Obesity Facts最新文献

Introduction: Bariatric and metabolic surgery carries risks of complications and may affect food tolerance. For patients who are overweight or do not meet surgical criteria, alternative weight loss strategies must be explored. One such option is naltrexone/bupropion (NB) treatment. This study evaluates the impact of NB treatment combined with lifestyle intervention on weight loss over 12 months in a real-world setting.

Methods: A retrospective cohort study included all patients initiating NB treatment at the Dutch Obesity Clinic from February 2021 to October 2022.

Results: Among 98 patients (17.5% male; median age 49 [43-53]; median BMI 35.4 [33.0-39.1]), mean percentage total weight loss (SD) was 7.9% (4.2) at 3 months, 10.3% (6.5) at 6 months, and 11.5% (8.3) at 12 months. During the buildup phase, 23.5% of patients experienced nausea/vomiting, 19.4% reported headaches, and 28.6% had constipation. At optimal dosage, 39.8% experienced side effects, with 33% reporting multiple symptoms. Treatment discontinuation within 12 months occurred in 52.7% of patients.

Conclusion: NB treatment combined with lifestyle intervention results in significant weight loss after 6 and 12 months. Despite high discontinuation rates due to multiple reasons including side effects, NB treatment in combination with lifestyle intervention may be of interest for a specific population.

Introduction: In Sweden, glucagon-like peptide-1 (GLP-1) receptor agonists are subsidized for diabetes indication but not for obesity. Unregulated off-label prescription of GLP-1 receptor agonists for obesity treatment may raise concerns about potential inequalities for both patient groups. This study aimed to describe socioeconomic and demographic characteristics of on- and off-label users of GLP-1 receptor agonists in persons without a diagnosis of diabetes.

Methods: This is a Swedish descriptive register-based cohort study of persons who filled a prescription of a GLP-1 receptor agonist at least once during 2018-2022. Individuals were excluded from the study population if they had a diagnosis of diabetes or previous prescription fills of insulin/analogs at any time prior to the first filled prescription of a GLP-1 receptor agonist. Socioeconomic and demographic characteristics were described overall and stratified by sex and prior use of anti-obesity medications. Off-label use was defined by filled prescriptions of GLP-1 receptor agonists which are indicated for diabetes treatment.

Results: The study population included 16,436 individuals, of which 70.1% were women, 30.7% had previously filled a prescription of anti-obesity medications, and 65.3% had Sweden as country of origin and 17.2% an Asian country. In the analyses stratified by sex, women were more likely to have an education longer than 9 years (84.8% vs. 78.3% in men). Nonetheless, women had lower annual individual (2,891.3 vs. 4,004.9 in men) and family disposable income (5,645.5 vs. 6,092.5 in men). Overall, on-label prescription was higher in women (49.2% vs. 30.9% in men), while off-label was more common among men (69% vs. 51% in women). Trends of GLP-1 users per 1,000 inhabitants showed four-fold variation between counties.

Conclusion: High family disposable income and male sex are common among off-label GLP-1 receptor agonist users compared to users of the only on-label GLP-1 receptor agonist available in Sweden during the study period. Large variation between counties indicates different clinical practices and guideline interpretations.

Introduction: There are controversies about whether women with polycystic ovary syndrome (PCOS) show a disproportionately higher visceral adiposity, and its relevance to their higher cardiometabolic risks. We investigated in women of Asian Indian descent in Mauritius, a population inherently prone to abdominal obesity, whether those with PCOS will show a more adverse cardiometabolic risk profile that could be explained by abnormalities in fat distribution.

Methods: Young women newly diagnosed with PCOS (n = 25) were compared with a reference control cohort (n = 139) for the following measurements made after an overnight fast: body mass index (BMI), waist circumference (WC), body composition by dual-energy X-ray absorptiometry, and blood pressure and blood assays for glycemic (glucose, HbA1c, and insulin) and lipid (triglycerides and cholesterols) profiles.

Results: Women with PCOS showed, on average, higher BMI, WC, fat mass and lean mass (p < 0.01) than controls, but linear regression analyses indicate that for the same BMI (or same WC), the two groups showed no significant differences in fat mass and lean mass. By contrast, linear regression plots indicate that for the same total fat mass, women with PCOS showed higher trunk, android, and visceral fat (p < 0.01); no difference in abdominal subcutaneous fat; and lower peripheral (gynoid or limb) fat (p < 0.05). Furthermore, women with PCOS showed higher fasting plasma insulin, insulin resistance (HOMA-IR) index, and lower insulin sensitivity index (QUICKI) (all p < 0.001), which were completely or markedly abolished after adjusting for visceral fat or central-to-peripheral fat ratios.

Conclusion: In Mauritius, young women of Asian Indian descent with PCOS show altered fat distribution characterized by a disproportionately higher visceral (hazardous) adiposity in parallel to lower peripheral (protective) adiposity, which together explain their exacerbated state of hyperinsulinemia and insulin resistance.

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.

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: Weight gain is associated with cardiac abnormalities, but the differences in cardiac remodeling between overweight and obesity (O&O) remain unclear. This study explored the structural and functional cardiac changes associated with O&O using noninvasive imaging.

Methods: A retrospective study included participants from August 2021 to July 2023. Clinical data, laboratory results, and echocardiography reports were collected, and cardiac magnetic resonance imaging was post-processed. Cardiac structural and functional parameters were compared among healthy weight, overweight, and obesity groups, and their relationships with body mass index (BMI) were analyzed.

Results: A total of 275 participants were included. Significant differences in left ventricular end-diastolic/systolic diameters, left atrial diameter, left ventricular ejection fraction, and stroke volume index were observed between O&O and healthy weight groups (p < 0.05). However, no significant differences were found between the O&O groups in terms of left ventricular septum thickness, left ventricular posterior wall thickness, cardiac index, or end-systolic volume index (p > 0.05). Multivariable regression showed a positive correlation between BMI and cardiac structural/functional indicators (p < 0.05), with greater changes in obesity. Loess spline analysis revealed that cardiac remodeling was more pronounced during the overweight stage.

Conclusions: Both O&O are associated with larger cardiac dimensions, increased myocardial mass, and impaired function. Cardiac remodeling accelerates during the overweight stage, emphasizing the need for early detection and intervention in overweight individuals to mitigate future health risks.

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: The relationship between obesity and dental caries in adults presents inconsistent findings in current literature, which necessitates further research to clarify this relationship. This study aimed to examine the association between obesity and dental caries in adults using a nationally representative sample.

Methods: This study employed data of US adults aged >20 years from the National Health and Nutrition Examination Survey (NHANES) pre-pandemic cycle. Obesity was defined using the waist-to-hip ratio (WHR), body mass index (BMI), and waist circumference. Dental caries were assessed using the Decayed, Missing, Filled Teeth (DMFT) scores.

Results: Most participants were categorized as individuals with obesity based on the WHR (74.5%) or BMI (72.7%). A significant difference in the DMFT scores and missing teeth was observed between individuals with normal weight and individuals with obesity. After adjusting for the sociodemographic variables, individuals with obesity had a 0.11 higher DMFT score (95% confidence interval [CI]: -0.01 to 0.23). A significant association was observed between the WHR and DMFT scores when age was excluded from the model, demonstrating a higher coefficient of 0.17 (95% CI: 0.05-0.30).

Conclusions: A positive association was observed between obesity and dental caries in the US adult population. However, age was found to be a confounding factor in this relationship. This study highlights the relationship between oral and general health, advocating healthcare providers for an integrated health promotion strategy, through comprehensive campaigns addressing obesity, diet, lifestyle, and dental health, aiming for raising awareness and a more effective public health strategy.