Obesity最新文献

Objective

This study aimed to optimize weight loss outcomes in an online behavioral obesity treatment program by evaluating the effects of five novel intervention components using a factorial experiment informed by the multiphase optimization strategy framework.

Methods

A randomized factorial experiment tested 12-month weight loss resulting from an established online obesity treatment program with randomization to zero to five novel intervention components (interactive video feedback, tailored intervention to promote physical activity, skills for dysregulated eating, virtual reality skills training, and social support with friendly competition).

Results

Adults (N = 384; 83% female, 12% male, 5% another sex/gender or did not disclose; 23% racial and/or ethnic minority) with (mean ± SD) age of 53.5 ± 11.7 years and BMI of 35.0 ± 6.1 kg/m² were randomized. No intervention component independently improved weight loss (p values > 0.199). Interaction terms (p values < 0.01) suggest the combination of interactive video feedback, skills for dysregulated eating, and social support with friendly competition improved weight loss. Mediation analysis indicated that social support and dysregulated eating interventions influenced weight loss outcomes through improvements in social support for physical activity and dietary quality.

Conclusions

This study identified a combination of intervention components that may improve weight loss outcomes compared to the established online treatment program.

Trial Registration: ClinicalTrials.gov identifier NCT04520256.

Objective

This study aimed to evaluate the weight loss efficacy of semaglutide initiated 6 months after laparoscopic sleeve gastrectomy (LSG).

Methods

This retrospective study included patients undergoing primary LSG. Patients receiving semaglutide (1.0 mg weekly) at 6 months post LSG for 6 months were matched 1:3 with controls not receiving semaglutide, balancing demographics, preoperative BMI, waist–hip ratio, comorbidities, and total weight loss (TWL) at 6 months post surgery. Primary outcomes were absolute and percentage weight loss from 6 to 12 months post LSG.

Results

Both the treatment (n = 34) and control (n = 102) groups achieved substantial TWL (23.16% ± 6.50% vs. 23.53% ± 4.87%) at 6 months post LSG. From 6 to 12 months, the treatment group experienced significantly greater absolute (14.03 ± 5.26 kg vs. 5.63 ± 6.25 kg; p < 0.0001) and percentage (12.61% ± 4.11% vs. 4.84% ± 5.18%; p < 0.0001) weight loss than controls. At 12 months, TWL was also higher in the treatment group (35.77% ± 8.35% vs. 28.37% ± 7.41%; p < 0.0001).

Conclusions

Semaglutide initiated 6 months post LSG significantly enhances short-term postoperative weight loss, even among patients who have already achieved substantial initial weight loss. These findings suggest its potential as an effective adjunct therapy for optimizing weight management in early postoperative care.

Objective

We investigated the associations of grandmaternal early pregnancy BMI with grand-offspring risks of birth asphyxia-related complications.

Methods

In a nationwide three-generation Swedish cohort, we estimated adjusted relative risks (RRs) of Apgar score 0–3 at 5 min and neonatal seizures for categories of grandmaternal BMI among 315,461 maternal and 203,522 paternal singleton live-born grand-offspring. To address unmeasured confounding by shared familial factors, we used the parental full sisters' BMI as a negative control exposure. In the maternal line, we assessed whether associations with grandmaternal obesity were mediated through maternal obesity.

Results

Compared with normal maternal grandmaternal BMI, RRs (95% CI) of low Apgar score were, respectively, 1.29 (1.06, 1.57) and 1.53 (1.03, 2.28) for overweight (BMI 25.0 to 29.9) and obesity (BMI ≥ 30.0). For neonatal seizures, the corresponding RRs (95% CI) were 1.32 (1.05, 1.66) and 1.81 (1.17, 2.79). Maternal sisters' BMI was unrelated to both outcomes. Maternal obesity mediated < 25% of the associations with maternal grandmaternal obesity. Paternal grandmaternal obesity was related to an increased risk of neonatal seizures; paternal sisters' BMI was unrelated to this outcome.

Conclusions

Grandmaternal overweight and obesity are related to increased risks of severe birth asphyxia-related complications in grand-offspring, independent of unmeasured shared familial factors.

Objective

Vertical sleeve gastrectomy (VSG) promotes significant metabolic improvements, though the underlying molecular mechanisms are not fully understood. Emerging evidence suggests that small extracellular vesicles (sEVs) contribute to metabolic improvements post VSG, such as improved fatty liver disease or adipose tissue function; however, it is unclear how different organ-specific sEVs interact with various metabolic parameters. The objective of this study is to establish the role of organ-specific sEVs in the metabolic improvements post VSG.

Methods

Demographic and anthropometric data, metabolic parameters, and sEV samples were collected pre VSG and 3–6 months post VSG in youth with obesity. sEV RNA was sequenced for bioinformatics analyses.

Results

A significant reduction of the liver-enriched mRNA cargo in sEVs was observed post VSG, whereas adipose-enriched mRNA cargo showed no such reduction. Liver-enriched mRNA cargo correlated with BMI, leptin, and resistin 6 months post VSG. Analysis of delta values (post minus pre surgery) revealed that adipose-enriched mRNA cargo correlated with markers of liver damage, whereas liver-derived mRNA cargo correlated with branched-chain amino acids.

Conclusions

Following VSG, significant changes occur in the liver-enriched mRNA cargo of sEVs. Liver-derived sEVs appear to influence adipose metabolism, whereas adipose-derived sEVs are linked with liver function, suggesting dynamic intertissue cross talk that shapes systemic metabolic outcomes.

Objective

From October 18 to 20, 2022, the National Institutes of Health held a workshop to examine the state of the science concerning obesity interventions in adults to promote health equity. The workshop had three objectives: (1) convene experts from key institutions and the community to identify gaps in knowledge and opportunities to address obesity, (2) generate recommendations for obesity prevention and treatment to achieve health equity, and (3) identify challenges and needs to address obesity prevalence and disparities and develop a diverse workforce.

Methods

A three-day virtual convening.

Results

Several key themes emerged from the workshop discussions that describe directions to build on the currently limited amount of research on obesity, disparities, and equity. Key themes centered on the determinants of health, leveraging technology, clinical, community, commercial, and policy approaches. Community-engaged work, particularly in populations that have received little focus (e.g., sexual gender minorities, Asian communities), was also discussed.

Conclusions

Future research may be impactful when multilevel approaches are undertaken that leverage equity-minded tools and can be scaled up to meet community-informed population needs in a variety of settings. Funding priorities and workforce development will be critical to realizing health equity.

Objective

This secondary analysis was conducted to compare the magnitude of adaptive thermogenesis (AT) following hypocaloric low-carbohydrate (CHO) versus low-fat diets in African American (AA) women.

Methods

Sixty-nine AA women with obesity were randomized to low-CHO or low-fat hypocaloric diets for 10 weeks, followed by a 4-week weight stabilization period (all food provided). At baseline and Week 13, insulin sensitivity (S _I) was measured by intravenous glucose tolerance test, body composition by bioimpedance analysis, total energy expenditure (EE) (TEE) by doubly labeled water, and resting EE (REE) by indirect calorimetry.

Results

Forty women finished the intervention, with an average weight loss of 6.3 ± 3.9 kg and no differences between groups. AT was present at the level of REE (−75 ± 136 kcal/day, p < 0.003, n = 38), but not TEE (−80 ± 288 kcal/day, p = 0.086, n = 40) at Week 13. Women with low S _I on the low-fat diet showed greater AT at the level of TEE compared to those on the low-CHO diet (−202 ± 213 vs. 127 ± 239 kcal/day, respectively, p < 0.006).

Conclusions

AA women with low S _I on low-CHO diets do not experience AT, which can contribute to the superiority of this dietary approach in inducing weight and fat mass loss.

Trial Registration

ClinicalTrials.gov Identifier: NCT03499509 https://clinicaltrials.gov/study/NCT03499509

Objective

This study aimed to identify key childhood obesity correlates in Southern California by analyzing individual components from four social determinants of health (SDoH) indices and explore their interactions.

Methods

We utilized publicly available data from 330 cities across 10 counties, incorporating childhood obesity rates from the 2019 California Department of Education Physical Fitness Test (684,419 children, 40% Latino). Fifty-two individual SDoH were obtained from the Healthy Places Index, Social Vulnerability Index, CalEnviroScreen, and Child Opportunity Index (2015–2019). Weighted quantile sum regression and an interpretable machine-learning tool were used to identify which individual SDoH were significantly associated with childhood obesity.

Results

We identified a SDoH mixture associated with increased percentile of childhood obesity (β [95% CI]: 10.1 [8.1, 12.1]). Fourteen factors significantly contributed, with the top six being school poverty, minority status, asthma emergency room visits, public assistance rates, hazardous waste sites, and lead exposure from housing. We also found positive associations between Latino percentage and key correlates. Cities with high school poverty and low-income housing burdens had higher obesity rates.

Conclusions

This analysis moved beyond composite indices to examine specific SDoH observed alongside childhood obesity in Southern California, drawing attention to dimensions related to school, healthcare, social services, and environmental exposures.

Objective

SURMOUNT-MAINTAIN aims to evaluate the efficacy and safety of reducing the tirzepatide dose and/or continuing the maximum tolerated dose (MTD) versus placebo in maintaining body weight (BW) reduction achieved with tirzepatide MTD.

Methods

This Phase 3b, multicenter, randomized, parallel-arm, double-blinded, placebo-controlled, 52-week clinical trial is in progress comparing treatment with once weekly tirzepatide (5 mg and/or MTD of 15 mg or 10 mg) versus placebo in achieving BW reduction maintenance from the initial 60-week open-label weight-loss period on tirzepatide MTD, in adults with obesity (BMI ≥ 30 kg/m² or ≥ 27 kg/m² with ≥ 1 obesity-related comorbidity, excluding type 2 diabetes). The primary endpoint is percent maintenance of BW reduction achieved during the weight-loss period at Week 112 among those who reached a BW plateau (i.e., < 5% BW change) between Weeks 48 and 60.

Results

Participants are mostly female (65%) with a mean ± SD age of 47 ± 13 years, BW 114 ± 27 kg, BMI 40 ± 8 kg/m², and waist circumference 119 ± 18 cm.

Conclusions

The SURMOUNT-MAINTAIN trial will evaluate whether reducing or continuing the tirzepatide dose as a long-term treatment option may help maintain the reduced BW initially achieved with tirzepatide MTD versus switching to placebo. Combined, this study may provide additional evidence to help tailor patient-centered strategies for maintenance of BW reduction in adults living with obesity.

Trial Registration

ClinicalTrials.gov identifier: NCT06047548