Obesity Reviews最新文献

Introduction: Aging population and growing obesity prevalence are two major public health issues. Bariatric surgery has been shown to be both safe and effective, but its role in the treatment of the elderly remains controversial.

Objectives: To evaluate the efficacy and safety of laparoscopic bariatric surgery in patients over 70 years of age.

Methods: A systematic review and assessment of the literature was performed in November-December 2023. Inclusion criteria gathered studies of elderly (age ≥70 years old) who underwent laparoscopic bariatric surgery. The data extraction focused on weight loss, obesity-related diseases, and complications.

Results: Fourteen retrospective studies were included, involving 3923 septuagenarians (female, 69.70%). One year after the surgery, the mean excess weight loss was 54.66%. At last follow-up, the improvement in obesity-related diseases was regarded as 50% diagnosed with diabetes, 36% with hypertension, 50% with reflux, 36% with sleep apnea, and 25% with hyperlipidemia. The overall postoperative major morbidity and mortality were about 2% and 1%, respectively.

Conclusions: This systematic review suggests that laparoscopic bariatric surgery is an effective and safe treatment for patients over 70 years of age.

Policymakers require health economic modeling to guide their decision-making over the choice of interventions for obesity. This scoping review was undertaken to report on the health economic models in use for estimating the value of behavioral interventions (individual or population level) for obesity reduction. Electronic databases (MEDLINE, Embase, PsycINFO, EconLit, and Web of Science) were searched for publications meeting inclusion criteria from January 2015 to May 2023. Seventy-three studies were included, using 44 health economic models between them. When considered against the expert recommendations for modeling of this type, only four models (9%) met all five key elements. The element most commonly unfulfilled was the use of a microsimulation modeling approach (41%, n = 18), followed by model validation (46%, n = 20). A majority of models met each of the other elements: use of a lifetime horizon (59%, n = 26), inclusion of key health events (66%, n = 29), and a risk equation approach to event simulation (71%, n = 31). In addition, under half of the studies considered health inequalities in their reporting. Continued proliferation of models with inadequate time horizons, breadth of obesity-related health conditions, and perspectives on costs and outcomes risks underestimation of the benefits of longer term interventions and impacts on health inequalities.

Metabolic dysfunction-associated steatohepatitis (MASH) is a condition characterized by hepatosteatosis, inflammation, and tissue damage, with steatosis as the initial stage, which involves chronic, excess deposition of lipids in hepatic lipid droplets. Despite the growing prevalence and serious risks it poses, including liver decompensation, the need for transplantation, and increased patient mortality, MASH currently faces no approved pharmacotherapy. Several promising treatment candidates have emerged from recent clinical trials, including analogs of FGF21 and agonists of the associated FGFR1-KLB complex. These agents were well-tolerated in trials and have demonstrated significant improvements in both histological and biochemical markers of liver fat content, inflammation, injury, and fibrosis in patients with MASH. Endocrine FGF21 plays a vital role in maintaining homeostasis of lipid, glucose, and energy metabolism. It achieves this through pathways that target lipids or lipid droplets in adipocytes and hepatocytes. Mechanistically, pharmacological FGF21 acts as a potent catabolic factor to promote lipid or lipid droplet lipolysis, fatty acid oxidation, mitochondrial catabolic flux, and heat-dissipating energy expenditure, leading to effective clearance of hepatic and systemic gluco-lipotoxicity and inflammatory stress, thereby preventing obesity, diabetes, and MASH pathologies. In this review, we aim to provide an update on the outcomes of clinical trials for several FGF21 mimetics. We compare these outcomes with preclinical studies and offer a lipid-centric perspective on the mechanisms underlying the clinical benefits of these agents for MASH.

The use of recommender systems in mobile health apps for weight control has grown, but user app uptake and engagement remain limited. The objective of our scoping review was to explore the influence of recommender systems on mHealth app user engagement, identify the theoretical frameworks that have been applied on digital health interventions designed for weight management, and examine the key aspects that support tailoring user engagement through recommender systems. Based on existing literature, we identified 13 articles on recommender systems for weight management. Themes emerged, including theoretical underpinnings, authors' domain knowledge, user motivation, and design. Most studies used constructs from the social cognitive theory. We found inconsistencies between authors' domain knowledge and the intervention's content, with few professionals from the health and psychology fields. Only 46% of articles measured user engagement, whereas gamification and tailored messages were common app features. Despite some positive weight change results, more attention is needed toward implementing behavior theory and other strategies to promote app user engagement. Future studies should more accurately measure user motivation and identify the best features and behavioral constructs to increase app user interaction. Larger studies with a more diverse population are needed to generalize findings and evaluate weight loss maintenance and physical activity habits among users of recommender system.

Primary care is central to ongoing health care following bariatric surgery and patients indicate a preference for receiving follow-up support by their primary care practitioner (PCP). This meta-synthesis investigates the perspectives of both PCPs and patients in post-bariatric surgery care provided by PCPs. The aim was to synthesize themes from qualitative research to recommend improvements in post-bariatric surgery clinical care in primary care settings. Systematic searches of Scopus, Medline, EMBASE, PsycINFO, the Cochrane Library, and Google Scholar resulted in the inclusion of eight papers in the meta-synthesis. Papers were critiqued using the Critical Appraisal Skills Program (CASP) and thematically coded in Quirkos Cloud. Seven themes were reached by author consensus including stigma and judgment; clinician barriers and facilitators; patient-related support needs; communication considerations; patient context or determinants; health care setting; and adapting to life after surgery. PCPs reported barriers including poor communication and guidance from bariatric surgery centers, limited knowledge and training in bariatric patient care, and patients who may have unrealistic outcomes and poor health literacy. Patients seek comprehensive care from their PCP, however, barriers hindering the provision of this care include adverse surgical outcomes, a poor relationship with their PCP, and limited and short-term follow-up care from the PCP. Insights from this meta-synthesis offer actionable recommendations for PCPs and bariatric surgery centers to enhance patient care immediately.

The adipose tissue is a complex organ that can play endocrine, metabolic, and immune regulatory roles in cancer. In particular, adipocytes provide metabolic substrates for cancer cell proliferation and produce signaling molecules that can stimulate cell adhesion, migration, invasion, angiogenesis, and inflammation. Cancer cells, in turn, can reprogram adipocytes towards a more inflammatory state, resulting in a vicious cycle that fuels tumor growth and evolution. These mechanisms are enhanced in obesity, which is associated with the risk of developing certain tumors. Diet, an exogenous source of lipids with pro- or anti-inflammatory functions, has also been connected to cancer risk. This review analyzes how adipocytes and lipids are involved in tumor development and progression, focusing on the relationship between obesity and cancer. In addition, we discuss how diets with varying lipid intakes can affect the disease outcomes. Finally, we introduce novel metabolism-targeted treatments and adipocyte-based therapies in oncology.

Despite numerous public health organizations supporting the pathologization of obesity and considering recent obesity rates a health crisis, many researchers in the humanities, social sciences, and even in the health sciences remain unconvinced. In this paper, we address a set of arguments coming from these academic fields that criticize medical models of obesity for their supposedly flawed diagnostic categories that shift focus onto individuals and support moralizing judgements. Clarifying some key claims in these models and explicating the view of obesity in terms of energy dysregulation, we aim to tease apart misunderstandings and argue that not only do these models not say what they are often accused of saying, but their apparent vices may actually be virtues in helping to combat stigma. Building on the social psychology of stigma and disease labeling, we then suggest that current medical models are largely supportive of many moral and political aims promoted by critics of these models.