Obesity Pillars最新文献_第10页

Background

Chronic non-communicable diseases (CNCD) represent a major cause of morbidity and mortality. Type 2 diabetes mellitus (T2DM) is one of the most prevalent CNCD that is associated with a significant medical and economic burden. One of the main modifiable risk factors of T2DM is obesity. Many medications used for T2DM can lead to weight gain, worsening one of the root causes of this disease.

Methods

In this clinical review, we study the effect of medications for T2DM on body weight. We used MEDLINE, Google scholar, PubMed, Scopus, and Embase databases to search for relevant studies between 1 January 1950 to 20 September 2022 in English language. Here, we review the most prescribed medications for T2DM and summarize their effect on patients’ body weight. We will also present an expert opinion on a recommended weight-centric approach to treat T2DM.

Results

Multiple T2DM medications have been associated with weight gain. Insulin, sulfonylureas, thiazolidinediones and meglitinides may increase body weight. However, biguanides (e.g., metformin), glucagon-like peptide-1 agonists (e.g., semaglutide, liraglutide, tirzepatide), sodium-glucose cotransporter 2 inhibitors, and amylin analogs (e.g., pramlintide) are associated with significant weight loss. Dipeptidyl peptidase-4 inhibitors are considered weight neutral medications. Experts in the fields of endocrinology and obesity recommend utilizing a weight-centric approach when treating T2DM.

Conclusion

Considering the high prevalence and debilitating complication of T2DM, it is of utmost importance to shift from a weight gain approach (i.e., insulin, sulfonylureas) into a weight loss/neutral one (i.e., GLP-1 agonists, SGLT-2 inhibitors, metformin).

背景慢性非传染性疾病(CNCD)是发病率和死亡率的一个主要原因。2型糖尿病(T2DM)是最常见的非传染性疾病之一，与重大的医疗和经济负担相关。2型糖尿病可改变的主要危险因素之一是肥胖。许多用于治疗2型糖尿病的药物会导致体重增加，加重了这种疾病的一个根本原因。方法在本临床综述中，我们研究T2DM药物治疗对体重的影响。我们使用MEDLINE、Google scholar、PubMed、Scopus和Embase数据库检索1950年1月1日至2022年9月20日的相关英文研究。在这里，我们回顾了T2DM最常用的处方药，并总结了它们对患者体重的影响。我们也将提出专家意见，推荐以体重为中心的方法治疗2型糖尿病。结果多种T2DM药物与体重增加有关。胰岛素、磺脲类药物、噻唑烷二酮类药物和美格列酮类药物可能会增加体重。然而，双胍类药物(如二甲双胍)、胰高血糖素样肽-1激动剂(如西马鲁肽、利拉鲁肽、替西帕肽)、钠-葡萄糖共转运蛋白2抑制剂和胰高血糖素类似物(如普兰林肽)与显著的体重减轻有关。二肽基肽酶-4抑制剂被认为是体重中性药物。内分泌学和肥胖领域的专家建议在治疗2型糖尿病时采用以体重为中心的方法。结论考虑到T2DM的高患病率和衰弱性并发症，从增重方法(如胰岛素、磺脲类药物)转变为减重/中性方法(如GLP-1激动剂、SGLT-2抑制剂、二甲双胍)至关重要。

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引用次数: 4

Medication-induced weight gain and advanced therapies for the child with overweight and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement 2022 超重和肥胖儿童的药物诱导体重增加和先进疗法:肥胖医学协会(OMA)临床实践声明2022

Obesity Pillars

Pub Date : 2022-12-01 DOI: 10.1016/j.obpill.2022.100048

Suzanne Cuda , Marisa Censani , Roohi Kharofa , Valerie O'Hara , Rushika Conroy , Dominique R. Williams , Jennifer Paisley , Allen F. Browne , Sara Karjoo , Nancy T. Browne

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) details medication-induced weight gain and advanced therapies for the child with overweight or obesity.

Methods

The scientific information and clinical guidance in this CPS are based on scientific evidence, supported by the medical literature, and derived from the clinical perspectives of the authors.

Results

This OMA Clinical Practice Statement addresses medication-induced weight gain and advanced therapies for the child with overweight or obesity.

Conclusions

This OMA Clinical Practice Statement on medication induced-weight gain and advanced therapies for the child with overweight or obesity is an overview of current recommendations. These recommendations provide a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications. This CPS also addresses treatment recommendations. This section is designed to help the provider with clinical decision making.

这份肥胖医学协会(OMA)临床实践声明(CPS)详细介绍了药物引起的体重增加和超重或肥胖儿童的先进治疗方法。方法本指南的科学信息和临床指导以科学证据为基础，以医学文献为支撑，并从作者的临床角度出发。本OMA临床实践声明涉及药物引起的体重增加和超重或肥胖儿童的先进治疗。本OMA临床实践声明对超重或肥胖儿童的药物诱导体重增加和先进疗法进行了概述。这些建议为改善肥胖儿童和青少年的健康，特别是那些有代谢、生理和心理并发症的儿童和青少年的健康提供了路线图。该CPS还提出了治疗建议。本节旨在帮助提供者进行临床决策。

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引用次数: 7

Obesity Pillars roundtable: Excessive weight reduction with highly effective anti-obesity medications (heAOMs) 肥胖支柱圆桌会议:使用高效抗肥胖药物过度减肥(heAOMs)

Obesity Pillars

Pub Date : 2022-12-01 DOI: 10.1016/j.obpill.2022.100039

Harold Edward Bays , Karli Burridge , Jesse Richards , Angela Fitch

Background

Historically, many anti-obesity medications (AOMs) were withdrawn from development and/or the market due to safety concerns. Another challenge was that, with some exceptions, most of these AOMs had limited weight reducing efficacy. Approved AOMs often did not meet the weight reduction expectations of either clinicians, or their patients. Currently, newer approved and investigational AOMs achieve greater weight reduction than older AOMs. This has prompted an emerging new challenge of “too much weight loss” with some of these highly effective anti-obesity medications (heAOM) – something many did not think possible prior to year 2020.

Methods

This roundtable review includes perspectives from 3 obesity specialists with experience in the clinical use of AOMs. The intent is to provide perspectives and guidance in managing patients with obesity who experience “too much weight loss” with heAOM.

Results

The panelists generally agreed that before treatment with heAOMs, patients with obesity are best informed about the importance of healthful nutrition, adequate hydration, routine physical activity, behavior modification techniques, goals of treatment, and anticipated changes not only from a medical standpoint, but also from a psychosocial standpoint. Clinicians might best recognize that the definition of “excessive weight reduction” may have both objective and subjective considerations, with body composition analyses often essential to accurately assess adiposity.

Conclusions

The consensus of the panelists is reflected in a proposed structured and algorithmic approach to the patient with excessive weight reduction. Once properly evaluated, if the excessive weight reduction is determined most likely due to the heAOM hyper-responders, then this should prompt the clinician to educate the patient (and possibly family and friends) on the health and psychosocial aspects of weight reduction, and engage in a shared decision-making process that determines if the heAOM is best kept at the same dose, decreased in dose, temporarily held, or rare cases, best discontinued.

历史上，许多抗肥胖药物(AOMs)由于安全问题而退出开发和/或市场。另一个挑战是，除了一些例外，大多数AOMs的减肥功效有限。批准的AOMs通常不能满足临床医生或患者的减肥期望。目前，新批准的和正在研究的AOMs比旧的AOMs减轻了更大的重量。这引发了一个新的挑战，即使用一些高效的抗肥胖药物(heAOM)“减肥过度”——这在2020年之前是许多人认为不可能的。方法本次圆桌会议综述包括3位具有AOMs临床应用经验的肥胖专家的观点。目的是为管理使用heAOM“体重减轻过多”的肥胖患者提供观点和指导。结果小组成员普遍同意，在接受heAOMs治疗前，肥胖患者最好了解健康营养的重要性，充足的水分，日常体育活动，行为矫正技术，治疗目标，以及不仅从医学角度，而且从社会心理角度预期的变化。临床医生最好认识到，“过度减肥”的定义可能有客观和主观的考虑，身体成分分析通常是准确评估肥胖的必要条件。小组成员的共识反映在对体重减轻过度的患者提出的结构化和算法方法中。一旦进行了适当的评估，如果确定体重过度减轻最有可能是由于heAOM的超反应，那么这应该促使临床医生教育患者(可能还有家人和朋友)关于减肥的健康和社会心理方面，并参与共同决策过程，以确定heAOM是否最好保持相同剂量，减少剂量，暂时使用，或罕见的情况下，最好停止使用。

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引用次数: 6

Sustainable nutritional behavior change (SNBC) model: How personal nutritional decisions bring about sustainable change in nutritional behavior 可持续营养行为改变(SNBC)模型:个人营养决策如何带来营养行为的可持续变化

Obesity Pillars

Pub Date : 2022-12-01 DOI: 10.1016/j.obpill.2022.100042

Shoma Berkemeyer , Johanna Wehrmann

Background

The aim of this qualitative study was to identify a practice level model that could explain a sustained change in nutritional behavior.

Methods

The study used three data inputs from four interviewees, one merged input from a married couple, as narrative interviews. The interviews were analyzed using grounded theory.

Results

Coexistence of a certain suffering and a triggering episode lead to the decision to change nutritional life-style by all interviewed. Maintenance of the self-determined newly learned nutritional behavior was supported by subject-related intrinsic motivation, the ability to reflect, and a low expectation of success from the behavioral change. Environment-related factors were identified as support from life-partner and peers. Subjects reported that the sustained nutritional behavior change impacted their holistic health through subject-perceived improved life quality, increase in the number of social contacts, and a change in personal attitudes and perception. The analysis remains limited, and at best hypothesis generating, in that only three data inputs from four interviewees were used.

Conclusion

In this hypothesis-generating narrative interview study of four study subjects, volition, personal decision making, and long-term motivation (though not external determination) seemed to sustain a change in newly learned nutritional behavior.

本定性研究的目的是确定一个实践水平的模型，可以解释营养行为的持续变化。方法采用四名受访者的三个数据输入，其中一个来自一对已婚夫妇的合并数据输入，作为叙述访谈。访谈采用扎根理论进行分析。结果所有受访者都存在某种痛苦和触发事件，导致他们决定改变营养生活方式。自我决定的新学营养行为的维持受到与主体相关的内在动机、反思能力和对行为改变成功的低期望的支持。环境相关因素包括生活伴侣和同伴的支持。受试者报告说，持续的营养行为改变影响了他们的整体健康，通过受试者感知到生活质量的改善，社会接触数量的增加，以及个人态度和感知的改变。分析仍然是有限的，充其量只能产生假设，因为只有来自四位受访者的三个数据输入被使用。结论:在四名研究对象的假设生成叙述性访谈研究中，意志、个人决策和长期动机(尽管不是外部决定)似乎维持了新学营养行为的变化。

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引用次数: 1

Sleep-disordered breathing, sleep apnea, and other obesity-related sleep disorders: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022 睡眠呼吸障碍、睡眠呼吸暂停和其他与肥胖相关的睡眠障碍:肥胖医学协会(OMA)临床实践声明(CPS) 2022

Obesity Pillars

Pub Date : 2022-12-01 DOI: 10.1016/j.obpill.2022.100043

Nicholas Pennings , Leslie Golden , Kanica Yashi , Justin Tondt , Harold Edward Bays

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides clinicians an overview of sleep-disordered breathing, (e.g., sleep-related hypopnea, apnea), and other obesity-related sleep disorders.

Methods

The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

Obesity contributes to sleep-disordered breathing, with the most prevalent manifestation being obstructive sleep apnea. Obesity is also associated with other sleep disorders such as insomnia, primary snoring, and restless legs syndrome. This CPS outlines the evaluation, diagnosis, and treatment of sleep apnea and other sleep disorders, as well as the clinical implications of altered circadian system.

Conclusions

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on “Sleep-Disordered Breathing, Sleep Apnea, and Other Obesity-Related Sleep Disorders” is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.

本肥胖医学协会(OMA)临床实践声明(CPS)为临床医生提供了睡眠呼吸障碍(例如，睡眠相关的低通气，呼吸暂停)和其他与肥胖相关的睡眠障碍的概述。方法:本CPS的科学支持基于已发表的引用、OMA作者的临床观点以及肥胖医学协会领导层的同行评审。结果肥胖可导致睡眠呼吸障碍，最常见的表现为阻塞性睡眠呼吸暂停。肥胖还与其他睡眠障碍有关，如失眠、原发性打鼾和不宁腿综合症。本CPS概述了睡眠呼吸暂停和其他睡眠障碍的评估、诊断和治疗，以及昼夜节律系统改变的临床意义。结论肥胖医学协会(OMA)关于“睡眠呼吸障碍、睡眠呼吸暂停和其他与肥胖相关的睡眠障碍”的临床实践声明(CPS)是OMA旨在帮助临床医生护理肥胖患者的一系列CPS之一。

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引用次数: 8

A comparison between weight loss outcomes with anti-obesity medications before and during Covid-19 pandemic at a tertiary weight management center 三级体重管理中心在Covid-19大流行之前和期间使用抗肥胖药物减肥结果的比较

Obesity Pillars

Pub Date : 2022-12-01 DOI: 10.1016/j.obpill.2022.100046

Alan De la Rosa , Wissam Ghusn , Daniel Sacoto , Alejandro Campos , Lizeth Cifuentes , Fauzi Feris , Bradley Busebee , Gerardo Calderon , Andres Acosta , Maria D. Hurtado

Background

/Objectives: Obesity is a risk factor for COVID-19 infection severity and mortality. Anti-obesity medications (AOM) are effective for weight loss. However, weight loss outcomes with AOM during the COVID-19 pandemic are yet to be described.

Subjects

/Methods: Between January 1, 2016, and June 30, 2021, a total of 966 patients were prescribed long-term FDA-approved AOMs at the Mayo Clinic. From these patients, 711 patients did not meet inclusion criteria. A total of 255 patients were included.

Interventions/methods

We performed a retrospective systematic review of electronic medical records and included patients who started a long-term FDA-approved AOM. We excluded patients with history of bariatric procedure, AOM prescription with lorcaserin, orlistat, semaglutide (approved for weight loss after the pandemic), or phentermine (short-term AOM), those taking ≥2 AOMs, <3 months of prescribed AOM, and/or pregnancy. Analysis was divided by 1)preCOVID-19: those who started an AOM before COVID-19 restrictions, 2)COVID-19: those who started an AOM during first quarter of 2020 after the establishment of COVID-19 restrictions. Our primary endpoint was the total body weight loss percentage (%TBWL) at 3, 6, and 12 months after AOM initiation.

Results

There was a statistical difference in TBWL% between the preCOVID-19 and COVID-19 group: 5.3 ± 3.5% vs 4 ± 3.0% (95% CI -2.4 to −0.2; p = 0.02) and 9.7 ± 7.2% vs 6.2 ± 4.7% (95% CI -5.7 to −1.3; p = 0.002) at 3 and 12 months, respectively. At 6 months, the TBWL% was 7.1 for the preCOVID-19 group compared to 6.2% for the COVID-19 (95% CI -2.5 to 0.7; p = 0.25).

Conclusion

With the possible exception of liraglutide, this study shows that weight loss outcomes to AOMs were inferior when prescribed during the routine clinical practice throughout COVID-19 pandemic, compared to the outcomes observed prior to the COVID-19 pandemic.

背景/目的:肥胖是COVID-19感染严重程度和死亡率的危险因素。抗肥胖药物(AOM)对减肥很有效。然而，在COVID-19大流行期间，AOM的减肥效果尚未得到描述。对象/方法:在2016年1月1日至2021年6月30日期间，共有966名患者在梅奥诊所服用了经fda批准的长期AOMs。在这些患者中，有711例患者不符合纳入标准。共纳入255例患者。干预措施/方法我们对电子病历进行了回顾性系统评价，并纳入了开始长期fda批准的AOM的患者。我们排除了有减肥手术史、服用氯卡色林、奥利司他、西马鲁肽(大流行后批准用于减肥)或芬特明(短期AOM)的AOM处方、服用AOM≥2个月、服用AOM处方超过3个月和/或怀孕的患者。分析分为:1)COVID-19前:在COVID-19限制之前开始AOM的人;2)COVID-19:在COVID-19限制建立后的2020年第一季度开始AOM的人。我们的主要终点是AOM开始后3、6和12个月的总体重减轻百分比(%TBWL)。结果COVID-19前和COVID-19组TBWL%的差异有统计学意义:5.3±3.5% vs 4±3.0% (95% CI为-2.4 ~ - 0.2;p = 0.02)和9.7±7.2%和6.2±4.7% (95% CI -5.7−1.3;P = 0.002)，分别在3个月和12个月。在6个月时，COVID-19前组的TBWL%为7.1，而COVID-19组为6.2% (95% CI -2.5至0.7;p = 0.25)。结论本研究表明，在COVID-19大流行期间，与COVID-19大流行之前观察到的结果相比，在常规临床实践中使用利拉鲁肽的AOMs减肥结果较差。

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引用次数: 1

Review of upstream social factors contributing to childhood obesity 儿童肥胖的上游社会因素综述

Obesity Pillars

Pub Date : 2022-12-01 DOI: 10.1016/j.obpill.2022.100040

Dominique R. Williams , Amy Braddock , Marcella Houser , Giselle Blair, Nancy Browne

引用次数: 5

Obesity Pillars Roundtable: Body mass index and body composition in Black and Female individuals. Race-relevant or racist? Sex-relevant or sexist? 肥胖支柱圆桌会议:黑人和女性个体的身体质量指数和身体成分。种族歧视还是种族歧视?与性有关还是性别歧视?

Obesity Pillars

Pub Date : 2022-12-01 DOI: 10.1016/j.obpill.2022.100044

Harold Edward Bays , Sylvia Gonsahn-Bollie , Courtney Younglove , Sean Wharton

Background

Body mass index (BMI or weight in kilograms/height in meters²) is the most common metric to diagnose overweight and obesity. However, a body composition analysis more thoroughly assesses adiposity, percent body fat, lean body mass (i.e., including skeletal muscle), and sometimes bone mineral density. BMI is not an accurate assessment of body fat in individuals with increased or decreased muscle mass; the diagnostic utility of BMI in individuals is also influenced by race and sex.

Methods

Previous Obesity Pillars Roundtables addressed the diagnostic limitations of BMI, the importance of android and visceral fat (especially among those with South and East Asian ancestry), and considerations of obesity among individuals who identify as Hispanic, diverse in sexual-orientation, Black, Native American, and having ancestry from the Mediterranean and Middle East regions. This roundtable examines considerations of BMI in Black and female individuals.

Results

The panelists agreed that body composition assessment was a more accurate measure of adiposity and muscle mass than BMI. When it came to matters of race and sex, one panelist felt: “race is a social construct and not a defining biology.” Another felt that: “BMI should be a screening tool to prompt further evaluation of adiposity that utilizes better diagnostic tools for body composition.” Regarding bias and misperceptions of resistance training in female individuals, another panelist stated: “I have spent my entire medical career taking care of women and have never seen a woman unintentionally gain ‘too much’ muscle mass and bulk up from moderate strength training.”

Conclusions

Conveying the importance of race and sex regarding body composition has proven challenging, with the discussion sometimes devolving into misunderstandings or misinformation that may be perceived as racist or sexist. Body composition analysis is the ultimate diagnostic equalizer in addressing the inaccuracies and biases inherent in the exclusive use of BMI.

身体质量指数(BMI或体重公斤/身高米2)是诊断超重和肥胖最常用的指标。然而，身体成分分析更彻底地评估肥胖、体脂百分比、瘦体重(即包括骨骼肌)，有时还包括骨矿物质密度。BMI并不能准确评估肌肉量增加或减少的个体的体脂;BMI对个体的诊断效用也受到种族和性别的影响。方法先前的肥胖支柱圆桌会议讨论了BMI的诊断局限性、android和内脏脂肪的重要性(特别是在南亚和东亚血统的人群中)，以及西班牙裔、不同性取向、黑人、美洲原住民和地中海和中东地区血统的个体中肥胖的考虑。本次圆桌会议探讨了黑人和女性个体的BMI。结果小组成员一致认为，身体成分评估比身体质量指数更准确地衡量肥胖和肌肉质量。当谈到种族和性别问题时，一位小组成员认为:“种族是一种社会建构，而不是一种决定性的生物学。”另一个人认为:“BMI应该是一种筛选工具，可以利用更好的身体成分诊断工具来促进对肥胖的进一步评估。”关于对女性个体抗阻训练的偏见和误解，另一位小组成员说:“我在整个医疗生涯中都在照顾女性，从来没有见过一个女性通过适度的力量训练无意中增加了‘过多’的肌肉量。”事实证明，传达种族和性别对身体构成的重要性具有挑战性，讨论有时会演变成误解或错误信息，可能被视为种族主义或性别歧视。身体成分分析是最终的诊断均衡器，可以解决BMI单独使用所固有的不准确性和偏差。

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引用次数: 6