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Abstract
PURPOSE OF REVIEW One begins to see improvement in glycemic measures and triglycerides with small amounts of weight loss, but with greater levels of weight loss there is even greater improvement. In fact, the relationship between weight loss and glycemia is one that is very close. RECENT FINDINGS This is fortunate for diabetes prevention; it takes only small amounts of weight loss to prevent progression to type 2 diabetes from impaired glucose tolerance, and after the 10 kg of weight loss, one cannot demonstrate much additional improvement in risk reduction. Modest weight loss (5 to 10%) is also associated with improvement in systolic and diastolic blood pressure and HDL cholesterol. With all these risk factors, more weight loss produces more improvement. Further, for patients with higher BMI levels (>40 kg/m2), the ability to lose the same proportion of weight with lifestyle intervention is equal to that of those with lower BMI levels, and there is equal benefit in terms of risk factor improvement with modest weight loss. For some comorbid conditions, more weight loss is needed-10 to 15%-to translate into clinical improvement. This is true with obstructive sleep apnea and non-alcoholic steatotic hepatitis. There is a graded improvement in improvements in measures of quality of life, depression, mobility, sexual dysfunction, and urinary stress incontinence, whereby improvements are demonstrable with modest weight loss (5-10%) and with further weight loss there are further improvements. For polycystic ovarian syndrome and infertility, modest weight loss (beginning at 2-5%) can bring improvements in menstrual irregularities and fertility. Moderate weight loss (5-10%) has been shown to be associated with reduced health care costs. Reduction in mortality may take more than 10% weight loss, although definitive studies have not been done to demonstrate that weight loss per se is associated with mortality reduction. Clinicians in medical weight management should bear in mind that the target should be health improvement rather than a number on the scale. The individual patient's targeted health goal should be assessed for response rather than a prescribed percentage weight loss.
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Affiliation(s)
- Donna H Ryan
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA.
| | - Sarah Ryan Yockey
- Department of Obstetrics and Gynecology, LSU School of Medicine, 1542 Tulane Avenue, New Orleans, LA, USA
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Does exercise training augment improvements in quality of life induced by energy restriction for obese populations? A systematic review. Qual Life Res 2017; 26:2593-2605. [DOI: 10.1007/s11136-017-1602-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2017] [Indexed: 01/22/2023]
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Holland-Carter L, Tuerk PW, Wadden TA, Fujioka KN, Becker LE, Miller-Kovach K, Hollander PL, Garvey WT, Weiss D, Rubino DM, Kushner RF, Malcolm RJ, Raum WJ, Hermayer KL, Veliko JL, Rost SL, Sora ND, Salyer JL, O'Neil PM. Impact on psychosocial outcomes of a nationally available weight management program tailored for individuals with type 2 diabetes: Results of a randomized controlled trial. J Diabetes Complications 2017; 31:891-897. [PMID: 28319001 DOI: 10.1016/j.jdiacomp.2017.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/19/2017] [Accepted: 01/31/2017] [Indexed: 12/15/2022]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) can substantially decrease quality of life (QOL). This study examined the effects on QOL-relevant psychosocial measures of a widely available commercial weight loss program enhanced for individuals with T2DM. METHODS A year-long multi-site randomized clinical trial compared the Weight Watchers (WW) approach, supplemented with phone and email counseling with a certified diabetes educator (CDE), to brief standard diabetes nutrition counseling and education (Standard Care; SC). Participants were 400 women and 163 men (N=279 WW; 284 SC) with T2DM [mean (±SD) HbA1c 8.32±1%; BMI=37.1±5.7kg/m2; age=55.1 ± 9.1years]. Psychosocial outcomes were assessed at baseline, month 6, and month 12 using a diabetes specific psychosocial measure (Diabetes Distress Scale [DDS]), Impact of Weight on Quality of Life-Lite scale (IWQOL), a generic QOL measure (SF-36), and a depression screen (PHQ-9). RESULTS WW participants showed significantly greater improvements than did SC participants on all DDS subscales and total score and on IWQOL total score and physical function, sex life and work domains (all ps<.05). There was no significant treatment effect on SF-36 scores or PHQ-9. CONCLUSIONS WW enhanced for individuals with T2DM was superior to SC in improving psychosocial outcomes most specific to T2DM and obesity. Available commercial WL programs, combined with scalable complementary program-specific diabetes counseling, may have benefits that extend to diabetes-related distress and weight-relevant QOL.
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Affiliation(s)
- Lauren Holland-Carter
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Suite 410 South, Charleston, SC, 29425.
| | - Peter W Tuerk
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Suite 410 South, Charleston, SC, 29425; Mental Health Service, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC, 29401.
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Suite 3029, Philadelphia, PA, 19104.
| | - Ken N Fujioka
- Scripps Clinical Research, 11025 N. Torrey Pines Road, Suite 200, LaJolla, CA 92037.
| | - Lynne E Becker
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Suite 410 South, Charleston, SC, 29425.
| | - Karen Miller-Kovach
- Weight Watchers International, 11 Madison Avenue 17th Floor, New York, NY 10010.
| | - Priscilla L Hollander
- Baylor Endocrine Center, 3600 Gaston Avenue, Wadley Tower, Suite 656, Dallas, TX 75246.
| | - W Timothy Garvey
- Department of Nutrition Sciences, 1675 University Blvd, University of Alabama at Birmingham, Birmingham, AL 35294; Birmingham Veterans Administration Medical Center.
| | - Daniel Weiss
- Your Diabetes Endocrine Nutrition Group, 8300 Tyler Blvd Suite 102, Mentor, OH 44060.
| | - Domenica M Rubino
- Washington Center for Weight Management & Research, 2800 S. Shirlington Road, Arlington, VA 22206.
| | - Robert F Kushner
- Northwestern University, Feinberg School of Medicine, Rubloff Building 10th Floor, 750 N. Lake Shore Drive, Chicago, IL 60611.
| | - Robert J Malcolm
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Suite 410 South, Charleston, SC, 29425
| | - William J Raum
- Oregon Weight Loss Surgery, 1040 NW 22nd Avenue, Suite 500, Portland, OR 97210.
| | - Kathie L Hermayer
- Division of Endocrinology, Diabetes and Medical Genetics, College of Medicine, Clinical Science Building, 8th Floor, 96 Jonathan Lucas Street, Medical University of South Carolina, Charleston, SC 29425.
| | - Jan L Veliko
- Weight Watchers International, 11 Madison Avenue 17th Floor, New York, NY 10010.
| | - Stephanie L Rost
- Weight Watchers International, 11 Madison Avenue 17th Floor, New York, NY 10010.
| | - Nicoleta D Sora
- Division of Endocrinology, Diabetes and Medical Genetics, College of Medicine, Clinical Science Building, 8th Floor, 96 Jonathan Lucas Street, Medical University of South Carolina, Charleston, SC 29425.
| | - Jonny L Salyer
- Lovelace Scientific Resources, 2441 Ridgecrest Drive, SE, Albuquerque, NM 87108
| | - Patrick M O'Neil
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Suite 410 South, Charleston, SC, 29425.
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Magni LR, Ferrari C, Rossi G, Staffieri E, Uberti A, Lamonaca D, Boggian I, Merlin S, Primerano G, Mombrini A, Poli R, Saviotti FM, Caldera MT, Zanotti L, Rossi R. Superwellness Program: a cognitive-behavioral therapy-based group intervention to reduce weight gain in patients treated with antipsychotic drugs. ACTA ACUST UNITED AC 2017; 39:244-251. [PMID: 28300948 PMCID: PMC7111394 DOI: 10.1590/1516-4446-2016-1993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/30/2016] [Indexed: 09/02/2023]
Abstract
Objective: To assess the effectiveness of a cognitive-behavioral therapy-based intervention (Superwellness Program) on weight gain compared with a treatment-as-usual (TAU) approach in patients treated with antipsychotics, and to evaluate the relationship between body mass index (BMI) variation and clinical variables. Method: Eighty-five patients treated with antipsychotics were allocated across two groups, experimental (n=59) and control (n=26). The Superwellness Program (experimental group) consisted of 32 twice-weekly 1-hour sessions, conducted by a psychologist and a nutritionist/nurse, concurrently with moderate food intake and moderate physical activity plans. Sociodemographic, clinical, and biological variables were collected at baseline, at the end of intervention (16 weeks), and after 6 months. Results: BMI change from baseline differed significantly between the experimental and control groups, with a larger decrease in the experimental group (F = 5.5, p = 0.021). Duration of illness moderated the effect of treatment on BMI (p = 0.026). No significant (p = 0.499) effect of intervention during the follow-up period was found. Interestingly, the intervention indirectly induced a significant (p = 0.024) reduction in metabolic risk by reducing BMI. Conclusion: A cognitive-behavioral therapy-based intervention could be useful in reducing weight in a clinical population taking antipsychotics, with consequent benefit to physical and mental health.
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Affiliation(s)
- Laura R Magni
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Unità di Psichiatria, Brescia, Italy
| | - Clarissa Ferrari
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuseppe Rossi
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Unità di Psichiatria, Brescia, Italy
| | - Elena Staffieri
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Aldo Uberti
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Dario Lamonaca
- Aulss 21, Dipartimento di Salute Mentale Legnago, VR, Italy
| | - Ileana Boggian
- Aulss 21, Dipartimento di Salute Mentale Legnago, VR, Italy
| | - Silvia Merlin
- Aulss 21, Dipartimento di Salute Mentale Legnago, VR, Italy
| | | | | | - Roberto Poli
- Dipartimento di Salute Mentale ASST Cremona, Italy
| | | | - Maria T Caldera
- Dipartimento di Salute Mentale A.O. Desenzano del Garda, BS, Italy
| | - Luciana Zanotti
- Dipartimento di Salute Mentale A.O. Desenzano del Garda, BS, Italy
| | - Roberta Rossi
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Unità di Psichiatria, Brescia, Italy
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Mollerup PM, Nielsen TRH, Bøjsøe C, Kloppenborg JT, Baker JL, Holm JC. Quality of life improves in children and adolescents during a community-based overweight and obesity treatment. Qual Life Res 2017; 26:1597-1608. [PMID: 28213684 DOI: 10.1007/s11136-017-1504-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE The quality of life is compromised in children and adolescents with overweight or obesity. The aim of this study was to evaluate whether the quality of life improves during a community-based overweight and obesity treatment, and whether improvements depend on reductions in the degree of obesity. METHODS Quality of life was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 in children and adolescents aged 3-18 years with overweight or obesity [body mass index (BMI) ≥85th percentile] upon entry into a community-based chronic care overweight and obesity treatment based upon The Children's Obesity Clinic's Treatment protocol, and upon follow-up after 10-30 months of treatment. Height and weight were measured at each consultation and converted into a BMI standard deviation score (SDS). RESULTS Upon entry, 477 children (212 boys) completed a PedsQL, and 317 (143 boys) completed another PedsQL after a median of 13 months of treatment. Quality of life improved (p < 0.001), regardless of sex, age, and pubertal development stage upon entry (p ≥ 0.108). Greater reductions in BMI SDS and high socioeconomic status were associated with greater improvements in the quality of life (p ≤ 0.047). However, improvements also occurred in children and adolescents with low socioeconomic status or who increased their BMI SDS (p < 0.001). CONCLUSIONS Improvements in quality of life occurred in children and adolescents during a community-based overweight and obesity treatment, even in children and adolescents who increased their BMI SDS. Thus, improvements may be due to the treatment itself and not exclusively to reductions in BMI SDS. TRIAL REGISTRATION Clinicaltrials.gov, ID-no.: NCT02013843.
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Affiliation(s)
- Pernille M Mollerup
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark.
| | - Tenna R H Nielsen
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
| | - Christine Bøjsøe
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
| | - Julie T Kloppenborg
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark
- Department of Paediatrics, Copenhagen University Hospital Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark
| | - Jennifer L Baker
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospital, The Capital Region, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark
| | - Jens-Christian Holm
- Department of Paediatrics, The Children's Obesity Clinic, Copenhagen University Hospital Holbæk, Smedelundsgade 60, 4300, Holbæk, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section for Metabolic Genetics, University of Copenhagen, Universitetsparken 1, 2100, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
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Hattar A, Pal S, Hagger MS. Predicting Physical Activity-Related Outcomes in Overweight and Obese Adults: A Health Action Process Approach. Appl Psychol Health Well Being 2016; 8:127-51. [PMID: 26970113 DOI: 10.1111/aphw.12065] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We tested the adequacy of a model based on the Health Action Process Approach (HAPA) in predicting changes in psychological, body composition, and cardiovascular risk outcomes with respect to physical activity participation in overweight and obese adults. METHODS Measures of HAPA constructs (action and maintenance self-efficacy, outcome expectancies, action planning, risk perceptions, intentions, behaviour), psychological outcomes (quality of life, depression, anxiety, stress symptoms), body composition variables (body weight, body fat mass), cardiovascular risk measures (total cholesterol, low density lipoprotein), and self-reported physical activity behaviour were administered to participants (N = 74) at baseline, and 6 and 12 weeks later. RESULTS Data were analysed using variance-based structural equation modelling with residualised change scores for HAPA variables. The model revealed effects of action self-efficacy and outcome expectancies on physical activity intentions, action self-efficacy on maintenance self-efficacy, and maintenance self-efficacy and intentions on action planning. Intention predicted psychological and body composition outcomes indirectly through physical activity behaviour. Action planning was a direct predictor of psychological, cardiovascular, and body composition outcomes. CONCLUSIONS Data supported HAPA hypotheses in relation to intentions and behaviour, but not the role of action planning as a mediator of the intention-behaviour relationship. Action planning predicted outcomes independent of intentions and behaviour.
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Affiliation(s)
| | | | - Martin S Hagger
- Curtin University, Western Australia.,Griffith University, Australia.,University of Jyväskylä, Finland
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New F, Somani BK. A Complete World Literature Review of Quality of Life (QOL) in Patients with Kidney Stone Disease (KSD). Curr Urol Rep 2016; 17:88. [PMID: 27771854 PMCID: PMC5075340 DOI: 10.1007/s11934-016-0647-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review The purpose of this study was to review the current evidence for quality of life (QOL) in patients with kidney stone disease (KSD). Recent Findings A review of literature from inception to May 2016 for all prospective English language articles on QOL in patients with KSD was done. QOL studies post urological procedures or ureteric stents were excluded. Nine studies (1570 patients) were included of which most (n = 6) used the SF-36 QOL tool. Overall, seven of the nine studies demonstrated a lower QOL in patients with KSD. Bodily pain and general health were significantly lower in patients with KSD compared to their control groups. Summary Patients with KSD have an overall lower QOL with most impact on bodily pain and general health domains. Compared to the scale of patients suffering from KSD, more work needs to be done in measuring QOL both in terms of ‘Stone specific’ QOL measuring tools and the quality/number of studies in this field.
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Affiliation(s)
- Francesca New
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK.
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Axon E, Atkinson G, Richter B, Metzendorf M, Baur L, Finer N, Corpeleijn E, O'Malley C, Ells LJ. Drug interventions for the treatment of obesity in children and adolescents. Cochrane Database Syst Rev 2016; 11:CD012436. [PMID: 27899001 PMCID: PMC6472619 DOI: 10.1002/14651858.cd012436] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Child and adolescent obesity has increased globally, and can be associated with significant short- and long-term health consequences. OBJECTIVES To assess the efficacy of drug interventions for the treatment of obesity in children and adolescents. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PubMed (subsets not available on Ovid), LILACS as well as the trial registers ICTRP (WHO) and ClinicalTrials.gov. Searches were undertaken from inception to March 2016. We checked references and applied no language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of pharmacological interventions for treating obesity (licensed and unlicensed for this indication) in children and adolescents (mean age under 18 years) with or without support of family members, with a minimum of three months' pharmacological intervention and six months' follow-up from baseline. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. In addition, we excluded trials which included growth hormone therapies and pregnant participants. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data following standard Cochrane methodology. Where necessary we contacted authors for additional information. MAIN RESULTS We included 21 trials and identified eight ongoing trials. The included trials evaluated metformin (11 trials), sibutramine (six trials), orlistat (four trials), and one trial arm investigated the combination of metformin and fluoxetine. The ongoing trials evaluated metformin (four trials), topiramate (two trials) and exenatide (two trials). A total of 2484 people participated in the included trials, 1478 participants were randomised to drug intervention and 904 to comparator groups (91 participants took part in two cross-over trials; 11 participants not specified). Eighteen trials used a placebo in the comparator group. Two trials had a cross-over design while the remaining 19 trials were parallel RCTs. The length of the intervention period ranged from 12 weeks to 48 weeks, and the length of follow-up from baseline ranged from six months to 100 weeks.Trials generally had a low risk of bias for random sequence generation, allocation concealment and blinding (participants, personnel and assessors) for subjective and objective outcomes. We judged approximately half of the trials as having a high risk of bias in one or more domain such as selective reporting.The primary outcomes of this review were change in body mass index (BMI), change in weight and adverse events. All 21 trials measured these outcomes. The secondary outcomes were health-related quality of life (only one trial reported results showing no marked differences; very low certainty evidence), body fat distribution (measured in 18 trials), behaviour change (measured in six trials), participants' views of the intervention (not reported), morbidity associated with the intervention (measured in one orlistat trial only reporting more new gallstones following the intervention; very low certainty evidence), all-cause mortality (one suicide in the orlistat intervention group; low certainty evidence) and socioeconomic effects (not reported).Intervention versus comparator for mean difference (MD) in BMI change was -1.3 kg/m2 (95% confidence interval (CI) -1.9 to -0.8; P < 0.00001; 16 trials; 1884 participants; low certainty evidence). When split by drug type, sibutramine, metformin and orlistat all showed reductions in BMI in favour of the intervention.Intervention versus comparator for change in weight showed a MD of -3.9 kg (95% CI -5.9 to -1.9; P < 0.00001; 11 trials; 1180 participants; low certainty evidence). As with BMI, when the trials were split by drug type, sibutramine, metformin and orlistat all showed reductions in weight in favour of the intervention.Five trials reported serious adverse events: 24/878 (2.7%) participants in the intervention groups versus 8/469 (1.7%) participants in the comparator groups (risk ratio (RR) 1.43, 95% CI 0.63 to 3.25; 1347 participants; low certainty evidence). A total 52/1043 (5.0%) participants in the intervention groups versus 17/621 (2.7%) in the comparator groups discontinued the trial because of adverse events (RR 1.45, 95% CI 0.83 to 2.52; 10 trials; 1664 participants; low certainty evidence). The most common adverse events in orlistat and metformin trials were gastrointestinal (such as diarrhoea, mild abdominal pain or discomfort, fatty stools). The most frequent adverse events in sibutramine trials included tachycardia, constipation and hypertension. The single fluoxetine trial reported dry mouth and loose stools. No trial investigated drug treatment for overweight children. AUTHORS' CONCLUSIONS This systematic review is part of a series of associated Cochrane reviews on interventions for obese children and adolescents and has shown that pharmacological interventions (metformin, sibutramine, orlistat and fluoxetine) may have small effects in reduction in BMI and bodyweight in obese children and adolescents. However, many of these drugs are not licensed for the treatment of obesity in children and adolescents, or have been withdrawn. Trials were generally of low quality with many having a short or no post-intervention follow-up period and high dropout rates (overall dropout of 25%). Future research should focus on conducting trials with sufficient power and long-term follow-up, to ensure the long-term effects of any pharmacological intervention are comprehensively assessed. Adverse events should be reported in a more standardised manner specifying amongst other things the number of participants experiencing at least one adverse event. The requirement of regulatory authorities (US Food and Drug Administration and European Medicines Agency) for trials of all new medications to be used in children and adolescents should drive an increase in the number of high quality trials.
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Affiliation(s)
- Emma Axon
- University of NottinghamCochrane Skin GroupNottinghamUKNG7 2NR
| | - Greg Atkinson
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupPO Box 101007DüsseldorfGermany40001
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Nicholas Finer
- UCL Institute of Cardiovascular ScienceNational Centre for Cardiovascular Prevention and Outcomes170 Tottenham Court RoadLondonUKW1T 7HA
- Novo Nordisk A/SGlobal Medical Affairs ManagementCopenhagenDenmark
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham UniversityDepartment of Sport and Exercise SciencesDurhamUKDH1 3HN
| | - Louisa J Ells
- Teesside UniversitySchool of Health and Social CareParkside West OfficesMiddlesbroughUKTS1 3BA
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Parker K, Mitchell S, O'Brien P, Brennan L. Psychometric Evaluation of Disordered Eating Measures in Bariatric Surgery Candidates. Obes Surg 2016; 26:563-75. [PMID: 26163361 DOI: 10.1007/s11695-015-1780-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Assessment of disordered eating is common in bariatric surgery candidates, yet psychometric properties of disordered eating measures in this population are largely unknown. METHODS Measures were completed by 405 adult bariatric surgery candidates at pre-surgical consultation. Fit of the original scale structures was tested using confirmatory factor analysis (CFA) and alternative factor solutions were generated using exploratory factor analysis (EFA). Reliability (internal consistency), construct validity (convergent and divergent) and criterion validity (with the EDE as criterion) were assessed. MATERIALS The measures prioritised for evaluation are the following: Eating Disorder Examination Questionnaire (EDE-Q; n = 405), Three-Factor Eating Questionnaire (TFEQ; n = 405), Questionnaire of Eating and Weight Patterns Revised (QEWP-R; n = 204), Clinical Impairment Assessment (CIA; n = 204) and the Eating Disorder Examination clinical interview (EDE; n = 131). RESULTS CFA revealed adequate fit for only the CIA in its current form (CFI = 0.925, RMSEA = 0.096). EFA produced revised scales with improved reliability for the EDE, EDE-Q and TFEQ. Reliability of revised subscales was improved (original scales α = 0.43-0.82; revised scales α = 0.67-0.93). Correlational analyses of the CIA and revised versions of remaining scales with measures of psychological wellbeing and impairment revealed adequate convergent validity. All measures differentiated an EDE-classified disordered eating group from a non-disordered eating group (criterion validity). Diagnostic concordance between the EDE, EDE-Q and QEWP-R was low, and identification of disordered eating behaviours was inconsistent across measures. CONCLUSIONS Findings highlight the limitations of existing disordered eating questionnaires in bariatric surgery candidates. Results suggest revised assessments are required to overcome these limitations and ensure that measures informing clinical recommendations regarding patient care are reliable and valid.
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Affiliation(s)
- Katrina Parker
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, VIC, Australia. .,School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
| | - Sarah Mitchell
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
| | - Paul O'Brien
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, VIC, Australia.
| | - Leah Brennan
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, VIC, Australia. .,School of Psychology, Australian Catholic University, 115 Victoria Parade, Locked Bag 4115, Melbourne, VIC, 3450, Australia.
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Kolotkin RL, Fujioka K, Wolden ML, Brett JH, Bjorner JB. Improvements in health-related quality of life with liraglutide 3.0 mg compared with placebo in weight management. Clin Obes 2016; 6:233-42. [PMID: 27198973 PMCID: PMC5084798 DOI: 10.1111/cob.12146] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/17/2016] [Accepted: 04/12/2016] [Indexed: 12/13/2022]
Abstract
Obesity has a negative impact on health-related quality of life (HRQoL). The SCALE Obesity and Prediabetes study investigated the effect of liraglutide 3.0 mg, as adjunct to diet and exercise, on HRQoL in patients with obesity [body mass index (BMI) ≥ 30 kg m(-2) ] or overweight (BMI ≥ 27 kg m(-2) ) with comorbidity. Participants were advised on a 500 kcal d(-1) deficit diet and a 150-min week(-1) exercise programme and were randomised 2:1 to once-daily subcutaneous liraglutide 3.0 mg or placebo. HRQoL was assessed using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and Short-Form 36 (SF-36) v2 health questionnaires. Individuals on liraglutide 3.0 mg (n = 2046) had significantly greater improvements in IWQOL-Lite total score (10.6 ± 13.3) vs. placebo (n = 1020) (7.7 ± 12.8) and SF-36 physical (PCS) and mental (MCS) component summary scores (PCS, 3.6 ± 6.8; MCS, 0.2 ± 8.1) vs. placebo (PCS, 2.2 ± 7.7; MCS, -0.9 ± 9.1). The estimated treatment differences were IWQOL-Lite total score 3.1 (95% CI: 2.2; 4.0), P < 0.0001; SF-36 PCS 1.7 (95% CI: 1.2; 2.2), P < 0.0001 and MCS 0.9 (95% CI: 0.3; 1.5), P = 0.003. All subscales of the IWQOL-Lite and SF-36 were significantly improved with liraglutide 3.0 mg vs. placebo. More patients on liraglutide 3.0 mg experienced meaningful improvement on the IWQOL-Lite total (P < 0.0001) and the SF-36 PCS (P < 0.0001) scores.
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Affiliation(s)
- R L Kolotkin
- Quality of Life Consulting, Durham, NC, USA
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
- Department of Health Studies, Sogn og Fjordane University College, Førde, Norway
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - K Fujioka
- Nutrition and Metabolic Research Center, Scripps Clinic Department of Endocrine, La Jolla, CA, USA
| | | | - J H Brett
- Novo Nordisk Inc., Plainsboro, NJ, USA
| | - J B Bjorner
- Optum Patient Insights, Lincoln, RI, USA
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
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61
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De Luca M, Angrisani L, Himpens J, Busetto L, Scopinaro N, Weiner R, Sartori A, Stier C, Lakdawala M, Bhasker AG, Buchwald H, Dixon J, Chiappetta S, Kolberg HC, Frühbeck G, Sarwer DB, Suter M, Soricelli E, Blüher M, Vilallonga R, Sharma A, Shikora S. Indications for Surgery for Obesity and Weight-Related Diseases: Position Statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg 2016; 26:1659-96. [PMID: 27412673 PMCID: PMC6037181 DOI: 10.1007/s11695-016-2271-4] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maurizio De Luca
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy.
| | | | - Jacques Himpens
- The European School of Laparoscopic Surgery, Brussels, Belgium
| | | | | | | | - Alberto Sartori
- Director Department of Surgery, Montebelluna Treviso Hospital, Montebelluna, Treviso, Italy
| | | | | | | | | | - John Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Michel Suter
- University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mattias Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | | | - Arya Sharma
- Obesity Research Management, University of Alberta, Edmonton, Canada
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62
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Yadav R, Yadav RK, Pandey RM, Kochar KP. Effect of a Short-Term Yoga-Based Lifestyle Intervention on Health-Related Quality of Life in Overweight and Obese Subjects. J Altern Complement Med 2016; 22:443-9. [DOI: 10.1089/acm.2015.0268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rashmi Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Raj Kumar Yadav
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ravindra Mohan Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwal P. Kochar
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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63
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Melasch J, Rullmann M, Hilbert A, Luthardt J, Becker GA, Patt M, Stumvoll M, Blüher M, Villringer A, Arelin K, Meyer PM, Bresch A, Sabri O, Hesse S, Pleger B. Sex differences in serotonin-hypothalamic connections underpin a diminished sense of emotional well-being with increasing body weight. Int J Obes (Lond) 2016; 40:1268-77. [PMID: 27102051 DOI: 10.1038/ijo.2016.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/11/2016] [Accepted: 01/28/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND/OBJECTIVES The neurobiological mechanisms linking obesity to emotional distress related to weight remain largely unknown. PARTICIPANTS/METHODS Here we combined positron emission tomography, using the serotonin transporter (5-HTT) radiotracer [(11)C]-3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile, with functional connectivity magnetic resonance imaging, the Beck Depression Inventory (BDI-II) and the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite) to investigate the role of central serotonin in the severity of depression (BDI-II), as well as in the loss of emotional well-being with body weight (IWQOL-Lite). RESULTS In a group of lean to morbidly obese individuals (n=28), we found sex differences in the 5-HTT availability-related connectivity of the hypothalamus. Males (n=11) presented a strengthened connectivity to the lateral orbitofrontal cortex, whereas in females (n=17) we found strengethened projections to the ventral striatum. Both regions are known as reward regions involved in mediating the emotional response to food. Their resting-state activity correlated positively to the body mass index (BMI) and IWQOL-Lite scores, suggesting that each region in both sexes also underpins a diminished sense of emotional well-being with body weight. Contrarily to males, we found that in females also the BDI-II positively correlated with the BMI and by trend with the activity in ventral striatum, suggesting that in females an increased body weight may convey to other mood dimensions than those weight-related ones included in the IWQOL-Lite. CONCLUSIONS This study suggests sex differences in serotonin-hypothalamic connections to brain regions of the reward circuitry underpinning a diminished sense of emotional well-being with an increasing body weight.
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Affiliation(s)
- J Melasch
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - M Rullmann
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - A Hilbert
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany
| | - J Luthardt
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - G A Becker
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - M Patt
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - M Stumvoll
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Medical Department III, University Hospital Leipzig, Leipzig, Germany
| | - M Blüher
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Medical Department III, University Hospital Leipzig, Leipzig, Germany
| | - A Villringer
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - K Arelin
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - P M Meyer
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - A Bresch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - O Sabri
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - S Hesse
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - B Pleger
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany.,BG University Clinic Bergmannsheil, Department of Neurology, Ruhr University Bochum, Bochum, Germany
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64
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Chiappetta S, Stier C, Squillante S, Theodoridou S, Weiner RA. The importance of the Edmonton Obesity Staging System in predicting postoperative outcome and 30-day mortality after metabolic surgery. Surg Obes Relat Dis 2016; 12:1847-1855. [PMID: 27317606 DOI: 10.1016/j.soard.2016.02.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Edmonton Obesity Staging System (EOSS) is a more comprehensive measure of obesity-related diseases and predictor of mortality than body mass index (BMI) or waist circumference. Its application for the selection of obese patients for obesity surgery has been suggested. OBJECTIVES The aim of this study was to determine whether the EOSS can also be used in predicting postoperative outcome and 30-day mortality after metabolic surgery. SETTING Center of maximum care in Germany METHODS: We collected data prospectively for patients undergoing laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), or laparoscopic omega-loop gastric bypass (LOLGB). The data collected included preoperative EOSS score, gender, age, BMI, waist circumference, waist-to-hip ratio, co-morbidities, early postoperative complications, and 30-day mortality. RESULTS A total of 534 patients were included. The mean BMI was 45.57 kg/m2 (range 35-64.5) for LRYGB patients (n = 168), 53.27 kg/m2 (range 35.1-82.1) for LSG patients (n = 282), and 49.42 kg/m2 (range 36-73.1) for LOLGB patients (n = 84). The total postoperative complication rate was 8.99%. The most common EOSS stage was 2 (70.6% of patients), followed by stages 3 (12.55%), 1 (11.61%), and 0 (5.06%). The postoperative complication rates after LRYGB, LSG, and LOLGB were 0% for EOSS 0 and 1.61% for EOSS 1. The postoperative complication rates were 8.22% for EOSS 2 and 22.39% for EOSS 3. CONCLUSION Patients with EOSS≥3 have a higher risk of postoperative complications. Our data confirm that the EOSS is useful as a scoring system for the selection of obese patients before surgery and suggest that it may also be useful for presurgical stratification and risk assessment in clinical practice. Patients should be recommended for obesity surgery when their EOSS stage is 2 to prevent impairments associated with metabolic disease and to reduce the risk of postoperative complications.
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Affiliation(s)
- Sonja Chiappetta
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany.
| | - Christine Stier
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Simone Squillante
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Sophia Theodoridou
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Rudolf A Weiner
- Department of Obesity and Metabolic Surgery, Sana Klinikum Offenbach, Offenbach am Main, Germany
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65
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Vallis M. Quality of life and psychological well-being in obesity management: improving the odds of success by managing distress. Int J Clin Pract 2016; 70:196-205. [PMID: 26842304 PMCID: PMC5067635 DOI: 10.1111/ijcp.12765] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Obesity is increasing in prevalence and placing an ever-greater burden on individuals and healthcare resources alike. Obesity management is complex and, for many, elusive. AIMS AND METHODS This paper reviews the major factors that influence psychological well-being in individuals with obesity and describes the means by which their impact on distress and other aspects of quality of life (QoL) can be quantified. The goal is to enable healthcare providers to set reasonable, achievable, maintainable weight loss targets that will improve the psychological well-being and QoL of individuals living with obesity. PubMed and Web of Science searches were conducted to identify literature that addresses the key question: How can distress over obesity be measured and taken into account when tailoring weight loss interventions for a particular patient? DISCUSSION AND CONCLUSIONS 'Distress over obesity' is a key parameter that illustrates the psychological consequences of excess weight. Healthcare providers can draw on a range of obesity-specific and non-specific assessment tools to quantify distress as well as the other contributions of obesity to QoL and mental/emotional health. When physicians consider the psychological/QoL aspects of obesity and how these change with successful weight loss, it becomes possible to set achievable, realistic weight loss goals and develop a manageable plan to achieve them. Any future developments that make it easier to achieve these goals should be made widely available to all patients in need, in order to help them turn a vicious cycle of failure into a virtuous cycle of success.
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Affiliation(s)
- M Vallis
- Nova Scotia Health Authority-Central Zone Behaviour Change Institute, Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
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66
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Kennedy BM, Ryan DH, Johnson WD, Harsha DW, Newton RL, Champagne CM, Allen HR, Katzmarzyk PT. Baton Rouge Healthy Eating and Lifestyle Program (BR-HELP): A Pilot Health Promotion Program. J Prev Interv Community 2016; 43:95-108. [PMID: 25898217 DOI: 10.1080/10852352.2014.973256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Preventing weight gain rather than treating recognized obesity is an important economic and public health response to the growing levels of obesity nationwide. Community centers offer potential sites for community health promotion programs targeting African Americans. In this article, results from a pilot health promotion program at a community center are reported. The purpose of this 12-month pilot program was to improve diet and increase physical activity to prevent weight gain in African-American adults by delivering a lifestyle intervention. Fifty-one African-American adults were randomized into two groups: lifestyle intervention or financial counseling, and 73% completed the program. At the end of 12 months, weight for all participants was maintained from baseline to completion with no significant differences between the groups. Both lifestyle intervention and financial counseling groups were approximately 87% food secure with improvements observed in self-esteem and total quality of life scores.
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Affiliation(s)
- Betty M Kennedy
- a Population & Public Health Sciences , Pennington Biomedical Research Center , Baton Rouge , Louisiana , USA
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67
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Kroes M, Osei-Assibey G, Baker-Searle R, Huang J. Impact of weight change on quality of life in adults with overweight/obesity in the United States: a systematic review. Curr Med Res Opin 2016; 32:485-508. [PMID: 26652030 DOI: 10.1185/03007995.2015.1128403] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review published evidence on the impact of weight/BMI change on health-related quality of life (HRQoL) in adults from the US with overweight/obesity. METHODS The systematic review was conducted in accordance with PRISMA guidelines. MEDLINE, Embase, EconLit, and Cochrane Library databases were reviewed using pre-defined eligibility criteria to identify relevant US studies in adults with overweight/obesity, with ≥1 year follow-up, quantified weight change, and measured HRQoL. This manuscript focuses on HRQoL derived using the Short-Form 36 (SF-36) and Impact of Weight on Quality of Life-Lite (IWQOL-Lite) instruments. RESULTS In total, 32 of 6793 identified publications reported HRQoL according to SF-36 or IWQOL-Lite; 20 provided adequate data for inclusion in this review. Although study design and outcomes were heterogeneous, improvements in HRQoL were generally observed with weight loss. Bariatric surgery studies provided the most evidence (12 publications) and demonstrated dramatic (≥20%) weight loss and associated HRQoL improvements. Sustained weight loss was associated with maintenance of HRQoL improvements out to 6 years in some studies. In lifestyle and pharmaceutical intervention studies showing weight loss of 5%-10%, some aspects of HRQoL improved, although the association with weight was not typically explored. Across the 20 publications, physical versus mental HRQoL improvements were more commonly statistically significant. CONCLUSION Overweight/obesity is typically associated with poorer HRQoL than normal weight (BMI 18.5-24.9 kg/m(2)). This systematic review of US literature demonstrated that significant weight loss after bariatric surgery may be associated with improvements in HRQoL. In non-bariatric studies with weight loss of ≥5%, improvements in some aspects of HRQoL were noted, although the causal nature of the relationship is uncertain. Although many SF-36 and IWQOL-Lite domain scores increased, improvements were typically only significant for physical, rather than mental, HRQoL. This systematic review provides evidence supporting that weight loss may improve HRQoL in people with overweight/obesity.
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68
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Smits A, Lopes A, Das N, Bekkers R, Massuger L, Galaal K. Exercise Programme in Endometrial Cancer; Protocol of the Feasibility and Acceptability Survivorship Trial (EPEC-FAST). BMJ Open 2015; 5:e009291. [PMID: 26674498 PMCID: PMC4691724 DOI: 10.1136/bmjopen-2015-009291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Obesity has been associated with impaired quality of life and poorer outcomes in endometrial cancer survivors. Lifestyle interventions promoting exercise and weight reduction have been proposed for survivorship care. However, studies evaluating exercise programmes for endometrial cancer survivors are lacking. PURPOSE The objective of this study is to evaluate the feasibility of an individualised exercise intervention for endometrial cancer survivors to improve quality of life. METHODS AND ANALYSIS This is a feasibility study in which women will undergo a 10-week exercise programme with a personal trainer. The study population comprises women with confirmed diagnosis of endometrial cancer, who have completed surgical treatment with curative intent, and are aged 18 years or older. The study will take place at the Royal Cornwall Hospital Trust, UK. Feasibility will be evaluated in terms of recruitment, adherence and compliance to the programme. Secondary outcomes are quality of life, psychological distress, fatigue, pain and complication rates. In addition, the acceptability of the programme will be assessed. ETHICS AND DISSEMINATION Ethical approval was obtained through the Exeter NRES Committee. The study results will be used to optimise the intervention content, and may serve as the foundation for a larger definitive trial. Results will be disseminated through peer-review journals, congresses, relevant clinical groups and presented on the Trust's website. TRIAL REGISTRATION NUMBER NCT02367950; pre-results.
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Affiliation(s)
- Anke Smits
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
| | - Alberto Lopes
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
| | - Nagindra Das
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
| | - Ruud Bekkers
- Department of Gynaecology, Radboud UMC, Nijmegen, The Netherlands
| | - Leon Massuger
- Department of Gynaecology, Radboud UMC, Nijmegen, The Netherlands
| | - Khadra Galaal
- Department of Gynaecology, Royal Cornwall Hospital Trust, Truro, Cornwall, UK
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69
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Melasch J, Rullmann M, Hilbert A, Luthardt J, Becker GA, Patt M, Villringer A, Arelin K, Meyer PM, Lobsien D, Ding YS, Müller K, Sabri O, Hesse S, Pleger B. The central nervous norepinephrine network links a diminished sense of emotional well-being to an increased body weight. Int J Obes (Lond) 2015; 40:779-87. [PMID: 26620766 DOI: 10.1038/ijo.2015.216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The neurobiological mechanisms linking obesity to emotional distress remain largely undiscovered. METHODS In this pilot study, we combined positron emission tomography, using the norepinephrine transporter (NET) tracer [(11)C]-O-methylreboxetine, with functional connectivity magnetic resonance imaging, the Beck depression inventory (BDI), and the impact of weight on quality of life-Lite questionnaire (IWQOL-Lite), to investigate the role of norepinephrine in the severity of depression (BDI), as well as in the loss of emotional well-being with body weight (IWQOL-Lite). RESULTS In a small group of lean-to-morbidly obese individuals (n=20), we show that an increased body mass index (BMI) is related to a lowered NET availability within the hypothalamus, known as the brain's homeostatic control site. The hypothalamus displayed a strengthened connectivity in relation to the individual hypothalamic NET availability to the anterior insula/frontal operculum, as well as the medial orbitofrontal cortex, assumed to host the primary and secondary gustatory cortex, respectively (n=19). The resting-state activity in these two regions was correlated positively to the BMI and IWQOL-Lite scores, but not to the BDI, suggesting that the higher the resting-state activity in these regions, and hence the higher the BMI, the stronger the negative impact of the body weight on the individual's emotional well-being was. CONCLUSIONS This pilot study suggests that the loss in emotional well-being with weight is embedded within the central norepinephrine network.
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Affiliation(s)
- J Melasch
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - M Rullmann
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - A Hilbert
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany
| | - J Luthardt
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - G A Becker
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - M Patt
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - A Villringer
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - K Arelin
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - P M Meyer
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - D Lobsien
- Department of Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Y-S Ding
- Department of Radiology, Psychiatry, and Chemistry, New York University School of Medicine, New York, USA
| | - K Müller
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - O Sabri
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - S Hesse
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - B Pleger
- IFB Adiposity Diseases, University Medical Centre, Leipzig, Germany.,Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
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70
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Kolotkin RL, Chen S, Klassen P, Gilder K, Greenway FL. Patient-reported quality of life in a randomized placebo-controlled trial of naltrexone/bupropion for obesity. Clin Obes 2015. [PMID: 26222044 DOI: 10.1111/cob.12108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Weight loss is associated with improved quality of life in some, but not all, weight loss trials. We evaluated changes at 56 weeks in quality of life, measured by the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, in a pooled analysis of patient-level data from four randomized controlled Phase 3 studies of naltrexone/bupropion (NB32 or Contrave®). The total number of subjects was 3362 (NB32 = 2043; placebo = 1319; mean body mass index = 36.3 kg m(2); mean age = 46). Improvements in IWQOL-Lite Total Score were greater in subjects treated with NB32 (11.9 points [SE 0.3]) vs. placebo (8.2 points [SE 0.3]; P < 0.001), corresponding to weight reductions of 7.0% (SE 0.2) and 2.3% (SE 0.2), respectively. Greater improvements were also observed for NB32 vs. placebo on all five subscale scores of the IWQOL-Lite. Fifty per cent of NB32-treated subjects achieved clinically meaningful improvements in IWQOL-Lite Total Score vs. 32.3% of placebo-treated subjects (odds ratio, 95% confidence interval; 2.09, 1.79-2.44). Subjects losing the most weight (≥ 15% of baseline weight) experienced the greatest improvement in IWQOL-Lite Total Score (19.3 points [SE 0.7] for NB32 and 18.7 points [SE 1.3] for placebo; P = 0.624). Improved quality of life was associated with weight reduction and was achieved in more subjects treated with NB32 than placebo.
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Affiliation(s)
- R L Kolotkin
- Quality of Life Consulting, Durham, NC, USA
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA
| | - S Chen
- Takeda Pharmaceuticals, Deerfield, IL, USA
| | - P Klassen
- Orexigen Therapeutics, La Jolla, CA, USA
| | - K Gilder
- Orexigen Therapeutics, La Jolla, CA, USA
| | - F L Greenway
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, USA
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Tchicaya A, Lorentz N, Demarest S, Beissel J, Wagner DR. Relationship between self-reported weight change, educational status, and health-related quality of life in patients with diabetes in Luxembourg. Health Qual Life Outcomes 2015; 13:149. [PMID: 26385815 PMCID: PMC4575476 DOI: 10.1186/s12955-015-0348-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 09/12/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The aim of this study was to assess the relationship between self-reported weight change, socio-economic status, and health-related quality of life (HRQOL) in patients with diabetes, 5 years after they underwent coronary angiography. METHODS Between 2013 and 2014, 1873 of 4391 patients (319 with diabetes) who underwent coronary angiography between 2008 and 2009 participated in a follow-up study. Three out of four domains of the World Health Organization Quality of Life (WHOQOL)-BREF (physical health, psychological health and social relationships) were surveyed during the follow-up period. To assess the relationship between weight change and HRQOL, generalized linear models were constructed for every dimension of the WHOQOL-BREF, with educational level as a predictor and sex, age, marital status, smoking status, hypertension, cholesterol, ischemic heart disease, acute myocardial infarction, and stable angina pectoris as covariates. RESULTS The mean age of the patients was 70 years and almost three-quarters of the patients (72.7 %) were men. During the 12 months preceding the follow-up survey, 22.6 % of the patients reported weight loss, 20 % reported weight gain, and 57.4 % reported no weight change. There were significant differences in the HRQOL scores between patients who reported weight loss and those who reported either weight gain or unchanged weight. The most affected domains were physical and psychological health, with higher scores for patients who reported weight loss (54.7 and 67.2, respectively) than those who reported weight gain (46.3 and 58.5, respectively). The generalized linear model confirmed higher HRQOL scores among patients who reported weight loss and revealed an association between the HRQOL score and education level. CONCLUSION Weight change and education level were associated with HRQOL in patients with diabetes. Self-reported weight loss and no weight change were positively associated with HRQOL in patients with diabetes, while weight gain was negatively associated with HRQOL.
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Affiliation(s)
- Anastase Tchicaya
- LISER -Luxembourg Institute of Socio-Economic Research, 3 Avenue de la fonte, L-4364, Esch/Alzette, Luxembourg.
| | - Nathalie Lorentz
- LISER -Luxembourg Institute of Socio-Economic Research, 3 Avenue de la fonte, L-4364, Esch/Alzette, Luxembourg
| | | | - Jean Beissel
- INCCI-Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
| | - Daniel R Wagner
- INCCI-Institut National de Chirurgie Cardiaque et de Cardiologie Interventionnelle, Luxembourg, Luxembourg
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Lao WL, Malone DC, Armstrong EP, Voellinger D, Somers S, Jin J, Dreyer N, Globe D. Effect of adjustable gastric banding on quality of life and weight loss in the Helping Evaluate Reduction in Obesity (HERO) registry study: 2 year analysis. Curr Med Res Opin 2015; 31:1451-60. [PMID: 26154653 DOI: 10.1185/03007995.2015.1059802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This report from the Helping Evaluate Reduction in Obesity (HERO) Study investigated weight loss, health-related quality of life (HRQOL), and factors predictive of HRQOL improvement during a 2 year period following Lap-Band AP implantation (post-LBAP). RESEARCH DESIGN AND METHODS This prospective, observational study included patients with 1 and 2 year follow-up data post-LBAP (N = 585). Changes in body mass index (BMI), percentage of weight loss (%WL), excess weight loss (%EWL) and HRQOL (Impact of Weight on Quality of Life [IWQOL]-Lite measure), and differences between <30% EWL and ≥30% EWL subgroups were assessed at 1 and 2 years post-LBAP. Multiple linear regression examined association of %EWL groups with IWQOL-Lite scores controlling for age, gender, region (US vs outside US), household income, employment status, and comorbidities. RESULTS Most patients were female (80.2%) and from the US (64.8%); overall mean (SD) age was 43.6 (11.28) years and 65.8% of patients had ≥30% EWL at year 2. At 2 years post-LBAP, mean %EWL was 43.5%; %EWL was 12.4% in the <30% EWL group and 59.6% in ≥30% EWL group (P ≤ 0.0001). Changes in IWQOL total and subscores were significantly greater in ≥30% EWL versus <30% EWL patients (all P < 0.0005) at years 1 and 2; Self-Esteem and Physical subscores had the largest changes. Multiple regression analysis showed that patients with ≥30% EWL had clinically meaningful improvements in HRQOL compared with patients having <30% EWL (P ≤ 0.001). Similarly, US patients and females had a clinically significant change in IWQOL score versus their counterparts (P ≤ 0.001). Conversely, income, comorbidities and employment status were not significant predictors of change in IWQOL scores at year 2. CONCLUSIONS These results support and extend findings regarding the effectiveness of LBAP for weight loss and illustrate the importance of ≥30% EWL as a significant factor in predicting clinically significant improvement in HRQOL 1 and 2 years post-LBAP. CLINICAL TRIAL REGISTRATION NCT00953173.
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Affiliation(s)
- W-L Lao
- a a University of Arizona , Tucson , AZ , USA
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Rueda-Clausen CF, Ogunleye AA, Sharma AM. Health Benefits of Long-Term Weight-Loss Maintenance. Annu Rev Nutr 2015; 35:475-516. [DOI: 10.1146/annurev-nutr-071714-034434] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Christian F. Rueda-Clausen
- Obesity Research & Management, Clinical Research Unit, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2E1 Canada; , ,
| | - Ayodele A. Ogunleye
- Obesity Research & Management, Clinical Research Unit, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2E1 Canada; , ,
| | - Arya M. Sharma
- Obesity Research & Management, Clinical Research Unit, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, T6G 2E1 Canada; , ,
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Cozacov Y, Roy M, Moon S, Marin P, Lo Menzo E, Szomstein S, Rosenthal R. Mid-term results of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass in adolescent patients. Obes Surg 2015; 24:747-52. [PMID: 24390732 DOI: 10.1007/s11695-013-1169-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The prevalence and severity of obesity in children and adolescents has been increasing in recent years at an unprecedented rate. Morbidly obese children will almost certainly develop severe comorbidities as they progress to adulthood, and bariatric surgery may provide the only alternative for achieving a healthy weight. The aim of this study was to assess the long-term outcomes and safety of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) as new treatment modalities for morbidly obese adolescents. We conducted a retrospective review of a prospectively collected database of all adolescent patients who underwent LSG and RYGB under IRB protocol at the Bariatric and Metabolic Institute in Cleveland Clinic Florida between 2002 and 2011. Patients were also contacted by phone, adhering to HIPAA regulations, and were asked to answer a survey. Eighteen adolescents had a bariatric procedure performed at this institution. The mean age was 17.5 years, the average weight was 293.1 lbs, and the average BMI was 47.2 kg/m2. The mean follow-up period consisted of 55.2 months. The postoperative weight at 55 months follow-up was 188.4 lbs and average BMI was 30.1 kg/m2. Fifteen of the patients were available for follow-up. Thirteen out of 16 (81%) comorbidities in patients available for follow-up were in remission following rapid weight loss. The long-term follow-up and perioperative morbidity shown in this study suggest that LSG and LRYGB appear to be safe and effective operations in morbidly obese adolescents.
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Affiliation(s)
- Yaniv Cozacov
- Department of General Surgery, Bariatric and Metabolic Institute and Section of Minimally Invasive Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA
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Strain GW, Kolotkin RL, Dakin GF, Gagner M, Inabnet WB, Christos P, Saif T, Crosby R, Pomp A. The effects of weight loss after bariatric surgery on health-related quality of life and depression. Nutr Diabetes 2014; 4:e132. [PMID: 25177912 PMCID: PMC4183970 DOI: 10.1038/nutd.2014.29] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/02/2014] [Accepted: 07/20/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In severe obesity, impairments in health-related quality of life (HRQoL) and dysphoric mood are reported. This is a post-surgery analysis of the relationship between HRQoL and depressive symptoms, and weight change after four different types of bariatric procedures. METHODS A total of 105 consented patients completed the Short-Form-36 Health Survey (SF-36), the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and the Beck Depression Inventory (BDI) before and 25 months after surgery. Analysis of variance or Kruskal-Wallis test evaluated changes. RESULTS Patients with Roux-en Y gastric bypass (46 patients), decreased body mass indexes (BMIs; kg m(-)(2)) 47-31 kg m(-)(2) (P<0.0001); biliopancreatic diversion with duodenal switch (18 patients), decreased BMIs 57-30 kg m(-)(2) (P<0.0001); adjustable gastric banding (18 patients), decreased BMIs 45-38 kg m(-)(2) (P<0.0001); and sleeve gastrectomies (23 patients), decreased BMIs 58 42 kg m(-)(2) (P<0.0001). The excess percentage BMI loss was 69, 89, 36 and 53 kg m(-)(2), respectively (P<0.0001). Before surgery, the SF-36 differences were significant regarding bodily pain (P=0.008) and social functioning (P=0.01). After surgery, physical function (P=0.03), general health (P=0.05) and physical component (P=0.03) were different. IWQOL-Lite recorded no differences until after surgery: physical function (P=0.003), sexual life (P=0.04) and public distress (P=0.003). BDI scores were not different for the four groups at baseline. All improved with surgery, 10.6-4.4 (P=0.0001). CONCLUSIONS HRQoL and depressive symptoms significantly improvement after surgery. These improvements do not have a differential effect over the wide range of weight change.Nutrition & Diabetes (2014) 4, e132; doi:10.1038/nutd.2014.29; published online 1 September 2014.
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Affiliation(s)
- G W Strain
- Department of Surgery, Weill Cornell College of Medicine, New York, NY, USA
| | - R L Kolotkin
- Obesity and Quality of Life Consulting, and Duke University School of Medicine, Durham, NC, USA
| | - G F Dakin
- Department of Surgery, Weill Cornell College of Medicine, New York, NY, USA
| | - M Gagner
- Department of Surgery, Hospital du Sacre Coeur, Montreal, Quebec, Canada
| | - W B Inabnet
- Department of Surgery, Mt Sinai Medical Center, New York, NY, USA
| | - P Christos
- Department of Surgery, Weill Cornell College of Medicine, New York, NY, USA
| | - T Saif
- Department of Surgery, Weill Cornell College of Medicine, New York, NY, USA
| | - R Crosby
- University of North Dakota Neuropsychiatry Institute, Fargo, ND, USA
| | - A Pomp
- Department of Surgery, Weill Cornell College of Medicine, New York, NY, USA
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Factors associated with choice of a low-fat or low-carbohydrate diet during a behavioral weight loss intervention. Appetite 2014; 83:117-124. [PMID: 25149197 DOI: 10.1016/j.appet.2014.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/12/2014] [Accepted: 08/14/2014] [Indexed: 11/20/2022]
Abstract
Individuals undertaking a weight loss effort have a choice among proven dietary approaches. Factors contributing to choice of either a low-fat/low-calorie diet or a low-carbohydrate diet, two of the most studied and popular dietary approaches, are unknown. The current study used data from participants randomized to the 'choice' arm of a trial examining whether being able to choose a diet regimen yields higher weight loss than being randomly assigned to a diet. At study entry, participants attended a group session during which they were provided tailored feedback indicating which diet was most consistent with their food preferences using the Geiselman Food Preference Questionnaire (FPQ), information about both diets, and example meals for each diet. One week later, they indicated which diet they chose to follow during the 48-week study, with the option of switching diets after 12 weeks. Of 105 choice arm participants, 44 (42%) chose the low-fat/low-calorie diet and 61 (58%) chose the low-carbohydrate diet. In bivariate analyses, diet choice was not associated with age, race, sex, education, BMI, or diabetes (all p > 0.05). Low-carbohydrate diet choice was associated with baseline higher percent fat intake (p = 0.007), lower percent carbohydrate intake (p = 0.02), and food preferences consistent with a low-carbohydrate diet according to FPQ (p < 0.0001). In a multivariable logistic regression model, only FPQ diet preference was associated with diet choice (p = 0.001). Reported reasons for diet choice were generally similar for those choosing either diet; however, concerns about negative health effects of the unselected diet was rated as more influential among participants selecting the low-fat diet. Only three low-carbohydrate and two low-fat diet participants switched diets at 12 weeks. Results suggest that when provided a choice between two popular weight loss dietary approaches, an individual's selection is likely influenced by baseline dietary intake pattern, and especially by his or her dietary preferences. Research is needed to determine if congruency between food preferences and dietary approach is associated with weight loss.
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Miras AD, Al-Najim W, Jackson SN, McGirr J, Cotter L, Tharakan G, Vusirikala A, le Roux CW, Prechtl CG, Scholtz S. Psychological characteristics, eating behavior, and quality of life assessment of obese patients undergoing weight loss interventions. Scand J Surg 2014; 104:10-7. [PMID: 25053582 DOI: 10.1177/1457496914543977] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Bariatric surgery is the most effective treatment for obesity. However, not all patients have similar weight loss following surgery and many researchers have attributed this to different pre-operative psychological, eating behavior, or quality-of-life factors. The aim of this study was to determine whether there are any differences in these factors between patients electing to have bariatric surgery compared to less invasive non-surgical weight loss treatments, between patients choosing a particular bariatric surgery procedure, and to identify whether these factors predict weight loss after bariatric surgery. MATERIAL AND METHODS This was a prospective study of 90 patients undergoing gastric bypass, vertical sleeve gastrectomy, or adjustable gastric banding and 36 patients undergoing pharmacotherapy or lifestyle interventions. All patients completed seven multi-factorial psychological, eating behavior, and quality-of-life questionnaires prior to choosing their weight loss treatment. Questionnaire scores, baseline body mass index, and percent weight loss at 1 year after surgical interventions were recorded. RESULTS AND CONCLUSIONS Surgical patients were younger, had a higher body mass index, and obesity had a higher impact on their quality of life than on non-surgical patients, but they did not differ in the majority of eating behavior and psychological parameters studied. Patients opting for adjustable gastric banding surgery were more anxious, depressed, and had more problems with energy levels than those choosing vertical sleeve gastrectomy, and more work problems compared to those undergoing gastric bypass. Weight loss after bariatric surgery was predicted by pre-operative scores of dietary restraint, disinhibition, and pre-surgery energy levels. The results of this study generate a number of hypotheses that can be explored in future studies and accelerate the development of personalized weight loss treatments.
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Affiliation(s)
- A D Miras
- Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - W Al-Najim
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - S N Jackson
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - J McGirr
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - L Cotter
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - G Tharakan
- Section of Investigative Medicine, Division of Diabetes, Endocrinology & Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - A Vusirikala
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - C W le Roux
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK Diabetes Complications Research Centre, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - C G Prechtl
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
| | - S Scholtz
- Metabolic Medicine Research Unit, Imperial College London, Charing Cross Hospital, London, UK
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Napoli N, Shah K, Waters DL, Sinacore DR, Qualls C, Villareal DT. Effect of weight loss, exercise, or both on cognition and quality of life in obese older adults. Am J Clin Nutr 2014; 100:189-98. [PMID: 24787497 PMCID: PMC4144098 DOI: 10.3945/ajcn.113.082883] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Obesity impairs cognition and health-related quality of life (HRQOL) in older adults; however, the appropriate treatment of obese older adults remains controversial. OBJECTIVE The objective was to determine the independent and combined effects of weight loss and exercise on cognition, mood, and HRQOL in obese older adults. DESIGN One hundred seven frail, obese older adults were randomly assigned to a control, weight-management (diet), exercise, or weight-management-plus-exercise (diet-exercise) group for 1 y. In this secondary analysis, main outcomes were Modified Mini-Mental State Examination (3MS) and total Impact of Weight on Quality of Life-Lite (IWQOL) scores. Other outcomes included Word Fluency Test, Trail Making Test Parts A and B, and Geriatric Depression Scale (GDS) scores. RESULTS Scores on the 3MS improved more in the diet (mean ± SE: 1.7 ± 0.4), exercise (2.8 ± 0.4), and diet-exercise (2.9 ± 0.4) groups than in the control group (0.1 ± 0.4) (between-group P = 0.0001-0.04); scores in the diet-exercise group improved more than in the diet group but not more than in the exercise group. Scores on the Word Fluency Test improved more in the exercise (4.1 ± 0.8) and diet-exercise (4.2 ± 0.7) groups than in the control group (-0.8 ± 0.8; both P = 0.001). For the Trail Making Test Part A, scores in the diet-exercise group (-11.8 ± 1.9) improved more than in the control group (-0.8 ± 1.9) (P = 0.001); a similar finding was observed for the Trail Making Test Part B. Scores on the IWQOL improved more in the diet (7.6 ± 1.6), exercise (10.1 ± 1.6), and diet-exercise (14.0 ± 1.4) groups than in the control group (0.3 ± 1.6) (P = 0.0001-0.03); scores in the diet-exercise group improved more than in the diet group but not more than in the exercise group. In the diet-exercise group, peak oxygen consumption and strength changes were independent predictors of 3MS changes; weight and strength changes were independent predictors of IWQOL changes. GDS scores did not change. CONCLUSIONS Weight loss and exercise each improve cognition and HRQOL, but their combination may provide benefits similar to exercise alone. These findings could inform practice guidelines with regard to optimal treatment strategies for obese older adults. This trial was registered atclinicaltrials.govas NCT00146107.
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Affiliation(s)
- Nicola Napoli
- From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV)
| | - Krupa Shah
- From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV)
| | - Debra L Waters
- From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV)
| | - David R Sinacore
- From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV)
| | - Clifford Qualls
- From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV)
| | - Dennis T Villareal
- From the Division of Endocrinology, University Campus Bio-Medico Di Roma, Rome, Italy (NN); the Division of Geriatrics and Aging, University of Rochester School of Medicine, Rochester, NY (KS); the Department of Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand (DLW); the Division of Geriatrics and Nutritional Science (DRS and DTV) and the Program in Physical Therapy (DRS), Washington University School of Medicine, St Louis, MO; the Department of Mathematics and Statistics (CQ) and the Division of Geriatrics (DTV), University of New Mexico School of Medicine, Albuquerque, NM; and the Section of Geriatrics, New Mexico VA Health Care System, Albuquerque, NM (DTV)
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Predictors of health-related quality of life changes after lifestyle intervention in persons at risk of type 2 diabetes mellitus. Qual Life Res 2014; 23:2585-93. [PMID: 24789668 PMCID: PMC4186973 DOI: 10.1007/s11136-014-0702-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2014] [Indexed: 10/31/2022]
Abstract
PURPOSE To assess health-related quality of life (HRQOL) of subjects at risk of type 2 diabetes undergoing lifestyle intervention, and predictors for improved HRQOL. METHODS The Finnish Diabetes Risk Score was used by general practitioners to identify individuals at risk. Low-intensity interventions with an 18-month follow-up were employed. HRQOL was assessed using the SF-36 at baseline and compared with results from a general Norwegian population survey and further at 6 and 18 months. Simple and multiple linear regression analyses were applied to identify predictors of changes in HRQOL of clinical importance. RESULTS Two hundred and thirteen participants (50 % women; mean age: 46 years, mean body mass index: 37) were included: 182 returned for 18-month follow-up, of whom 172 completed the HRQOL questionnaire. HRQOL was reduced with clinical significance compared with general Norwegians. The mean changes in HRQOL from the baseline to the follow-up were not of clinical importance. However, one out of three individuals achieved a moderate or large clinical improvement in HRQOL. The best determinant for improved HRQOL was obtained for a composite, clinically significant lifestyle change, i.e. both a weight reduction of at least 5 % and an improvement in exercise capacity of at least 10 %, which was associated with an improvement in five out of the eight SF-36 domains. CONCLUSION Subjects at risk of type 2 diabetes report a clinically important reduction in HRQOL compared with general Norwegians. The best predictor of improved HRQOL was a small weight loss combined with a small improvement in aerobic capacity.
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Laurino Neto RM, Herbella FAM. Changes in quality of life after short and long term follow-up of Roux-en-Y gastric bypass for morbid obesity. ARQUIVOS DE GASTROENTEROLOGIA 2014; 50:186-90. [PMID: 24322189 DOI: 10.1590/s0004-28032013000200033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/07/2013] [Indexed: 11/22/2022]
Abstract
CONTEXT It is unclear whether health-related quality of life (HRQL) is sustained in a long-term follow-up of morbidly obese patients who underwent Roux-en-Y gastric bypass (RYGB). Objective This study aims to analyze the HRQL changes following RYGB in short and long-term follow-up. METHODS We compared the health-related quality of life among three separate patient groups, using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Group A - 50 preoperative morbidly obese patients; Group B - 50 RYGB patients 1-2 years post-surgery; Group C - 50 RYGB patients more than 7 years post-surgery. RESULTS The groups were similar for gender, age and body mass index before surgery. We observed that physical functioning, social function, emotional role functioning and mental health scales did not vary between the three groups. The physical role functioning scale was unchanged in the short-term and decreased compared to the preoperative scale in the long-term follow-up. Bodily pain improved after the operation but returned to the initial level after 7 years. The vitality and general health perceptions improved after the operation and maintained these results after 7 years compared with the preoperative perceptions. CONCLUSIONS RYGB improved health-related quality of life in three SF-36 domains (bodily pain, general health perceptions and vitality) in the short-term and two SF-36 domains (general health perceptions and vitality) in the long-term.
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Affiliation(s)
- Rafael M Laurino Neto
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Cirurgia
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Jagielski AC, Brown A, Hosseini-Araghi M, Thomas GN, Taheri S. The association between adiposity, mental well-being, and quality of life in extreme obesity. PLoS One 2014; 9:e92859. [PMID: 24671197 PMCID: PMC3966835 DOI: 10.1371/journal.pone.0092859] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/26/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore the cross-sectional association between adiposity, mental well-being, and quality of life in extreme obese individuals entering a UK specialist weight management service prior to treatment commencement. METHODS The sample comprised 263 extreme obese individuals who were referred to the service as a result of having a body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 with a co-morbid health condition. In a retrospective analysis, routinely collected baseline clinical examination data and self-report questionnaires (Impact of Weight on Quality of Life: IWQOL-Lite, EQ5D-3L, and Hospital Anxiety and Depression Scale: HADS) were analysed to examine the cross-sectional association between adiposity and quality of life. RESULTS The sample was predominantly female (74.8%) with mean BMI 47.0±7.9 kg/m2. Increasing adiposity was significantly negatively associated with quality of life, with an increase of 1 BMI unit associated with decreases of 1.93 in physical function (95% CI -2.86 - -1.00, p<0.001), 1.62 in self-esteem (95% CI -2.67 - -0.57, p<0.05), 2.69 in public distress (95% CI -3.75 - -1.62, p<0.001), 1.33 in work (95% CI -2.63 - -0.02, p<0.05), and 1.79 in total IWQOL-Lite scores (95% CI -2.65 - -0.93, p<0.001). Adiposity was associated with significantly increased risk of problems in mobility (OR = 3.44, 95% CI 1.47-8.05), and performing usual activities (OR = 2.45, 95% CI 1.10-5.46) in highest relative to lowest BMI tertile. The prevalence of experience of symptoms of anxiety (70.3%) and depression (66.2%) as measured by HADS was consistently high. CONCLUSIONS We identified a high prevalence of psychological co-morbidity, including widespread experience of symptoms of anxiety and depressive disorders and reduced quality of life among these extreme obese individuals seeking weight management treatment. Clinical implications include the need for the incorporation of strategies to improve mental well-being into multi-disciplinary weight management interventions.
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Affiliation(s)
| | - Adrian Brown
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | | | - G. Neil Thomas
- Birmingham and Black Country NIHR CLAHRC, Birmingham, United Kingdom
- Public Health, Epidemiology and Biostatistics, University of Birmingham, United Kingdom
- Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany
| | - Shahrad Taheri
- Birmingham and Black Country NIHR CLAHRC, Birmingham, United Kingdom
- Specialist Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, United Kingdom
- Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America, and Doha, Qatar
- Department of Medicine, King’s College London, London, United Kingdom
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83
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Kennedy BM, Katzmarzyk PT, Johnson WD, Johnson GS, McGee BB, Champagne CM, Harsha DW, Crawford T, Ryan DH. People United to Sustain Health (PUSH): a community-based participatory research study. Clin Transl Sci 2014; 7:108-14. [PMID: 24405579 DOI: 10.1111/cts.12133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The prevention of weight gain to address the obesity epidemic rather than weight loss involves promoting small changes in food choices and physical activity. People United to Sustain Health (PUSH) was designed to increase fruit and vegetable consumption, physical activity, and food security to prevent weight gain in rural adults. Forty-nine participants were randomized into a treatment group which received access to a "Rolling Store," nutrition education and physical activity, and a control group which received family coping classes. Forty-one (84%) of participants completed the study. At the end of 6 months, weight for all participants was maintained from baseline to completion with no significant differences between the groups. The mean fruit consumption over 6 months for the treatment group increased and was significantly greater than change in the control group (p = 0.01). This community-based participatory research study was considered successful because weight gain was prevented.
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Affiliation(s)
- Betty M Kennedy
- The Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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84
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Caixàs A, Lecube A, Morales MJ, Calañas A, Moreiro J, Cordido F, Díaz MJ, Masmiquel L, Moreno B, Vidal J, Goday A, Arrizabalaga JJ, García-Luna PP, Iglesias P, Burguera B, Rubio MA, Monereo S, Crosby RD, Kolotkin RL. Weight-related quality of life in Spanish obese subjects suitable for bariatric surgery is lower than in their North American counterparts: a case-control study. Obes Surg 2013; 23:509-14. [PMID: 23090430 DOI: 10.1007/s11695-012-0791-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Obesity impairs quality of life, but the perception of the impairment could be different from one country to another. The purpose was to compare weight-related quality of life (QOL) between cohorts from Spain and North America. METHODS A cross-sectional case-control study was performed between two populations. Four hundred Spanish and 400 North American obese subjects suitable for bariatric surgery closely matched for race, gender, age, and body mass index (BMI) were included. Two non-obese control groups matched for gender, age, and BMI from each population were also evaluated (n = 400 in each group). The participants completed the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, a measure of weight-related QOL. RESULTS Spanish morbidly obese patients showed poorer QOL than their North American counterparts in physical function, sexual life, work, and total score. By contrast, Spanish non-obese control subjects reported better QOL in all domains than their North American counterparts. Women, both in Spain and North America, reported reduced QOL compared to men on the domain of self-esteem. In addition, North American women reported reduced QOL on the sexual life domain compared to men. BMI correlated negatively with all domains of QOL except for self-esteem in both national groups. CONCLUSIONS Spanish obese subjects suitable for bariatric surgery report poorer weight-related quality of life than their North American counterparts, and obese women, regardless of nationality, perceive a reduced quality of life compared to men.
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Affiliation(s)
- Assumpta Caixàs
- S. Endocrinología y Nutrición, Corporació Sanitaria Univ. Parc Taulí, Institut de Recerca Parc Taulí (UAB), C/Parc Taulí s/n, 08208, Sabadell, Barcelona, Spain.
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85
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Grimm M, Han J, Weaver C, Griffin P, Schulteis CT, Dong H, Malloy J. Efficacy, safety, and tolerability of exenatide once weekly in patients with type 2 diabetes mellitus: an integrated analysis of the DURATION trials. Postgrad Med 2013; 125:47-57. [PMID: 23748506 DOI: 10.3810/pgm.2013.05.2660] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIM Exenatide is a glucagon-like peptide-1 receptor agonist demonstrated to improve glycemic control with low hypoglycemia risk in patients with type 2 diabetes mellitus. The Diabetes Therapy Utilization: Researching Changes in A1C, Weight, and Other Factors Through Intervention With Exenatide Once Weekly (DURATION) program comprised 6 randomized, comparator-controlled, 24- to 30-week trials of exenatide once weekly (EQW), an extended-release formulation. This post hoc analysis pooled data from patients taking EQW across 6 trials to assess efficacy and safety in a large, varied patient population. MATERIALS AND METHODS The intent-to-treat (ITT) population contained 1379 patients (baseline mean ± standard deviation glycated hemoglobin [HbA1c] levels of 8.4% ± 1.1%) who were treated with EQW over the course of 24 to 30 weeks. Changes from baseline in efficacy parameters for the ITT population and a completer population (1195 patients with ≥ 22 weeks of exposure) were evaluated. RESULTS The ITT population experienced significant reductions from baseline (least-squares mean [95% CI]) in HbA1c levels (-1.4% [-1.5% to -1.4%]), fasting blood glucose levels (-36 mg/dL [-38.4 mg/dL to -33.8 mg/dL]), and body weight (-2.5 kg [-2.8 kg to -2.3 kg]) after 24 to 30 weeks of EQW treatment. Reductions in HbA1c and fasting blood glucose levels were observed across baseline HbA1c level strata; patients with higher baseline HbA1c levels experienced greater reductions. Treatment with EQW was associated with modest, significant reductions in blood pressure (systolic blood pressure, -2.8 mm Hg [-3.5 mm Hg to -2.1 mm Hg]; diastolic blood pressure, -0.8 mm Hg [-1.2 mm Hg to -0.4 mm Hg]), and fasting lipid levels (total cholesterol, -6.5 mg/dL [-8.2 mg/dL to -4.7 mg/dL]; low-density lipoprotein cholesterol, -3.9 mg/dL [5.3 mg/dL to -2.5 mg/dL]; and triglyceride [geometric least-squares mean percent change (95% CI)], -6% [-8% to -4%] levels). Similar reductions were observed in the completer population. Exenatide once weekly was generally well tolerated. Transient, mild-to-moderate gastrointestinal treatment-emergent adverse events and injection-site treatment-emergent adverse events were reported most frequently, but were seldom treatment limiting. No major hypoglycemic events were observed; minor hypoglycemic events occurred infrequently in patients not using a sulfonylurea. CONCLUSION This post hoc analysis of > 1300 patients demonstrated that EQW was associated with significant reductions in HbA1c levels, body weight, blood pressure, and fasting lipid levels, with minimal hypoglycemia risk. Consistent with established safety profiles, EQW therapy was generally well tolerated. TRIAL REGISTRATION www.ClinicalTrials.gov identifiers: NCT00308139, NCT00637273, NCT00641056, NCT00676338, NCT00877890, NCT01029886.
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Affiliation(s)
- Michael Grimm
- Amylin Pharmaceuticals, LLC, San Diego, CA 92121, USA
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86
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Retinol-binding protein 4 and insulin resistance are related to body fat in primary and secondary schoolchildren: the Ouro Preto study. Eur J Nutr 2013; 53:433-40. [PMID: 23764679 DOI: 10.1007/s00394-013-0543-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Evidence suggests that plasma retinol-binding protein 4 (RBP4) and insulin resistance are related to body fat (BF). We aimed to assess the relationship between RBP4 and insulin resistance with obesity in a mixed (skin color) cohort of the Brazilian population. METHODS A nested case-control study was conducted in 227 schoolchildren aged 7-14 years. Schoolchildren with a high BF percentage (% BF, ≥ 30 for girls and ≥ 25 for boys) were identified as the obese group (n = 137), and those with lower values were identified as the non-obese group (n = 90). Percentage of body fat (% BF) was determined by tetrapolar bioimpedance (Quantum II, RJL System), RBP4 by enzyme-linked immunosorbent assay (Immunology Consultants Laboratory), plasma fasting insulin by chemiluminescent immunoassay (Access(®) Immunoassay System) and insulin resistance by the homeostasis model insulin resistance (IR(HOMA)) index. Serum lipid profile and arterial blood pressure were evaluated. RESULTS The significant independent risk factors associated with obesity were as follows: male sex, increased serum LDL-C, RBP4 and IR(HOMA). Among children with higher RBP4, the association with obesity increased significantly (from 3.1 to 8.5) in the presence of insulin resistance, when compared to higher RBP4 and non-insulin resistance. CONCLUSION IR(HOMA) and RBP4 showed significant associations with obesity and traditional CVD risk factors. They might therefore be used as a marker for CVD risk and have clinical implications in the development of comorbidities associated with obesity.
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87
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Yancy WS, Coffman CJ, Geiselman PJ, Kolotkin RL, Almirall D, Oddone EZ, Mayer SB, Gaillard LA, Turner M, Smith VA, Voils CI. Considering patient diet preference to optimize weight loss: design considerations of a randomized trial investigating the impact of choice. Contemp Clin Trials 2013; 35:106-16. [PMID: 23506974 PMCID: PMC4351659 DOI: 10.1016/j.cct.2013.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 02/11/2013] [Accepted: 03/10/2013] [Indexed: 02/06/2023]
Abstract
A variety of diet approaches achieve moderate weight loss in many individuals. Yet, most diet interventions fail to achieve meaningful weight loss in more than a few individuals, likely due to inadequate adherence to the diet. It is widely conjectured that targeting the diet to an individual's food preferences will enhance adherence, thereby improving weight loss. This article describes the design considerations of a study protocol aimed at testing this hypothesis. The study is a 2-arm randomized trial recruiting 216 medical outpatients with BMI ≥30 kg/m(2) followed for 48 weeks. Participants in the experimental arm (Choice) select from two of the most widely studied diets for weight loss, a low-carbohydrate, calorie-unrestricted diet (LCD) or a low-fat, reduced-calorie diet (LFD). The participant's choice is informed by results from a validated food preference questionnaire and a discussion of diet options with trained personnel. Choice participants are given the option to switch to the other diet after three months, if desired. Participants in the Control arm are randomly assigned to follow one of the two diets for the duration of follow-up. The primary outcome is weight assessed every 2-4 weeks for 48 weeks. Secondary outcomes include adherence to diet by food frequency questionnaire and obesity-specific health-related quality of life. If assisting patients to choose their diet enhances adherence and increases weight loss, the results will support the provision of diet options to patients who desire weight loss, and bring us one step closer to remediating the obesity epidemic faced by our healthcare systems.
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Affiliation(s)
- William S Yancy
- Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC, USA.
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88
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Freitas-Rosa M, Gonçalves S, Antunes H. The relationship between weight status and psychopathology in adolescence: The role of social support. J Health Psychol 2013; 19:907-17. [DOI: 10.1177/1359105313482162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study evaluated the differences between normal-weight and overweight adolescents in psychopathology, social support and emotional competences, and the role of social support in the relationship between psychopathology and weight. We examined a clinical group of 83 overweight/obese adolescents, a community group of 82 overweight/obese adolescents, and 205 adolescents with normal weight. No differences were found in psychopathology and emotional skills. Compared to healthy peers, however, the overweight/obese community group was less satisfied with their friendships, and the clinical group was less satisfied with their intimate support and social activities. Social support mediates the relationship between weight and psychopathology.
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Affiliation(s)
| | | | - Henedina Antunes
- University of Minho, Portugal
- Braga Hospital, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, Portugal
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89
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Cash SW, Duncan GE, Beresford SAA, McTiernan A, Patrick DL. Increases in physical activity may affect quality of life differently in men and women: the PACE project. Qual Life Res 2013; 22:2381-8. [PMID: 23504523 DOI: 10.1007/s11136-013-0389-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Obesity is associated with impaired quality of life (QoL), but less is known about physical activity. We investigated how decreases in body mass index (BMI) and increases in activity affect obesity-specific QoL and potential gender differences in associations. METHODS In a large worksite randomized trial of a multilevel intervention on diet and physical activity behaviors, we conducted a cohort analysis at two years of follow-up. Self-reported activity and Obesity and Weight Loss Quality of Life (OWLQOL) were analyzed for individual-level associations using linear mixed models accounting for random worksite effects. RESULTS Gender modified the BMI-OWLQOL relationship, so analyses were conducted for males and females separately. Adjusting for demographic confounders, baseline OWLQOL, and several worksite-level variables including intervention arm, a 1.9 unit decrease in BMI (the interquartile range) was associated with an OWLQOL increase of 1.7 (95 % CI: 1.2, 2.2) in males and 3.6 (95 % CI: 3.2, 4.0) in females. Similarly, a 23 unit increase in physical activity score was associated with an OWLQOL increase of 0.9 (95 % CI: 0.5, 1.4) in males and 1.6 (95 % CI: 1.0, 2.3) in females. Physical activity associations were attenuated when adjusting for change in BMI, but remained significant for women (mean BMI 27.8 kg/m(2)). CONCLUSIONS This is the first study to demonstrate that increasing physical activity may improve obesity-specific QoL to a greater extent in women, particularly among overweight women, independent of BMI. Results may inform the design of interventions tailored to women targeting well-being through messages of increasing physical activity.
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90
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Stubbs RJ, Lavin JH. The challenges of implementing behaviour changes that lead to sustained weight management. NUTR BULL 2013. [DOI: 10.1111/nbu.12002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R. J. Stubbs
- Nutrition and Research Department; Slimming World; Derbyshire; UK
| | - J. H. Lavin
- Nutrition and Research Department; Slimming World; Derbyshire; UK
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91
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Gjevestad E, Karlsen TI, Røislien J, Maehlum S, Hjelmesaeth J. The effectiveness of secondary and tertiary care lifestyle intervention in morbidly obese patients: a 1-year non-randomized controlled pragmatic clinical trial. Clin Obes 2013; 3:39-50. [PMID: 25586390 DOI: 10.1111/cob.12011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/20/2013] [Accepted: 03/05/2013] [Indexed: 11/29/2022]
Abstract
In this non-randomized clinical pragmatic trial, we aimed to compare the effectiveness of an outpatient intensive lifestyle intervention (ILI) programme conducted in a tertiary care obesity rehabilitation centre with an outpatient moderate lifestyle intervention (MLI) programme at a secondary care obesity centre. Effectiveness was measured in terms of the 1-year effect each programme had on body weight, physical activity and health-related quality of life (HRQL). A total of 232 morbidly obese subjects were recruited to the ILI group and 140 to the MLI group, with retention rates of 78% and 44%, respectively. The ILI group had a significantly larger mean (95% confidence interval [CI]) weight loss than the MLI group, 11% (9%, 12%) vs. 2% (1%, 6%), P < 0.001, and a larger proportion of completers attaining ≥5% weight loss (71% vs. 33%), P < 0.001. Compared with the MLI group, the ILI group achieved a significant larger mean (95% CI) increase in the physical dimension of HRQL 6.9 (4.4, 9.3), P < 0.001, the mental dimension of HRQL 4.4 (1.4, 7.4), P = 0.018 and in the emotional dimension of HRQL 17.8 (12.8, 22.6), P < 0.001. There were no significant differences in terms of changes in physical activity. Compared with MLI, ILI was associated with significantly larger weight loss and better HRQL.
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Affiliation(s)
- E Gjevestad
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway; Clinic Physical Medicine and Rehabilitation, Vestfold Hospital Trust, Stavern, Norway
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92
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Bottone FG, Hawkins K, Musich S, Cheng Y, Ozminkowski RJ, Migliori RJ, Yeh CS. The relationship between body mass index and quality of life in community-living older adults living in the United States. J Nutr Health Aging 2013; 17:495-501. [PMID: 23732544 DOI: 10.1007/s12603-013-0022-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Carrying excess weight is associated with various chronic conditions especially in older adults, and can have a negative influence on the quality of life of this population. OBJECTIVE The objective of this study was to estimate the independent (i.e. adjusted for demographic, socioeconomic and health status differences) impact of Body Mass Index (BMI) on health-related quality of life. DESIGN A mail survey was sent to 60,000 older adults living in 10 states. METHODS The survey assessed quality of life using the average physical component scores (PCS) and mental component scores (MCS) obtained from the Veterans Rand 12-item (VR-12) health status tool embedded in the survey. Ordinary least squares (OLS) regression techniques were used to estimate the independent impact of each BMI category on quality of life, compared to the impact of other chronic conditions. RESULTS A total of 22,827 (38%) eligible sample members responded to the survey. Of those, 2.2% were underweight, 38.5% had a normal BMI, 37.0% were overweight, 18.5% were obese and 1.9% were morbidly obese. Following OLS regression techniques, respondents' PCS values were statistically significantly lower for the underweight, overweight, obese and morbidly obese BMI categories, compared to the normal BMI group. Compared with all other chronic conditions, being morbidly obese (-6.0 points) had the largest negative impact on the PCS. Underweight was the only BMI category with a statistically significantly lower MCS value. CONCLUSIONS The greatest negative impacts of the various BMI categories on quality of life were on physical rather than mental aspects, especially for those in the underweight, obese and morbidly obese categories, more so than many other chronic conditions.
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Affiliation(s)
- F G Bottone
- Advanced Analytics, OptumInsight, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI 48108, USA
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93
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Pimenta F, Leal I, Maroco J, Ramos C. Brief cognitive-behavioral therapy for weight loss in midlife women: a controlled study with follow-up. Int J Womens Health 2012; 4:559-67. [PMID: 23091402 PMCID: PMC3474154 DOI: 10.2147/ijwh.s35246] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT) has proven to be effective in weight reduction. This study explores whether individual, 8-session CBT can promote weight loss in midlife women. METHODS Anthropometric (weight, abdominal perimeter, and body mass index calculation), psychological (health-related and sexual quality of life, stress, anxiety, and depression), and behavioral measures (binge eating disorder and restrained, external, and emotional eating) were assessed at baseline (T1), posttreatment (T2), and 4-month follow-up (T3), for a total of 21 women at baseline; the CBT group (n = 11) and the control group (n = 10; waiting list) were compared. RESULTS Statistically significant effects that were dependent on the intervention were observed on weight (F = 4.402; P = 0.035; η(p) (2) = 0.404; π = 0.652) and body mass index (F = 3.804; P = 0.050; η(p) (2) = 0.369; π = 0.585); furthermore, marginally significant effects were observed on external eating (F = 2.844; P = 0.095; η(p) (2) = 0.304; π = 0.461). At follow-up, women in the CBT group presented with lower weight, abdominal perimeter, body mass index, and external eating; higher health-related quality-of-life and restrained eating were also observed in this group. Most differences identified were at a marginally significant level. Moreover, at follow-up, none of the participants of the CBT group met the criteria for binge eating disorder, whereas the number of women with binge eating disorder in the control group remained the same through all three assessments. CONCLUSION An effective, though small, weight loss was achieved. Changes in quality of life were also observed. Moreover, changes in external eating behavior were successful.
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Affiliation(s)
- Filipa Pimenta
- Psychology and Health Research Unit, ISPA – Instituto Universitário, Lisbon, Portugal
| | - Isabel Leal
- Psychology and Health Research Unit, ISPA – Instituto Universitário, Lisbon, Portugal
| | - João Maroco
- Psychology and Health Research Unit, ISPA – Instituto Universitário, Lisbon, Portugal
| | - Catarina Ramos
- Psychology and Health Research Unit, ISPA – Instituto Universitário, Lisbon, Portugal
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Davies M, Speight J. Patient-reported outcomes in trials of incretin-based therapies in patients with type 2 diabetes mellitus. Diabetes Obes Metab 2012; 14:882-92. [PMID: 22420869 DOI: 10.1111/j.1463-1326.2012.01595.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Incretin-based therapies have a glucose-dependent mode of action that results in excellent glucose-lowering efficacy with very low risk of hypoglycaemia, and weight neutrality [dipeptidyl peptidase-4 (DPP-4) inhibitors] or weight loss [glucagon-like peptide-1 (GLP-1) receptor agonists], in people with type 2 diabetes mellitus (T2DM). Patient-reported outcomes (PROs) complement physician evaluations of efficacy and tolerability and offer insights into the subjective experience of using modern diabetes treatments. We conducted a systematic search of clinical trials of the GLP-1 receptor agonists liraglutide, exenatide and long-acting exenatide, one of which included the oral DPP-4 inhibitor sitagliptin as a comparator. No other PRO data for DPP-4 inhibitors were identified. This review summarizes PRO data from eight clinical trials, the majority of which used the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and/or Impact of Weight on Quality of Life-Lite (IWQOL-Lite) to evaluate patient experience. People with T2DM were highly satisfied with modern incretin-based therapies compared with traditional therapies. Treatment satisfaction (including perceptions of convenience and flexibility) was high and generally higher with GLP-1 agonists in association with their greater glucose-lowering efficacy and tendency to facilitate weight loss. Weight-related quality of life (QoL) also improved in people using incretin therapies. The glycaemic improvements achieved with GLP-1 receptor agonists, coupled with the low incidence of hypoglycaemia and ability to cause weight loss, seemed to offset potential concern about injections. It is plausible that superior patient-reported benefits found in clinical trials may translate into improved, clinically meaningful, long-term outcomes through increased treatment acceptability. Long-term, prospective data are needed to ascertain whether this is the case in practice.
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Affiliation(s)
- M Davies
- Department of Cardiovascular Sciences, University of Leicester, UK.
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95
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Kolotkin RL, Westman EC, Østbye T, Crosby RD, Eisenson HJ, Binks M. Does Binge Eating Disorder Impact Weight-Related Quality of Life? ACTA ACUST UNITED AC 2012; 12:999-1005. [PMID: 15229340 DOI: 10.1038/oby.2004.122] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine whether binge eating disorder (BED) impacts weight-related quality of life in obese individuals seeking weight loss treatment and to investigate the role of psychological symptoms, BMI, and demographic variables in the relationship between BED and weight-related quality of life. RESEARCH METHODS AND PROCEDURES Three hundred seventeen women (BMI = 37.6) and 213 men (BMI = 41.3) completed questionnaires on admission into an intensive residential lifestyle modification program. Weight-related quality of life was assessed using the Impact of Weight on Quality of Life-Lite (IWQOL-Lite). The presence of BED was determined using the Questionnaire on Eating and Weight Patterns-Revised. Psychological symptoms were assessed using the Beck Depression Inventory and the global severity index of the Symptom Checklist 90-R. RESULTS BED prevalence in this sample was 17.9%. Participants with BED, in comparison with those without BED, were more likely to be women (75.8% vs. 56.3%, p < 0.001), younger (45.0 vs. 49.7 years, p = 0.003), white (98.9% vs. 91.7%), heavier (BMI = 42.0 vs. 38.5, p = 0.002), psychologically distressed, and more impaired on total IWQOL-Lite (51.5 vs. 65.3, p < 0.001) and all IWQOL-Lite subscales. However, after controlling for demographic variables, BMI, and psychological symptoms, BED was not independently associated with weight-related quality of life. DISCUSSION The association between BED and impairment in quality of life that has been previously reported in the literature may largely be accounted for by differences between those with and without BED on demographic variables, BMI, and psychological symptoms. BED does not seem to independently impact weight-related quality of life.
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Affiliation(s)
- Ronette L Kolotkin
- Obesity and Quality of Life Consulting, 1004 Norwood Avenue, Durham, NC 27707, USA.
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96
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White MA, O'Neil PM, Kolotkin RL, Byrne TK. Gender, Race, and Obesity-Related Quality of Life at Extreme Levels of Obesity. ACTA ACUST UNITED AC 2012; 12:949-55. [PMID: 15229334 DOI: 10.1038/oby.2004.116] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research investigating obesity-related quality of life (QOL) has shown that at increasing levels of overweight, individuals report more impaired QOL. Further, some research has indicated that white women suffer more impairment than men and African Americans. The current study sought to expand the existing literature by investigating an extreme subsample of the obese population. It was expected that participants in the current study would report more impaired obesity-related QOL than in previous research conducted with less obese individuals. It was also hypothesized that race and gender groups would differ in obesity-related QOL and that the relationship between degree of overweight and QOL would not be consistent across race and gender groups. RESEARCH METHODS AND PROCEDURES Impact of Weight on Quality of Life Questionnaire-Lite Version data were collected from 512 individuals seeking gastric bypass surgery (mean BMI = 53.3) RESULTS Results confirmed the study hypotheses. In general, white women reported the most QOL impairment, despite having significantly lower BMI than other race/gender groups. Compared with previous studies, the observed relationships between BMI and QOL were somewhat attenuated. DISCUSSION Various domains of QOL may be differentially affected by degree of obesity; these relationships are not homogeneous throughout the obese population.
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Affiliation(s)
- Marney A White
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston 29424, USA
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97
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A within-trial cost-effectiveness analysis of primary care referral to a commercial provider for weight loss treatment, relative to standard care--an international randomised controlled trial. Int J Obes (Lond) 2012; 37:828-34. [PMID: 22929209 PMCID: PMC3679478 DOI: 10.1038/ijo.2012.139] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Due to the high prevalence of overweight and obesity there is a need to identify cost-effective approaches for weight loss in primary care and community settings. Objective: We evaluated the cost effectiveness of two weight loss programmes of 1-year duration, either standard care (SC) as defined by national guidelines, or a commercial provider (Weight Watchers) (CP). Design: This analysis was based on a randomised controlled trial of 772 adults (87% female; age 47.4±12.9 years; body mass index 31.4±2.6 kg m−2) recruited by health professionals in primary care in Australia, United Kingdom and Germany. Both a health sector and societal perspective were adopted to calculate the cost per kilogram of weight loss and the ICER, expressed as the cost per quality adjusted life year (QALY). Results: The cost per kilogram of weight loss was USD122, 90 and 180 for the CP in Australia, the United Kingdom and Germany, respectively. For SC the cost was USD138, 151 and 133, respectively. From a health-sector perspective, the ICER for the CP relative to SC was USD18 266, 12 100 and 40 933 for Australia, the United Kingdom and Germany, respectively. Corresponding societal ICER figures were USD31 663, 24 996 and 51 571. Conclusion: The CP was a cost-effective approach from a health funder and societal perspective. Despite participants in the CP group attending two to three times more meetings than the SC group, the CP was still cost effective even including these added patient travel costs. This study indicates that it is cost effective for general practitioners (GPs) to refer overweight and obese patients to a CP, which may be better value than expending public funds on GP visits to manage this problem.
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98
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Andrés A, Saldaña C, Mesa J, Lecube A. Psychometric evaluation of the IWQOL-Lite (Spanish version) when applied to a sample of obese patients awaiting bariatric surgery. Obes Surg 2012; 22:802-9. [PMID: 21898041 DOI: 10.1007/s11695-011-0518-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obesity may have an impact on key aspects of health-related quality of life (HRQOL). In this context, the Impact of Weight Quality of Life (IWQOL) questionnaire was the first scale designed to assess HRQOL. The aim of the present study was twofold: to assess HRQOL in a sample of Spanish patients awaiting bariatric surgery and to determine the psychometric properties of the IWQOL-Lite and its sensitivity to detect differences in HRQOL across groups. METHODS Participants were 109 obese adult patients (BMI ≥ 35 kg/m(2)) from Barcelona, to whom the following measurement instruments were applied: IWQOL-Lite, Depression Anxiety Stress Scales, Brief Symptom Inventory, and self-perception items. RESULTS Descriptive data regarding the IWQOL-Lite scores obtained by these patients are reported. Principal components analysis revealed a five-factor model accounting for 72.05% of the total variance, with factor loadings being adequate for all items. Corrected item-total correlations were acceptable for all items. Cronbach's alpha coefficients were excellent both for the subscales (0.88-0.93) and the total scale (0.95). The relationship between the IWQOL-Lite and other variables supports the construct validity of the scale. Finally, sensitivity analysis revealed large effect sizes when comparing scores obtained by extreme BMI groups. CONCLUSIONS This is the first study to report the application of the IWQOL-Lite to a sample of Spanish patients awaiting bariatric surgery and to confirm that the Spanish version of the instrument has adequate psychometric properties.
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Affiliation(s)
- Ana Andrés
- Department of Methodology for the Behavioural Sciences, University of Barcelona, Passeig Vall d'Hebron 171, 08035 Barcelona, Spain.
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Verkleij SPJ, Adriaanse MC, Wendel-Vos GCW, Schuit AJ. Longitudinal relation between weight change and quality of life in a community-based population: a prospective cohort study. Eur J Public Health 2012; 23:285-90. [DOI: 10.1093/eurpub/cks058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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100
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Guimarães C, Martins M, Moutinho dos Santos J. Função pulmonar em doentes obesos submetidos a cirurgia bariátrica. REVISTA PORTUGUESA DE PNEUMOLOGIA 2012; 18:115-9. [DOI: 10.1016/j.rppneu.2012.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 01/03/2012] [Indexed: 11/26/2022] Open
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