Obesity Science & Practice最新文献

Autistic individuals represent approximately 1 in 31 people in the United States and experience disproportionately high rates of obesity, type 2 diabetes, cardiovascular disease, and feeding and eating challenges, alongside reduced life expectancy. However, evidence-based metabolic health interventions for autistic populations remain sparse. This Perspective synthesizes evidence on two interconnected barriers that limit metabolic health research in the autism field: (1) lack of accessible biomedical research methodologies and (2) insufficient attention to mechanisms underlying poor metabolic health in this population, including chronic stress and weight stigma. Drawing on principles from neurodiversity, Universal Design for Research, and the Academic Autism Spectrum Partnership in Research and Education (AASPIRE) guidelines, we outline a neuro-affirming paradigm that can improve metabolic health research in the autism field. Finally, we provide phase-by-phase practical recommendations for researchers, spanning study design, measure development, recruitment, consent, screening, data collection, and interpretation. Aligning metabolic health research with neuro-affirming principles can generate more rigorous, representative, and ethically grounded evidence and ultimately support more meaningful improvements in metabolic health and overall well-being for autistic individuals across the life course.

Objective: Obesity is associated with an increased risk of chronic kidney disease. Metabolic and bariatric surgery (MBS) is currently the most effective intervention for sustained weight loss and may reduce the risk of obesity-associated kidney disease. This study examined the relationships between MBS and adverse kidney outcomes.

Methods: This retrospective cohort analysis included 4322 patients with obesity, with or without type 2 diabetes mellitus (T2D), who underwent MBS, and 30,919 nonsurgical control patients from a large health system within the state of Indiana. A primary kidney composite [≥ 1 estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m², ≥ 1 eGFR measurement with a ≥ 40% decrease from baseline, or kidney failure-related death], as well as secondary and tertiary composite and individual outcomes were assessed. Multivariable Cox regression models with and without inverse propensity of treatment weighting were employed to assess associations between MBS and incidence rate for each kidney outcome compared with nonsurgical controls.

Results: The mean (standard deviation) follow-up duration was 6.1 (4.5) years. MBS was associated with a 53% (HR: 0.47; 95% CI: 0.42, 0.52; p < 0.001) and 48% (HR: 0.52; 95% CI: 0.46, 0.60; p < 0.001) lower incidence of the primary kidney composite outcome in patients with and without T2D, respectively, and 48%-56% lower risks for the secondary and tertiary outcomes, regardless of T2D status, compared to controls.

Conclusions: MBS was associated with markedly lower risks for adverse kidney outcomes in patients with obesity. These results support the potential for MBS as a weight loss intervention to preserve kidney function in patients with obesity, both with and without T2D.

Background: In perioperative settings exercise testing can be used to assess a patient's physical fitness, with VO₂max used as a marker to indicate fitness and subsequent risk of adverse surgical outcomes. However, the commonly used reporting methods of VO₂max may be problematic in populations with excessive FM such as those awaiting MBS for obesity. Hence, alternative ways of expressing VO₂max will be explored.

Methods: Historical data from individuals presenting for MBS were analyzed. Predicted VO₂max values were adjusted relative to the participants measured and "normative" body mass, where each prediction was assigned a classification score. Predicted VO₂max adjusted to the participants measured FFM was also considered. Data were compared to individuals that are lean and sedentary as well as those with obesity from a previous study.

Results: Data from 20 participants awaiting MBS (43.15 ± 11.82 years, 68.50 ± 8.39 cm, 115.29 ± 16.82 kg and 59.93 ± 8.69 kg FFM) were examined. Predicted VO₂max relative: to total mass was 20.15 ± 5.00 mL/kg/min; normative body mass was 30.04 ± 6.58 mL/kg/min; and FFM was 38.55 ± 9.08 mL/kg FFM/min. Median fitness classifications increased from very poor to poor when predicted VO₂max was expressed relative to normative body mass.

Conclusions: Reporting predicted VO₂max results relative to body mass may be underestimating fitness and overestimating surgical risk in people who are very obese.

Objective: Obesity has been associated with worse clinical outcomes after mild traumatic brain injury (mTBI; Glasgow Coma Scale score between 13 and 15). Augmented inflammatory response to mTBI appears to be an important modifier of outcomes for the patients with obesity, but the contribution of comorbidity profile has yet to be analyzed. The objective of this study was to examine the association of: 1. comorbidity profile; and 2. the interaction of obesity with comorbidity profile on clinical outcomes and inflammatory blood biomarkers after mTBI.

Methods: Participants were enrolled across emergency departments within 24 h of injury, with clinical outcomes and neurocognitive tests assessed at 2 weeks and 6 months post-injury (n = 1337). Latent class analysis (LCA) was used to identify comorbidity profiles and mixed-effect models for the association of obesity and comorbidity profile on inflammatory/clinical outcomes.

Results: Using LCA, 3 classes of comorbidities were identified: "cardiovascular" (high rates of cardiovascular disease, hypertension, hyperlipidemia, diabetes; n = 287; 21%), "internalizing" (high rates of depression/anxiety, n = 121; 9%), and "healthy" (0%-8% rate of comorbidities; n = 929; 69%). "Healthy" had higher rates of functional recovery at 6 month (31%; p = 0.001) than "cardiovascular" and "internalizing" (15%-26%). Within "healthy," obesity was associated with higher c-reactive protein levels on day 1 (ratio = 1.86; p < 0.001), 2 week (ratio = 2.05; p < 0.001) and 6 month (ratio = 2.34; p < 0.001) relative to normal BMI. Obesity was associated with higher IL-6 levels at 2 week (ratio = 1.36; p = 0.005) and 6 month (ratio = 1.47; p < 0.001) relative to normal BMI within "healthy."

Conclusions: Obesity and comorbidity profiles are associated with an inflammatory response with the potential to impact recovery; consideration of systemic health at the time of injury could improve recovery.

Objective: Cardiovascular diseases (CVDs) are a significant cause of mortality worldwide. Smoking, unhealthy diets, physical inactivity, and psychological stress are the main lifestyle factors associated with CVDs. This study was designed to investigate the relationship between electrocardiographic (ECG) changes and various body mass index (BMI) categories, considering demographic characteristics of the participants, such as age, gender, height, and weight.

Methods: This cross-sectional study was conducted on 964 patients attending Mostafa Khomeini Hospital, Ilam, Iran. Pearson correlation coefficients and regression models were employed using SPSS v. 24 to assess the relationship between BMI and ECG parameters recorded using a 12-lead ECG.

Results: A 10-cm increase in height (165 ± 14) was associated with a 0.089 ms decrease in the PR interval, while a 5-kg weight gain resulted in a 0.20 ms increase in the PR interval (p = 0.49). The QRS interval increased by 2 and 0.03 ms, with a 10 cm height and 5 kg weight gain, respectively. The QT interval remained stable with changes in height but decreased by 1.34 ms with a 5-kg increase in weight.

Conclusion: The findings of this study suggest that ECG parameters are influenced by BMI and may be related to cardiovascular risks. An increase in PR and QRS intervals, a decrease in QRS voltage, and alterations in the ST segment and QT interval underscore the importance of maintaining a healthy BMI to reduce the risk of CVD. This message encourages proactive lifestyle changes to improve heart health.

Background: Long-term weight loss success with dietary interventions is notoriously limited. Mobile health (mHealth) interventions offering personalized dietary guidance combined with real-time biofeedback may enhance long-term adherence and provide a sustainable solution for weight management.

Objectives: This study reports the prespecified secondary outcome of weight loss at 48 weeks from a parallel-arm randomized clinical trial (ClinicalTrials.gov: NCT04165707) that aimed to evaluate the long-term effectiveness and sustainability of a Mediterranean-style low-carbohydrate diet delivered via an mHealth application paired with breath biofeedback compared with a calorie-restricted low-fat diet application.

Methods: Adults with overweight or obesity (N = 155; mean ± SD age, 41 ± 11 years; 71% female; BMI, 33.5 ± 4.7 kg/m²) were randomized to either an intervention promoting a Mediterranean-style low-carbohydrate diet combined with biofeedback from a handheld breath acetone device or an evidence-based comparator promoting a calorie-restricted, low-fat diet. Participants recorded their daily weights using Bluetooth scales. Weight loss over 48 weeks was analyzed using a linear mixed-effects model, incorporating all available daily weight measurements from participants who provided at least one follow-up measurement.

Results: At 48 weeks, participants using the breath biofeedback mHealth app achieved clinically meaningful weight loss (-9.54 kg, 95% CI: -12.27 to -6.81 kg). In contrast, participants using the low-fat diet app did not achieve statistically significant weight loss (-2.68 kg, 95% CI: -5.49 to 0.14 kg), resulting in a statistically significant between-group difference (-6.9 kg, 95% CI: -10.8 to -2.9, p < 0.001). No adverse effects were reported in either group.

Conclusions: This study demonstrates that a Mediterranean-style diet promoting carbohydrate restriction coupled with biofeedback support delivered via an mHealth app results in clinically meaningful sustained weight loss at 48 weeks. Given its practicality and demonstrated effectiveness, this approach presents a promising non-pharmacological alternative or complement for longer-term weight management.

Objective: To enhance shared decision-making (SDM) about metabolic and bariatric surgery (MBS) through the systematic implementation and evaluation of SDM tools across two large healthcare systems.

Methods: The project involved developing and integrating SDM tools into clinical workflows at two health systems and training clinicians to use two decision aids with eligible patients. Data were collected using patient surveys, electronic health record (EHR) data, and qualitative interviews with clinicians. The primary outcome was change in patient-reported measures of SDM using the collaboRATE items.

Results: Decision aids were delivered to 1675 patients. Implementation was associated with an increase in referrals to MBS and the number of patients undergoing surgery at KPWA but not at UPMC. Baseline levels of SDM quality were high. Post-implementation collaboRATE scores decreased significantly, indicating a perceived decline in SDM quality, but not in two other SDM measures. Qualitative feedback highlighted the challenges and successes of integrating SDM tools into clinical practice.

Conclusions: Implementation of SDM tools had mixed results across the sites. Implementation was associated with an increase in referrals and surgery at KPWA but not at UPMC. The perceived quality of SDM conversations also declined. Future efforts should focus on incorporating all weight management options, including medications and lifestyle interventions.

Introduction: Participants in behavioral weight management programs are typically provided with weekly interventionist-crafted self-monitoring feedback; however, there is a lack of empirical evidence regarding optimal feedback construction.

Methods: Using a Delphi method, experts (N = 67) provided perspectives regarding the optimal focus, frequency, interactivity, and modality of feedback messages. Directed content analyses were used to analyze qualitative data, and descriptive statistics were used to summarize quantitative data.

Results: Experts' views on the modality (e.g., email, app notification) varied, and participant preference and practicality were noted as key considerations. Experts ranked 8 feedback components as most important: problem solving, goal setting prompts, calorie intake and physical activity goal attainment, diet tracking frequency, weight trajectory (since the last message and since the start of the program), and diet quality. More experts endorsed the "sandwich" approach (i.e., positive comments along with strategies for change) for those experiencing weight loss challenges (95%) than for those experiencing weight loss success (55%). Overall, 82% noted that personalized feedback was important, but they were not always able to provide it due to time restrictions/personnel cost (75% identified these as key barriers).

Conclusions: Although most experts viewed personalized self-monitoring feedback as important, time/cost considerations in crafting this feedback are critical. Future experimental studies should be used to evaluate the expert recommendations gathered from this Delphi study.

Objectives: Although weight stigma in healthcare is common, existing measures may not capture the full range of patients' weight stigma experiences in clinical practice. We aimed to examine how physical examination by healthcare providers, communication, and the built environment perpetuate weight stigma and impact healthcare avoidance. Items from the previously developed Weight Stigma in Healthcare Inventory (WSHCI) were tested to assess weight stigma experiences and assess association with healthcare avoidance.

Methods: Two sample groups, identified through ResearchMatch and a Qualtrics survey panel, completed the WSHCI online. We analyzed the association between individual items and healthcare avoidance, and between a summation of weight stigma experiences and healthcare avoidance, adjusting for demographics.

Results: Five-hundred twenty four surveys were received. All weight stigma items were associated with healthcare avoidance, with the strongest associations found for items related to experiencing stigma during physical examination. Greater numbers of stigmatizing experiences were associated with healthcare avoidance (OR 1.31, 95% CI [1.26, 1.37]).

Conclusions: To reduce healthcare avoidance due to weight stigma, all aspects-the physical examination, communication, overall experiences and the built environment-need to be addressed. Reducing the overall number of negative experiences and reducing weight stigma experiences during physical examination may be especially important to reduce healthcare avoidance.

Objective: Weight management during the first few years postpartum is considered important for the prevention of future metabolic disturbances. Body fat percentage measured using air displacement plethysmography is an accurate marker of body adiposity. In this secondary analysis of a randomized controlled trial, the aims were to identify distinctive body fat percentage trajectories up to 2 years postpartum in women with overweight and to investigate whether fish oil and/or probiotic supplements, diet, gestational diabetes, or gestational weight gain influenced the body composition.

Methods: Women with overweight or obesity (n = 439) were randomized to receive fish oil (1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid) and/or probiotics (Lacticaseibacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 10¹⁰ CFU each) in a double-blind manner from early pregnancy until 6 months postpartum. Body composition (n = 329) was measured using air displacement plethysmography, at three, six, 12, and 24 months postpartum. Diet in early pregnancy was evaluated using nutrient intakes, dietary patterns, and the Index of Diet Quality (IDQ) questionnaire.

Results: Three postpartum body fat percentage trajectories were identified, but none displayed a sustained decrease in adiposity. A healthy dietary pattern (adjusted OR 5.8 [95% CI 2.5-13.5], p < 0.001) and high IDQ score (adjusted OR 2.5 [95% CI 1.1-5.5], p = 0.023) in early pregnancy increased the odds of a decreasing trend during the first postpartum year. The fish oil and/or probiotic intervention did not impact the body composition.

Conclusion: Good overall dietary quality during pregnancy may benefit the body composition of women with overweight or obesity at postpartum.

Trial registration: NCT01922791, ClinicalTrials.gov.