyin-tang in patients with obesity. In addition, it will provide evidence of correlation between obesity and Sasang constitutional medicine. ClinicalTrials.gov, NCT01724099 . Registered on 2 November 2012.
Häkkänen, Paula; Ketola, Eeva; Laatikainen, Tiina
School health care offers a natural setting for childhood obesity interventions. Earlier studies reveal inadequate screening and treatment in primary care. However, longitudinal studies in unselected populations are lacking. We aimed to examine how school nurses and physicians identified obesity, diagnosed it and offered interventions over primary school. We compared the results with Finnish recommendations. From our cohort of 2000 primary school sixth graders (aged 12-14), 172 were obese at least once during primary school. We manually collected retrospective electronic health record (EHR) data of these 'ever-obese' children. Of the ever-obese children, 96% attended annual nurse assessments more than twice. School physicians met 53% of the ever-obese children at health checks at first grade and 93% at fifth grade. Of overweight-related extra visits to school nurses, 94% took place without parents. Parents were present in 48% of extra school physician visits. Only 29% of the 157 who became obese during the first five school grades received an obesity diagnosis. However, school physicians mentioned weight problems in EHR for 90% of the children and, similarly, school nurses for 99%. The majority received a treatment plan at least once. For 78%, at least one plan was made with the parents. Still, 28% missed nutrition plans, 31% exercise plans and 90% lacked recorded weight development targets. The gap between clinical guidelines and reality in school health care could be narrowed by improving diagnosing and parent collaboration. Obstacles in parent involvement and work methods in school health care need further study. © 2018 Nordic College of Caring Science.
Full Text Available Background:The rising trend in the prevalence of obesity has during the past decades become a major public health concern in many countries, as obesity may lead to comorbidities and death. A frequent used marker for obesity is the Body Mass Index (BMI. The cost of treatment for obesity related diseases has become a heavy burden on national health care budget in many countries. While diet and exercise are the cornerstones of weight management, pharmacotherapy is often needed to achieve and maintain desired weight loss. In some cases of extreme obesity, bariatric surgery may be recommended. It is expected to increase by 50% in Sweden.Objective: The overall objective was to develop a cost-effectiveness model using the best available evidence to assess the cost-effectiveness of gastric bypass (GBP surgical treatments for obesity in adult patients, in comparison with conventional treatment (CT, in Sweden from a healthcare perspective. With the model we also seeked to identify the lower cut-off point using BMI criteria, for the surgical intervention to be cost-effective. Methods:A micro-simulation model with an underlying Markov methodology was developed, that simulates individual patients. It simulates the outcomes of the patients in terms of treatment costs, life years, and quality adjusted life years (QALY over his/her remaining lifetime. The costs are presented in SEK in the year 2006 price level (1 SEK ≈ 0.11 EUR ≈ 0.14 USD.Results: We estimated that the incremental cost per QALY gained will not exceed SEK 33,000 per QALY in patients with BMI < 35. In patients with BMI > 35 kg/m2, gastric bypass surgery has lower costs compared to conventional treatment. Conclusion: Gastric bypass surgery is a cost-effective intervention compared to conventional treatment consisting of watchful waiting, diet and exercise.
Louis, Xavier L; Thandapilly, Sijo J; MohanKumar, Suresh K; Yu, Liping; Taylor, Carla G; Zahradka, Peter; Netticadan, Thomas
We hypothesized that a low-dose resveratrol will reverse cardiovascular abnormalities in rats fed a high-fat (HF) diet. Obese prone (OP) and obese resistant (OR) rats were fed an HF diet for 17 weeks; Sprague-Dawley rats fed laboratory chow served as control animals. During the last 5 weeks of study, treatment group received resveratrol daily by oral gavage at a dosage of 2.5 mg/kg body weight. Assessments included echocardiography, blood pressure, adiposity, glycemia, insulinemia, lipidemia, and inflammatory and oxidative stress markers. Body weight and adiposity were significantly higher in OP rats when compared to OR rats. Echocardiographic measurements showed prolonged isovolumic relaxation time in HF-fed OP and OR rats. Treatment with resveratrol significantly improved diastolic function in OP but not in OR rats without affecting adiposity. OP and OR rats had increased blood pressure which remained unchanged with treatment. OP rats had elevated fasting serum glucose and insulin, whereas OR rats had increased serum glucose and normal insulin concentrations. Resveratrol treatment significantly reduced serum glucose while increasing serum insulin in both OP and OR rats. Inflammatory and oxidative stress markers, serum triglycerides and low-density lipoprotein were higher in OP rats, which were significantly reduced with treatment. In conclusion, HF induced cardiac dysfunction in both OP and OR rats. Treatment reversed abnormalities in diastolic heart function associated with HF feeding in OP rats, but not in OR rats. The beneficial effects of resveratrol may be mediated through regression of hyperglycemia, oxidative stress and inflammation. Copyright © 2012 Elsevier Inc. All rights reserved.
Oksana V. Logvinova
Full Text Available Pharmacotherapy is an essential component of obesity treatment, as well as efforts focused on changing the lifestyle, correcting the food consumption and increasing the physical activity. The administration of central-acting drugs as pharmacotherapy of obesity is pathogenetically justified and allows improving the effectiveness of treatment. In this article, the use of sibutramine, a serotonin and norepinephrine reuptake inhibitor, is considered in various aspects of endocrinologist’s practice. In addition to aforesaid there is an application of a specific clinical observation.
Mollerup, Pernille M; Nielsen, Tenna R H; Bøjsøe, Christine
PURPOSE: The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree...... of obesity. METHODS: Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based...... upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS). RESULTS: Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys...
Kiess, W; Reich, A; Müller, G; Meyer, K; Galler, A; Bennek, J; Kratzsch, J
The level of fatness at which morbidity increases is determined on an acturial basis. Direct measurements of body fat content, eg hydrodensitometry, bioimpedance or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is frequently used to define obesity clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (MC4R). Environmental/exogenous factors contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc) and genetic syndromes (Prader-Labhard-Willi syndrome, Bardet-Biedl syndrome etc) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behavior modification and nutrition education. The role of regular exercise and exercise programs is emphasized. Surgical procedures and drugs used as treatments for adult obesity are still not recommended for children and adolescents with obesity. As obesity is the most common chronic disorder in the industrialized societies, its impact on individual lives as well as on health economics has to be
Steinsbekk, Silje; Odegård, Rønnaug; Wichstrøm, Lars
Research supports the use of family-based interventions in the treatment of obesity in children, but there is a lack of knowledge about what factors affect parents' ability to carry out the lifestyle changes necessary to reduce their child's obesity. The aim of the present study was to examine whether parents' self-efficacy, perceived emotional barriers, subjective norms, and attitudes could predict change in their children's body fat at 6 month and 2 year follow-ups after a family-based treatment of obesity. Body Mass Index Standard Deviation Scores (BMI SDS) were calculated and body fat (dual-energy X-ray absorptiometry) were measured in 99 treatment-seeking children with obesity (ages 7-12; 48 girls, 51 boys; mean BMI SDS = 2.99) at baseline, after 6 month and after 2 year follow-up. Parental cognitions regarding diet and physical activity were examined by parent-completed questionnaires. Structural equation modeling (SEM) was used to test whether the selected health cognitions could predict treatment outcome. Parental perceived emotional barriers was a significant predictor of change in body fat at 6 month (β = -.32, p = .001) and 2 year (β = -.38, p = .002) follow-up when the initial body fat values were controlled. Self-efficacy, subjective norms and attitudes did not improve the amount of variance explained. Parents' perceived emotional barriers significantly predict change in total body fat in children treated for obesity. In order to increase treatment-efficacy, perceived emotional barriers should be addressed. Â© 2011 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.
Zhang, Yuqi; Liu, Qiongming; Yu, Jicheng; Yu, Shuangjiang; Wang, Jinqiang; Qiang, Li; Gu, Zhen
Obesity is one of the most serious public health problems in the 21st century that may lead to many comorbidities such as type-2 diabetes, cardiovascular diseases, and cancer. Current treatments toward obesity including diet, physical exercise, pharmacological therapy, as well as surgeries are always associated with low effectiveness or undesired systematical side effects. In order to enhance treatment efficiency with minimized side effects, we developed a transcutaneous browning agent patch to locally induce adipose tissue transformation. This microneedle-based patch can effectively deliver browning agents to the subcutaneous adipocytes in a sustained manner and switch on the "browning" at the targeted region. It is demonstrated that this patch reduces treated fat pad size, increases whole body energy expenditure, and improves type-2 diabetes in vivo in a diet-induced obesity mouse model.
G, Riva; B.K, Wiederhold; F, Mantovani; A, Gaggioli
For many of us, obesity is the outcome of an energy imbalance: more energy input than expenditure. However, our waistlines are growing in spite of the huge amount of diets and fat-free/low-calorie products available to cope with this issue. Even when we are able to reduce our waistlines, maintaining the new size is very difficult: in the year after the end of a nutritional and/or behavioral treatment obese persons typically regain from 30% to 50% of their initial losses. A possible strategy for improving the treatment of obesity is the use of advanced information technologies. In the past, different technologies (internet, virtual reality, mobile phones) have shown promising effects in producing a healthy lifestyle in obese patients. Here we suggest that a new technological paradigm - Interreality – that integrates assessment and treatment within a hybrid experiential environment - including both virtual and real worlds - has the potential to improve the clinical outcome of obesity treatments. The potential advantages offered by this approach are: (a) an extended sense of presence: Interreality uses advanced simulations (virtual experiences) to transform health guidelines and provisions in experiences; (b) an extended sense of community: Interreality uses virtual communities to provide users with targeted – but also anonymous, if required - social support in both real and virtual worlds; (c) real-time feedback between physical and virtual worlds: Interreality uses bio and activity sensors and devices (smartphones) both to track in real time the behavior/health status of the user, and to provide targeted suggestions and guidelines. This paper describes in detail the different technologies involved in the Interreality vision. In order to illustrate the concept of Interreality in practice, a clinical scenario is also presented and discussed: Daniela, a 35-year-old fast-food worker with obesity problems. PMID:21559236
Mandelblatt, Jeanne; van Ravesteyn, Nicolien; Schechter, Clyde; Chang, Yaojen; Huang, An-Tsun; Near, Aimee M; de Koning, Harry; Jemal, Ahmedin
US breast cancer mortality is declining, but thousands of women still die each year. Two established simulation models examine 6 strategies that include increased screening and/or treatment or elimination of obesity versus continuation of current patterns. The models use common national data on incidence and obesity prevalence, competing causes of death, mammography characteristics, treatment effects, and survival/cure. Parameters are modified based on obesity (defined as BMI ≥ 30 kg/m(2) ). Outcomes are presented for the year 2025 among women aged 25+ and include numbers of cases, deaths, mammograms and false-positives; age-adjusted incidence and mortality; breast cancer mortality reduction and deaths averted; and probability of dying of breast cancer. If current patterns continue, the models project that there would be about 50,100-57,400 (range across models) annual breast cancer deaths in 2025. If 90% of women were screened annually from ages 40 to 54 and biennially from ages 55 to 99 (or death), then 5100-6100 fewer deaths would occur versus current patterns, but incidence, mammograms, and false-positives would increase. If all women received the indicated systemic treatment (with no screening change), then 11,400-14,500 more deaths would be averted versus current patterns, but increased toxicity could occur. If 100% received screening plus indicated therapy, there would be 18,100-20,400 fewer deaths. Eliminating obesity yields 3300-5700 fewer breast cancer deaths versus continuation of current obesity levels. Maximal reductions in breast cancer deaths could be achieved through optimizing treatment use, followed by increasing screening use and obesity prevention. © 2013 American Cancer Society.
Żurawiński, Wojciech; Sokołowski, Dariusz; Krupa-Kotara, Karolina; Czech, Elżbieta; Sosada, Krystyn
Overweight and obesity are ranked in the fifth place among the risk factors responsible for the greatest number of deaths in the world. To assess the effects of treatment of patients with morbid obesity using endoscopic intragastric balloon (IGB) implantation. Two hundred and seventy-two patients with obesity were treated using endoscopic intragastric balloon implantation. Upon analysis of the inclusion and exclusion criteria, the study covered a group of 63 patients with morbid obesity. The patients were implanted with the LexBal balloon. Reduction of excess body mass, changes to BMI values and ailments and complications divided into mild and severe were assessed. Before intragastric balloon treatment, the average body mass index (BMI) value was 58.3 ±10.5 kg/m 2 , whereas after 6 months of treatment it decreased to 49.5 ±8.7 kg/m 2 . The patients with postoperative BMI equal to or greater than 50.0 kg/m 2 reported nausea (69.7%), vomiting (51.5%), flatulence (45.5%), upper abdominal pain (36.4%) and general discomfort (424%) more frequently. Dehydration (9.1%) was also more frequent in this group, whereas frequency of occurrence of such ailments and complications as heartburn (23.3%) and oesophageal candidiasis (10.0%) was higher in the patients with postoperative BMI below 50.0 kg/m 2 . Endoscopic intragastric balloon implantation is an effective and safe method of excess body mass reduction in patients with morbid obesity before a planned bariatric surgical procedure. Pre-operative excess body mass and BMI value and post-operative excess weight loss in patients with morbid obesity have no impact on frequency of occurrence of ailments and complications in IGB treatment.
Full Text Available Variety of intervention programs for controlling the obesity epidemic has been done worldwide. However, it is still not yet available a scientific tool to measure the effectiveness of those programs. This is due to the difficulty in parameterizing the human interaction and transition process of obesity. A dynamical model for simulating the interaction between healthy people, overweight people, and obese people in a randomly mixed population is discussed in here. Two scenarios of intervention programs were implemented in the model, dietary program for overweight people with healthy life campaign and treatment program for obese people. Assuming all control rates are constant, disease free equilibrium point, endemic equilibrium point, and basic reproductive ratio (ℛ0 as the epidemic indicator were shown analytically. We find that the disease free equilibrium point is locally asymptotical stable if and only if ℛ0<1. From sensitivity analysis of ℛ0, we obtain that larger rate of dietary program and treatment program will reduce ℛ0 significantly. With control rates are continuous in time, an optimal control approach was applied into the model to find the best way to minimize the number of overweight and obese people. Some numerical analysis and simulations for optimal control of the intervention were shown to support the analytical results.
Chaplais, Elodie; Naughton, Geraldine; Thivel, David; Courteix, Daniel; Greene, David
Traditional approaches for treating or managing children and adolescents with overweight or obesity have limited effectiveness. Current advances in smartphone technology may improve the attractiveness and accessibility of weight management support for children and adolescents with overweight or obesity. This systematic review aimed to provide a comparative evaluation of the effectiveness of using smartphones in the multidisciplinary treatment of child and adolescent overweight or obesity, with a specific interest in behavior change. The databases of Medline complete, OVID, CINAHL, EMBASE, and PubMed were searched for randomized controlled trial (RCT) studies addressing behavioral change using smartphone technology, plus nutrition and/or physical activity, to treat or manage child and adolescent obesity. Only two RCTs have described the effectiveness of smartphone devices in pediatric overweight or obesity treatment. Within the limitation of the two studies, electronic contact (e-contact) appeared unsuccessful in achieving weight loss. However, smartphone usage was linked to improved engagement and reduced dropout rates during important sustainability phases of these long-term interventions. Smartphone technologies allow users to accomplish tasks anywhere and anytime and, as such, provide researchers with additional and generationally appropriate capacities to deliver health promotion. E-contact should be used for its significant capacity to prolong engagement and decrease withdrawal during sustainability phases that follow intensive intervention for weight management in young populations. Despite increasing popularity in published protocols of weight management trials, the effectiveness of the impact of smartphone technology in pediatric programs remains equivocal.
Hughes, T E; Kim, D D; Marjason, J; Proietto, J; Whitehead, J P; Vath, J E
Evaluate the safety and tolerability of beloranib, a fumagillin-class methionine aminopetidase-2 (MetAP2) inhibitor, in obese women over 4 weeks. Thirty-one obese (mean BMI 38 kg/m2) women were randomized to intravenous 0.1, 0.3, or 0.9 mg/m2 beloranib or placebo twice weekly for 4 weeks (N = 7, 6, 9, and 9). The most frequent AEs were headache, infusion site injury, nausea, and diarrhea. Nausea and infusion site injury occurred more with beloranib than placebo. The most common reason for discontinuation was loss of venous access. There were no clinically significant abnormal laboratory findings. In subjects completing 4 weeks, median weight loss with 0.9 mg/m2 beloranib was -3.8 kg (95% CI -5.1, -0.9; N = 8) versus -0.6 kg with placebo (-4.5, -0.1; N = 6). Weight change for 0.1 and 0.3 mg/m2 beloranib was similar to placebo. Beloranib (0.9 mg/m2) was associated with a significant 42 and 18% reduction in triglycerides and LDL-cholesterol, as well as improvement in C-reactive protein and reduced sense of hunger. Changes in β-hydroxybutyrate, adiponectin, leptin, and fibroblast growth factor-21 were consistent with the putative mechanism of MetAP2 inhibition. Glucose and blood pressure were unchanged. Beloranib treatment was well tolerated and associated with rapid weight loss and improvements in lipids, C-reactive protein, and adiponectin. Copyright © 2013 The Obesity Society.
Sacha, C R; Page, C M; Goldman, R H; Ginsburg, E S; Zera, C A
To assess attitudes towards weight loss interventions in patients seeking infertility treatment. We evaluated prior weight loss experiences, attitudes towards future interventions by body mass index (BMI), and willingness to delay fertility treatment for weight loss interventions stratified by BMI using logistic regression amongst women ≤45years old with infertility over three months or recurrent pregnancy loss. The average age of our convenience sample of respondents (148 of 794 eligible women, 19%) was 34.5 years old, with a mean BMI of 26.7±7.4kg/m 2 , including 37 with a BMI >30kg/m 2 (25%). Most women had attempted conception over 1year. The majority of women with overweight or obesity were attempting weight loss at the time of survey completion (69%). While 47% of these women reported interest in a supervised medical weight loss program, 92% of overweight women and 84% of women with obesity were not willing to delay fertility treatment more than 3 months to attempt weight loss. Most women with obesity and infertility in our population are unwilling to postpone fertility treatment for weight loss interventions. Copyright © 2017 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Christensen, Marie Møller; Jorsal, Tina; Naver, Lars Peter Skat
Aspiration therapy with AspireAssist is a novel endoscopic obesity treatment. Patients aspirate approximately 30% of an ingested meal through a draining system connected to a percutanous endoscopic gastrostomy tube. AspireAssist was recently approved by the US Food and Drug Administration, and it......-term effects are warranted....
Kirschenbaum, Daniel S.; Gierut, Kristen
Objective: To compare and contrast 5 sets of expert recommendations about the treatment of childhood and adolescent obesity. Method: We reviewed 5 sets of recent expert recommendations: 2007 health care organizations' four stage model, 2007 Canadian clinical practice guidelines, 2008 Endocrine Society recommendations, 2009 seven step model, and…
Nielsen, Tenna Ruest Haarmark; Fonvig, Cilius Esmann; Dahl, Maria; Mollerup, Pernille Maria; Lausten-Thomsen, Ulrik; Pedersen, Oluf; Hansen, Torben; Holm, Jens-Christian
The body mass index (BMI) standard deviation score (SDS) may not adequately reflect changes in fat mass during childhood obesity treatment. This study aimed to investigate associations between BMI SDS, body composition, and fasting plasma lipid concentrations at baseline and during childhood obesity treatment. 876 children and adolescents (498 girls) with overweight/obesity, median age 11.2 years (range 1.6-21.7), and median BMI SDS 2.8 (range 1.3-5.7) were enrolled in a multidisciplinary outpatient treatment program and followed for a median of 1.8 years (range 0.4-7.4). Height and weight, body composition measured by dual-energy X-ray absorptiometry, and fasting plasma lipid concentrations were assessed at baseline and at follow-up. Lipid concentrations (total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), non-HDL, and triglycerides (TG)) were available in 469 individuals (264 girls). Linear regressions were performed to investigate the associations between BMI SDS, body composition indices, and lipid concentrations. At baseline, BMI SDS was negatively associated with concentrations of HDL (p = 6.7*10-4) and positively with TG (p = 9.7*10-6). Reductions in BMI SDS were associated with reductions in total body fat percentage (pobesity during multidisciplinary childhood obesity treatment are accompanied by improvements in body composition and fasting plasma lipid concentrations. Even in individuals increasing their BMI SDS, body composition and lipid concentrations may improve.
Stokes, Victoria J; Anderson, Richard A; George, Jyothis T
Adiposity is associated with reduced fertility in men. The aetiology is multifactorial, with obese men at greater risk of suffering from impaired spermatogenesis, reduced circulating testosterone levels, erectile dysfunction and poor libido. The diagnosis and treatment of reduced fertility observed in obese men therefore requires insight into the underlying pathology, which has hormonal, mechanical and psychosocial aspects. This article summarises the current epidemiological, experimental and clinical trial evidence from the perspective of a practicing clinician. The following conclusions and recommendations can be drawn: Obesity is associated with low serum testosterone concentrations, but treatment with exogenous testosterone is likely to adversely impact on fertility. It is important to discuss this with men prior to initiation of testosterone therapy. Obesity adversely affects sperm concentration and may affect sperm quality. However, whether or not weight loss will correct these factors remain to be established. Oestrogen receptor modulators (and aromatase inhibitors) are unlicensed in the treatment for male hypogonadism and/or infertility. These treatments should hence be considered experimental approach until ongoing clinical trials report their outcomes. © 2014 John Wiley & Sons Ltd.
Watson, P. M.; Dugdill, L.; Murphy, R.; Knowles, Z.; Cable, N. T.
Childhood obesity is one of the most serious challenges of the 21st century and it is vital that evidence-based treatment approaches can be translated into practice to meet public health needs. Yet policy-makers cannot afford to wait for the results of lengthy trials before "probably efficacious" interventions are made available to the public, and…
Werrij, M.Q.; Mulkens, S.; Hospers, H.J.; Smits-de Bruyn, Y.; Jansen, A.T.M.
Objectives: In the present study the hypothesis was tested that a regular dietary treatment for obesity that is primarily directed at decreasing weight will also decrease concerns about shape, weight and eating, will reduce binge eating and will improve mood and self-esteem. Moreover we investigated
...] Changing Regulatory and Reimbursement Paradigms for Medical Devices in the Treatment of Obesity and... Administration (FDA) is announcing a public workshop entitled ``Changing Regulatory and Reimbursement Paradigms... information on the AGA Web site. If you need special accommodations due to a disability, please contact...
Christensen, Marie Møller; Jorsal, Tina; Naver, Lars Peter Skat
Aspiration therapy with AspireAssist is a novel endoscopic obesity treatment. Patients aspirate approximately 30% of an ingested meal through a draining system connected to a percutanous endoscopic gastrostomy tube. AspireAssist was recently approved by the US Food and Drug Administration...
V. A. Mezentsev
Full Text Available INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the
Dalle Grave, R; Calugi, S; Compare, A; El Ghoch, M; Petroni, M L; Colombari, S; Minniti, A; Marchesini, G
Studies on small samples or in single units applying specific treatment programmes found an association between some personality traits and attrition and weight loss in individuals treated for obesity. We aimed to investigate whether pre-treatment personality traits were associated with weight loss outcomes in the general population of women with obesity. Attrition and weight loss outcomes after 12 months were measured in 634 women with obesity (mean age, 48; body mass index (BMI), 37.8 kg m(-2)) seeking treatment at eight Italian medical centres, applying different medical/cognitive behavioural programmes. Personality traits were assessed with the Temperament and Character Inventory (TCI), eating disorder features with the Binge Eating Scale (BES) and Night Eating Questionnaire (NEQ). Within the 12-month observation period, 32.3% of cases were lost to follow-up. After adjustment for demographic confounders and the severity of eating disorders, no TCI personality traits were significantly associated with attrition, while low scores of the novelty seeking temperament scale remained significantly associated with weight loss ≥ 10% (odds ratio, 0.983; 95% confidence interval, 0.975-0.992). Additional adjustment for education and job did not change the results. We conclude that personality does not systematically influence attrition in women with obesity enrolled into weight loss programmes in the community, whereas an association is maintained between novelty seeking and weight loss outcome. Studies adapting obesity interventions on the basis of individual novelty seeking scores might be warranted to maximize the results on body weight. © 2015 World Obesity.
Thaïs Florence D. Nogueira
Full Text Available OBJECTIVE To analyze the reasons for non-adherence to follow-up at a specialized outpatient clinic for obese children and adolescents. METHODS Descriptive study of 41 patients, including information from medical records and phone recorded questionnaires which included two open questions and eight closed ones: reason for abandonment, financial and structural difficulties (distance and transport costs, relationship with professionals, obesity evolution, treatment continuity, knowledge of difficulties and obesity complications. RESULTS Among the interviewees, 29.3% reported that adherence to the program spent too much time and it was difficult to adjust consultations to patientsâ€(tm and parentsâ€(tm schedules. Other reasons were: childrenâ€(tms refusal to follow treatment (29.3%, dissatisfaction with the result (17.0%, treatment in another health service (12.2%, difficulty in schedule return (7.3% and delay in attendance (4.9%. All denied any relationship problems with professionals. Among the respondents, 85.4% said they are still overweight. They reported hurdles to appropriate nutrition and physical activity (financial difficulty, lack of parentsâ€(tm time, physical limitation and insecure neighborhood. Among the 33 respondents that reported difficulties with obesity, 78.8% had emotional disorders such as bullying, anxiety and irritability; 24.2% presented fatigue, 15.1% had difficulty in dressing up and 15.1% referred pain. The knowledge of the following complications prevailed: cardicac (97.6%, aesthetic (90.2%, psychological (90.2%, presence of obesity in adulthood (90.2%, diabetes (85.4% and cancer (31.4%. CONCLUSIONS According to the results, it is possible to create weight control public programs that are easier to access, encouraging appropriate nutrition and physical activities in order to achieve obesity prevention.
Harris Katherine I
Full Text Available Abstract Background The increasing prevalence of obesity is a significant health threat and a major public health challenge. A critical need exists to develop and evaluate practical methods for the treatment of obesity in the clinical setting. One of the factors contributing to the obesity epidemic is food portion sizes. Limited data are available on the efficacy of visual or tactile devices designed to enhance patient understanding and control of portion sizes. A portion control plate is a commercially-available product that can provide visual cues of portion size and potentially contribute to weight loss by enhancing portion size control among obese patients. This tool holds promise as a useful adjunct to dietary counseling. Our objective was to evaluate a portion control intervention including dietary counseling and a portion control plate to facilitate weight loss among obese patients in a primary care practice. Findings We randomized 65 obese patients [body mass index (BMI ≥ 30 and vs. -0.5% ± 2.2%; p = 0.041 and a non significant trend in weight change from baseline at 6 months (-2.1% ± 3.8% vs. -0.7% ± 3.7%; p = 0.232 compared with usual care. Nearly one-half of patients assigned to the portion control intervention who completed the study reported the overall intervention was helpful and the majority would recommend it to others. Conclusions Our findings suggest that a portion control intervention incorporating dietary counseling and a portion control plate may be effective for enhancing weight loss among obese subjects. A portion control intervention deserves further evaluation as a weight control strategy in the primary care setting. Trial registration Current controlled trials NCT01451554
Ng Tang Fui, Mark; Hoermann, Rudolf; Grossmann, Mathis
In obese men with lowered testosterone levels, testosterone treatment augments diet-associated loss of body fat. We hypothesized that testosterone treatment modulates circulating concentrations of hormonal mediators of fat mass and energy homeostasis in obese men undergoing a weight loss program. Prespecified secondary analysis of a randomized, double-blind, placebo-controlled trial. Tertiary referral center. Obese men (body mass index ≥30 kg/m 2 ) with a repeated total testosterone level ≤12 nmol/L. One hundred participants mean age 53 years (interquartile range 47 to 60 years) receiving 10 weeks of a very low-energy diet followed by 46 weeks of weight maintenance were randomly assigned at baseline to 56 weeks of intramuscular testosterone undecanoate (cases, n = 49) or matching placebo (controls, n = 51). Eighty-two men completed the study. Between-group differences in leptin, adiponectin, ghrelin, glucagon like peptide-1, gastric inhibitory polypeptide, peptide YY, pancreatic polypeptide, and amylin levels. At study end, compared with controls, cases had greater reductions in leptin [mean adjusted difference (MAD), -3.6 ng/mL (95% CI, -5.3 to -1.9); P diet-associated weight loss. Testosterone treatment may reduce leptin resistance in obese men.
Morgan, Philip J; Young, Myles D; Lloyd, Adam B; Wang, Monica L; Eather, Narelle; Miller, Andrew; Murtagh, Elaine M; Barnes, Alyce T; Pagoto, Sherry L
Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention research. This review investigated the involvement of fathers in obesity treatment and prevention programs targeting children and adolescents (0-18 years). A systematic review of English, peer-reviewed articles across 7 databases. Retrieved records included at least 1 search term from 2 groups: "participants" (eg, child*, parent*) and "outcomes": (eg, obes*, diet*). Randomized controlled trials (RCTs) assessing behavioral interventions to prevent or treat obesity in pediatric samples were eligible. Parents must have "actively participated" in the study. Two authors independently extracted data using a predefined template. The search retrieved 213 eligible RCTs. Of the RCTs that limited participation to 1 parent only (n = 80), fathers represented only 6% of parents. In RCTs in which participation was open to both parents (n = 133), 92% did not report objective data on father involvement. No study characteristics moderated the level of father involvement, with fathers underrepresented across all study types. Only 4 studies (2%) suggested that a lack of fathers was a possible limitation. Two studies (1%) reported explicit attempts to increase father involvement. The review was limited to RCTs published in English peer-reviewed journals over a 10-year period. Existing pediatric obesity treatment or prevention programs with parent involvement have not engaged fathers. Innovative strategies are needed to make participation more accessible and engaging for fathers. Copyright © 2017 by the American Academy of Pediatrics.
Grow, H. Mollie; Fernandez, Cristina; Lukasiewicz, Gloria J.; Rhodes, Erinn T.; Shaffer, Laura A.; Sweeney, Brooke; Woolford, Susan J.; Estrada, Elizabeth
Abstract Background: Type 2 diabetes mellitus (T2DM) and prediabetes have increased in prevalence among overweight and obese children, with significant implications for long-term health. There is little published evidence on the best approaches to care of prediabetes among overweight youth or the current practices used across pediatric weight management programs. Methods: This article reviews the literature and summarizes current practices for screening, diagnosis, and treatment of prediabetes at childhood obesity treatment centers. Findings regarding current practice were based on responses to an online survey from 28 pediatric weight management programs at 25 children's hospitals in 2012. Based on the literature reviewed, and empiric data, consensus support statements on prediabetes care and T2DM prevention were developed among representatives of these 25 children's hospitals' obesity clinics. Results: The evidence reviewed demonstrates that current T2DM and prediabetes diagnostic parameters are derived from adult-based studies with little understanding of clinical outcomes among youth. Very limited evidence exists on preventing progression of prediabetes. Some evidence suggests that a significant proportion of obese youth with prediabetes will revert to normoglycemia without pharmacological management. Evidence supports lifestyle modification for children with prediabetes, but further study of specific lifestyle changes and pharmacological treatments is needed. Conclusion: Evidence to guide management of prediabetes in children is limited. Current practice patterns of pediatric weight management programs show areas of variability in practice, reflecting the limited evidence base. More research is needed to guide clinical care for overweight youth with prediabetes. PMID:25055134
Overweight children are at an increased risk of becoming obese adults, which may lead to shorter life expectancies in the current generation of children as compared to their parents. Furthermore, being an overweight child has a negative psycho-social impact. We consider obesity in children...... circumference, growth, pubertal stage, blood pressure, neurology and skin and provide comprehensive paraclinical investigations for obesity and obesity related conditions. Treatment of obesity in children and adolescents is fully dependent on the combined effort of the entire family. This cannot...... as a "chronic care model" based on "best clinical practice" inspired by an American expert committee and the daily practice of The Children's Obesity Clinic at Copenhagen University Hospital Holbaek. Children and adolescents should be referred for examination and treatment in a pediatric setting when BMI...
Gray, Jane Simpson; Filigno, Stephanie Spear; Santos, Melissa; Ward, Wendy L.; Davis, Ann M.
Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service. PMID:23224661
Gray, Jane Simpson; Spear Filigno, Stephanie; Santos, Melissa; Ward, Wendy L; Davis, Ann M
Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service.
Vander Naalt SJ
Full Text Available Steven J Vander Naalt, Juan P Gurria, AiXuan L HoltermanUniversity of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Department of Surgery/Pediatric Surgery, Peoria, IL, USAAbstract: Obesity is a multi-organ system disease with underlying metabolic abnormalities and chronic systemic inflammation. Nonalcoholic fatty liver disease (NAFLD is a hepatic manifestation of obesity metabolic dysfunction and its associated cardiovascular- and liver-related morbidities and mortality. Our current understanding of NAFLD pathogenesis, disease characteristics, the role of insulin resistance, chronic inflammation, gut–liver and gut–brain crosstalk and the effectiveness of pharmacotherapy is still evolving. Bariatric surgery significantly improves metabolic and NAFLD histology in severely obese patients, although its positive effects on fibrosis are not universal. Bariatric surgery benefits NAFLD through its metabolic effect on insulin resistance, inflammation, and insulinotropic and anorexinogenic gastrointestinal hormones. Further studies are needed to understand the natural course of NAFLD in severely obese patients and the role of weight loss surgery as a primary treatment for NAFLD.Keywords: NAFLD, severe obesity, bariatric surgery
Alonso-Álvarez, María Luz; Terán-Santos, Joaquin; Navazo-Egüia, Ana Isabel; Martinez, Mónica Gonzalez; Jurado-Luque, María José; Corral-Peñafiel, Jaime; Duran-Cantolla, Joaquin; Cordero-Guevara, José Aurelio; Kheirandish-Gozal, Leila; Gozal, David
The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m(-2), corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h(-1). Among group 1 children, 21.2% had an RDI ≥3 events·h(-1) at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; p<0.05) in obese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82, 95% CI 1.09-3.02 (p<0.03) and OR 8.71, 95% CI 1.24-61.17 (p=0.03)).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up. Copyright ©ERS 2015.
Kirk, Shelley; Armstrong, Sarah; King, Eileen; Trapp, Christine; Grow, Mollie; Tucker, Jared; Joseph, Madeline; Liu, Lenna; Weedn, Ashley; Sweeney, Brooke; Fox, Claudia; Fathima, Samreen; Williams, Ronald; Kim, Roy; Stratbucker, William
Prospective patient registries have been successfully utilized in several disease states with a goal of improving treatment approaches through multi-institutional collaboration. The prevalence of youth with severe obesity is at a historic high in the United States, yet evidence to guide effective weight management is limited. The Pediatric Obesity Weight Evaluation Registry (POWER) was established in 2013 to identify and promote effective intervention strategies for pediatric obesity. Sites in POWER provide multicomponent pediatric weight management (PWM) care for youth with obesity and collect a defined set of demographic and clinical parameters, which they regularly submit to the POWER Data Coordinating Center. A program profile survey was completed by sites to describe characteristics of the respective PWM programs. From January 2014 through December 2015, 26 US sites were enrolled in POWER and had submitted data on 3643 youth with obesity. Ninety-five percent were 6-18 years of age, 54% female, 32% nonwhite, 32% Hispanic, and 59% publicly insured. Over two-thirds had severe obesity. All sites included a medical provider and used weight status in their referral criteria. Other program characteristics varied widely between sites. POWER is an established national registry representing a diverse sample of youth with obesity participating in multicomponent PWM programs across the United States. Using high-quality data collection and a collaborative research infrastructure, POWER aims to contribute to the development of evidence-based guidelines for multicomponent PWM programs.
Full Text Available Gut microbiota (GM plays several crucial roles in host physiology and influences several relevant functions. In more than one respect, it can be said that you “feed your microbiota and are fed by it.” GM diversity is affected by diet and influences metabolic and immune functions of the host’s physiology. Consequently, an imbalance of GM, or dysbiosis, may be the cause or at least may lead to the progression of various pathologies such as infectious diseases, gastrointestinal cancers, inflammatory bowel disease, and even obesity and diabetes. Therefore, GM is an appropriate target for nutritional interventions to improve health. For this reason, phytochemicals that can influence GM have recently been studied as adjuvants for the treatment of obesity and inflammatory diseases. Phytochemicals include prebiotics and probiotics, as well as several chemical compounds such as polyphenols and derivatives, carotenoids, and thiosulfates. The largest group of these comprises polyphenols, which can be subclassified into four main groups: flavonoids (including eight subgroups, phenolic acids (such as curcumin, stilbenoids (such as resveratrol, and lignans. Consequently, in this review, we will present, organize, and discuss the most recent evidence indicating a relationship between the effects of different phytochemicals on GM that affect obesity and/or inflammation, focusing on the effect of approximately 40 different phytochemical compounds that have been chemically identified and that constitute some natural reservoir, such as potential prophylactics, as candidates for the treatment of obesity and inflammatory diseases.
Full Text Available Jin Hee Shin,1 Kishore M Gadde2 1Department of Community and Family Medicine, Duke University Medical Center, 2Obesity Clinical Trials Program, Duke University Medical Center, Durham, NC, USA Abstract: Qsymia™ (Vivus Inc, Mountain View, CA, USA, a combination of phentermine and delayed-release topiramate, has been available in the US since September 2012 for the treatment of obesity. Phentermine is an anorexigenic agent, which is approved for the short-term treatment of obesity, while topiramate is approved for nonweight loss indications – seizure disorders and migraine prophylaxis. The amount of weight loss achieved with combination therapy is of a greater magnitude than what could be achieved with either agent alone. Adverse events that occur with the combination therapy are in line with the known side effect profiles of the constituent drugs; teratogenicity, a slight increase in heart rate, psychiatric and cognitive adverse effects, and metabolic acidosis are concerns. Keywords: Qsymia, combination drug, antiobesity drugs, phentermine, topiramate, obesity, weight loss
Rita de Cássia Garcia Pereira
Full Text Available Objective: the objective was to compare the efficacy of individual treatment (consulting and group treatment combined with individualized care, in childhood and juvenile obesity situations. Methodology: The study was carried out in 2 different places: in the Nutrition Clinic of the Integrated Health Clinic of UNIARA and in another clinical school. In both places there was a treatment with individual consultations, however, in the Integrated Health Clinic of UNIARA treatment was also done in group care. The target individuals were composed of children and adolescents of both sexes who participated in the consultations, however, only patients who were above the 85th percentile for BMI, according to the international reference population (NCHS, 2000, were included in the sample which was composed of 58 individuals. The choice of clinical records occurred at random in both places. Results: the most effective program in the positive change in dietary habits was group together with individual treatment, where 20 patients (68.96% showed some change in eating behavior. In individual treatment, 11 patients (37.93% showed some change in dietary habits existing before treatment. There was a reduction in the rate of obesity of 24% for patients in groups, however, both types of treatment were favorable to changes in dietary habits and weight reduction. The findings showed that the strategy of individualized care together with group care is an alternative for the treatment of overweight.
Tóthová, Valérie; Bártlová, Sylva; Šedová, Lenka; Olišarová, Věra; Prokešová, Radka; Adámkova, Věra; Mauritzová, Ilona; Trešlová, Marie; Chloubová, Ivana; Mikšová, Zdeňka
The aim of this research into 'self-management' was to determine to what extent respondents were aware of their status as overweight or obese. For respondents who indicated that they were overweight or obese, the goal was to determine whether they tried to lose weight, what steps they took to control their, and what specific methods they used. Information was collected using semi-structured interviews from May 31, 2014, to January 30, 2015. Data processing was performed using statistical analysis of the social data SASDM 01/04/10 software. The total study group consisted of 600 respondents, including 302 from the Roma minority, and 298 from the non-Roma majority population (control group). Respondents were selected specifically from South Bohemia Region of the Czech Republic. The sample from the Roma minority was constructed using the snowball method (Snowball Sampling). The control sample of non-Roma was selected through quota sampling. The results indicate that the respondents from both the Roma minority and the non-Roma control group generally recognized when they were overweight or obese, or they were aware of it to a much lesser extent than objective indicators revealed. More than two thirds of the respondents who admitted they were overweight or obese (N = 143) reported that they had suffered from overweight or obesity since they were young adults. Significantly more members of the majority population had tried to lose weight using self-management, whereas the level of effort was significantly less among members of the Roma minority (P = 0). Nevertheless, Roma respondents significantly more often reported (P < 0.01) that they had agreed on a specific weight loss plan with a doctor. The results of our research show that in the context of prevention, it is important to promote self-managed skills, habits and other characteristics that can play an important role in the prevention and treatment of obesity and overweight.
Full Text Available Abstract Background Childhood obesity is a serious health concern affecting over 155 million children in developed countries worldwide. Childhood obesity is associated with significantly increased risk for development of type 2 diabetes, cardiovascular disease and psychosocial functioning problems (i.e., depression and decreased quality of life. The two major strategies for management of obesity and associated metabolic abnormalities are lifestyle modification and pharmacologic therapy. This paper will provide the background rationale and methods of the REACH childhood obesity treatment program. Methods/design The REACH study is a 2-year multidisciplinary, family-based, childhood obesity treatment program. Seventy-two obese adolescents (aged 10-16 years and their parents are being recruited to participate in this randomized placebo controlled trial. Participants are randomized to receive either metformin or placebo, and are then randomized to a moderate or a vigorous intensity supervised exercise program for the first 12-weeks. After the 12-week exercise program, participants engage in weekly exercise sessions with an exercise facilitator at a local community center. Participants engage in treatment sessions with a dietitian and social worker monthly for the first year, and then every three months for the second year. The primary outcome measure is change in body mass index and the secondary outcome measures are changes in body composition, risk factors for type 2 diabetes and cardiovascular disease, changes in diet, physical activity, and psychosocial well-being (e.g., quality of life. It is hypothesized that participants who take metformin and engage in vigorous intensity exercise will show the greatest improvements in body mass index. In addition, it is hypothesized that participants who adhere to the REACH program will show improvements in body composition, physical activity, diet, psychosocial functioning and risk factor profiles for type 2
Norman, Gregory J.; Crow, Scott J.; Rock, Cheryl L.; Boutelle, Kerri N.
Abstract Background: Identifying factors associated with effective treatment for childhood obesity is important to improving weight loss outcomes. The current study investigated whether child or parent motivation throughout the course of treatment predicted reductions in BMI. Methods: Fifty 8- to 12-year-old children with overweight and obesity (BMI percentiles 85–98%) and their parents participated in a guided self-help weight loss program, which included 12 brief sessions across 5 months. Parents and interventionists reported on child and parent motivation level at each session. Multilevel slopes-as-outcome models were used to examine growth trajectories for both child and parent BMI across sessions. Results: Greater interventionist-rated child motivation predicted greater reductions in child BMI; parent motivation did not. However, interventionist-rated parent motivation predicted greater reductions in parent BMI, and its impact on BMI became more pronounced over the course of treatment, such that sustained motivation was more important than initial motivation. Children who were older, Latino, or who had lower initial BMIs had slower reductions in BMI. Conclusions: This study suggests that motivation may be an important predictor of reduced BMI in child obesity treatment, with sustained motivation being more important than initial motivation. In particular, interventionist-rated, but not parent-rated, motivation is a robust predictor of child and parent BMI outcomes. Future research may evaluate whether motivational interventions can enhance outcome, with particular attention to improving outcomes for Latino children. PMID:25181608
Yoo, Taehwan; Starr, Jean E; Go, Michael R; Vaccaro, Patrick S; Satiani, Bhagwan; Haurani, Mounir J
Ultrasound-guided thrombin injection (UGTI) is a well-established practice for the treatment of femoral artery pseudoaneurysm. This procedure is highly successful but dependent on appropriate pseudoaneurysm anatomy and adequate ultrasound visualization. Morbid obesity can present a significant technical challenge due to increased groin adiposity, resulting in poor visualization of critical structures needed to safely perform the procedure. We aim to evaluate the safety and efficacy of UGTI to treat femoral artery pseudoaneurysm in the morbidly obese. This is a retrospective cohort study in which all patients who underwent UGTI at The Ohio State University Ross Heart Hospital from 2009 to 2014 were analyzed for patient characteristics and stratified by body mass index (BMI). Patients with BMI ≥ 35 were considered morbidly obese and were compared to patients with a BMI injection. There were 41 nonmorbidly obese and 13 morbidly obese patients. Mean age was 64.5 years. The cohort was 44.4% male. There were 6 failures, of which 1 underwent successful repeat injection and 5 underwent open surgical repair. There was no statistically significant difference in failure between nonmorbidly obese and morbidly obese patients (9.8% vs 15.4%, P = .45). There were no embolic/thrombotic complications. Ultrasound-guided thrombin injection is a safe and effective therapy in the morbidly obese for the treatment of femoral artery pseudoaneurysm. In the hands of experienced sonographers and surgeons with adequate visualization of the pseudoaneurysm sac, UGTI should remain a standard therapy in the morbidly obese.
Portie Felix, Antonio; Navarro Sanchez, Gustavo; Hernandez Solar, Abel; Grass Baldoquin, Jorge Alberto; Domloge Fernandez, Joana, E-mail: firstname.lastname@example.org [Hospital Universitario General Calixto Garcia, La Havana (Cuba)
The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)
Full Text Available Background: Considering the large economic consequences of severe childhood obesity for the society, we aimed to conduct an economic evaluation comparing two intensive 1-year lifestyle treatments with varying inpatient periods for severely obese children and adolescents with regard to standard deviation score BMI (SDS-BMI and quality-adjusted life years (QALYs. Methods: An economic evaluation from a societal perspective accompanying a randomized controlled trial with a 24-month follow-up. 80 participants (8-19 years with severe obesity were included. Participants received an intensive 1-year lifestyle treatment with an inpatient period of 2 months (short-stay group or 6 months (long-stay group. Data were collected at baseline, 6, 12 ,and 24 months and included SDS-BMI and QALYs. Results: SDS-BMI decreased in the first 6 months of treatment, stabilized in the second 6 months, and increased during the 2nd year in both groups. After 24 months, SDS-BMI was similar in both groups, but remained lower than baseline values (mean difference -0.24, 95% CI -0.42; -0.06. There was no difference in QALYs between the groups after 24 months. For SDS-BMI, the probability of the short-stay treatment being cost-effective in comparison with the long-stay treatment was 1 at a willingness-to-pay of 0 EUR/unit of effect, which slowly decreased to 0.54 for larger willingness-to-pay values. Conclusions: Based on the results of this study, the short-stay treatment is considered to be more cost-effective from the societal perspective in comparison with the long-stay treatment. Future research should provide insight in whether the short-stay treatment is cost-effective in comparison with usual care.
Full Text Available BACKGROUND: Gut microbiota play a major role in digestion and energy conversion of nutrients. Antibiotics, such as avoparcin (a vancomycin analogue, and probiotics, such as Lactobacillus species, have been used to increase weight in farm animals. We tested the effect of antibiotics given for infective endocarditis (IE on weight gain (WG. METHODOLOGY/PRINCIPAL FINDINGS: Forty-eight adults with a definite diagnosis of bacterial IE (antibiotic group were compared with forty-eight age-matched controls without IE. Their body mass index (BMI was collected at one month before the first symptoms and one year after hospital discharge. The BMI increased significantly and strongly in vancomycin-plus-gentamycin-treated patients (mean [+/-SE] kg/m(2, +2.3 [0.9], p = 0.03, but not in controls or in patients treated with other antibiotics. Seventeen patients had a BMI increase of >or=10%, and five of the antibiotic group developed obesity. The treatment by vancomycin-plus-gentamycin was an independent predictor of BMI increase of >or=10% (adjusted OR, 6.7; 95% CI, 1.37-33.0; p = 0.02, but not treatment with other antibiotics. Weight gain was particularly high in male patients older than 65 who did not undergo cardiac surgery. Indeed, all three vancomycin-treated patients with these characteristics developed obesity. CONCLUSIONS/SIGNIFICANCE: A major and significant weight gain can occur after a six-week intravenous treatment by vancomycin plus gentamycin for IE with a risk of obesity, especially in males older than 65 who have not undergone surgery. We speculate on the role of the gut colonization by Lactobacillus sp, a microorganism intrinsically resistant to vancomycin, used as a growth promoter in animals, and found at a high concentration in the feces of obese patients. Thus, nutritional programs and weight follow-up should be utilized in patients under such treatment.
Norlelawati, A T; Kartini, A; Ramli, M; Norsidah, K; Wan Azizi, W S; Tariq, A R
OBJECTIVES. Obesity is an issue of concern among patients with schizophrenia as it is a co-morbid condition that is closely related to metabolic syndrome. The present study assessed the correlation of body mass index with antipsychotic use among multiracial schizophrenia outpatients. The study also compared the patients' body mass index with Malaysian Adult Nutrition Survey (MANS) data. METHODS. A total of 216 participants were recruited into a cross-sectional study conducted over 5 months, from December 2010 to April 2011. Body weight and height were measured using the standard methods. Demographic data and treatment variables were gathered through interview or review of the medical records. RESULTS. There were differences in mean body mass index between men and women (p = 0.02) and between Malay, Chinese and Indian races (p = 0.04). Stratified by sex, age, and race, the body mass index distributions of the patients were significantly different to those of the reference MANS population. The prevalence of obesity among patients was more than 2-fold greater than among the reference population in all variables. Although body mass index distribution was related to antipsychotic drugs (χ(2) = 33.42; p = 0.04), obesity could not be attributed to any specific drug. CONCLUSION. The prevalence of obesity among patients with schizophrenia was significantly greater than that in the healthy Malaysian population, and affects the 3 main races in Malaysia.
Paulo N. Vieira
Full Text Available This study examined the association of autonomy-related variables, including exercise motivation, with psychological well-being and quality of life, during obesity treatment. Middle-aged overweight/obese women (n=239 participated in a 1-year behavioral program and completed questionnaires measuring need support, general self-determination, and exercise and treatment motivation. General and obesity-specific health-related quality of life (HRQOL, self-esteem, depression, and anxiety were also assessed. Results showed positive correlations of self-determination and perceived need support with HRQOL and self-esteem, and negative associations with depression and anxiety (P<.001. Treatment autonomous motivation correlated positively with physical (P=.004 and weight-related HRQOL (P<.001, and negatively with depression (P=.025 and anxiety (P=.001. Exercise autonomous motivation was positively correlated with physical HRQOL (P<.001, mental HRQOL (P=.003, weight-related HRQOL (P<.001, and self-esteem (P=.003, and negatively with anxiety (P=.016. Findings confirm that self-determination theory's predictions apply to this population and setting, showing that self-determination, perceived need support, and autonomous self-regulation positively predict HRQOL and psychological well-being.
Deurenberg, P; Hautvast, J G
The prevalence and incidence of overweight and obesity has been studied in a young adult population aged 19-35 years. Special attention was given to the relation with psychosociological variables and life-style. The prevalence of overweight and obesity was also studied in a representative population for The Netherlands, in which population also the relation with self-reported illness and subjective health was studied. In the patient population of four general practices the relation of overweight and obesity with disease was investigated in a retrospective design. Also the influence of the body fat distribution was studied. The prevalence of overweight (BMI greater than 25 kg/m2) in the Dutch adult population was 34% in men and 24% in women. The prevalence of obesity (BMI greater than 30 kg/m2) was 4 and 6% in men and women, respectively. The prevalence of overweight and obesity was negatively related with social class and increased with age. Also, life-style variables such as coffee consumption, alcohol consumption, smoking and amount of hours sleep (CASS behavior), physical activity during leisure time, slimming behavior and health-conscious behavior were correlated with the prevalence of overweight. Life events caused an increase in body weight, but in women (not in men) this gain was suppressed by following slimming periods. Thus, emotional eating seems to be an important factor in the etiology of obesity. The results of our studies on the relation of overweight and obesity with morbidity aspects show a clear relation of some diseases and subjective health with overweight, especially in men and women with an abdominal fat distribution. From the results of this study starting points for the prevention and treatment of obesity are proposed.
Andersen, Ida Gillberg; Holm, Jens-Christian; Homøe, Preben
OBJECTIVES: To systematically review and discuss the outcome of treating obstructive sleep apnea (OSA) in obese children and adolescents. METHODS: In February 2016 Pub Med was searched using a predetermined string to retrieve all relevant articles. The search identified 518 publications. In total...... 10 and 38%. Positive airway pressure was effective for treating OSA, but the mean nightly use was needed...
van der Baan-Slootweg, Olga; Benninga, Marc A; Beelen, Anita; van der Palen, Job; Tamminga-Smeulders, Christine; Tijssen, Jan G P; van Aalderen, Wim M C
Severe childhood obesity has become a major health problem, and effective, evidence-based interventions are needed. The relative effectiveness of inpatient compared with ambulatory treatment remains unknown. To determine whether an inpatient treatment program is more effective than an ambulatory treatment program at achieving a sustained weight loss in children and adolescents with severe obesity. We conducted a randomized clinical trial with a 2-year follow-up at a tertiary referral center for pediatric obesity in the Netherlands. We recruited 90 children and adolescents aged 8 to 18 years with severe obesity (body mass index [BMI] z score, ≥3.0 or >2.3 with obesity-related health problems). Patients were randomly assigned to an inpatient (6 months of hospitalization on working days) or an ambulatory (12 days of hospital visits at increasing intervals during a 6-month period) treatment program. Both treatment programs involved an intensive, family-based, lifestyle intervention, including exercise, nutritional education, and behavior modification for the patients and their caregiver(s). Change in BMI z score. Secondary outcomes included fasting insulin, fasting plasma glucose, 2-hour plasma glucose, and lipid levels, insulin sensitivity, liver function test results, waist circumference, blood pressure, body composition, and aerobic fitness (peak oxygen consumption, Vo₂). Outcomes were analyzed by intention to treat. Immediately after treatment, reductions in the BMI z score were significantly larger for the inpatient than the ambulatory groups (mean [SE] difference, -0.26 [0.12; 95% CI, -0.59 to -0.01]; P = .04). Change from baseline for the BMI z score in the inpatient group was -18.0% (P = .001) immediately after treatment, -8.5% (P = .008) at 18 months, and -6.3% (P = .38) at 30 months; in the ambulatory group, changes from baseline were -10.5% (P = .001), -6.2% (P = .39), and -1.5% (P > .99), respectively. The favorable outcomes
García-Díaz, Juan José; Ferrer-Márquez, Manuel; Moreno-Serrano, Almudena; Barreto-Rios, Rogelio; Alarcón-Rodríguez, Raquel; Ferrer-Ayza, Manuel
Laparoscopic sleeve gastrectomy is a surgical procedure for the treatment of morbid obesity. However, there are still controversies regarding its efficiency in terms of weight reduction and incidence of complications. In this prospective study, the experience is presented of a referral centre for the treatment of morbid obesity with laparoscopic sleeve gastrectomy. A prospective study on 73 patients subjected to laparoscopic sleeve gastrectomy from February 2009 to September 2013. Patients were followed-up for a period of 12 months, evaluating the development of complications, reduction of gastric volume, and the weight loss associated with the surgery, as well as their impact on the improvement of comorbidities present at beginning of the study. There was a statistically a significantly reduction between the preoperative body mass index (BMI) and the BMI at 12 months after laparoscopic sleeve gastrectomy (p < 0.001), despite there being an increase in the gastric volume during follow-up, measured at one month and 12 months after surgery (p < 0.001). Five patients (6.85%) had complications, with none of them serious and with no deaths in the whole series. Laparoscopic sleeve gastrectomy is a safe and effective technique for the treatment of morbid obesity. Its use is associated with a significant reduction in the presence of comorbidities associated with obesity. Multicentre studies with a longer period of monitoring are required to confirm the efficacy and safety of this surgical technique. Copyright © 2015 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.
Al-Tahami, Belqes Abdullah Mohammad; Al-Safi Ismail, Ab Aziz; Sanip, Zulkefli; Yusoff, Zurkurnai; Shihabudin, Tg Muzaffar Tm; Singh, Taran Singh Pall; Rasool, Aida Hanum Ghulam
Obesity is associated with numerous health problems, particularly metabolic and cardiovascular complications. This study aimed to assess the effects that, nine months of pharmacological intervention with orlistat or sibutramine, on obese Malaysians' body weight and compositions, metabolic profiles and inflammatory marker. Seventy-six obese subjects were randomly placed into two groups. The first group received three daily 120 mg dosages of orlistat for nine months (n=39), and the second group received a once daily 10 or 15 mg dosage of sibutramine for nine months (n=37). Baseline measurements for weight, body mass index (BMI), waist circumference (WC), body fat percentage (BF), visceral fat (VF), adiponectin, fasting plasma glucose (FPG), fasting insulin, pancreatic B cell secretory capacity (HOMA%B), insulin sensitivity (HOMA%S), insulin resistance (HOMA-IR) and serum high sensitivity C-reactive protein (hs-CRP) were performed and repeated during the sixth and ninth months of treatment. Twenty-four subjects completed the trial in both groups. For both groups, weight, BMI, WC, BF, VF, HOMA-IR and hs-CRP were significantly lower at the end of the nine month intervention. However, there were no significant differences between the two groups for these parameters with nine months treatment. There was a significant decrease in FPG in orlistat group; while fasting insulin and HOMA%B reduced in sibutramine group. For both groups, there were also significant increases in adiponectin levels and HOMA%S at the end of the nine month intervention. Nine months of treatment with orlistat and sibutramine not only reduced weight but also significantly improved BMI, WC, BF, VF, FPG, adiponectin, fasting insulin, HOMA%B, HOMA%S, HOMA-IR and hs-CRP. These improvements could prove useful in the reduction of metabolic and cardiovascular risks in obese subjects.
Vigerust, Natalya Filipchuk; Bohov, Pavol; Bjørndal, Bodil
To determine fasting and insulin-stimulated levels of carnitine precursors, total and free carnitine, and acylcarnitines, and evaluate the impact of pioglitazone treatment in obese patients with polycystic ovary syndrome (PCOS).......To determine fasting and insulin-stimulated levels of carnitine precursors, total and free carnitine, and acylcarnitines, and evaluate the impact of pioglitazone treatment in obese patients with polycystic ovary syndrome (PCOS)....
Ewald, H.; Kirby, J.; Rees, K.; Robertson, W.
Background An effective and cost-effective treatment is required for the treatment of childhood obesity. Comparing parent-only interventions with interventions including the child may help determine this. Methods A systematic review of published and ongoing studies until 2013, using electronic database and manual searches. Inclusion criteria: randomized controlled trials, overweight/obese children aged 5-12 years, parent-only intervention compared with an intervention that included the child,...
Alonso-Álvarez, María Luz; Terán-Santos, Joaquin; Gonzalez Martinez, Mónica; Cordero-Guevara, José Aurelio; Jurado-Luque, María José; Corral-Peñafiel, Jaime; Duran-Cantolla, Joaquin; Ordax Carbajo, Estrella; MasaJimenez, Fernando; Kheirandish-Gozal, Leila; Gozal, David
Obesity and obstructive sleep apnea in children have been associated with metabolic morbidities. The present study aimed to evaluate the presence of metabolic alterations among obese children recruited from the community, with and without obstructive sleep apnea syndrome (OSAS), and the impact of treatment of OSAS on metabolic profiles. A cross-sectional, prospective, multicenter study of Spanish children aged 3-14 years with a body mass index (BMI) ≥95th percentile for age and sex were randomly selected in the first phase. Four groups emerged for follow-up: (1) no treatment; (2) dietary intervention; (3) surgical treatment of OSA; and (4) continuous positive airway pressure (CPAP) treatment of OSA. Fasting blood tests were performed at baseline (T0) and approximately one year after the intervention (T1). A total of 113 obese children with a mean age of 11.3 ± 2.9 years completed T0 and T1 assessments. Their mean BMI z-score at T1 was 1.34 ± 0.59, and mean Respiratory Disturbance Index was 8.6 ± 13.0 at T0 and 3.3 ± 4.0/hour total sleep time at T1. Only glucose fasting levels differed among metabolic parameters in obese children with OSAS and without OSAS at baseline (T0) (p = 0.018). There were statistically significant differences between surgically treated OSAS (p = 0.002), and CPAP-treated OSAS (p = 0.024) versus the non-OSAS group in the glucose levels between baseline (T0) and follow-up (T1) after controlling for age and change in BMI. Significant univariate associations between BMI and C-reactive protein, insulin, and homeostasis model assessment of insulin resistance emerged at both T0 and T1. Concurrent obesity and OSAS could promote metabolic and inflammatory alterations, and the latter appeared to be sensitive to OSAS treatment outcomes. ClinicalTrials.gov Identifier: NCT01322763. Copyright © 2017 Elsevier B.V. All rights reserved.
More than one-third of U.S. adults over the age of 20 years are classified as obese and nearly two-thirds are overweight or obese. The prevalence of obesity among U.S. children and adolescents has almost tripled since 1980, with 17% of all youth and children now considered obese. Nine million children aged 6-19 years are overweight, making obesity the largest health care threat facing today's children. Historically, the arsenal against obesity has been primarily focused on interventions that increase physical activity and decrease caloric intake. American weight loss strategies that incorporate dietary modifications and exercise have proven effective in achieving weight loss, but most of the weight is regained over time. Mindfulness based interventions, combined with other traditional weight loss strategies, have the potential to offer a long-term, holistic approach to wellness. However, research reports examining the complementary addition of mindfulness based approaches in the treatment obesity and eating disorders are relatively scarce in the empirical literature. This paper describes what is currently known about the role of mindfulness based interventions when used alone, or in combination with, other traditional approaches in the treatment of obesity and eating disorders. Copyright © 2013 Elsevier Ltd. All rights reserved.
Riccardo Dalle Grave
Full Text Available Objective: The analysis of the relation between weight loss goals and attrition in the treatment of obesity has produced conflicting results. The aim of the present study was to investigate the role of weight loss goals on attrition in a cohort of obese women seeking treatment at 8 Italian medical centres. Methods: 634 women with obesity, consecutively enrolled in weight loss programmes, were included in the study. Weight loss goals were evaluated with the Goals and Relative Weights Questionnaire (GRWQ, reporting a sequence of unrealistic (‘dream' and ‘happy' and more realistic (‘acceptable' and ‘disappointing' weight loss goals. Attrition was assessed at 12 months on the basis of patients' medical records. Results: At 12 months, 205/634 patients (32.3% had interrupted their programme and were lost to follow-up. After adjustment for age, baseline weight, education and employment status, attrition was significantly associated with higher percent acceptable and disappointing weight loss targets, not with dream and happy weight loss. Conclusion: In ‘real world' clinical settings, only realistic expectations might favour attrition whenever too challenging, whereas unrealistic weight loss goals have no effect. Future studies should assess the effect of interventions aimed at coping with too challenging weight goals on attrition.
Sutin, Angelina R; Boutelle, Kerri; Czajkowski, Susan M; Epel, Elissa S; Green, Paige A; Hunter, Christine M; Rice, Elise L; Williams, David M; Young-Hyman, Deborah; Rothman, Alexander J
Within the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, the psychosocial domain addresses how psychosocial processes underlie the influence of obesity treatment strategies on weight loss and weight maintenance. The subgroup for the psychosocial domain identified an initial list of high-priority constructs and measures that ranged from relatively stable characteristics about the person (cognitive function, personality) to dynamic characteristics that may change over time (motivation, affect). This paper describes (a) how the psychosocial domain fits into the broader model of weight loss and weight maintenance as conceptualized by ADOPT; (b) the guiding principles used to select constructs and measures for recommendation; (c) the high-priority constructs recommended for inclusion; (d) domain-specific issues for advancing the science; and (e) recommendations for future research. The inclusion of similar measures across trials will help to better identify how psychosocial factors mediate and moderate the weight loss and weight maintenance process, facilitate research into dynamic interactions with factors in the other ADOPT domains, and ultimately improve the design and delivery of effective interventions. © 2018 The Obesity Society.
María Matilde Socarrás Suárez
Full Text Available La obesidad es un importante problema de salud en nuestros días, por el riesgo aumentado de morbilidad y mortalidad, sobre todo por las enfermedades cardiovasculares que provoca. El objetivo de este trabajo fue actualizar los conocimientos acerca del tratamiento no farmacológico y la prevención de la enfermedad. Se expuso que en el 95 % de los casos la obesidad es de origen exógeno o nutricional, y en el 5 %, de causa genética o endocrina. En relación con los factores genéticos, las investigaciones plantean las diferentes mutaciones que se acompañan de fenotipos obesos. Se señalaron los diferentes métodos empleados para el diagnóstico de la obesidad, antropométricamente. Se afirmó que en la actualidad es muy utilizado el IMC y la relación cintura/cadera. Se concluyó que el tratamiento de la obesidad supone modificaciones dietéticas, actividad física e intervención conductual y/o psicológica y que la prevención sigue siendo la acción fundamental para evitar su aparición por lo que los esfuerzos de todos los médicos se deben dirigir hacia este problema de salud.Obesity is an important health problem at present due to the increased risk of morbidity and mortality and, mainly, to the cardiovascular diseases resulting from it. The objective of this paper was to bring up to date the knowledge about the nonpharmacological treatment and the prevention of the disease. It was explained that in 95 % of the cases, obesity has an exogenous or nutritional origin, whereas in the other 5 % its cause is genetic or endocrine. In relation to the genetic factors, the investigations state the different mutations that are accompanied by obese phenotypes.The different anthropometric methods used to diagnose obesity were described. It was confirmed that nowadays the BMI and the waist/hip relationship are widely used. It was concluded that the obesity treatment pressuposes diet modifications, physical activity and behavioral and/or psychological
Kalarchian, Melissa A; Levine, Michele D; Marcus, Marsha D
Structured dietary interventions have been associated with improved outcomes in adult weight-control programs, but virtually no research has focused on children. Thus, we conducted an uncontrolled pilot study to determine the potential utility of structured approaches to enhance the dietary component of family-based treatment of severe pediatric obesity (body mass index [BMI] >97th percentile for age and sex). Children aged 8-12 years participated with a parent or guardian. Individualized menu plans were provided (MENU, n =12) alone, or along with meals and snacks for the child (MENU+MEAL, n =6). All families received up to $30/week reimbursement for foods included in the menus. Median BMI change was -1.2 kg/m 2 for MENU ( n =12), and -1.8 kg/m 2 for MENU+MEAL ( n =6). Both approaches were associated with significant reductions in BMI ( p obesity are acceptable to families and warrant further development.
Full Text Available The effect of hyperbaric oxygen treatment (HBOT was examined using MSG mice, which are an animal model of obesity, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease. Nineteen MSG male mice were divided into HBOT treated and control groups at 12 weeks of ages. The HBOT group was treated with hyperbaric oxygen from 12 to 14 weeks (first phase and then from 16 to 18 weeks (second phase. Interestingly, the body weight of the HBOT group was significantly lower (P<0.01 than that of the control group. In contrast, the serum lipid level did not show significant changes between the two groups. As for the effects of increasing oxidative stress, the liver histology of the HBOT group showed severer cellular damage and aberrant TNF-α expression. HBOT has the advantage of improving obesity in patients with metabolic syndrome, but the fault of causing organ damage by increasing oxidative stress.
Alison Sally Poulton
Full Text Available Background and aimsThere is a clear need for a new approach to the treatment of obesity which is inexpensive and is effective for establishing lifestyle change. We conducted a pilot study to evaluate whether dexamphetamine can be used safely, combined with diet and exercise, for treating obesity. Our ultimate aim is to develop a 6 month treatment program for establishing the lifestyle changes necessary for weight control, utilising dexamphetamine for its psychotropic effect on motivation. We viewed the anorexigenic effect as an additional advantage for promoting initial weight loss. Methods Obese adults were treated with dexamphetamine for 6 months (maximum of 30mg twice daily, diet and exercise. Weight, electrocardiogram, echocardiogram and blood pressure were monitored. ResultsTwelve out of 14 completed 6 months treatment. Weight loss by intention to treat was 10.6kg (95%CI 5.8-15.5, p<0.001. The mean weight gain in the 6 months after ceasing dexamphetamine was 4.5kg (95%CI 1.9 to 7.2, p=0.003, leaving a mean weight loss at 12 months from baseline of 7.0kg (95%CI -13.4 to -0.6, p=0.03. All reported favourable increases in energy and alertness. Dose-limiting symptoms were mood changes (2 and insomnia (2. None had drug craving on ceasing dexamphetamine and there were no cardiac complications. Among the 7 women, there was a significant correlation for those who lost most weight on treatment to have the least regain in the following 6 months (r=0.88, p=0.009.ConclusionsOur treatment with dexamphetamine, diet and exercise was well tolerated and effective for initial weight loss. Future research will focus on identifying baseline predictive variables associated with long-term weight control. Trial registration: ACTRN12612000831886
Tenna Ruest Haarmark Nielsen
Full Text Available The body mass index (BMI standard deviation score (SDS may not adequately reflect changes in fat mass during childhood obesity treatment. This study aimed to investigate associations between BMI SDS, body composition, and fasting plasma lipid concentrations at baseline and during childhood obesity treatment.876 children and adolescents (498 girls with overweight/obesity, median age 11.2 years (range 1.6-21.7, and median BMI SDS 2.8 (range 1.3-5.7 were enrolled in a multidisciplinary outpatient treatment program and followed for a median of 1.8 years (range 0.4-7.4. Height and weight, body composition measured by dual-energy X-ray absorptiometry, and fasting plasma lipid concentrations were assessed at baseline and at follow-up. Lipid concentrations (total cholesterol (TC, low-density lipoprotein (LDL, high-density lipoprotein (HDL, non-HDL, and triglycerides (TG were available in 469 individuals (264 girls. Linear regressions were performed to investigate the associations between BMI SDS, body composition indices, and lipid concentrations.At baseline, BMI SDS was negatively associated with concentrations of HDL (p = 6.7*10-4 and positively with TG (p = 9.7*10-6. Reductions in BMI SDS were associated with reductions in total body fat percentage (p<2*10-16 and percent truncal body fat (p<2*10-16. Furthermore, reductions in BMI SDS were associated with improvements in concentrations of TC, LDL, HDL, non-HDL, LDL/HDL-ratio, and TG (all p <0.0001. Changes in body fat percentage seemed to mediate the changes in plasma concentrations of TC, LDL, and non-HDL, but could not alone explain the changes in HDL, LDL/HDL-ratio or TG. Among 81 individuals with available lipid concentrations, who increased their BMI SDS, 61% improved their body composition, and 80% improved their lipid concentrations.Reductions in the degree of obesity during multidisciplinary childhood obesity treatment are accompanied by improvements in body composition and fasting plasma
Full Text Available Marco D DiBonaventura,1 Henrik Meincke,2 Agathe Le Lay,2 Janine Fournier,2 Erik Bakker,3 Allison Ehrenreich1 1Kantar Health, New York, NY, USA; 2Novo Nordisk, Copenhagen, Denmark; 3Novo Nordisk, Mexico City, Mexico Objective: The goal of this study is to investigate obesity and its concomitant effects including the prevalence of comorbidities, its association with patient-reported outcomes and costs, and weight loss strategies in a sample of Mexican adults. Methods: Mexican adults (N=2,511 were recruited from a combination of Internet panels and street intercepts using a random-stratified sampling framework, with strata defined by age and sex, so that they represent the population. Participants responded to a survey consisting of a range of topics including sociodemographics, health history, health-related quality of life (HRQoL, work productivity, health care resource use, and weight loss. Results: The sample consisted of 50.6% male with a mean age of 40.7 years (SD=14.5; 38.3% were overweight, and 24.4% were obese. Increasing body mass index (BMI was associated with increased rates of type 2 diabetes, prediabetes, and hypertension, poorer HRQoL, and decreased work productivity. Of the total number of respondents, 62.2% reported taking steps to lose weight with 27.6% and 17.1% having used an over-the-counter/herbal product and a prescription medication, respectively. Treatment discontinuation rates were high. Conclusion: Findings indicated that 62% of participants reported, at least, being overweight and that they were experiencing the deleterious effects associated with higher BMI despite the desire to lose weight. Given the rates of obesity, and its impact on humanistic and societal outcomes, improved education, prevention, and management could provide significant benefits. Keywords: obesity, quality of life, costs, treatment patterns, weight loss
Ishøy, Pelle L; Knop, Filip K; Broberg, Brian V
AIMS: Schizophrenia is associated with cardiovascular co-morbidity and a reduced life-expectancy of up to 20 years. Antipsychotics are dopamine D2 receptor antagonists and the standard of medical care in schizophrenia, but the drugs are associated with severe metabolic side effects like obesity...... and diabetes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are registered for treatment of both obesity and type 2 diabetes. We investigated metabolic effects of the GLP-1RA, exenatide once-weekly, in non-diabetic, antipsychotic-treated, obese patients with schizophrenia. MATERIAL AND METHODS......: Antipsychotic-treated, obese, non-diabetic, schizophrenia spectrum patients were randomized to double-blinded adjunctive treatment with once-weekly subcutaneous exenatide (n = 23) or placebo (n = 22) injections for three months. The primary outcome was body weight loss after treatment and repeated measures...
Fonvig, Cilius Esmann; Hamann, Sophie Amalie; Nielsen, Tenna Ruest Haarmark; Johansen, Mia Østergaard; Grønbæk, Helle Nergaard; Mollerup, Pernille Maria; Holm, Jens-Christian
To investigate the effects of a multidisciplinary childhood obesity treatment programme on subjective evaluations of psychosocial well-being and quality of life. This longitudinal observational study included 1291 children, adolescents and young adults, 6-22 years of age, with overweight or obesity. At entry and after 2-82 months of obesity treatment, the patients evaluated the following domains of psychosocial well-being on a visual analogue scale: quality of life, mood, appetite, bullying, motivation for weight loss and body image satisfaction. The degree of overweight was calculated using a body mass index (BMI) standard deviation score (SDS) at each visit. At entry, the mean BMI SDS was 2.81 (range: 1.35-6.65, 95% confidence interval (95% CI): 2.44-3.18). After a median of 14 months of treatment, the median reduction in BMI SDS was 0.29 (95% CI: 0.26-0.31, p bullying and body image satisfaction (p < 0.0001). Larger reductions in BMI SDS were associated with greater improvements in the domains of quality of life (p = 0.001), mood (p = 0.04) and body image satisfaction (p < 0.0001), independent of BMI SDS at entry. However, improvements in psychosocial well-being were also observed in those increasing their BMI SDS (n = 315). In a large group of children and youths, psychosocial well-being improved during a multidisciplinary childhood obesity treatment programme, irrespective of the degree of obesity at treatment entry. Greater reductions in BMI SDS were associated with greater improvements in psychosocial well-being, but even in the group increasing their BMI SDS improvements were observed.
Call, C C; Devlin, M J; Fennoy, I; Zitsman, J L; Walsh, B T; Sysko, R
Limited data are available on the characteristics of adolescents with obesity who seek bariatric surgery. Existing data suggest that adolescent surgery candidates have a higher body mass index (BMI) than comparison adolescents with obesity, but the limited findings regarding psychosocial functioning are mixed. This study aimed to compare BMI and psychosocial functioning among adolescent bariatric surgery candidates, outpatient medical-treatment-seeking adolescents with obesity (receiving lifestyle modification), and adolescents in the normal-weight range. All adolescents completed self-report measures of impulsivity, delay discounting, depression, anxiety, stress, eating pathology, family functioning and quality of life, and had their height and weight measured. Adolescent surgical candidates had higher BMIs than both comparison groups. Surgical candidates did not differ from medical-treatment-seeking adolescents with obesity on any measure of psychosocial functioning, but both groups of adolescents with obesity reported greater anxiety and eating pathology and poorer quality of life than normal-weight adolescents. Quality of life no longer differed across groups after controlling for BMI, suggesting that it is highly related to weight status. Adolescents with obesity may experience greater anxiety, eating pathology, and quality of life impairments than their peers in the normal-weight range regardless of whether they are seeking surgery or outpatient medical treatment. Clinical implications and directions for future research are discussed. © 2017 World Obesity Federation.
Wilfley, Denise E.; Staiano, Amanda E.; Altman, Myra; Lindros, Jeanne; Lima, Angela; Hassink, Sandra G.; Dietz, William H.; Cook, Stephen
Objectives To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e. clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 hours over 6–12 months to improve weight status) and to expand payment for these services. Methods In July 2015, forty-three cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. Results Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multi-disciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g. >25 hours) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. Conclusion Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale-up training to ensure quality of care. PMID:27925451
Alonso-Castro, Angel Josabad; Domínguez, Fabiola; Zapata-Morales, Juan Ramón; Carranza-Álvarez, Candy
Obesity is a worldwide medical concern. New ethnobotanical information regarding the antiobesity effect of medicinal plants has been obtained in the last 30 years in response to socio-demographic changes and high-fat diets became common. This review provides a summary of medicinal plants used in Mexico, Central America and the Caribbean for the empirical treatment of obesity in terms of ethnobotany, toxicity, pharmacology, conservation status, trade and chemistry. Bibliographic investigation was performed by analyzing recognized books, undergraduate and postgraduate theses and peer-reviewed scientific articles, consulting worldwide accepted scientific databases from the last four decades. Medicinal plants used for the treatment of obesity were classified in two categories: (1) plants with pharmacological evidence and (2) plants without pharmacological evidence. A total of 139 plant species, belonging to 61 families, native to Mexico, Central America and the Caribbean that are used for the empirical treatment of obesity were recorded. From these plants, 33 were investigated in scientific studies, and 106 plants lacked scientific investigation. Medicinal plants were experimentally studied in vitro (21 plants) and in vivo (16 plants). A total of 4 compounds isolated from medicinal plants used for the empirical treatment of obesity have been tested in vitro (2 compounds) and in vivo (4 compounds) studies. No clinical trials on obese subjects (BMI>30 kg/m(2)) have been performed using the medicinal plants cited in this review. There are no herbal-based products approved in Mexico for the treatment of obesity. There are a limited number of scientific studies published on medicinal plants from Mexico, Central America and the Caribbean used for the treatment of obesity. This review highlights the need to perform pharmacological, phytochemical, toxicological and ethnobotanical studies with medicinal flora to obtain new antiobesity agents. Copyright © 2015 Elsevier Ireland
Monteiro, Mariana P
Obesity is one of the largest and fastest growing public health problems in the world. Last century social changes have set an obesogenic milieu that calls for micro and macro environment interventions for disease prevention, while treatment is mandatory for individuals already obese. The cornerstone of overweight and obesity treatment is diet and physical exercise. However, many patients find lifestyle modifications difficult to comply and prone to failure in the long-term; therefore many pa...
In this article, I describe the processes through which patients diagnosed with 'morbid obesity' become active subjects through undergoing obesity surgery and an empowerment lifestyle programme in a Dutch obesity clinic. Following work in actor-network theory and material semiotics that complicates the distinction between active and passive subjects, I trace how agency is configured and re-distributed throughout the treatment trajectory. In the clinic's elaborate care assemblage - consisting of dieticians, exercise coaches and psychologists - the person is not only actively involved in his/her own change, the subject of intervention is the self as 'actor': his/her material constitution, inclinations and feelings. The empirical examples reveal that a self becomes capable of self-care only after a costly and laborious conditioning through which patients are completely transformed. In this work, the changed body, implying a new, potentially disruptive reality that patients must learn to cope with, is pivotal to what the patient can do and become. Rather than striving to be disembodied, self-contained liberal subjects that make sensible decisions for their body, patients become empowered through submission and attachment and by arranging support. © 2017 Foundation for the Sociology of Health & Illness.
Kelly, Owen J; Gilman, Jennifer C
Body composition changes occur with aging; bone and muscle mass decrease while fat mass increases. The collective term for these changes is osteosarcopenic obesity. It is known that conventional resistance exercise programs build/maintain lean mass and reduce fat mass. However, unconventional (to Western society/medicine) forms of exercise may be viable for the treatment/prevention of osteosarcopenic obesity. The purpose of this review is to assess relatively unconventional exercises for their efficacy in maintaining/improving bone and muscle mass and reducing fat mass. A literature search for unconventional exercise showed Tai Chi, yoga, Pilates, whole body vibration, electrical stimulation of muscle, and the Alexander Technique were considered alternative/ unconventional. A PubMed and Medline search for human data using combinations and synonyms of osteoporosis, sarcopenia and obesity, and each exercise was then conducted. Tai Chi, yoga, and Pilates, in addition to whole body vibration, electrical stimulation of muscle, and the Alexander Technique are all considered low impact. Tai Chi, yoga, and Pilates not only physically support the body, but also increase balance and quality of life. The devices showed promise in reducing or preventing muscle atrophy in older people that are unable to perform conventional exercises. Any exercise, conventional or otherwise, especially in sedentary older people, at risk of, or diagnosed with osteosarcopenic obesity may be better than none. Exercise prescriptions should suit the patient and the desired outcomes; the patient should not be forced to fit an exercise prescription, so all potential forms of exercise should be considered. Copyright© Bentham Science Publishers; For any queries, please email at email@example.com.
Mollerup, Pernille M; Nielsen, Tenna R H; Bøjsøe, Christine; Kloppenborg, Julie T; Baker, Jennifer L; Holm, Jens-Christian
The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree of obesity. Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS). Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys) completed another PedsQL after a median of 13 months of treatment. Quality of life improved (p quality of life (p ≤ 0.047). However, improvements also occurred in children and adolescents with low socioeconomic status or who increased their BMI SDS (p quality of life occurred in children and adolescents during a community-based overweight and obesity treatment, even in children and adolescents who increased their BMI SDS. Thus, improvements may be due to the treatment itself and not exclusively to reductions in BMI SDS. Clinicaltrials.gov, ID-no.: NCT02013843.
Full Text Available Background. The aim was to study efficiency of pathogenetic therapy and dynamics of anthropometric indexes in obese women of childbearing age having different endocrine pathology before and 6 months later after treatment. Materials and methods. Under an etiologic factor the obese patients were divided into three groups: with polycystic syndrome of ovaries (PCOS (n = 30, hypothalamic obesity (n = 21 and with obesity and primary hypothyroidism (n = 20. All patients were examined using biochemical, hormonal methods of research, magnetic resonance tomography of pituitary. Results. The patients of the first and second groups had significant decrease of body mass index (BMI after 6 months of treatment, while patients of the third group did not attain significant decrease of BMI over 6 months of treatment. In addition, 10 patients of the first group became pregnant (19.5 %. The patients of the first and second groups had significant improvement of indexes as compared to average data of waist circumference and waist — hip ratio against the treatment, while the patients of the third group did not find significant changes of those indexes over 6 months of treatment. Conclusions. The treatment with metformine in obese patients significantly improves clinical indices and declines BMI. Optimization of treatment of obesity in women of reproductive age is based on the individual programs, the choice of which is determined by the values of anthropometric indices, hormonal and metabolic status, features of food behavior and personality-emotional sphere, menstrual and reproductive functioning. Realization of curative measures complex considering the worked out algorithm of individual selection of obesity therapy allows reduce effectively and retain the attained body weight, improves somatic and reproductive health for the women of reproductive age.
Kennett, G A; Clifton, P G
In this review we assess the range of centrally active anorectics that are either in human clinical trials, or are likely to be so in the near future. We describe their weight loss efficacy, mode of action at both pharmacological and behavioural levels, where understood, together with the range of side effects that might be expected in clinical use. We have however evaluated these compounds against the considerably more rigorous criteria that are now being used by the Federal Drugs Agency and European Medicines Agency to decide approvals and market withdrawals. Several trends are evident. Recent advances in the understanding of energy balance control have resulted in the exploitation of a number of new targets, some of which have yielded promising data in clinical trials for weight loss. A second major trend is derived from the hypothesis that improved weight loss efficacy over current therapy is most likely to emerge from treatments targeting multiple mechanisms of energy balance control. This reasoning has led to the development of a number of new treatments for obesity where multiple mechanisms are targeted, either by a single molecule, such as tesofensine, or through drug combinations such as qnexa, contrave, empatic, and pramlintide+metreleptin. Many of these approaches also utilise advances in formulation technology to widen safety margins. Finally, the practicality of peptide therapies for obesity has become better validated in recent studies and this may allow more rapid exploitation of novel targets, rather than awaiting the development of orally available small molecules. We conclude that novel, more efficacious and better tolerated treatments for obesity may become available in the near future. Copyright © 2010 Elsevier Inc. All rights reserved.
Zapico Augusto G
Full Text Available Abstract Background At present, scientific consensus exists on the multifactorial etiopatogenia of obesity. Both professionals and researchers agree that treatment must also have a multifactorial approach, including diet, physical activity, pharmacology and/or surgical treatment. These two last ones should be reserved for those cases of morbid obesities or in case of failure of the previous ones. The aim of the PRONAF study is to determine what type of exercise combined with caloric restriction is the most appropriate to be included in overweigth and obesity intervention programs, and the aim of this paper is to describe the design and the evaluation methods used to carry out the PRONAF study. Methods/design One-hundred nineteen overweight (46 males and 120 obese (61 males subjects aged 18–50 years were randomly assigned to a strength training group, an endurance training group, a combined strength + endurance training group or a diet and physical activity recommendations group. The intervention period was 22 weeks (in all cases 3 times/wk of training for 22 weeks and 2 weeks for pre and post evaluation. All subjects followed a hypocaloric diet (25-30% less energy intake than the daily energy expenditure estimated by accelerometry. 29–34% of the total energy intake came from fat, 14–20% from protein, and 50–55% from carbohydrates. The mayor outcome variables assesed were, biochemical and inflamatory markers, body composition, energy balance, physical fitness, nutritional habits, genetic profile and quality of life. 180 (75.3% subjects finished the study, with a dropout rate of 24.7%. Dropout reasons included: personal reasons 17 (28.8%, low adherence to exercise 3 (5.1%, low adherence to diet 6 (10.2%, job change 6 (10.2%, and lost interest 27 (45.8%. Discussion Feasibility of the study has been proven, with a low dropout rate which corresponds to the estimated sample size. Transfer of knowledge is foreseen as a spin-off, in order
transaminase (AST) levels. Finally, at the histological level KBP treatment reduced hepatic steatosis, ballooning and inflammation, hence resulting in a reduced NAS score in combination with a lowered fibrosis stage. In conclusion, KBPs induce and sustain weight loss, leading to improved metabolic parameters...... including food preference, and these are beyond those observed simply by dietinduced weight loss. Additionally, these peptides are well tolerated when introduced by dose escalation. Finally, KBPs reduce liver steatosis in both obese and NASH rats, and importantly reduced inflammation and fibrosis scores...
Lanoye, Autumn; Gorin, Amy A; LaRose, Jessica Gokee
Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight-related constructs. The aim of this review is to explore young adults' attitudes toward obesity and weight management, with particular attention to those factors that may play a role in the development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults' perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group.
Lanoye, Autumn; Gorin, Amy A.; LaRose, Jessica Gokee
Young adults are underrepresented in standard behavioral weight loss trials, and evidence suggests that they differ from older adults on many weight related constructs. The aim of this review is to explore young adults’ attitudes toward obesity and weight management, with particular attention to those factors that may play a role in development of future treatment efforts. Both intrapersonal and interpersonal considerations unique to young adulthood are assessed; in addition, we examine young adults’ perceptions of specific weight-related behaviors such as dieting, physical activity, and self-weighing. Conclusions are consistent with other findings suggesting that weight management interventions should be adapted and designed specifically for this age group. PMID:26923688
Eg, M; Cortes, Dina; Johansen, A.
Committee in 2015. RESULTS: About 32% of the 19 departments had multi-dis-cip-linary programmes resembling the guideline recommendations. Roughly 37% of the departments offered considerably less comprehensive programmes than proposed by the guidelines, and roughly 32% offered only a general basic...... of departments offered less comprehensive programmes. The final third offered no multidisciplinary treatment programme for the target group. The criteria for referral to the paediatric departments that offered obesity programmes were heterogeneous. FUNDING: Funding for this study was received from Region...
Carciofi Aulus Cavalieri
Full Text Available The success of a weight loss program for pets depends on the owners collaboration. Their compliance is fundamental in establishing the correct food management. The objective of this study was to compare the effectiveness of a weight loss program in two groups of dogs, one maintained under experimental conditions and the other with their owners. The same hypocaloric food was used to feed all animals, the amount being restricted to 60% of the estimated maintenance energy requirement for a 15% reduction of the present body weight of the dog. The animals were followed during 90 days. A standard questionnaire was used to study the owners' perception of obesity and its treatment. The protocol and the diet were found to be effective. The control dogs had an average weight loss of 1.39% per week. Dogs with owners lost on average 0.75% of their body weight per week, a statistically lower result (P<0.05, suggesting that the owners did not follow the treatment closely. The owners were clearly satisfied with the results that were obtained, even with this modest weight loss. The questionnaires were shown to be an important tool in determining the causes of canine obesity, as well as in the follow-up of the treatment.
Nicolas Padilla-Raygoza; Rosalina Diaz-Guerrero; Ma. Laura Ruiz-Paloalto
Introduction: Obesity is a risk factor in chronic diseases, and its frequency among children in Mexico is increasing. Objective: To determine the effect of lifestyle intervention as a treatment for obesity in school-age-children from Celaya, Mexico.Methodology: For this experimental study, four schools were randomly selected. Children and parents participated voluntarily and signed consent forms. Two schools were chosen as the experimental group and the other two formed the control group. Age...
VanBuskirk, Katherine A.; Potenza, Marc N.
Obesity and binge eating disorder are detrimental health conditions that are associated with lower qualities of life. Individuals with obesity often face societal discrimination and frequently experience related medical disorders such as diabetes, hypertension, and hyperlipidemia. Current research suggests neurobiological similarities between obesity, binge eating disorder, and substance dependence. In addition, behavioral similarities link the two conditions; obese and substance dependent in...
Hofstra, J.M.; Loves, S.; Wageningen, B. van; Ruinemans-Koerts, J.; Jansen, I.; Boer, H. de
BACKGROUND: Obesity can be associated with biochemical evidence of isolated hypogonadotropic hypogonadism (IHH) in men. Prevalence and severity of IHH in obese men are not exactly known. OBJECTIVE: To assess the prevalence of IHH in obese men. DESIGN AND SUBJECTS: Cross-sectional study of 160 obese
Delaney, Charlotte B; Eddy, Kamryn T; Hartmann, Andrea S; Becker, Anne E; Murray, Helen B; Thomas, Jennifer J
Pica and rumination disorder (RD)-formerly classified within DSM-IV Feeding and Eating Disorders of Infancy or Early Childhood-are now classified within DSM-5 Feeding and Eating Disorders. Though pica and RD have been studied in select populations (e.g., pregnant women, intellectually disabled persons), their typical features and overall prevalence remain unknown. This study examined the clinical characteristics and frequency of DSM-5 pica and RD among individuals seeking treatment for eating disorders and obesity. We conducted structured interviews with adolescent and young adult females from a residential eating disorder center (N = 149), and adult males and females with overweight or obesity from an outpatient weight-loss clinic (N = 100). Several participants reported ingesting non-nutritive substances (e.g., ice) for weight-control purposes. However, only 1.3% (n = 2; 95% CI: .06% to 5.1%) at the residential eating disorder center and 0% at the weight-loss clinic met DSM-5 criteria for pica, consuming gum and plastic. Although no eating disorder participants were eligible for an RD diagnosis due to DSM-5 trumping rules, 7.4% (n = 11; 95% CI: 4.0% to 12.9%) endorsed rumination behavior under varying degrees of volitional control. At the weight-loss clinic, 2.0% (n = 2; 95% CI: 0.1% to 7.4%) had RD. DSM-5 pica and RD were rare in our sample of individuals seeking treatment for eating disorders and obesity, but related behaviors were more common. The wide range of pica and rumination presentations highlights the challenges of differential diagnosis with other forms of disordered eating. © 2014 Wiley Periodicals, Inc.
Kordzadeh, Ali; Lorenzi, Bruno; Hanif, Muhammad A; Charalabopoulos, Alexandros
Endovascular left gastric artery (LGA) embolisation has gained significant attention in the treatment of obesity/morbid obesity and reduction of ghrelin. The objective of this systematic review is to evaluate the recent literature, strengths, limitations and practical aspects of this new procedure in combination with its physiological and anatomical paradigm. A systematic electronic search of literature from 1966 to June 2017 in Medline, CINHAL, Embase, Scopus and Cochrane library in English language and adult subjects was conducted. This search was conducted in accordance with Preferred Reporting in Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality assessment of the articles was performed, using Oxford critical appraisal skills programme (CASP), and their recommendation for practice was examined through National Institute for health Care Excellence (NICE). Inter-related reliability (Cronbach's Alpha) was assessed between the two independent reviewers. A total of n = 62 individuals were subjected to LGA embolisation. At 1-3 months, 7-11% and, at 12 months, 2% weight reduction was associated with ghrelin concentration reduction of 36% at 6 months. There was Haemoglobin A1c reduction (7.4 to 6.3%) and improved quality of life (SF-36 questionnaire) at 6 months (9.5 points) (range, 3.2-17.2). Despite immediate epigastric pain and mucosal ulceration, no long-term adverse outcome was identified. The overall length of stay was 2-3 days. The outcome of this review (level of evidence 3) suggests LGA embolisation is feasible and effective and perhaps a safe procedure in the treatment of obesity and reduction of ghrelin. However, further trials are highly advocated.
Raynor, Hollie A; Steeves, Elizabeth Anderson; Bassett, David R; Thompson, Dixie L; Gorin, Amy A; Bond, Dale S
increasing LPA. Future research should examine the effect of reducing TV watching during obesity treatment over a longer time frame in a larger sample. Copyright © 2013. Published by Elsevier Ltd.
Full Text Available Chitosan treatment results in significantly lower serum low density lipoprotein (LDL cholesterol concentrations. To assess the working mechanisms of chitosan, we measured serum surrogate markers of cholesterol absorption (campesterol, sitosterol, cholestanol, synthesis (lathosterol, lanosterol, desmosterol, and degradation to bile acids (7α-hydroxy-cholesterol, 27-hydroxy-cholesterol, corrected for cholesterol concentration (R_sterols. Over 12 weeks, 116 obese subjects (Body Mass Index, BMI 31.7, range 28.1–38.9 kg/m2 were studied under chitosan (n = 61 and placebo treatments (n = 55. The participants were briefly educated regarding improvement of nutrition quality and energy expenditure. Daily chitosan intake was 3200 mg. Serum LDL cholesterol concentration decreased significantly more (p = 0.0252 under chitosan (−8.67 ± 18.18 mg/dL, 5.6% than under placebo treatment (−1.00 ± 24.22 mg/dL, 0.9%. This reduction was not associated with the expected greater decreases in markers of cholesterol absorption under chitosan treatment. Also, increases in markers of cholesterol synthesis and bile acid synthesis under chitosan treatment were not any greater than under placebo treatment. In conclusion, a significant selective reduction of serum LDL cholesterol under chitosan treatment is neither associated with a reduction of serum surrogate markers of cholesterol absorption, nor with increases of markers for cholesterol and bile acid synthesis.
Mei R. Fu
Full Text Available Obesity is one of the risk factors for developing lymphedema following breast cancer treatment. We prospectively enrolled 140 women and followed the participants for 12 months after surgery to investigate patterns of obesity and lymph fluid level in the first year of cancer treatment. Electrical bioimpedance devices were used to measure weight, BMI, and percent of body fat as well as lymph fluid level. General instructions were given to the participants on maintaining pre-surgery weight. Among the 140 participants, 136 completed the study with 2.9% attrition. More than 60% of the participants were obese (30.8% or overweight (32.4%, while only two participants were underweight and about 35% had normal weight. This pattern of obesity and overweight was consistent at 4–8 weeks and 12 months post-surgery. At 12 months post-surgery, the majority of the women (72.1% maintained pre-surgery weight and 15.4% had >5% weight loss; 12.5% of the women increase >5% of their weight. Significantly more patients in the obesity group had lymphedema defined by L-Dex ratio >7.1 than those in the normal/underweight and overweight group at pre-surgery and 4–8 weeks post-surgery. There was a trend of more patients in the obesity group had L-Dex ratio >7.1 at 12 months post-surgery. Obesity and overweight remain among women at the time of cancer diagnosis and the patterns of obesity and overweight continue during the first year of treatment. General instructions on having nutrition-balanced and portion-appropriate diet and physical activities daily or weekly can be effective to maintain pre-surgery weight.
Fu, Mei R.; Axelrod, Deborah; Guth, Amber A.; Fletcher, Jason; Qiu, Jeanna M.; Scagliola, Joan; Kleinman, Robin; Ryan, Caitlin E.; Chan, Nicholas; Haber, Judith
Obesity is one of the risk factors for developing lymphedema following breast cancer treatment. We prospectively enrolled 140 women and followed the participants for 12 months after surgery to investigate patterns of obesity and lymph fluid level in the first year of cancer treatment. Electrical bioimpedance devices were used to measure weight, BMI, and percent of body fat as well as lymph fluid level. General instructions were given to the participants on maintaining pre-surgery weight. Among the 140 participants, 136 completed the study with 2.9% attrition. More than 60% of the participants were obese (30.8%) or overweight (32.4%), while only two participants were underweight and about 35% had normal weight. This pattern of obesity and overweight was consistent at 4–8 weeks and 12 months post-surgery. At 12 months post-surgery, the majority of the women (72.1%) maintained pre-surgery weight and 15.4% had >5% weight loss; 12.5% of the women increase >5% of their weight. Significantly more patients in the obesity group had lymphedema defined by L-Dex ratio >7.1 than those in the normal/underweight and overweight group at pre-surgery and 4–8 weeks post-surgery. There was a trend of more patients in the obesity group had L-Dex ratio >7.1 at 12 months post-surgery. Obesity and overweight remain among women at the time of cancer diagnosis and the patterns of obesity and overweight continue during the first year of treatment. General instructions on having nutrition-balanced and portion-appropriate diet and physical activities daily or weekly can be effective to maintain pre-surgery weight. PMID:26404383
Bassaganya-Riera, Josep; Guri, Amir J; Hontecillas, Raquel
The prevalence of obesity and its associated comorbidities has grown to epidemic proportions in the US and worldwide. Thus, developing safe and effective therapeutic approaches against these widespread and debilitating diseases is important and timely. Activation of peroxisome proliferator-activated receptors (PPARs) α, γ, and δ through several classes of pharmaceuticals can prevent or treat a variety of metabolic and inflammatory diseases, including type II diabetes (T2D). Thus, PPARs represent important molecular targets for developing novel and better treatments for a wide range of debilitating and widespread obesity-related diseases and disorders. However, available PPAR γ agonistic drugs such as Avandia have significant adverse side effects, including weight gain, fluid retention, hepatotoxicity, and congestive heart failure. An alternative to synthetic agonists of PPAR γ is the discovery and development of naturally occurring and safer nutraceuticals that may be dual or pan PPAR agonists. The purpose of this paper is to summarize the health effects of three plant-derived PPAR agonists: abscisic acid (ABA), punicic acid (PUA), and catalpic acid (CAA) in the prevention and treatment of chronic inflammatory and metabolic diseases and disorders.
Wright, J. A.; Phillips, B.D.; Watson, B.L.; Newby, P.K.; Norman, G. J.; Adams, W.G.
Objective To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care and delivered using interactive voice technology (IVR) to families from underserved populations. Design and Methods Fifty parent-child dyads (child 9–12 yrs, BMI >95th percentile) were recruited from a pediatric primary care clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidenced-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3 mo follow-up. Results Forty-three dyads completed the study. IVR parents ate 1 cup more fruit than WLC (p 75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods. Conclusion An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations. PMID:23512915
Thanh Nho Do
Full Text Available Intra-gastric balloons (IGB have become an efficient and less invasive method for obesity treatment. The use of traditional IGBs require complex insertion tools and flexible endoscopes to place and remove the balloon inside the patient's stomach, which may cause discomfort and complications to the patient. This paper introduces a new ingestible weight-loss capsule with a magnetically remote-controlled inflatable and deflatable balloon. To inflate the balloon, biocompatible effervescent chemicals are used. As the source of the actuation is provided via external magnetic fields, the magnetic capsule size can be significantly reduced compared to current weight-loss capsules in the literature. In addition, there are no limitations on the power supply. To lose weight, the obese subject needs only to swallow the magnetic capsule with a glass of water. Once the magnetic capsule has reached the patient's stomach, the balloon will be wirelessly inflated to occupy gastric space and give the feeling of satiety. The balloon can be wirelessly deflated at any time to allow the magnetic capsule to travel down the intestine and exit the body via normal peristalsis. The optimal ratio between the acid and base to provide the desired gas volume is experimentally evaluated and presented. A prototype capsule (9.6mm x 27mm is developed and experimentally validated in ex-vivo experiments. The unique ease of delivery and expulsion of the proposed magnetic capsule is slated to make this development a good treatment option for people seeking to lose excess weight.
Saelens, Brian E; Arteaga, S Sonia; Berrigan, David; Ballard, Rachel M; Gorin, Amy A; Powell-Wiley, Tiffany M; Pratt, Charlotte; Reedy, Jill; Zenk, Shannon N
There is growing interest in how environment is related to adults' weight and activity and eating behaviors. However, little is known about whether environmental factors are related to the individual variability seen in adults' intentional weight loss or maintenance outcomes. The environmental domain subgroup of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project sought to identify a parsimonious set of objective and perceived neighborhood and social environment constructs and corresponding measures to include in the assessment of response to adult weight-loss treatment. Starting with the home address, the environmental domain subgroup recommended for inclusion in future weight-loss or maintenance studies constructs and measures related to walkability, perceived land use mix, food outlet accessibility (perceived and objective), perceived food availability, socioeconomics, and crime-related safety (perceived and objective) to characterize the home neighborhood environment. The subgroup also recommended constructs and measures related to social norms (perceived and objective) and perceived support to characterize an individual's social environment. The 12 neighborhood and social environment constructs and corresponding measures provide a succinct and comprehensive set to allow for more systematic examination of the impact of environment on adults' weight loss and maintenance. © 2018 The Obesity Society.
Tsamalaidze, Levan; Elli, Enrique F
Experience with bariatric surgery in patients after orthotopic heart transplantation (OHT) is still limited. We performed a retrospective review of patients who underwent bariatric surgery after OHT from January 1, 2010 to December 31, 2016. Two post-OHT patients with BMI of 37.5 and 36.2 kg/m² underwent laparoscopic robotic-assisted Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, respectively. Quality of life substantially improved for both patients. Bariatric surgery is safe and feasible in OHT patients, despite numerous risk factors. Careful selection of patients is required with proper preoperative management and overall care. Due to the complexity of treatment and perioperative care in this specific population, these operations should be done in high-volume centers with multidisciplinary teams composed of bariatric, cardiac transplant surgeons and critical care physicians. Bariatric surgery can be highly effective for treatment of obesity after OHT.
Masiero, Stefano; Vittadini, Filippo; Ferroni, Costanza; Bosco, Anna; Serra, Roberto; Frigo, Anna Chiara; Frizziero, Antonio
Osteoarthritis (OA) is the most common form of arthritis clinically characterized by joint pain, functional limitation, and reduced quality of life. Several studies have shown a clear link between obesity and higher risk of knee OA. According to the multifactorial OA pathogenesis, the management of this condition requires a multidisciplinary approach. The objective of this study is to evaluate hydrokinesitherapy effects in thermal setting in obese patients with knee OA. Fifty-three patients were assessed for eligibility, of which 33 refused the treatment, while 10 patients dropped out after the enrollment for personal reasons or inability to adhere to the program. Ten patients (8 females, 2 males, mean age of 59.4 years) with obesity (range BMI 30-45 kg/m2) and knee OA (II-III grade of Kellgren-Lawrence scale) treated with hydrokinetic therapy in thermal water (two sessions per week for 8 consecutive weeks) completed the study. Primary outcome measure was pain (VAS). Secondary outcomes were clinical knee evaluation (range of motion—ROM, lower-limb muscle strength), WOMAC, and Lequesne Algofunctional Index. Patellar tendon and peri-articular soft tissue ultrasound evaluation and gait analysis at baseline (T0), at the end of treatment (T1), and at 6 months of follow-up (T2) were performed. Significant decrease on VAS pain during walking on a flat surface and going up/down stairs was reached from baseline at T1 ( p = 0.0039; p = 0.0098) and was maintained at T2 ( p = 0.00954) exclusively for VAS pain during walking on a flat surface. WOMAC score showed a significant reduction between T0 and T1 ( p = 0.0137) and between T0 and T2 ( p = 0.006438), as ROM evaluations. Kinematic path assessment did not show significant results in individual gait steps, except for the space-time variables of the average speed and the values of ground reaction force (GRF) obtained with force platforms. Hydrokinesitherapy in thermal environment in obese patients with knee OA may determine
Madsen, Kenneth Grønkjær; Pottegård, Anton; Hallas, Jesper
Background: In treatment of inflammatory bowel disease (IBD) with anti-tumor necrosis factor-α agents (anti-TNF-α), obesity has been suspected as a cause of accelerated loss of response (LOR). We sought to determine whether overweight IBD patients have accelerated LOR when treated with anti......, and 45 (21%) were obese. Regression analysis produced the following adjusted HRs, compared with the normal weight group: overweight 0.89 (95% confidence interval [CI], 0.51-1.56) and obese 1.31 (95% CI, 0.76-2.24), thus showing no statistically significant association between BMI and time to LOR....... Subgroup analyses produced similar results, except for obese ulcerative colitis patients having an adjusted HR of 2.42 (95% CI, 1.03-5.70). Conclusions: In IBD patients treated with anti-TNF-α agents, we found no overall association between increased BMI and accelerated LOR....
O. L. Andrianova
Full Text Available Background: Obesity is characterized by an increased risk of diabetes mellitus, coronary heart disease, arterial hypertension and reproductive system disorders, which makes it necessary to implement multifactorial correction of metabolic disturbances.Aim: To analyze diet intake structure of patients with obesity, efficacy and safety of sibutramine monotherapy and sibutramine/metformin combination therapy in the formation of adequate nutritional stereotypes and reduction of bodyweight.Materials and methods: Eighty-two obese women aged 18 to 49 years (mean age 29.7±5.7 years were included into this observational study. Inclusion criteria: women aged 18 to 49 years, with waist circumference>80 cm, body mass index (BMI>27 kg/m², triglyceride level>1.7 mmol/L and/or low-density lipoprotein cholesterol>3.8 mmol/L, and/or high-density lipoprotein cholesterol<1.29 mmol/L. Exclusion criteria in this study were presence of severe somatic and endocrine disorders. The control group consisted of 35 healthy women aged 18 to 49 years (mean age 28.7±5.6 years. All patients were recruited within the observational program PrimaVera. Results: Analysis of dietary intake in female obese patients showed an excess of daily energy intake of 650±250 kcal compared to that in subjects with normal BMI and normal waist circumference. Seventy one percent of patients had excessive expectations from treatment duration and desired weight loss. For control of their eating behavior, 52 patients were administered Reduxin® (sibutramine+cellulose microcristallic 10 mg daily. Other 30 patients (24 women with a history of carbohydrate metabolism disturbances during pregnancy and 6 women who had delivered babies with birth weight of above4 kg were administered Reduxin® 10 mg and metformin 500 mg daily, with weekly dose increase by 500 mg to the final dose of 1500 mg daily. The treatment lasted for 24 weeks. Daily caloric intake decreased by 24±4% from baseline (p<0
Full Text Available S Barja-Fernandez,1–3 R Leis,2 FF Casanueva,3,4 LM Seoane1,3 1Grupo Fisiopatología Endocrina, 2Departamento de Pediatría, Universidad de Santiago de Compostela (USC, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS, Complexo Hospitalario Universitario de Santiago (CHUS/SERGAS, Santiago de Compostela, Spain; 3CIBER Fisiopatologia de la Obesidad y Nutrición, Instituto de Salud Carlos III, Santiago de Compostela, Spain; 4Laboratorio de Endocrinología Molecular y Celular, Universidad de Santiago de Compostela (USC Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS, Complexo Hospitalario Universitario de Santiago (CHUS/SERGAS, Santiago de Compostela, Spain Abstract: The prevalence of obesity has increased worldwide, and approximately 25%–35% of the adult population is obese in some countries. The excess of body fat is associated with adverse health consequences. Considering the limited efficacy of diet and exercise in the current obese population and the use of bariatric surgery only for morbid obesity, it appears that drug therapy is the only available method to address the problem on a large scale. Currently, pharmacological obesity treatment options are limited. However, new antiobesity drugs acting through central nervous system pathways or the peripheral adiposity signals and gastrointestinal tract are under clinical development. One of the most promising approaches is the use of peptides that influence the peripheral satiety signals and brain–gut axis such as GLP-1 analogs. However, considering that any antiobesity drug may affect one or several of the systems that control food intake and energy expenditure, it is unlikely that a single pharmacological agent will be effective as a striking obesity treatment. Thus, future strategies to treat obesity will need to be directed at sustainable weight loss to ensure maximal safety. This strategy will probably require the coadministration of medications
Full Text Available Introduction. Increasing energy expenditure through certain exercise is an important component of effective interventions to enhance initial weight loss and prevent weight regain. Objective. The purpose of this study was to determine the effect of a 16-week weight loss exercise programme on morpho-functional changes in female adults and to examine the programme effects on two subpopulations with different levels of obesity. Methods. Fifty-six middle-aged women were divided into 2 groups according to their body mass index (BMI: 25-29.9 kg/m2 - overweight (OW and ≥30 kg/m2 - obese (OB. The exercise protocol included a walking technique based on hip rotation at horizontal plane at speeds close to the preferred transition speed (PTS. At the initiation of the study and after 16 weeks of the programme, anthropometric, morphological and cardiovascular parameters of all subjects were assessed. The main effects of Group (OW and OB and Time and the interaction effect of Group by Time were tested by time repeated measures General Linear Model (mixed between-within subjects ANOVA. Results. Mean weight loss during the programme was 10.3 kg and 20.1 kg in OW and OB, respectively. The average fat mass (FM loss was 9.4 kg in OW and 16.9 kg in OB. The Mixed ANOVA revealed a significant Group by Time interaction effects for waist circumference, body weight, body water, fat free mass, FM, %FM and BMI (p<0.05. Conclusion. The applied exercise protocol has proved as beneficial in the treatment of obesity, since it resulted in a significant weight loss and body composition changes. The reduction in body weight was achieved mainly on account of the loss of fat mass.
Ostrowska, Lucyna; Stefańska, Ewa; Czapska, Danuta; Karczewski, Jan
The study objective was to evaluate the realization of the reducing diet recommended in the treatment of overweight or obesity (1500 kcal) with regard to the caloric value and the content of basic nutrients, vitamins and bioelements. The study was conducted on a group of 48 women. Daily food rations were evaluated based on a week's dietary register. Results were averaged in each patient and compared to the norms worked out by the Institute of Food and Feeding in Warsaw for subjects with low physical activity. The mean energetic value of the diets was found to meet the requirements. Approximately 50% of the obese women consumed high-protein, low-fat and low-carbohydrate food rations. The analysis of vitamin content in daily food rations showed insufficient intake of vitamin E (in 89.6% of women), thiamin (83.3%), riboflavin (93.7%), niacin (60.4%), vitamin B6 (87.5%), folic acid (89.6%) and vitamin C (72.9%). Vitamin A intake was higher than the recommended norm in 47.9% of women. The lowest realization was noted in the case of potassium (64.6% of rations below the norm), calcium (100% below the norm), magnesium (64.6% below the norm). However, dietary sodium and phosphate content in most obese women exceeded the norms. The intake was too low in the case of iron (in 91.7%), zinc (in 97.9%) and copper (in 100%). It seems that long-term compliance with such a diet requires additional individual supplementation.
Konttinen, Hanna; Peltonen, Markku; Sjöström, Lars; Carlsson, Lena; Karlsson, Jan
There is a need for a better understanding of the factors that influence long-term weight outcomes after bariatric surgery. We examined whether pretreatment and posttreatment levels of cognitive restraint, disinhibition, and hunger and 1-y changes in these eating behaviors predict short- and long-term weight changes after surgical and conventional treatments of severe obesity. Participants were from an ongoing, matched (nonrandomized) prospective intervention trial of the Swedish Obese Subjects (SOS) study. The current analyses included 2010 obese subjects who underwent bariatric surgery and 1916 contemporaneously matched obese controls who received conventional treatment. Physical measurements (e.g., weight and height) and questionnaires (e.g., Three-Factor Eating Questionnaire) were completed before the intervention and 0.5, 1, 2, 3, 4, 6, 8, and 10 y after the start of the treatment. Structural equation modeling was used as the main analytic strategy. The surgery group lost more weight and reported greater decreases in disinhibition and hunger at 1- and 10-y follow-ups (all P women) and experienced larger 1-y decreases in these behaviors (β = 0.31-0.48, P women) lost more weight 2, 6, and 10 y after surgery. In control patients, larger 1-y increases in cognitive restraint predicted a greater 2-y weight loss in both sexes. A higher tendency to eat in response to various internal and external cues shortly after surgery predicted less-successful short- and long-term weight outcomes, making postoperative susceptibility for uncontrolled eating an important indicator of targeted interventions. © 2015 American Society for Nutrition.
Full Text Available Background: Insights into the characteristics of treatment seekers for lifestyle changes and treatment preferences are necessary for intervention planning. Aim: To compile a profile of treatment-seeking obese patients with non-communicable diseases (NCDs or NCD risk factors and to compare patients who choose group-based (facility-based therapeutic group [FBTG] versus usual care (individual consultations treatment. Setting: A primary healthcare facility in Cape Town, South Africa. Methods: One hundred and ninety-three patients were recruited in this cross-sectional study. Ninety six chose FBTG while 97 chose usual care. A questionnaire, the hospital database and patients’ folders were used to collect data. Weight, height and waist circumference were measured. STATA 11.0 was used for descriptive statistics and to compare the two groups. Results: The subjects’ mean age was 50.4 years, 78% were women and of low education levels and income, and 41.5% had type 2 diabetes, 83.4% hypertension and 69.5% high cholesterol. Mean (s.d. HbA1c was 9.1 (2.0%, systolic BP 145.6 (21.0 mmHg, diastolic BP 84.5 (12.0 mmHg, cholesterol 5.4 (1.2 mmol/L, body mass indicator (BMI 39.3 (7.3 kg/m2 and waist circumference 117 (12.6 cm. These figures were undesirable although pharmacological treatment for diabetes and hypertension was in place. Only 14% were physically active, while TV viewing was > 2h/day. Mean daily intake of fruit and vegetables (2.2 portions/day was low while added sugar (5 teaspoons and sugar-sweetened beverages (1.3 glasses were high. Usual care patients had a higher smoking prevalence, HbA1c, number of NCD risk factors and refined carbohydrate intake, and a lower fruit and vegetable intake. Conclusion: Treatment seekers were typically middle-aged, low income women with various modifiable and intermediate risk factors for NCDs. Patients choosing usual care could have more NCD risks. Keywords: Non-communicable diseases; primary health care; family
Barata José T
Full Text Available Abstract Background Changes in body image and subjective well-being variables (e.g. self-esteem are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment. Methods Participants (BMI = 31.1 ± 4.1 kg/m2; age = 38.4 ± 6.7 y were 144 women who attended a 12-month obesity treatment program and a comparison group (n = 49, who received a general health education program. The intervention included regular group meetings promoting lasting behavior changes in physical activity and dietary intake. Body image, quality of life, subjective well-being, and body weight were measured at baseline and treatment's end. Mediation was tested by multiple regression and a resampling approach to measure indirect effects. Treatment group assignment was the independent variable while changes in weight and in psychosocial variables were analyzed alternatively as mediators and as dependent variables. Results At 12 months, the intervention group had greater weight loss (-5.6 ± 6.8% vs. -1.2 ± 4.6%, p Conclusion Changes in weight and body image may reciprocally affect each other during the course of behavioral obesity treatment. No evidence of reciprocal relationships was found for the other models under analysis; however, weight changes partially explained the effects of treatment on quality of life and self-esteem. Weight and psychosocial changes co-occur during treatment and will probably influence each other dynamically, in ways not yet adequately understood. Results from this study support the inclusion of intervention contents aimed at improving body image in weight management programs.
Mathus-Vliegen, Elisabeth M H; de Groot, Gerrit H
Satiety is centrally and peripherally mediated by gastrointestinal peptides and the vagal nerve. We aimed to investigate whether intragastric balloon treatment affects satiety through effects on fasting and meal-stimulated cholecystokinin (CCK) and pancreatic polypeptide (PP) secretion. Patients referred for obesity treatment were randomised to 13 weeks of sham treatment followed by 13 weeks of balloon treatment (group 1; sham/balloon) or to twice a 13-week period of balloon treatment (group 2; balloon/balloon). Blood samples were taken for fasting and meal-stimulated CCK and PP levels at the start (T0) and after 13 (T1) and 26 (T2) weeks. Patients filled out visual analogue scales (VAS) to assess satiety. Forty-two patients (35 females, body weight 125.1 kg, BMI 43.3 kg/m(2)) participated. In group 1, basal CCK levels decreased but meal-stimulated response remained unchanged after 13 weeks of sham treatment. In group 2, basal and meal-stimulated CCK levels decreased after 13 weeks of balloon treatment. At the end of the second 13-week period, when group 1 had their first balloon treatment, they duplicated the initial 13-week results of group 2, whereas group 2 continued their balloon treatment and reduced meal-stimulated CCK release. Both groups showed reduced meal-stimulated PP secretions at T1 and T2 compared to T0. Changes in diet composition and VAS scores were similar. Improvements in glucose homeostasis partly explained the PP results. The reduced CCK and PP secretion after balloon positioning was unexpected and may reflect delayed gastric emptying induced by the balloon. Improved glucose metabolism partly explained the reduced PP secretion. Satiety and weight loss were not adversely influenced by these hormonal changes.
The Errors of Individualistic Public Health Interventions: Denial of Treatment to Obese Persons; Comment on “Denial of Treatment to Obese Patients—the Wrong Policy on Personal Responsibility for Health”
Daniel S. Goldberg
Full Text Available I agree entirely with Nir Eyal’s perspective that denying treatment to obese patients is morally wrong. However, the reasons for this belief differ in some ways from Eyal’s analysis. In this commentary, I will try to explain the similarities and differences in our perspectives. My primary claim is that the denial of treatment to obese patients is wrong principally because (i it eschews a whole-population approach to the problem of poor nutrition and is therefore likely to be ineffective; (ii it is likely to expand obesity-related health inequities; and (iii it is likely to intensify stigma against already-marginalized social groups. I shall consider each in turn, and explore the extent to which Eyal would be likely to agree with my claims.
Wing, R R
The purpose of this paper is to review the evidence on the role of physical activity in the treatment of adult overweight and obesity. Three specific questions are addressed: (1) Does exercise alone produce weight loss? (2) Does exercise in combination with diet produce greater weight loss than diet only? and (3) Does exercise in combination with diet produce better maintenance of weight loss than diet alone? The literature initially identified by the Expert Panel on Clinical Guidelines for the Treatment of Obesity, three key meta analyses, and additional literature searches were used to identify randomized trials related to the three aforementioned topics. These articles were reviewed and tabulated. Six of 10 randomized studies found significantly greater weight loss in exercise alone versus no treatment controls. The magnitude of the effect averaged 1-2 kg. Only 2 of 13 studies found significant differences in initial weight loss for diet plus exercise versus diet only, although almost all studies pointed in this direction. Six studies were identified with maintenance periods of at least 1 yr. In two of the six there were significant long term differences favoring diet plus exercise, but in every study considered the direction of the difference favored diet plus exercise. Other strong evidence showing benefits of exercise for long-term weight loss comes from correlational analyses which consistently find that those individuals who report the greatest exercise have the best maintenance of weight loss. Randomized trials consistently show benefits of exercise for weight loss, but the effects are often modest. This may result from small sample sizes, short study duration, and poor adherence to the exercise prescriptions. To better define the doses and types of exercise that will promote long-term weight loss, it is necessary to develop better ways to measure exercise and promote adherence to exercise.
Pretlow, Robert A; Stock, Carol M; Allison, Stephen; Roeger, Leigh
The aim of this study was to test a weight loss program for young people based on an addiction treatment approach. A pilot study (n=43) was conducted of a 20-week child/adolescent obesity intervention based on an addiction treatment model (staged, incremental withdrawal from problem foods, snacking/grazing, and excessive amounts at meals) and implemented by a server-integrated smartphone app with health professional support. The primary outcome was standardized %overBMI measured at four time points. Secondary outcomes were participants' self-ratings of self-esteem, control over food, and the degree they turned to food when stressed. User satisfaction data were collected with an online questionnaire. Latent growth modeling techniques were used to identify independent variables and possible mediating treatment process variables associated with weight change. Mean age of participants was 16 years (range, 10-21), 65% girls, and 84% Caucasian. Twenty-seven (63%) completed the program. There was a significant decrease in %overBMI over time of 7.1. There were significant improvements in participant ratings of self-esteem, control over food, and a reduction in turning to food when stressed. Males, younger participants, and participants with higher levels of program compliance achieved better weight loss. Participants who reported that calling obesity an addiction made their guilt worse experienced poorer weight loss. Females were more likely than males to report "addiction guilt," and this partly mediated the overall gender effect. The staged, incremental food withdrawal approach was feasible to implement and was useful in helping reduce excessive weight, particularly among boys.
Johansen, Anders; Holm, Jens-Christian; Pearson, Seija; Kjærsgaard, Mimi; Larsen, Lone Marie; Højgaard, Birgitte; Cortes, Dina
Overweight children are at an increased risk of becoming obese adults, which may lead to shorter life expectancies in the current generation of children as compared to their parents. Furthermore, being an overweight child has a negative psycho-social impact. We consider obesity in children and adolescents a chronic illness, which is in line with the American Medical Society. We summarize the evidence for the efficacy of a combination of diet, physical activity and behavior-focused interventions in a family-based setting. The present guidelines propose a multidisciplinary service implemented as a "chronic care model" based on "best clinical practice" inspired by an American expert committee and the daily practice of The Children's Obesity Clinic at Copenhagen University Hospital Holbaek. Children and adolescents should be referred for examination and treatment in a pediatric setting when BMI corresponds to an isoBMI of minimum 30 or BMI corresponds to an isoBMI of 25 and complex obesity is suspected. Obtaining a thorough medical history is pivotal. We propose a structured interview to ensure collection of all relevant information. We recommend physical examination focused on BMI, waist circumference, growth, pubertal stage, blood pressure, neurology and skin and provide comprehensive paraclinical investigations for obesity and obesity related conditions. Treatment of obesity in children and adolescents is fully dependent on the combined effort of the entire family. This cannot be overemphasized! The main principle of the treatment is developing an individual detailed plan for every patient to reduce caloric intake whilst increasing physical activity, leaving no ambiguity with the recommendations.
Skelton, JA; Buehler, C; Irby, MB; Grzywacz, JG
Family-based approaches to pediatric obesity treatment are considered the ‘gold-standard,’ and are recommended for facilitating behavior change to improve child weight status and health. If family-based approaches are to be truly rooted in the family, clinicians and researchers must consider family process and function in designing effective interventions. To bring a better understanding of family complexities to family-based treatment, two relevant reviews were conducted and are presented: (1) a review of prominent and established theories of the family that may provide a more comprehensive and in-depth approach for addressing pediatric obesity; and (2) a systematic review of the literature to identify the use of prominent family theories in pediatric obesity research, which found little use of theories in intervention studies. Overlapping concepts across theories include: families are a system, with interdependence of units; the idea that families are goal-directed and seek balance; and the physical and social environment imposes demands on families. Family-focused theories provide valuable insight into the complexities of families. Increased use of these theories in both research and practice may identify key leverage points in family process and function to prevent the development of or more effectively treat obesity. The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment. PMID:22531090
Ashmore, Jamile A; Friedman, Kelli E; Reichmann, Simona K; Musante, Gerard J
To evaluate the associations between weight-based stigmatization, psychological distress, and binge eating behavior in a treatment-seeking obese sample. Ninety-three obese adults completed three questionnaires: 1) Stigmatizing Situations Inventory, 2) Brief Symptoms Inventory, and 3) Binge Eating Questionnaire. Correlational analyses were used to evaluate the association between stigmatizing experiences, psychological distress and binge eating behavior. Stigmatizing experiences predicted both binge eating behavior (R(2)=.20, p<.001) and overall psychological distress (R(2)=.18, p<.001). A substantial amount of the variance in binge eating predicted by weight-based stigmatization was due to the effect of psychological distress. Specifically, of the 20% of the variance in binge eating accounted for by stigmatizing experiences, between 7% and 34% (p<.01) was due to the effects of various indicators of psychological distress. These data suggest that weight-based stigmatization predicts binge eating behavior and that psychological distress associated with stigmatizing experiences may be an important mediating factor.
Faria Alessandra Nunes
Full Text Available OBJECTIVE: To assess the effects of weight reduction with 10mg of sibutramine or placebo on blood pressure during 24 hours (ambulatory blood pressure monitoring, on left ventricular mass, and on antihypertensive therapy in 86 obese and hypertensive patients for 6 months. METHODS: The patients underwent echocardiography, ambulatory blood pressure monitoring, and measurement of the levels of hepatic enzymes prior to and after treatment with sibutramine or placebo. RESULTS: The group using sibutramine had a greater weight loss than that using placebo (6.7% versus 2.5%; p<0.001, an increase in heart rate (78.3±7.3 to 82±7.9 bpm; p=0.02, and a reduction in the left ventricular mass/height index (105±29.3 versus 96.6±28.58 g/m; p=0.002. Both groups showed similar increases in the levels of alkaline phosphatase and comparable adjustments in antihypertensive therapy; blood pressure, however, did not change. CONCLUSION: The use of sibutramine caused weight loss and a reduction in left ventricular mass in obese and hypertensive patients with no interference with blood pressure or with antihypertensive therapy.
Norén, Erik; Forssell, Henrik
Very low calorie diet (VLCD) is routinely used in programs for treatment of obesity and before bariatric surgery in order to reduce risk of postoperative complications. Aspartame, an artificial sweetener, is commonly used in VLCD and is well approved as a food additive without any adverse effects. The development of a new fructose containing VLCD formula without aspartame raises questions as to effects on glucose and lipid control. As part of an ongoing study of a novel bariatric surgery procedure, twenty-five obese subjects with mean body mass index (BMI) 39.8 kg/m2 and mean age of 48.8 years enrolled in a single center observational study. Seven subjects presented with type 2 diabetes mellitus. The subjects underwent four weeks dietary treatment with VLCD Slanka (Slanka). Blood samples including fasting plasma glucose, HbA1c, cholesterol and triglycerides were performed at start and after four weeks of diet. Blood pressure and weight were noted. All subjects completed the diet without any adverse events. Mean weight reduction was 8.2 kg with 95% confidence interval 7.1-9.2 kg (p = 0.001). Excess weight (i.e. proportion of weight exceeding BMI 25) loss decreased by median 19.5% (inter quartile range (IQR) 16,8-24,2). Median fasting plasma glucose was at inclusion 5,6 mmol/l (IQR 5,3-6,8) and after diet 4.8 mmol/l (IQR 4,6-5,2) (p = 0.001). Median HbA1c changed from 39 mmol/mol (IQR 37-44) to 37 mmol/mol (IQR 35-43) (p = 0.001). There was also significant reduction in cholesterol and triglyceride levels as well as in systolic blood pressure. Changes in other monitored blood chemistry values were without clinical importance. Four weeks treatment with fructose containing VLCD of obese subjects preparing for bariatric surgery gave a substantial weight reduction without any significant negative metabolic effects.
Childhood obesity has become an epidemic on a worldwide scale. This article gives an overview of the progress made in childhood and adolescent obesity research in the last decade, with a particular emphasis on the transdisciplinary and complex nature of the problem. The following topics are addressed: 1) current definitions of childhood and adolescent overweight and obesity; 2) demography of childhood and adolescent obesity both in the US and globally; 3) current topics in the physiology of f...
Chueca, M; Azcona, C; Oyárzabal, M
Obesity during childhood and adolescence is an increasingly frequent cause for medical consultation. The increase in the prevalence of this disease, which has been considered as an epidemic by the World Health Organisation, is worrying. Obesity is a complex disease, whose aetiology still remains to be clarified due to the numerous factors involved: environmental, genetic, life style and behavioural, neuroendocrinological and metabolic. The persistence of childhood obesity until adulthood significantly increases the risk of suffering from diabetes mellitus, cardiovascular disease, hypertension, cholecystitis and cholelithiasis. Treatment of obesity is complicated and few patients regularly attend follow up examinations. A multidisciplinary team is required to carry out a suitable treatment, composed of paediatricians, dieticians, nurses, psychologists and psychiatrists. Successful treatment of obesity resides in reducing the calorie intake in relation to energy expenditure, and at the time providing instruction in appropriate eating habits and life styles that in the long term will promote the maintenance of the ideal weight.
Sarwer, David B.; Dilks, Rebecca J.
The prevalence of childhood and adolescent obesity has tripled in the past three decades. This increase has been accompanied by a dramatic rise in obesity-related health complications among American youth. Thus, many obese youth are now experiencing illnesses that will threaten their life expectancy in the absence of significant weight loss.…
Vancampfort, Davy; De Herdt, Amber; Vanderlinden, Johan; Lannoo, Matthias; Adriaens, An; De Hert, Marc; Stubbs, Brendon; Soundy, Andrew; Probst, Michel
The primary aim was to compare the functional exercise capacity between obese treatment-seeking people with and without binge eating disorder (BED) and non-obese controls. The secondary aim was to identify clinical variables including eating and physical activity behaviour, physical complaints, psychopathology and physical self-perception variables in obese people with BED that could explain the variability in functional exercise capacity. Forty people with BED were compared with 20 age-, gender- and body mass index (BMI)-matched obese persons without BED and 40 age and gender matched non-obese volunteers. A 6-minute walk test (6MWT), the Baecke physical activity questionnaire, the Symptom Checklist-90, the Physical Self-Perception Profile and the Eating Disorder Inventory were administered. Physical complaints before and after the 6MWT were also documented. The distance achieved on the 6MWT was significantly lower in obese participants with BED (512.1 ± 75.8 m versus 682.7 ± 98.4, p binge eating disorder should incorporate a functional exercise capacity assessment. Clinicians involved in the rehabilitation of people with binge eating disorder should consider depression and lower self-esteem as potential barriers. Clinicians should take into account the frequently observed physical discomfort when developing rehabilitation programmes for people with binge eating disorder.
Deborah R. Leitner
Full Text Available Obesity is a chronic metabolic disease affecting adults and children worldwide. It has become one of the leading causes of death, as obesity is known to be the main risk factor for a number of non-communicable diseases, in particular type 2 diabetes. This close relationship led to the connotation ‘diabesity', highlighting the fact that the majority of individuals with diabetes are overweight or obese. Until today the BMI is still used to classify overweight and obesity. Since reduced muscle mass is highly prevalent throughout the BMI range, the measurement of body composition is strongly recommended. Moreover, it is essential for monitoring the course of weight reduction, which is part of every effective anti-obesity treatment. Weight reduction can be achieved via different weight loss strategies, including lifestyle intervention (diet and exercise, pharmacotherapy, or bariatric surgery. However, not all of these strategies are suitable for all patients, and any further needs should be considered. Besides, attention should also be drawn to concomitant therapies. These therapies may promote additional weight gain and further trigger the deterioration of blood glucose control. Thus, therapeutic strategies are warranted, which can be easily used for the management of obese patients with type 2 diabetes to achieve their glycemic and weight loss goals.
Dickey, Wayne; Arday, David R; Kelly, Joseph; Carnahan, Col David
As childhood obesity is a concern in many communities, this study investigated outpatient evaluation and initial management of overweight and obese pediatric patients in U.S. military medical treatment facilities (MTFs). Samples of 579 overweight and 341 obese patients (as determined by body mass index [BMI]) aged 3-17 years were drawn from MTFs. All available FY2011 outpatient records were searched for documentation of BMI assessment, overweight/obesity diagnosis, and counseling. Administrative data for these patients were merged to assess coded diagnostic and counseling rates and receipt of recommended laboratory screenings. Generic BMI documentation was high, but BMI percentile assessments were found among fewer than half the patients. Diagnostic recording or recognition totaled 10.9% of overweight and 32.0% of obese. Counseling rates were higher, with 46.4% and 61.0% of overweight and obese patients, respectively, receiving weight related counseling. Among patients 10 years of age or older, rates of recommended lab screenings for diabetes, liver abnormality, and dyslipidemia were not greater than 33%. BMI percentile recording was strongly associated with diagnostic recording, and diagnostic recording was strongly associated with counseling. Improvements to electronic health records or implementation of local procedures to facilitate better diagnostic recording would likely improve adherence to clinical practice guidelines. ©2016 American Association of Nurse Practitioners.
Gao, Ya; Wang, Changjiang; Pan, Tianrong; Luo, Li
Visfatin is a recently discovered adipocytokine that contributes to glucose and obesity-related conditions. Until now, its responses to the insulin-sensitizing agent metformin and to exercise are largely unknown. We aim to investigate the impact of metformin treatment and/or swimming exercise on serum visfatin and visfatin levels in subcutaneous adipose tissue (SAT), peri-renal adipose tissue (PAT) and skeletal muscle (SM) of high-fat-induced obesity rats. Sprague-Dawley rats were fed a normal diet or a high-fat diet for 16 weeks to develop obesity model. The high-fat-induced obesity model rats were then randomized to metformin (MET), swimming exercise (SWI), or adjunctive therapy of metformin and swimming exercise (MAS), besides high-fat obesity control group and a normal control group, all with 10 rats per group. Zoometric and glycemic parameters, lipid profile, and serum visfatin levels were assessed at baseline and after 6 weeks of therapy. Visfatin levels in SAT, PAT and SM were determined by Western Blot. Metformin and swimming exercise improved lipid profile, and increased insulin sensitivity and body weight reduction were observed. Both metformin and swimming exercise down-regulated visfatin levels in SAT and PAT, while the adjunctive therapy conferred greater benefits, but no changes of visfatin levels were observed in SM. Our results indicate that visfatin down-regulation in SAT and PAT may be one of the mechanisms by which metformin and swimming exercise inhibit obesity.
Leslie, William D; Lix, Lisa M; Yogendran, Marina S; Morin, Suzanne N; Metge, Colleen J; Majumdar, Sumit R
Diverging international trends in fracture rates have been observed, with most reports showing that fracture rates have stabilized or decreased in North American and many European populations. We studied two complementary population-based historical cohorts from the Province of Manitoba, Canada (1996-2006) to determine whether declining osteoporotic fracture rates in Canada are attributable to trends in obesity, osteoporosis treatment, or bone mineral density (BMD). The Population Fracture Registry included women aged 50 years and older with major osteoporotic fractures, and was used to assess impact of changes in osteoporosis treatment. The BMD Registry included all women aged 50 years and older undergoing BMD tests, and was used to assess impact of changes in obesity and BMD. Model-based estimates of temporal changes in fracture rates (Fracture Registry) were calculated. Temporal changes in obesity and BMD and their association with fracture rates (BMD Registry) were estimated. In the Fracture Registry (n=27,341), fracture rates declined 1.6% per year (95% confidence interval [CI], 1.3% to 2.0%). Although osteoporosis treatment increased from 5.6% to 17.4%, the decline in fractures was independent of osteoporosis treatment. In the BMD Registry (n=36,587), obesity increased from 12.7% to 27.4%. Femoral neck BMD increased 0.52% per year and lumbar spine BMD increased 0.32% per year after covariate adjustment (pobesity or osteoporosis treatment. © 2014 American Society for Bone and Mineral Research.
Alligier, Maud; Dewulf, Evelyne M; Salazar, Nuria; Mairal, Aline; Neyrinck, Audrey M; Cani, Patrice D; Langin, Dominique; Delzenne, Nathalie M
To investigate whether inulin-type fructan (ITF) prebiotics could counteract the thiazolidinedione (TZD, PPARγ activator) induced-fat mass gain, without affecting its beneficial effect on glucose homeostasis, in high-fat (HF) diet fed mice. Male C57bl6/J mice were fed a HF diet alone or supplemented with ITF prebiotics (0.2 g/day × mouse) or TZD (30 mg pioglitazone (PIO)/kg body weight × day) or both during 4 weeks. An insulin tolerance test was performed after 3 weeks of treatment. As expected, PIO improved glucose homeostasis and increased adiponectinaemia. Furthermore, it induced an over-expression of several PPARγ target genes in white adipose tissues. ITF prebiotics modulated the PIO-induced PPARγ activation in a tissue-dependent manner. The co-treatment with ITF prebiotics and PIO maintained the beneficial impact of TZD on glucose homeostasis and adiponectinaemia. Moreover, the combination of both treatments reduced fat mass accumulation, circulating lipids and hepatic triglyceride content, suggesting an overall improvement of metabolism. Finally, the co-treatment favored induction of white-to-brown fat conversion in subcutaneous adipose tissue, thereby leading to the development of brite adipocytes that could increase the oxidative capacity of the tissue. ITF prebiotics decrease adiposity and improve the metabolic response in HF fed mice treated with TZD. © 2014 The Obesity Society.
Hall, Kevin D; Chung, Stephanie T
Summarize the physiological effects of low-carbohydrate diets as they relate to weight loss, glycemic control, and metabolic health. Low-carbohydrate diets are at least as effective for weight loss as other diets, but claims about increased energy expenditure and preferential loss of body fat are unsubstantiated. Glycemic control and hyperinsulinemia are improved by low-carbohydrate diets, but insulin sensitivity and glucose-stimulated insulin secretion may be impaired, especially in the absence of weight loss. Fasting lipid parameters are generally improved, but such improvements may depend on the quality of dietary fat and the carbohydrates they replaced. Postprandial hyperlipemia is a potential concern given the high fat content typical of low-carbohydrate diets. Low-carbohydrate diets have several potential benefits for treatment of obesity and type 2 diabetes, but more research is required to better understand their long-term consequences as well as the variable effects on the endocrine control of glucose, lipids, and metabolism.
Chang, Yi-Cheng; Hee, Siow-Wey; Hsieh, Meng-Lun; Chuang, Lee-Ming
The type 2 diabetes pandemic in recent decades is a huge global health threat. This pandemic is primarily attributed to the surplus of nutrients and the increased prevalence of obesity worldwide. In contrast, calorie restriction and weight reduction can drastically prevent type 2 diabetes, indicating a central role of nutrient excess in the development of diabetes. Recently, the molecular links between excessive nutrients, organelle stress, and development of metabolic disease have been extensively studied. Specifically, excessive nutrients trigger endoplasmic reticulum stress and increase the production of mitochondrial reactive oxygen species, leading to activation of stress signaling pathway, inflammatory response, lipogenesis, and pancreatic beta-cell death. Autophagy is required for clearance of hepatic lipid clearance, alleviation of pancreatic beta-cell stress, and white adipocyte differentiation. ROS scavengers, chemical chaperones, and autophagy activators have demonstrated promising effects for the treatment of insulin resistance and diabetes in preclinical models. Further results from clinical trials are eagerly awaited. PMID:26613076
Sánchez-Garrido, Miguel A.; Brandt, Sara J; Clemmensen, Christoffer
Over a relatively short period, obesity and type 2 diabetes have come to represent a large medical and economic burden to global societies. The epidemic rise in the prevalence of obesity has metabolic consequences and is paralleled by an increased occurrence of other diseases, such as diabetes......, cancer and cardiovascular complications. Together, obesity and type 2 diabetes constitute one of the more preventable causes of premature death and the identification of novel, safe and effective anti-obesity drugs is of utmost importance. Pharmacological attempts to treat obesity have had limited...
Engström, Anna; Abildsnes, Eirik; Mildestvedt, Thomas
The health burden related to obesity is rising among children and adolescents along with the general population worldwide. For the individual as well as the society this trend is alarming. Several factors are driving the trend, and the solution seems to be multifaceted because long-lasting treatment alternatives are lacking. This study aims to explore adolescents' and young adults' motivation for attending group-based obesity treatment and social and environmental factors that can facilitate or hinder lifestyle change. In this study, we arranged three focus groups with 17 participants from different obesity treatment programs in the west and south of Norway. The content in these programs differed, but they all used Motivational Interviewing as a teaching method. We conducted a data-driven analysis using systematic text condensation. Self-determination theory has been used as an explanatory framework. We identified four major themes: 1) motivation, 2) body experience and self-image, 3) relationships and sense of belonging, and 4) the road ahead. Many of the participants expressed external motivation to participate but experienced increasing inner motivation and enjoyment during the treatment. Several participants reported negative experiences related to being obese and appreciated group affiliation and sharing experiences with other participants. Motivation may shift during a lifestyle course. Facilitating factors include achieving and experiencing positive outcomes as well as gaining autonomy support from other course participants and friends. Obstacles to change were a widespread obesogenic environment as well as feelings of guilt, little trust in personal achievements and non-supporting friends.
van Santen, Hanneke M.; Schouten-Meeteren, Antoinette Y.; Serlie, Mireille; Meijneke, Ruud W. H.; van Trotsenburg, A. S.; Verberne, Hein; Holleman, Frits; Fliers, Eric
Patients treated for childhood craniopharyngioma often develop hypothalamic obesity (HO), which has a huge impact on the physical condition and quality of life of these patients. Treatment for HO thus far has been disappointing, and although several different strategies have been attempted, all
Menez, Steven; Cheskin, Lawrence; Geller, Gail
Objective: To determine and compare the perspectives of the general public and health care providers (HCPs) on obesity and its treatment in rural West Virginia (WV) and Baltimore, MD. Method: Surveys were completed in both locations by the general public (WV: "n" = 200; Baltimore: "n" = 171) and HCPs (WV: "n" = 25;…
Peeters, Paul J H L; Bazelier, Marloes T; Leufkens, Hubert G M; de Vries, Frank; De Bruin, Marie L
OBJECTIVE: To assess the risk of colorectal cancer associated with type 2 diabetes, as compared with a nondiabetic reference population, and to study additional associations between treatment stage and duration of obesity and colorectal cancer risk. RESEARCH DESIGN AND METHODS: We conducted an
Pratt, Keeley J; Lazorick, Suzanne; Lamson, Angela L; Ivanescu, Andrada; Collier, David N
Changes in Quality of Life (QOL) measures over time with treatment of obesity have not previously been described for youth. We describe the changes from baseline through two follow up visits in youth QOL (assessed by the Pediatric Quality Life Inventory, PedsQL4.0), teen depression (assessed by the Patient Health Questionnaire, PHQ9A), Body Mass Index (BMI) and BMI z-score. We also report caregiver proxy ratings of youth QOL. A sample of 267 pairs of youth and caregiver participants were recruited at their first visit to an outpatient weight-treatment clinic that provides care integrated between a physician, dietician, and mental health provider; of the 267, 113 attended a visit two (V2) follow-up appointment, and 48 attended visit three (V3). We investigated multiple factors longitudinally experienced by youth who are overweight and their caregivers across up to three different integrated care visits. We determined relationships at baseline in QOL, PHQ9A, and BMI z-score, as well as changes in variables over time using linear mixed models with time as a covariate. Overall across three visits the results indicate that youth had slight declines in relative BMI, significant increases in their QOL and improvements in depression. We encourage clinicians and researchers to track youth longitudinally throughout treatment to investigate not only youth's BMI changes, but also psychosocial changes including QOL.
Gluck, Marci E; Geliebter, Allan; Lorence, Margarita
Stress is the most commonly reported trigger of binge eating, and high cortisol levels are positively related to both central body fat and food intake after laboratory stress. We therefore examined waist circumference (WHR) and cortisol stress responsivity after a cold pressor stress test (CPT) in 22 obese (BMI > 27) women (11 BED, 11 non-BED). BMI and WHR did not differ between groups. The BED group had higher morning basal cortisol than the non-BED group (P = .03) and greater AUC cortisol after CPT, after controlling for AUC insulin (P = .04). In the BED group, WHR was related to AUC cortisol (P = .002) and peak cortisol stress responsivity (P = .003). Twenty (10 non-BED, 10 BED) were randomized to a 6-week treatment program (CBT + Diet) or Wait-List (WL) control group. There were no BED group or treatment-group differences in WHR, morning basal cortisol, or AUC cortisol after CPT. The relationship between WHR and both AUC cortisol (P = .002) and peak cortisol stress responsivity after CPT (P = .008) remained significant in the BED group. In BED, there is a hyperactive HPA axis related to abdominal obesity that persists even after treatment, suggesting that cortisol might be a primary factor in the disorder.
Full Text Available Lauren M Rossen,1,2 Vanessa A Milsom,1,3 Kathryn R Middleton,1,4 Michael J Daniels,5,6 Michael G Perri1,71Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; 2National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA; 3Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; 4Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University and The Miriam Hospital, Providence, RI, USA; 5Department of Statistics, University of Florida, Gainesville, FL, USA; 6Division of Statistics and Scientific Computation, University of Texas at Austin, Austin, TX, USA; 7College of Public Health and Health Professions, University of Florida, Gainesville, FL, USABackground: A key issue in the treatment of obesity in older adults is whether the health benefits of weight loss outweigh the potential risks with respect to musculoskeletal injury.Objective: To compare change in weight, improvements in metabolic risk factors, and reported musculoskeletal adverse events in middle-aged (50–59 years and older (65–74 years, obese women.Materials and methods: Participants completed an initial 6-month lifestyle intervention for weight loss, comprised of weekly group sessions, followed by 12 months of extended care with biweekly contacts. Weight and fasting blood samples were assessed at baseline, month 6, and month 18; data regarding adverse events were collected throughout the duration of the study.Results: Both middle-aged (n = 162 and older (n = 56 women achieved significant weight reductions from baseline to month 6 (10.1 ± 0.68 kg and 9.3 ± 0.76 kg, respectively and maintained a large proportion of their losses at month 18 (7.6 ± 0.87 kg and 7.6 ± 1.3 kg, respectively; there were no significant differences between the two groups with respect to weight change. Older women further
Obesity and cardiovascular risk: a call for action from the European Society of Hypertension Working Group of Obesity, Diabetes and the High-risk Patient and European Association for the Study of Obesity: part A: mechanisms of obesity induced hypertension, diabetes and dyslipidemia and practice guidelines for treatment.
Kotsis, Vasilios; Jordan, Jens; Micic, Dragan; Finer, Nicholas; Leitner, Deborah R; Toplak, Hermann; Tokgozoglu, Lale; Athyros, Vasilios; Elisaf, Moses; Filippatos, Theodosios D; Redon, Josep; Redon, Pau; Antza, Christina; Tsioufis, Konstantinos; Grassi, Guido; Seravalle, Gino; Coca, Antonio; Sierra, Cristina; Lurbe, Empar; Stabouli, Stella; Jelakovic, Bojan; Nilsson, Peter M
: Obesity is a key factor for cardiovascular diseases and complications. Obesity is associated with hypertension, dyslipidemia and type II diabetes, which are the major predictors of cardiovascular disease in the future. It predisposes for atrial fibrillation, heart failure, sudden cardiac death, renal disease and ischemic stroke that are the main causes of cardiovascular hospitalization and mortality. As obesity and the cardiovascular effects on the vessels and the heart start early in life, even from childhood, it is important for health policies to prevent obesity very early before the disease manifestation emerge. Key roles in the prevention are strategies to increase physical exercise, reduce body weight and to prevent or treat hypertension, lipids disorders and diabetes earlier and efficiently to prevent cardiovascular complications.Epidemiology and mechanisms of obesity-induced hypertension, diabetes and dyslipidemia will be reviewed and the role of lifestyle modification and treatment strategies in obesity will be updated and analyzed. The best treatment options for people with obesity, hypertension, diabetes and dyslipidemia will discussed.
Guseman, Emily Hill; Cauffman, Samuel P; Tucker, Jared M; Smith, Lucie; Eisenmann, Joey C; Stratbucker, William
Both cardiorespiratory fitness (CRF) and measures of muscular fitness are associated with metabolic syndrome in adults. However, limited information exists about these relationships in youth with severe obesity who are at increased risk of metabolic dysfunction. The purpose of this study was to examine the relationship between fitness and metabolic health in treatment-seeking youth with obesity. Data for this analysis were collected at the time of baseline visits at a stage 3 pediatric weight management center. Maximal voluntary contractions were obtained by using isometric hand-grip dynamometry, and CRF was obtained from a maximal treadmill test. Resting blood pressure and fasting measures of blood lipids, glucose, and insulin were used to calculate a continuous metabolic syndrome score (cMetS); homeostasis model assessment of insulin resistance (HOMA-IR) was calculated from fasting insulin and glucose. Relationships between measures of fitness and metabolic health were evaluated by using partial correlations adjusted for age. Sixty-nine participants (21 boys, 48 girls) were included in this analysis. Of these, 46% (n = 32) met the criteria for metabolic syndrome. No differences were found between boys and girls for any variable analyzed. Muscular strength was positively associated with cMetS (r = 0.35), though this association weakened after adjustment for body mass index percentile. CRF was inversely associated with homeostasis model assessment of insulin resistance (HOMA-IR) (r = -0.26) and fasting insulin (r = -0.27). Body fat percentage was positively associated with insulin (r = 0.36). No significant relationship was found between CRF and cMetS. Contrary to previous studies, CRF was not associated with metabolic syndrome in this group. Muscular strength, however, was associated with cMetS. Notably, CRF was associated with elevated HOMA-IR, which may be seen as a precursor to metabolic syndrome. These results suggest that CRF and muscular
Epstein, Leonard H; Kilanowski, Colleen; Paluch, Rocco A; Raynor, Hollie; Daniel, Tinuke Oluyomi
Basic research has shown that increasing variety increases energy intake, and repeated consumption of the same food increases habituation to those foods and reduces consumption. Twenty-four families with overweight/obese 8-12 year-old children and overweight/obese parents were randomly assigned to 6months of usual family based treatment (FBT) or FBT plus reduced variety of high energy-dense foods (FBT+Variety). Intention to treat mixed model ANOVA showed between group differences in child percent overweight (FBT+Variety-15.4% vs. FBT-8.9%, p=0.017) and parent BMI (FBT+Variety-3.7kg/m(2) vs. FBT-2.3kg/m(2); p=0.017). Positive relationships were observed between child zBMI and parent BMI changes (r=0.51, p=0.018), and between reductions in food variety of high energy-dense foods and reductions in child zBMI (r=0.54, p=0.02) and parent BMI (r=0.45, p=0.08). These pilot data suggest that reducing the variety of high energy dense foods and repeating meals within the context of FBT resulted in improved child and parent weight changes at six months. This represents easy to implement changes that reduce choice and may reduce response burden on families. Reducing variety may be a complement to standard FBT that enhances weight loss. Long term studies are needed to assess maintenance of these changes. Copyright © 2015 Elsevier Ltd. All rights reserved.
Uno, Kohei; Seki, Yosuke; Kasama, Kazunori; Wakamatsu, Kotaro; Umezawa, Akiko; Yanaga, Katsuhiko; Kurokawa, Yoshimochi
We have experienced numerous cases of super morbid obesity (SMO), defined by a BMI of ≥50 kg/m 2 , in which laparoscopic sleeve gastrectomy (LSG) was not able to achieve a sufficient weight loss effect. However, the most appropriate procedure for the treatment of SMO has not yet been established. The subjects included 248 successive patients who underwent surgery at our hospital from June 2006 to December 2012. We divided the subjects into an SMO group (BMI, 50 to <70 kg/m 2 ) and a morbid obesity (MO) group (BMI, 35 to <50 kg/m 2 ). The subjects underwent LSG, LSG with duodenojejunal bypass (LSG/DJB), or laparoscopic Roux-en-Y gastric bypass (LRYGB). The weight loss effects, safety of surgery, and metabolic profile changes were compared. Sixty-two subjects were classified into the SMO group (25%). The percent excess weight loss (%EWL) after LSG among the patients in the SMO group was not significantly different from that of patients who underwent other procedures. LSG was associated with a significantly lower success rate in terms of weight loss (%EWL ≥ 50%), in comparison to the weight loss at 1 year after LRYGB and at 2 years after LSG/DJB and LRYGB. Among the patients in the MO group, the %EWL and the rate of successful weight loss did not differ to a statistically significant extent. This study demonstrated that in patients with SMO, LSG/DJB and LRYGB can achieve superior weight loss effects in comparison to LSG.
Bryant, M; Ashton, L; Nixon, J; Jebb, S; Wright, J; Roberts, K; Brown, J
Consensus is lacking in determining appropriate outcome measures for assessment of childhood obesity treatments. Inconsistency in the use and reporting of such measures impedes comparisons between treatments and limits consideration of effectiveness. This study aimed to produce a framework of recommended outcome measures: the Childhood obesity treatment evaluation Outcomes Review (CoOR) framework. A systematic review including two searches was conducted to identify (1) existing trial outcome measures and (2) manuscripts describing development/evaluation of outcome measures. Outcomes included anthropometry, diet, eating behaviours, physical activity, sedentary time/behaviour, fitness, physiology, environment, psychological well-being and health-related quality of life. Eligible measures were appraised by the internal team using a system developed from international guidelines, followed by appraisal from national external expert collaborators. A total of 25,486 papers were identified through both searches. Eligible search 1 trial papers cited 417 additional papers linked to outcome measures, of which 56 were eligible. A further 297 outcome development/evaluation papers met eligibility criteria from search 2. Combined, these described 191 outcome measures. After internal and external appraisal, 52 measures across 10 outcomes were recommended for inclusion in the CoOR framework. Application of the CoOR framework will ensure greater consistency in choosing robust outcome measures that are appropriate to population characteristics. © 2014 The Authors. Pediatric Obesity © 2014 International Association for the Study of Obesity.
Ishøy, Pelle L; Knop, Filip K; Broberg, Brian V
and placebo groups experienced significant ( P = .004), however similar ( P = .98), weight losses of 2.24 ± 3.3 and 2.23 ± 4.4 kg, respectively, after 3 months of treatment. CONCLUSIONS: Treatment with exenatide once-weekly did not promote weight loss in obese, antipsychotic-treated patients......AIMS: Schizophrenia is associated with cardiovascular co-morbidity and a reduced life-expectancy of up to 20 years. Antipsychotics are dopamine D2 receptor antagonists and are the standard of medical care in schizophrenia, but the drugs are associated with severe metabolic side effects...... such as obesity and diabetes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are registered for treatment of both obesity and type 2 diabetes. We investigated metabolic effects of the GLP-1RA, exenatide once-weekly, in non-diabetic, antipsychotic-treated, obese patients with schizophrenia. MATERIAL...
Hayes, Jacqueline F; Altman, Myra; Kolko, Rachel P; Balantekin, Katherine N; Holland, Jodi Cahill; Stein, Richard I; Saelens, Brian E; Welch, R Robinson; Perri, Michael G; Schechtman, Kenneth B; Epstein, Leonard H; Wilfley, Denise E
Food fussiness (FF), or the frequent rejection of both familiar and unfamiliar foods, is common among children and, given its link to poor diet quality, may contribute to the onset and/or maintenance of childhood obesity. This study examined child FF in association with anthropometric variables and diet in children with overweight/obesity participating in family-based behavioral weight loss treatment (FBT). Change in FF was assessed in relation to FBT outcome, including whether change in diet quality mediated the relation between change in FF and change in child weight. Child (N = 170; age = 9.41 ± 1.23) height and weight were measured, and parents completed FF questionnaires and three 24-h recalls of child diet at baseline and post-treatment. Healthy Eating Index-2005 scores were calculated. At baseline, child FF was related to lower vegetable intake. Average child FF decreased from start to end of FBT. Greater decreases in FF were associated with greater reductions in child body mass index and improved overall diet quality. Overall, diet quality change through FBT mediated the relation between child FF change and child body mass index change. Children with high FF can benefit from FBT, and addressing FF may be important in childhood obesity treatment to maximize weight outcomes. © 2016 The Obesity Society.
Johansen, Anders; Holm, Jens-Christian; Pearson, Seija
as a "chronic care model" based on "best clinical practice" inspired by an American expert committee and the daily practice of The Children's Obesity Clinic at Copenhagen University Hospital Holbaek. Children and adolescents should be referred for examination and treatment in a pediatric setting when BMI......Overweight children are at an increased risk of becoming obese adults, which may lead to shorter life expectancies in the current generation of children as compared to their parents. Furthermore, being an overweight child has a negative psycho-social impact. We consider obesity in children...... and adolescents a chronic illness, which is in line with the American Medical Society. We summarize the evidence for the efficacy of a combination of diet, physical activity and behavior-focused interventions in a family-based setting. The present guidelines propose a multidisciplinary service implemented...
Joharapurkar, Amit A; Dhanesha, Nirav A; Jain, Mukul R
Amit A Joharapurkar, Nirav A Dhanesha, Mukul R Jain Department of Pharmacology and Toxicology, Zydus Research Centre, Cadila Healthcare Limited, Ahmedabad, India Abstract: Worldwide prevalence of obesity has nearly doubled since 1980. Obesity is the result of interactions among the environmental factors, genetic predisposition, and human behavior. Even modest weight reduction in obese patients provides beneficial health outcomes. For effective weight reduction, a drug should either increase ...
George A. Kelley
Full Text Available Purpose. Conduct a systematic review of previous meta-analyses addressing the effects of exercise in the treatment of overweight and obese children and adolescents. Methods. Previous meta-analyses of randomized controlled exercise trials that assessed adiposity in overweight and obese children and adolescents were included by searching nine electronic databases and cross-referencing from retrieved studies. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR Instrument. The alpha level for statistical significance was set at P≤0.05. Results. Of the 308 studies reviewed, two aggregate data meta-analyses representing 14 and 17 studies and 481 and 701 boys and girls met all eligibility criteria. Methodological quality was 64% and 73%. For both studies, statistically significant reductions in percent body fat were observed (P=0.006 and P<0.00001. The number-needed-to treat (NNT was 4 and 3 with an estimated 24.5 and 31.5 million overweight and obese children in the world potentially benefitting, 2.8 and 3.6 million in the US. No other measures of adiposity (BMI-related measures, body weight, and central obesity were statistically significant. Conclusions. Exercise is efficacious for reducing percent body fat in overweight and obese children and adolescents. Insufficient evidence exists to suggest that exercise reduces other measures of adiposity.
Foley, Perry; Steinberg, Dori; Levine, Erica; Askew, Sandy; Batch, Bryan C; Puleo, Elaine M; Svetkey, Laura P; Bosworth, Hayden B; DeVries, Abigail; Miranda, Heather; Bennett, Gary G
Obesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. Track is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12months, with study visits at baseline, 6, and 12months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24months. Participants are 68% female and on average 50.7years old with a mean BMI of 35.9kg/m(2). Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression. Track utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment. Copyright © 2016 Elsevier Inc. All rights reserved.
Phan, Thao-Ly T; Chen, Fang Fang; Pinto, Alison Taggi; Cox, Courtney; Robbins, Jennifer; Kazak, Anne E
To test the hypothesis that children with elevated psychosocial risk would have increased attrition and worse weight outcomes in weight management treatment. This was a prospective cohort study of 100 new patients, aged 4-12 years, in a weight management clinic. Parents completed the Psychosocial Assessment Tool. Logistic regression analyses were conducted to calculate the odds of attrition from the clinic and a nonmeaningful change in body mass index (BMI) z-score (ie, psychosocial risk category, adjusting for child demographics and baseline weight category. The majority of patients were male (59%), black (36%) or white (43%), and had severe obesity (55%), and 59% of families were categorized as having moderate or high psychosocial risk. Over the 6-month period, 53% of families were lost to follow-up, and 67% did not have a clinically meaningful decrease in BMI z-score. Compared with children of families with low psychosocial risk, children of families with moderate or high psychosocial risk were 3.1 times (95% CI, 1.3-7.2 times) more likely to be lost to follow-up and 2.9 times (95% CI, 1.1-7.9 times) more likely to have a non-clinically meaningful change in BMI z-score. Children presenting with increased psychosocial risk have higher attrition and poorer weight outcomes, supporting the need for psychosocial screening as a standard component of pediatric weight management treatment. Copyright © 2018 Elsevier Inc. All rights reserved.
Dreber, Helena; Reynisdottir, Signy; Angelin, Bo; Hemmingsson, Erik
To characterize treatment-seeking young adults (16-25 years) with severe obesity, particularly mental health problems. Cross-sectional study of 165 participants (132 women, 33 men) with BMI ≥35 kg/m2 or ≥30 kg/m2 with comorbidities, enrolling in a multidisciplinary obesity treatment program. Data collection at admission of present and life-time health issues including symptomatology of anxiety, depression (Hospital Anxiety and Depression Scale) and attention-deficit/hyperactivity disorder (Adult ADHD Self-Report scale); self-esteem (Rosenberg Self-Esteem Scale), suicide attempts, health-related quality of life (Short Form-36 Health Survey), psychosocial functioning related to obesity (Obesity-related Problems Scale), cardiorespiratory fitness (Astrand's bicycle ergometer test), somatic and psychiatric co-morbidities, cardiometabolic risk factors, and micronutritional status. We used multiple regression analysis to identify variables independently associated with present anxiety and depressive symptomatology. Mean body mass index was 39.2 kg/m2 (SD = 5.2). We found evidence of poor mental health, including present psychiatric diagnoses (29%), symptomatology of anxiety (47%), depression (27%) and attention-deficit/hyperactivity disorder (37%); low self-esteem (42%), attempted suicide (12%), and low quality of life (physical component score = 46, SD = 11.2; mental component score = 36, SD = 13.9, Pobesity-related problems (P = 0.018). The prevalence of type 2 diabetes was 3%, and hypertension 2%. Insulin resistance was present in 82%, lipid abnormality in 62%, and poor cardiorespiratory fitness in 92%. Forty-eight percent had at least one micronutritional deficiency, vitamin D being the most common (35%). A wide range of health issues, including quite severe mental health problems, was prevalent in treatment-seeking young adults with severe obesity. These are likely to constitute a major treatment challenge, including options relating to bariatric surgery.
Antonio Portie Félix
Full Text Available La obesidad es la enfermedad crónica no trasmisible con mayor índice de crecimiento en los últimos 20 años. Es un factor de riesgo para la diabetes mellitus de tipo 2, hipertensión arterial, afecciones cardiovasculares y respiratorias, infertilidad, impotencia sexual y funcional, síndrome metabólico, trastornos en las articulaciones de carga y ciertos cánceres (mama, colon, próstata. La cirugía bariátrica metabólica es el tratamiento quirúrgico efectivo de la obesidad mórbida, a mediano y a largo plazo, y no los tratamientos farmacológicos y las dietas aisladas. El objetivo de esta revisión histórica de la literatura internacional sobre la evolución de las técnicas quirúrgicas de cirugía bariátrica (técnicas malabsortivas, técnicas restrictivas gástricas y técnicas mixtas, es poner al alcance de los interesados en el tema este valioso arsenal terapéutico para que sea utilizado racionalmente.The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate. The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long- and medium-term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques, is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used.
Ng, Winda L; Peeters, Anna; Näslund, Ingmar; Ottosson, Johan; Johansson, Kari; Marcus, Claude; Shaw, Jonathan E; Bruze, Gustaf; Sundström, Johan; Neovius, Martin
To examine the change in use of hypnotics and/or sedatives after gastric bypass surgery or intensive lifestyle modification in adults with obesity. Adults with obesity who underwent gastric bypass surgery or initiated intensive lifestyle modification between 2007 and 2012 were identified through the Scandinavian Obesity Surgery Registry and a Swedish commercial weight loss database. The two cohorts were matched on BMI, age, sex, education, history of hypnotics and/or sedatives use, and treatment year (surgery n = 20,626; lifestyle n = 11,973; 77% women, mean age 41 years, mean BMI 41 kg/m 2 ). The proportion of participants with filled hypnotics and/or sedatives prescriptions was compared yearly for 3 years. In the matched treatment cohorts, 4% had filled prescriptions for hypnotics and/or sedatives during the year before treatment. At 1 year follow-up, following an average weight loss of 37 kg and 18 kg in the surgery and intensive lifestyle cohorts, respectively, this proportion had increased to 7% in the surgery cohort but remained at 4% in the intensive lifestyle cohort (risk ratio 1.7; 95% CI: 1.4-2.1); at 2 years, the proportion had increased to 11% versus 5% (risk ratio 2.0; 95% CI: 1.7-2.4); and at 3 years, it had increased to 14% versus 6% (risk ratio 2.2; 95% CI: 1.9-2.6). Gastric bypass surgery was associated with increased use of hypnotics and/or sedatives compared with intensive lifestyle modification. © 2017 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).
Ells, Louisa J.; Mead, Emma; Atkinson, Greg; Corpeleijn, Eva; Roberts, Katharine; Viner, Russell; Baur, Louise; Metzendorf, Maria-Inti; Richter, Bernd
Background Child and adolescent overweight and obesity have increased globally, and are associated with significant short and long term health consequences. Objectives To assess the effects of surgical interventions for treating obesity in childhood and adolescence. Search methods We searched the
R.M. Kiewiet-Kemper (Rosalie)
textabstractObesity has become a worldwide epidemic that threatens to overwhelm both developed and developing countries. The major burden of obesity to both patients and public health as a whole is the significantly increased morbidity and mortality. It is generally acknowledged that a decrease
Rocha, Julio C.; van Spronsen, Francjan J.; Almeida, Manuela F.; Soares, Gabriela; Quelhas, Dulce; Ramos, Elisabete; Guimaraes, Joao T.; Borges, Nuno
Background: Little is known about the consequences of the special energy enriched diet used to treat patients with phenylketonuria (PKU) in terms of obesity and metabolic syndrome (MetSyn) development. Objective: To investigate the prevalence of overweight and obesity, and its consequences in terms
Childhood obesity has become an epidemic on a worldwide scale. This article gives an overview of the progress made in childhood and adolescent obesity research in the last decade, with a particular emphasis on the transdisciplinary and complex nature of the problem. The following topics are addressed: (1) current definitions of childhood and…
Cho, Youngji; Shore, Stephanie A.
Obesity is a risk factor for asthma, but standard asthma drugs have reduced efficacy in the obese. Obesity alters the gastrointestinal microbial community structure. This change in structure contributes to some obesity-related conditions and also could be contributing to obesity-related asthma. Although currently unexplored, obesity may also be altering lung microbiota. Understanding the role of microbiota in obesity-related asthma could lead to novel treatments for these patients.
There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demo...
McElroy, Susan L.; Frye, Mark A.; Altshuler, Lori L.; Suppes, Trisha; Hellemann, Gerhard; Black, David; Mintz, Jim; Kupka, Ralph; Nolen, Willem; Leverich, Gabriele S.; Denicoff, Kirk D.; Post, Robert M.; Keck, Paul E.
Objectives: Patients with bipolar disorder (BD) have an increased risk of obesity as well as psychotropic-associated weight gain. The objective of this study was to compare sibutramine and topiramate as adjunctive treatments for psychotropic-associated weight gain in overweight or obese outpatients
Verbeken, S.; Braet, C.; Goossens, L.; van der Oord, S.
For obese children behavioral treatment results in only small changes in relative weight and frequent relapse. The current study investigated the effects of an Executive Functioning (EF) training with game-elements on weight loss maintenance in obese children, over and above the care as usual in an
Barstad, Lisa Ha; Júlíusson, Pétur B; Johnson, Line Kristin; Hertel, Jens Kristoffer; Lekhal, Samira; Hjelmesæth, Jøran
Obesity during adolescence is associated with cardiovascular mortality in adulthood. The adverse obesity-related cardiometabolic risk profile is already observed in adolescence. We aimed to examine possible gender differences in cardiometabolic risk factors and lifestyle behaviors among adolescents with severe obesity, hypothesizing that boys would have both a higher prevalence of the metabolic syndrome as well as less healthy lifestyle behaviors than girls. Cross-sectional study of treatment-seeking adolescents with severe obesity who attended the Morbid Obesity Centre at Vestfold Hospital Trust and who were consecutively enrolled in the Vestfold Register of Obese Children between September 2009 and September 2015. A total of 313 adolescents aged 12 to 18 years were recruited, whereof 268 subjects (49% boys) completed a food and activity frequency questionnaire and were included in the analysis. Mean (SD) age, BMI and BMI SDS were 15 (1.6) years, 38.6 (5.9) kg/m 2 and 3.5 (0.6). Levels of LDL cholesterol, fasting insulin and glucose and diastolic blood pressure (DBP) did not differ between genders. Compared to girls, boys had significantly higher triglycerides (p = 0.037) and systolic blood pressure (SBP) (p = 0.003), as well as lower HDL cholesterol (p = 0.002). The metabolic syndrome was present in 27% of the boys and 19% of the girls (p = 0.140), and the prevalence of high DBP, dyslipidemia and dysglycemia also did not differ significantly between genders. The prevalence of high SBP was higher in boys than in girls (19% vs. 9%, p = 0.021). Gender was associated with a number of lifestyle habits, as a larger proportions of boys had higher screen time (p = 0.032), more regular breakfast eating (p = 0.023), higher intake of sugar sweetened soda (p = 0.036), and lower intake of vegetables than girls (p = 0.011). By contrast, physical activity level and intake of fruit and berries did not differ between genders. Male treatment
Annesi, James J
It has been suggested that physical activity may affect weight reduction outcomes through associated improvements in mood. Relations of physical activity, mood, and weight change are not well understood in persons classified as severely obese (BMI > or = 40 kg/m(2)), however. This research tested these relationships in women with severe obesity. 57 women with a mean BMI of 43.8 kg/m(2) were enrolled in a cognitive-behavioral exercise support treatment with group-based nutrition information. Measurement of depression, tension, overall mood, and BMI was taken at baseline and month 6, and exercise session attendance was recorded. The treatment was associated with significant improvements in depression, tension and total mood disturbance scores as well as in BMI over 6 months. Changes in mood scores that were more positive were correlated with a greater reduction in BMI. Mean attendance in the prescribed 3 session/week exercise regimen was 46.0%, and attendance was significantly correlated with changes in tension and total mood disturbance scores, and approached significance with changes in depression scores. Findings suggested significant relations of mood and weight change as well as of physical activity and mood in severely obese women associated with a treatment of moderate physical activity. With extensions of this research, weight loss theory and treatment may benefit. Copyright 2008 S. Karger AG, Basel.
Chater, Peter I; Wilcox, Matthew D; Houghton, David; Pearson, Jeffrey P
Seaweeds are an underutilised nutritional resource that could not only compliment the current western diet but potentially bring additional health benefits over and above their nutritional value. There are four groups of seaweed algae; green algae (Chlorophyceae), red algae (Rhodophycae), blue-green algae (Cyanophyceae) and brown algae (Phaeophyceae). Seaweeds are rich in bioactive components including polysaccharides and polyphenols. Polysaccharides content, such as fucoidan, laminarin, as well as alginate is generally high in brown seaweeds which are also a source of polyphenols such as phenolic acids, flavonoids, phlorotannin, stilbenes and lignans. These components have been shown to reduce the activity of digestive enzymes, modulating enzymes such as α-amylase, α-glucosidase, pepsin and lipase. This review discusses the effect of several of these components on the digestive processes within the gastrointestinal tract; focusing on the effect of alginate on pancreatic lipase activity and its potential health benefits. Concluding that there is evidence to suggest alginate has the potential to be used as an obesity treatment, however, further in vivo research is required and an effective delivery method for alginate must be designed.
Hurren, Kathryn M; Dunham, Marissa W
Lorcaserin is a serotonin 2C receptor antagonist that was FDA approved in 2012. Lorcaserin is recently available as an extended-release (ER) formulation for the treatment of obesity as an adjunct to lifestyle modification. Areas covered: The pharmacokinetics, pharmacodynamics, efficacy, and safety of lorcaserin ER will be reviewed. Expert opinion: Lorcaserin ER 20mg daily provides drug exposure bioequivalent to lorcaserin immediate release (IR) 10mg twice daily. Lorcaserin IR is associated with 3.3 and 3.0% placebo-subtracted weight loss in patients without and with diabetes, respectively. A1C was reduced by 0.9% in patients with diabetes. Common side effects include headache, dry mouth, constipation, dizziness, fatigue, and nausea. Lorcaserin provides potential advantages over other antiobesity medications in regards to tolerability and simplicity of medication initiation, but may not be as effective as other options. Lorcaserin ER offers improved ease of administration and anticipated adherence compared to the IR formulation. The place in therapy for lorcaserin ER and other antiobesity medications will be further clarified by results of pending clinical trials addressing cardiovascular outcomes as well as the role pharmacogenomics and comorbid disease states may play in choosing patient-specific therapy.
Stice, Eric; Lawrence, Natalia S; Kemps, Eva; Veling, Harm
The present review first summarizes results from prospective brain imaging studies focused on identifying neural vulnerability factors that predict excessive weight gain. Next, findings from cognitive psychology experiments evaluating various interventions involving food response inhibition training or food response facilitation training are reviewed that appear to target these neural vulnerability factors and that have produced encouraging weight loss effects. Findings from both of these reviewed research fields suggest that interventions that reduce reward and attention region responses to high calorie food cues and increase inhibitory region responses to high calorie food cues could prove useful in the treatment of obesity. Based on this review, a new conceptual model is presented to describe how different cognitive training procedures may contribute to modifying eating behavior and important directions for future research are offered. It is concluded that there is a need for evaluating the effectiveness of more intensive food response training interventions and testing whether adding such training to extant weight loss interventions increases their efficacy. Copyright © 2016 Elsevier Ltd. All rights reserved.
Tate, Deborah F
The feasibility and efficacy of Internet treatment programs for overweight and obese people have been demonstrated in a series of randomized trials. Initial studies examined various approaches to Internet behavioral treatment. Other studies have examined delivery of group behavioral counseling using Internet chat rooms, using the Internet for long-term maintenance of weight loss, and enhancing motivation in Internet programs. These interventions have produced weight losses of 4-7 kg over 6 months to 1 year when support via e-mail, automated messages, or chat rooms is provided. Outcomes and lessons learned with application to the treatment of substance use and misuse are provided.
Mollerup, P M; Lausten-Thomsen, U; Fonvig, C E
Due to the pandemic of childhood obesity and thus obesity-related hypertension, improvements in treatment availability are needed. Hence, we investigated whether reductions in blood pressure (BP) would occur in children with overweight and obesity exhibiting prehypertension/hypertension during...... a community-based overweight and obesity treatment program, and if changes in body mass index (BMI) are associated with changes in BP. The study included 663 children aged 3-18 years with a BMI ⩾85th percentile for sex and age that entered treatment from June 2012 to January 2015. Height, weight and BP were....../hypertension developed in 23.3% of the normotensive children despite reductions in BMI SDSs (Pobesity treatment can reduce BP, and thus may help improve treatment availability....
Barrera-Cruz, Antonio; Avila-Jiménez, Laura; Cano-Pérez, Evaluz; Molina-Ayala, Mario Antonio; Parrilla-Ortiz, Juan Ismael; Ramos-Hernández, Rosa Isela; Sosa-Caballero, Alejandro; Sosa-Ruiz, María del Rosario; Gutiérrez-Aguilar, Judith
Excess body weight (overweight and obesity) is currently recognized as one of the most important challenges of public health in the world, due to its size, speed of growth and the negative effect on health. Currently, Mexico and United States have the highest prevalence of obesity in the adult population (30 %), which is nearly ten times higher than that of Japan or Korea (4 %). In our country, the trends of overweight and obesity in different national surveys show steady increase in prevalence over time. According to the results of the National Survey of Health and Nutrition 2012 (ENSANUT, according to its initials in Spanish), the combined prevalence of overweight or obese (BMI = 25 kg/m(2)) in the population over 20 years is higher in women (73.0 %) than men (69.4 %), while the prevalence of obesity (BMI = 30 kg/m(2)) is almost higher in females than in males. Global experience shows that proper care of obesity and overweight requires formulating and coordinating comprehensive and efficient multilevel strategies for enhancing protective factors to health, particularly to modify individual, family and community behavior. It is unlikely that a single intervention can modify the incidence or natural history of overweight and obesity.
Scheen, A J
Liraglutide is an analogue of Glucagon-Like Peptide-1 (GLP-1) already indicated under the trade name of Victoza for the treatment of type 2 diabetes, at usual doses of 1.2 or 1.8 mg as once daily subcutaneous injection. It is henceforth indicated at a dose of 3.0 mg, also as once daily subcutaneous injection, for the treatment of obesity or overweight with comorbidities under the trade name of Saxenda, in combination with diet and exercise. Besides a specific action on the endocrine pancreas, mainly responsible for the antihyperglycaemic effect, liraglutide helps controlling appetite at the hypothamalic level. A specific programme of controlled trials (especially SCALE studies) demonstrated both efficacy and safety of the 3.0 mg dose of liraglutide in obese or overweight patients with various comorbidities.
Bocca, Gianni; Kuitert, Mirije W B; Sauer, Pieter J J; Corpeleijn, Eva
The effects of multidisciplinary treatment programs on eating behavior in overweight preschool-aged children are largely unknown. We evaluated a multidisciplinary intervention program on eating behavior in 3- to 5-year-old overweight children, comparing them with children given standard treatment. We also assessed the parental eating behavior changes and investigated associations between parents and children. We randomized 75 children to a multidisciplinary intervention or to a standard care program. During a 16-week period, children and parents in the multidisciplinary group were given dietary advice, physical activity sessions and, for parents only, psychological counseling. Children and parents in the standard group visited a pediatrician 3 times and were given information on a healthy lifestyle. At baseline, after 16 weeks, and after 12 months, children were measured and parents completed the Dutch Child Eating Behavior Questionnaire (DEBQ-C) for their children and the DEBQ for themselves. At the three time points, 70 (93.3%), 57 (91.9%), and 42 (73.7%) DEBQ-Cs were analyzed. We found no differences in the changes in eating behavior between the two groups over time. In both groups, there was a significant increase in restrained eating behavior present at 16 weeks, however, this was no longer present at 12 months. We found no associations between changes in eating behavior between the children and their parents. A multidisciplinary obesity intervention program in preschool-aged children induced more restrained eating behavior between baseline and 16 weeks. However, there was no difference with the children in the standard care group.
Sabin, M A; Shield, J P H
The prevalence of childhood obesity continues to increase worldwide. Its presence is associated with significant adverse effects on health including an increased propensity to type II diabetes, cardiovascular, respiratory, and liver disease. In the vast majority of children, obesity is lifestyle-related, yet there is a dearth of evidence on how to best develop effective prevention and treatment strategies. This review outlines the importance of childhood and adolescent growth on long-term health, the definitions used to define obesity in children (along with up-to-date prevalence data), causes and consequences, and aspects of prevention and management.
Fenton, Kathryn; Marvicsin, Donna; Danford, Cynthia A
Evidence has shown correlations between obesity and sleep in children. The purpose of this review was to identify sleep interventions that could be utilized in primary care settings to prevent obesity in children. Three themes emerged: bedtime routines and environment; parental presence and graduated extinction; and health education. Effective strategies to improve sleep in children include consistent bedtime routine and self-soothing. Health care professionals can provide innovative and prevention-based sleep education for parents early in a child's development. Education, related to sleep, and appropriate sleep strategies may help prevent obesity and its long-term consequences. Copyright © 2014 Elsevier Inc. All rights reserved.
Waring, Molly E; Schneider, Kristin L; Appelhans, Bradley M; Busch, Andrew M; Whited, Matthew C; Rodrigues, Stephanie; Lemon, Stephenie C; Pagoto, Sherry L
Some adults with comorbid depression and obesity respond well to lifestyle interventions while others have poor outcomes. The objective of this study was to evaluate whether early-treatment weight loss progress predicts clinically significant 6-month weight loss among women with obesity and depression. We conducted a secondary analysis of data from 75 women with obesity and depression who received a standard lifestyle intervention. Relative risks (RRs) and 95% confidence intervals (CIs) for achieving ≥5% weight loss by 6 months were calculated based on whether they achieved ≥1 lb/week weight loss in weeks 2-8. Among those on target at week 3, we examined potential subsequent time points at which weight loss progress might identify additional individuals at risk for treatment failure. At week 2, women who averaged ≥1 lb/week loss were twice as likely to achieve 5% weight loss by 6 months than those who did not (RR=2.40; 95% CI: 2.32-4.29); weight loss at weeks 3-8 was similarly predictive (RRs=2.02-3.20). Examining weight loss progress at week 3 and subsequently at a time point during weeks 4-8, 52-67% of participants were not on target with their weight loss, and those on target were 2-3 times as likely to achieve 5% weight loss by 6 months (RRs=1.82-2.92). Weight loss progress as early as week 2 of treatment predicts weight loss outcomes for women with comorbid obesity and depression, which supports the feasibility of developing stepped care interventions that adjust treatment intensity based on early progress in this population. Copyright © 2014 Elsevier Inc. All rights reserved.
Lopez-Legarrea, P. (Patricia); Zulet, M.A. (María Ángeles); Martinez, J.A. (José Alfredo)
Obesity and metabolic syndrome (MetS) have become major public health problems worldwide. Dietary strategies represent the primary choice treatment. The aim of this study was to investigate the effect of a new energy-restricted dietary strategy (RESMENA) involving different dietary aspects such us a modified macronutrient profile including a moderately increased amount of proteins, an augmented meal frequency, an enhancement of low GI/GL and high antioxidant content food and with a high adher...
Kahal, Hassan; Aburima, Ahmed; Ungvari, Tamas; Rigby, Alan S; Coady, Anne M; Vince, Rebecca V; Ajjan, Ramzi A; Kilpatrick, Eric S; Naseem, Khalid M; Atkin, Stephen L
Polycystic ovary syndrome (PCOS) is associated with obesity and increased cardiovascular (CV) risk markers. In this study our aim was to assess the effects of six months treatment with liraglutide 1.8 mg od on obesity, and CV risk markers, particularly platelet function, in young obese women with PCOS compared to controls of similar age and weight. Carotid intima-media wall thickness (cIMT) was measured by B-mode ultrasonography, platelet function by flow cytometry, clot structure/lysis by turbidimetric assays and endothelial function by ELISA and post-ischaemic reactive hyperemia (RHI). Data presented as mean change (6-month - baseline) ± standard deviation. Nineteen obese women with PCOS and 17 controls, of similar age and weight, were recruited; baseline atherothrombotic risk markers did not differ between the two groups. Twenty five (69.4%) participants completed the study (13 PCOS, 12 controls). At six months, weight was significantly reduced by 3.0 ± 4.2 and 3.8 ± 3.4 kg in the PCOS and control groups, respectively; with no significant difference between the two groups, P = 0.56. Similarly, HOMA-IR, triglyceride, hsCRP, urinary isoprostanes, serum endothelial adhesion markers (sP-selectin, sICAM and sVCAM), and clot lysis area were equally significantly reduced in both groups compared to baseline. Basal platelet P-selectin expression was significantly reduced at six months in controls -0.17 ± 0.26 but not PCOS -0.12 ± 0.28; between groups difference, 95% confidence interval = -0.14 - 0.26, P = 0.41. No significant changes were noted in cIMT or RHI. Six months treatment with liraglutide (1.8 mg od) equally affected young obese women with PCOS and controls. In both groups, liraglutide treatment was associated with 3-4% weight loss and significant reduction in atherothrombosis markers including inflammation, endothelial function and clotting. Our data support the use of liraglutide as weight loss medication in simple obesity
Full Text Available To characterize treatment-seeking young adults (16-25 years with severe obesity, particularly mental health problems.Cross-sectional study of 165 participants (132 women, 33 men with BMI ≥35 kg/m2 or ≥30 kg/m2 with comorbidities, enrolling in a multidisciplinary obesity treatment program.Data collection at admission of present and life-time health issues including symptomatology of anxiety, depression (Hospital Anxiety and Depression Scale and attention-deficit/hyperactivity disorder (Adult ADHD Self-Report scale; self-esteem (Rosenberg Self-Esteem Scale, suicide attempts, health-related quality of life (Short Form-36 Health Survey, psychosocial functioning related to obesity (Obesity-related Problems Scale, cardiorespiratory fitness (Astrand's bicycle ergometer test, somatic and psychiatric co-morbidities, cardiometabolic risk factors, and micronutritional status. We used multiple regression analysis to identify variables independently associated with present anxiety and depressive symptomatology.Mean body mass index was 39.2 kg/m2 (SD = 5.2. We found evidence of poor mental health, including present psychiatric diagnoses (29%, symptomatology of anxiety (47%, depression (27% and attention-deficit/hyperactivity disorder (37%; low self-esteem (42%, attempted suicide (12%, and low quality of life (physical component score = 46, SD = 11.2; mental component score = 36, SD = 13.9, P<0.001 for difference. Variables independently associated with present anxiety symptomatology (R2 = 0.33, P<0.001 included low self-esteem (P<0.001 and pain (P = 0.003, whereas present depressive symptomatology (R2 = 0.38, P<0.001 was independently associated with low self-esteem (P<0.001, low cardiorespiratory fitness (P = 0.009 and obesity-related problems (P = 0.018. The prevalence of type 2 diabetes was 3%, and hypertension 2%. Insulin resistance was present in 82%, lipid abnormality in 62%, and poor cardiorespiratory fitness in 92%. Forty-eight percent had at
Dreber, H; Reynisdottir, S; Angelin, B; Tynelius, P; Rasmussen, F; Hemmingsson, E
Young adults (18-25) with severe obesity constitute a challenging patient group, and there is limited evidence about their mental health status compared to population controls. Mental distress in treatment seeking young adults with severe obesity (n = 121, mean body mass index [BMI] = 39.8 kg m -2 ) was compared with matched (1:3 for age, gender and socioeconomic status) population controls of normal weight (n = 363, mean BMI = 22.4 kg m -2 ), as well as unmatched population controls with class I obesity (n = 105, mean BMI = 32.1 kg m -2 ) or severe obesity (n = 41, mean BMI = 39.7 kg m -2 ). Mental distress was measured by the General Health Questionnaire-12 (GHQ-12), and we quantified physician-diagnosed depression, present anxiety and suicide attempts. Poisson regression and linear regression analysis were used for analysing differences in mental distress between groups. Treatment seekers experienced more mental distress than normal weight controls as measured by continuous (adjusted mean: 3.9 vs. 2.2 points, P obesity (adjusted mean: 2.3 points) or severe obesity (adjusted mean: 2.1; both, P Young adult treatment seekers with severe obesity constitute a risk group for mental distress compared to population controls of different BMI levels. © 2017 World Obesity Federation.
Siva Sankara Vara Prasad Sakamuri
Full Text Available BACKGROUND: 11beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1 regulates local glucocorticoid action in tissues by catalysing conversion of inactive glucocorticoids to active glucocorticoids. 11β-HSD1 inhibition ameliorates obesity and associated co-morbidities. Here, we tested the effect of 11β-HSD inhibitor, carbenoxolone (CBX on obesity and associated comorbidities in obese rats of WNIN/Ob strain, a new animal model for genetic obesity. METHODOLOGY/PRINCIPAL FINDINGS: Subcutaneous injection of CBX (50 mg/kg body weight or volume-matched vehicle was given once daily for four weeks to three month-old WNIN/Ob lean and obese rats (n = 6 for each phenotype and for each treatment. Body composition, plasma lipids and hormones were assayed. Hepatic steatosis, adipose tissue morphology, inflammation and fibrosis were also studied. Insulin resistance and glucose intolerance were determined along with tissue glycogen content. Gene expressions were determined in liver and adipose tissue. CBX significantly inhibited 11β-HSD1 activity in liver and adipose tissue of WNIN/Ob lean and obese rats. CBX significantly decreased body fat percentage, hypertriglyceridemia, hypercholesterolemia, insulin resistance in obese rats. CBX ameliorated hepatic steatosis, adipocyte hypertrophy, adipose tissue inflammation and fibrosis in obese rats. Tissue glycogen content was significantly decreased by CBX in liver and adipose tissue of obese rats. Severe fat loss and glucose- intolerance were observed in lean rats after CBX treatment. CONCLUSIONS/SIGNIFICANCE: We conclude that 11β-HSD1 inhibition by CBX decreases obesity and associated co-morbidities in WNIN/Ob obese rats. Our study supports the hypothesis that inhibition of 11β-HSD1 is a key strategy to treat metabolic syndrome. Severe fat loss and glucose -intolerance by CBX treatment in lean rats suggest that chronic 11β-HSD1 inhibition may lead to insulin resistance in normal conditions.
Obesity and eating disorders are usually considered unrelated problems with different causes. However, various studies identify unhealthful weight-control behaviors (fasting, vomiting, or laxative abuse), induced by a negative experience of the body, as the common antecedents of both obesity and eating disorders. But how might negative body image--common to most adolescents, not only to medical patients--be behind the development of obesity and eating disorders? In this paper, I review the "allocentric lock theory" of negative body image as the possible antecedent of both obesity and eating disorders. Evidence from psychology and neuroscience indicates that our bodily experience involves the integration of different sensory inputs within two different reference frames: egocentric (first-person experience) and allocentric (third-person experience). Even though functional relations between these two frames are usually limited, they influence each other during the interaction between long- and short-term memory processes in spatial cognition. If this process is impaired either through exogenous (e.g., stress) or endogenous causes, the egocentric sensory inputs are unable to update the contents of the stored allocentric representation of the body. In other words, these patients are locked in an allocentric (observer view) negative image of their body, which their sensory inputs are no longer able to update even after a demanding diet and a significant weight loss. This article discusses the possible role of virtual reality in addressing this problem within an integrated treatment approach based on the allocentric lock theory. © 2011 Diabetes Technology Society.
Freitas, Camila R M; Gunnarsdottir, Thrudur; Fidelix, Yara L; Tenório, Thiago R S; Lofrano-Prado, Mara C; Hill, James O; Prado, Wagner L
To investigate the effects of multidisciplinary treatment with and without psychological counseling on obese adolescents' self-reported quality of life. Seventy-six obese adolescents (15.87±1.53 y) were allocated into psychological counseling group (PCG; n=36) or control group (CG; n=40) for 12 weeks. All participants received the same supervised exercise training, nutritional and clinical counseling. Participants in PCG also received psychological counseling. QOL was measured before and after 12 weeks of intervention by Generic Questionnaire for the Evaluation of Quality of Life (SF-36). The dropout rate was higher in GC (22.5%) when compared with PCG (0.0%) (p<0.001). After 12 weeks, participants from PCG presents lower body weight, relative fat mass and higher free fat mass (p<0.001 for all) compared to GC. QOL improved among adolescents from both groups (p<0.05), however, a better QOL was reported from those adolescents enrolled in PCG. The inclusion of a psychological counseling component in multidisciplinary treatment for adolescent obesity appears to provide benefits observed for improved QOL as compared with treatment without psychological counseling. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
Forman, Evan M; Butryn, Meghan L; Manasse, Stephanie M; Crosby, Ross D; Goldstein, Stephanie P; Wyckoff, Emily P; Thomas, J Graham
To evaluate the efficacy, as well as potential moderators and mediators, of a revised acceptance-based behavioral treatment (ABT) for obesity, relative to standard behavioral treatment (SBT). Participants with overweight and obesity (n = 190) were randomized to 25 sessions of ABT or SBT over 1 year. Primary outcome (weight), mediator, and moderator measurements were taken at baseline, 6 months, and/or 12 months, and weight was also measured every session. Participants assigned to ABT attained a significantly greater 12-month weight loss (13.3% ± 0.83%) than did those assigned to SBT (9.8% ± 0.87%; P = 0.005). A condition by quadratic time effect on session-by-session weights (P = 0.01) indicated that SBT had a shallower trajectory of weight loss followed by an upward deflection. ABT participants were also more likely to maintain a 10% weight loss at 12 months (64.0% vs. 48.9%; P = 0.04). No evidence of moderation was found. Results supported the mediating role of autonomous motivation and psychological acceptance of food-related urges. Behavioral weight loss outcomes can be improved by integrating self-regulation skills that are reflected in acceptance-based treatment, i.e., tolerating discomfort and reduction in pleasure, enacting commitment to valued behavior, and being mindfully aware during moments of decision-making. © 2016 The Obesity Society.
Ewald, H; Kirby, J; Rees, K; Robertson, W
An effective and cost-effective treatment is required for the treatment of childhood obesity. Comparing parent-only interventions with interventions including the child may help determine this. A systematic review of published and ongoing studies until 2013, using electronic database and manual searches. randomized controlled trials, overweight/obese children aged 5-12 years, parent-only intervention compared with an intervention that included the child, 6 months or more follow-up. Outcomes included measures of overweight. Ten papers from 6 completed studies, and 2 protocols for ongoing studies, were identified. Parent-only groups are either more effective than or similarly effective as child-only or parent-child interventions, in the change in degree of overweight. Most studies were at unclear risk of bias for randomization, allocation concealment and blinding of outcome assessors. Two trials were at high risk of bias for incomplete outcome data. Four studies showed higher dropout from parent-only interventions. One study examined programme costs and found parent-only interventions to be cheaper. Parent-only interventions appear to be as effective as parent-child interventions in the treatment of childhood overweight/obesity, and may be less expensive. Reasons for higher attrition rates in parent-only interventions need further investigation. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Högberg, T.; Frimurer, T.M.; Sasmal, P.K.
Obesity is a global epidemic associated with multiple severe diseases. Several pharmacotherapies have been investigated including the melanin concentrating hormone (MCH) and its receptor 1. The development of MCHR1 antagonists are described with a specific perspective on different chemotypes...
This article examines psychological sequelae underlying dysregulated eating in the overweight and obese patient and proposes a psychotherapy approach informed by classical and modern attachment theory, developmental trauma, and neuroscience to address these structural deficits.
Carter, Adrian; Hendrikse, Joshua; Lee, Natalia; Yücel, Murat; Verdejo-Garcia, Antonio; Andrews, Zane B.; Hall, Wayne
There is a growing view that certain foods, particularly those high in refined sugars and fats, are addictive and that some forms of obesity can usefully be treated as a food addiction. This perspective is supported by a growing body of neuroscience research demonstrating that the chronic consumption of energy-dense foods causes changes in the brain's reward pathway that are central to the development and maintenance of drug addiction. Obese and overweight individuals also display patterns of eating behavior that resemble the ways in which addicted individuals consume drugs. We critically review the evidence that some forms of obesity or overeating could be considered a food addiction and argue that the use of food addiction as a diagnostic category is premature. We also examine some of the potential positive and negative clinical, social, and public policy implications of describing obesity as a food addiction that require further investigation.
Mancini, Marcio C; de Melo, Maria Edna
The prevalence of obesity increases worldwide. Treating obesity and its associated health problems has a significant economic impact on health care systems. The unsatisfactory long-term outcomes observed in the obesity treatment are due to its complex pathophysiology and the inherent difficulties associated with maintenance of lifestyle modifications. Determined by genetic and environmental factors, obesity has been officially recognized as a chronic disease, an action that allowed the recognition of anti-obesity drugs as legitimate therapeutic options to address the growing obesity endemic. Like other chronic diseases, obesity requires long-term treatment. Pharmacological interventions, when used as an adjunct to lifestyle changes, are useful to facilitate clinically meaningful weight loss, which may impact on obesity-associated comorbid conditions. In the past, medications for weight reduction were limited. However, the landscape has changed and new drugs provide additional options for weight management. Among the new drugs, liraglutide is the most studied, especially regarding its effects on the limbic system. As an adjunct to a reduced-calorie diet and increased physical activity, treatment with liraglutide 3.0 mg provides a statistically significant and clinically meaningful weight loss. Liraglutide is a glucagon-like peptide 1 (GLP-1) receptor agonist that shares 97% homology to native GLP-1. Receptor agonists of GLP-1, including liraglutide, have emerged as effective therapies for type 2 diabetes and obesity. This review will address the major findings concerning the central regulation of appetite and the main studies that evaluated new drugs for obesity treatment, with a greater focus on liraglutide 3.0 mg.
Videmsek, Mateja; Stihec, Joze; Karpljuk, Damir; Starman, Anja
The aims of the study were to analyse the sport activity and eating habits of obese people in their childhood and adulthood. The research was underpinned by a survey questionnaire containing 37 variables which was completed by 71 people attending the obesity programme. The frequencies and contingency tables were calculated, whereas statistical significance was established at a 5% significance level. The analysis of the results showed that more than one-half of the survey respondents joined the obesity programme primarily for reasons of health and well-being. Most obese people did not engage in any organised sport activity in their childhood, nor did most of their parents. The respondents practiced sport in their childhood to a greater extent if their parents were also physically active and if they guided and encouraged their children. No less than one-third of the respondents were overweight in their childhood, of whom two-thirds did not participate in any organised sport activity. The majority of the respondents (85.9%) are currently engaged in an organised sport activity in their adulthood, mainly due to their participation in the weight reduction programme; most of them practice sport twice a week. Their eating habits are encouraging; the share of skipped meals is considerably lower and practically negligible compared to that in childhood. It has to be emphasized that most of them are of opinion that obese people have difficulties finding expert information on obesity, nutrition and sport activities as well as weight management centers and institutions.
Hoelscher, Deanna M; Kirk, Shelley; Ritchie, Lorrene; Cunningham-Sabo, Leslie
It is the position of the Academy of Nutrition and Dietetics that prevention and treatment of pediatric overweight and obesity require systems-level approaches that include the skills of registered dietitians, as well as consistent and integrated messages and environmental support across all sectors of society to achieve sustained dietary and physical-activity behavior change. This position paper provides guidance and recommendations for levels of intervention targeting overweight and obesity prevention and treatment from preschool age through adolescence. Methods included a review of the literature from 2009 to April 2012, including the Academy's 2009 evidence analysis school-based reviews. Multicomponent interventions show the greatest impact for primary prevention; thus, early childhood and school-based interventions should integrate behavioral and environmental approaches that focus on dietary intake and physical activity using a systems-level approach targeting the multilevel structure of the socioecological model as well as interactions and relationships between levels. Secondary prevention and tertiary prevention/treatment should emphasize sustained family-based, developmentally appropriate approaches that include nutrition education, dietary counseling, parenting skills, behavioral strategies, and physical-activity promotion. For obese youth with concomitant serious comorbidities, structured dietary approaches and pharmacologic agents should be considered, and weight-loss surgery can be considered for severely obese adolescents. Policy and environmental interventions are recommended as feasible and sustainable ways to support healthful lifestyles for children and families. The Academy supports commitment of resources for interventions, policies, and research that promote healthful eating and physical-activity behaviors to ensure that all youth have the opportunity to achieve and maintain a weight that is optimal for health. Copyright © 2013 Academy of
Full Text Available Rimonabant, a selective cannabinoid-1 (CB1 receptor antagonist, has been shown to reduce weight and enhance improvements in cardiometabolic risk parameters in Western populations. This study assessed these effects of rimonabant in Asian population. A total of 643 patients (BMI 25 kg/m2 or greater without diabetes from China, Republic of Korea, and Taiwan were prescribed a hypocaloric diet (600 kcal/day deficit and randomized to rimonabant 20 mg (n=318 or placebo (n=325 for 9months. The primary efficacy variable was weight change from baseline after 9 months of treatment. Results showed that rimonabant group lost more weight than placebo, (LSM ± SEM of −4.7 ± 0.3 kg vs. −1.7 ± 0.3 kg, P<.0001. The 5% and 10% responders were 2 or 3 folds more in the rimonabant group (53.0% vs. 20.0% and 21.5% vs. 5.7%, resp. (P<.0001. Rimonabant also significantly increased HDL-cholesterol, decreased triglycerides and waist circumference,by 7.1%, 10.6%, and 2.8 cm, respectively (P<.0001. This study confirmed the comparable efficacy and safety profile of rimonabant in Asian population to Caucasians. Owing to the recent suspension of all the CB1 antagonists off the pharmaceutical market for weight reduction in Europe and USA, a perspective in drug discovery for intervening peripheral CB1 receptor in the management of obesity is discussed.
Full Text Available Priscilla A Hollander1,21Baylor Endocrine Center, 2Baylor Medical Center, Dallas, Texas, USAAbstract: The risk for developing type 2 diabetes (T2DM is greater among obese individuals. Following onset of the disease, patients with T2DM become more likely to be afflicted with diabetic micro- and macrovascular complications. Decreasing body weight has been shown to lower glycosylated hemoglobin and improve other metabolic parameters in patients with T2DM. Medications used to lower blood glucose may increase body weight in patients with T2DM and this has been repeatedly shown to be the case for conventional, human insulin formulations. Insulin detemir is a neutral, soluble, long-acting insulin analog in which threonine-30 of the insulin B-chain is deleted, and the C-terminal lysine is acetylated with myristic acid, a C14 fatty acid chain. Insulin detemir binds to albumin, a property that enhances its pharmacokinetic/pharmacodynamic profile. Results from clinical trials have demonstrated that treatment with insulin detemir is associated with less weight gain than either insulin glargine or neutral protamine Hagedorn insulin. There are many potential reasons for the lower weight gain observed among patients treated with insulin detemir, including lower risk for hypoglycemia and therefore decreased defensive eating due to concern about this adverse event, along with other effects that may be related to the albumin binding of this insulin that may account for lower within-patient variability and consistent action. These might include faster transport across the blood–brain barrier, induction of satiety signaling in the brain, and preferential inhibition of hepatic glucose production versus peripheral glucose uptake. Experiments in diabetic rats have also indicated that insulin detemir increases adiponectin levels, which is associated with both weight loss and decreased eating.Keywords: basal insulin, body mass index, detemir, insulin analog, satiety
Favero, L; Arreghini, A; Cocilovo, F; Favero, V
Obesity and allergic susceptibility are worsening problems in the most industrialised countries. With different mechanisms, they both lead to a deterioration of children's life quality because they affect the respiratory system, leading to asthma and respiratory disorders such as mouth breathing and obstructive sleep apnoea. The latter are related to specific types of malocclusions that require an early diagnosis and specific multidisciplinary treatment. The purpose of this work is to show the characteristic signs and symptoms of these disorders in children of the two phenotypes (allergic and slim, obese and dysmetabolic). Intercepting such issues allows both pediatricians and paediatric dentists to refer the child to a multidisciplinary team of specialists able to deal, in a holistic way, with both the physical and behavioural causes, and also with the consequences on systemic and craniofacial development in particular. The literature available on this topic in the years between 1997 and 2011 was reviewed, paying special attention to prevention, paediatric visits, diagnostic tools and treatment options for each of the two conditions. Dysmetabolic obese children and allergic slim children have specific respiratory problems during rest and exercise. Mouth breathing and obstructive sleep apnoea are due to an abnormal craniofacial development and can cause serious systemic problems in adulthood. Intercepting early signs of pathognomonic symptoms of sleep aponea and mouth breathing permits to treat children with an early multidisciplinary approach, and allows for proper physical and psychological development of the child.
Barnes, Rachel D.; Sawaoka, Takuya; White, Marney A.; Masheb, Robin M.; Grilo, Carlos M.
Prior research on the relations among eating behaviors and thought suppression is limited to a measure of general thought suppression, the White Bear Suppression Inventory. To address this limitation, researchers recently validated the Food Thought Suppression Inventory (FTSI). Analyses using this measure suggest that food thought suppression is distinct from and is more predictive of eating disorder psychopathology than is general thought suppression. The FTSI, however, has not yet been validated in clinical samples. The purpose of the current study is to examine the factor structure and clinical correlates of the FTSI within treatment seeking obese women with binge eating disorder (BED; N = 128). Analyses revealed a valid and reliable one-factor measure of food thought suppression that was related to higher levels of eating and general psychopathology. The findings provide evidence for the use of the FTSI with obese women with BED. Future research should examine the psychometric properties of the FTSI within larger and more diverse samples. PMID:23265399
Sánchez-Garrido, Miguel A; Brandt, Sara J; Clemmensen, Christoffer; Müller, Timo D; DiMarchi, Richard D; Tschöp, Matthias H
Over a relatively short period, obesity and type 2 diabetes have come to represent a large medical and economic burden to global societies. The epidemic rise in the prevalence of obesity has metabolic consequences and is paralleled by an increased occurrence of other diseases, such as diabetes, cancer and cardiovascular complications. Together, obesity and type 2 diabetes constitute one of the more preventable causes of premature death and the identification of novel, safe and effective anti-obesity drugs is of utmost importance. Pharmacological attempts to treat obesity have had limited success, with notable adverse effects, rendering bariatric surgery as the only current therapy for substantially improving body weight. Novel unimolecular, multifunctional peptides have emerged as one of the most promising medicinal approaches to enhance metabolic efficacy and restore normal body weight. In this review, we will mainly focus on the discovery and translational relevance of dual agonists that pharmacologically function at the receptors for glucagon and glucagon-like peptide-1. Such peptides have advanced to clinical evaluation and inspired the pursuit of multiple related approaches to achieving polypharmacy within single molecules.
Dalle Grave, Riccardo; Calugi, Simona; El Ghoch, Marwan
Some personality traits seem to be associated with obesity, but there is little information available regarding their association with obesity treatment outcomes. The aim of this systematic review was therefore to assess the associations between personality traits-evaluated by means of the Temperament and Character Inventory (TCI)-and outcomes of obesity treatment, including attrition, weight loss, and weight loss maintenance. The PubMed database was searched, and studies were screened as per the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, and data were collated using a narrative approach. Of the 886 articles retrieved, 9 studies assessing personality traits by means of the TCI in participants with obesity met the inclusion criteria and were reviewed. This approach revealed three main findings: (i) only one study found that attrition rate-during a 6-month behavioral weight loss program-is predicted by low reward dependence scores at baseline; (ii) two studies found that lower novelty-seeking and higher self-directedness scores at baseline positively predict short-term weight-loss magnitude; and (iii) four studies found that higher persistence and lower novelty-seeking scores at baseline predicted weight maintenance at 12 and 24 months. Novelty-seeking and self-directedness traits appear to be predictors of short-term weight loss (≤ 6 months), and persistence and novelty-seeking traits may be related to long-term weight loss maintenance (≥ 12 months), although great uncertainty still exists regarding predictors of attrition.
Incorporating Primary and Secondary Prevention Approaches To Address Childhood Obesity Prevention and Treatment in a Low-Income, Ethnically Diverse Population: Study Design and Demographic Data from the Texas Childhood Obesity Research Demonstration (TX CORD) Study
Butte, Nancy F.; Barlow, Sarah; Vandewater, Elizabeth A.; Sharma, Shreela V.; Huang, Terry; Finkelstein, Eric; Pont, Stephen; Sacher, Paul; Byrd-Williams, Courtney; Oluyomi, Abiodun O.; Durand, Casey; Li, Linlin; Kelder, Steven H.
Abstract Background: There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2–12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. Methods: Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. Results: Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3–83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. Conclusions: Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity. PMID:25555188
Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study.
Hoelscher, Deanna M; Butte, Nancy F; Barlow, Sarah; Vandewater, Elizabeth A; Sharma, Shreela V; Huang, Terry; Finkelstein, Eric; Pont, Stephen; Sacher, Paul; Byrd-Williams, Courtney; Oluyomi, Abiodun O; Durand, Casey; Li, Linlin; Kelder, Steven H
There is consensus that development and evaluation of a systems-oriented approach for child obesity prevention and treatment that includes both primary and secondary prevention efforts is needed. This article describes the study design and baseline data from the Texas Childhood Obesity Research Demonstration (TX CORD) project, which addresses child obesity among low-income, ethnically diverse overweight and obese children, ages 2-12 years; a two-tiered systems-oriented approach is hypothesized to reduce BMI z-scores, compared to primary prevention alone. Our study aims are to: (1) implement and evaluate a primary obesity prevention program; (2) implement and evaluate efficacy of a 12-month family-centered secondary obesity prevention program embedded within primary prevention; and (3) quantify the incremental cost-effectiveness of the secondary prevention program. Baseline demographic and behavioral data for the primary prevention community areas are presented. Baseline data from preschool centers, elementary schools, and clinics indicate that most demographic variables are similar between intervention and comparison communities. Most families are low income (≤$25,000) and Hispanic/Latino (73.3-83.8%). The majority of parents were born outside of the United States. Child obesity rates exceed national values, ranging from 19.0% in preschool to 35.2% in fifth-grade children. Most parents report that their children consume sugary beverages, have a television in the bedroom, and do not consume adequate amounts of fruits and vegetables. Interventions to address childhood obesity are warranted in low-income, ethnically diverse communities. Integrating primary and secondary approaches is anticipated to provide sufficient exposure that will lead to significant decreases in childhood obesity.
Barlow, S E; Dietz, W H
The development of recommendations for physicians, nurse practitioners, and nutritionists to guide the evaluation and treatment of overweight children and adolescents. The Maternal and Child Health Bureau, Health Resources and Services Administration, the Department of Health and Human Services convened a committee of pediatric obesity experts to develop the recommendations. The Committee recommended that children with a body mass index (BMI) greater than or equal to the 85th percentile with complications of obesity or with a BMI greater than or equal to the 95th percentile, with or without complications, undergo evaluation and possible treatment. Clinicians should be aware of signs of the rare exogenous causes of obesity, including genetic syndromes, endocrinologic diseases, and psychologic disorders. They should screen for complications of obesity, including hypertension, dyslipidemias, orthopedic disorders, sleep disorders, gall bladder disease, and insulin resistance. Conditions that indicate consultation with a pediatric obesity specialist include pseudotumor cerebri, obesity-related sleep disorders, orthopedic problems, massive obesity, and obesity in children younger than 2 years of age. Recommendations for treatment evaluation included an assessment of patient and family readiness to engage in a weight-management program and a focused assessment of diet and physical activity habits. The primary goal of obesity therapy should be healthy eating and activity. The use of weight maintenance versus weight loss to achieve weight goals depends on each patient's age, baseline BMI percentile, and presence of medical complications. The Committee recommended treatment that begins early, involves the family, and institutes permanent changes in a stepwise manner. Parenting skills are the foundation for successful intervention that puts in place gradual, targeted increases in activity and targeted reductions in high-fat, high-calorie foods. Ongoing support for families
Stroh, C; Wilhelm, B; Weiner, R; Ludwig, K; Benedix, F; Knoll, C; Lippert, H; Manger, T; Adipositas, Kompetenznetz
Since January 2005, the situation of metabolic and obesity surgery in Germany has been constantly evaluated by the German Bariatric Surgery Registry (GBSR). Data registration is performed using an internet online database with prospective data collection. All registered data were analysed in cooperation with the Institute of Quality Assurance at the Otto-von-Guericke University Magdeburg. Data collection includes primary and revision/redo-procedures. A main focus of the current study is the analysis of data regarding the perioperative management, in particular, administration of antibiotics. Since 2005 a significant increase of primary bariatric procedures has been reported. For evaluation of the antibiotic regimen 12 296 primary operations including 684 balloons (BIB), 2950 gastric bandings (GB), 5115 Roux-en-Y-gastric bypasses (RYGBP), 120 Scopinaro's biliopancreatic diversions (BPD), 164 duodenal switches (DS), 3125 sleeve gastrectomies (SG) and 138 other procedures were analysed. In total 77.3 % of the patients with primary procedures received perioperative antibiotics. Patients without concomitant comorbidities received antibiotics significantly less often compared to those with comorbidities. Wound infection rates were comparable for patients who underwent either gastric banding or sleeve gastrectomy. Surgery has been accepted step by step as a treatment for morbid obesity and its comorbidities in Germany during the last few years. There is only little experience in the literature regarding antibiotic therapy as well as prophylaxis in bariatric surgery. Based on the results of the current study we recommend rather the selective than the routine use of antibiotics depending on different parameters, e.g., operative time, preoperative BMI and concomitant comorbidities. Georg Thieme Verlag KG Stuttgart · New York.
Boutelle, Kerri N; Braden, Abby; Douglas, Jennifer M; Rhee, Kyung E; Strong, David; Rock, Cheryl L; Wilfley, Denise E; Epstein, Leonard; Crow, Scott
Approximately 1 out of 3 children in the United States is overweight or obese. Family-based treatment (FBT) is considered the gold-standard treatment for childhood obesity, but FBT is both staff and cost intensive. Therefore, we developed the FRESH (Family, Responsibility, Education, Support, & Health) study to evaluate the effectiveness of intervening with parents, without child involvement, to facilitate and improve the child's weight status. Targeting parents directly in the treatment of childhood obesity could be a promising approach that is developmentally appropriate for grade-school age children, highly scalable, and may be more cost effective to administer. The current paper describes the FRESH study which was designed to compare the effectiveness of parent-based therapy for pediatric obesity (PBT) to a parent and child (FBT) program for childhood obesity. We assessed weight, diet, physical activity, and parenting, as well as cost-effectiveness, at baseline, post-treatment, and at 6- and 18-month follow-ups. Currently, all participants have been recruited and completed assessment visits, and the initial stages of data analysis are underway. Ultimately, by evaluating a PBT model, we hope to optimize available child obesity treatments and improve their translation into clinical settings. Copyright © 2015 Elsevier Inc. All rights reserved.
Inge, Thomas H; Pfluger, Paul; Zeller, Meg; Rose, Susan R; Burget, Lukas; Sundararajan, Sumana; Daniels, Stephen R; Tschöp, Matthias H
A 14-year-old boy presented with daytime somnolence, intermittent emesis and hypothyroidism. Neuroimaging revealed a calcified suprasellar intracranial mass, suspected to be a craniopharyngioma. Subtotal resection of the tumor confirmed the diagnosis. Extreme obesity (BMI >60 kg/m(2)) and hyperinsulinemia followed tumor resection and cranial irradiation. Dietary interventions were unsuccessful, and pharmacologic intervention (i.e. octreotide) only slowed the rate of weight gain. Radiography documented the suprasellar mass. Following surgical resection and radiotherapy, hypothalamic-pituitary deficiencies were found. Preprandial and postprandial excursions of insulin, active ghrelin and leptin were measured before and after gastric bypass surgery. Panhypopituitarism, hypothalamic obesity and hyperinsulinemia following craniopharyngioma therapy. Severe caloric restriction, octreotide, and pituitary hormone replacement did not produce weight loss. Gastric bypass surgery led to reduced food cravings, significant weight loss, and amelioration of obesity-related comorbidities. Correction of fasting hyperinsulinemia, normalization of postprandial insulin responses, and reductions in active ghrelin and leptin concentrations were also observed.
Andreia Cristina Ferraz Araújo
Full Text Available ABSTRACT: The present study evaluated the effects of baru nut consumption on body weight, percent adiposity, amount of adipose tissue and blood levels in obese male Swiss mice. After inducing obesity by providing high-glucose diet (60 days, the mice were divided into 4 groups (7 animals per group and were fed on a control diet (C, high-glucose diet (HG or high-glucose diet added with baru (HGBA or soybean oil (HGSO. Groups fed with diet HGBA had a decrease in the weight gain and glucose and triglyceride levels when compared to diet HG. Aimals fed with HG exhibited a higher proportion of epididymal and retroperitoneal adipose tissue. The inclusion of baru nut in the diet improved the control of weight gain and glucose and triglyceride levels in obese mice.
Full Text Available Objective: Recent case reports suggest a link between reduced melanocortinergic tone and both obesity and attention deficit / hyperactivity disorder (ADHD. We present the case of a 13-year-old, male, obese MC4R mutation carrier with ADHD. Case Report: The boy carries a heterozygous mutation in the melanocortin 4 receptor gene (MC4R; Met281Val, that leads to a reduced receptor function. Dominant mutations of this type represent major gene effects for obesity. He participated in a lifestyle intervention program for obesity and received treatment with the selective norepinephrine re-uptake inhibitor atomoxetine for 31 months. The boy markedly reduced his BMI from 47.2 to 29.6 kg/m². Conclusion: Atomoxetine proved to efficiently reduce weight in a severely obese MC4R mutation carrier with ADHD. We briefly discuss possible mechanisms for our observation, including evidence for the functional connectivity between melanocortinergic, dopaminergic, and norepinephrinergic brain circuitries.
Linde, Jennifer A; Simon, Gregory E; Ludman, Evette J; Ichikawa, Laura E; Operskalski, Belinda H; Arterburn, David; Rohde, Paul; Finch, Emily A; Jeffery, Robert W
Obesity is associated with clinical depression among women. However, depressed women are often excluded from weight loss trials. This study examined treatment outcomes among women with comorbid obesity and depression. Two hundred three (203) women were randomized to behavioral weight loss (n = 102) or behavioral weight loss combined with cognitive-behavioral depression management (n = 101). Average participant age was 52 years; mean baseline body mass index was 39 kg/m(2). Mean Patient Health Questionnaire and Hopkins Symptom Checklist (SCL-20) scores indicated moderate to severe baseline depression. Weight loss and SCL-20 changes did not differ between groups at 6 or 12 months in intent-to-treat analyses (p = 0.26 and 0.55 for weight, p = 0.70 and 0.25 for depressive symptoms). Depressed obese women lost weight and demonstrated improved mood in both treatment programs. Future weight loss trials are encouraged to enroll depressed women.
Uccella, Stefano; Bonzini, Matteo; Palomba, Stefano; Fanfani, Francesco; Ceccaroni, Marcello; Seracchioli, Renato; Vizza, Enrico; Ferrero, Annamaria; Roviglione, Giovanni; Casadio, Paolo; Corrado, Giacomo; Scambia, Giovanni; Ghezzi, Fabio
To evaluate the impact of obesity on the outcomes of surgical treatment for endometrial cancer in general and also comparing laparoscopic and open abdominal approach. Retrospective case-control study (Canadian Task Force classification II-1). Obstetrics and Gynecology Department, University of Insubria, Varese, Catholic University of the Sacred Heart, Rome, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, and Sant'Orsola-Malpighi Hospital, Bologna, Italy. Data of consecutive patients who underwent surgery for endometrial cancer in 4 centers were reviewed. Univariate and multivariable analyses were performed. Adjustment for potential selection bias in surgical approach was made using propensity score (PS) matching. Laparoscopic or open surgical treatment for endometrial cancer. A total of 1266 patients were included, including 764 in the laparoscopy group and 502 in the open surgery group. A total of 391 patients (30.9%) were obese, including 238 (18.8%) with class I obesity, 89 (7%) with class II obesity, and 64 (5.1%) with class III obesity. The total number of complications, risk of wound complications, and venous thromboembolic events were higher in obese women compared with nonobese women. Blood transfusions, incidence/severity of postoperative complications, and postoperative hospital stay were significantly higher in the open surgery group compared with the laparoscopy group, irrespective of obesity. These differences remained significant in both multivariable analysis and PS-matched analysis. The percentage of patients who received lymphadenectomy declined significantly in patients with BMI ≥40 in both the laparoscopy and open surgery groups. Conversions from the initially intended minimally invasive approach to open surgery were 1.1% to 2.2% for women with BMI obese women in the laparoscopic group. Laparoscopy for endometrial cancer retains its advantages over open surgery, even in obese patients. However, operating on obese
Kruyff Carolien C
Full Text Available Abstract Background The prevalence of childhood obesity has increased rapidly during the last three decades in the Netherlands. It is assumed that mainly environmental factors have contributed to this trend. Parental overweight and low social economic status are risk factors for childhood obesity. Childhood obesity affects self-esteem and has negative consequences on cognitive and social development. Obese children tend to become obese adults, which increases the risk for developing cardiovascular complications, type 2 diabetes mellitus, and psychosocial problems. Additionally, the secretion of several gastrointestinal hormones, responsible for appetite and food intake, is impaired in obese subjects. Weight reduction through lifestyle changes in order to change health risks is, until now, suggested as the preferred treatment for childhood obesity. The objective of this study is the effect evaluation of a family-based cognitive behavioral multidisciplinary lifestyle treatment. The intervention aims to establish long-term weight reduction and stabilization, reduction of obesity-related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques. Study design/Methods In this randomized clinical trial newly presented children with obesity (8-17 years old are divided, by randomization, in an intervention and control group, both consisting of 40 obese children. The intervention is carried out in groups of 8-11 children, and consists of respectively 7 and 5 separate group meetings for the children and their parents and 1 joint group meeting of 2 ½ hours. Main topics are education on nutrition, self-control techniques, social skills, physical activity and improvement of self-esteem. The control group is given advice on physical activity and nutrition. For normal data comparison, data were collected of 40 normal-weight children, 8-17 years old. Discussion Because of the increasing prevalence of
Vos, Rimke C; Wit, Jan M; Pijl, Hanno; Kruyff, Carolien C; Houdijk, Euphemia C A M
The prevalence of childhood obesity has increased rapidly during the last three decades in the Netherlands. It is assumed that mainly environmental factors have contributed to this trend. Parental overweight and low social economic status are risk factors for childhood obesity. Childhood obesity affects self-esteem and has negative consequences on cognitive and social development. Obese children tend to become obese adults, which increases the risk for developing cardiovascular complications, type 2 diabetes mellitus, and psychosocial problems. Additionally, the secretion of several gastrointestinal hormones, responsible for appetite and food intake, is impaired in obese subjects. Weight reduction through lifestyle changes in order to change health risks is, until now, suggested as the preferred treatment for childhood obesity.The objective of this study is the effect evaluation of a family-based cognitive behavioral multidisciplinary lifestyle treatment. The intervention aims to establish long-term weight reduction and stabilization, reduction of obesity-related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques. In this randomized clinical trial newly presented children with obesity (8-17 years old) are divided, by randomization, in an intervention and control group, both consisting of 40 obese children. The intervention is carried out in groups of 8-11 children, and consists of respectively 7 and 5 separate group meetings for the children and their parents and 1 joint group meeting of 2 ½ hours. Main topics are education on nutrition, self-control techniques, social skills, physical activity and improvement of self-esteem. The control group is given advice on physical activity and nutrition. For normal data comparison, data were collected of 40 normal-weight children, 8-17 years old. Because of the increasing prevalence of childhood obesity and the impact on the individual as well as on society
Esophageal Cancer; Gastric Cancer; Sarcopenia; Sarcopenic Obesity; Obesity; Visceral Obesity; Quality of Life; Surgery; Complication of Treatment; Chemotherapeutic Toxicity; Physical Activity; Oncology
Full Text Available Siew Sun Wong,1 Yu Meng,1 Paul D Loprinzi,2 Nobuko Hongu3 1School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA; 2Department of Exercise Science, Donna and Allan Lansing School of Nursing and Health Sciences, Bellarmine University, Louisville, KY, USA; 3Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA Abstract: The primary purpose of this review is to answer three research questions: 1 What are the most popular features of physical activity (PA tracking and recording mobile applications (apps; 2 what features drive the app cost, peak rank, or gross sales; and 3 to what extent are evidence-based weight loss recommendations used in PA apps? Two hundred top grossing iOS health care and fitness apps were screened using a systematic review method. Fifty-five apps met the criteria as PA tracking and recording apps. Nearly half of these iOS PA apps are also available in Android. Two separate reviewers evaluated each PA app using 48 features. The top three most popular features are the use of behavioral strategies, use of the FITT Principles (frequency, intensity, time, type, and the use of the Principles for Physical Fitness. Free apps contain a mean of nine of the ten most popular features in paid apps, making them good bargains in PA promotion. Better peak rank is associated with the use of Fitness Principles, weight loss goal setting, or training videos. Ten PA apps met at least four of eight of the American College of Sports Medicine (ACSM recommendations for weight loss and prevention of weight regain for adults. The least popular features were PA safety and workouts for special need populations. Implications for obesity treatment are discussed in relationship to individual end-users, health care providers, and app developers. Because current PA apps still lack validity and compliance to standards for PA safety and data security, medical consultation for weight loss is
Wadden, Thomas A.; And Others
Explored the effectiveness of a very low calorie diet to induce rapid weight loss, combined with behavioral techniques to maintain this loss in 17 obese women. Results showed a substantial and sustained weight loss. Subjects did not experience increased anxiety or depression. (JAC)
And Others; Silverman, Lloyd H.
Obese women were treated in behavior modification programs for overeating. Behavior programs were accompanied by subliminal stimulation and by symbiotic and control messages. The symbiotic condition gave evidence of enhancing weight loss. This finding supports the proposition that subliminal stimulation of symbiotic fantasies can enhance the…
Riet, H.G. van; Schwarz, F.; Kinderen, P.J. der; Veeman, W.
Ten very obese female patients were treated by periods of total starvation lasting 10 days each. In the interval between these starvation periods, a diet of 600 calories was given. Twenty-one periods were completed, 6 patients went through 3 periods each. The fasting was generally well tolerated;
Jochemsen-van der Leeuw, H. G. A.; van Dijk, N.; Wieringa-de Waard, M.
Both patients and government expect the GP to treat obesity. Previous studies reported a negative attitude of GPs towards this task. Little is known about the attitude of GP trainees. To assess the attitude and other factors that influence the willingness and ability of GP trainees to provide
de Castro, Maria Luisa; Morales, Maria Jose; Martínez-Olmos, Miguel A; Pineda, Juan R; Cid, Lucia; Estévez, Pamela; del-Campo, Victor; Rodríguez-Prada, J Ignacio
intragastric balloons provide early satiety and thereby induce short-term weight loss. The aim of this study was to evaluate safety and short and medium-term effectiveness of gastric balloons associated to hypocaloric diet in obesity. from May 2004 to June 2011 91 obese patients, body mass index (BMI) 45.2 +/- 7.2 kg/m2 were prospectively followed after endoscopic implantation of a gastric balloon associated to restricted diet. Successful therapy was defined as percent loss of total weight (%LTW) > or = 5 % at six months after balloon placement and 6 and 12 months after their withdrawal. All analyses followed intention-to treat principles considering significant p-values or = 5 %. Short-term and medium-term effectiveness was negatively associated to obesity in first-grade relatives (p = 0.003 and p = 0.04). Higher weight loss 6 months after balloon placement independently predicted medium-term effectiveness (p = 0.0001). Mortality was absent but there were two spontaneous deflations of air-filled balloons and severe withdrawal difficulties in 8 patients, leading to surgery in one case. Retrieval complications associated to air-filled balloons (p = 0.0005). in obesity, effectiveness of gastric balloons associated to hypocaloric diet decreases over time.Complications occurred mainly in the retrieval endoscopic procedure and related to air-filled balloons.
Jelalian, Elissa; Evans, E Whitney
Pediatric obesity is a worldwide health epidemic affecting both developed and developing countries. Mexico ranks second to the United States in rates of pediatric obesity. Obesity among youth has immediate and long-term consequences on physical and psychosocial development, including cardiovascular, respiratory, and health-related quality of life. Eventual amelioration of this epidemic will require change at the level of the family and community, along with policy initiatives to support healthier eating and activity habits. Evidence-based interventions for overweight/obese youth include family-based lifestyle programs that incorporate attention to diet quantity and quality, physical activity, sedentary behavior, and behavioral strategies to support change. While much of this research has been conducted in the United States, several recent studies suggest the efficacy of similar approaches for youth in Mexico. © The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: email@example.com.
Duffy, Danielle; Rader, Daniel
Abdominal obesity is a prevalent, worldwide problem linked to cardiometabolic comorbidities and an increased risk of coronary heart disease. First-line therapy to reduce such risk revolves around diet and exercise; however, such changes are often difficult to implement and unsuccessful. Understanding the underlying pathophysiology of underlying metabolic derangements could provide new targets for pharmacologic therapy. One system that has gained recent attention is the endocannabinoid system. The endocannabinoid system has a significant role in central appetite control and peripheral lipogenesis and is up-regulated in diet-induced obesity. Rimonabant is a selective cannabinoid-1 receptor antagonist and is the first compound of its type to test the hypothesis that down-regulating an overactive endocannabinoid system could have therapeutic benefit not only for weight loss but also for the atherogenic dyslipidemia and insulin resistance that cluster with abdominal obesity in particular. Animal models have been critical for elucidating the role of the endocannabinoid system in obesity and in demonstrating that antagonism with rimonabant can induce loss of visceral fat and improve insulin sensitivity. Early human trials with rimonabant have confirmed significant reductions in weight, as well as favorable changes in atherogenic dyslipidemia, insulin resistance, and markers of inflammation. Interestingly, some of these beneficial metabolic effects are partially weight-loss-independent, confirming the importance of peripheral endocannabinoid system effects in addition to central effects.
Full Text Available In many countries around the world, including Iran, obesity is reaching epidemic proportions. Doctors have recently taken, or expressed support for, an extreme ‘personal responsibility for health’ policy against obesity: refusing services to obese patients. This policy may initially seem to improve patients’ incentives to fight obesity. But turning access to medical services into a benefit dependent on health improvement is a bad policy. It conditions the very aid that patients need in order to become healthier or success in becoming healthier. Whatever else we may think of personal responsibility for health policies, this particular one is absurd. Unfortunately, quite a few personal responsibility for health policies use similar absurd conditioning. They mistakenly use ‘carrots’ or ‘sticks’ for adherence the basic means to the same health outcomes that they seek to promote. This perspective proposes the following rule of thumb: any conditional incentive for healthy choice should be in a currency other than the basic means to that healthy choice.
Schnurr, Theresia Maria; Bech, Bianca; Haarmark Nielsen, Tenna Ruest
We investigated the relationship between interview-based subjective ratings of physical activity (PA) engagement and accelerometer-assessed objective measured PA in children and adolescents with overweight or obesity. A total of 92 children and adolescents (40 males, 52 females) with BMI ≥ 90th p...
Full Text Available Metabolic syndrome can be defined as a state of disturbed metabolic homeostasis characterized by visceral obesity, atherogenic dyslipidemia, arterial hypertension, and insulin resistance. The growing prevalence of metabolic syndrome will certainly contribute to the burden of cardiovascular disease. Obesity and dyslipidemia are main features of metabolic syndrome, and both can present with adipose tissue dysfunction, involved in the pathogenic mechanisms underlying this syndrome. We revised the effects, and underlying mechanisms, of the current approved drugs for dyslipidemia and obesity (fibrates, statins, niacin, resins, ezetimibe, and orlistat; sibutramine; and diethylpropion, phentermine/topiramate, bupropion and naltrexone, and liraglutide on adipose tissue. Specifically, we explored how these drugs can modulate the complex pathways involved in metabolism, inflammation, atherogenesis, insulin sensitivity, and adipogenesis. The clinical outcomes of adipose tissue modulation by these drugs, as well as differences of major importance for clinical practice between drugs of the same class, were identified. Whether solutions to these issues will be found in further adjustments and combinations between drugs already in use or necessarily in new advances in pharmacology is not known. To better understand the effect of drugs used in dyslipidemia and obesity on adipose tissue not only is challenging for physicians but could also be the next step to tackle cardiovascular disease.
Pediatric obesity in the US disproportionately impacts minority populations who face socioeconomic and cultural barriers to weight management programs. The specific aim of this pilot study was to test the effectiveness of diet behavior modification or diet behavior modification plus structured aerob...
Bliddal, Henning; Leeds, Anthony; Stigsgaard, Lise
OBJECTIVE: To evaluate 1-year symptomatic improvement in obese patients with knee osteoarthritis (OA) on an intensive low-energy diet (LED) maintained by frequent consultations with a dietician compared to minimal attention. METHODS: The LED programme consisted of group therapy with dietary...
Full Text Available Introduction: Obesity is a risk factor in chronic diseases, and its frequency among children in Mexico is increasing. Objective: To determine the effect of lifestyle intervention as a treatment for obesity in school-age-children from Celaya, Mexico.Methodology: For this experimental study, four schools were randomly selected. Children and parents participated voluntarily and signed consent forms. Two schools were chosen as the experimental group and the other two formed the control group. Age, gender, weight, height, BMI and blood pressure were recorded for each participant. Intervention: Children and parents were asked to walk in their schools for 30 minutes a day Monday through Friday and to attend 8 instructional sessions over a period of four months dedicated to the selection and preparation of meals. Statistical Analysis: The OR and 95% CI were calculated to determine the effect of the intervention; a Z-test for two proportions for overweight and obesity in the control and experimental groups were carried out for comparison.Results: 157 children were included in the experimental group and 144 in the control group. To compare the proportions of the overweight and the obese between the groups, a Z-test = - 0.36 (p-value 0.72 were obtained showing no effect of the intervention in lifestyle; OR =1.09, 95% CI (0.67, 1.77. It was adjusted according to the attendance to the sessions resulting in an OR = 2.00, 95% CI (0.69, 5.77, demonstrating that not attending the sessions was a confounder.Conclusions: Intervention in lifestyle should be measured over a longer period of time in order to determine what effects it may have on changes in body mass index.
Full Text Available Introduction: The phenomenon of obesity has nowadays become an epidemic, as it seems to greatly affect the populations of both developed and developing countries. General issues involving the evaluation of the phenomenon, its consequences and the health policies that can be used to confront it, are discussed.Objectives: The objectives of this paper were to critically discuss and analyze the relation between obesity and major diseases of the western societies such as cancers and diabetes mellitus. Furthermore its aim was to demonstrate the direct relation between various prevention strategies and the reduction of the phenomenon.Method: An online search in Medline, Pumed and the Cochrane Database of peer-reviewed Systematic Reviews and meta-analysis was conducted. Retrieved studies were screened to meet certain inclusion criteria, i.e. relevance, significant meanings in correspondence with this paper’s objectives and of interest to an international health-professional readership.Results: There is a clear demonstration of the direct relation between obesity and a series of diseases such as cancer, diabetes and coronary disease. Obesity also seems to be directly related to an increased incidence of caesarian sections and gestational diabetes mellitus. Reduced smoking rates during pregnancy and an increased time of breastfeeding seem to have a protective role. The importance of physical training, of a “healthy nutritional model” adopted by the parents, and of the Mediterranean diet are shown to be fundamental in the confrontation of the phenomenon. Additionally, family doctor interventions, cognitivebehavioral therapy and internet-mediated actions seem to sufficiently aid in its prevention.Conclusion: There is a clear proof that certain primary and secondary prevention strategies along with the the increase of health-concience in communities may lead to the decrease in the rates of obesity and its undoubtfully harmful consequences.
Kelly, Owen J; Gilman, Jennifer C; Kim, Youjin; Ilich, Jasminka Z
Aging, chronic inflammation and/or many chronic conditions may result in loss of bone, loss of muscle and increased adiposity, manifested either overtly (overweight) or furtively as fat infiltration into bone and muscle. This combined condition has been identified as osteosarcopenic obesity. Micronutrients are required, not just to prevent deficiency diseases, but for optimal health and metabolic homeostasis. Further, micronutrients have multifunctional roles in the body. However, it is unknown if the micronutrient intake of the Western diet contributes to bone and muscle loss, increased adiposity, and ultimately osteosarcopenic obesity. The aim of this review is to examine the micronutrient intake using US National Health and Nutrition Examination Survey (NHANES) data, and explore if the insufficiencies, or excesses present contribute to the development of osteosarcopenic obesity in aging. First NHANES food intake data from 2002-2012 were obtained and transposed to Microsoft Excel for analysis. A literature search of PubMed and Medline for human data using combinations and synonyms of osteoporosis, sarcopenia and obesity, and each mineral and vitamin indicated as insufficient by NHANES. NHANES data suggested phosphorus, calcium, magnesium, potassium, iron, and vitamins B6/B12/C/A/D/E and K were candidates for further evaluation. 170 articles were included. While chronic single/multiple micronutrient insufficiency/excess is not studied in clinical trials, NHANES data suggest that they have existed for at least a decade. Examining the status and roles of those nutrients may be important to understanding the health issues associated with Western-type diets, including development of osteosarcopenic obesity.
Vilhena, Edgard Costa de; Castilho, Euclides Ayres de
Context • Worldwide, 35 million people suffer from obesity. Mental disorders have been associated with being overweight or obese. Considerable evidence has shown a correlation between stress and the use of homeopathy and stress and obesity. However, few studies have examined the relationship between weight loss and homeopathic treatment of obesity. Objective • The study intended to evaluate the efficacy of a homeopathic treatment in preventing excessive weight gain during pregnancy in overweight or obese women who were suspected of having a common mental disorder. Design • The study was a randomized, controlled, double-blinded clinical trial. Setting • The study took place at the Center for the Social Support of Motherhood (São Paulo, Brazil). Participants • Participants were pregnant women who were enrolled at the center. Intervention • For the homeopathic group, 9 drugs were preselected, including (1) Pulsatilla nigricans, (2) Sepia succus, (3) Lycopodium clavatum, (4) sulphur, (5) Lachesis trigonocephalus, (6) Nux vomica, (7) Calcarea carbonica, (8) phosphorus; and (9) Conium maculatum. From those 9 drugs, 1 was prioritized for administration for each participant. After the first appointment, a reselection or selection of a new, more appropriate drug occurred, using the list of preselected drugs. The dosage was 6 drops orally 2 ×/d, in the morning and at night, on 4 consecutive days each wk, with an interval of 3 d between doses, up until the next appointment medical appointment. The control group received the equivalent placebo drug. Both groups also received a diet orientation. Outcome Measures • We evaluated pregnant women who were overweight or had class 1 or 2 obesity and were suspected of having a common mental disorder, with no concomitant diseases, in 2 groups: those receiving a placebo (control group, n = 72); and those receiving homeopathic treatment (homeopathy group, n = 62). Weight change during pregnancy was defined as the
Griffith, Marcus; Griffith, Jeana; Cobb, Mellanese; Oge, Vladimir
Childhood obesity is a health care crisis according to the leading pediatric advocacy groups (National Medical Association, American Academy of Pediatrics, and American Diabetes Association) and the White House. The problem has reached epidemic proportions for all children, but it has an even greater impact on racial minorities. The subject of childhood obesity can lead to a host of medical, psychological, and social problems, including low self-esteem and discrimination.We wrote an interventional children's book and workbook (The Tale of Two Athletes: The Story of Jumper and The Thumper) and developed a three-step intervention based on the narrative. The intervention's purpose is to increase public awareness, reduce stigma, and to help members of underserved communities become more comfortable discussing obesity. In classrooms and other community settings, a storied education program is presented to students of various ages. Interactive storytelling is the first step: live narration with direct listening and active participation. Didactic information on obesity is shared, including a sociocultural explanation for why the issue is more problematic among racial minorities. The audience is then introduced to the story of Jumper and The Thumper, two larger-than-life characters who experience different outcomes as a result of their choices about diet and exercise. True examples are described during the narration about these two young men, accompanied by cartoons and photographs for visual emphasis.The next step is reading: audience members are provided with a book to reinforce what was learned. Readers are allowed to more closely examine the importance of making healthy choices.Practicing positive behaviors and decision making through games and exercises from the companion workbook is the final step. These activities help children and their families live a healthier lifestyle. The goal is that these three steps, linked to a common narrative, will have a meaningful
Udo, Tomoko; McKee, Sherry A; White, Marney A; Masheb, Robin M; Barnes, Rachel D; Grilo, Carlos M
Although community-based studies suggest equivalent levels of physical and psychological impairment by binge eating disorder (BED) in men and women, men with BED are still underrepresented in clinical studies. This study aimed to provide a comprehensive analysis of sex differences in biopsychosocial correlates of treatment-seeking obese patients with BED in primary care. One hundred-ninety obese adults (26% men) were recruited in primary care settings for a treatment study for obesity and BED. Very few significant sex differences were found in the developmental history and in current levels of eating disorder features, as well as psychosocial factors. Women reported significantly earlier age at onset of overweight and dieting and greater frequency of dieting. Men reported more frequent strenuous exercise. Men were more likely than women to meet criteria for metabolic syndrome; men were more likely to show clinically elevated levels of triglycerides, blood pressure, and fasting glucose levels. Despite few sex differences in behavioral and psychosocial factors, metabolic problems associated with obesity were more common among treatment-seeking obese men with BED than women. The findings highlight the importance of including men in clinical studies of BED and active screening of BED in obese men at primary care settings. © 2013.
Riecke, B.F.; Christensen, R.; Christensen, Pia
OBJECTIVES: To evaluate in a prospective, randomized clinical trial (RCT), symptom response among obese knee osteoarthritis (OA) patients following a feasible, intensive weight-loss program for 16 weeks. METHODS: Eligible patients were obese [body mass index (BMI)>30kg/m(2)]; >50 years old......, with primary knee OA. Participants were randomized to either a very-low-energy diet (VLED) or a low-energy diet (LED) (415kcal/day and 810kcal/day, respectively), using commercially available formula foods - only for the first 8 weeks, managed by dieticians. Followed by an additional 8-week period of a hypo......-energetic diet consisting of normal food plus meal replacements (1200kcal/day). The primary endpoint was the number of patients responding according to the Outcome Measures in Rheumatology Clinical Trials and Osteoarthritis Research Society International (OMERACT-OARSI) responder criterion. The statistical...
Predictors of weight loss and maintenance during 2 years of treatment by sibutramine in obesity. Results from the European multi-centre STORM trial. Sibutramine Trial of Obesity Reduction and Maintenance
Hansen, D; Astrup, A; Toubro, S
In this report we assess pre-treatment determinants of weight loss and maintenance outcome in The Sibutramine Trial of Obesity Reduction and Maintenance (STORM), a 2 y randomized, double-blind, placebo-controlled, European multicenter study examining the effect of sibutramine (Sib) on inducing...
Padmanabhan, V; Smith, P; Veiga-Lopez, A
Prenatal testosterone (T) excess leads to reproductive dysfunctions in sheep with obesity exaggerating such defects. Developmental studies found ovarian reserve is similar in control and prenatal T sheep at fetal day 140, with prenatal T females showing increased follicular recruitment and persistence at 10 months of age (postpubertal). This study tested if prenatal T sheep show accelerated depletion prepubertally and if depletion of ovarian reserve would explain loss of cyclicity in prenatal...
Kopecký, Jan; Rossmeisl, Martin; Flachs, Pavel; Brauner, Petr; Šponarová, Jana; Matějková, Olga; Růžičková, Jana; Růžičková, Jana; Bardová, Kristina; Kuda, Ondřej
Roč. 53, Suppl.1 (2004), s. S225-S232 ISSN 0862-8408 R&D Projects: GA ČR GA303/02/1220; GA ČR GP303/03/P127; GA AV ČR KJB5011303; GA MŠk LN00A079 Institutional research plan: CEZ:AV0Z5011922 Keywords : obesity * adipose tissue Subject RIV: CE - Biochemistry Impact factor: 1.140, year: 2004
M.ª Luisa de Castro
Full Text Available Introduction: intragastric balloons provide early satiety and thereby induce short-term weight loss. The aim of this study was to evaluate safety and short and medium-term effectiveness of gastric balloons associated to hypocaloric diet in obesity. Material and methods: from May 2004 to June 2011 91 obese patients, body mass index [BMI] 45.2 ± 7.2 kg/m² were prospectively followed after endoscopic implantation of a gastric balloon associated to restricted diet. Successful therapy was defined as percent loss of total weight (%LTW ≥ 5% at six months after balloon placement and 6 and 12 months after their withdrawal. All analyses followed intention-to treat principles considering significant p-values < 0.05. Results: we placed 73 fluid-filled balloons (80.2% and 18 air-filled ones (19.8%. Compared to baseline values, at 6-month 73.7% subjects succeeded, showing significant reductions in weight (13.3 ± 8.8 kg, BMI (5 ± 3.4 kg/m² (p < 0.0001, with% LTW 11 ± 7%. Six and twelve months after retrieval 45.1% and 28.6% patients reached% LTW ≥ 5%. Short-term and medium-term effectiveness was negatively associated to obesity in first-grade relatives (p = 0.003 and p = 0.04. Higher weight loss 6 months after balloon placement independently predicted medium-term effectiveness (p = 0.0001. Mortality was absent but there were two spontaneous deflations of air-filled balloons and severe withdrawal difficulties in 8 patients, leading to surgery in one case. Retrieval complications associated to air-filled balloons (p = 0.0005. Conclusions: in obesity, effectiveness of gastric balloons associated to hypocaloric diet decreases over time. Complications occurred mainly in the retrieval endoscopic procedure and related to air-filled balloons.
Hollander, Priscilla A
Priscilla A Hollander1,21Baylor Endocrine Center, 2Baylor Medical Center, Dallas, Texas, USAAbstract: The risk for developing type 2 diabetes (T2DM) is greater among obese individuals. Following onset of the disease, patients with T2DM become more likely to be afflicted with diabetic micro- and macrovascular complications. Decreasing body weight has been shown to lower glycosylated hemoglobin and improve other metabolic parameters in patients with T2DM. Medications used to lower blood glucose...
Maletínská, Lenka; Pražienková, Veronika; Zemenová, Jana; Popelová, Andrea; Blechová, Miroslava; Mikulášková, Barbora; Holubová, Martina; Železná, Blanka; Kuneš, Jaroslav
Roč. 22, Suppl S2 (2016), S179-S180 ISSN 1075-2617. [European Peptide Symposium /34./ and International Peptide Symposium /8./. 04.09.2016-09.09.2016, Leipzig] R&D Projects: GA TA ČR(CZ) TE01020028; GA ČR(CZ) GA15-08679S Institutional support: RVO:61388963 Keywords : prolactin-releasing peptide * food intake * obesity Subject RIV: CE - Biochemistry
Paumgartten,Francisco José Roma; Pereira,Sabrina Schaaf Teixeira Costa; Oliveira,Ana Cecilia Amado Xavier de
ABSTRACT OBJECTIVE To evaluate clinical evidence on the safety and efficacy of fenproporex for treating obesity. METHODS MEDLINE, LILACS and Cochrane Controlled Trials Register were searched as well as references cited by articles and relevant documents. Two authors independently assessed the studies for inclusion and regarding risk of bias, collected data, and accuracy. Eligible studies were all those placebo-controlled that provided data on the efficacy and safety of Fenproporex to trea...
inflammation, hepatic steatosis , and atherosclerosis in mice. J Nutr. 2007;137(7):1776-1782. 26. Jehle AW, Gardai SJ, Li S, L insel-Nitschke P, Morimoto K...Martinez-Clemente M, Lopez-Parra M, Arroyo V, Claria J. Obesity-induced insulin resistance and hepatic steatosis are alleviat ed by ome ga-3 fatty acids: a...impaired hepatic insulin sensitivity and respond only partially to PPARγ agonists. Adiponectin-mediated metabolic improvements are associated with
Krentz, A J; Fujioka, K; Hompesch, M
Pharmacotherapy directed toward reducing body weight may provide benefits for both curbing obesity and lowering the risk of obesity-associated comorbidities; however, many weight loss medications have been withdrawn from the market because of serious adverse effects. Examples include pulmonary hypertension (aminorex), cardiovascular toxicity, e.g. flenfluramine-induced valvopathy, stroke [phenylpropanolamine (PPA)], excess non-fatal cardiovascular events (sibutramine), and neuro-psychiatric issues (rimonabant; approved in Europe, but not in the USA). This negative experience has helped mould the current drug development and approval process for new anti-obesity drugs. Differences between the US Food and Drug Administration (FDA) and the European Medicines Agency, however, in perceptions of risk-benefit considerations for individual drugs have resulted in discrepancies in approval and/or withdrawal of weight-reducing medications. Thus, two drugs recently approved by the FDA, i.e. lorcaserin and phentermine + topiramate extended release, are not available in Europe. In contrast, naltrexone sustained release (SR)/bupropion SR received FDA approval, and liraglutide 3.0 mg was recently approved in both the USA and Europe. Regulatory strategies adopted by the FDA to manage the potential for uncommon but potentially serious post-marketing toxicity include: (i) risk evaluation and mitigation strategy programmes; (ii) stipulating post-marketing safety trials; (iii) considering responder rates and limiting cumulative exposure by discontinuation if weight loss is not attained within a reasonable timeframe; and (iv) requiring large cardiovascular outcome trials before or after approval. We chronicle the adverse effects of anti-obesity pharmacotherapy and consider how the history of high-profile toxicity issues has shaped the current regulatory landscape for new and future weight-reducing drugs. © 2016 John Wiley & Sons Ltd.
Stice, Eric; Yokum, Sonja; Veling, Harm; Kemps, Eva; Lawrence, Natalia S
Elevated brain reward and attention region response, and weaker inhibitory region response to high-calorie food images have been found to predict future weight gain. These findings suggest that an intervention that reduces reward and attention region response and increases inhibitory control region response to such foods might reduce overeating. We conducted a randomized pilot experiment that tested the hypothesis that a multi-faceted food response and attention training with personalized high- and low-calorie food images would produce changes in behavioral and neural responses to food images and body fat compared to a control training with non-food images among community-recruited overweight/obese adults. Compared to changes observed in controls, completing the intervention was associated with significant reductions in reward and attention region response to high-calorie food images (Mean Cohen's d = 1.54), behavioral evidence of learning, reductions in palatability ratings and monetary valuation of high-calorie foods (p = 0.009, d's = 0.92), and greater body fat loss over a 4-week period (p = 0.009, d = 0.90), though body fat effects were not significant by 6-month follow-up. Results suggest that this multifaceted response and attention training intervention was associated with reduced reward and attention region responsivity to food cues, and a reduction in body fat. Because this implicit training treatment is both easy and inexpensive to deliver, and does not require top-down executive control that is necessary for negative energy balance obesity treatment, it may prove useful in treating obesity if future studies can determine how to create more enduring effects. Copyright © 2017 Elsevier Ltd. All rights reserved.
Kuhl, Elizabeth S; Clifford, Lisa M; Bandstra, Nancy F; Filigno, Stephanie S; Yeomans-Maldonado, Gloria; Rausch, Joseph R; Stark, Lori J
Preschoolers (ages 2-5 years) have been significantly underrepresented in the obesity treatment outcome literature, despite estimates that 12.1% are already obese. As such, little is known about the most important intervention targets for weight management within this age group. The aims of this study were (a) to examine lifestyle behavior changes for 30 obese preschoolers participating in a weight-control intervention and (b) to explore which lifestyle behavior changes predicted changes in body mass index (BMI) z score. Preschooler height, weight, diet (three 24-hr recalls), physical activity (accelerometry), and television use (parent report) were measured at baseline and posttreatment (6 months). A linear regression was conducted to examine pre- to posttreatment changes in diet (i.e., intake of calories, sugar-sweetened beverages, fruits and vegetables, and sweet and salty snacks) and activity (i.e., moderate-to-vigorous activity and television use) behaviors on changes in BMI z score. Despite significant reductions in sugar-sweetened beverage intake and television use, and increases in fruit and vegetable intake, only reductions in absolute caloric intake significantly predicted reductions in BMI z score. Our findings suggest that attaining healthy caloric goals may be the most important component of weight-control interventions for preschoolers. Future research using innovative methodologies, such as the Multiphase Optimization Strategy, may be helpful to prospectively identifying the lifestyle behavior changes that are most effective in helping families to achieve healthy weight outcomes for preschoolers and thereby improve intervention efficiency and decrease treatment burden for families. 2014 APA, all rights reserved
Kirschenbaum, D S; Pecora, K; Raphaeli, T; Germann, J N
This study compared successful with unsuccessful participants and their mothers 1.5 years following completion of an immersion programme for the treatment of adolescent obesity. Teenagers (M age = 14.5; 69.5% female) participated in a 4- to 8-week therapeutic camp; those who continued losing weight 1.5 years post-camp were identified as 'Losers'; those who regained weight were considered 'Gainers'. Twenty-six Loser campers, 23 Gainer campers and all mothers were interviewed about their current weights and lifestyle habits. Losers' and Gainers' mothers both reported losing weight significantly. Relative to Gainer mothers, however, Loser mothers reported 26% fewer high-fat foods in the house and greater likelihood of self-monitoring. Loser campers, relative to Gainer campers, reported self-monitoring more consistently; using trainers more frequently; and consuming fewer calories and less fat. Gainer campers also reported a tendency to use family therapy more than Loser families. The Loser campers reported following the dictates of the programme more than the Gainer campers, as expected. One striking and unique finding, however, was that Gainer mothers seemed to follow the programme for themselves as much as Loser mothers. Apparently for some participants in immersion treatment (like the Loser campers in this study), parents who participate fully may promote sustained success; for other adolescent weight controllers (like the present Gainer campers), having 'Do as I do' mothers clearly does not guarantee sustained changes in lifestyle for the teenagers. A hypothesis based on these results is that additional cognitive-behaviour therapy subsequent to immersion may be useful for this latter group. © 2011 The Authors. Clinical Obesity © 2011 International Association for the Study of Obesity.
Pearl, Rebecca L; Wadden, Thomas A; Hopkins, Christina M; Shaw, Jena A; Hayes, Matthew R; Bakizada, Zayna M; Alfaris, Nasreen; Chao, Ariana M; Pinkasavage, Emilie; Berkowitz, Robert I; Alamuddin, Naji
Weight stigma is a chronic stressor that may increase cardiometabolic risk. Some individuals with obesity self-stigmatize (i.e., weight bias internalization, WBI). No study to date has examined whether WBI is associated with metabolic syndrome. Blood pressure, waist circumference, and fasting glucose, triglycerides, and high-density lipoprotein cholesterol were measured at baseline in 178 adults with obesity enrolled in a weight-loss trial. Medication use for hypertension, dyslipidemia, and prediabetes was included in criteria for metabolic syndrome. One hundred fifty-nine participants (88.1% female, 67.3% black, mean BMI = 41.1 kg/m 2 ) completed the Weight Bias Internalization Scale and Patient Health Questionnaire (PHQ-9, to assess depressive symptoms). Odds ratios and partial correlations were calculated adjusting for demographics, BMI, and PHQ-9 scores. Fifty-one participants (32.1%) met criteria for metabolic syndrome. Odds of meeting criteria for metabolic syndrome were greater among participants with higher WBI, but not when controlling for all covariates (OR = 1.46, 95% CI = 1.00-2.13, P = 0.052). Higher WBI predicted greater odds of having high triglycerides (OR = 1.88, 95% CI = 1.14-3.09, P = 0.043). Analyzed categorically, high (vs. low) WBI predicted greater odds of metabolic syndrome and high triglycerides (Ps metabolic syndrome require further exploration. © 2017 The Obesity Society.
Novak, Nicole L; Brownell, Kelly D
The contemporary American food environment makes energy-dense, nutrient-poor foods and beverages the "default" option for most consumers. Economic interventions like taxes can shift the relative prices of unhealthy foods to nudge consumers towards healthier options. Beverages with added sugar are a good starting point for food taxation; they constitute over 10 percent of caloric intake nationwide and provide little or no nutritional value. Current levels of taxation on sugar-sweetened beverages (SSBs) are too low to affect consumer behavior, but the implementation of a penny-per-ounce excise tax could lead to substantial public health benefits. Current estimates predict that a tax that raised the cost of SSBs by 20 percent could lead to an average reduction of 3.8 pounds per year for adults, causing the prevalence of obesity to decline from 33 to 30 percent. SSB taxes would also generate considerable revenue for public health and obesity prevention programs. Although the beverage industry is fighting such taxes with massive lobbying and public relations campaigns, support for the policies is increasing, especially when revenue is earmarked for obesity prevention.
The progressive nature of type 2 diabetes mellitus (T2DM) calls for step-wise intensification of therapy for maintaining normal glycemic levels and lowering cardiovascular (CV) risk. Because obesity is a prominent risk factor and comorbidity of T2DM, it further elevates the CV risk in T2DM. Therefore, it is vital to manage weight, obesity, and glycemic parameters for effective T2DM management. Few oral antidiabetic drugs (sulfonylureas and thiazolidinediones) and insulin are not suitable for obese patients with T2DM because these drugs cause weight gain. The present review discusses the place of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the treatment of obese patients with T2DM and the significance of these drugs in the prevention of future CV risk in patients with T2DM. A literature search of PubMed and EMBASE was conducted by using the search terms T2DM, GLP-1RAs, obesity, and cardiovascular complication. Randomized controlled trials measuring the effect of GLP-1RAs versus that of placebo on CV outcomes were included in the review. GLP-1RAs have emerged as a therapeutic alternative; these drugs exert their actions by providing glycemic control, improving insulin resistance and ö̇-cell function, and reducing weight. The risk of hypoglycemia with GLP-1RAs is minimal; however, GLP-1RAs are associated with gastrointestinal adverse events and raise concerns regarding pancreatitis. Combining GLP-1RAs with insulin analogues results in higher efficacy, a lowered insulin dose, and reduced insulin-related hypoglycemia and weight gain. Longer acting GLP-1RAs are also associated with improvement in medication adherence. Improvement in CV risk factors such as blood pressure and lipid profile further increases their usability for improving CV outcomes. Overall, the properties of GLP-1RAs make them suitable for combination with oral antidiabetic drugs in the early stages of T2DM and with insulins in the later stages for optimizing comprehensive management of the
Ishøy, Pelle L; Knop, Filip K; Broberg, Brian V; Bak, Nikolaj; Andersen, Ulrik B; Jørgensen, Niklas R; Holst, Jens J; Glenthøj, Birte Y; Ebdrup, Bjørn H
Schizophrenia is associated with cardiovascular co-morbidity and a reduced life-expectancy of up to 20 years. Antipsychotics are dopamine D 2 receptor antagonists and are the standard of medical care in schizophrenia, but the drugs are associated with severe metabolic side effects such as obesity and diabetes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are registered for treatment of both obesity and type 2 diabetes. We investigated metabolic effects of the GLP-1RA, exenatide once-weekly, in non-diabetic, antipsychotic-treated, obese patients with schizophrenia. Antipsychotic-treated, obese, non-diabetic, schizophrenia spectrum patients were randomized to double-blinded adjunctive treatment with once-weekly subcutaneous exenatide (n = 23) or placebo (n = 22) injections for 3 months. The primary outcome was loss of body weight after treatment and repeated measures analysis of variance was used as statistical analysis. Between March 2013 and June 2015, 40 patients completed the trial. At baseline, mean body weight was 118.3 ± 16.0 kg in the exenatide group and 111.7 ± 18.0 kg in the placebo group, with no group differences ( P = .23). The exenatide and placebo groups experienced significant ( P = .004), however similar ( P = .98), weight losses of 2.24 ± 3.3 and 2.23 ± 4.4 kg, respectively, after 3 months of treatment. Treatment with exenatide once-weekly did not promote weight loss in obese, antipsychotic-treated patients with schizophrenia compared to placebo. Our results could suggest that the body weight-lowering effect of GLP-1RAs involves dopaminergic signaling, but blockade of other receptor systems may also play a role. Nevertheless, anti-obesity regimens effective in the general population may not be readily implemented in antipsychotic-treated patients with schizophrenia. © 2016 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
Burguera, Bartolomé; Jesús Tur, Juan; Escudero, Antonio Jorge; Alos, María; Pagán, Alberto; Cortés, Baltasar; González, Xavier Francesc; Soriano, Joan B.
Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients. Objective. This controlled, clinical trial with a two-year intervention was aimed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery, on body weight changes and metabolic parameters in morbidly obese patients. Methods. Patients were randomized to an Intensive Lifestyle Intervention (ILI) (n = 60) or Conventional Obesity Therapy (COT) (n = 46). The ILI group received behavioral therapy and nutritional counseling. The COT group received standard medical treatment. They were compared with a third group, Surgical Obesity Group (SOG) (n = 37). Results. Patients who received ILI had a greater percentage of weight loss than patients receiving COT (−11.3% versus −1.6%; p < 0.0044). Interestingly 31.4% of patients included in the ILI group were no longer morbidly obese after just six months of intervention, increasing to 44.4% after 24 months of intervention. The percentage weight loss in SOG was −29.6% after that same period of time. Conclusions. ILI was associated with significant weight loss when compared to COT, in a group of patients with obesity. An ILI approach could be an alternative therapy to patients with obesity, who are not candidates to undergo bariatric surgery. This trial is registered with EudraCT 2009-013737-24. PMID:26257780
Full Text Available Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients. Objective. This controlled, clinical trial with a two-year intervention was aimed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery, on body weight changes and metabolic parameters in morbidly obese patients. Methods. Patients were randomized to an Intensive Lifestyle Intervention (ILI (n=60 or Conventional Obesity Therapy (COT (n=46. The ILI group received behavioral therapy and nutritional counseling. The COT group received standard medical treatment. They were compared with a third group, Surgical Obesity Group (SOG (n=37. Results. Patients who received ILI had a greater percentage of weight loss than patients receiving COT (−11.3% versus −1.6%; p<0.0044. Interestingly 31.4% of patients included in the ILI group were no longer morbidly obese after just six months of intervention, increasing to 44.4% after 24 months of intervention. The percentage weight loss in SOG was −29.6% after that same period of time. Conclusions. ILI was associated with significant weight loss when compared to COT, in a group of patients with obesity. An ILI approach could be an alternative therapy to patients with obesity, who are not candidates to undergo bariatric surgery. This trial is registered with EudraCT 2009-013737-24.
Masheb, Robin M; Dorflinger, Lindsey M; Rolls, Barbara J; Mitchell, Diane C; Grilo, Carlos M
Binge eating disorder (BED) is strongly associated with obesity and related medical and psychiatric morbidities. Cognitive behavioral therapy (CBT) has consistently been shown to reduce binge eating frequency and improve psychological functioning, as well as to produce abstinence rates of roughly 50%. This study examined the relationship between binge abstinence and dietary and psychological outcomes after CBT for BED. Fifty adult patients with BED received 6-month treatments using a combination of CBT and dietary counseling. Trained interviewers conducted two 24-hour dietary recall interviews on randomly selected days at baseline and at 6 months. Participants had significant reductions in energy, macronutrient, and sugar intake and an increase in fruit intake. They reported significant reductions in BMI and binge eating frequency (from mean = 14.24 to mean = 1.90 binge eating episodes during the previous 28 days), as well as improvements in psychological functioning. Those who became binge abstinent reported eating roughly 400 fewer calories per day and experienced greater improvements in psychological functioning than those who did not. Findings from this study suggest that individuals who achieve complete cessation from binge eating have significantly improved dietary and psychological outcomes that could potentially improve weight status, compared with those who continue to binge eat post-treatment. © 2016 The Obesity Society.
Buchholz, Tina; Melzig, Matthias F
In order to find new pancreatic lipase (PL) and α-amylase inhibitors from natural sources for the treatment of obesity and related diseases as diabetes mellitus II, 23 medicinal plants with weight-reducing, serum glucose-reducing or related potential were investigated. Methanolic and water extracts of the plants were evaluated by using two in vitro test systems. Our findings have shown that the methanolic extract of Hibiscus sabdariffa L. (Malvaceae) showed high inhibitory activities to PL (IC50 : 35.8 ± 0.8 µg/mL) and α-amylase (IC50 : 29.3 ± 0.5 µg/mL). Furthermore, the methanolic extract of Tamarindus indica L. (Leguminosae) showed a high anti-lipase (IC50 : 152.0 ± 7.0 µg/mL) and the aqueous extract a high anti-amylase (IC50 : 139.4 ± 9.0 µg/mL) activity. This work provides a priority list of interesting plants for further study with respect to the treatment of obesity and associated diseases. Copyright © 2015 John Wiley & Sons, Ltd.
Södlerlund, Anne; Fischer, Annika; Johansson, Titti
The aim was to extend the body of knowledge through a systematic review that combines the strengths and partly fills the gaps from earlier reviews. The aim is to review randomized controlled trials of the long-term effectiveness of physical exercise/activity with or without diet and/or behaviour modification therapy in terms of training effect, weight loss and improvement of body composition in overweight and obese, healthy adults. Data for systematic review was collected via a search of databases for literature published between 1995 and 2006. The search yielded 12 articles. The studies showed that training intensity should be moderate. The treatment of overweight and obese individuals with training alone cannot be expected to result in any substantial weight loss but should be combined with diet and behaviour modification therapy. However training can be an important factor in preventing further weight gain, or in helping individuals maintain a lowered body weight. According to this systematic review of randomized controlled trials, the treatment that produced the best weight loss results included a combination of training, behaviour therapy and diet.
Karlsen, Kamilla; Humaidan, Peter; Sørensen, Lise H; Alsbjerg, Birgit; Ravn, Pernille
This is a retrospective study to investigate whether motivational interviewing increases weight loss among obese or overweight women prior to fertility treatment. Women with body mass index (BMI) > 30 kg/m(2) approaching the Fertility Clinic, Regional Hospital Skive, were given advice about diet and physical activity with the purpose of weight loss. In addition, they were asked if they wanted to receive motivational interviewing. Among other data, age, height and weight were obtained. Main outcomes were weight loss measured in kg and decrease in BMI. We studied 187 women: 110 received sessions of motivational interviewing (intervention group, n = 110), 64 received motivational support by phone or e-mail only and 13 women did not wish any motivational support (control group, n = 77). The mean weight loss and decrease in BMI was greater in the intervention group compared with the control group (9.3 kg versus 7.3 kg, difference p = 0.01, 3.3 kg/m(2) versus 2.6 kg/m(2), difference p = 0.02). The mean period of intervention was comparable in the two groups, 7.9 month and 7.3 month, respectively, (difference non significant: NS). The study indicates that motivational interviewing may be a valuable tool in weight loss programs for obese and overweight women prior to fertility treatment.
Harris, Leanne; Hamilton, Sharon; Azevedo, Liane B; Olajide, Joan; De Brún, Caroline; Waller, Gillian; Whittaker, Vicki; Sharp, Tracey; Lean, Mike; Hankey, Catherine; Ells, Louisa
To examine the effectiveness of intermittent energy restriction in the treatment for overweight and obesity in adults, when compared to usual care treatment or no treatment. Intermittent energy restriction encompasses dietary approaches including intermittent fasting, alternate day fasting, and fasting for two days per week. Despite the recent popularity of intermittent energy restriction and associated weight loss claims, the supporting evidence base is limited. This review included overweight or obese (BMI ≥25 kg/m) adults (≥18 years). Intermittent energy restriction was defined as consumption of ≤800 kcal on at least one day, but no more than six days per week. Intermittent energy restriction interventions were compared to no treatment (ad libitum diet) or usual care (continuous energy restriction ∼25% of recommended energy intake). Included interventions had a minimum duration of 12 weeks from baseline to post outcome measurements. The types of studies included were randomized and pseudo-randomized controlled trials. The primary outcome of this review was change in body weight. Secondary outcomes included: i) anthropometric outcomes (change in BMI, waist circumference, fat mass, fat free mass); ii) cardio-metabolic outcomes (change in blood glucose and insulin, lipoprotein profiles and blood pressure); and iii) lifestyle outcomes: diet, physical activity, quality of life and adverse events. A systematic search was conducted from database inception to November 2015. The following electronic databases were searched: MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, ISRCTN registry, and anzctr.org.au for English language published studies, protocols and trials. Two independent reviewers evaluated the methodological quality of included studies using the standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from papers included in the review by two independent reviewers using the standardized data
Full Text Available Obesity presents a major health hazard of the 21st century. It promotes co-morbid diseases such as heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis. Excessive energy intake, physical inactivity, and genetic susceptibility are main causal factors for obesity, while gene mutations, endocrine disorders, medication, or psychiatric illnesses may be underlying causes in some cases. The development and maintenance of obesity may involve central pathophysiological mechanisms such as impaired brain circuit regulation and neuroendocrine hormone dysfunction. Dieting and physical exercise offer the mainstays of obesity treatment, and anti-obesity drugs may be taken in conjunction to reduce appetite or fat absorption. Bariatric surgeries may be performed in overtly obese patients to lessen stomach volume and nutrient absorption, and induce faster satiety. This review provides a summary of literature on the pathophysiological studies of obesity and discusses relevant therapeutic strategies for managing obesity.
Lobelo, Felipe; Garcia de Quevedo, Isabel; Holub, Christina K; Nagle, Brian J; Arredondo, Elva M; Barquera, Simón; Elder, John P
Rapidly rising childhood obesity rates constitute a public health priority in Latin America which makes it imperative to develop evidence-based strategies. Schools are a promising setting but to date it is unclear how many school-based obesity interventions have been documented in Latin America and what level of evidence can be gathered from such interventions. We performed a systematic review of papers published between 1965 and December 2010. Interventions were considered eligible if they had a school-based component, were done in Latin America, evaluated an obesity related outcome (body mass index [BMI], weight, %body fat, waist circumference, BMI z-score), and compared youth exposed vs not exposed. Ten studies were identified as having a school-based component. Most interventions had a sample of normal and overweight children. The most successful interventions focused on prevention rather than treatment, had longer follow-ups, a multidisciplinary team, and fewer limitations in execution. Three prevention and 2 treatment interventions found sufficient improvements in obesity-related outcomes. We found sufficient evidence to recommend school-based interventions to prevent obesity among youth in Latin America. Evidence-based interventions in the school setting should be promoted as an important component for integrated programs, policies, and monitoring frameworks designed to reverse the childhood obesity in the region. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
Paumgartten, Francisco José Roma; Pereira, Sabrina Schaaf Teixeira Costa; de Oliveira, Ana Cecilia Amado Xavier
To evaluate clinical evidence on the safety and efficacy of fenproporex for treating obesity. MEDLINE, LILACS and Cochrane Controlled Trials Register were searched as well as references cited by articles and relevant documents. Two authors independently assessed the studies for inclusion and regarding risk of bias, collected data, and accuracy. Eligible studies were all those placebo-controlled that provided data on the efficacy and safety of Fenproporex to treat obesity. Only four controlled studies met the inclusion criteria. One randomized, placebo-controlled trial on Fenproporex was found on electronic databases. Three placebo-controlled studies (in non-indexed journals) were identified by hand-searching. Patients with cardiovascular and other comorbidities were excluded in all studies. Trials lasted from 40 to 364 days and doses ranged from 20 to 33.6 mg/d. All controlled studies found that weight loss among Fenproporex-treated patients was greater than that produced by the placebo, but drug effect was modest. Fenproporex produced additional weight reductions of 4.7 kg (one year), 3.8 kg (six months) and 1.55 kg (two months) in average, in relation to diet and exercise only (three trials). Insomnia, irritability, and anxiety were the most frequently reported side effects in the four studies. There is a paucity of randomized, placebo-controlled trials on Fenproporex and those identified here present major methodological flaws. These studies suggest that Fenproporex is modestly effective in promoting weight loss. Nonetheless, they failed to provide evidence that it reduces obesity-associated morbidity and mortality. Data from these studies are insufficient to determine the risk-benefit profile of Fenproporex. Abuse potential and amphetamine-like adverse effects are causes for concern.
Francisco José Roma Paumgartten
Full Text Available ABSTRACT OBJECTIVE To evaluate clinical evidence on the safety and efficacy of fenproporex for treating obesity. METHODS MEDLINE, LILACS and Cochrane Controlled Trials Register were searched as well as references cited by articles and relevant documents. Two authors independently assessed the studies for inclusion and regarding risk of bias, collected data, and accuracy. Eligible studies were all those placebo-controlled that provided data on the efficacy and safety of Fenproporex to treat obesity. RESULTS Only four controlled studies met the inclusion criteria. One randomized, placebo-controlled trial on Fenproporex was found on electronic databases. Three placebo-controlled studies (in non-indexed journals were identified by hand-searching. Patients with cardiovascular and other comorbidities were excluded in all studies. Trials lasted from 40 to 364 days and doses ranged from 20 to 33.6 mg/d. All controlled studies found that weight loss among Fenproporex-treated patients was greater than that produced by the placebo, but drug effect was modest. Fenproporex produced additional weight reductions of 4.7 kg (one year, 3.8 kg (six months and 1.55 kg (two months in average, in relation to diet and exercise only (three trials. Insomnia, irritability, and anxiety were the most frequently reported side effects in the four studies. CONCLUSIONS There is a paucity of randomized, placebo-controlled trials on Fenproporex and those identified here present major methodological flaws. These studies suggest that Fenproporex is modestly effective in promoting weight loss. Nonetheless, they failed to provide evidence that it reduces obesity-associated morbidity and mortality. Data from these studies are insufficient to determine the risk-benefit profile of Fenproporex. Abuse potential and amphetamine-like adverse effects are causes for concern.
DiBonaventura, Marco D; Meincke, Henrik; Le Lay, Agathe; Fournier, Janine; Bakker, Erik; Ehrenreich, Allison
Marco D DiBonaventura,1 Henrik Meincke,2 Agathe Le Lay,2 Janine Fournier,2 Erik Bakker,3 Allison Ehrenreich1 1Kantar Health, New York, NY, USA; 2Novo Nordisk, Copenhagen, Denmark; 3Novo Nordisk, Mexico City, Mexico Objective: The goal of this study is to investigate obesity and its concomitant effects including the prevalence of comorbidities, its association with patient-reported outcomes and costs, and weight loss strategies in a sample of Mexican adults. Methods: Mexican adults (N=2,511) ...
Ovchinnikov, V.I.; Lipko, N.S.; Yashkov, Yu.I.; Timoshin, A.D.; Movchun, A.A; Oppel', T.A.
The operation vertical gastroplasty is used to treat the socalled morbid obesity. It ends with the formation of a small stomach, Some experience gained with X-ray of the stomach is analyzed in 17 patients undergone vertical gastroplasty. X-ray evaluated the status of the small stomach arranged as a tube in the upper portions in the vicinity of the lesser curvature of the stomach. The shape, sizes, outlet of the small stomach, as well as emptying rates and the state of an internal vertical suture of the stomach are to be studies. 8 refs., 4 figs
Hussain, Mirza Izhar; Naqvi, Baqir Shyum
Our study finds out drug usage trends in over weight and obese patients without any compelling indications in Karachi, looks for deviations of current practices from evidence based antihypertensive therapeutic guidelines and identifies not only cost minimization opportunities but also communication strategies to improve patients' awareness and compliance to achieve therapeutic goal. In present study two sets were used. Randomized stratified independent surveys were conducted in hospital doctors and family physicians (general practitioners), using pretested questionnaires. Sample size was 100. Statistical analysis was conducted on Statistical Package for Social Science (SPSS). Opportunities of cost minimization were also analyzed. One the basis of doctors' feedback, preference is given to non-pharmacologic management of obesity. Mass media campaign and media usage were recommended to increase patients awareness and patients' education along with strengthening family support systems was recommended for better compliance of the patients to doctor's advice. Local therapeutic guidelines for weight reduction were not found. Feedbacks showed that global therapeutic guidelines were followed by the doctors practicing in the community and hospitals in Karachi. However, high price branded drugs were used instead of low priced generic therapeutic equivalents. Patient's education is required for better awareness and improving patients' compliance. The doctors found preferring brand leaders instead of low cost options. This trend increases cost of therapy by 0.59 to 4.17 times. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines.
Suplicy, H; Boguszewski, C L; dos Santos, C M C; do Desterro de Figueiredo, M; Cunha, D R; Radominski, R
No long-term studies have compared centrally acting drugs for treating obesity. To compare the efficacy and safety of diethylpropion (DEP), fenproporex (FEN), mazindol (MZD), fluoxetine (FXT) and sibutramine (SIB) in promoting weight loss. A prospective, randomized, placebo (PCB)-controlled study conducted at a single academic institution. A total of 174 obese premenopausal women. Participants randomly received DEP 75 mg (n=28), FEN 25 mg (n=29), MZD 2 mg (n=29), SIB 15 mg (n=30), FXT 20 mg (n=29) or PCB (n=29) daily over 52 weeks. Diet and physical activity were encouraged. The primary endpoints were changes in body weight and the proportion of women who achieved at least 5% weight loss by week 52 in the intent-to-treat population. Other measurements included anthropometry, safety, metabolic and cardiovascular parameters. Weight loss was greater than PCB (-3.1±4.3 kg) with DEP (-10.0±6.4 kg; Pobese premenopausal women, with a satisfactory benefit-risk profile.
Barnes, Emily R; Theeke, Laurie A; Mallow, Jennifer
Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits. © 2015 John Wiley & Sons, Ltd.
Full Text Available BackgroundMost type 2 diabetes mellitus patients are obese and have obesity related vascular complications. Exenatide treatment is well known for both decreasing glycated hemoglobin levels and reduction in body weight. So, this study aimed to determine the effects of exenatide on body composition, glycated hemoglobin levels, and vascular stiffness in obese type 2 diabetes mellitus patients.MethodsFor 1 month, 32 obese type 2 diabetes mellitus patients were administered 5 µg of exenatide twice daily. The dosage was then increased to 10 µg. Patients' height, body weight, glycated hemoglobin levels, lipid profile, pulse wave velocity (PWV, body mass index, fat mass, and muscle mass were measured by using Inbody at baseline and after 3 months of treatment.ResultsAfter 3 months of treatment, glycated hemoglobin levels decreased significantly (P=0.007. Triglyceride, total cholesterol, and low density lipoprotein levels decreased, while aspartate aminotransferase and alanine aminotransferase levels were no change. Body weight, and fat mass decreased significantly (P=0.002 and P=0.001, respectively, while interestingly, muscle mass did not decrease (P=0.289. In addition to, Waist-to-hip ratio and aortic PWV decreased significantly (P=0.006 and P=0.001, respectively.ConclusionEffects of short term exenatide use in obese type 2 diabetes mellitus with cardiometabolic high risk patients not only reduced body weight without muscle mass loss, body fat mass, and glycated hemoglobin levels but also improved aortic PWV in accordance with waist to hip ratio.
To establish the differential criteria for Binge Eating Disorder (BED) and Food Addiction (FA). We performed a detailed analysis of comparative diagnostic criteria for BED and Substance use disorder contained in the Diagnostic and Statistical Manual of Mental Disorders DSM-V. We applied the diagnostic criteria for both disorders to scientific publications on the issue of excessive eating in obese people, during the years 2005-2016, available on PubMed. We isolated specific similarities and differences between Binge Eating Disorder and Food Addiction. We formulated differential criteria for BED and FA. In BED as well as FA the following characteristics are apparent: preoccupation with food, excessive eating, loss of control over the amount of food and manner of eating, inability to change behavior, continuing behavior despite negative consequences, increased impulsiveness and emotional imbalance. Differences between BED and FA relate to the function of food, reaction to omitted food, psychological mechanisms of coping with excessive eating and body image, the issue of tolerance, withdrawal syndrome and the correlation between excessive eating and other areas of life. The criteria of differentiation between BED and FA concern the following: function of food, eating circumstances, reaction to the unavailability of food, awareness of the problem. Appropriate diagnosis of these disorders and their differentiation increases the chances of adequate treatment of obese patients.
Barnes, Rachel D; Sawaoka, Takuya; White, Marney A; Masheb, Robin M; Grilo, Carlos M
Prior research on the relations among eating behaviors and thought suppression is limited to a measure of general thought suppression, the White Bear Suppression Inventory. To address this limitation, researchers recently validated the Food Thought Suppression Inventory (FTSI). Analyses using this measure suggest that food thought suppression is distinct from and is more predictive of eating disorder psychopathology than is general thought suppression. The FTSI, however, has not yet been validated in clinical samples. The purpose of the current study is to examine the factor structure and clinical correlates of the FTSI within treatment seeking obese women with binge eating disorder (BED; N=128). Analyses revealed a valid and reliable one-factor measure of food thought suppression that was related to higher levels of eating and general psychopathology. The findings provide evidence for the use of the FTSI with obese women with BED. Future research should examine the psychometric properties of the FTSI within larger and more diverse samples. Copyright © 2012. Published by Elsevier Ltd.
D'Hondt, Eva; Gentier, Ilse; Deforche, Benedicte; Tanghe, Ann; De Bourdeaudhuij, Ilse; Lenoir, Matthieu
This study evaluated the short-term effectiveness of a multidisciplinary residential obesity treatment program by describing changes in body weight, related measures, and gross motor co-ordination. Secondarily, it was examined to what extent the amount of relative weight loss achieved by overweight and obese (OW/OB) participants explained the projected improvement in gross motor co-ordination. Thirty-six OW/OB children (aged 10.5 ± 1.4 years, 12 girls and 24 boys) were recruited at the Zeepreventorium VZW (De Haan, Belgium), where they followed a specific program consisting of moderate dietary restriction, psychological support, and physical activity. For reference purposes, an additional group of 36 age- and gender-matched healthy-weight (HW) children was included in the study. Anthropometric measures were recorded and gross motor co-ordination was assessed using the Körperkoordinationstest für Kinder (KTK) on two occasions with an interval of 4 months. Regardless of the test moment, OW/OB participants displayed significantly poorer KTK performances (P motor co-ordination performance, with a greater increase in KTK score(s) from baseline to re-test as compared to HW peers (P motor co-ordination, which in turn may promote physical activity participation.
Full Text Available Objective: Obesity-associated impaired fat accumulation in the visceral adipose tissue can lead to ectopic fat deposition and increased risk of insulin resistance and type 2 diabetes mellitus (T2DM. This study investigated whether impaired adipogenesis of omental (OM adipose tissues and elevated 4-hydroxynonenal (4-HNE accumulation contribute to this process, and if combined metformin and insulin treatment in T2DM patients could rescue this phenotype. Methods: OM adipose tissues were obtained from forty clinically well characterized obese individuals during weight reduction surgery. Levels of 4-HNE protein adducts, adipocyte size and number of macrophages were determined within these tissues by immunohistochemistry. Adipogenic capacity and gene expression profiles were assessed in preadipocytes derived from these tissues in relation to insulin resistance and in response to 4-HNE, metformin or combined metformin and insulin treatment. Results: Preadipocytes isolated from insulin resistant (IR and T2DM individuals exhibited lower adipogenesis, marked by upregulation of anti-adipogenic genes, compared to preadipocytes derived from insulin sensitive (IS individuals. Impaired adipogenesis was also associated with increased 4-HNE levels, smaller adipocytes and greater macrophage presence in the adipose tissues. Within the T2DM group, preadipocytes from combined metformin and insulin treated subset showed better in vitro adipogenesis compared to metformin alone, which was associated with less presence of macrophages and 4-HNE in the adipose tissues. Treatment of preadipocytes in vitro with 4-HNE reduced their adipogenesis and increased proliferation, even in the presence of metformin, which was partially rescued by the presence of insulin. Conclusion: This study reveals involvement of 4-HNE in the impaired OM adipogenesis-associated with insulin resistance and T2DM and provides a proof of concept that this impairment can be reversed by the synergistic
van Santen, Hanneke M; Schouten-Meeteren, Antoinette Y; Serlie, Mireille; Meijneke, Ruud W H; van Trotsenburg, A S; Verberne, Hein; Holleman, Frits; Fliers, Eric
Patients treated for childhood craniopharyngioma often develop hypothalamic obesity (HO), which has a huge impact on the physical condition and quality of life of these patients. Treatment for HO thus far has been disappointing, and although several different strategies have been attempted, all interventions had only transient effects. Since thyroid hormones increase energy expenditure metabolism (thyroid hormone induced thermogenesis), it was speculated that treatment with tri-iodothyronine (T3) may be beneficial. In 2002, a case report was published on reduction of body weight after T3 treatment for HO. No studies have been reported since. Recent experimental studies in rodents showed that T3 increases brown adipose tissue (BAT) activity via (pre)sympathetic pathways between the hypothalamus and BAT. Our aim was to investigate whether T3 treatment increases BAT activity in a patient with HO resulting from (treatment of) childhood craniopharyngioma. Thyroxine treatment for central hypothyroidism was switched to T3 monotherapy. Serum T3 and free thyroxine (FT4) concentrations were measured twice weekly for 2 months. ¹²³I-MIBG and ¹⁸F-FDG-PET after induction of non-shivering thermogenesis for the assessment of sympathetic and metabolic activity of BAT as well as indirect calorimetry for assessment of resting energy expenditure were performed before and during T3 treatment. No change in sympathetic and metabolic BAT activity, energy expenditure, or BMI was seen during T3 treatment despite the expected changes in thyroid hormone plasma concentrations. We conclude that T3 monotherapy does not seem to be effective in decreasing HO in childhood craniopharyngioma.
Skj?k?deg?rd, Hanna F.; Danielsen, Yngvild S.; Morken, Mette; Linde, Sara-Rebekka F.; Kolko, Rachel P.; Balantekin, Katherine N.; Wilfley, Denise E.; J?l?usson, P?tur B.
Background The purpose of the FABO-study is to evaluate the effect of family-based behavioral social facilitation treatment (FBSFT), designed to target children?s family and social support networks to enhance weight loss outcomes, compared to the standard treatment (treatment as usual, TAU) given to children and adolescents with obesity in a routine clinical practice. Methods Randomized controlled trial (RCT), in which families (n?=?120) are recruited from the children and adolescents (ages 6...
Harris, Leanne; Hamilton, Sharon; Azevedo, Liane B.; Olajide, Joan; De Brun, Caroline; Waller, Gillian; Whittaker, Vicki; Sharp, Tracey; Lean, Mike; Hankey, Catherine; Ells, Louisa
Objective:\\ud To examine the effectiveness of intermittent energy restriction in the treatment for overweight and obesity in adults, when compared to usual care treatment or no treatment.\\ud \\ud Introduction:\\ud Intermittent energy restriction encompasses dietary approaches including intermittent fasting, alternate day fasting, and fasting for two days per week. Despite the recent popularity of intermittent energy restriction and associated weight loss claims, the supporting evidence base is ...
Kozuka, Chisayo; Yabiku, Kouichi; Takayama, Chitoshi; Matsushita, Masayuki; Shimabukuro, Michio
The prevalences of obesity and type 2 diabetes mellitus are dramatically increasing, and there is a strong need for more effective and safer therapies. However, some of drugs show limited efficacy and considerable adverse effects. Furthermore, artificial energy-dense foods and non-caloric foods may promote overeating and weight gain. In this context, a natural food-based approach may represent a valuable means of tackling the obesity-diabetes syndrome. Although recent studies have shown that brown rice improves glucose intolerance and prevents obesity and type 2 diabetes in humans, the underlying molecular mechanisms remain unclear. We found that one of the major components of brown rice, γ-oryzanol (Orz), plays an important role in the metabolically beneficial effects of brown rice. Orz acts as a chemical chaperone and decreases high fat diet (HFD)-induced endoplasmic reticulum (ER) stress in the hypothalamus, thereby leading to a significant shift in preference from fatty to healthy foods. Orz also decreases HFD-induced ER stress in pancreatic β-cells and improves β-cell function. Notably, Orz directly acts on pancreatic islets and enhances glucose-stimulated insulin secretion (GSIS). This evidence highlights food preference as a promising therapeutic target in obesity-diabetes syndrome and suggests that brown rice and Orz may have potential for the treatment of obesity and type 2 diabetes in humans. © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.
Yanik, Burcu; Ayrim, Aylin; Ozol, Duygu; Koktener, Asli; Gokmen, Derya
The etiology of osteoporosis in asthma is complex as various factors contribute to its pathogenesis. The purpose of our study was to investigate the effects of obesity and inhaled steroids, as well as the severity and duration of asthma, on osteoporosis in postmenopausal asthma patients as compared to healthy controls. A total of 46 patients with asthma and 60 healthy female controls, all postmenopausal, were enrolled in our study. Bone mineral density was assessed at the lumbar spine and hip using a Lunar DPX-L densitometer. Bone mineral density (BMD) scores were comparable between the asthmatic and control groups, with average scores of 0.95 +/- 0.29 and 0.88 +/- 0.14 g/cm(2), respectively. Likewise, osteoporosis was diagnosed in a similar percentage of patients in the asthmatic (39.1%) and control (43.3%) groups. Bone fracture was identified in four patients with asthma (8.6%) and in six patients from the control group (10%). We could not detect any relationship between BMD and duration of asthma, asthma severity, inhaled steroids or body mass index (BMI). There was no difference between the two groups with respect to age or years since menopause. Although asthma patients were more likely to be overweight and presented higher BMD scores on average than the control subjects, these differences were not statistically significant. There is a slight positive protective effect of high BMI against osteoporosis in asthma patients, but this effect is overcome by time and menopause status. Therefore, the protective effect of obesity against osteoporosis in asthma patients seems to not be significant.
Full Text Available OBJECTIVES: The etiology of osteoporosis in asthma is complex as various factors contribute to its pathogenesis. The purpose of our study was to investigate the effects of obesity and inhaled steroids, as well as the severity and duration of asthma, on osteoporosis in postmenopausal asthma patients as compared to healthy controls. METHODS: A total of 46 patients with asthma and 60 healthy female controls, all postmenopausal, were enrolled in our study. Bone mineral density was assessed at the lumbar spine and hip using a Lunar DPX-L densitometer. RESULTS: Bone mineral density (BMD scores were comparable between the asthmatic and control groups, with average scores of 0.95 ± 0.29 and 0.88 ± 0.14 g/cm², respectively. Likewise, osteoporosis was diagnosed in a similar percentage of patients in the asthmatic (39.1% and control (43.3% groups. Bone fracture was identified in four patients with asthma (8.6% and in six patients from the control group (10%. We could not detect any relationship between BMD and duration of asthma, asthma severity, inhaled steroids or body mass index (BMI. There was no difference between the two groups with respect to age or years since menopause. Although asthma patients were more likely to be overweight and presented higher BMD scores on average than the control subjects, these differences were not statistically significant. CONCLUSIONS: There is a slight positive protective effect of high BMI against osteoporosis in asthma patients, but this effect is overcome by time and menopause status. Therefore, the protective effect of obesity against osteoporosis in asthma patients seems to not be significant.
Obese patients have many physical limitations and much psychiatric burden to overcome. Several studies have shown that the prevalence of psychiatric morbidity in the obese is similar to those with normal weight. However, in obese patients seeking treatment there is an increased prevalence (40-60%) of psychiatric morbidity, most commonly depression. It is difficult to separate the effects of depression on obesity and, on the contrary, the neuroendocrine changes associated with stress and depression may cause metabolic changes that predispose and perpetuate obesity. The stigma associated with obesity causes bullying in school as well as childhood psychiatric morbidity. Prejudice is not limited to the general public but exists among health professionals too. This chapter discusses the treatment of depression in obesity and the psychiatric evaluation of the pre-bariatric surgery patient. Education of society, starting with schools and including healthcare professionals will reduce bias and stigma as well as assist this vulnerable group of patients to seek help for their obesity and the many problems that come with it. Given that by the year 2025 obesity will be the world's number one health problem with the US leading the way, it is very important that we pursue preventive measures as well as encourage research for treatments of obesity.
Santiprabhob, Jeerunda; Leewanun, Chanin; Limprayoon, Kawewan; Kiattisakthavee, Pornpimol; Wongarn, Renu; Aanpreung, Prapun; Likitmaskul, Supawadee
An uncontrolled study was conducted to evaluate the effects of a group-based program on weight control, metabolic profiles, and obesity-related complications in obese youth. The program consisted of an initial in-patient session and five group sessions, one, two, three, six, and nine months into the study, providing participants and their parents with information about the consequences of obesity and lifestyle modifications. The severity of obesity and obesity-related complications were evaluated at baseline and 12 months after the intervention. The participants' and their parents' perceptions of the program were assessed. Of the obese youth recruited (n=126), 115 completed the study. Their percentage weight for height and percentage body fat decreased significantly (both pchildhood obesity, improving metabolic profiles, and alleviating certain obesity-related complications. A group-based program that provides education and raises the awareness of obese children and their parents about the consequences of obesity is an effective model for treating childhood obesity. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Koot, B. G. P.; van der Baan-Slootweg, O. H.; Vinke, S.; Bohte, A. E.; Tamminga-Smeulders, C. L. J.; Jansen, P. L. M.; Stoker, J.; Benninga, M. A.
Lifestyle intervention is the only established therapy for non-alcoholic fatty liver disease (NAFLD). The optimal treatment schedule and predictors of response of this treatment have not been established in children. We aimed to evaluate the 2-year efficacy of an inpatient versus ambulatory
May 22, 2009 ... c Department of Dentistry, Bobath Memorial Hospital, Japan d Department of ... accomplish a short-term treatment effectively for them. Obesity is a ... various types of antipsychotic agents over a long treatment course, which ...
Sampath, Kartik; Dinani, Amreen M; Rothstein, Richard I
The obesity epidemic, recognized by the World Health Organization in 1997, refers to the rising incidence of obesity worldwide. Lifestyle modification and pharmacotherapy are often ineffective long-term solutions; bariatric surgery remains the gold standard for long-term obesity weight loss. Despite the reported benefits, it has been estimated that only 1% of obese patients will undergo surgery. Endoscopic treatment for obesity represents a potential cost-effective, accessible, minimally invasive procedure that can function as a bridge or alternative intervention to bariatric surgery. We review the current endoscopic bariatric devices including space occupying devices, endoscopic gastroplasty, aspiration technology, post-bariatric surgery endoscopic revision, and obesity-related NOTES procedures. Given the diverse devices already FDA approved and in development, we discuss the future directions of endoscopic therapies for obesity.
Makkes, Sabine; Halberstadt, Jutka; Renders, Carry M; Bosmans, Judith E; van der Baan-Slootweg, Olga H; Seidell, Jacob C
BACKGROUND: Intensive combined lifestyle interventions are the recommended treatment for severely obese children and adolescents, but there is a lack of studies and their cost-effectiveness. The objective of this study is to compare the cost-effectiveness of two intensive one-year inpatient
Grilo, Carlos M.; Masheb, Robin M.; Wilson, G. Terence; Gueorguieva, Ralitza; White, Marney A.
Objective: Cognitive-behavioral therapy (CBT) is the best established treatment for binge-eating disorder (BED) but does not produce weight loss. The efficacy of behavioral weight loss (BWL) in obese patients with BED is uncertain. This study compared CBT, BWL, and a sequential approach in which CBT is delivered first, followed by BWL (CBT + BWL).…
Pelantová, H.; Bugáňová, M.; Holubová, M.; Šedivá, B.; Zemenová, J.; Sýkora, D.; Kaválková, P.; Haluzík, M.; Železná, B.; Maletínská, L.; Kuneš, Jaroslav; Kuzma, M.
Roč. 431, C (2016), s. 88-100 ISSN 0303-7207 Institutional support: RVO:67985823 Keywords : NMR metabolomics * mouse * obesity * type 2 diabetes mellitus * urine * antidiabetic treatment Subject RIV: FB - Endocrinology, Diabetology, Metabolism, Nutrition Impact factor: 3.754, year: 2016
Passchier, J.; de Niet, J.; Timman, R.; Bauer, S.; van den Akker, E.; Buijks, H.; De Klerk, C.; Kordy, H.
Objective: Maintaining weight loss results in childhood obesity treatment is difficult to achieve. Self-management techniques such as self-monitoring are associated with increased weight loss and maintenance. This study analyzes whether self-monitoring of lifestyle behaviours through a short message
Larsen, Julie R; Vedtofte, Louise; Jakobsen, Mathilde S L
in Denmark. Of 214 eligible participants with a schizophrenia spectrum disorder, 103 were randomized to liraglutide or placebo. Participants received stable treatment with clozapine or olanzapine, were overweight or obese, and had prediabetes. Data were collected from May 1, 2013, through February 25, 2016...
Full Text Available Pioglitazone, a selective ligand of peroxisome proliferator-activated receptor gamma (PPARγ, is an insulin sensitizer drug that is being used in a number of insulin-resistant conditions, including non-alcoholic fatty liver disease (NAFLD. However, there is a discrepancy between preclinical and clinical data in the literature and the benefits of pioglitazone treatment as well as the precise mechanism of action remain unclear. In the present study, we determined the effect of chronic pioglitazone treatment on hepatic gene expression profile in diet-induced obesity (DIO C57BL/6J mice in order to understand the mechanisms of NAFLD induced by PPARγ agonists. DIO mice were treated with pioglitazone (25 mg/kg/day for 38 days, the gene expression profile in liver was evaluated using Affymetrix Mouse GeneChip 1.0 ST array. Pioglitazone treatment resulted in exacerbated hepatic steatosis and increased hepatic triglyceride and free fatty acids concentrations, though significantly increased the glucose infusion rate in hyperinsulinemic-euglycemic clamp test. The differentially expressed genes in liver of pioglitazone treated vs. untreated mice include 260 upregulated and 86 downregulated genes. Gene Ontology based enrichment analysis suggests that inflammation response is transcriptionally downregulated, while lipid metabolism is transcriptionally upregulated. This may underlie the observed aggravating liver steatosis and ameliorated systemic insulin resistance in DIO mice.
da Silva, Patrícia Leão; de Mello, Marco Túlio; Cheik, Nadia Carla; Sanches, Priscila Lima; Piano, Aline; Corgosinho, Flávia Campos; Campos, Raquel Munhoz da Silveira; Carnier, June; Inoue, Daniela; do Nascimento, Claudia Mo; Oyama, Lila M; Tock, Lian; Tufik, Sérgio; Dâmaso, Ana R
Recent studies have demonstrated a greater prevalence in exercise-induced bronchospasm (EIB) in obese adolescents. However, the role of pro-/anti-inflammatory adipokines and the repercussions of obesity treatment on EIB need to be explored further. Therefore, the objective of this study was to evaluate the role of pro-/anti-inflammatory adipokines on EIB in obese adolescents evaluated after long-term interdisciplinary therapy. Thirty-five post-pubertal obese adolescents, including 20 non-EIB (body mass index [BMI] 36 ± 5 kg/m(2)) and 15 EIB (BMI 36 ± 5 kg/m(2)), were enrolled in this study. Body composition was measured by plethysmography, using the BOD POD body composition system, and visceral fat was analyzed by ultrasound. Serum levels of adiponectin and leptin were analyzed. EIB and lung function were evaluated according to the American Thoracic Society criteria. Patients were recruited to a 1-year interdisciplinary intervention of weight loss, consisting of medical, nutritional, exercise, and psychological components. Anthropometrics and lung function variables improved significantly after the therapy in both groups. Furthermore we observed a reduction in EIB occurrence in obese adolescents after treatment. There was an increase in adiponectin levels and a reduction in leptin levels after the therapy. In addition, a low FEV(1) value was a risk factor associated with EIB occurrence at baseline, and was correlated after treatment with changes in anthropometric and maximal O(2) consumption values as well as the adipokines profile. In the present study it was demonstrated that 1 year of interdisciplinary therapy decreased EIB frequency in obese adolescents, paralleled by an increase in lung function and improvement in pro-/anti-inflammatory adipokines.
Full Text Available Abstract Background Only protein diet has been used successfully to prevent loss of lean body mass first in post-surgical and then in obese patients. We studied overweight and obese patients receiving short treatments of an exclusively protein-based nutritional solution as 24-hour enteral infusion. Methods 19,036 patients (age 44.3 ± 13, M:F = 2:5 with an initial body mass index of 36.5 ± 7.1 underwent 10-day cycles of enteral nutrition through a fine nasogastric tube. The nutritional solution consisted solely of 50–65 g of proteins, plus vitamins and electrolytes. The 24-hour infusion was controlled with a small portable pump. Before and after each 10-day cycle body composition was checked with a Handy 3000 impedance analyzer. At the onset of treatment, average fat mass was 40.9 ± 12.8 kg while body cell mass was 42.7 ± 7.2 kg in males and 27.4 ± 4.6 kg in females. Results After an average of 2.5 cycles the patients lost 10.2 ± 7.0 kg of body weight, 5.8 ± 5.5 kg of fat mass and 2.2 ± 3.3 kg of body cell mass. No significant adverse effects were recorded except asthenia and constipation which were easily controlled with therapy. Long-term results were obtained from 15,444 patients and after an average of 362 ± 296 days we found a mean weight regain of 15.4%. Conclusion Ketogenic Enteral Nutrition treatment of over 19,000 patients induced a rapid 10% weight loss, 57% of which was Fat Mass. No significant adverse effects were found. The treatment is safe, fast, inexpensive and has good one-year results for weight maintenance.
Tripicchio, Gina L; Ammerman, Alice S; Neshteruk, Cody; Faith, Myles S; Dean, Kelsey; Befort, Christie; Ward, Dianne S; Truesdale, Kimberly P; Burger, Kyle S; Davis, Ann
Strategies to treat pediatric obesity are needed, especially among high-need populations. Technology is an innovative approach; however, data on technology as adjuncts to in-person treatment programs are limited. A total of 64 children [body mass index (BMI) ≥85th percentile, mean age = 9.6 ± 3.1 years, 32.8% female, 84.4% Hispanic] were recruited to participate in one of three cohorts of a family-based behavioral group (FBBG) treatment program: FBBG only, TECH1, and TECH2. Rolling, nonrandomized recruitment was used to enroll participants into three cohorts from May 2014 to February 2015. FBBG began in May 2014 and received the standard, in-person 12-week treatment only (n = 21); TECH1 began in September 2014 and received FBBG plus a digital tablet equipped with a fitness app (FITNET) (n = 20); TECH2 began in February 2015 and received FBBG and FITNET, plus five individually tailored TeleMed health-coaching sessions delivered via Skype (n = 23). Child BMI z-score (BMI-z) was assessed at baseline and postintervention. Secondary aims examined weekly FBBG attendance, feasibility/acceptability of FITNET and Skype, and the effect of technology engagement on BMI-z. FBBG and TECH1 participants did not show significant reductions in BMI-z postintervention [FBBG: β = -0.05(0.04), p = 0.25; TECH1: β = -0.006(0.06), p = 0.92], but TECH2 participants did [β = -0.09(0.02), p < 0.001] and TeleMed session participation was significantly associated with BMI-z reduction [β = -0.04(0.01), p = 0.01]. FITNET use and FBBG attendance were not associated with BMI-z in any cohort. Overall, participants rated the technology as highly acceptable. Technology adjuncts are feasible, used by hard-to-reach participants, and show promise for improving child weight status in obesity treatment programs.
Cabler, Stephanie; Agarwal, Ashok; Flint, Margot; du Plessis, Stefan S
The obesity pandemic has grown to concerning proportions in recent years, not only in the Western World, but in developing countries as well. The corresponding decrease in male fertility and fecundity may be explained in parallel to obesity, and obesity should be considered as an etiology of male fertility. Studies show that obesity contributes to infertility by reducing semen quality, changing sperm proteomes, contributing to erectile dysfunction, and inducing other physical problems related to obesity. Mechanisms for explaining the effect of obesity on male infertility include abnormal reproductive hormone levels, an increased release of adipose-derived hormones and adipokines associated with obesity, and other physical problems including sleep apnea and increased scrotal temperatures. Recently, genetic factors and markers for an obesity-related infertility have been discovered and may explain the difference between fertile obese and infertile obese men. Treatments are available for not only infertility related to obesity, but also as a treatment for the other comorbidities arising from obesity. Natural weight loss, as well as bariatric surgery are options for obese patients and have shown promising results in restoring fertility and normal hormonal profiles. Therapeutic interventions including aromatase inhibitors, exogenous testosterone replacement therapy and maintenance and regulation of adipose-derived hormones, particularly leptin, may also be able to restore fertility in obese males. Because of the relative unawareness and lack of research in this area, controlled studies should be undertaken and more focus should be given to obesity as an etiolgy of male infertility.
Grubnik, V V; Golliak, V P; Kresiun, M S
The gastric shunting (GSH) method, permitting to control the patients body mass more effectively and promoting complete remission of diabetes mellitus type II, was elaborated. In 2008 - 2009 yrs 29 patients (9 men, 20 women) were operated on for morbid obesity, using shunting interventions. In 21 patients (the first group) a standard GSH was performed, in 8 (second group)--a modified operation. In 18-24 mo the excessive patient's body mass in patients of the first group have reduced by 62.8%, of the second group--by 89.3%. Complete compensation of diabetes mellitus type II with rejection from insulin and other antidiabetic preparations was achieved in 4 patients of the first group and in all--in the second group. Resistence for insulin have had lowered in patients of both groups, including in the first group--in 1,4 times, in the second group--in 3.2 times. Thus, preliminary results accurately demonstrate, that application of a modified GSH method is more effective, concerning the patients body mass reduction and achievement of complete compensation of diabetes mellitus type II.
Iordache, N; Vizeteu, R; Iorgulescu, A; Zmeu, B; Iordache, M
The authors present the results of a prospective study regarding their 1st year experience in laparoscopic adjustable gastric banding (LABG), which included 21 patients (5 males, 16 females), with an average age of 39 (between 20-53 years). The follow up was made at one and six months postoperative. The medium weight was 138 kg (between 95-172 kg), with a medium excess of body mass of 66.89 kg (extremes between 27.75 and 104 kg). The medium BMI (body mass index) was 48.9 (extremes: 34.5-66), 8 patients being superobese (BMI > 50). The average operating time was 120 min, all operations were finished laparosopically. Postoperative complications were: total disfagia (1 case), parietal suppuration (2 cases) and partial intragastric migration of the prosthesis (1 case). There were no deceased patients. The medium excess of body mass at 6 months after surgery was 46.57 (only 13 patients evaluated in this interval). After 6 months postoperative the comorbidities were healed at half of the patients. Although we do not benefit of a long time follow up, the favorable initial results permits us to state that LABG must find its place in the efforts of struggling against obesity and its consequences.
So Hun Kim
Full Text Available Brown fat is a specialized fat depot that can increase energy expenditure and produce heat. After the recent discovery of the presence of active brown fat in human adults and novel transcription factors controlling brown adipocyte differentiation, the field of the study of brown fat has gained great interest and is rapidly growing. Brown fat expansion and/or activation results in increased energy expenditure and a negative energy balance in mice and limits weight gain. Brown fat is also able to utilize blood glucose and lipid and results in improved glucose metabolism and blood lipid independent of weight loss. Prolonged cold exposure and beta adrenergic agonists can induce browning of white adipose tissue. The inducible brown adipocyte, beige adipocyte evolving by thermogenic activation of white adipose tissue have different origin and molecular signature from classical brown adipocytes but share the characteristics of high mitochondria content, UCP1 expression and thermogenic capacity when activated. Increasing browning may also be an efficient way to increase whole brown fat activity. Recent human studies have shown possibilities that findings in mice can be reproduced in human, making brown fat a good candidate organ to treat obesity and its related disorders.
Felt, Ulrike; Felder, Kay; Penkler, Michael
Diversity has become a buzzword in medical care, denoting a re-evaluation of what it means to attend to differences among human bodies and lives. Questions about what types of differences matter and how they should be defined have become important normative and analytical challenges. Drawing on two case studies, we show how differences between patients and patient-collectives are not simply waiting to be recognised and addressed but also enacted within situated healthcare practices. Although concerns with diversity are present in both cases, they take different forms. In a Viennese health-promotion project for obese clients, care practices are both based on and reproduce large-scale categories that divide the population into distinct subgroups with specific needs. Conversely, in an outpatient clinic for bariatric surgery patients, a technical fix-oriented procedure leads to concerns over diversity becoming an add-on realised by tending to each patient's idiosyncrasies and personal stories. By tracing the practices of diversity and the tensions they produce, we show how classifications and understandings of human difference are based on infrastructures that enable and constrain them. Furthermore, we discuss how they become consequential in healthcare, thereby indicating the importance of remaining reflexive about the political implications of diversity discourse and practice. © 2016 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.
Bordnick, Patrick S; Carter, Brian L; Traylor, Amy C
Virtual reality (VR), a system of human-computer interaction that allows researchers and clinicians to immerse people in virtual worlds, is gaining considerable traction as a research, education, and treatment tool. Virtual reality has been used successfully to treat anxiety disorders such as fear of flying and post-traumatic stress disorder, as an aid in stroke rehabilitation, and as a behavior modification aid in the treatment of attention deficit disorder. Virtual reality has also been employed in research on addictive disorders. Given the strong evidence that drug-dependent people are highly prone to use and relapse in the presence of environmental stimuli associated with drug use, VR is an ideal platform from which to study this relationship. Research using VR has shown that drug-dependent people react with strong craving to specific cues (e.g., cigarette packs, liquor bottles) as well as environments or settings (e.g., bar, party) associated with drug use. Virtual reality has also been used to enhance learning and generalization of relapse prevention skills in smokers by reinforcing these skills in lifelike environments. Obesity researchers and treatment professionals, building on the lessons learned from VR research in substance abuse, have the opportunity to adapt these methods for investigating their own research and treatment questions. Virtual reality is ideally suited to investigate the link between food cues and environmental settings with eating behaviors and self-report of hunger. In addition, VR can be used as a treatment tool for enhancing behavior modification goals to support healthy eating habits by reinforcing these goals in life-like situations. © 2011 Diabetes Technology Society.
Bordnick, Patrick S; Carter, Brian L; Traylor, Amy C
Virtual reality (VR), a system of human–computer interaction that allows researchers and clinicians to immerse people in virtual worlds, is gaining considerable traction as a research, education, and treatment tool. Virtual reality has been used successfully to treat anxiety disorders such as fear of flying and post-traumatic stress disorder, as an aid in stroke rehabilitation, and as a behavior modification aid in the treatment of attention deficit disorder. Virtual reality has also been employed in research on addictive disorders. Given the strong evidence that drug-dependent people are highly prone to use and relapse in the presence of environmental stimuli associated with drug use, VR is an ideal platform from which to study this relationship. Research using VR has shown that drug-dependent people react with strong craving to specific cues (e.g., cigarette packs, liquor bottles) as well as environments or settings (e.g., bar, party) associated with drug use. Virtual reality has also been used to enhance learning and generalization of relapse prevention skills in smokers by reinforcing these skills in lifelike environments. Obesity researchers and treatment professionals, building on the lessons learned from VR research in substance abuse, have the opportunity to adapt these methods for investigating their own research and treatment questions. Virtual reality is ideally suited to investigate the link between food cues and environmental settings with eating behaviors and self-report of hunger. In addition, VR can be used as a treatment tool for enhancing behavior modification goals to support healthy eating habits by reinforcing these goals in life–like situations. PMID:21527092
The W.H.O. identifies obesity as one of the ten leading health risk factors. Obesity is a worldwide non-infectious pandemic with dramatic consequences, and its usual treatment comes generally to a failure. One may wonder if our therapeutic proposal is adequate, instead of speaking about the lack of willpower of our patients. The explanation of weight gain should not be reduced to a caloric balance. Obese people may have other physiological characteristics than lean ones. Examples are quoted.
Lucchetta, Rosa Camila; Riveros, Bruno Salgado; Pontarolo, Roberto; Radominski, Rosana Bento; Otuki, Michel Fleith; Fernandez-Llimos, Fernando; Correr, Cassyano Januário
The aim of this study was to evaluate efficacy and safety of amfepramone, fenproporex and mazindol as a monotherapy for the treatment of obese or overweight patients. A systematic review of primary studies was conducted, followed by a direct meta-analysis (random effect) and mixed treatment comparison. Medline and other databases were searched. Heterogeneity was explored through I2 associated with a p-value. Of 739 identified publications, 25 were included in the meta-analysis. The global eva...
Foster, Gary D; Shantz, Kerri Leh; Vander Veur, Stephanie S; Oliver, Tracy L; Lent, Michelle R; Virus, Amy; Szapary, Philippe O; Rader, Daniel J; Zemel, Babette S; Gilden-Tsai, Adam
Background: Increased consumption of nuts has been advocated because of their health benefits, but the role of nuts in the treatment of obesity is unclear given their high energy density. Objective: This study was designed to evaluate the effects of a hypocaloric, almond-enriched diet (AED) compared with a hypocaloric nut-free diet (NFD) on body weight and cardiovascular disease risk factors in the context of an 18-mo behavioral weight-management program. Design: Overweight and obese individuals [n = 123; age = 46.8 y, BMI (in kg/m2) = 34.0] were randomly assigned to consume an AED or NFD and instructed in traditional behavioral methods of weight control. Anthropometric and metabolic measurements were made at baseline, 6 mo, and 18 mo. Results: Those in the AED group lost slightly but significantly less weight than did those in the NFD group at 6 mo (−5.5 compared with −7.4 kg; P = 0.04), but there were no differences at 18 mo. No significant differences in body composition were found between the groups at 6 or 18 mo. The AED, compared with the NFD, was associated with greater reductions in total cholesterol (P = 0.03), total:HDL cholesterol (P = 0.02), and triglycerides (P = 0.048) at 6 mo, and no differences were observed between the groups at 18 mo. Conclusions: The AED and NFD groups experienced clinically significant and comparable weight loss at 18 mo. Despite smaller weight loss in the AED group at 6 mo, the AED group experienced greater improvements in lipid profiles. This trial was registered at clinicaltrials.gov as NCT00194428. PMID:22743313
Foster, Gary D; Shantz, Kerri Leh; Vander Veur, Stephanie S; Oliver, Tracy L; Lent, Michelle R; Virus, Amy; Szapary, Philippe O; Rader, Daniel J; Zemel, Babette S; Gilden-Tsai, Adam
Increased consumption of nuts has been advocated because of their health benefits, but the role of nuts in the treatment of obesity is unclear given their high energy density. This study was designed to evaluate the effects of a hypocaloric, almond-enriched diet (AED) compared with a hypocaloric nut-free diet (NFD) on body weight and cardiovascular disease risk factors in the context of an 18-mo behavioral weight-management program. Overweight and obese individuals [n = 123; age = 46.8 y, BMI (in kg/m(2)) = 34.0] were randomly assigned to consume an AED or NFD and instructed in traditional behavioral methods of weight control. Anthropometric and metabolic measurements were made at baseline, 6 mo, and 18 mo. Those in the AED group lost slightly but significantly less weight than did those in the NFD group at 6 mo (-5.5 compared with -7.4 kg; P = 0.04), but there were no differences at 18 mo. No significant differences in body composition were found between the groups at 6 or 18 mo. The AED, compared with the NFD, was associated with greater reductions in total cholesterol (P = 0.03), total:HDL cholesterol (P = 0.02), and triglycerides (P = 0.048) at 6 mo, and no differences were observed between the groups at 18 mo. The AED and NFD groups experienced clinically significant and comparable weight loss at 18 mo. Despite smaller weight loss in the AED group at 6 mo, the AED group experienced greater improvements in lipid profiles. This trial was registered at clinicaltrials.gov as NCT00194428.
AlMatar, Manaf; Islam, Md Rashedul; Albarri, Osman; Var, Isil; Koksal, Fatih
Four distinguished although overlying stages make up the methodical procedure of wound healing, which are hemostasis, inflammation, proliferation and remodelling. Multiple sclerosis (MS) is described as an incessant inflammatory central nervous system disease, and is linked with neurodegeneration, demyelination, as well as susceptibility to oxidative pressure. Obesity signifies a swiftly developing danger to the wellbeing of populations in a rising number of nations. Usually called diabetes mellitus (DM) by medical practitioners, diabetes details a collection of metabolic diseases within which the individual has raised blood glucose, either due to an insufficiency of insulin generation, or the lack of suitable response by the body to insulin, or both. Conventionally, the pomegranate, as well as its flowers, leaves, fruit juice and tree bark, has been applied in the treatment of conditions including acidosis, haemorrhage, diarrhoea and microbial contagions. Extracts of pomegranate have been established to contain intense anti-inflammatory, antioxidant as well as antitumor features in vivo as well as ex vivo. Of late, beneficial consequences of decrease of fat have been illustrated employing the pomegranate as well as its extracts. Several of the favourable consequences are associated with the availability of anthocyanins, tannins, and considerably elevated amounts of antioxidants, as well as flavonoids and polyphenols. A summary of the endeavours applied to deal with the possible advantages of the pomegranate towards healing wounds, Alzheimer's disease (AD), diabetes mellitus (DM) and obesity, as well as an appraisal of the efficiency of intervention through the pomegranate and its extracts is provided in this article. Copyright© Bentham Science Publishers; For any queries, please email at firstname.lastname@example.org.
Kirk-Ballard, Heather; Kilroy, Gail; Day, Britton C; Wang, Zhong Q; Ribnicky, David M; Cefalu, William T; Floyd, Z Elizabeth
Obesity is linked to insulin resistance, a primary component of metabolic syndrome and type 2 diabetes. The problem of obesity-related insulin resistance is compounded when age-related skeletal muscle loss, called sarcopenia, occurs with obesity. Skeletal muscle loss results from elevated levels of protein degradation and prevention of obesity-related sarcopenic muscle loss will depend on strategies that target pathways involved in protein degradation. An extract from Artemisia dracunculus, termed PMI 5011, improves insulin signaling and increases skeletal muscle myofiber size in a rodent model of obesity-related insulin resistance. The aim of this study was to examine the effect of PMI 5011 on the ubiquitin-proteasome system, a central regulator of muscle protein degradation. Gastrocnemius and vastus lateralis skeletal muscle was obtained from KK-A(y) obese diabetic mice fed a control or 1% (w/w) PMI 5011-supplemented diet. Regulation of genes encoding enzymes of the ubiquitin-proteasome system was determined using real-time quantitative reverse transcriptase polymerase chain reaction. Although MuRF-1 ubiquitin ligase gene expression is consistently down-regulated in skeletal muscle, atrogin-1, Fbxo40, and Traf6 expression is differentially regulated by PMI 5011. Genes encoding other enzymes of the ubiquitin-proteasome system ranging from ubiquitin to ubiquitin-specific proteases are also regulated by PMI 5011. Additionally, expression of the gene encoding the microtubule-associated protein-1 light chain 3 (LC3), a ubiquitin-like protein pivotal to autophagy-mediated protein degradation, is down-regulated by PMI 5011 in the vastus lateralis. PMI 5011 alters the gene expression of ubiquitin-proteasome system enzymes that are essential regulators of skeletal muscle mass. This suggests that PMI 5011 has therapeutic potential in the treatment of obesity-linked sarcopenia by regulating ubiquitin-proteasome-mediated protein degradation. Copyright © 2014 Elsevier Inc
Kapetanakis, Stylianos; Gkantsinikoudis, Nikolaos; Chaniotakis, Constantinos; Charitoudis, Georgios; Givissis, Panagiotis
Percutaneous transforaminal endoscopic discectomy (PTED) is a minimally invasive surgical technique used principally for the treatment of lumbar disc herniation (LDH). LDH is a frequent spinal ailment in obese individuals. The aim of this prospectively designed study was to assess for the first time in the literature the impact of PTED in postoperative parameters of health-related quality of life (HRQoL) in obese patients with LDH within a 2-year follow-up period, to further evaluate the effectiveness of PTED. Patients with surgically treatable LDH were divided into 2 groups. Group A constituted 20 obese patients, and group B was composed of 10 patients with normal body mass index (BMI). A visual analog scale was used for pain evaluation, and the Short Form SF-36 Medical Survey Questionnaire contributed to HRQoL assessment. Follow-up was conducted preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively. Two of the 20 patients (10%) presented with severe postoperative pain, necessitating conventional microdiscectomy. All studied parameters exhibited maximal improvement at 6 months in group A and at 6 weeks in group B, with subsequent stabilization. Obese patients scored lower in all parameters compared with their healthy counterparts with normal BMI, acquiring a less favorable clinical benefit. PTED appears to be a generally safe and effective method for treating obese patients with LDH. However, major technical challenges that lead to a higher frequency of complications, as well as the lesser acquired clinical benefit, in obese patients may contribute to the further consideration for PTED in specific obese patients, especially on the grounds of low surgical experience. Copyright © 2018 Elsevier Inc. All rights reserved.
Guedes, Erika Paniago; Madeira, Eduardo; Mafort, Thiago Thomaz; Madeira, Miguel; Moreira, Rodrigo Oliveira; de Mendonça, Laura Maria Carvalho; de Godoy-Matos, Amélio Fernando; Lopes, Agnaldo José; Farias, Maria Lucia Fleiuss
Obesity is a worldwide public health issue with a negative impact on quality of life. Different weight loss interventions have demonstrated improvements in quality of life. The aim of this study was to investigate the effect of 6 months of treatment with an intragastric balloon (IGB) on health-related quality of life (HRQOL) and its relation to changes in body fat in obese individuals with metabolic syndrome (MS). Fifty obese patients with MS aged 18-50 were selected for treatment with IGB for 6 months. Body fat was assessed with anthropometric measures and dual-energy X-ray absorptiometry (DXA) at baseline and after removal of the IGB. HRQOL was evaluated with the short form of the World Health Organization Quality of Life (WHOQOL-BREF) at baseline and soon after removal of the IGB. Thirty-nine patients completed the study. After 6 months, there was a significant improvement in quality of life (p = 0.0009) and health (p quality of life. The decrease in the percentage of total fat was the parameter that better correlated with improvements in quality of life perception after regression (p = 0.032). In obese individuals with MS, weight loss parameters were associated with short-term improvements in HRQOL after 6 months of treatment with IGB. However, only total fat was independently related to HRQOL perception. ClinicalTrials.gov NCT01598233 .
Mathus-Vliegen, Elisabeth M. H.; de Groot, Gerrit H.
Satiety is centrally and peripherally mediated by gastrointestinal peptides and the vagal nerve. We aimed to investigate whether intragastric balloon treatment affects satiety through effects on fasting and meal-stimulated cholecystokinin (CCK) and pancreatic polypeptide (PP) secretion. Patients
Pasciak, A; Bradley, Y; Nodit, L; Bourgeois, A; Paxton, B; Arepally, A
Purpose: To evaluate the feasibility of Yttrium-90 (90Y) radionuclide therapy as a potential treatment for obesity in a porcine model. As the only appetite-stimulating hormone, localized targeting of ghrelin-producing X/A cells in the fundus of the stomach using 90Y may reduce serum ghrelin levels and decrease hunger. Methods: Under approval of the University of Tennessee IACUC, 8 young female pigs aged 12–13 weeks and weighing 21.8–28.1 Kg were included in this study. Six animals underwent transfemoral angiography as part of a two-day procedure involving: (1) infusion of 99mTc-MAA, followed by nuclear scintigraphy and contrast-enhanced CT for treatment-planning and (2) administration of resin 90Y microspheres into the stomach fundus. Calibrated 90Y activities were infused into the main left gastric and the gastric artery arising from the splenic to yield predetermined fundal absorbed doses. Control animals underwent a sham procedure with saline and contrast. Weekly animal weight and serum ghrelin were measured along with post-euthanasia histologic analyses of mucosal integrity and ghrelin immunoreactive cell-density. Results: 90Y radioembolization was administered to six pigs in dosages from 46.3 to 105.1 MBq resulting in average fundal absorbed doses between 35.5 and 91.9 Gy. No animal showed any signs of pain or GI complication through the duration of the study. Ghrelin immunoreactive cell-density was significantly lower in treated vs. control animals in both the stomach fundus (13.5 vs 34.8, P < 0.05) and body (11.2 vs 19.8, P < 0.05). A trend towards decreased weight gain in treated animals as well as a decrease in explanted stomach volume was also noted. Conclusion: The safety and technical feasibility of radiation therapy using 90Y radioembolization as a potential treatment for obesity has been demonstrated at fundal absorbed doses over 90 Gy. Preliminary data is suggestive of short-term safety and potential efficacy, however, further animal studies are
Myllylä, Minna; Kurki, Samu; Anttalainen, Ulla; Saaresranta, Tarja; Laitinen, Tarja
Study Objectives: Obstructive sleep apnea syndrome (OSAS) patients benefit from continuous positive airway pressure (CPAP) treatment in a dose-response manner. We determined adherence and weight control, as well as their predictors, among long-term CPAP users. Methods: Cohort of 1,023 OSAS patients had used CPAP on average of 6.6 ± 1.2 years. BMI was determined at baseline and at follow-up visits. There were 7.4 ± 1.7 BMI and 6.5 ± 1.8 CPAP usage measurements per patient on average. Using the Bayesian hierarchical model, we determined the patients' individual trends of BMI and adherence development. Patients with significantly increasing or decreasing trends were identified at the posterior probability level of > 90%. Results: The mean age in the cohort was 55.6 ± 9.8 years, BMI 33.5 ± 6.4 kg/m2, apnea-hypopnea index 33.7 ± 23.1, and CPAP usage 6.0 ± 1.8 h/day. The majority of patients had no significant change in BMI (mean annual weight gain 0.04 ± 0.29 kg/m2) or CPAP adherence (mean annual increase 11.4 ± 7.0 min/day). However, at the individual level, 10% of the patients showed significant annual weight gain (0.63 ± 0.35 kg/m2) during the 5-year follow-up period. At baseline these patients were already more severely obese (mean BMI 40.0 ± 5.9 kg/m2) despite being younger (mean 50.9 ± 9.5 years) than the rest of the cohort. Conclusions: In the majority of CPAP-treated OSAS patients, weight did not significantly change but gained slightly slower than in age-matched population in general. However, in 10% of patients, high adherence to CPAP treatment did not prevent the continuation of weight gain. These patients present a high-risk group for OSAS-related multimorbidity later in life. Citation: Myllylä M, Kurki S, Anttalainen U, Saaresranta T, Laitinen T. High adherence to CPAP treatment does not prevent the continuation of weight gain among severely obese OSAS patients. J Clin Sleep Med 2016;12(4):519–528. PMID:26888588
Pasciak, A; Bradley, Y; Nodit, L; Bourgeois, A; Paxton, B; Arepally, A [University of Tennessee Medical Center, Knoxville, TN (United States)
Purpose: To evaluate the feasibility of Yttrium-90 (90Y) radionuclide therapy as a potential treatment for obesity in a porcine model. As the only appetite-stimulating hormone, localized targeting of ghrelin-producing X/A cells in the fundus of the stomach using 90Y may reduce serum ghrelin levels and decrease hunger. Methods: Under approval of the University of Tennessee IACUC, 8 young female pigs aged 12–13 weeks and weighing 21.8–28.1 Kg were included in this study. Six animals underwent transfemoral angiography as part of a two-day procedure involving: (1) infusion of 99mTc-MAA, followed by nuclear scintigraphy and contrast-enhanced CT for treatment-planning and (2) administration of resin 90Y microspheres into the stomach fundus. Calibrated 90Y activities were infused into the main left gastric and the gastric artery arising from the splenic to yield predetermined fundal absorbed doses. Control animals underwent a sham procedure with saline and contrast. Weekly animal weight and serum ghrelin were measured along with post-euthanasia histologic analyses of mucosal integrity and ghrelin immunoreactive cell-density. Results: 90Y radioembolization was administered to six pigs in dosages from 46.3 to 105.1 MBq resulting in average fundal absorbed doses between 35.5 and 91.9 Gy. No animal showed any signs of pain or GI complication through the duration of the study. Ghrelin immunoreactive cell-density was significantly lower in treated vs. control animals in both the stomach fundus (13.5 vs 34.8, P < 0.05) and body (11.2 vs 19.8, P < 0.05). A trend towards decreased weight gain in treated animals as well as a decrease in explanted stomach volume was also noted. Conclusion: The safety and technical feasibility of radiation therapy using 90Y radioembolization as a potential treatment for obesity has been demonstrated at fundal absorbed doses over 90 Gy. Preliminary data is suggestive of short-term safety and potential efficacy, however, further animal studies are