Obesity (Silver Spring, Md.)最新文献

Objective: The objective of this study was to estimate the 10-year clinical benefits and economic value of weight loss in a Swedish population with obesity using a value of weight-loss simulation model.

Methods: Data on the prevalence of and costs associated with obesity and obesity-related complications (ORCs) were applied within an adapted simulation model to evaluate weight-loss benefits for a 2023 Swedish population over 10 years. The 10-year incidence of 10 ORCs and treatment costs in a random cohort of 10,000 individuals were estimated for a stable weight scenario and four weight-loss (5%-20%) scenarios.

Results: The model included 887,272 individuals with obesity aged 20 to 60 years. Hypertension (24.1%), asthma (20.9%), dyslipidemia (18.3%), and type 2 diabetes (10.6%) were highly prevalent. For 10,000 individuals, a 5% to 20% weight loss was estimated to prevent ORCs over 10 years, leading to annual savings between 9.0 million Swedish krona (SEK)/€0.8 million (5% weight loss) and 30.0 million SEK/€2.6 million (20%) by 2033.

Conclusions: Annual treatment costs of ORCs in Sweden will double over 10 years, and weight loss would be associated with significant savings because of the reductions in the incidence of ORCs. Therefore, there is an urgent need to effectively treat obesity to prevent morbidity.

Objective: The objective of this study is to generate an algorithm for making predictions about individual treatment responses to a lifestyle intervention for weight loss to maximize treatment effectiveness and public health impact.

Methods: Using data from Action for Health in Diabetes (Look AHEAD), a national, multisite clinical trial that ran from 2001 to 2012, and machine-learning techniques, we generated predicted individual treatment effects for each participant. We tested for heterogeneity in treatment response and computed the degree to which treatment effects could be improved by targeting individuals most likely to benefit.

Results: We found significant individual differences in effects of the Look AHEAD intervention. Based on these predictions, two-thirds of the sample was predicted to experience a treatment effect within ±2% weight loss from the average treatment effect. If the treatment was targeted to the 69% of patients expected to meet a 7% weight-loss target at 1-year follow-up, the average treatment effect increases, with 10% average observed weight loss in the intervention group.

Conclusions: The Look AHEAD intervention would achieve a 10% average weight reduction if targeted to those most likely to benefit. Future research must seek external validation of these predictions. We make this algorithm available with instructions for use to demonstrate its potential capacity to inform shared decision-making and patient-centered care.

Obesity is a complex, chronic, and recurrent disease marked by abnormal or excessive fat accumulation that poses significant health risks. The distribution of body fat, especially ectopic fat deposition, plays a crucial role in the development of chronic metabolic diseases. Under normal conditions, fatty acids are primarily stored in subcutaneous adipose tissue; however, excessive intake can lead to fat accumulation in visceral adipose tissue and ectopic sites, including the pancreas, heart, and muscle. This redistribution is associated with disruptions in energy metabolism, inflammation, and insulin resistance, impairing organ function and raising the risk of cardiovascular disease, diabetes, and fatty liver. This review explores the roles of visceral and ectopic fat in the development of insulin resistance and related diseases such as type 2 diabetes and metabolic dysfunction-associated steatotic liver disease. Specifically, we examine the structure and characteristics of different fat types, their associations with disease, and the underlying pathogenic mechanisms. Future strategies for managing obesity-related diseases may include lifestyle modifications, surgical interventions, and emerging medications that target lipid metabolism and energy regulation, aiming to improve patient outcomes.

Objective: The objective of this study was to evaluate associations of early-pregnancy plasma per- and polyfluoroalkyl substances (PFAS) with maternal post-pregnancy weight trajectory parameters.

Methods: We studied 1106 Project Viva participants with measures of early-pregnancy plasma concentrations of eight PFAS. We measured weight at in-person visits at 6 months and 3, 7, and 12 years after pregnancy and collected self-reported weight via annual questionnaires up to 17 years after pregnancy. Weight trajectory parameters were estimated via the Superimposition by Translation and Rotation model. We assessed individual and joint effects of PFAS with trajectory parameters using linear regression and Bayesian kernel machine regression (BKMR).

Results: Perfluorooctane sulfonate (PFOS) concentrations were positively associated with weight trajectory magnitude in both linear regression (0.8 kg [95% CI: 0.1 to 1.4] per doubling of PFOS) and BKMR analyses (2.6 kg [95% CI: 1.4 to 3.8] per increase from 25th to 75th percentile of PFOS concentrations). Conversely, in BKMR analyses, perfluorononanoate was negatively associated with trajectory magnitude (-2.0 kg [95% CI: -2.9 to -1.1]). In stratified linear regression, older-aged participants had more pronounced positive associations of PFOS, perfluorooctanoate, and 2-(N-ethyl-perfluorooctane sulfonamido) acetate with weight trajectory velocity. No associations were observed with the overall PFAS mixture.

Conclusions: Select PFAS, assessed in pregnancy, may affect maternal weight trajectories spanning 17 years after pregnancy, especially for older-aged individuals.

Objective: This study aimed to evaluate adipose tissue of lipedema patients.

Methods: Gluteo-femoral (affected area) and interscapular (nonaffected area) adipose tissue from 10 lean patients affected by lipedema stage 1 to 2 was studied and compared with tissue from 10 patients with obesity and 12 lean patients.

Results: The main features were alterations of capillaries with wall thickening (p ≤ 0.0001), endothelial and pericyte hyperplasia (p = 0.03 and p = 0.004), hypodense areas in basal membrane, and endothelial degeneration with exfoliation of degenerated cells into the capillary lumen. Adipocytes were larger (hypertrophic) in affected (P ≤ 0.0001) and nonaffected (p = 0.0003) areas compared with those with obesity and who were lean (both p ≤ 0.0001). Frequently the cytoplasm of adipocytes contained massive deposition of calcium crystals as revealed by Von Kossa staining (p = 0.023) and electron microscopy. CD68 immunoreactive macrophages were more abundant in affected areas (p = 0.005), and their number was similar to that found in fat from patients with obesity (p = 0.17). Despite adipocyte hypertrophy and inflammation, lack of the healthy marker perilipin-1 and the presence of crown-like structures were only rarely seen, while they were quite frequent in patients with obesity.

Conclusions: Our data support the idea that cell alterations happen in the early stages of adipocyte development (endothelium/pericyte) in the adipose organ of women affected by lipedema.

Objective: Increases in adiposity and adverse changes in adipose distribution commonly occur in women during midlife and with the onset of menopause. This post hoc analysis assessed body weight changes with tirzepatide by reproductive stage.

Methods: Women participants from SURMOUNT-1, -3, and -4 randomized to tirzepatide (15 mg or maximum tolerated dose) or placebo were retrospectively categorized as being in the pre-, peri-, or post-menopause stages. Body weight and waist circumference changes, the proportion of participants achieving body weight-reduction thresholds, and waist to height ratio (WHtR) category shift among those with baseline BMI < 35 kg/m² were assessed at end of study treatment.

Results: In SURMOUNT-1, significantly greater body weight reductions from baseline were observed with tirzepatide versus placebo in women in the premenopause (26% vs. 2%), perimenopause (23% vs. 3%), and postmenopause stages (23% vs. 3%; p < 0.001). Greater waist circumference reductions were also observed with tirzepatide across the subgroups (22 vs. 4 cm, 20 vs. 5 cm, and 20 vs. 4 cm, respectively; p < 0.001). Across the reproductive stage subgroups, 97% to 98% of participants achieved body weight reductions that were ≥5% with tirzepatide versus 29% to 33% with placebo. Furthermore, 30% to 52% of women among the reproductive stage subgroups who had baseline BMI < 35 kg/m² reached WHtR ≤ 0.49 (low central adiposity) with tirzepatide. Similar results were observed in SURMOUNT-3 and -4.

Conclusions: In this post hoc analysis, tirzepatide treatment was associated with significant body weight, waist circumference, and WHtR reductions versus placebo in women living with obesity or overweight and without type 2 diabetes, irrespective of reproductive stage.

Objective: This study sought to evaluate the distinct impact of fetal exposure to gestational diabetes (GDM) severity, as well as the impact of infant breastfeeding (BF) and sugary beverage intake, on preadolescent overweight and obesity, accounting for other established risk factors.

Methods: This analysis included 850 mother-infant dyads exposed to GDM who reported monthly infant BF duration and intensity, as well as sugary beverage intake (sugar-sweetened beverages [SSB] and 100% fruit juice [FJ]) during the first year of life, BMI measured at ages 6 to 11 years, and GDM severity variables (i.e., diagnosis time, treatment, and glycemic control). Preadolescent weight and height from electronic health records classified the following BMI percentiles: normal weight, <85th percentile (referent); overweight (85th to <95th percentile); obesity (≥95th percentile); moderate obesity (100 to <120% of 95th percentile); and severe obesity (≥120% of 95th percentile). Log-binomial regression models estimated adjusted relative risk (aRR) and 95% CI of BMI categories associated with fetal exposure to GDM severity and infant diet (inadequate BF, <6 months or adequate BF, ≥6 months, combined with or without SSB/FJ intake).

Results: Among preadolescents, 17.6% had overweight, 18.2% had moderate obesity, and 7.6% had severe obesity. Compared with adequate BF with no SSB/FJ, aRR (95% CI) of developing obesity was 1.55 (95% CI: 1.05-2.30) for inadequate BF with SSB/FJ intake and 1.50 (95% CI: 1.01-2.21) for adequate BF with SSB/FJ intake, independent of GDM severity and covariates. The aRR (95% CI) of developing severe obesity was 3.80 (95% CI: 1.55-9.29) for inadequate BF with SSB/FJ intake versus adequate BF without SSB/FJ intake.

Conclusions: BF adequacy and avoidance of sugary beverages in early life are modifiable lifestyle behaviors that may combat preadolescent obesity in infants exposed to GDM, suggesting potential longer-term benefits on child cardiometabolic health.

Objective: Estimating physical activity levels (PAL) is difficult outside of the laboratory, and patient-reported PAL are often overestimated. Herein, we determine the importance of selecting the correct PAL when computing estimated energy requirements (EER) to determine gestational weight gain (GWG). Then, we examine whether data from a wearable can be used to select PAL and predict EER.

Methods: PAL were measured at early and late pregnancy among 53 pregnant female individuals (BMI > 30 kg/m²) in the laboratory and from wearables. To simulate overreporting physical activity, PAL in early pregnancy were used to compute EER in late pregnancy and assess the effect on GWG.

Results: PAL decreased from early to late pregnancy (p = 0.01). When simulating the effect of overestimating physical activity on EER in late pregnancy, excess GWG occured in all individuals (p < 0.001) with decreased PAL during pregnancy. Average daily step counts and activity minutes in early and late pregnancy overlapped across PAL and are not recommended for use.

Conclusions: Step count and activity minute data from wearables cannot be used to determine PAL in pregnant individuals with obesity. To minimize excess GWG risks, our outcomes suggest assuming "inactive" physical activity when estimating EER for pregnant people with obesity.

Despite adverse metabolic and functional consequences of obesity (BMI ≥30 kg/m²), clinical recommendations for weight loss (WL) in older adults (65+ years) with obesity remain controversial. Reluctance stems partly from epidemiologic data demonstrating musculoskeletal tissue loss with WL and increased risk of disability and osteoporotic fracture. Randomized controlled trials in older adults complement and extend knowledge in this area showing: (1) lifestyle-based WL interventions often yield clinically meaningful (~8%-10%) WL in older adults; (2) lean mass loss is significant, although fat mass loss is preferential and physical performance is often improved, particularly when combined with aerobic and resistance training (RT); (3) bone loss is also significant, with some evidence that RT can attenuate WL-associated bone loss; and (4) fat mass regain after intervention cessation is common, yet physical performance gains appear to be maintained. Best practices for treating older adults with obesity include comprehensive assessment of baseline musculoskeletal health; patient-centered goal setting; moderate (i.e., -500 kcal/day) caloric restriction ensuring protein (1-1.2 g/kg/day), calcium (1000-1200 mg/day), and vitamin D (800-1000 IU/day) needs are met; incorporation of RT (≥2 days/week) and moderate-intensity weight-bearing aerobic training (≥150 min/week); and delivery of care by a multidisciplinary team.

Objective: Youth with Down syndrome (DS) experience high rates of overweight and obesity; therefore, weight-loss interventions are warranted. We aimed to systematically review weight-loss interventions for adolescents with DS to better understand the most effective strategies and identify the current gaps in the literature.

Methods: This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (International Prospective Register of Systematic Reviews [PROSPERO] #CRD42022303781). Databases were searched through July 28, 2023, and screening, evaluation, and data extraction were performed by two independent reviewers. Change scores for weight or BMI were presented by study design and intervention components.

Results: The 26 included papers describing 24 unique studies included a total of n = 1171 participants, of whom n = 393 were participants with DS. Eleven studies focused on physical activity, one on diet, and two on physical activity and diet; seven studies used multicomponent interventions; and three studies investigated laparoscopic sleeve gastrectomy. Thirteen studies using either a multicomponent intervention, a physical activity intervention, or surgery resulted in weight loss or a decrease in BMI in adolescents with DS.

Conclusions: Weight-loss interventions can be effective for adolescents with DS and could benefit from increasing duration/intensity to meet the existing weight-loss intervention recommendations. More research on surgery and weight-loss medications is needed.