Obesity Facts最新文献

Introduction: Proper diagnosis of obesity, its severity, and complications and their effective treatment requires an interdisciplinary healthcare approach. Nevertheless, obesity remains under-identified and undertreated. Academic knowledge concerning obesity pathology, diagnosis, and treatment is advancing. It is not clear whether this translates into clinical practice. The goal of the study was to assess the knowledge of healthcare professionals (HCPs) on obesity and particularly on the criteria for diagnosis as well as for conservative and surgical treatment.

Methods: This cross-sectional study was conducted among active HCPs (N = 184), including physicians, nurses, physiotherapists, and paramedics who had contact with adult patients with obesity. The proprietary research survey, implemented in an online tool, was used to assess knowledge on the diagnosis and treatment of obesity and self-assessment of that knowledge. The analysis was limited to the following: body mass index (BMI) definition, BMI values, visceral obesity definition, bariatric surgery indications, choice of treatment method, role of diet and physical activity, knowledge of obesity pharmacotherapy, length of obesity pharmacotherapy, financing of bariatric procedures, and goals of bariatric treatment. The correct answers were determined according to the Polish guidelines for the diagnosis and treatment of obesity.

Results: Half of the respondents (52.2%) were doctors, 20.7% were nurses and midwives, 19.0% were physiotherapists, and 8.2% were other medical professionals. Among questions related to knowledge on obesity, 67.1% of respondents provided correct answers, with respondents answering questions concerning obesity diagnosis correctly more frequently (70.1%) than those concerning methods of treatment (64.6%). The largest number of correct answers was related to the definition of BMI and normal BMI values. The smallest number of correct answers pertained to the diagnostic criteria for visceral obesity and pharmacological treatment of obesity. There was no statistically significant impact of a responder's knowledge levels on the obesity of different HCPs. Workplace and participation in training sessions were found to have the largest impact on the level of knowledge on obesity. HCPs' own assessment of their knowledge on obesity was negatively correlated with their actual level of knowledge.

Conclusion: The prevalence of overweight and obesity implies that essentially every HCP has daily contact with patients with excessive body weight. Knowledge of BMI values cannot be considered as exclusively medical knowledge: these values were established years ago and are present in widely available sources. Our research showed that 32.9% of HCPs did not have sufficient knowledge about how to diagnose and treat obesity.

Introduction: Bariatric surgery is a safe and effective treatment for obesity, although in super-obese patients (BMI ≥50 kg/m2) it can become challenging for anatomical and anesthesiologic issues. Several bridging therapies have been proposed to increase preoperative weight loss and decrease perioperative morbidity and mortality. The aim of this study was to compare the efficacy and safety of different two-stage approaches in super-obese patients: laparoscopic sleeve gastrectomy (LSG) following preoperative liraglutide therapy versus LSG with preoperative intragastric balloon (IGB) during a 1-year follow-up.

Methods: Clinical records of 86 patients affected by super-obesity who underwent two-stage approach between January 2019 and January 2022 were retrospectively reviewed using a prospectively maintained database. Patients were separated into two groups: those managed with preoperative IGB and those with liraglutide 3.0 mg prior to LSG. Weight (kg), BMI (kg/m2), %EWL, and %EBWL were reported and compared between the two groups at the end of bridging therapy, at 6th month and 12th month postoperatively. Postoperative complications were recorded.

Results: Forty-four patients underwent IGB insertion prior to LSG, while 42 were treated with liraglutide. There were no statistical differences in baseline weight and BMI. At the end of preoperative treatment, the group treated with IGB reported a significant reduction in BMI (47.24 kg/m2 vs. 53.6 kg/m2; p < 0.391) compared to liraglutide group. There were no differences recorded between the two groups concerning postoperative complications. At 6 months, the liraglutide group had lower %EWL (15.8 vs. 29.84; p < 0.05) and %EBWL (27.8 vs. 55.6; p < 0.05) when compared to IGB group. At 12 months, the IGB preserved with higher %EWL (39.9 vs. 25; p < 0.05) and %EBWL (71.2 vs. 42; p < 0.05).

Conclusion: A two-stage therapeutic approach with IGB prior to LSG in super-obese patients could be considered an attractive alternative to liraglutide as bridging therapy before bariatric surgery.

This is a abstract book of Late-Breaking Abstracts.

This is the prelims for the 30th European Congress on Obesity (ECO 2023).

Introduction: Laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients often results in remission of type 2 diabetes (T2DM), but diabetes relapses in some of those patients. The frequency of T2DM relapse in Asians and the factors involved have not been adequately investigated.

Methods: The J-SMART study was conducted on 322 Japanese subjects with body mass index (BMI) ≥32 kg/m2 who underwent LSG at 10 accredited centers in Japan between 2011 and 2014. Of these, 82 T2DM subjects with diabetes in complete or partial remission at 1 year after LSG and followed postoperatively for 5 years were included in the subgroup analysis and classified into two groups: diabetes remission-maintained and diabetes relapse.

Results: The mean age of all included subjects was 49.2 years, median BMI was 41.5 kg/m2, and median HbA1c was 6.7%. Compared with the diabetes remission-maintained group, the diabetes relapse group at 5 years after LSG had significantly higher preoperative HbA1c, number of antidiabetic medications, and high-density lipoprotein cholesterol level; and lower BMI and homeostasis model assessment-beta cell function (HOMA-β). As many as 83.0% of the subjects were able to achieve HbA1c <7% at 5 years after LSG, but 26.8% of the subjects had diabetes relapse. Preoperative HbA1c significantly contributed to diabetes relapse (odds ratio 1.54, p = 0.049). In addition, the diabetes relapse group tended to have lower percentage total weight loss (%TWL) at 1 year after LSG and higher percentage weight regain (%WR) from postoperative nadir weight, compared with the diabetes remission-maintained group. The hazard ratio for diabetes relapse was 3.14-fold higher in subjects with %TWL ≥20% and %WR ≥25%, and 5.46-fold higher in those with %TWL <20% and %WR ≥25%, compared with %TWL ≥20% and %WR <25%.

Conclusion: While LSG provides a high remission rate for T2DM, relapse is not uncommon. Preoperative HbA1c, poor weight loss, and excess weight regain after LSG contribute to diabetes relapse, suggesting the importance of treatment strategies focusing on these factors.

Background/objectives: Overweight and obesity result in a substantial economic burden in both low- and high-income countries. Moreover, this burden is often underestimated because it only partially accounts for unreimbursed out-of-pocket expenses (OOPE) related to obesity. The objective of our study was not only to evaluate OOPE incurred by people with obesity in relation to their disease with respect to direct medical expenditures and direct non-medical expenditures but also the proportion of people living with obesity who have forgone obesity-related healthcare due to the costs of such care.

Methods: An observational descriptive survey was conducted among people with class II/III obesity attending six obesity treatment centers in France. Volunteer adult participants completed a written/phone questionnaire on their related expenditures over the last 6 months for current expenditures and over the last 5 years for occasional ones. The costs were expressed in 2022 EUR.

Results: 299 people participated (age: 46 years [SD: 13.9], women: 72%, BMI ≥40 kg/m2: 62% and 48% with comorbidities). 65% had a professional activity. 83% declared that they had OOPE related to obesity representing annually EUR 2027/individual on average (5% of the household revenue), including weight loss and nutritional products, vitamins, meal programs, gym memberships, psychologists, but mainly adapted clothing, additional travel costs, and others. 15% of the respondents had to modify their professional activity due to obesity and 15% forwent some medical care in the last 12 months.

Conclusions: OOPE is a significant part of the economic burden of obesity. Despite some limitations due to the specificities of the participants and because some costs may be more related to social activities affected by obesity than to healthcare, it seems important to consider these expenditures in cost estimates for obesity.

Introduction: The current study aimed to investigate the association of three stable obesity phenotypes (persistent metabolically healthy normal weight [P MHNW], persistent metabolically healthy obese [P MHO], persistent metabolically unhealthy obese [P MUO]), and one transient (MHO to MUO) obesity phenotype throughout 18 years with health-related quality of life (HRQoL).

Methods: 1,932 participants (649 men and 1,283 women) who completed the HRQoL questionnaire during 2016-2019 were recruited in the current investigation. Based on the body mass index and metabolic status, participants were classified into four obesity phenotypes, including (1) P MHNW, (2) P MHO, (3) P MUO, and (4) transient from MHO to MUO. The HRQoL was compared between groups using analysis of covariance. Participants' age, marital status, occupation status, education level, physical activity, and smoking were adjusted.

Results: After adjustment for confounder variables, a significant difference among obesity phenotypes was indicated in (physical component summary) PCS scores of both sexes and (mental component summary) MCS scores just in women (p value = <0.001). The P MUO had the lowest scores in PCS and MCS, and P MHO had the highest MCS scores compared to other obesity phenotypes in either sex.

Conclusion: The results of the present study indicate the negative effect of long-term concurrence of obesity and metabolic disorders on the HRQoL of adults. However, long-term obesity alone or loss of metabolic health in the short term did not affect individuals' assessment of their physical and mental health. These findings highlight the importance of preventive interventions in people with obesity; also indicate the need for awareness-raising strategies about healthy lifestyles to improve the quality of life in society.

Introduction: Food addiction (FA) is a promising construct regarding the multifactorial aetiology of obesity and the search for therapeutic approaches. However, there is an ongoing debate regarding the overlap/differentiation with eating disorders and the classification as a substance- or behaviour-related addiction. Energy-dense foods, especially those combining carbohydrates and fat, are associated with addictive eating and suspected of playing a role in the genesis of FA. This study aims to further understand the clinical significance of FA and to identify possible therapeutic targets. A special focus is set on potentially addictive foods (combination of carbohydrates and fat).

Methods: Based on the Yale Food Addiction Scale 2.0, a cohort of 112 German adults with morbid obesity was divided into two sub-samples (patients with and without FA), which were examined for differences in the variables listed below.

Results: The prevalence of FA was 25%. Patients meeting criteria for FA showed higher degrees of hunger, emotional, binge, and night eating than patients without FA. In addition, hunger and disinhibition were found to be significant predictors of FA. FA was not associated with sex, age, body mass index (BMI), cognitive restraint, rigid and flexible control, prevalence of substance use, age of onset of obesity, stress level, level of social support, reduction of BMI during a weight loss programme, or programme withdrawal rate. There was no significant difference in the consumption of foods rich in both carbohydrates and fat, nor of fat or carbohydrates alone.

Conclusion: FA can be considered as a sub-phenotype of obesity, occurring in approximately 25% of obesity cases. Dysfunctional emotional coping mechanisms associated with low distress tolerance showed to be significantly related to FA and should be targeted therapeutically. Behavioural interventions should include a bio-psycho-social model. Binge eating episodes were found to be characteristic for FA and the already stated overlap between FA and binge eating behaviour can be confirmed. The results do not support a decisive difference due to a substance-related component of FA. Despite this, the existence of FA as a distinct entity cannot be excluded, as not all patients with FA exhibit binges.

Introduction: Obesity is a major risk factor for type 2 diabetes (T2DM) and liver disease, and obesity-attributable liver disease is a common indication for liver transplant. Obesity prevalence in Saudi Arabia (SA) has increased in recent decades. SA has committed to the WHO "halt obesity" target to shift prevalence to 2010 levels by 2025. We estimated the future benefits of reducing obesity in SA on incidence and costs of T2DM and liver disease under two policy scenarios: (1) SA meets the "halt obesity" target; (2) population body mass index (BMI) is reduced by 1% annually from 2020 to 2040.

Methods: We developed a dynamic microsimulation of working-age people (20-59 years) in SA between 2010 and 2040. Model inputs included population demographic, disease and healthcare cost data, and relative risks of diseases associated with obesity. In our two policy scenarios, we manipulated population BMI and compared predicted disease incidence and associated healthcare costs to a baseline "no change" scenario.

Results: Adults <35 years are expected to meet the "halt obesity" target, but those ≥35 years are not. Obesity is set to decline for females, but to increase amongst males 35-59 years. If SA's working-age population achieved either scenario, >1.15 million combined cases of T2DM, liver disease, and liver cancer could be avoided by 2040. Healthcare cost savings for the "halt obesity" and 1% reduction scenarios are 46.7 and 32.8 billion USD, respectively.

Conclusion: SA's younger working-age population is set to meet the "halt obesity" target, but those aged 35-59 are off track. Even a modest annual 1% BMI reduction could result in substantial future health and economic benefits. Our findings strongly support universal initiatives to reduce population-level obesity, with targeted initiatives for working-age people ≥35 years of age.

Introduction: In the context of obesity pandemic, the health care providers involved in the primary care should have a significant role. Several guidelines for the management of obesity in primary care were proposed recently. In general lines, these guidelines include recommendation on the baseline assessment, therapy, and algorithm for referral to specialized obesity clinic and follow-up. Nevertheless, at present, there is no guideline or protocol that continuously and bidirectionally links the two settings: primary care and specialized obesity clinic.

Methods: We present a model of continuous, bilateral, and integrative interaction between primary care units and reference tertiary care setting in the chronic management of obesity that is already implemented in a public health system.

Results: The novelty of our algorithm is that incorporates the support and continuous communication with the specialized obesity clinic of the tertiary care setting from the beginning in the management of a patient with obesity, in a bidirectional manner.

Conclusion: This kind of bidirectional and continuous collaboration will help engage health care providers in the management of obesity, optimize efforts, shorten the time until proper intervention, personalize the approach and, finally, save costs for the health system.