Obesity Facts最新文献

Introduction: Overweight and obesity (OW/OB) are underdiagnosed. The primary aim was to assess whether a diagnosis of OW/OB recorded by a primary care physician (PCP) is associated with clinically significant weight loss, compared to a missed diagnosis. The secondary aim was to investigate the association between OW/OB diagnosis and patient attendance at dietary consultations.

Methods: This retrospective, observational cohort study was conducted using a nationwide healthcare database. The study included a random sample of 200,000 adults with BMI ≥25 kg/m2, recorded on a primary care visit, between 2014 and 2020. Patients with prior diagnosis of OW/OB or obesity-related complications were excluded. The independent variable was OW/OB diagnosis recorded by the PCP immediately after BMI measurement. The outcome variable was ≥5% weight loss at a second weight measurement within 9-15 months. Multivariate regression analysis was applied.

Results: Of the 200,000 people with OW/OB, 36,033 (18.0%) had a diagnosis of OW/OB, and 37,368 (18.7%) had a second body weight measurement, of which 7,635 (20.4%) lost ≥5% of their baseline body weight. The prescription rate of anti-obesity medication was 1.2% and did not differ between patients who achieved weight loss and those who did not. Those with a recorded diagnosis were 2.6 times more likely to visit a dietitian (odds ratio [OR] 2.57, 95% confidence interval [CI]: 2.56-2.64) and 2.5 times more likely to achieve weight loss (OR 2.53, 95% CI: 2.46-2.60). After adjusting for multiple confounders, including attendance at dietary consultation, people who received OW/OB diagnosis were 32% more likely to achieve weight loss (OR 1.32, 95% CI: 1.28-1.36, p < 0.001) compared to people with missed diagnosis.

Conclusions: Recording a diagnosis of obesity among relatively healthy people is associated with clinically significant weight loss at 1-year follow-up, independent of attendance at dietary consultation. Early obesity diagnosis is a significant opportunity to promote weight loss in the primary care setting and may affect weight trajectory.

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: 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.