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: 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: The Weight Control/Blame (WCB) subscale of the Antifat Attitudes Test (AFAT) measures weight stigma, particularly beliefs linking obesity to personal responsibility, which contributes to discrimination and negative psychological, often reinforced by political ideologies and authoritarian attitudes. This study sought to (1) develop and validate an economic version of the WCB subscale and (2) evaluate associations between weight stigmatizing attitudes, authoritarian beliefs, sexist attitudes, and conspiracy mentality.

Methods: A four-item short form of the WCB subscale (WCB-4) was developed using a representative sample of the German population (N = 1,000) and validated on a second sample (N = 2,524). We assessed psychometric properties, convergent, and divergent validity.

Results: The four-item solution demonstrated good internal consistency (ω = 0.807) and favorable confirmatory factor analysis results. Weight stigma positively correlated with authoritarian and sexist beliefs, and negatively with depression, anxiety, and body mass index.

Conclusion: The WCB-4 is a reliable and valid tool for assessing weight stigma in epidemiological research. It highlighted positive associations with authoritarian beliefs and sexist attitudes, reflecting an interconnected system of biases against marginalized groups. Though a minor correlation was found between conspiracy mentality and authoritarian beliefs, no significant link emerged between conspiracy mentality and weight stigma.

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.