Current Obesity Reports最新文献

Purpose of review: This narrative review summarizes current knowledge on the link between poverty and childhood obesity, and then describes conventional and modern epidemiologic methods for causal inference that may help provide more robust evidence on how poverty reduction can prevent childhood obesity.

Recent findings: Household poverty has been consistently associated with increased risk of childhood obesity across observational studies in industrialized countries. Due to ethical and feasibility limitations, few randomized controlled trials directly test the effect of poverty reduction. A growing number of studies use quasi-experimental methods to study the effects of poverty reduction policies on childhood obesity. These methods include instrumental variables, difference-in-differences, interrupted time series analysis, and regression discontinuity. Other complementary methods such as causal mediation analysis allow us to elucidate the mechanisms of how poverty reduction affects childhood obesity outcomes, while examining heterogeneous treatment effects using cutting-edge machine learning algorithms may further identify subpopulations that benefit the most from poverty interventions. Despite the strong associations between poverty and childhood obesity observed in industrialized countries, current evidence about the causal effect of poverty reduction on childhood obesity is mixed. This is likely due to the complex etiology of childhood obesity and potentially unintended effects of policies. Future studies that leverage advances in causal inference with quasi-experimental approaches will help provide more robust evidence to help guide practitioners and policymakers in ongoing childhood obesity prevention efforts.

Purpose of review: The development of long-acting incretin receptor agonists represents a significant advance in the fight against the concurrent epidemics of type 2 diabetes mellitus (T2DM) and obesity. The aim of the present review is to examine the cellular processes underlying the actions of these new, highly significant classes of peptide receptor agonists. We further explore the potential actions of multi-agonist drugs as well as the mechanisms through which gut-brain communication can be used to achieve long-term weight loss without negative side effects.

Recent findings: Several unimolecular dual-receptor agonists have shown promising clinical efficacy studies when used alone or in conjunction with approved glucose-lowering medications. We also describe the development of incretin-based pharmacotherapy, starting with exendin- 4 and ending with the identification of multi-incretin hormone receptor agonists, which appear to be the next major step in the fight against T2DM and obesity. We discuss the multi-agonists currently in clinical trials and how each new generation of these drugs improves their effectiveness. Since most glucose-dependent insulinotropic polypeptide (GIP) receptor: glucagon-like peptide- 1 receptor (GLP- 1) receptor: glucagon receptor triagonists compete in efficacy with bariatric surgery, the success of these agents in preclinical models and clinical trials suggests a bright future for multi-agonists in the treatment of metabolic diseases. To fully understand how these treatments affect body weight, further research is needed.

Purpose of review: Eating disorders (EDs) are a relatively uncommon yet salient concern for patients undergoing metabolic and bariatric surgery (MBS). This report aims to advance understanding of the complex relationship between EDs and MBS by highlighting recent empirical evidence and identifying areas for future research.

Recent findings: Little-to-no empirical evidence suggests that EDs be considered an absolute contraindication for MBS. However, a small subset of patients experience recurrent or emergent ED symptoms following surgery, invariably resulting in poorer postsurgical outcomes. Plausibly, a confluence of psychosocial and neurobiological mechanisms explains post-MBS ED symptoms. Accurate identification of MBS-related ED concerns is essential, with growing evidence suggesting structured postsurgical treatment may be optimal. Despite recent advances, more research on EDs in the context of MBS is needed, including rigorous mechanistic studies with long-term follow-up that clarify how predisposing factors interact to precipitate postsurgical ED symptoms. More work is also required to inform design and dissemination of targeted ED interventions for patients pursuing MBS.

Purpose of review: This review addresses critical gaps in knowledge and provides a literature overview of the molecular pathways connecting gut microbiota dysbiosis to increased intestinal permeability (commonly referred to as "leaky gut") and its contribution to metabolic disorders. Restoring a healthy gut microbiota holds significant potential for enhancing intestinal barrier function and metabolic health. These interventions offer promising therapeutic avenues for addressing leaky gut and its associated pathologies in metabolic syndrome.

Recent findings: In metabolic disorders such as obesity and type 2 diabetes (T2D), beneficial microbes such as those producing short-chain fatty acids (SCFAs) and other key metabolites like taurine, spermidine, glutamine, and indole derivatives are reduced. Concurrently, microbes that degrade toxic metabolites such as ethanolamine also decline, while proinflammatory, lipopolysaccharide (LPS)-enriched microbes increase. These microbial shifts place a higher burden on intestinal epithelial cells, which are in closest proximity to the gut lumen, inducing detrimental changes that compromise the structural and functional integrity of the intestinal barrier. Such changes include exacerbation of tight junction protein (TJP)s dysfunction, particularly through mechanisms such as destabilization of zona occludens (Zo)-1 mRNA or post-translational modifications. Emerging therapeutic strategies including ketogenic and Mediterranean diets, as well as probiotics, prebiotics, synbiotics, and postbiotics have demonstrated efficacy in restoring beneficial microbial populations, enhancing TJP expression and function, supporting gut barrier integrity, reducing leaky gut and inflammation, and ultimately improving metabolic disorders. This review summarizes the mechanisms by which gut microbiota contribute to the development of leaky gut and inflammation associated with metabolic syndrome. It also explores strategies for restoring gut microbiota balance and functionality by promoting beneficial microbes, increasing the production of beneficial metabolites, clearing toxic metabolites, and reducing the proportion of proinflammatory microbes. These approaches can alleviate the burden on intestinal epithelial cells, reduce leaky gut and inflammation, and improve metabolic health.

Purpose of review: This paper reports the effectiveness of peer intervention in physical activity and obesity, with a focus on implementation. Peer intervention is a parallel method to traditional professional clinical processes, often targeting hard to reach populations. It includes peer education, peer counseling and peer support.

Recent findings: There were ten reviews on Physical Activity and seven on Obesity. Six reviews on obesity had mainly positive results; one on obesity in mental health was more negative. About two-thirds of reviews of Physical Activity interventions had positive outcomes. The overall effect was moderate. There were 39 single studies on Obesity and 46 on Physical Activity. 36% of Obesity studies and 13% of Physical Activity studies were from developing countries. Three single studies from developing countries and three from developed countries were elaborated. The extensively described implementation program was from a developed country. Discussion of limitations and strengths led to recommendations for implementation and evaluation. Overall, peer intervention in both obesity and physical activity showed quite strong evidence of effectiveness. Had all studies followed the implementation/evaluation recommendations, the strength of evidence might have been better. Future research should focus on cost-effectiveness and long-term follow-up.

Purpose of review: This narrative review comprehensively analyzes VLEKT as an advanced nutritional strategy for obesity management. The focus is on the beneficial effects on key disease organs, such as adipose tissue and liver, as well as the modulation of intestinal permeability and its fundamental role in influencing the gut microbiota and inflammatory pathways.

Recent findings: The impact of VLEKT on obesity-related comorbidities, including metabolic syndrome, cardiovascular disease, endocrine disorders, metabolic dysfunction-associated steatotic liver disease (MASLD), neurological disorders, and kidney alterations, is also investigated. Moreover, to assess its wider application in obesity treatment, the combination of ketogenic regimes with additional strategies such as physical activity, bariatric surgery, and digital health technologies is examined. Despite promising clinical results, adherence to VLEKT and potential nutritional deficiencies require careful follow-up and individualized programming monitored by specialists. Future research should focus on elucidating the molecular mechanisms underlying the effects on physiological systems, and long-term safety. Nevertheless, VLEKT is an innovative approach to obesity treatment, offering a target-oriented and highly effective strategy for people fighting against overweight and its associated medical complications. Obesity is a multifactorial and chronic disease associated with numerous comorbidities; given its increasing prevalence, effective and personalized intervention strategies are crucial to inhibit the "obesity pandemic" according to a "food re-educational" protocol. Among dietary interventions, the ketogenic diet (KD) has attracted attention for its effectiveness in weight management and metabolic benefits. A variant, the very low-calorie ketogenic diet (VLCKD), more recently defined as very low-energy ketogenic diet (VLEKD), combines the metabolic benefits of ketosis with substantial calorie restriction, improving overall health.

Purpose of review: This review summarizes the most recent research on the physiology of weight regain. It describes developments in areas that are currently being addressed and that may indicate promising directions for future research.

Recent findings: Weight regain occurs independent of the way prior weight loss is achieved, i.e. by lifestyle, surgery or pharmacotherapy. Recent novel findings regarding weight regain belong to four areas. First, the immune obesity memory of which besides persistent immune cells promoting weight regain cells have been found that reduce weight regain. Second, the gut microbiome where autologous transplantation can limit weight regain. Third, the composition of the weight loss with the percentage of lost fat-free mass being inverse to the amount of regained weight independent of the weight loss procedure. Fourth, appetite control where after weight loss altered hypothalamic activity promoting hunger and weight regain persists, possibly mediated by altered neurotensin responses. In all four areas more conclusive evidence for their role in weight regain still needs to be obtained. Most studies on physiological mechanisms of weight regain are associative in nature and the number of intervention studies is very limited. To bring the field further, carefully designed intervention studies taking into account the dynamic character of weight loss and weight regain are needed.

Purpose of review: This systematic review aims to map the existing literature on salivary biomarkers in adults with metabolically unhealthy obesity (MUO), identify key biomarkers associated with this high-risk group, and highlight areas requiring further research to advance this emerging field.

Recent findings: Obesity is characterized by an abnormal accumulation of body fat and chronic inflammation. However, not all individuals with obesity experience metabolic dysfunction. This review focuses on MUO, which is strongly linked to metabolic disorders such as insulin resistance, cardiovascular disease, type 2 diabetes, and systemic inflammation. Linking MUO and salivary biomarkers may enhance our understanding of how systemic health influences salivary composition and could enable the early identification of high-risk individuals through non-invasive saliva testing. This review synthesized findings from recent studies and identified key salivary biomarkers consistently elevated in individuals with MUO, including 8-OHdG, IL-6, IL-8, resistin, TNFR1, PTX-3, AEA, OEA, TNF-α, and sICAM-1. These biomarkers are associated with inflammation, oxidative stress, and metabolic dysregulation. The majority of studies utilized cross-sectional designs and used various saliva collection methods. Salivary biomarkers hold promise as non-invasive indicators of obesity-related metabolic dysfunction, particularly in MUO. However, their clinical diagnostic utility remains uncertain due to heterogeneity in study designs, a lack of biomarker validation, and limited longitudinal studies. Further research is needed to establish their bona fide diagnostic potential.

Purpose of review: This paper aims to analyze and consolidate the existing evidence on models of care and clinical obesity services for adults living with obesity 1) to identify the key components of clinical obesity services, and 2) to propose recommendations for future directions of promoting the international development of clinical obesity care.

Recent findings: The key components of clinical obesity services include 1) a contextualized composition of multi-disciplinary teams and mechanisms to empower the healthcare professionals, 2) clear stepwise pathways matching patient needs with appropriate clinical and community resources in a timely manner, 3) comprehensive assessment and individualized treatment plan informed by the evidence-based clinical practice guidelines. Furthermore, clinical information systems and financing resources are instrumental to the effective and sustainable functioning of a comprehensive clinical service with strong connections across primary, secondary and tertiary levels of care. We synthesized these findings to make recommendations for healthcare practitioners, hospital administrations and policymakers in developing and improving comprehensive clinical services to address the needs of adults living with obesity.

Purpose of review: This review investigates the relationship of paternal smoking and overweight/obesity during pregnancy and up to one-year post-birth with childhood overweight/obesity up to age 12. Both exposures were analysed separately and together, if appropriate.

Recent findings: Included studies indicate that paternal overweight/obesity is consistently associated with increased risk of childhood overweight/obesity, suggesting a robust intergenerational link. Conversely, findings on paternal smoking are less consistent. Five out of six studies suggest that paternal smoking during pregnancy may contribute to increased risk but one found no association. Children of fathers with overweight/obesity are at higher risk of overweight/obesity in childhood. Paternal smoking was associated with higher risk of child overweight/obesity in most studies. Trajectories of overweight and obesity are likely to be transgenerational and systemic changes to tackle their socioeconomic determinants may be required to address these.