Obesity Science & Practice最新文献

Background: Behavioral weight loss (WL) interventions typically follow standard diet and activity prescriptions for intervention duration to produce an energy deficit. Though average weight losses in these programs are clinically meaningful, there is heterogeneity in weight outcomes. Personalized diet and activity prescriptions may help increase the potency of WL programs by reducing this heterogeneity.

Methods: This 12-week pilot study randomized participants (n = 35; BMI 34.6 ± 4.9 kg/m², 34% with HbA1c 5.7%-6.4%) in a 3:1 ratio to a Personalized Behavioral Weight Loss (PBWL) or standard BWL and compared the feasibility and efficacy of these approaches. Both groups received a study mobile app, smart scale, activity tracker, and weekly telephone coaching sessions; PBWL participants received a continuous glucose monitoring device. PBWL participants had goals for 1) macronutrient composition (low fat or carbohydrate), 2) meal frequency (3 meals or meals and snacks), and 3) activity focus (daily or weekly goal); they experimented with different 3-part prescriptions, in random order and combination, for the first 4 weeks then picked their 3 goals to follow for weeks 5-12.

Results: Study retention (100%) and satisfaction were high. Mean 3-month weight loss (kg) was greater in PBWL (-7.08 (0.74)) than BWL (-3.79 (0.84), P = 0.03); 74% of PBWL and 63% of BWL participants were "optimizers" who achieved a 5% weight loss at 3 months. PBWL optimizers lost more weight (-8.66 (0.66)) than BWL optimizers (-4.76 (0.43), p < 0.001).

Conclusions: Experimentally-derived personalized prescriptions supported greater 12-week weight loss than standard recommendations. Trial Registration: ClinicalTrials.gov NCT04639076.

Background: The rising prevalence of obesity and type 2 diabetes (T2DM) is a significant public health concern, particularly in low- and middle-income countries. This study aimed to explore the association between physical activity levels, overweight/obesity, and T2DM in a nationwide survey of Nepalese adults.

Methods: This was a secondary analysis of the 2019 non-communicable diseases (NCD) risk factors STEPS survey conducted in Nepal. Demographic and anthropometric data, body mass index (BMI) and T2DM status were collected along with assessment of physical activity using Global Physical Activity Questionnaire (GPAQ). A two-stage data analysis was conducted, first using descriptive statistics to summarize participant characteristics and differences across BMI and T2DM status, and then applying multivariate analyses to assess associations between physical activity levels, BMI and T2DM.

Results: Of the 5284 participants included, 28.0% had overweight/obesity, 5.8% had obesity, and 6.5% had T2DM. The mean age of the participants was 40.1 years (95% CI: 39.8-40.6), and 63.9% were female. The overall physical activity energy expenditure was higher in the lean group (BMI < 25 kg/m²) compared to the those with overweight/obesity, and among participants without T2DM compared to those with T2DM. Sedentary behavior was more common among individuals with overweight/obesity and T2DM. A higher proportion of participants with low physical activity was observed in the overweight/obesity group compared to the lean group (8.9% vs. 6.3%) and the T2DM group compared to the non-T2DM group (11.7% vs. 6.7%). Low physical activity was associated with overweight/obesity (OR:1.4; 95% CI:1.1-1.8), obesity (OR:2.1; 95% CI:1.5-2.3), T2DM (OR:1.6; 95% CI:1.1-2.3) and T2DM in the presence of obesity (OR:3.6; 95% CI:1.7-7.8).

Conclusion: This study highlights the low rates of physical activity and higher rates of sedentary behavior among adults with overweight/obesity and T2DM in Nepal. Public health interventions promoting physical activity and reducing sedentary behavior may help reduce the burden of these NCDs.

Introduction: Studies examining preoperative weight loss using pharmacotherapy in metabolic and bariatric patients are limited. The objective was to investigate if patients taking a low-dose formulation of phentermine had improved weight loss.

Methods: This study was a randomized, placebo-controlled trial including patients undergoing laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy. Anthropometric and serological data were collected during the initial consult visit and again during two follow-up visits. Lomaira is a low-dose formulation of phentermine. Patients took 8-mg tablets three times a day for 14 weeks. The primary outcome of this study was weight loss, which was measured as percentage total weight loss (%TWL) and change in body mass index (BMI).

Results: Among 53 participants randomized, 45 (85%) completed the trial. Participants were predominantly female (91%); the mean age was 41 years (SD = 11); and the mean initial BMI was 48.4 kg/m² (SD = 8.2 kg/m²). Average weight loss was 6.2 kg (SD = 6) in the treatment group versus 1.1 kg (SD = 4.54) in the placebo group (p = 0.001). Average % TWL was greater in treatment Group 4.7 ± 4.3 versus placebo Group 1.1 ± 3.6, p = 0.001. Multivariate regression analysis demonstrated that preoperative medication use was significantly associated with greater %TWL (p = 0.004). There was no difference in OR time or post-operative complications between the groups.

Conclusions: Low-dose phentermine is efficacious and safe for preoperative weight loss in patients undergoing metabolic and bariatric surgery.

Background: Virtually-delivered obesity care has the potential to increase access to weight loss interventions at scale. While there is ample literature assessing various weight loss interventions, studies specifically demonstrating outcomes of commercial programs offering antiobesity medications in virtual care settings are lacking.

Methods: This retrospective cohort study assessed the weight loss outcomes of 66,094 participants in a virtual weight care program that prescribes antiobesity medications alongside a digital behavior change program. Outcomes included the primary endpoint of percent weight loss at 12 months, as well as absolute change in body weight, change in body mass index (BMI), categorical weight loss at three, six, and 12 months, and stratifications by program engagement and medication type (first vs. second generation antiobesity medications).

Results: At program enrollment, members were on average 42.6 years old and 91.5% female, with a BMI of 36.0 kg/m². At 12 months, the mean percent weight loss was 8.0%, with weight loss increasing over time from 2.9 kg (SD = 3.7, Cohen's d = 0.8) at 3 months, to 5.8 kg (SD = 6.1, Cohen's d = 0.9) at 6 months, to 8.0 kg (SD = 8.7, Cohen's d = 0.9) at 12 months (p < 0.001 for all time points). At 12 months, 64.2% had achieved ≥ 5% weight loss. Weight loss outcomes increased with program engagement. At 12 months, those engaging at least once weekly lost 10.0% of body weight, while those logging weight at least weekly lost 12.0%.

Conclusion: This study provides real-world evidence that users of a virtual commercial weight care clinic who were prescribed antiobesity medications achieved clinically significant weight loss at six and 12 months. These findings support the value of virtual platforms in efficiently scaling access to high-quality weight care.

Introduction: The association of screen time and physical activity with body weight in children has been investigated in cross-sectional and prospective studies, as well as randomized controlled trials. The present study extends previous research by examining how longitudinal within-person changes in screen time and physical activity relate to changes in Body Mass Index (BMI) in children, and how changes in screen time and physical activity relate to each other.

Methods: The data for the present study came from the PIER Youth Study. Data were collected from 971 children and their parents at two time points approximately 1 year apart. A multilevel modeling approach with measurement occasions nested within children was used to model changes in BMI across age.

Results: Within a child, a change in daily hours of TV viewing was associated with a corresponding change in BMI, whereas a change in daily hours of physical activity was associated with an opposite change in BMI. Within-person correlations between changes in screen time and physical activity were small but positive.

Conclusion: The present findings have important implications for interventions to reduce and prevent childhood overweight and obesity. Specifically, interventions should focus on both reducing daily TV viewing and promoting physical activity.

Purpose: Pre-operative eating disorders are well documented within the metabolic and bariatric surgery (MBS) population, yet subthreshold dieting attempts are less understood. The objectives of this study were to define and categorize patients' preoperative dieting attempts, and to determine how attempts are associated with postoperative outcomes, eating disorders, and demographics.

Materials and methods: Three hundred twenty-one patients (81.0% female; 68.3% White) who had MBS (57.3% Roux-en-Y) between 2019 and 2020 were included. Preoperative dieting attempt responses were categorized as provider-managed, non-medically managed, and self-directed attempts; subtypes of dieting methods (e.g., low calorie) were described. Descriptive analyses were conducted for attempt categories and subtypes, and between attempts and readmissions, complications, eating disorders, and demographics. ANOVAs determined associations between attempts and %TWL at 6 and 12 months.

Results: Patients reported an average of five to six preoperative dieting attempts; self-directed attempts were the most common (91.9%), and exercise was the most common subcategory (70.7%). Patients with  ≥ 1 provider-managed attempt were less likely to experience a complication (p < 0.001) and more likely to experience readmission (p = 0.018). Patients with 1 self-directed attempt were less likely to experience a complication (p = 0.045) and readmission (p < 0.001). Patients who experienced  ≥ 2 low fat diet attempts were more likely to have complications (p < 0.001) and readmissions (p = 0.008); patients with  ≥ 2 VLCD attempts were more likely to have a complication (p < 0.001). Patients who experienced  ≥ 2 non-medically managed attempts had higher preoperative BMIs (p = 0.03).

Discussion: Given that patients engaged in frequent dieting attempts that fall outside formal assessments, future work should seek to expand pre-operative assessments.

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.