International Journal of Obesity最新文献

Background: Obesity represents a critical global health challenge, yet the neurocognitive distinctions in processing different rewards among individuals with overweight/obesity (OW/OB) remain poorly characterized. This meta-analysis aims to synthesize functional MRI evidence to delineate common and distinct neural abnormalities during processing of food or monetary reward cues in individuals with OW/OB compared to normal-weight (NW) controls.

Methods: Searches were conducted in Web of Science, PubMed, and PsycInfo to identify eligible citations from inception until May 2025. The review protocol was registered in PROSPERO (No. CRD42024595608). Data analyses were carried out using the Activation Likelihood Estimation (ALE) algorithm. MRIcroGL was used to show the results with MNI coordinates.

Results: We systematically reviewed 26 studies with 1065 participants, comprising 6 monetary reward and 20 food reward studies. Overlapping reduced activation occurred in the left posterior cingulate cortex (PCC) and insula across both reward types; the left middle frontal gyrus (MFG) exhibited decreased activation in response to food reward cues, while it showed increased activation in response to monetary reward cues in individuals with OW/OB. During food-reward tasks, individuals with OW/OB exhibited increased activation in the bilateral caudate nucleus, hippocampus, anterior cingulate cortex (ACC), and medial prefrontal cortex, alongside decreased activation in amygdala responses. For monetary-reward tasks, increased activation was observed in the right lateral nucleus and hypothalamus, while decreased activation was observed in the right subthalamic nucleus (STN) and posterior ventral lateral nucleus.

Conclusion: Obesity represents a critical global health challenge, yet the neurocognitive distinctions in processing different rewards among individuals with OW/OB remain poorly characterized. Our findings reveal both dissociable and overlapping neural alterations during the processing of primary (food) versus secondary (monetary) rewards in OW/OB, implicating altered reward sensitivity, decision-making, and inhibitory control. The results underscore the necessity for reward-type-specific interventions targeting these neural mechanisms to address obesity-related dysregulation. Contrasts in brain activation during food and monetary reward processing between individuals with overweight/obesity (OW/OB) and normal weight (NW).

Background: Metabolic and bariatric surgery (MBS) is a highly effective treatment for patients with obesity, with increasing prevalence in France. However, some patients require revisional MBS (RMBS) due to suboptimal initial response, recurrent weight gain, and correction of technique-related complications. Understanding the prevalence and risks associated with RMBS is essential for optimizing patient care.

Objective: This study aims to assess the rate of RMBS in France and to delineate the associated complications and risk factors.

Setting: France.

Methods: Using national discharge data from 2016 to 2022, this observational study compared morbidity and mortality rates between primary and RMBS. Patient demographics, comorbidities, and procedural details were analyzed. Major complications within 90 days post-surgery were assessed using logistic regression models adjusted for potential confounders.

Results: Among 284,271 bariatric procedures analyzed, the revision rate was 12.8%. Patients undergoing RMBS were older, predominantly female, and had more comorbidities compared to those undergoing primary procedures. RMBS were associated with significantly higher rates of severe complications (OR 1.58, 95% CI 1.49-1.68, p < 0.001), particularly after gastric bypass (GB) (OR 2.70, 95% CI 2.27-3.20). Subgroup analyses showed increased morbidity following revisional sleeve gastrectomy compared to primary procedures.

Conclusions: This study highlights a notable rate of RMBS in France, with evolving trends towards more complex revisions. RMBS are associated with increased morbidity, emphasizing the need for careful patient selection and enhanced postoperative management. Further research into surgical techniques, long-term pharmacological interventions, and surgeon expertise is warranted to optimize outcomes in this population.

Background: Obesity is linked to adverse health effects, but paradoxically improves survival in heart failure (HF). Peak oxygen consumption (VO₂), a measure of exercise capacity, is a key prognostic indicator in HF. We examined the interaction between obesity and peak VO₂ in predicting survival in patients with HF with reduced ejection fraction (HFrEF).

Methods: We retrospectively reviewed 18,879 patients who underwent maximal cardiopulmonary exercise testing using the modified Bruce ramp protocol between 2012 and 2020. The inclusion criteria were left ventricular ejection fraction <40% and body mass index (BMI) > 18.5 kg/m². Patients were classified as those with normal weight (BMI: 18.5-22.9 kg/m²), overweight (23.0-24.9 kg/m²), or obesity (≥25.0 kg/m²) per 2020 Korean Society for the Study of Obesity guidelines.

Results: For the 819 included patients (292 with normal weight, 197 with overweight, 330 with obesity), median age was 59 (interquartile range [IQR]: 49-67) years, 75.2% were male, and the median BMI was 24.1 (IQR: 22.1-26.5) kg/m². Patients with obesity achieved the highest workload, peak VO₂, and exercise time (all P < 0.001). They also had lower all-cause mortality versus patients with normal weight (hazard ratio 0.46, 95% confidence interval 0.25-0.82, P = 0.009). In patients with obesity, elevated peak VO₂ was associated with a U-shaped mortality curve, unlike the linear relationship in other groups (P for interaction = 0.001).

Conclusions: Patients with obesity and HFrEF showed better survival, consistent with the obesity paradox. However, the U-shaped relationship between peak VO₂ and mortality in this group suggests the survival advantage may diminish at higher levels of exercise capacity, warranting further investigation.

Background/objective: There is evidence that living with obesity can affect an individual's pay and employment, but there is little evidence on the impact of weight-management interventions in improving labour market outcomes of individuals. We evaluate the impact of bariatric surgery on monthly earnings and employee status among working-age adults, and examine variations across sociodemographic characteristics.

Methods: This population-based, retrospective longitudinal cohort study for England included 40,662 individuals who had a bariatric surgery procedure and obesity diagnosis between 1 April 2014 and 31 December 2022, with no bariatric surgery history in the previous 5 years, and were 25 to 64 years old at the date of surgery. 49,921 individuals sampled from the general population who had not had bariatric surgery were also included, matched by age and sex. The main outcome measures were monthly employee pay-for all months and only months where the individual was in paid employment-expressed in 2023 prices and paid employee status.

Results: Among people living with obesity who had bariatric surgery, there was a sustained increase in monthly employee pay from 6 months after surgery with a mean increase of £84 per month (95% confidence interval [Cl]: 63-106) 5 years after surgery compared with the 6 months before surgery. There was a sustained increase in the probability of being a paid employee from 4 months after bariatric surgery, with a mean increase of 4.3 percentage points (95% Cl: 3.7-4.9) 5 years after surgery.

Conclusion: Bariatric surgery is associated with an increased probability of being employed, resulting in increased earnings. This suggests that living with obesity negatively impacts labour market outcomes and that obesity management interventions are likely to generate economic benefits both to individuals and on a macroeconomic level by increasing the likelihood of employment of people living with obesity.

Background: Glucosylsphingosine (Lyso-GL-1), a glycosphingolipid formed by glucosylceramide hydrolysis, is known to be increased in Gaucher disease. Recently, increased ceramides and sphingolipids have been implicated in obesity, insulin resistance, and atherogenesis. However, limited data exists on serum Lyso-GL-1 level in children with obesity and its relation with insulin resistance, lipid dysfunction, and atherogenesis. Hence, this study aimed to assess Lyso-GL-1 level among children with obesity and correlate it with biomarkers of insulin resistance and atherogenic index of plasma (AIP).

Methodology: Sixty children with obesity with a mean age of 10.06 years (SDS ± 2.22) and 60 age- and sex-matched normal-weighed controls were assessed for anthropometric measures, mean blood pressure percentiles, serum Lyso-GL-1, glycated hemoglobin (HbA1c), fasting insulin, triglycerides, cholesterol, low-density (LDL-C) and high-density lipoprotein cholesterol (HDL-C) with calculation of the homeostatic model assessment of insulin resistance (HOMA-IR) and the AIP.

Results: Children with obesity have significantly higher Lyso-GL-1 and AIP than controls. Lyso-GL-1 is significantly positively correlated with body mass index (BMI) z-score, waist/hip ratio z-score, systolic and diastolic blood pressure percentiles, LDL-C, HOMA-IR, and AIP (p < 0.05), being independently correlated with systolic blood pressure percentile, LDL-C, and AIP on multivariate regression analysis.

Conclusion: Serum Lyso-GL-1 is elevated in children with obesity, being closely correlated with hypertension, insulin resistance, and atherogenesis. This could provide a mechanistic insight on the role of Lyso-GL-1 in obesity and atherogenesis. Further studies are warranted to explore the potential role of Lyso-GL-1 as a biomarker and target for the prevention and treatment of obesity-related atherogenesis and insulin resistance.

Objective: The objective of our 14-day technology-supported free-living study was to assess how psychological, environmental, and social factors affect overeating among participants with obesity.

Methods: We recruited 47 adults with obesity (BMI ≥ 30 kg/m²), who collectively logged 2004 meals, wore and used study devices for meal verification, and completed daily food recalls administered by dietitians. Participants reported on stress, affect, hunger, and meal contexts through Ecological Momentary Assessments (EMA). To explore the factors influencing caloric intake per meal, we employed a two-level mixed-effects location scale model, capturing both between-subject (BS) and within-subject (WS) factors based on the EMA data. This is a secondary analysis of the SenseWhy study, focusing on the association between stress and intake.

Results: Our analysis identified six BS factors (e.g., stress, perception of overeating, restaurant food, later meals, pleasure-seeking meal) and ten WS factors (e.g., biological hunger, perceived overeating, uncontrolled eating, social eating, restaurant food, snacks) to be significantly associated with caloric intake. Notably, participants who were more stressed, on average, consumed more calories (0.74; p = 0.002) with high consistency (-0.7; p = 0.048) between individuals. When stressed and not at home, participants consumed less calories (-0.62; p = 0.0043).

Conclusion: Conventional strategies for managing stress-related overeating fall short. Effectively addressing overeating requires an understanding of both psychological and contextual factors.

Background: Weight stigma is pervasive in pregnancy care. However, there is limited research on how pregnant women with higher body weight experience stigma through language documented in electronic health records (EHR). The purpose of this study was to examine the association between higher body weight and stigmatizing language documented in the EHR during the hospital birth admission.

Methods: We used EHR data from women over 20 weeks of gestation admitted to two large metropolitan hospitals in the Northeast United States between 2017 and 2019. The primary exposure was higher body weight. We identified women with higher body weight with ICD-10 codes and keyword searches for terms associated with higher body weight in clinical notes. Study outcomes were the presence of any stigmatizing language and four subcategories of stigmatizing language documented in the clinical note. We employed logistic regression to calculate unadjusted and adjusted associations.

Results: After adjusting for covariates, women with higher body weight were more likely to have any stigmatizing language documented compared to women without higher body weight in birth hospitalization notes (adjusted odds ratio [aOR] = 1.10, 95% confidence interval [CI] = 1.01, 1.20). Women with higher body weight were also more likely to have language documented from the marginalized language/identities category (aOR = 1.38, 95% CI = 1.20, 1.59).

Discussion: Women with higher body weight experience stigma in clinical documentation. Findings support the need for clinician training in equitable documentation and the removal of stigmatizing terms from clinic documents and workflows to promote perinatal health equity.

Background: Obesity is a complex metabolic condition with a disproportionate impact among African American youth. Metabolomic profiling enables high-resolution mapping of obesity-related biochemical changes across metabolic pathways.

Methods: We analyzed 551 African American pediatric participants (aged 2-21 years) recruited at the Children's Hospital of Philadelphia between 2002 and 2020. Vitamin D deficiency was observed in 86 participants, including 62 of 309 individuals with overweight or obesity (20%). Plasma metabolites were quantified using the Nightingale NMR platform. Obesity was defined using age- and sex-specific BMI percentiles.

Results: A total of 142 individual metabolite markers and ratios were significantly associated with obesity (FDR < 0.05). Obesity‑related metabolic changes were characterized by elevated branched-chain and aromatic amino acids, GlycA, and triglyceride-rich VLDL subclasses, along with reduced Gly, large HDL particles, and cholesterol-enriched lipoproteins. Global enrichment analysis identified a significant overrepresentation of nominally significant interactions with vitamin D deficiency (p < 2.2 × 10^-¹⁶).

Conclusions: Obesity in African American youth is linked to widespread metabolic remodeling across amino acid, lipid, and inflammatory pathways, reflecting core features of cardiometabolic risk. Vitamin D status may also influence these responses, suggesting a potential role in modifying obesity-related risk. These findings highlight the importance of early identification and prevention strategies and point to vitamin D as a possible target for future investigation.

Breast cancer has now become the most common malignant tumor and the leading cause of cancer deaths in women worldwide, and its pathogenesis has not yet been elucidated. Obesity is a risk factor for multiple cancers, and with the improvement of living standards and changes in dietary structure, obesity has become a major public health challenge in Asia, North America, Europe, and even worldwide. The study of obesity and breast cancer risk is a popular topic in epidemiological research. However, due to variations in obesity assessment criteria, conclusions regarding breast cancer risk in premenopausal versus postmenopausal women have been inconsistent. This review systematically reviews diverse diagnostic criteria for obesity from domestic and international studies, and thoroughly analyzes the differential associations between obesity and breast cancer risk in premenopausal and postmenopausal women, along with their potential molecular biological mechanisms. This paper further summarizes the clinical characteristics of breast cancer patients with obesity, including delayed diagnosis, poor pathological features, and unfavorable prognosis. At the mechanistic level, we integrate multidimensional evidence spanning obesity-related genes (e.g., fat mass and obesity associated genes (FTO)), adipokines (e.g., leptin (LEP), resistin, visfatin, adiponectin (ADPN)), estrogen metabolism, chronic inflammation, and tumor microenvironment remodeling (including cancer-associated adipocytes, extracellular matrix, and microbiota). Finally, this paper envisions the broad prospects of bariatric metabolic surgery in future adjuvant breast cancer treatment. By comprehensively employing lifestyle interventions, drug therapies, and bariatric metabolic surgery, we can provide patients with more comprehensive and personalized treatment plans to achieve better therapeutic outcomes and prognosis.

Background: This study aims to assess the impact of insulin resistance (IR) on gut microbiota (GM) composition, incretin responses, and metabolic outcomes following sleeve gastrectomy (SG) in people with severe obesity who do not have diabetes.

Methods: A prospective single-center study encompassed patients with severe obesity and normal glucose tolerance who underwent SG. Participants were stratified into two cohorts based on the magnitude of their insulin resistance state, as determined by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index: high-IR (Hi-IR; HOMA-IR > 95th percentile) and low-IR (Lo-IR; HOMA-IR <25th percentile). Body composition measurements, biochemical analyses, and microbiota assessments were performed before and 6 months post-surgery. Additionally, the responses to a standardized meal tolerance test (MTT) of glucagon-like peptide-1 (GLP-1) and glucagon-like peptide-2 (GLP-2) were evaluated.

Results: The study cohort consisted of 18 patients (9 with Hi-IR and 9 with Lo-IR), with a mean age of 48.8 ± 9.2 years and a mean body mass index (BMI) of 45.03 ± 4.82 kg/m². Six months post-surgery, the mean percentage of total weight loss (WL) was 26.5 ± 6%, with both groups exhibiting enhanced secretion of GLP-1 and GLP-2 following MTT. At baseline, participants exhibited distinct microbiota profiles; the Hi-IR group showed a higher relative abundance of Prevotella species, which are previously associated with adverse metabolic and inflammatory profiles. Post-surgery, both groups exhibited positive incretin responses and significant modifications in GM composition. Notably, Hi-IR people experienced more pronounced changes in microbial diversity, including increases in Akkermansia and Veillonella species and decreases in Prevotella species. Enhanced GLP-1 and GLP-2 responses were correlated with WL and metabolic improvement, particularly in the Lo-IR population.

Conclusions: These findings underscore the role of GM in metabolic changes and surgical outcomes after SG. Targeting gut microbiota may offer a promising avenue for improving obesity treatment strategies.