Obesity Science & Practice最新文献

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: Emerging adults are underrepresented in standard behavioral weight loss interventions (BWLIs). Offering BWLIs in college health centers may help to address obesity in emerging adulthood by reducing student barriers associated with participation; however, implementation barriers and facilitators for health centers are unknown.

Methods: Health services center administrators and providers (n = 14) and students eligible to participate in a BWLI (n = 9, average BMI = 29.8 ± 4.2 kg/m²) participated in semi-structured interviews. Interviews focused on the need for and appropriateness of BWLIs in health centers and perceived barriers and facilitators to their implementation.

Results: Participants generally believed that BWLIs delivered through a health center were appropriate and indicated that BWLIs would be a beneficial offering on-campus. Facilitators of health center implementation included availability of trained health professionals, intradepartmental relationships, supportive infrastructure and resources, and in-house planning and execution. Barriers included limited student use and knowledge of health center offerings, narrow referral/recruitment pathways related to stigma concerns, and challenges related to infrastructure, resources, and competing demands.

Conclusions: College health centers are a feasible and appropriate setting to offer BWLIs, though barriers to implementation exist. It will be important to construct a plan for implementation to address unique barriers in health centers prior to BWLI implementation.

Objective: While weight status and clinical laboratory measures are important in assessing obesity-related disease severity and chronic disease risk, including a broader range of emotional, psychosocial, and behavioral factors would provide greater context of an individual's overall state of wellness and could be used to better guide treatment decisions. The purpose of this research was to develop a comprehensive Lifestyle Wellness assessment for use in lifestyle-based wellness interventions and programs.

Methods: A cross-sectional exploratory factor analysis (EFA) was conducted using baseline data from N = 138 adults participating in behavioral weight loss trials. An unweighted least squares extraction method with oblique rotation was used. Twenty-one putative measures spanning constructs related to metabolic health, emotional health/wellbeing, body weight and composition, diet quality, and fitness were analyzed for retention.

Results: Mean body mass index (BMI) was 38.0 ± 6.6 kg/m², mean age was 57.3 ± 11.1 years, and 77.5% of participants were female. The EFA produced a five-factor model with 13 items that explained 80.3% of the variance. The retained factors included: (1) Psychosocial State: mindfulness, resilience, quality of life, and happiness; (2) Blood Pressure State: systolic and diastolic blood pressure; (3) Lipid State: total cholesterol and LDL-cholesterol; (4) Fitness State: grip strength, jump height, and percent body fat; and (5) Body State: BMI and waist circumference.

Conclusions: Lifestyle Wellness is a comprehensive assessment that enables innovative wellness-related research such as metabolically healthy obese phenotypes and weight-neutral interventions. Future research should include investigations in additional populations with greater age, sex/gender, and body size diversity.

Objective: Adaptive interventions may improve the potency and scalability of behavioral weight loss interventions, but the treatments-or treatment combinations-that should be offered are unknown. A two-stage pilot sequential multiple assignment randomized trial was used to test the timing and dose of human support added to a core digital weight loss program.

Methods: In stage 1, 99 adults with overweight/obesity were randomized at baseline to a kick-off with or without additional human support. In stage 2, "early non-responders" who had not achieved a 2% weight loss were re-randomized after 4 weeks to either biweekly counseling (120 min over 8 weeks) or a one-time check-in (30 min) with a dietitian. "Early responders" continued with the mHealth program alone. Feasibility and acceptability were assessed against pre-specified criteria. Preliminary outcomes (weight loss, self-monitoring and behavioral goal adherence) were explored.

Results: The study met all feasibility and acceptability criteria. The rate of early response was 52.5%. Mean (SE) 3-month percent weight losses were significantly greater in early responders (-6.63% (0.72)) than non-responders (-1.70% (0.43), p < 0.001). Outcomes were similar by first- and second-line treatment though more counseling (27.3%) than check-in (12.5%) participants achieved a 5% weight loss.

Conclusions: Identifying early responders may help optimize weight loss interventions, but more research is needed on rescue treatments for early non-responders.

Trial registration: ClinicalTrial.gov, NCT05929469.

Background: Individuals with overweight or obesity often endure significant weight-based prejudice and discrimination in various settings. Experiencing weight-related stigma is linked to many adverse psychosocial outcomes. Weight self-stigma is when an individual internalizes and identifies with negative attributes ascribed to people with larger bodies and has self-devaluing thoughts because of their weight and is associated with poorer health outcomes.

Aims: This study explored how weight self-stigma may impact weight management efforts and outcomes for adults participating in an onlight weight-loss intervention.

Materials and methods: 508 adults (86.2% female, 84.6% White) with overweight or obesity participated in an asynchronous 12-week online weight-loss intervention with computer-generated feedback. Weight and weight self-stigma were measured at baseline and 3 months later.

Results: Thirty-one point five percent of the sample reported high levels of stigma, which was associated with greater program dropout than those who did not report high stigma (32.5% vs. 21.6%). Program completers reporting high self-stigma showed better treatment engagement (77.0% vs. 69.7% lessons viewed) and weight loss (M = -6.31% vs. -5.08%); these differences were not observed when using intent-to-treat assumptions. When analyzed as a continuous variable, weight self-stigma showed no association with treatment engagement and outcome.

Discussion: These findings highlight the complexity of understanding how self-stigma affects treatment engagement and outcome in behavioral weight loss and the need for more targeted research in this understudied area.

Conclusion: Results suggest that weight self-stigma plays a role in weight management during an online weight-loss intervention, affecting engagement and outcomes.

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.