Obesity Science & Practice最新文献

Background: Endogenous glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) regulate islet cell function. GLP-1 receptor agonists (GLP-1RAs) have been associated with an elevated risk of acute pancreatitis. Data on the pancreatic safety of tirzepatide (a dual GLP-1 and GIP agonist) and its effects on islet cell function in randomized controlled trials (RCTs) are scarce. Moreover, no meta-analysis has comprehensively examined such effects of tirzepatide.

Methods: Electronic databases were searched for RCTs with tirzepatide as the intervention and a placebo or active comparator as the control. The primary outcome was adjudication-confirmed pancreatitis; secondary outcomes were the percent changes from baseline in serum pancreatic amylase, lipase, insulin, C-peptide, glucagon, and homeostasis model assessment of insulin resistance (HOMA2-IR).

Results: Seventeen RCTs with 18 published reports involving 14,645 subjects were analyzed. Over a follow-up duration of 12-72 weeks, tirzepatide had identical risks of pancreatitis to placebo (tirzepatide 5 mg: RR 2.04, 95% CI [0.27-15.69], p = 0.49; 10 mg: RR 0.63, 95% CI [0.08-5.12], p = 0.67; and 15 mg: RR 1.26, 95% CI [0.36-4.98], p = 0.72). Tirzepatide was also associated with comparable risks of pancreatitis to insulin and GLP-1RAs. However, tirzepatide (at all doses) caused greater increases in pancreatic amylase and lipase than placebo and insulin. Individuals on tirzepatide 15 mg and GLP-1RAs had similar risks of having increased lipase levels. The percent reductions in fasting insulin were greater with tirzepatide 10 and 15 mg than with placebo. All doses of tirzepatide caused greater percent reductions in fasting insulin, C-peptide, and glucagon than GLP-1RAs. Compared to placebo and GLP-1RAs, the percent reductions in HOMA2-IR were greater with all doses of tirzepatide.

Conclusion: The meta-analysis provides evidence of the safety of tirzepatide regarding pancreatitis and establishes its positive effect on islet cell functions and insulin resistance.

Objective: Obesity is related to the recurrence of breast cancer. In-person groups or individual telephone counseling currently comprise the behavioral weight loss (BWL) programs tested for cancer survivors. Group support via telehealth may be convenient and provide support from fellow survivors, but feasibility, acceptability, and efficacy testing are needed.

Methods: A single-arm, 6-month BWL program was conducted for female breast cancer survivors with an ECOG performance 0 or 1, BMI > 25 kg/m², and > 6 months from completion of adjuvant chemotherapy and/or radiation treatment. Participants attended 22 video group sessions over 6 months, completing acceptability ratings, weight measurements, Patient Health Questionnaire (PHQ-9), City of Hope Breast Cancer Quality of Life Scale (QOL), and International Physical Activity Questionnaire. Changes in survey scores and weight (last-observation carried forward) and differences in outcomes by patients' race were computed with paired t-tests, ANCOVAs and Chi-square tests.

Results: Twenty-one (5 Black, 15 White, 1 Asian American; Mean (SD) = 60.7 (11.6) years; BMI 33.1 (5.9) kg/m²) survivors enrolled with 90% retention and 81.3% of sessions attended. Acceptability ratings were high (all > 4 on a five-point scale). Mean (SD) weight loss was 5.9% (5.2%), with 60% losing ≥ 5% of baseline weight; White participants lost 7.5% and Black participants lost 1.9% (p = 0.04). Significant improvements were observed in mood (PHQ-9; p = 0.01) and physical wellbeing QOL (p = 0.01). Physical activity did not change.

Conclusion: This telehealth group BWL program was feasible and acceptable for breast cancer survivors, yielding a clinically significant weight loss. Future studies should test this intervention in larger, more diverse samples.

Trail registration: ClinicalTrials.gov identifier: NCT04855552, posted April 22, 2021.

Introduction: Childhood obesity and physical inactivity rates in Mexico are among the highest in the world. While parenting is a key factor in shaping children's physical activity behavior, there is a lack of research in this area, particularly in Mexico.

Objective: This qualitative study aims to better understand aspects of parenting relevant to children's physical engagement, including what parents understand by physical activity, how engaged they are and how important they find it, that is, their physical literacy.

Methods: Seven focus group discussions were conducted with 43 caregivers of overweight primary school children. Inquiry topics included components of physical literacy (i.e., motivation, confidence, physical competence, knowledge and understanding, engagement in physical activity), parenting practices, role modeling, perception of children's physical activity, parental self-efficacy and general parenting style.

Results: Although many participants stated that they were aware of their child's health problems and that they did not set a good example themselves, most could not overcome personal obstacles to exercise such as lack of time and energy. Most participants showed a knowledge gap about appropriate levels of physical activity or underestimated its importance. Several reported increased motivation after participating in the focus group discussion and developed their own ideas to deal with barriers or to support their children, such as engaging in physical activity together and introducing family routines.

Conclusion: Following a participatory approach, future studies should use these ideas to develop context-sensitive group interventions. Empowering parents by considering their physical literacy in children's weight management could be a valuable addition to theory-based strategies in research and practice.

Background: Ultra-processed foods (UPFs) are harmful to health but ubiquitous in the modern food environment, comprising almost 60% of the average American diet. This study assessed the feasibility, acceptability, and preliminary efficacy of a novel behavioral intervention designed to reduce UPF intake.

Methods: Fourteen adults participated in an 8-week pilot intervention, which consisted of weekly group sessions, individual meal planning sessions, and financial support. Dietary intake was assessed using three Automated Self-Administered 24-h Dietary Recalls (ASA24) at both baseline and post-treatment.

Results: The intervention was highly feasible and acceptable. Qualitative data demonstrated that participants were enthusiastic about the benefits of reducing UPF intake and found the intervention highly valuable. Participants reduced average daily calories from UPF by 48.9%, number of UPFs consumed by almost half, total daily calorie intake by 612 calories/day, sodium consumption by 37% and sugar consumption by 50%. There were no significant changes in fruit or vegetable intake. Participants lost an average of 3.5 kg (SD = 3.0 kg).

Conclusion: This pilot data suggests that behavioral interventions to reduce UPF intake will be well-received and are capable of success despite the barriers of the United States food environment. Future research should prioritize behavioral interventions targeting UPF consumption alongside policy changes.

Background: Experimental studies reveal that deficits in food-related inhibitory control, rather than general impulsiveness, are closely linked to overweight and obesity. To date, the real-world implications remain unknown, and it is unclear whether these results are supported in the clinical field.

Objective: To examine the effectiveness of a mobile health (mHealth) intervention with cognitive and behavioral therapeutic elements in altering impulsiveness and food-related inhibitory control.

Methods: Prespecified secondary outcome analysis of a randomized controlled trial. Participants with overweight/obesity (BMI: M = 33.35 kg/m², SD = 3.79 kg/m², N = 213) were randomly assigned to either a 12-week mHealth intervention (n = 116) or wait-list control group (n = 97). The Barratt-Impulsiveness-Scale (BIS-15) and the Food-Related Inhibitory Control Scale (FRIS) were administered at baseline (T0) following the intervention (T1), at 9 and 15 month post baseline (T2, T3). Multi-level analyses were calculated.

Results: Compared to the control group, the intervention group reported higher food-related inhibitory control on several subscales of the FRIS: In Withholding in Social Situations at T1 (95% CI: 0.06-0.46) and T2 (95%CI: 0.09-0.50), Action Cancellation at T1 (95%CI: 0.05-0.45), Resisting despite Craving at T1 (95% CI: 0.07-0.49), Withstanding Rewarding Food at T2 (95%CI: 0.08-0.55) and Action Withholding at T3 (95% CI: 0.01-0.55). No differences were found for trait impulsiveness (T1: 95%CI: -1.91-0.47; T2: 95%CI: -1.65-0.84; T3: 95%CI: -0.88-1.67).

Conclusions: Food-related inhibitory control, rather than global measures of impulsiveness, addresses the critical association between inhibitory control and health-conscious dietary choices and can be improved by mHealth intervention.

Trial registration: ClinicalTrials.gov identifier: NCT04080193.

Background: Obesity is a chronic, relapsing, progressive disease of excess adiposity that increases the risk of dying from at least 16 types of cancer. The prevalence of obesity has increased more rapidly in cancer survivors compared with the general population. Tailored weight management strategies are needed to improve prognosis and health outcomes in the growing population of cancer survivors. However, certain cancer survivor population subgroups require unique consideration when developing weight management strategies.

Methods: In a symposium convened by The Obesity Society during ObesityWeek 2023 titled "From Surviving to Thriving: Key Considerations for Weight Control Across Diverse Cancer Survivorship Populations," experts presented the current state of the science and highlighted existing research gaps.

Results: Topics included key considerations for weight management in adolescent and young adult cancer survivors, older adult cancer survivors, and understudied cancer survivor subgroups at high risk for poor health outcomes and innovative interventions that can be tested to improve cancer survivorship.

Conclusions: This report reviews the symposium and offers perspectives from the expert panel about unique opportunities for future research on tailored weight management strategies to equitably improve prognosis and health outcomes in the diverse and growing population of cancer survivors.

Objective: Smartphone applications (apps) with optical imaging capabilities are transforming the field of physical anthropometry; digital measurements of body size and shape in clinical settings are increasingly feasible. Currently available apps are usually designed around the capture of two-dimensional images that are then transformed with app software to three-dimensional (3D) avatars that can be used for digital anthropometry. The aim of the current study was to compare waist circumference (WC), hip circumference (HC), four other circumferences (right/left upper arm, thigh) and WC/HC evaluated with a novel high-precision 3D smartphone app to ground-truth measurements made with a flexible tape by a trained anthropometrist.

Methods: Forty-four participants aged 20-78 years and body mass index 18.5-48.5 kg/m² completed digital and manual circumference evaluations and dual-energy X-ray absorptiometry for visceral adipose tissue mass (VAT).

Results: 3D-digital and ground-truth tape WC, HC, and WC/HC estimates were highly correlated (R ²s, 0.90-0.97, p < 0.001), mean 3D and tape group means at each site did not differ significantly, mean absolute (± SD) and root-mean square errors were low (e.g., WC, 3.4 ± 2.6 and 4.4 cm), and strong concordance correlations were present (0.90-0.99); bias with Bland-Altman analyses was small but significant (p < 0.001) for WC and WC/HC. Comparable results were observed for the four other circumferences. VAT was equally well-correlated with 3D and tape WC measurements (R ²s 0.70, 0.69, both p < 0.001); comparable tape-3D VAT-WC/HC associations were also observed in males (R ²s, 0.85, 0.73, both p < 0.001) and females (R ²s, 0.43, p < 0.01; 0.73, p < 0.001).

Conclusions: Digital anthropometry, with accessible technology such as the evaluated novel 3D app, has reached a sufficiently developed stage to go beyond body mass index for phenotyping patient's metabolic disease risks.

Background: In Kazakhstan the pediatric population levels of obesity based on fat mass (FM) assessment are currently unknown. The present work aimed to assess average childhood FM levels and the prevalence of high levels of adiposity (based upon FM levels).

Methods: Cross-sectional data from 2015 to 2020 nationally representative Childhood obesity surveillance initiative and 2022 regional surveys were used for this study of children aged 8 years (n = 4770) and 9 years (n = 3863). Childhood FM assessment was made using a validated prediction model using height, weight, age, sex and ethnicity. Average levels of FM, fat mass percent (FM%) and the prevalence of overfat and obesity were estimated.

Results: Amongst 8-year-olds, the population average FM% was 32.3% (95% CI: 31.7%-32.8%) for boys and 35.2% (95% CI: 34.8-35.6) for girls (2015) and 32.7% (95% CI: 32.3-33.1) for boys and 35.1% (95% CI: 34.7-35.5) for girls in 2020. The Almaty region had the average FM% 32.7% (95% CI: 32.1-33.2) and 34.8% (95% CI: 34.3-35.4) for boys and girls respectively in 2022. The similar pattern was observed for 9 year old children.

Conclusions: The present study reveals high FM% levels in primary school age children from Kazakhstan across study years. Understanding patterns of FM levels is important for preventing and addressing childhood obesity.

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.