Obesity Science & Practice最新文献

Background: It is anticipated that by 2030, 20% of the world's population will live with obesity. Success in the management of obesity is predominately determined in terms of BMI or percentage weight loss, yet the limitations of these have been widely recognized. This study aimed to understand patient definitions of success in obesity treatment.

Methods: A series of in-depth focus groups, carried out with n = 30 adults living with obesity, offered a qualitative insight into patient definitions of success.

Results: A thematic analysis of data yielded four thematic findings: Success as freedom from stigma, bias and the mental burden of obesity; success as being able to participate fully in the world; success as measured by NSVs [non-scale victories]; and success is not a number on a scale.

Conclusions: What this study highlights is (1) how current measures of success do not accurately encompass the priorities of people living with obesity, (2) the importance of addressing the psychological and emotional aspects of living with obesity in any definition of success , and (3) the importance of meaningful co-creation of goals and indicators of success between clinician and patient for the effective management of the disease of obesity.

Objectives: In many countries, obesity treatments are not fully reimbursed by healthcare systems. People living with obesity (PwO) often pay out-of-pocket (OOP) for pharmacological and non-pharmacological interventions, placing them in a position of financial risk to manage their condition. This study sought to understand the OOP expenditures and non-financial costs incurred by PwO to manage weight.

Methods: A 25-min cross-sectional online survey was conducted with PwO between ages 18-60 in Italy, Japan, India, Brazil, Spain and South Korea. Respondents were recruited using proprietary vendor panels and non-probability sampling. N = 600 participants completed the survey (n = 100 per country).

Results: The mean annual OOP expenditure related to weight loss/management was $7,351, accounting for nearly 17% of annual household income. Costs generally increased by BMI. Half or more of the respondents agreed that obesity affected multiple aspects of their lives (outside activities, running a household, social life, work, family life, traveling). 46% agreed that obesity limited their job prospects.

Conclusion: PwO spend a notable amount of their income paying OOP expenditures related to managing their weight. Quantifying the individual economic burden of living with obesity can inform the understanding of the resources required and policy changes needed to treat obesity as a disease.

Background: The EXOFFIT study compared the effectiveness of three time-matched exercise interventions in women with obesity for improving cardiorespiratory fitness. To best inform future research, evaluation of the interventions' acceptability is needed. Previous research has been inconsistent with methods and reporting of acceptability. Thus, the theoretical framework of acceptability (TFA) can be utilized to ensure that all aspects of acceptability are evaluated. No study to date in women with obesity has utilized the TFA in conjunction with quantitative data (i.e., frequencies of themes) to highlight the aspects of interventions that may be most important for participants.

Objective: This study aimed to examine the acceptability of the EXOFFIT program and gain insight into the participants' experience of participation, their perspective on the acceptability of trial procedures and interventions and gather their feedback on program changes.

Methods: A mixed-methods approach was employed. Thirty-eight participants who completed the exercise interventions were interviewed and completed a self-reported exit questionnaire. Interviews were transcribed verbatim and analyzed in three phases: emergent themes were agreed upon, then mapped to the TFA constructs and the frequencies of each construct and theme were presented as counts. Data collected from the exit questionnaire were collated and reported using descriptive statistics.

Results: All seven TFA constructs were identified in the analysis. The EXOFFIT program was found to have a high level of acceptability, with affective attitude, perceived effectiveness and self-efficacy being the most reported constructs. The burden and opportunity costs associated with the program were mainly related to family commitments and support needed to participate. Any negative impact of participation was noted to be outweighed by the perceived benefits.

Conclusions: The results of this study will inform the development of future programs with women with obesity and support the consideration of the TFA constructs from the outset of study design.Clinical Trial Registration Number: ISRCTN13517067.

Background: Anti-obesity medications (AOMs) may provide a viable option for obesity management. However, little is known about the use of AOMs in persons with SCI/D.

Objective: Describe health care providers' (HCPs) views about barriers to AOM use in persons living with SCI/D.

Methods: Descriptive qualitative design using in-depth interviews Descriptive statistics were used to calculate demographic and employment characteristics. Interviews were audio-recorded and transcribed verbatim. Transcripts were coded and analyzed using Braun and Clarke's (2006) six thematic analysis phases.

Results: HCPs (n = 12) were from 11 different nationwide facilities. Most HCPs were male (75%), a large majority were white (67%), and most were 26-49 years of age. Participants were dietitians (75%), physicians (17%), and psychologists (8%). HCPs ranged from 1.5 to 15 years of providing SCI/D care. HCPs described four main thematic barriers to AOM use in persons with SCI/D: (1) AOM side effects that are especially concerning in persons with SCI/D; (2) AOMs contribute to poor eating habits; (3) availability, accessibility, and administration; and (4) lack of evidence, clinical agreement, and knowledge about AOM use in the SCI/D population.

Conclusions: There are several potential barriers to AOM use in the SCI/D population. Barriers include AOM side effects which may cause or exacerbate conditions that are already concerns in persons with SCI/D, such as bowel and skin problems, and muscle loss. SCI/D HCPs reported a lack of evidence about AOM use in persons with SCI/D, but interest in obtaining more knowledge.

Background: Metabolic and bariatric surgery (MBS) reduces glomerular hyperfiltration. The renoprotective effects of GLP-1 analogs were derived from clinical studies in type 2 diabetes (T2D). The objective of this study was to evaluate the changes in glomerular filtration rate (GFR) over time associated with weight loss in patients with a BMI ≥ 35 kg/m² treated with liraglutide compared with patients treated with MBS.

Methods: A longitudinal study derived from a retrospective cohort of patients with BMI ≥ 35 kg/m² treated with either MBS or liraglutide 3 mg/day, with follow-up ≥1 year. Clinical variables, baseline GFR, and 1-year GFR were analyzed. A generalized estimating equation (GEE) model was used to compare changes in GFR between both groups while controlling for confounding variables.

Results: A total of 159 patients were included in the analysis. Of these, 129 patients underwent MBS (median age 60.5 years [IQR 51.8-66.6], body mass index (BMI) 40.9 kg/m2 [IQR 0.68-0.89]), and 30 patients were treated with liraglutide (median age 56 years [IQR 46-62], BMI 37.4 kg/m² [IQR 0.69-0.93]). No difference in baseline GFR or at 12 months of follow-up was found between the two interventions. GEE analysis revealed an increase of 0.32 mL/min/1.73 m² per month of follow-up. Factors associated with a greater increase in GFR were the percentage total weight loss (%TWL) (0.12 mL/min/1.73 m², p = 0.023) and baseline GFR (0.69 mL/min/1.73 m², p > 0.001) for both interventions, independent of a history of T2D.

Conclusion: In patients with BMI ≥ 35 kg/m², changes in GFR are related to %TWL and baseline GFR, regardless of the presence of diabetes or the type of intervention used.

Background: Socioecological factors are associated with key health behaviors that are critical for weight management, and major life events may disrupt engagement in these behaviors. However, the influence of socioecological factors on health behaviors in the midst of major life events is not clear and is difficult to study due to the random and sporadic nature of their occurrence. The COVID-19 pandemic provided a unique opportunity to study a major life event and its impacts on diet, physical activity, and body weight.

Objective: This cross-sectional study aimed to investigate associations between socioecological factors (environmental, interpersonal, and individual) and self-reported weight change during a major life event using data collected during the COVID-19 pandemic, and whether the associations were mediated through self-reported changes in eating and physical activity behaviors.

Methods: Participants self-reported socioecological factors, weight change, and changes in eating behaviors (EB) and physical activity (PA) via online questionnaires between December 2020 and October 2021. Changes in EB and PA were measured using scales with higher scores reflecting more positive changes during the COVID-19 pandemic.

Results: Participants (n = 1283) were mostly female (84.9%) with age 52.1 ± 14.1 years (mean ± SD) and BMI of 32.9 ± 8.2 kg/m². Stronger healthy eater and exercise identities (individual factors) were associated with higher EB scores (EBS) and PA scores (PAS), respectively (p's < 0.00001). Less discouragement for healthy eating by family/friends (interpersonal factor) was associated with higher EBS (p = 0.002). Higher EBS and PAS were associated with weight loss. The indirect effect of healthy eater identity (-0.72; 95% CI: -0.90, -0.55) and discouragement for diet (0.07; 95% CI: 0.03, 0.12) on weight change through EBS were significant, as was the indirect effect of exercise identity (-0.25; 95% CI: -0.35, -0.15) on weight change through PAS.

Conclusions: Stronger identities and less discouragement from family/friends may support health promoting behaviors and weight loss during a major life event, as well as identify additional behavioral targets for lifestyle interventions.

Clinical trial registration: IWCR was registered at ClinicalTrials.gov (NCT04907396).

Background: Type 2 diabetes (T2D) is a risk factor for female breast cancer (FBC). Obesity has also been associated with FBC, also depending on menopausal status. This study aimed to evaluate the impact of obesity and T2D on the development, aggressiveness, and invasiveness of FBC.

Methods: Demographic, clinical, and histopathological data from 335 women with FBC were collected, and analyzed according to weight category (102 normal weight, 117 overweight, and 116 living with obesity) and the presence/absence of T2D.

Results: Age at oncologic diagnosis was not statistically significantly different for body weight; women with overweight or obesity were more likely to have an oncologic diagnosis after menopause than normal weight (p < 0.001). The presence of overweight/obesity and T2D seemed to be associated with a higher incidence of metastasis, recurrence, and triple-negative breast cancer (TNBC) subtype (p < 0.001). Excess body weight was also associated with high histologic grade (G3) (p < 0.005).

Conclusions: These results confirm excess body weight and T2D as unfavorable prognostic factors in terms of the presence of the TNBC subtype, tumor metastasis, recurrence, and aggressiveness (G3 and Ki-67 > 20%). This study highlights the importance of prevention in all women, with early screening, and adequate nutritional programs.

Objective: Treatment of obesity has been transformed by the recent approval of incretin-based therapies for weight loss (e.g., glucagon-like peptide 1 agonist semaglutide), but little is known about patient perspectives on these medications.

Methods: Between December 2023 and March 2024, healthcare patients from an academic medical center in the Southeast United States with Body Mass Index ≥30 kg/m² completed a cross-sectional online survey on attitudes toward incretin-based medications.

Results: Compared to patients with a bachelor's degree, those without a degree were less likely to be aware of incretin-based pharmacotherapies (96% vs. 78%) and to have discussed pharmacotherapies with a doctor (43% vs. 27%) but had greater interest in using these pharmacotherapies (4.3 vs. 4.7). These pharmacotherapy-related variables did not differ significantly according to gender, race, or financial security. Concerns about side effects, long-term health risks, and potential for weight regain were highly endorsed and were associated with lower interest in using incretin-based therapies and with some demographic factors. Patients reported high interest in lifestyle programs designed for individuals taking anti-obesity medications.

Conclusion: Demographic considerations, notably education level, should be factored into the strategy to promote equitable utilization of incretin-based therapies, particularly as their accessibility expands.

Background: The prevalence of excess weight and obesity is increasing in an extremely concerning manner worldwide, with highly diverse therapies for current treatment. This review evaluated the scientific evidence of the past 10 years on the use of probiotics in treating excess weight and obesity in the absence of dieting.

Materials: A systematic review was conducted by searching for clinical trials on humans published in English in the PubMed, Scopus and Cochrane Central databases, using the combination of keywords "Overweight", "Probiotics" and "Obesity", and published between 2012 and 2022.

Results: Six published studies met the inclusion criteria. The review showed that, although there is a lack of consensus in the literature, the use of probiotics in the absence of dieting produced a significant reduction in body weight and body mass index in 66.6% of the reviewed studies, a significant reduction in waist circumference in 80.0% of the reviewed studies, and an improvement in total body fat mass and waist circumference.

Conclusions: This review showed evidence of a trend in preventing body weight gain and reducing weight through the use of probiotics in individuals with excess weight or obesity. A combination of various strains of the genera Bifidobacterium and Lactobacillus was the most effective.

Introduction: Physical activity and exercise are movement behaviors that support the lifestyle management of overweight and obesity. However, home-based exercise programs are commonly generic, and inconsistently undertake a holistic approach to program design.

Methods: This work applied the Behavior Change Wheel, supplemented with previously conducted interviews, to the development of a home-based exercise program, specifically for people living with overweight and obesity. This provided an understanding of the target behavior and identified a behavioral diagnosis. These findings were mapped onto the Capability, Opportunity, Motivation-Behavior model and Theoretical Domains Framework, identifying changes needed and corresponding intervention functions.

Results: Suitable Behavior Change Techniques were identified, alongside Capability Opportunity Motivation-Behavior components needed to facilitate an increase in exercise behaviors, and five key intervention functions. This housed the delivery of 24 Behavior Change Techniques, including goal setting, feedback, monitoring and repetition.

Conclusion: Applying the Behavior Change Wheel has enabled detailed development of a home-based exercise program for adults living with overweight and obesity.