Obesity Science & Practice最新文献

Background: Identifying patient-, facility-, and environment-level factors that influence the initiation and retention of comprehensive lifestyle management interventions (CLMI) for urban and rural Veterans could improve obesity treatment and reach at Veterans Affairs (VA) facilities.

Aims: This study identified factors at these various levels that predicted treatment engagement, retention, and weight management among urban and rural Veterans.

Methods: A retrospective cohort study of 631,325 Veterans was designed using VA databases to identify Veterans with class II and III obesity during 2015-2017. Primary outcomes were initiation of CLMI, bariatric surgery, or obesity pharmacotherapy within 1 year of index date. Secondary outcomes included treatment retention and successful weight loss. Generalized linear mixed models were used to evaluate the relationships between factors and obesity-related outcomes, with rurality differences assessed through interaction terms.

Results: Patient characteristics associated with increased odds of initiating CLMI included female sex (p < 0.001), black race (p < 0.001), sleep apnea (p < 0.001), mood disorder (p < 0.001), and use of medications associated with weight loss (p < 0.001) or weight gain (p < 0.001). Facility use of telehealth was associated with greater odds of CLMI initiation in urban Veterans (p < 0.001) but lower retention in both populations (p = 0.003). Routine consideration of pharmacotherapy was associated with higher CLMI initiation. Environmental characteristics associated with increased odds of CLMI initiation included percent of population foreign born (OR = 1.03 per 10% increase; p < 0.001), percent black (p < 0.001), and high walkability index (p < 0.001). The relationship between total population and CLMI initiation differed by rurality, as greater population was associated with lower odds of CLMI initiation in urban areas (OR: 0.99 per 1000 population; p < 0.001), but higher odds in rural areas (OR:1.01, p = 0.01). Veterans in the south were less likely to initiate CLMI and had lower retention (p < 0.001).

Conclusion: Treatment and retention of CLMI among Veterans remain low, highlighting areas for improvement to expand its reach both urban and rural Veterans.

Introduction: Obesity is associated with increased morbidity in patients with advanced liver disease, but it is particularly challenging for these patients to preserve skeletal muscle mass during weight loss and accelerating sarcopenia is a concern. Alternate-day modified fasting (ADMF) may be particularly effective for weight loss in patients with concomitant cirrhosis and obesity due to preservation of fat-free mass (FFM).

Methods: A weight loss program featuring either ADMF or a continuous low-calorie diet (LCD) was evaluated in a 24-week randomized clinical trial in 20 adult patients with Child-Pugh Class A cirrhosis and obesity. Participants were randomized to either ADMF (n = 11) or LCD (n = 9). Both groups received a remotely delivered exercise program. Body composition, sarcopenia measures, and functional outcomes were assessed pre-post.

Results: Thirteen participants completed the intervention (Age = 57 ± 10; BMI = 37.7 ± 5.8 kg/m²). The median body weight lost in ADMF was 13.7 ± 4.8 kg (13.9% of initial body weight), while LCD lost 9.9 ± 6.9 kg (10.7% of initial body weight). Total body fat percentage decreased in both groups (ADMF: -4.1 ± 4.0%; LCD = -2.8 ± 1.4%). Fat-free mass accounted for 34 ± 20% of total weight loss in ADMF and 38 ± 10% in LCD. Functional measures, such as timed chair stands, improved in both groups.

Conclusion: This pilot study demonstrates the feasibility of the ADMF and LCD interventions to produce significant weight loss while improving body composition in patients with cirrhosis and obesity. Further research is needed to validate these findings in larger cohorts and to assess changes in muscle quality and visceral fat.

Trial registration: ClinicalTrials.gov Identifier: NCT05367596.

Background: Obesity is recognized as a risk factor for various cancers, including thyroid cancer. However, the association between different metabolic obesity phenotypes and thyroid cancer risk remains unclear. This systematic review aimed to comprehensively evaluate the existing literature to elucidate the association between metabolic obesity phenotypes and thyroid cancer risk.

Methods: This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were searched for relevant studies until April 2024. Studies examining the link between metabolic obesity phenotypes and thyroid cancer risk were included.

Results: Five cohort studies involving 831,510 participants met the inclusion criteria. Metabolically unhealthy obesity was consistently associated with an increased risk of thyroid cancer in both men and women. Central adiposity emerged as a significant predictor of thyroid cancer risk. Mechanistically, chronic inflammation, dysregulated adipokine secretion, hormonal imbalances, and altered signaling pathways may contribute to thyroid carcinogenesis. There is an ongoing debate regarding the risk associated with metabolically healthy obesity, with some suggesting potential protective effects due to favorable metabolic profiles.

Conclusion: This systematic review highlights the complex relationship between metabolic obesity phenotypes and thyroid cancer risk. The findings highlighted the importance of considering metabolic status alongside obesity in thyroid cancer risk assessment and intervention strategies.

Rationale: Short-term weight loss is possible in a variety of settings. However, long-term, free-living weight loss maintenance following structured weight loss interventions remains elusive.

Objective: The purpose was to study body weight trajectories over 2 years of intensive lifestyle intervention (ILI) and up to 4 years of follow-up versus usual care (UC).

Methods: Data were obtained from electronic medical records (EMRs) from participating clinics. Baseline (Day 0) was established as the EMR data point closest but prior to the baseline date of the trial. The sample included 111 ILI and 196 UC patients. The primary statistical analysis focused on differentiating weight loss trajectories between ILI and UC.

Results: The ILI group experienced significantly greater weight loss compared with the UC group from Day 100 to Day 700, beyond which there were no significant differences. Intensive lifestyle intervention patients who maintained ≥5% and ≥10% weight loss at 24 months demonstrated significantly greater weight loss (p < 0.001) across the active intervention and follow-up.

Conclusions: Following 24 months of active intervention, patients with ILI regained weight toward their baseline to the point where ILI versus UC differences were no longer statistically or clinically significant. However, patients in the ILI who experienced ≥5% or ≥10% weight loss at the cessation of the active intervention maintained greater weight loss at the end of the follow-up phase.

Clinical trial registration: ClinicalTrials.gov: NCT02561221.

Introduction: There is a relationship between excess body weight and the risk of a number of infectious diseases, including urinary tract infections (UTIs). This study aimed to investigate the correlation between body mass index (BMI) and UTIs among Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan Cohort Study (PGCS) population.

Methods: This cross-sectional study was conducted on 10,520 individuals aged 35-70 years from PGCS. The demographical data and clinical characteristics of the participants were recorded. Microscopic examination of the urine samples was performed to detect the presence of bacteria or white blood cells (WBC) as indicators of infection. UTI was defined as the presence of bacteria in the urine (Few, moderate, and many) and a value of ≥10 WBC/high power field (HPF) by light microscopy.

Results: The prevalence of UTIs in this study was 8.8%, with a higher incidence in females compared to males (12.2% vs. 4.7%, p < 0.001). Among participants, the prevalence of UTIs across different weight categories was as follows: underweight/normal weight, 7.1%; overweight, 8.1%; and obesity, 10.9%. According to the unadjusted model, subjects with obesity were at significantly higher odds for UTIs than subjects with underweight/normal BMI (OR = 1.62, 95% CI: 1.35-1.93, p < 0.001). However, this association was no longer significant after adjusting for demographic and clinical variables.

Conclusion: The findings of this study provide evidence supporting a higher prevalence of UTIs among individuals with obesity.

Introduction: Effective, evidence-based obesity treatment is needed, which often involves use of anti-obesity medications (AOMs). Data on the breadth and quality of guideline-directed obesity treatment implementation in primary care remain limited. This study aimed to assess primary care clinicians' agreement with and knowledge of guideline-directed obesity treatment, as well as to assess the health status of persons with obesity and their use of AOMs.

Methods: This multimethod study included a prospective survey of primary care clinicians, utilizing a questionnaire that measured agreement on a 5-point Likert scale and knowledge via multiple choice questions. A retrospective analysis was also performed of patient data collected between 30 June 2016 and 30 June 2020 from primary care clinics in the Midwest.

Results: Data were analyzed from 27 clinician survey responders, finding agreement toward all measured areas, however less strong for chronic AOM use and resource allocation. The survey identified multiple gaps in knowledge. Researchers assessed 5656 baseline encounters and 2941 corresponding follow-up encounters. Analysis revealed ≥50% of the total patients experienced persistently uncontrolled obesity (mean body mass index of ≥40 kg/m²) and weight-related complications. Low rates (≤10%) of AOM use in clinically eligible patients were shown, with phentermine monotherapy being the most commonly used.

Conclusions: Clinicians agree with guideline-directed obesity treatment. Persons with obesity who are poorly controlled identify an opportunity for patient care improvement.

Introduction: General practitioners (GPs) have been identified as pivotal in the identification and initiation of treatment for obesity, yet effective obesity management remains challenging in general practice. Despite the growing prevalence of obesity and the central role of GPs, there is a dearth of research exploring their experiences and challenges in managing the disease.

Objective: This study aimed to understand these challenges by exploring GPs' experiences and to identify factors influencing their obesity management practices to inform the development of targeted intervention strategies.

Method: In-depth interviews were conducted with 10 GPs. Data were analyzed using abductive thematic analysis underpinned by the theoretical domains framework (TDF). Findings were mapped to the behavior change wheel (BCW) and the behavior change taxonomy to identify potential future intervention strategies.

Findings: Participants described multiple barriers to effective obesity management, including knowledge gaps, lack of training, patient factors, and systemic challenges. Key themes identified were the need for increased support, improved patient engagement, and system-level changes.

Conclusion: This study offers valuable insights into the challenges GPs encounter when managing obesity in general practice. Application of the TDF and BCW frameworks identified complex interactions between knowledge, beliefs, and environmental factors influencing GP behavior. These findings highlight key areas for targeted interventions to enhance obesity care and drive best practice.

Background: Changes in gene expression related to obesity are linked to microRNAs, such as miR-141, which play a crucial role in metabolic homeostasis. Sirtuin 1 (SIRT1), an enzyme that plays a crucial role in regulating various cellular functions and metabolism, is implicated in obesity and the ensuing non-alcoholic fatty liver disease (NAFLD). The aim of this research was to evaluate the levels of miR-141 and its relationship with SIRT1 and NAFLD.

Methods: A group of 100 adults (50 with obesity and 50 with normal-weight) were selected and underwent complete clinical evaluation and anthropometric measurements. Biochemical parameters were assessed in blood serum, and the levels of miR-141 in plasma were measured by real-time PCR. The expression of the SIRT1 gene was also evaluated in the peripheral blood mononuclear cells using Real-time PCR. The ELISA technique was used to determine insulin levels. Liver steatosis was assessed by ultrasound.

Results: The results showed that levels of miR-141 were significantly increased in participants with obesity compared with the control group. Conversely, the expression of the SIRT1 gene in individuals with obesity was lower than that in control participants. A strong negative correlation was observed between miR-141 and SIRT1 and a strong positive association was observed between miR-141 and metabolic parameters. Furthermore, participants with fatty liver had significantly elevated levels of miR-141 gene expression and lower expression of SIRT1 gene, compared to those without fatty liver.

Conclusion: elevated levels of miR-141 in individuals with obesity might be a contributing factor in the repression of SIRT1 in obesity and its consequences, including NAFLD. Therefore, miR-141 might serve as a suitable diagnostic and therapeutic target in obesity and NAFLD.

Objective: Prior research has found that plant-based diets (PBDs) are rated as acceptable and have similar levels of adherence as compared to other therapeutic dietary approaches; however, previous studies were mostly among white populations. Plant-based diets can produce clinically meaningful weight loss, but outcomes may vary by level of adherence. The goal of this study was to examine the differences in weight and lipids among participants in the Nutritious Eating with Soul study based on adherence to their diet assignment.

Methods: African American adults (n = 159; 79% female) with overweight or obesity (mean BMI 36.9 ± 6.9 kg/m²) were recruited to participate in a 24-month intervention. Participants were randomized to a plant-based vegan (n = 77) or a low-fat omnivorous (n = 82) diet, both emphasizing soul food cuisine. Participants attended nutrition classes and had dietary intake/adherence (three 24-h recalls; adherence score 1-5), body weight, lipids, and other secondary outcomes assessed at baseline, 6-, 12-, and 24 months. Participants who met at least half of the adherence criteria (≥2.5 out of 5) were categorized as adherents.

Results: At 24 months, adherent vegans lost 5% of their body weight, non-adherent vegans lost -0.005%, adherent omnivores lost -0.03%, and non-adherent omnivores lost -0.02%. Adherent vegans lost more weight (kg) than all other participants at both 6- (-3.32 ± 0.92 (-5.14, -1.49), p < 0.001) and 24 months (-3.27 ± 1.49 (-6.23, -0.31), p = 0.03). Adherent vegans also lost more weight than less adherent vegans (-3.74 ± 1.05 (-5.82, -1.65)), adherent omnivores (-4.00 ± 1.27 (-6.51, -1.48)), and less adherent omnivores (-2.22 ± 0.98 (-4.15, -0.28)) at 6 months and lost more weight than less adherent vegans at 24 months (-4.96 ± 1.8 (-8.54, -1.37)) (all p < 0.05). Adherent vegans had greater improvements in cholesterol-to-HDL ratio at 24 months (-0.47 ± 0.22 (-0.92, -0.03), p = 0.04) and greater decreases in insulin (-4.57 ± 2.16 (-8.85, -0.29), p = 0.04) at 6 months than all other participants combined.

Conclusions: The study points to the benefit of the use of a PBD for reducing weight, lipids, and insulin in African American adults, but also highlights the importance of supporting adherence to the PBD.

Clinical trialsgov id: Nutritious Eating With Soul (The NEW Soul Study); NCT03354377.

Objective: Commonly used terms like "obese person" have been identified as stigmatizing by those with lived experience. Thus, this study sought to revise a commonly used measure of weight stigmatizing attitudes, the Attitudes Toward Obese Persons (ATOP) scale.

Methods: The original terminology in the 20-item ATOP (e.g., "obese") was compared to a modified version using neutral terms (e.g., "higher weight"). Participants (N = 832) were randomized to either receive the original or modified ATOP.

Results: There was a statistically significant difference, with a small effect size (d = -0.22), between the scores of participants who received the original ATOP (M = 69.25) and the modified ATOP (M = 72.85), t(414) = -2.27, p = 0.024. Through principal component analysis, the modified ATOP was best used as a brief, 8-item unidimensional measure. In a second sample, confirmatory factor analysis verified the fit of the brief, 8-item factor structure.

Conclusions: Findings suggest that a modified, brief version of the ATOP (ATOP-Heigher Weight; ATOP-HW) with neutral language is suitable for assessing negative attitudes about higher-weight people. The ATOP-HW may slightly underestimate weight stigma compared to the original ATOP, or the language in the ATOP may magnify negative attitudes. Further examination of the terminology used in weight stigma measures is needed to determine how to best assess weight stigma without reinforcing stigmatizing attitudes. The present study's findings suggest that the use of neutral terms in measures of anti-fat bias is a promising solution that warrants further investigation.