Clinical Obesity最新文献

The global prevalence of obesity and its related complications continue to rise, emphasising the need for effective treatment strategies. Tirzepatide, a novel glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide dual agonist, has emerged as a promising pharmacological option in obesity management due to its potential in weight reduction and cardiometabolic improvement. We conducted a systematic review and meta-analysis following PRISMA guidelines, including randomised controlled trials (RCTs) comparing the efficacy and safety of Tirzepatide with placebo in adults with obesity, with or without type 2 diabetes. We searched PubMed, Cochrane Library, and EMBASE databases up to December 15, 2024. Ten RCTs were included, comprising 6257 participants. Tirzepatide significantly reduced body weight compared to placebo, with a total pooled mean difference of −11.62 kg (95% confidence interval: −14.24 to −9.01, p < 0.001). In the highest dosage group of 15 mg, 88.1%, 63.3%, and 51.8% of participants achieved weight reductions exceeding 5%, 10%, and 15% respectively. Significant improvements were also noted in cardiometabolic risk factors, including haemoglobin A1C, waist circumference, body mass index, and lipid profiles. Tirzepatide showed a favourable safety profile, without increasing the risk of serious adverse events or impacting mortality rates. Tirzepatide has demonstrated effectiveness in achieving significant weight loss and enhancing cardiometabolic health in adults with obesity. While it maintains a favourable safety profile, further studies are essential to investigate its long-term safety and determine the optimal duration of treatment.

The aim of this study was to determine if a program including exercise training before surgery is effective in maintaining muscle mass 1 year after bariatric surgery. This is a nonrandomised, retrospective, single-centre study. Patients were operated on between January 2021 and December 2023. During the preparatory course, patients are offered to join the metabolic rehabilitation protocol. This consists of 3 h of day hospital three times a week during eight consecutive weeks, before surgery. A total of 178 patients were included in the study: 63 (35.4%) in the exercise group and 115 (64.6%) in the control group. A total of 150 (84.3%) were female, with a mean age was 42.0 years and a mean body mass index (BMI) was 41.8 ± 6.0 kg/m². Patients in the exercise group were older than patients in the control group, 45.6 ± 11.8 versus 40.1 ± 10.7 years old (p = 0.002), they had higher LDLc 1.34 ± 0.41 versus 1.21 ± 0.33 g/L (p = 0.05), and more of them were diabetics (p = 0.01). There were no significant differences between the two groups, but the increase in muscle mass seemed higher in exercise group versus control group: 6.3% ± 5.2% versus 5.2% ± 4.4% (p = 0.14). HDLc and delta LDLc seemed higher in the exercise group versus control group: 0.57 ± 0.13 versus 0.55 ± 0.12 g/L and − 0.29 ± 0.27 versus − 0.22 ± 0.26 g/L, and CRP tends to be lower in the exercise group 1.1 ± 1.2 versus 1.8 ± 3.4 mg/L, but these results were not significant. The implementation of a rehabilitation protocol before surgery is difficult in patients with obesity. Nevertheless, it probably allows the patients to establish regular and lasting physical activity.

The aims are (1) to identify and interpret the role of registered dietitian in clinical trials on the efficacy of glucagon like peptide-1 (GLP-1) agonists in adult individuals with obesity but without diabetes, and (2) to quantify the effect of GLP-1 agonists on body weight loss in adult individuals with obesity but without diabetes. An electronic search using PubMed and Scopus was implemented to locate eligible randomised clinical trials. Data extraction and quality assessment were conducted for 13 studies that met the inclusion criteria. Medical nutrition therapy (MNT) steps were evaluated based on the registered dietitian (RD) interventions and procedures that are included in six studies. Data analysis was carried out using specialised software. The meta-analysis results showed pooled mean differences in weight change of −5.4 kg (95% CI: −5.8, −5.0), in waist circumference change of −5.5 cm (95% CI: −7.7, −3.25), and in weight loss as a percentage from baseline of −7.75% (95% CI: −11.1, −4.3). Quality assessment and bias of each study have been reported. Nutrition practice guidelines and MNT are also listed to include screening, assessment, intervention, and monitoring. Based on current available evidence, using GLP-1 agonists for weight loss shows their effectiveness to reduce weight and waist circumference. However, further incorporation of RD in trials will help in understanding the sole effect of MNT in treating obesity using GLP-1 agonists.

Bariatric surgery is associated with low but definite early and late mortality. This study aims to further understand early (≤ 90 days) and delayed (> 90 days) mortality related to bariatric surgery. This is a retrospective collaborative audit of patients who had undergone bariatric surgery and developed complications that ultimately led to death. Individuals who were 18 years or older and had undergone bariatric surgery (primary, revisional, and endoscopic procedures) and subsequently died within 90 days or after 90 days following the surgery between 1 January 2022, and 31 December 2022. A descriptive analysis was conducted. About 30 centres from 21 countries submitted data on 82 patients where patient death was deemed to be related to bariatric surgery. Mortality within 90 days post-surgery was observed in 58 individuals (70.7%), while 24 patients (29.3%) died after this period. Causes of mortality after SG include GI leak, PE, respiratory infection, and malnutrition. Causes of mortality after RYGB include GI leak, coronary heart disease, and bleeding. Reported common causes of early mortality in this study were gastrointestinal leaks, bleeding, coronary heart disease, and pulmonary embolism. Reported common causes of delayed mortality were gastrointestinal leaks and malnutrition. This study characterises patients where death was attributed to a bariatric procedure and identifies common causes of death in these patients. This could aid development of strategies for preventing and managing these complications in the future.

The goal of this study was to ascertain the effect of patient body size on clinic- or patient-delayed health care during the COVID-19 pandemic and factors predicting delay. Primary survey data were collected in August 2021 from 3593 individuals living within the communities near Mayo Clinic facilities in Minnesota, Wisconsin, Arizona, and Florida. More people who identified with the higher-weight BMI categories reported having their care appointments cancelled (62.3%) compared to those who identified with normative weight (38.0%) or underweight (47.7%; p < .001) and reported more frequently delaying their own care (67.9%) relative to those who identified with normative weight (47.0%) or underweight (62.3%; p < .001). Higher-weight people were more likely than others to report delay was due to not knowing where to get care (UW: 5.6%, NW: 3.5%, HW: 7.0%, p_chi-square < .001), worrying about weight-based judgement (UW: 2.1%, NW: 2.1%, HW: 4.5%, p_chi-square < .001), and fearing discrimination (UW: 2.9%, NW: 2.4%, HW: 5.5%, p_chi-square < .001). There was no difference across groups in delay due to fear of COVID-19 exposure. Weight gain was associated with care delay in higher-weight and normative weight groups. Having experienced more patient-centred care pre-COVID was associated with less care delay in the normative weight group, but more care delay in other groups. Higher-weight people were more likely to have their care delayed by health care providers and to delay care themselves. Patient weight gain and concerns about discrimination and judgement about weight gain may have driven the delay of needed care during COVID-19.