Obesity Facts最新文献

Introduction: Bariatric surgery effectively treats severe obesity; however, publicly funded bariatric surgery in Australia and New Zealand is limited. Bariatric surgeons play an important role in deciding individuals' suitability for surgery. This study explored Australian and New Zealand bariatric surgeons' views on barriers and enablers to bariatric surgery.

Methods: Sixteen bariatric surgeons and registrars across Australia and New Zealand were interviewed in 2023 about their opinions on barriers and enablers to bariatric surgery. Conventional qualitative content analysis was used to synthesise the data.

Results: Eight content categories originated from the analysis: (1) patient characteristics; (2) factors related to a patient's residential location; (3) economic factors; (4) lifestyle factors; (5) health-related factors; (6) surgery-related fears and concerns; (7) social factors; and (8) institutional and organisational factors. Surgical demand and supply issues were salient in discussions about the pre-operative process and patient (non)progression to surgery. Patients' financial circumstances were similarly emphasised. Societal values and norms, including gender stereotypes, were featured, and the role of close others was substantiated, with patients' families and friends considered both barriers and enablers to surgery.

Conclusion: Participants discussed more barriers than enablers to bariatric surgery. Their views generally aligned with the patient-based literature; however, the qualitative nature of the study allowed for the perceived reasons underlying the barriers and enablers to be explored. Findings offer potential avenues for modifying the pre-operative process to better support patients' needs and promote equity in access to surgery.

Introduction: Whether the weight-loss plateau and its values differ in obesity with or without metabolic dysfunction-associated steatotic liver disease (MASLD) undergoing continuous lifestyle intervention remains unknown. We aimed to investigate this problem.

Methods: This prospective observational cohort study included 305 patients with obesity and MASLD and 103 matched individuals with non-MASLD from January 2015 to April 2023, with a 12-month follow-up to monitor weight changes. Liver biochemistry, liver fat content with magnetic resonance imaging-based proton density fat fraction with Dixon sequence, and liver stiffness measurement via 2D-SWE were assessed at baseline and after 12 months. A validated weight trajectory regression model was applied to estimate the weight-loss plateau.

Results: Individuals with MASLD and non-MASLD presented a similar timing of the weight plateau at 6 months, but patients with MASLD experienced less weight loss and maintained their weight plateaus longer compared to those with non-MASLD. Among patients with MASLD, a greater total weight loss (TWL) at 6 months was associated with better treatment response in hepatic steatosis and injury (all p < 0.001). Further multivariate logistic analysis showed that the 6-month TWL was an independent predictor of subsequent improvements in hepatic steatosis (OR: 0.78, 95% CI: 0.72-0.84) and alanine aminotransferase levels (OR: 0.82, 95% CI: 0.76-0.90) at 12 months.

Conclusion: Patients with MASLD experienced gradual weight loss followed by a prolonged plateau, with the maximum reduction observed at 6 months. The degree of 6-month weight loss was a valuable prognostic factor for the 12-month hepatic treatment outcomes. Strategies to overcome this plateau are essential for improving long-term treatment efficacy in MASLD.

Introduction: A large body of literature has shown that media representations of obesity influence people's attitudes and contribute to weight stigma and discriminatory behaviors. The present study aimed to identify the representations of obesity in nine main Italian national newspapers and analyze how these representations varied before and after the COVID-19 lockdown (2016-2023), also in relation to the political orientation of the newspapers.

Methods: The Automated Co-occurrence Analysis for Semantic Mapping procedure (ACASM) was used to identify the themes. A t test and time series analysis were conducted to test the hypotheses.

Results: Findings showed that the selected Italian newspapers represented obesity according to five different themes labeled Wellness, Problem, Health, Nutrition, and Disease. It was found that the articles related to obesity increased after the lockdown. The Wellness and Health themes were found to be the more prevalent after the end of the emergency period. This result differed according to the newspapers' political orientation.

Conclusion: The findings suggest considering the representations that specific newspapers convey according to their political orientation in order to promote different narratives that could have a relevant impact on obesity.

Introduction: Fat distribution is a stronger predictor for cardiometabolic morbidity and mortality. We aimed to investigate the association of elevated iron stores, measured as serum ferritin levels, with total and regional body fat.

Methods: Data from 2,646 adults from the National Health and Nutrition Examination Survey 2017-2018 were analyzed. Dual-energy X-ray absorptiometry was used to measure overall and regional body fat. The fat mass index (FMI) was calculated by dividing the fat mass (kg) by the square of body height (m2). The leg fat mass to trunk fat mass ratio (LTR) was used to assess the relative distribution of leg fat compared to trunk fat.

Results: Medians (IQR) of serum ferritin levels were 0.168 μg/mL (0.104-0.269) for men and 0.053 μg/mL (0.026-0.102) for women. After adjusting for sociodemographic, lifestyle, and metabolic factors, serum ferritin showed a significant positive association with total FMI (β = 2.662) and trunk FMI (β = 0.983), and a negative association with leg FMI (β = -0.324) and LTR (β = -0.160) in men. In women, serum ferritin showed a significant positive association with total FMI (β = 4.658), trunk FMI (β = 2.085), and negative association with LTR (β = -0.312). Significant positive trends were observed for serum ferritin with total and trunk FMI in men and women, using the lowest serum ferritin quartile as the reference group. Additionally, significant negative trends were observed for serum ferritin with leg FMI and LTR in men. The mediation analysis revealed that C-reactive protein mediated 16.4% and 22.6% of the potential effects of serum ferritin on trunk FMI in men and women, respectively.

Conclusion: Higher ferritin levels were associated with greater total and trunk fat but lower leg fat. Further prospective and mechanistic studies are warranted to confirm the study results.

Introduction: Obesity shows significant association with depression, elevating morbidity burden. Obesity surgery (OS) has been proven as an effective therapy, reducing weight as well as depression prevalence rates, though the latter decrease appears to be unstable over time. For a better interpretation of the time trend, data on depression prevalence in OS patients for the period before the surgery are needed. Furthermore, sex-stratified analyses can reveal potentials for improvements in mental health care in OS patients.

Methods: Claims data from a German statutory health insurance provider were used for the estimation of depression prevalence in patients who underwent obesity surgery in 2012 (n = 340) and controls with (CGO) and without a diagnosis of obesity (CG; n = 1,700 each). The controls were matched to OS patients regarding sex, age, and insurance type. Sex-stratified depression prevalence was calculated between 2009 and 2015.

Results: Overall, depression rates were higher in women than in men and increased from 2009 to 2015. Depression prevalence rates differed significantly between female OS patients and controls in every year analyzed, e.g., in 2012: 39.4% in OS (95% CI: 33.4%-45.5%) vs. 19.8% in CGO (17.6%-22.0%) and 15.4% in CG (13.4%-17.4%). In men, no significant differences between OS patients and controls could be observed at any time. After OS, depression prevalence rates dropped in women, then gradually increased until 2015. Also, in male OS patients, depression prevalence decreased in the year after OS and increased in the following years. In both sexes, the prevalence rates in 2015 did not significantly differ from the rates in 2012 (year of OS).

Conclusions: We found a decrease in depression prevalence rates in the first year after OS in both sexes, followed by an increase in the subsequent 2 years. OS appears to have a short-term effect on the prevalence rates of depression followed by a subsequent increase paralleling the increase over time found in the non-OS control groups. Due to the sex-stratified approach, differential results in the comparison of depression prevalence between OS patients and controls became apparent. Depression prevalence was significantly increased 3 years before and after OS compared to controls in women, but not in men. Measures to perpetuate the decrease in depression prevalence rates after OS should be implemented during post-operative treatment.

Introduction: Current obesogenic environments, along with intrinsic factors, contribute to the obesity pandemic, which impacts the quality of life and healthcare for individuals with obesity. In addition, discrimination and stigma related to obesity remain widespread in our society. In this scenario, the Spanish Society for the Study of Obesity (SEEDO), in collaboration with 38 recognized scientific societies and 12 patients' organization, has elaborated the Spanish guideline for obesity management in adults, referred to as the GIRO guideline. GIRO aims to drive a shift in obesity management and serve as a guide for healthcare professionals (HCPs) to address this chronic and multifactorial disease.

Methods: A comprehensive systematic review was conducted and completed with experts' contribution, with a particular focus on Spanish society. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Experts selected the recommendations and determined their strength through consensus.

Results: A total of 121 recommendations were proposed, including 32 adopted from the Canadian Adult Obesity Clinical Practice Guidelines and 89 specific recommendations created for the Spanish context, and were distributed across five areas of application: (1) recognition of obesity as a chronic disease, (2) obesity assessment, (3) multidisciplinary approach to obesity treatment, (4) recommendations for obesity management in special populations, and (5) implementation of the GIRO guideline and future challenges.

Conclusion: The GIRO recommendations are intended to serve as a useful and interactive tool for HCPs, policymakers, and other stakeholders to ensure access to and quality of healthcare for individuals living with obesity.

Introduction: Some clinical resemblance may exist between obesity, particularly abdominal obesity, and Cushing's syndrome. This has stimulated ongoing interest in the role of cortisol's secretion pattern, control, and metabolism in obesity.

Goals: The aim of the study was to investigate whether basal and stimulated levels of cortisol differ between healthy people with obesity and individuals with normal weight.

Methods: Total, free, and salivary cortisol was tested at baseline state and after 1 μg ACTH stimulation in 60 healthy subjects with obesity and 54 healthy lean controls.

Results: Baseline total cortisol was lower in subjects with obesity compared to lean controls (347 [265-452] nmol/L vs. 422 [328-493] nmol/L, respectively; p < 0.05). Similarly, basal salivary cortisol was significantly lower in subjects with obesity (7.5 [5.2-9.7] nmol/L vs. 10.7 [7.5-17.6] nmol/L; p < 0.05). Upon challenge with ACTH, total peak serum and salivary peak cortisol responses were significantly lower in people with obesity than in lean subjects (665.16 ± 151.8 vs. 728.64 ± 124.2 nmol/L; p < 0.05 and 31.66 [19-38.64] vs. 40.05 [31.46-46.64] nmol/L; p < 0.05, respectively). Additionally, baseline total cortisol and salivary cortisol were inversely related to BMI (r = -0.24, r = -0.27; p < 0.05 for both) and waist circumference (r = -0.27, r = -0.34; p < 0.05 for both).

Conclusion: Baseline as well as peak stimulated total serum and salivary cortisol were significantly lower in subjects with obesity. It thus appears that obesity is not associated with enhanced basal or ACTH-stimulated cortisol.

Introduction: Rates of cholecystectomy in the general population continue to rise despite little being known about its long-term metabolic implications. Existing studies have suggested that cholecystectomy may be linked to type 2 diabetes mellitus and metabolic syndrome, though there is yet to be quality investigation of its associations with important ectopic fat depots - hepatic fat and intrapancreatic fat. The aim of the present study was to investigate the relationship of cholecystectomy with both hepatic and intrapancreatic fat.

Methods: The study involved 367 participants who underwent abdominal scanning, with hepatic and intrapancreatic fat quantified using gold-standard MRI-based methods. Linear regression analyses were adjusted for age, sex, ethnicity, BMI, fasting plasma glucose, fasting insulin, triglyceride, LDL-C, and HDL-C.

Results: In the most adjusted model, cholecystectomy was significantly negatively associated with hepatic fat (β coefficient = -3.671; p = 0.019) but not intrapancreatic fat (β coefficient = 0.133; p = 0.586). In analyses stratified by BMI, this association with hepatic fat was significant in the obese group only (β coefficient = -7.163; p = 0.048). The association with intrapancreatic fat was not influenced by BMI.

Conclusion: Cholecystectomy is significantly associated with lower hepatic fat in obese individuals. This affirms that people with indications for cholecystectomy should not be dissuaded from undergoing the procedure based on fears of harmful effects of increasing hepatic fat content.

Introduction: Health-related quality of life (HRQoL) may be impaired in individuals living with obesity, possibly due to exposure to obesity-related stigma which may in turn activate shame. Few studies have been conducted on shame in relation to obesity and its potential association with other constructs such as HRQoL, self-esteem, and body image. In this study, internalized shame and the potential association with HRQoL, self-esteem, and body image were investigated in treatment-seeking patients with obesity class II-III.

Methods: In total, 228 patients referred for obesity treatment at a tertiary clinic in Sweden participated in the study. The cohort was stratified into two groups using a clinical cutoff (≥50) indicating pathological levels of shame as reported on the Internalized Shame Scale (ISS): a high shame group (HSG) and low shame group (LSG).

Results: The mean ISS score for the overall cohort was 41.6, with a mean of 28.1 for the LSG and 66.5 for the HSG. Compared to the LSG, the HSG reported a lower quality of life in seven of eight HRQoL domains as well as a lower obesity-specific health-related quality of life. Furthermore, a higher shame score was associated with poorer body image and lower self-esteem.

Conclusion: Taken together, these findings indicate that a substantial number of patients with obesity report high internalized shame and that these individuals could benefit from extra support in treatment settings.