Obesity Science & Practice最新文献

Importance: Despite the current enthusiasm for anti-obesity medications, there is a critical need for effective lifestyle interventions that can be broadly implemented.

Objective: To assess the effectiveness of REWIND, an obesity and diabetes treatment program.

Design: Prospective cohort study.

Setting: Virtual, community-based weight management program.

Participants: Two-hundred and nineteen participants, BMI ≥ 30 kg/m², with and without type 2 diabetes (T2D).

Intervention: Three phases: "induction" with meal replacement diet to promote ≥ 15% weight loss; "transition" to everyday foods; and "maintenance" to prevent weight regain. REWIND leveraged teams including community leaders, media personalities, nationally recognized athletes and participants, to disseminate information, and foster belonging, commitment, and resilience.

Main outcomes: The co-primary outcomes were the change in weight at 6-, 12-, and 18 months. Secondary outcomes were the proportion of patients achieving ≥ 5%, 10%, 15%, and 20% weight loss at 6, 12, and 18 months, and remission rates in T2D at 6-, 12-, and 18-month, respectively.

Results: Two hundred and nineteen participants (mean age 49.1 [SD 10.5] years), 37% men, 12% Black, 26% with T2D. Weight decreased from: 114.4 (20.8) kg to 96.1 (18.4) kg at 6 months, to 98.5 (18.1) kg at 12 months, and to 101.1 (20.5) kg at 18 months. Weight loss percentages at 6, 12, and 18 months were ≥ 5%: 95%, 91%, 84%; ≥ 10%: 79%, 72%, 67%; ≥ 15%: 58%, 46%, 47%; and ≥ 20%: 24%, 25%, 22%. Diabetes remission was achieved by 52% and 43% of participants with T2D at 12- and 18-month, respectively.

Limitations: Single geographic region. Weight was self-reported.

Conclusion: A virtual community-based program for individuals with obesity and T2D facilitated substantial weight loss and T2D remission. This model has the potential for wide-scale implementation in diverse settings.

Background and aim: Glucagon-like peptide-1 receptor (GLP-1R) agonists are well-established therapies for obesity and type 2 diabetes mellitus (T2DM). Emerging evidence also suggests their potential role in managing obstructive sleep apnea (OSA). This study aimed to investigate the association between GLP-1R agonists and OSA using genetic evidence.

Methods: Cis-expression quantitative trait loci (cis-eQTLs) associated with the GLP1R gene were identified and used as genetic proxies for GLP-1R agonist exposure. To validate the selected genetic instruments, positive control analyses were conducted for T2DM and body mass index (BMI). Mendelian randomization was employed to evaluate the effect of genetically proxied GLP-1R agonists on OSA. OSA data were obtained from FinnGen Release 11 (R11), comprising 50,200 cases and 401,484 controls of European ancestry. The inverse variance weighted (IVW) method served as the primary analytical approach, supplemented by heterogeneity tests and sensitivity analyses.

Results: IVW analysis showed that genetically predicted GLP-1R agonist exposure was associated with a reduction in BMI (β = -0.063, 95% confidence interval [CI]: -0.10 to -0.03, p = 8.43 × 10^-4) and a decreased risk of T2DM (odds ratio [OR] = 0.80, 95% CI: 0.65 to 0.98, p = 0.032), supporting the validity of the genetic instruments. Notably, GLP-1R agonists were also associated with a significantly lower risk of OSA (OR = 0.83, 95% CI: 0.76 to 0.91, p = 6.15 × 10^-5). No evidence of heterogeneity or horizontal pleiotropy was detected, and leave-one-out analysis confirmed the robustness of the findings.

Conclusion: This study provides genetic evidence supporting the protective role of GLP-1R agonists against OSA, highlighting their potential as a therapeutic strategy for OSA management.

Objective: Although smoking, an established cardiovascular disease (CVD) risk, is a modifier of body mass index (BMI), studies are still lacking addressing a potential association between smoking and BMI or BMI-related risk factors in Asia. The aim of this study was to investigate the association between smoking and BMI or CVD risk factors in a working-age population in Japan.

Methods: Eight thousand eight hundred thirty-six male and seven thousand three hundred seventy female health checkup examinees in a single center without self-reported heart disease or stroke were analyzed by multiple regression analysis for an association between the smoking status (never, current, or past) or the number of cigarettes consumed (never (0/day), mild (< 10/day), moderate (10-19/day) or heavy (≧ 20/day)) and age-adjusted BMI. In subgroups of 3430 males and 2407 females, the predictive risk score of CVD from the Hisayama study except for the smoking item was calculated and compared among groups with different smoking habits.

Results: In the analysis of the association between smoking and BMI, age-adjusted BMI was significantly higher in heavy smokers than never, mild, or moderate smokers in males (p < 0.01 vs. never, p < 0.05 vs. mild, p < 0.01 vs. moderate). Past smokers exhibited a higher CVD risk score than never or current smokers (p < 0.01 vs. never, p < 0.01 vs. current). Even though the score of the smoking item was excluded from the calculation, heavy smokers showed a significantly higher CVD risk score than the other three groups in males (p < 0.01 vs. never, p < 0.05 vs. mild, p < 0.01 vs. moderate). This was accompanied by the deterioration of CVD risk factors, including diabetes, dyslipidemia, proteinuria, and lack of exercise habit.

Conclusions: Smoking status or the number of cigarettes was associated with age-adjusted BMI or CVD risk factors in Japanese males.

Background: Vertebral bone marrow (VBM) plays a critical role in bone homeostasis and metabolic health. Alterations in VBM fat and iron composition have been linked to age-related metabolic and musculoskeletal disorders, yet remain underexplored in large population-based studies.

Objectives: This study aimed to assess VBM adipose tissue and iron concentration in the UK Biobank imaging cohort (N = 26,524) using magnetic resonance imaging (MRI).

Methods: VBM adipose tissue using two approaches: fat fraction (FF) measured from 2-point Dixon MRI images and proton density fat fraction (PDFF) from multi-echo MRI scans, along with iron concentration from multi-echo MRI images, were measured. Sex-specific relationships between VBM measures, anthropometric and lifestyle factors as well as disease status were explored using correlation and linear regression analyses.

Results: VBM FF and PDFF were higher, whereas VBM iron concentration was lower in participants with osteoporosis and type-2 diabetes (T2D; p < 0.00016). VBM FF and PDFF were positively associated with visceral adipose tissue and T2D and were inversely associated with spine bone mineral density (BMD) and total muscle (p < 0.00016) in both sexes; however, positive associations with smoking were observed only in women. VBM iron concentration was significantly positively associated with visceral adipose tissue, spine BMD, and alcohol intake, but negatively associated with T2D in men only.

Discussion: These findings enhance the understanding of VBM measures in metabolic health assessments, highlighting their role as potential indicators of metabolic and musculoskeletal health.

Background: Metabolic and bariatric surgery (MBS) is the most effective and durable approach to treating obesity, yet recurrent weight gain occurs in a subset of patients. Primary care often serves as a routine point of contact for patients following MBS and is a potential gateway for addressing and/or preventing recurrent weight gain.

Methods: Although guidelines for the management of recurrent weight gain after MBS exist, this narrative review was undertaken to clarify the role of the primary care providers in enhancing long-term outcomes and preventing weight gain after MBS.

Findings: Regular follow-up in primary care provides an opportunity to identify challenges related to weight management and overall health outcomes, which may include concerns related to nutrition, mental or physical well-being, body image, motivation, and behavior change, for example. The availability of multidisciplinary providers within primary care settings, including behavioral health specialists, dietitians, and physical therapists, is an important strength of this setting in addressing potential post-MBS concerns such as recurrent weight gain.

Conclusion: This review outlines clinical considerations for managing recurrent weight gain post-MBS in primary care and includes recommendations for both primary care providers and specialty clinicians working in primary care to deliver care effectively and mitigate weight stigma post-MBS.

Introduction: Semaglutide 2.4 mg (Wegovy) is the first second-generation anti-obesity medication approved by the FDA for long-term obesity treatment. Given the effectiveness of semaglutide 2.4 mg compared to first-generation anti-obesity medications and amid ongoing national shortages, understanding the real-world experiences of individuals using semaglutide 2.4 mg is crucial. This qualitative study aims to explore the narratives of individuals using semaglutide 2.4 mg for weight management, as expressed in Reddit posts.

Methods: One thousand posts from the r/WegovyWeightLoss subreddit between October 10, 2022, and October 6, 2023, were retrospectively analyzed. After excluding irrelevant posts, 660 posts were included in the analysis. A codebook was collaboratively developed and data was coded using qualitative software. Themes were finalized and reviewed.

Results: Seven themes were identified from the analysis: medication efficacy (29.4% of coded posts), psychosocial impact of weight loss (22.8%), side effects management (13.3%), barriers to access (10.7%), lifestyle modification (10.2%), support and community (9.2%), and stigma surrounding use of semaglutide 2.4 mg for weight loss (4.4%).

Conclusion: This qualitative analysis of Reddit posts provides valuable insights into the real-world experiences of individuals using semaglutide 2.4 mg for weight management. By understanding these user experiences, healthcare providers can better tailor obesity treatment plans and enhance patient-centered care for those using second-generation anti-obesity medications like semaglutide 2.4 mg.

Introduction: Conventional weight-loss strategies often result in inadequate fat loss, poor sustainability, and unintended lean mass loss. Prolonged water-only fasting followed by dietary change may offer an effective alternative, but its impact on body composition remains underexplored.

Methods: This secondary analysis utilized dual-energy X-ray absorptiometry (DXA) to assess changes in fat-free mass (FFM), fat mass (FM), and bone mineral content (BMC) in adults [median (IQR) age: 62 (15) years with overweight or obesity. Participants underwent a median (IQR) of 14 (6) days of water-only fasting, followed by 6 (3) days of food reintroduction with a whole-plant-food diet and a subsequent maintenance period of 45 (5) days. Study visits occurred at baseline and at the end of each period.

Results: At end of fasting, FFM accounted for 74% of total BW lost during fasting. However, at the follow-up visit, the median (IQR) percentage change in total BW, FFM, FM, and visceral adipose tissue (VAT) mass from baseline was -8.2 (5.2), -4.4 (5.6), -14.7 (8.9), -15.8 (12.8) %, respectively. At follow-up, FM loss accounted for 67% of the total BW lost. BMC remained unchanged across all study visits.

Conclusions: This protocol produced sustained FM loss, specifically VAT mass, and FFM recovery, suggesting it may support effective weight management.

Background: Individuals with obesity frequently encounter weight bias, which can contribute to the internalization of negative weight-related attitudes. This study examined sex differences in self-reported weight bias internalization among a racially and ethnically diverse sample of adults with obesity engaged in treatment.

Methods: Mixed method approach was used. Weight bias internalization was assessed quantitatively using the 11-item weight bias internalization scale (WBIS) and qualitatively through in-depth interviews. Sex differences were examined with univariate and multivariate linear regressions. Interviews were thematically analyzed to explore sex differences.

Results: Quantitative analysis (n = 60, 62% female) revealed that non-Hispanic White individuals with obesity exhibited significantly greater weight bias internalization than non-Hispanic Black individuals with obesity. There was no significant difference in mean WBIS scores between males (4.15 ± 1.34; p = 0.13) and females (3.68 ± 1.02; p = 0.13). Qualitative analysis (n = 24, 50% female) identified themes such as childhood trauma, self-esteem, health challenges, discrimination, and social interactions. No major conceptual differences emerged in the internalization of weight bias between male and female participants. However, female participants mostly described weight bias internalization as contributing to social avoidance and negatively impacting their career prospects.

Conclusion: Quantitative analyses indicated no statistically significant sex differences in weight bias internalization, and qualitative findings revealed no substantial conceptual differences between male and female participants. Future research should explore socioecological factors such as race/ethnicity, relationship status, and employment to identify populations at greater risk and inform targeted strategies for improving health outcomes.

Background: BMI has limitations in assessing metabolic health, especially in diverse populations. Fat mass index (FMI) and skeletal muscle mass (SMM) are more accurate predictors of obesity-related risks. Redefining obesity as a fat accumulation disease highlights the need for body composition-focused assessments in clinical practice.

Objectives: This study assessed body composition changes in a Latino population over 6 months, evaluating the utility of fat mass index (FMI) and skeletal muscle mass (SMM) in detecting significant variations and exploring associations with baseline characteristics.

Methods: In this retrospective observational study, 1571 Latino patients were categorized into hypocaloric-high protein (HHP) and eucaloric-high protein (EHP) groups based on baseline BMI. Body composition was measured using bioelectrical impedance analysis at baseline and after 6 months. Chi-square tests evaluated categorical shifts in classifications, while multinomial logistic and linear regression models identified factors associated with fat and muscle mass changes, adjusting for sex, age, and baseline composition metrics.

Results: Over 6 months, participants experienced significant reductions in body fat mass (31.24-27.25 kg, p < 0.001) and increases in skeletal muscle mass (24.31-25.85 kg, p < 0.001). In the HHP group, baseline FMI and age were significantly associated with fat mass changes, with younger individuals and those with lower baseline FMI being more prone to fat accumulation (p < 0.001). In both groups, higher baseline SMM was associated with greater likelihood of muscle loss and lower probability of muscle gain, suggesting a physiological ceiling effect (p < 0.001).

Conclusions: FMI and SMM enhance clinical assessments by providing more individualized metrics for obesity management in Latino populations. These findings support the integration of body composition analysis into clinical practice for more precise evaluation of metabolic health beyond traditional BMI classifications.

Background: Childhood and adolescent obesity, which affects nearly 1 in 5 youth in the US, presents a pressing public health concern. Obesity is linked to chronic low-grade inflammation, which exacerbates comorbidities. Noninvasive tools are needed to monitor obesity-related inflammation and assess weight-management interventions in children and adolescents.

Objective: This study investigated the associations between Body Mass Index z-score (BMIz) and salivary biomarkers: C-reactive protein (CRP), cytokines interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α.

Methods: A sample of 280 adolescents (Mage = 12.1 years, SD = 0.44) was followed for 2 years (3 time points) from 2019 to 2021. An autoregressive cross-lagged path model was used to examine the prospective relationships between BMIz and salivary biomarkers.

Results: Findings indicated a bidirectional relationship between BMIz and salivary CRP levels, suggesting a feed-forward cycle in which excessive weight gain and inflammation mutually amplify each other. Salivary cytokines were not associated with BMIz.

Conclusions: This study underscores the utility of salivary CRP as a noninvasive biomarker for obesity-related inflammation. Monitoring salivary CRP levels could aid in targeting interventions to prevent obesity-related complications early in life.