Obesity Reviews最新文献

Introduction

Cardiometabolic pregnancy complications increase future cardiometabolic disease risk. Accurate risk perception plays a central role in adopting risk-reducing lifestyle and health-related behaviors, such as healthy eating, physical activity, and weight management. This review aimed to explore high-risk pregnant and postpartum women's perception of their risk of developing cardiometabolic pregnancy complications or future cardiometabolic disease.

Methods

Systematic search identified quantitative and qualitative data exploring risk perception in women (pregnant/postpartum) at risk of or diagnosed with gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR), and preterm birth (PTB). A convergent integrated mixed-methods synthesis was undertaken, with findings interpreted using the health belief and capability, opportunity, and motivation for behavior change models.

Results

Overall, 84 studies were included, with the majority in GDM (77.4%) and HDP (23.8%), with limited research in PTB (8.3%) and IUGR (6.0%). Women had low–moderate knowledge of pregnancy complications as risk factors for future cardiometabolic disease and low–moderate perceived susceptibility to potential pregnancy complications and future cardiometabolic disease. Self-perceived barriers, facilitators, cues to action, self-efficacy, and self-optimism impacted engagement with lifestyle and screening measures. The highest risk perception for future type 2 diabetes or cardiovascular disease was among women who had previously experienced GDM or HDP, respectively.

Conclusion

Designing interventions to optimize women's risk perception will support informed decision-making and empower women to make lifestyle changes to reduce future cardiometabolic risk.

Introduction

Although the physiologic alterations seen in obesity often affect the pharmacokinetics and pharmacodynamics of drugs, most clinical trials do not consider these aspects specifically for this population. To date, there is no list of potentially inappropriate medications for patients living with obesity. The aim of this study was to use the Delphi method to identify useful recommendations for the prescription of some specific drug classes in patients living with severe obesity.

Methods

We identified five therapeutic groups of drugs using data from the HEGP Clinical Data Warehouse. We conducted a literature review and sought the opinions of local experts to produce potential recommendations. We selected volunteer medical experts from the French network FORCE and set up a two-round Delphi method, concluded by a synthesis meeting, to establish a list of recommendations. In each round, the experts were asked to rate the potential recommendations.

Results

Forty-three proposed recommendations were evaluated in the first round. The experts approved four recommendations with a strong consensus and 16 with a relative consensus. In the second round, they approved six recommendations with a strong consensus and 13 with a relative consensus.

Conclusion

This is the first study to use the Delphi method to produce a summary of consensus recommendations for several drug classes in patients living with severe obesity. It provides an expert-based consensus on the use of the five most commonly prescribed therapeutic drug classes and develops a list of recommendations for drug prescription in patients living with severe obesity.

Background

Early childhood is a critical period to prevent future poor health outcomes. The modification of health behaviors in the first 2000 days of life is particularly crucial. Yet, obesity is increasingly prevalent in children from culturally and linguistically diverse (CALD) backgrounds, demonstrating a need to provide culturally-tailored care to this population.

Aims

To understand the extent of literature that explores cultural competence and responsiveness of preventive healthcare services delivered to culturally and linguistically diverse families (CALD) in the first 2000 days and to identify gaps in the literature and key characteristics and outcomes in these studies that are associated with culturally competent and responsive healthcare.

Methods

A search strategy was developed, and five databases were searched. Title and abstract screening, full-text screening, data extraction, and quality appraisal were performed by two or more independent reviewers.

Results

A total of 28 included studies identified bilingual facilitators, language-modified materials, and educational resources as key characteristics associated with culturally competent care. Improved breastfeeding practices and increased engagement with healthcare services were identified as key outcomes. Studies involving healthcare cultural competence training were associated with significant changes in outcomes.

Conclusion

Many characteristics and health outcomes associated with culturally competent and responsive care were identified in this review. However, preventive health services delivered to CALD families are still an area of research and practice that is lacking cultural competence. A multidisciplinary and community-centered approach is needed to improve health services delivered to CALD families and address persistent barriers to healthcare.

Background

Childhood obesity is a global health challenge linked to metabolic, cardiovascular, and psychosocial complications. While lifestyle interventions represent the key strategy for obesity management, metabolic and bariatric surgery (MBS) has emerged as a therapeutic option for severe obesity. This systematic review with meta-analysis assessed the effectiveness and safety of MBS and weight management devices in children and adolescents.

Methods

We included randomized and prospective controlled cohort studies assessing MBS or weight management devices in children and adolescents with obesity, searching PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry through January 2025. Critical outcomes included body mass index (BMI) and weight reduction, adverse events, and incidence or severity of obesity-related outcomes.

Results

Seven studies (three RCTs and four non-RCTs), all involving adolescents undergoing MBS, were included. No studies evaluated children or devices. Meta-analysis showed that compared with lifestyle intervention, MBS reduced BMI by 11.7 kg/m² (95% CI: –13.2 to −10.1; two RCTs, n = 100) and 14.5 kg/m² (95% CI: –15.7 to −13.3; three non-RCTs, n = 307), and weight by 20.9% (95% CI: –23.6 to −18.1; three RCTs, n = 152) and 31.2% (95% CI: –34.3 to −28.0; two non-RCTs, n = 173). Certainty of evidence was low. One non-RCT comparing Roux-en-Y gastric bypass and sleeve gastrectomy found similar outcomes. Both RCTs and non-RCTs reported improvements in obesity-related outcomes.

Conclusions

Although MBS leads to substantial weight loss and health benefits in adolescents, the risk of complications underscores the need for careful patient selection, surgical expertise, and comprehensive postoperative care.

Trial Registration: PROSPERO registration: CRD42023438469

Objective

To systematically review and meta-analyze psychiatric and cognitive outcomes following metabolic and bariatric surgery (MBS). [Correction added on 1 July 2025, after first online publication: The objective statement has been updated for clarity.]

Methods

Six databases were searched. Randomized controlled trials (RCTs) and nonrandomized studies (NRS) of people with obesity comparing MBS with any nonsurgical intervention or control condition were included. Main outcomes included symptoms of depression, anxiety, and non-normative eating, substance use disorder diagnosis, suicide death, and cognitive performance in attention, memory, and executive function. Evidence certainty was assessed with GRADE. Heterogeneity was explored with subgroup analyses of ≤ 2 years vs. > 2 years post-intervention.

Results

There were 79 studies (75 NRS and 4 RCTs) found, including 732,149 people with obesity who underwent MBS, and 7,670,770 who did not. Among RCTs, MBS may improve depressive symptoms (standardized mean difference [SMD] = −0.40, 95% CI −1.04, 0.24; very low certainty). Among NRS, there was low to very low certainty that MBS may improve depressive (SMD = 0.56, 95% CI −0.87, −0.26), anxiety (SMD = −0.60, 95% CI −1.00, −0.19), and non-normative eating symptoms (SMD = −0.75, 95% CI −0.97, −0.53) and cognitive performance in attention (SMD = −0.72, 95% CI −1.61, 0.17), but not executive function or memory. MBS may slightly increase suicide deaths (1/1000 more people, 95% CI 0 fewer to 3 more; very low certainty) and substance use disorders (4/100 more, 95% CI from 1 to 9 more; low certainty) > 2-years post-surgery.

Conclusions

Compared to nonsurgical conditions, MBS may improve depression, anxiety, non-normative eating, and attention, but slightly increase suicides and substance use disorders. There was low to very low certainty in most outcomes, therefore additionalhigh-quality studies are needed to strengthen the evidence base.