Economic Burden of Obesity: A Systematic Literature Review

Visceral Adiposity Index (VAI) in Children and Adolescents with Obesity: No Association with Daily Energy Intake but Promising Tool to Identify Metabolic Syndrome (MetS)

(1) Background. Visceral adiposity index (VAI) has been recently identified as a new cardiometabolic risk marker reflecting abdominal fat distribution and dyslipidaemia. The aim of the present paper was to evaluate the relationship between VAI, daily energy intake and metabolic syndrome (MetS) in a cohort of obese Caucasian children and adolescents, aged 8 to 15 years. (2) Methods. Consecutive Italian children and adolescents with obesity, according to World Health Organization were enrolled. Anthropometric parameters and blood pressure were measured. Fasting blood samples have been analyzed for lipids, insulin and glucose levels. MetS was diagnosed using identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) or International Diabetes Federation (IDF) criteria according to age. Homeostatic model assessment index (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), A body shape index (ABSI) and VAI were calculated. Multivariable logistic regression analyses with sex, age and each anthropometric parameter (body mass index (BMI) z-score, ABSI, waist-to-height ratio (WHR)) or VAI was performed to predict MetS. Receiver operation curve (ROC) analysis was used to define the optimal VAI cut-off to identify MetS. Multiple regression was performed to predict the BMI z-score and VAI from daily energy intake after adjusting for age and sex. (3) Results. Six hundred and thirty-seven (313 boys and 324 girls) children and adolescents with obesity with median age 11 (interquartile range 10–13) years were included in the analysis. MetS was diagnosed in 79 patients. VAI correlated with BMI, WHR, ABSI, HOMA-IR, QUICKI, systolic blood pressure, low- and high-density lipoprotein cholesterol, triglycerides and triglycerides-to-HDL ratio (p < 0.050). Optimal VAI cut-off (AUC) values to identify MetS were 1.775 (0.774), 1.685 (0.776) and 1.875 (0.797) in the whole population, boys and girls, respectively. Energy intake was positively associated with BMI z-score but no association was found with VAI. (4) Conclusion. VAI is a promising tool to identify MetS in children and adolescents with obesity and should be used in the management of abdominal obesity together with dietary assessment.

Effects of Banana Resistant Starch on the Biochemical Indexes and Intestinal Flora of Obese Rats Induced by a High-Fat Diet and Their Correlation Analysis

The effects of banana resistant starch (BRS) on obesity-related metabolic and intestinal flora were investigated in a high-fat diet-induced obesity model. After 6 weeks of intervention, the glucolipid metabolism index [blood glucose (GLU), total cholesterol (TC), triacylglycerol (TG), low density lipoprotein-cholesterol (LDL-C), and high density lipoprotein-cholesterol (HDL-C)], hormone index [leptin (LEP), insulin (INS), ghrelin, adiponectin (ADP), and thyroxine (T4)], and 16S rRNA sequencing analyses were performed for each group to explore the regulating effect of intestinal flora and the mechanism of weight loss in obese rats. The results showed that (1) BRS intervention significantly reduced the levels of GLU, TG, TC, LDL-C, LEP, and INS (p < 0.01) and increased the contents of ghrelin (p < 0.05) and ADP (p < 0.01). (2) BRS could improve the diversity of intestinal flora and regulate the overall structure of intestinal microorganisms, mainly by upregulating the Bacteroides/Firmicutes ratio and the relative abundance of Cyanobacteria and downregulating the relative abundances of Deferribacteres and Tenericutes (at the phylum level). BRS could inhibit the proliferation of Turicibacter, Romboutsia, and Oligella and increase the abundances of Bacteroides, Ruminococcaceae, and Lachnospiraceae (at the genus level). (3) Some significant correlations were observed between the gut microbiota and biomarkers. Turicibacter, Romboutsia, and Oligella were positively correlated with GLU, TG, TC, LEP, and INS and negatively correlated with ghrelin and ADP. Bacteroides, Parabacteroides, and Akkermansia were negatively correlated with GLU, TG, and TC. Conclusion: BRS had promising effects on weight loss, which could be associated with the improvement in host metabolism by regulating intestinal flora.

Self-Nucleic Acid Sensing: A Novel Crucial Pathway Involved in Obesity-Mediated Metaflammation and Metabolic Syndrome

Obesity and overweight are a global health problem affecting almost one third of the world population. There are multiple complications associated with obesity including metabolic syndrome that commonly lead to development of type II diabetes and non-alcoholic fatty liver disease. The development of metabolic syndrome and severe complications associated with obesity is attributed to the chronic low-grade inflammation that occurs in metabolic tissues such as the liver and the white adipose tissue. In recent years, nucleic acids (mostly DNA), which accumulate systemically in obese individuals, were shown to aberrantly activate innate immune responses and thus to contribute to metabolic tissue inflammation. This minireview will focus on (i) the main sources and forms of nucleic acids that accumulate during obesity, (ii) the sensing pathways required for their detection, and (iii) the key cellular players involved in this process. Fully elucidating the role of nucleic acids in the induction of inflammation induced by obesity would promote the identification of new and long-awaited therapeutic approaches to limit obesity-mediated complications.

Understanding the genetic architecture of the metabolically unhealthy normal weight and metabolically healthy obese phenotypes in a Korean population

Understanding the mechanisms underlying the metabolically unhealthy normal weight (MUHNW) and metabolically healthy obese (MHO) phenotypes is important for developing strategies to prevent cardiometabolic diseases. Here, we conducted genome-wide association studies (GWASs) to identify the MUHNW and MHO genetic indices. The study dataset comprised genome-wide single-nucleotide polymorphism genotypes and epidemiological data from 49,915 subjects categorised into four phenotypes-metabolically healthy normal weight (MHNW), MUHNW, MHO, and metabolically unhealthy obese (MUHO). We conducted two GWASs using logistic regression analyses and adjustments for confounding variables (model 1: MHNW versus MUHNW and model 2: MHO versus MUHO). GCKR, ABCB11, CDKAL1, LPL, CDKN2B, NT5C2, APOA5, CETP, and APOC1 were associated with metabolically unhealthy phenotypes among normal weight individuals (model 1). LPL, APOA5, and CETP were associated with metabolically unhealthy phenotypes among obese individuals (model 2). The genes common to both models are related to lipid metabolism (LPL, APOA5, and CETP), and those associated with model 1 are related to insulin or glucose metabolism (GCKR, CDKAL1, and CDKN2B). This study reveals the genetic architecture of the MUHNW and MHO phenotypes in a Korean population-based cohort. These findings could help identify individuals at a high metabolic risk in normal weight and obese populations and provide potential novel targets for the management of metabolically unhealthy phenotypes.

Sustaining weight loss among adults with obesity using a digital meal planning and food purchasing platform for 12, 24, and 36 months: a longitudinal study

Background

Previous studies have shown that lifestyle changes, such as diet and exercise, can lead to weight loss, resulting in dramatic improvements in overall health and chronic disease risk. However, while many traditional dieting, food tracking and weight loss coaching programs result in short-term weight loss, there is less evidence of their effectiveness on sustaining weight loss over time.

Methods

We conducted a retrospective analysis of 1,740 adults with obesity who used Foodsmart, a digital personalized dietary assessment, meal planning and food purchasing platform. Participants reported age, gender, at least three measures of weight, and their diet using a food frequency questionnaire. We defined sustained weight loss as participants who lost 5 % of initial weight between their first and second reported weights and lost weight or maintained weight between second and third reported weights. A healthy eating score, Nutriscore, was calculated to assess overall diet quality. We used multivariate logistic regression models to examine the association between user characteristics and odds of sustained weight loss.

Results

Over a median of 25 months, the mean (standard deviation) change in weight among participants was − 6.2 (19.8) pounds. In total, 39.3 % (684/1,740) of participants lost at least 5 % of their initial weight, and 22.4 % percent (389/1,740) of participants sustained weight loss. In the fully-adjusted logistic regression model, we found that obesity class 2 (odds ratio, OR: 1.69, 95 % confidence interval, CI: 1.27–2.24, P < 0.001), obesity class 3 (OR: 2.23, 95 % CI: 1.68–2.97, P < 0.001), baseline diet quality (OR: 1.06, 95 % CI: 1.02–1.09, P < 0.001), and greater change in diet quality (OR: 1.10, 95 % CI: 1.07–1.14, P < 0.001) were significantly associated with sustained weight loss.

Conclusions

This study characterized and demonstrated the utility of Foodsmart, a digital platform that gives personalized nutrition recommendations and meal planning tools, in sustained weight reduction among users with obesity.

Association between Breakfast Skipping and Body Weight-A Systematic Review and Meta-Analysis of Observational Longitudinal Studies

Globally, increasing rates of obesity are one of the most important health issues. The association between breakfast skipping and body weight is contradictory between cross-sectional and interventional studies. This systematic review and meta-analysis aims to summarize this association based on observational longitudinal studies. We included prospective studies on breakfast skipping and overweight/obesity or weight change in adults. The literature was searched until September 2020 in PubMed and Web of Science. Summary risk ratios (RRs) or β coefficients with a 95% confidence interval (CI), respectively, were estimated in pairwise meta-analyses by applying a random-effects model. In total, nine studies were included in the systematic review and three of them were included in the meta-analyses. The meta-analyses indicated an 11% increased RR for overweight/obesity when breakfast was skipped on ≥3 days per week compared to ≤2 days per week (95% CI: 1.04, 1.19, n = two studies). The meta-analysis on body mass index (BMI) change displayed no difference between breakfast skipping and eating (β = −0.02; 95% CI: −0.05, 0.01; n = two studies). This study provides minimal evidence that breakfast skipping might lead to weight gain and the onset of overweight and obesity.

Effects of Coenzyme Q10 Supplementation on Anthropometric Indices in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background:

Obesity is related to increase in the incidence of morbidity and mortality. Previous studies have led to conflicting results regarding the effect of coenzyme Q10 (CoQ10) supplementation on anthropometric indices. This study aimed to evaluate the efficacy of CoQ10 supplementation on body weight, body mass index (BMI), and waist circumference (WC) through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods:

PubMed, Scopus, Web of Science, and Cochrane Library as well as the reference lists of the identified relevant RCTs were searched up to March 2019, and weighted mean differences (WMDs) were pooled by using the random-effects model.

Results:

Twenty RCTs (976 participants) were eligible to be included in the systematic review. The meta-analysis revealed that CoQ10 supplementation had no effect on body weight (WMD = −0.04 kg; 95% confidence interval [CI]: −1.96, 1.6; I² = 0.0%), BMI (WMD = −0.06 kg/m²; 95% CI: −0.54, 0.42; I² = 0.0%), and WC (WMD = 0.79 cm; 95% CI: −2.83, 0.04; I² = 0.0%).

Conclusions:

CoQ10 supplementation might not improve anthropometric indices. Future well-designed trials are still needed to confirm these results.

Spatial analysis of the prevalence of obesity and overweight among women in Ghana

OBJECTIVE

Identifying hot spots for the overweight aids in effective public health interventions due to the associated public health burden and morbidities. This study, therefore aimed to explore and determine the spatial disparities in the overweight/obesity prevalence among women in Ghana. The study also aims at modelling the average body mass index (BMI) values using the spatial regression and the performance compared with the standard regression model.

DESIGN

This is a cross-sectional study using data from the 2014 Ghana Demographic and Health Survey (GDHS).

SETTING

The study was set in Ghana.

PARTICIPANTS AND METHODS

Data on 4393 non-pregnant women aged 15-49 years from the 2014 GDHS. Both global (Moran's I) and the local indicators for spatial dependence were examined through the mapped BMI values across the country by clusters. An estimated spatial lag model was used to explain the spatial differences in the average body sizes of women.

RESULTS

The overall prevalence of overweight/obesity among reproductive women in Ghana was 35.4%, and this was highly prevalent among educated women (p<0.001), those from wealthy households (p<0.001) and dwelling in an urban setting (p<0.001). Significant clustering (Moran's I=0.3145, p<0.01) of overweight/obesity was observed with hot spots (clustering) in Greater Accra, Central, Western and Ashanti regions. The spatial lag model was the best fit based on the Likelihood ratio test and the Akaike information criterion and Bayesian information criterion values. The mean age of women and household wealth were significant factors accounting for the increase in the average cluster body size (BMI) of women and the spatial differences.

CONCLUSION

The prevalence of overweight/obesity was high and spatially clustered in the southern, middle and coastal regions. Geographic specific and effective public health interventions and strategies are needed to address the growing morbidity burden associated with the rise in the average body sizes of reproductive women.

Diet quality improvement and 30-year population health and economic outcomes: a microsimulation study

OBJECTIVE

Diets closer aligned with nutritional guidelines could lower the risk of several chronic conditions and improve economic outcomes, such as employment and healthcare costs. However, little is known about the range, order of magnitude and timing of these potential effects.

DESIGN

We used a microsimulation approach to predict US population changes over 30 years in health and economic outcomes that could result from a substantial (but not impossible) improvement in diet quality - an improvement from the third to the fifth quintile of US scores on the Alternate Healthy Eating Index, 2010 version.

SETTING

Risk ratios from the literature for diabetes, heart disease and stroke were used to modify the Future Adult Model (FAM) to simulate outcomes from a higher-quality diet. Model parameter uncertainty was assessed using bootstrap and sensitivity analysis examined the variation in published risk ratios.

PARTICIPANTS

FAM simulates outcomes for the US adult population aged 25 and older.

RESULTS

Improved diet quality initially leads to very small changes in chronic disease prevalence, but these accumulate over time. If diets improved beginning in 2019, after 30 years diabetes prevalence could be reduced by 5·9 million cases (11·5 %), heart disease prevalence by 4·0 million cases (7·2 %) and stroke prevalence by 1·9 million cases (10·3 %). These reductions in disease prevalence would be accompanied that same year by fewer deaths (88 000) and healthcare cost savings of $144·0 billion (2019 USD).

CONCLUSIONS

This microsimulation study suggests that improvements in diet are likely to improve health and economic population outcomes over time.

Keeping weight off: Mindfulness-Based Stress Reduction alters amygdala functional connectivity during weight loss maintenance in a randomized control trial

Obesity is associated with significant comorbidities and financial costs. While behavioral interventions produce clinically meaningful weight loss, weight loss maintenance is challenging. The objective was to improve understanding of the neural and psychological mechanisms modified by mindfulness that may predict clinical outcomes. Individuals who intentionally recently lost weight were randomized to Mindfulness-Based Stress Reduction (MBSR) or a control healthy living course. Anthropometric and psychological factors were measured at baseline, 8 weeks and 6 months. Functional connectivity (FC) analysis was performed at baseline and 8 weeks to examine FC changes between regions of interest selected a priori, and independent components identified by independent component analysis. The association of pre-post FC changes with 6-month weight and psychometric outcomes was then analyzed. Significant group x time interaction was found for FC between the amygdala and ventromedial prefrontal cortex, such that FC increased in the MBSR group and decreased in controls. Non-significant changes in weight were observed at 6 months, where the mindfulness group maintained their weight while the controls showed a weight increase of 3.4% in BMI. Change in FC at 8-weeks between ventromedial prefrontal cortex and several ROIs was associated with change in depression symptoms but not weight at 6 months. This pilot study provides preliminary evidence of neural mechanisms that may be involved in MBSR’s impact on weight loss maintenance that may be useful for designing future clinical trials and mechanistic studies.

Investigating the Adipose Tissue Secretome: A Protocol to Generate High-Quality Samples Appropriate for Comprehensive Proteomic Profiling

In this chapter we describe in detail how to prepare a sample containing the complete set of secretion products from primary adipocytes, which are suitable for comprehensive and sensitive secretome analysis. The underlying protocol should be seen as starting point guiding through critical steps of the complex workflow of preperation of secretomes. For diverse research questions and in the context of different sample types used, the protocol has to be carefully adjusted in order to approximate to the real secretome.

Effect-directed analysis and chemical identification of agonists of peroxisome proliferator-activated receptors in white button mushroom

Obesity has a serious effect on human health. It relates to metabolic syndrome, including the associated disorders such as type 2 diabetes, heart disease, stroke and hyperemia. The peroxisome proliferator-activated receptors (PPARs) are important receptors to control fat metabolism in the human body. Because of the safety concerns of synthetic drugs targeting PPARs, ligands from natural sources have drawn interest. Earlier, we have found high PPAR activities in extracts from Agaricus bisporus (white button mushroom, WBM). WBM contains a wide range of candidate compounds which could be agonists of PPARs. To identify which compounds are responsible for PPAR activation by WBM extracts, we used fractionation coupled to effect-directed analysis with reporter gene assays specific for all three PPARs for purification and LC/MS-TOF and NMR for compound identification in purified active fractions. Surprisingly, we identified the relatively common dietary fatty acid, linoleic acid, as the main ligand of PPARs in WBM. Possibly, the relatively low levels of linoleic acid in WBM are sufficient and instrumental in inducing its anti-obesogenic effects, avoiding high energy intake and negative health effects associated with high levels of linoleic acid consumption. However, it could not be excluded that a minor relatively potent compound contributes towards PPAR activation, while the anti-obesity effects of WBM may be further enhanced by receptor expression modulating compounds or compounds with completely PPAR unrelated modes of action.

Discovery of a Positive Allosteric Modulator of Cholecystokinin Action at CCK1R in Normal and Elevated Cholesterol

Drugs useful in prevention/treatment of obesity could improve health. Cholecystokinin (CCK) is a key regulator of appetite, working through the type 1 CCK receptor (CCK1R); however, full agonists have not stimulated more weight loss than dieting. We proposed an alternate strategy to target this receptor, while reducing likelihood of side effects and/or toxicity. Positive allosteric modulators (PAMs) with minimal intrinsic agonist activity would enhance CCK action, while maintaining spatial and temporal characteristics of physiologic signaling. This could correct abnormal stimulus-activity coupling observed in a high-cholesterol environment observed in obesity. We utilized high-throughput screening to identify a molecule with this pharmacological profile and studied its basis of action. Compound 1 was a weak partial agonist, with PAM activity to enhance CCK action at CCK1R, but not CCK2R, maintained in both normal and high cholesterol. Compound 1 (10 µM) did not exhibit agonist activity or stimulate internalization of CCK1R. It enhanced CCK activity by slowing the off-rate of bound hormone, increasing its binding affinity. Computational docking of Compound 1 to CCK1R yielded plausible poses. A radioiodinatable photolabile analogue retained Compound 1 pharmacology and covalently labeled CCK1R Thr²¹¹, consistent with one proposed pose. Our study identifies a novel, selective, CCK1R PAM that binds to the receptor to enhance action of CCK-8 and CCK-58 in both normal and disease-mimicking high-cholesterol environments. This facilitates the development of compounds that target the physiologic spatial and temporal engagement of CCK1R by CCK that underpins its critical role in metabolic regulation.

Case Report: Liraglutide for Weight Management in Beckwith-Wiedemann Syndromic Obesity

Genetic obesity, including syndromic and non-syndromic forms, represents a minority of cases compared to essential obesity but gene dysregulations lead to complex clinical conditions that make their management particularly difficult. Among them, Beckwith-Wiedemann syndrome (BWS) is a multisystem human genomic imprinting disorder characterized by overgrowth. We describe the first case of liraglutide treatment in an 18-year-old boy patient affected by BWS complicated by macroglossia, cryptorchidism, nephroblastoma, organomegaly, microscopic lymphocytic colitis, pharmacologically treated arterial hypertension, obesity, and obstructive sleep apnea syndrome. He presented a normal cognitive development. Body mass index at the time of first transition visit in the adult endocrinology department at the age of 18-years-old was 40.6 kg/m² without glucose metabolism impairment. Lifestyle interventions failed because of poor compliance. During 20 months of 3.0 mg liraglutide treatment, a weight loss of 19 kg (-13.3%) and BMI reduction of 6.8 points were registered without side effects. To date, liraglutide treatment was effective on obesity in 7 subjects with Prader Willy Syndrome and 14 with melanocortin-4 receptor mutations. The efficacy of liraglutide in BWS could be related to a crosstalk among glucagon-like peptide (GLP)-1 system, mechanisms related to the cyclin-dependent kinase inhibitor 1C (CDKN1C), and dopamine mesolimbic circuit. Clinical trials aiming at a tailored medicine in genetic obesity are needed.

Association Between Aggressive Clinicopathologic Features of Papillary Thyroid Carcinoma and Body Mass Index: A Systematic Review and Meta-Analysis

BACKGROUND

The association between adiposity and papillary thyroid carcinoma (PTC) has been reported in several studies, but its association with aggressive clinicopathologic features is not well-recognized. Our aim is to systematically review the literature to identify whether adiposity, expressed through Body Mass Index (BMI), is related to aggressive clinicopathologic features such as tumor-node-metastasis (TNM) stage, extrathyroidal extension (ETE), lymph node (LN) metastasis and multifocality in patients with PTC.

METHODS

A systematic search for articles was performed using the PubMed, EBSCO, and Cochrane Library for all articles published in English until December 2020. Specific keywords such as "papillary thyroid carcinoma", "Body Mass Index", "clinicopathologic features" were used in the search strategy. Two independent reviewers screened all retrieved articles based on predefined inclusion and exclusion criteria. Meta-analysis was performed in the studies that reported crude and adjusted odds ratios (OR). The methodological quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 11 retrospective cohort studies involving 26,196 participants included. Our findings showed that elevated BMI was significantly associated with ETE in both overweight (OR 1.26, 95% CI: 1.09-1.44) and obesity group (OR 1.45, 95% CI:1.26-1.64). Elevated BMI was also significantly associated with multifocality in overweight patients (OR 1.17, 95% CI:1.10-1.24) and obese patients (OR 1.45, 95% CI:1.29-1.62). Also, obesity was significantly associated with increased tumor size (OR 1.77, 95% CI:1.52-2.03) and with LN metastasis (OR 1.28, 95% CI: 1.12-1.44), whereas being overweight was significantly associated with advanced TNM stage (OR 1.55, 95% CI:1.27-1.83).

CONCLUSION

Our results provide strong evidence for the association between higher BMI and ETE, multifocality, and tumor size. Further studies with a larger number of participants are required to elucidate further the association of increased BMI with advanced TNM stage and LN metastasis.

Effectiveness of a Program Based on Telehealth in Nutritional Knowledge and Body Mass Index in Peruvian University Teachers

BACKGROUND

University teachers, as agents of socialization, are one of the most influential groups in improving public health, and their nutritional knowledge can influence both the eating behavior of students and the family.

OBJECTIVE

This study was carried out to evaluate the effect of a telehealth program on the level of nutritional knowledge and body mass index (BMI) of university teachers.

METHODS

A pre-experimental study was carried out from August to December 2020. A pretest and a posttest were applied. The number of teachers in the initial test was 88 and those included in the final evaluation, 83; and they were selected by nonprobability sampling for convenience. The telehealth-based program lasted 18 weeks and included basic information on nutrition and motivational messages. Sociodemographic and anthropometric data were collected through a predesigned questionnaire before and after the educational program.

RESULTS

Posttest knowledge scores increased significantly from 6.40 ± 1.70 to 10.59 ± 1.18 (P < .001). In relation to time, significant variations are observed in weight measurements (P < .001), BMI (P < .001), and basic nutritional knowledge (P < .001) before and after the intervention program.

CONCLUSION

The telehealth-based intervention improved basic nutritional knowledge levels and BMI. Likewise, the current findings provide evidence on the importance and need to develop future nutritional education programs that comprehensively encompass all study plans for the benefit of the university community.

An assessment of rapamycin for weakening binge-eating memories via reconsolidation: a pre-registered, double-blind randomised placebo-controlled experimental study

BACKGROUND

Maladaptive learning linking environmental food cues to high-palatability food reward plays a central role in overconsumption in obesity and binge eating disorders. The process of memory reconsolidation offers a mechanism to weaken such learning, potentially ameliorating over-eating behaviour. Here we investigated whether putatively interfering with synaptic plasticity using the mammalian target of rapamycin (mTOR) inhibitor, rapamycin, could weaken retrieved chocolate reward memories through blockade of reconsolidation.

METHODS

Seventy five healthy volunteers with a tendency to binge eat chocolate were randomised to retrieve chocolate reward memory under 10 mg rapamycin (RET + RAP, active condition), or placebo (RET + PBO), or they received 10 mg rapamycin without subsequent retrieval (NO RET + RAP). Indices of chocolate reward memory strength were assessed one week pre and post manipulation and at one month follow-up.

RESULTS

Contrary to hypotheses, the RET + RAP group did not show any greater reduction than control groups on indices of motivational salience of chocolate cues, motivation to consume chocolate or liking of chocolate. Mild evidence of improvement in the RET + RAP group was found, but this was limited to reduced chocolate binge episodes and improved healthy food choices.

CONCLUSIONS

We did not find convincing evidence of comprehensive naturalistic chocolate reward memory reconsolidation blockade by rapamycin. The effects on chocolate bingeing and food choices may warrant further investigation. These limited positive findings may be attributable to insufficient interference with mTOR signalling with 10 mg rapamycin, or failure to destabilise chocolate memories during retrieval.

Intermittent Versus Continuous Energy Restriction for Weight Loss and Metabolic Improvement: A Meta-Analysis and Systematic Review

OBJECTIVE

This study aimed to evaluate the effects of intermittent energy restriction (IER; only for 2-3 d/wk) versus continuous energy restriction (CER) on weight loss and metabolic outcomes in adults with overweight or obesity.

METHODS

Methods included searching databases from the last decade to December 18, 2019, for randomized controlled trials (RCTs) that assessed weight loss and metabolic outcomes in IER and CER. RevMan version 5.3 software was used for statistical analysis of the data. The effect sizes were expressed as weight mean differences and 95% CI.

RESULTS

This review included 11 RCTs (n = 850). Meta-analysis showed that IER had greater effects on absolute weight loss, the percentage of weight loss, and improving insulin sensitivity than CER. In the subgroup analysis, short-term (2-3 months) intervention (P < 0.0001) was associated with weight loss.

CONCLUSIONS

This systematic review shows that IER (2-3 d/wk) had greater effects on short-term weight loss than CER and that IER results in comparative metabolic improvements. Furthermore, longer RCTs are needed to validate these findings.

Modeling Obesity in Norway (The MOON Study): A Decision-Analytic Approach-Prevalence, Costs, and Years of Life Lost

BACKGROUND

Limited knowledge exists on the expected long-term effects and cost-effectiveness of initiatives aiming to reduce the burden of obesity.

AIM

To develop a Norwegian obesity-focused disease-simulation model: the MOON model.

MATERIAL AND METHODS

We developed a Markov model and simulated a Norwegian birth cohort's movement between the health states "normal weight,""overweight,""obese 1,""obese 2," and "dead" using a lifetime perspective. Model input was estimated using longitudinal data from health surveys and real-world data (RWD) from local and national registers (N = 99,348). The model is deterministic and probabilistic and stratified by gender. Model validity was assessed by estimating the cohort's expected prevalence, health care costs, and mortality related to overweight and obesity.

RESULTS

Throughout the cohort's life, the prevalence of overweight increased steadily and stabilized at 45% at 45 y of age. The number of obese 1 and 2 individuals peaked at age 75 y, when 44% of women and 35% of men were obese. The incremental costs per person associated with obesity was highest in older ages and, when accumulated over the lifetime, higher among women (€12,118, €9,495-€15,047) than men (€6,646, €5,252-€10,900). On average, obesity shortened the life expectancy of women/men in the whole cohort by 1.31/1.08 y. The life expectancy for normal-weight women/men at age 30 was 83.31/80.31. The life expectancy was reduced by 1.05/0.65 y if the individual was overweight, obese (2.87/2.71 y), or obese 2 (4.06/4.83 y).

CONCLUSION

The high expected prevalence of obesity in the future will lead to substantial health care costs and large losses in life-years. This underscores the need to implement interventions to reduce the burden of obesity; the MOON model will enable economic evaluations for a wide range of interventions.

Transition Patterns of Weight Status and Their Predictive Lipid Markers Among Chinese Adults: A Longitudinal Cohort Study Using the Multistate Markov Model

BACKGROUND

Obesity is well recognized as a risk factor for cardiometabolic diseases. The development of obesity is a dynamic process that can be described as a multistate process with an emphasis on transitions between weight states. However, it is still unclear what convenient biomarkers predict transitions between weight states. The aim of this study was to show the dynamic nature of weight status in adults stratified by age and sex and to explore blood markers of metabolic syndrome (MetS) that predict transitions between weight states.

METHODS

This study involved 9795 individuals aged 18 to 56 at study entry who underwent at least two health check-ups in the eight-year period of study in the health check-up centre of our institution. Weight, height and biochemical indices were measured at each check-up. The participants were divided into four groups based on age and sex (young male, middle-aged male, young female and middle-aged female groups). A multistate Markov model containing 3 states (healthy weight, overweight and obesity) was adopted to study the longitudinal weight data.

RESULTS

Young people were more likely to transit between weight states than middle-aged people, and middle-aged people were more resistant to recover from worse states. The mean sojourn time in obesity was greatest in the middle-aged male group (6.23 years), and the predicted rate of obesity beginning with healthy weight was greatest in the young male group (13.7%). In multivariate models, age group and triglyceride (TG) and high-density lipoprotein cholesterol (HDL) levels were significant for specific transitions in females, whereas age group and HDL levels were significant in males. In females, if HDL levels increased 1 mmol/L, the probability of progression from healthy weight to overweight decreased by 37.0% (HR= 0.63), and the probabilities of recovery (overweight to healthy weight and obesity to overweight) increased by 62.0% (HR= 1.62) and 1.23-fold (HR= 2.23), respectively. In males, if TG levels increased 1 mmol/L, the risk of progression from healthy weight to overweight increased by 24.0% (HR= 1.24). Each unit increase in HDL levels was associated with a 0.99-fold (HR= 1.99) increase in the chance of recovery from overweight to healthy weight and with a 0.37-fold (HR= 0.63) decrease in the risk of progression from healthy weight to overweight.

CONCLUSION

The weight status of young people was less stable than that of middle-aged people. Males were more likely to become overweight and more resistant to recover from worse states than females. Young males with healthy weight were more likely to develop obesity than other healthy weight groups. Blood lipid levels, especially HDL, were predictors of weight transitions in adults. Prevention and intervention measures should be applied early.

Obesogens: How They Are Identified and Molecular Mechanisms Underlying Their Action

Adult and childhood obesity have reached pandemic level proportions. The idea that caloric excess and insufficient levels of physical activity leads to obesity is a commonly accepted answer for unwanted weight gain. This paradigm offers an inconclusive explanation as the world continually moves towards an unhealthier and heavier existence irrespective of energy balance. Endocrine disrupting chemicals (EDCs) are chemicals that resemble natural hormones and disrupt endocrine function by interfering with the body's endogenous hormones. A subset of EDCs called obesogens have been found to cause metabolic disruptions such as increased fat storage, in vivo. Obesogens act on the metabolic system through multiple avenues and have been found to affect the homeostasis of a variety of systems such as the gut microbiome and adipose tissue functioning. Obesogenic compounds have been shown to cause metabolic disturbances later in life that can even pass into multiple future generations, post exposure. The rising rates of obesity and related metabolic disease are demanding increasing attention on chemical screening efforts and worldwide preventative strategies to keep the public and future generations safe. This review addresses the most current findings on known obesogens and their effects on the metabolic system, the mechanisms of action through which they act upon, and the screening efforts through which they were identified with. The interplay between obesogens, brown adipose tissue, and the gut microbiome are major topics that will be covered.

Greater and More Focused Measures Are Needed to Tackle Diabetes and Obesity Epidemics in the Nations of the Gulf Cooperation Council

Beyond the suffering of the affected subjects, type 2 diabetes (T2D) and obesity epidemics gripping the Gulf Cooperation Council (GCC) states are expected to seriously jeopardize these nations' economies and development due to productivity losses. Available data show that healthcare budgets in GCC nations are under tremendous pressure because of diabetes- and obesity-linked comorbidities. Furthermore, T2D, once an over-forties disease, risks becoming a whole-adult-life condition because of obesity-associated early-onset T2D and prediabetes. The incidence of T2D is set to worsen unless efficient actions are taken to fight obesity and prevent the conversion of prediabetes to T2D. There is a consensus that the concomitant increase in obesity rates drives T2D rates upward. Fighting obesity at all levels should, therefore, take center stage for the GCC nations. The battle against obesity and T2D is a long-term and complex one. Therefore, only through concerted efforts between several public and private actors, including health, economic, and urbanization agencies, food producers and retailers, schools, families, youth organizations, sports clubs, and voluntary organizations, can this battle be won. The present review tries to assess the current status of diabetes and obesity epidemics in the GCC context and take stock of some of the policies and initiatives that have been, or need to be, implemented to address their growing burden.

Exercise and fruit/vegetable intake, and their associations with body weight status in university students

Introduction

Background: evidence suggests that exposure to risk factors related to excess body weight is more frequent in the second and third decades of life. Thus, one of the most propitious environments for the acquisition of habits that can inhibit overweight is the university. Objective: to identify the frequency of aerobic and strength exercises and of fruit/vegetable intake in university students, and subsequently establish associations between both health behaviors and excess body weight. Methods: the sample was comprised of 5,310 university students. An online questionnaire was used to collect the frequency of exercises and fruit/vegetable intake. The body mass index was used to define body weight status. The data were analyzed statistically by employing a bivariate analysis and binary logistic regression. Results: the practice of aerobic and strength exercises was reported by 80.4 % and 51.6 % of the sample, respectively. Only 13 % of the surveyed university students had an adequate fruit/vegetable intake. The proportion of excess body weight was 39.1 %, the condition being significantly higher in men. The risk for excess body weight identified in the university students who reported not consuming fruits/vegetables daily was two to three times higher than in their peers who reported an adequate intake (women: OR = 2.92 [95 % CI 2.07-4.12]; men: OR = 1.98 [95 % CI 1.41-3.02]). Exposure to the risk for excess body weight was progressively lower as the reported frequency of aerobic exercise became higher. Conclusion: these findings suggest the need to promote initiatives aimed at the preparation and implementation of health education and promotion programs in the university context, through actions of guidance about exercise and food intake that may help to minimize the risks of onset and development of excess body weight.

Obesity Trends and Associations with Types of Physical Activity and Sedentary Behavior in US Adults: National Health and Nutrition Examination Survey, 2007-2016

OBJECTIVE

Physical activity (PA) and sedentary behavior (SB) have been linked to adult adiposity. This research aims to explore 10-year (2007-2016) trends in obesity and abdominal obesity prevalence and associations with different types of PA and SB among US adults.

METHODS

National Health and Nutrition Examination Survey (NHANES) data were used with 20- to 64-year-old adults (n = 20,360; mean age: 41.9 years; male: 50.5%; non-Hispanic White: 64.3%). Sex- and sex- and race-specific linear trends in the prevalence of obesity, abdominal obesity, and moderate and vigorous work- and recreation-related PA and SB were estimated. Weighted logistic models explored the association between risk of obesity or abdominal obesity with each type of PA and SB by sex, adjusted for relevant confounders.

RESULTS

There were significant increasing trends in obesity and abdominal obesity in both sexes and in Hispanic adults. Men at higher vigorous work-related PA levels (P = 0.045) and women at higher moderate recreational-related PA (P = 0.005) levels had decreased risk of abdominal obesity. Women at the highest versus the lowest level of SB had increased risk of abdominal obesity (P = 0.017).

CONCLUSIONS

There was a significantly reduced risk for abdominal obesity with a few types of PA among both sexes and an increased risk with SB among women only.

Association between RBC Indices, Anemia, and Obesity-Related Diseases Affected by Body Mass Index in Iranian Kurdish Population: Results from a Cohort Study in Western Iran

OBJECTIVE

The relationship between RBC indices and metabolic diseases remains unclear. The association between anemia and obesity is also controversial. The present study aimed to investigate the relationship between RBC indices and metabolic diseases caused by obesity and evaluate the effect of body mass index (BMI) on RBC indices on the Ravansar cohort data.

METHOD

For the purpose of this study, 9826 participants aged 35-65 years (5158 females and 4668 males) were recruited in the analyses. A quadratic prediction fit plot investigated the association between RBC indices with BMI and lipid profile. The odds ratio of obesity-related diseases in each quartile category of RBC indices and anemia was estimated using multivariable logistic regression models.

RESULTS

Subjects in the fourth quartiles of RBC count, hematocrit (HCT), hemoglobin (HGB), and red cell distribution width (RDW) had a higher risk for obesity-related diseases compared to the first quartiles. However, individuals with the mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) in fourth quartiles had lower ORs of obesity-related diseases. While BMI reduced the effect of RBC count, HCT, HGB, and RDW on the incidence risk of obesity-related disease, it increased the impact of MCV, MCH, and MCHC. There was a negative association between BMI and RBC indices except for RDW. The BMI effect on RBC indices was different in normal and obese individuals. BMI in mild anemia lowered the risk of metabolic diseases, but it increased the risk of metabolic diseases for moderate anemia.

CONCLUSION

A higher risk of obesity-related diseases was observed in the fourth quartiles of RBC count, HCT, HGB, and RDW compared to the first quartiles. However, the incidence risk was lower for MCV, MCH, and MCHC. BMI plays an anemia-type dependent role in the relationship. Consideration should be given to the type of anemia in the relationship between BMI and anemia.

The impact of sleep quality and duration on leptin, appetite, and obesity indices in adults

BACKGROUND Poor sleep duration and quality were previously reported to increase the risk of obesity. This study was aimed to evaluate the impact of sleep quality and duration on leptin, appetite, and adiposity in Indonesian adults. METHODS This cross-sectional study recruited adults in Yogyakarta, Indonesia, in 2016. Sleep quality was assessed using the Pittsburgh sleep quality index, appetite was evaluated using the community nutrition appetite questionnaire, and dietary intake was assessed by interviews using the semi-quantitative food frequency questionnaire. Sleep duration was also asked. Obesity indices were measured using the body mass index (BMI), waist-hip circumference, and percentage of body fat. Leptin was analyzed using the enzyme-linked immunosorbent assay. A Spearman analysis was done to evaluate the correlation between sleep quality, sleep duration, anthropometric measures, dietary intake, appetite, and leptin. RESULTS 244 adults participated in this study. This study showed that lower sleep quality and duration was significantly correlated with higher body weight (r = 0.129, p = 0.043 and r = −0.228, p<0.001), BMI (r = 0.176, p = 0.006 and r = −0.202, p = 0.001), and waist circumference (r = 0.179, p = 0.005 and r = −0.254, p<0.001). There was a correlation between poor sleep quality and higher leptin concentration (r = 0.186, p = 0.004). Sleep quality and duration were not associated with appetite (r = 0.109, p = 0.109 and r = −0.043, p = 0.500). CONCLUSIONS This study found that lower sleep quality was correlated with higher BMI, higher leptin concentration, but not appetite.

Effects of Physical Activity on Children's Motor Skill Development: A Systematic Review of Randomized Controlled Trials

Objective

This systematic review synthesized current randomized controlled trials (RCTs) examining casual evidence regarding the effects of traditional and exergaming-based physical activity (PA) interventions on motor skill development in typically developed children (i.e., those aged 6-12 years).

Methods

We adhered to the PRISMA-P statement and searched electronic databases (Medline, PsycInfo, Web of Science, PubMed, ERIC, Scopus, and SportDiscus) from inception through July 2020. We screened for peer reviewed RCTs published in English between 2000 and 2020 examining the effect of PA on motor skill development in healthy children.

Results

A total of 25 RCTs were included, 20 (80%) of which reported significant improvements in children's motor skill performance. Specifically, 18 studies examined traditional PA interventions and 7 studies examined exergaming-based PA interventions, 83% and 71% of which observed statistically significant improvements in children's motor skill development, respectively.

Conclusions

Findings support the causal evidence regarding the effects of PA on motor skill development in children. Notable limitations of this review included heterogeneity of measurement protocols and assessment tools used to test children's motor skills across studies, a wide range of PA intervention dose across studies, and the lack of power analyses and long-term follow-up assessments in individual studies to discern appropriate sample sizes and long-term effectiveness, respectively. To further strengthen the evidence in this emerging field, we advocate for future RCTs to employ a priori power analyses, long-term follow-up measurements, and more exergaming-based interventions to allow for comparisons with traditional PA interventions, to explore the dose response and moderating relationships between PA and motor skill development in childhood, and to utilize homogenous assessment instruments to allow for more rigorous, quantitative syntheses.

Sandwich ELISA-Based Electrochemical Biosensor for Leptin in Control and Diet-Induced Obesity Mouse Model

Leptin is a peptide hormone produced primarily in adipose tissues. Leptin is considered a biomarker associated with obesity and obesity-mediated diseases. Biosensor detection of leptin in the blood may play a critical role as an indicator of dynamic pathological changes. In this paper, we introduce an electrochemical biosensor that adopts o-Phenylenediamine (oPD) on screen-printed gold electrodes (SPGEs) for detecting the leptin from a mouse model of diet-induced obesity (DIO). A linear calibration curve for the leptin concentration was obtained in the ranges from 0.1 to 20 ng/mL with a lower detection limit of 0.033 ng/mL. The leptin concentration was quantified with HRP (horseradish peroxidase)-catalyzed oxidation of oPD by two voltammetry methods: cyclic voltammetry (CV) and square-wave voltammetry (SWV). The proposed sandwich enzyme-linked immunosorbent assay (ELISA)-based electrochemical biosensor for the leptin in mouse blood serum showed high stability, sensitivity, selectivity, and effectivity compared to the commercial Leptin ELISA measurement. Thus, we believe that this leptin biosensor can be a sensitive analytical tool to detect low-levels of biomarkers in clinics and point-of-care testing (POCT).

Body mass index and risk of obesity-related conditions in a cohort of 2.9 million people: Evidence from a UK primary care database

Objective

Obesity rates in the United Kingdom are some of the highest in Western Europe, with considerable clinical and societal impacts. Obesity is associated with type 2 diabetes (T2D), osteoarthritis, cardiovascular disease, and increased mortality; however, relatively few studies have examined the occurrence of multiple obesity‐related outcomes in the same patient population. This study was designed to examine the associations between body mass index (BMI) and a broad range of obesity‐related conditions in the same large cohort from a UK‐representative primary care database.

Methods

Demographic data and diagnosis codes were extracted from the Clinical Practice Research Datalink GOLD database in January 2019. Adults registered for ≥ 3 years were grouped by BMI, with BMI 18.5–24.9 kg/m² as reference group. Associations between BMI and 12 obesity‐related outcomes were estimated using Cox proportional hazard models, adjusted for age, sex, and smoking.

Results

More than 2.9 million individuals were included in the analyses and were followed up for occurrence of relevant outcomes for a median of 11.4 years during the study period. Generally, there was a stepwise increase in risk of all outcomes with higher BMI. Individuals with BMI 40.0–45.0 kg/m² were at particularly high risk of sleep apnea (hazard ratio [95% confidence interval] vs. reference group: 19.8 [18.9–20.8]), T2D (12.4 [12.1–12.7]), heart failure (3.46 [3.35–3.57]), and hypertension (3.21 [3.15–3.26]).

Conclusions

This study substantiates evidence linking higher BMI to higher risk of a range of serious health conditions, in a large, representative UK cohort. By focusing on obesity‐related conditions, this demonstrates the wider clinical impact and the healthcare burden of obesity, and highlights the vital importance of management, treatment approaches, and public health programs to mitigate the impact of this disease.

An exploration of lifestyle/obesity programmes for adults with intellectual disabilities through a realist lens: Impact of a 'context, mechanism and outcome' evaluation

BACKGROUND

Obesity is higher in people with intellectual disabilities.

AIMS

There are two aims of this explorative paper. Firstly, using a realist lens, to go beyond 'what works' and examine the 'context, mechanisms and outcomes' (CMO) of lifestyle/obesity programmes for this population. Second, using a logic model framework to inform how these programmes could be implemented within practice.

METHOD

We explored six-review papers and the individual lifestyle/obesity programmes that these papers reviewed using the CMO framework.

RESULTS

There were few theoretically underpinned, multi-component programmes that were effective in the short to long-term and many failed to explore the 'context and mechanisms'. We developed a logic model and engaged in two co-production workshops to refine this model.

DISCUSSION

Using a realist approach, programmes need to be underpinned by both individual and systems change theories, be multi-component, have a closer understanding of the interplay of the 'context and mechanisms', and co-designed using a logic model framework.

Culturing Articular Cartilage Explants in the Presence of Autologous Adipose Tissue Modifies Their Inflammatory Response to Lipopolysaccharide

The purpose of the current study was to explore the effect of autologous adipose tissue on cartilage responses to lipopolysaccharide (LPS). We hypothesized that LPS elicits an inflammatory response in cartilage, and that response is augmented in the presence of adipose tissue. Furthermore, we hypothesized that this augmented inflammatory response is due, at least in part, to increased exposure of cartilage to adipose tissue-derived c3a. Porcine cartilage explants from market-weight pigs were cultured in the presence or absence of autologous adipose tissue for 96 hours, the final 48 hours of which they were stimulated with LPS (0 or 10 μg/mL). Adipose tissue explants were also cultured alone, in the presence or absence of LPS. Media from all cartilage treatments was assayed for c3a/c3a des Arg, PGE₂, GAG, and NO, and the viability of cartilage tissue was determined by differential fluorescent staining. Media from adipose tissue explants was assayed for c3a/c3a des Arg and PGE₂. LPS produced a significant increase in PGE₂, GAG, and NO production when cartilage was cultured in the absence of adipose tissue. Coculture of adipose tissue prevented a significant increase in PGE₂ in cartilage explants. There was no effect of adipose tissue on LPS-induced GAG or NO, but the presence of adipose tissue significantly reduced cell viability in LPS-stimulated cartilage explants. Adipose tissue explants from lean animals reduced inflammatory responses of cartilage to LPS via a c3a/c3a des Arg-independent mechanism and were associated with a significant decline in cell viability. Thus, contrary to our hypothesis, adipose tissue from lean animals does not augment the inflammatory response of cartilage to stimulation by LPS. The mechanism of modulatory effects of adipose tissue on LPS-induced increase in PGE₂ and decline in chondrocyte viability requires further research but appears to have occurred via a mechanism that is independent of adipocentric c3a/c3a des Arg.

The Role of Eating Behaviours in Genetic Susceptibility to Obesity

PURPOSE OF REVIEW

Eating behaviours are hypothesised to be the behavioural expression of genetic risk of obesity. In this review, we summarise findings from behavioural genetic research on the association between genetic risk for obesity and validated psychometrics measures of eating behaviours in children and adults (published in the past 10 years).

RECENT FINDINGS

Twin studies have produced some evidence for a shared genetic aetiology underlying body mass index and eating behaviours. Studies using measured genetic susceptibility to obesity have suggested that increased genetic liability for obesity is associated with variation in obesogenic eating behaviours such as emotional and uncontrolled eating. More research on this topic is needed. Especially longitudinal studies using genetically sensitive designs to investigate the direction of genetic pathways between genetic liability of eating behaviours to weight and vice versa, as well as the potential subsequent link to eating disorders.

Present and Future of Digital Health in Diabetes and Metabolic Disease

The use of information and communication technology (ICT) in medical and healthcare services goes beyond everyday life. Expectations of a new medical environment, not previously experienced by ICT, exist in the near future. In particular, chronic metabolic diseases such as diabetes and obesity, have a high prevalence and high social and economic burden. In addition, the continuous evaluation and monitoring of daily life is important for effective treatment and management. Therefore, the wide use of ICTbased digital health systems is required for the treatment and management of these diseases. In this article, we compiled a variety of digital health technologies introduced to date in the field of diabetes and metabolic diseases.

Determination of Body Fat Ratio Standards in Children at Early School Age Using Bioelectric Impedance

Background and objectives: Body mass index (BMI) is commonly used to assess the proportionality of body mass; however, there are currently no standards for assessing the weight status of the child population for the needs of epidemiological studies. This study aims to establish bioelectric impedance analysis (BIA) standards for assessing the body weight of children (body fat, visceral fat) using BMI percentile growth charts. Materials and Methods: The study was implemented in a group of 1674 children (816 boys and 858 girls), ages 6 to 11. To classify the subjects at a percentile level, the percentile growth charts from the 6th national anthropological study in the Czech Republic were used. Body composition parameters were ascertained by BIA. Results: Body fat (%) and visceral fat standard values were determined for all age categories. The standards were in three-stages, enabling the determination of underweight, normal weight and overweight children aged 6-11 years. For boys with proportionate body mass, standard body fat values ranging from 14.3-16.0% to 15.5-18.0% were determined, while for girls' values ranging from 16.7-19.4% to 18.3-20.5% were determined, depending on age. As far as visceral fat is concerned, standard values in boys ranging from 30.3-36.9 cm2 to 36.1-44.9 cm2 and in girls 30.3-36.9 cm2 to 36.1-44.9 cm2 were determined, depending on age. Conclusions: Standards for assessing weight status are applicable to children aged 6-11 years, while it can be confirmed that BMI can be considered as an objective tool in assessing body mass and body composition in children.

Body Mass Index and stimulus control: Results from a real-world study of eating behaviour

BACKGROUND

Evidence suggests decisions about when, what, and how much to eat can be influenced by external (location, food outlet presence, food availability) and internal (affect) cues. Although the relationship between stimulus control and obesity is debated, it is suggested that individuals with higher BMIs are more driven by cues to eating than individuals in the healthy-weight range (HWR). This study investigates the influence of stimulus control on real-world food intake, and whether stimulus control differs by BMI. It was hypothesised that, compared to those in the HWR, eating among individuals with higher BMIs would be under greater stimulus control.

METHOD

74 participants (n = 34 BMI < 24.9, n = 40 BMI > 24.9) recorded food intake for 14 days using Ecological Momentary Assessment. Participants also responded to 4-5 randomly-timed assessments per day. Known external and internal eating cues were assessed during both assessment types. Within-person logistic regression analyses were used to predict eating vs. non-eating occasions from stimulus control domains.

FINDINGS

Results support the hypothesis that eating was influenced by stimulus control: food availability, affect, time of day, and location significantly distinguished between eating and non-eating instances (AUC-ROC = 0.56-0.69, all p's < 0.001). The presence of food outlets was significantly better at distinguishing between eating and non-eating instances for those with higher BMIs (compared to individuals in the HWR).

DISCUSSION

Results support the notion of stimulus control in shaping eating decisions. Differences in levels of stimulus control between participants in the HWR compared to those with a high BMI suggest that dietary improvement interventions may be more effective when they are tailored to the individual and consider environmental influences on eating behaviour.

Long-Term Changes in Weight in Patients With Severe and Complicated Obesity After Completion of a Milk-Based Meal Replacement Programme

Introduction: Even with very significant short term weight loss with intensive dietary restriction, subsequent weight regain remains a challenge for most patients. We sought to assess long-term weight change in patients with obesity following completion of a 24-week milk-based meal replacement programme. Methods: We conducted a retrospective cohort study of bariatric patients who completed our milk-based meal replacement programme. This programme started with an 8-week weight loss phase, followed by weight stabilization (8 weeks) and weight maintenance (8 weeks) phases, after which patients were followed up in the bariatric outpatient clinics. A paired sample t-test was used to compare mean differences in weight at the start and the end of the programme and at follow-up. Linear regression was used to identify predictors of weight regain. Results: In total, 78 patients had long term follow-up data at a mean of 34.4 ± 19.8 months after the start of the milk diet and were included in this analysis. Mean body mass index at baseline was 50.5 ± 7.6 kg m^-2, 41 (52.6%) were female and the mean age was 51.6 ± 12.0 (range 18.0-71.5) years. Weight decreased from144 ± 26 kg at the start of the milk diet to 121.2 ± 24 kg at completion (P < 0.001), with a non-significant trend upwards in the 1st and 2nd years of follow-up to 129.0 ± 27.7 (P = 0.07 compared to nadir) and 123.4 ± 29.0kg (P = 0.17), respectively. Although regains in the 3rd and 4th follow-up years were substantial to 131.0 ± 22.3 (P < 0.001), and 139.8 ± 35.4 kg (P < 0.001), there was still a moderate net weight loss of 4.7 [9.5, 0.21] and 7.0 [13.9, 0.26] kg (both P = 0.04) between the start and the 3rd and 4th follow-up years, respectively. The amount of weight regain was inversely associated with weight loss at completion of the programme, age, and directly associated with the duration of follow up in months (β = 1.2 [0.46, 1.9] P = 0.002). Conclusion: In patients with severe obesity who completed a milk-based meal replacement programme and lost a large amount of weight, over 4 years of follow-up there was very substantial weight regain. Greater initial weight loss and older age were associated with less subsequent weight regain.

The impact of genetic polymorphisms on weight regain after successful weight loss

Obesity is associated with an increased risk of various diseases and mortality. Although nearly 50 % of adults have been reported trying to lose weight, the prevalence of obesity has increased. One factor that hinders weight loss-induced decrease in obesity prevalence is weight regain. Although behavioural, psychological and physiological factors associated with weight regain have been reviewed, the information regarding the relationship between weight regain and genetics has not been previously summarised. In this paper, we comprehensively review the association between genetic polymorphisms and weight regain in adults and children with obesity after weight loss. Based on this information, identification of genetic polymorphism in patients who undergo weight loss intervention might be used to estimate their risks of weight regain. Additionally, the genetic-based risk estimation may be used as a guide for physicians and dietitians to provide each of their patients with the most appropriate strategies for weight loss and weight maintenance.

Causal associations between urinary sodium with body mass, shape and composition: a Mendelian randomization study

Observational studies have found associations between urinary sodium (UNa) with obesity, body shape and composition; but the findings may be biased by residual confounding. The objective of this two-sample Mendelian randomization (MR) study was to analyze their causal associations in both sex-combined and sex-specific models. Genome-wide association studies of UNa, body mass index (BMI), BMI-adjusted waist-to-hip ratio (WHR), body fat (BF) percentage and estimated glomerular filtration rate (eGFR) were identified. We initially extracted fifty SNPs associated with UNa at significance level of 5 × 10^–8, but further removed those SNPs with potential horizontal pleiotropy. Univariable and multivariable MR with adjustment for eGFR were performed. Inverse-variance weighted MR was performed as the primary analysis, with MR-Egger methods as sensitivity analysis. The potential bidirectional association between BMI and UNa was investigated. All exposure and outcomes were continuous, and the effect measure was regression coefficients (beta) and their 95% confidence intervals (95% CI). The total sample size was up to 322 154. UNa was causally associated with increased BMI in both men [eGFR-adjusted beta 0.443 (0.163–0.724)] and women [0.594 (0.333–0.855)]. UNa caused BF percentage increase in men [0.622 (0.268–0.976)] and women [0.334 (0.007–0.662)]. UNa significantly elevated BMI-adjusted WHR in men [0.321 (0.094–0.548)], but not in women [0.170 (− 0.052 to 0.391)]. Additionally, we found that BMI causally increased UNa [0.043 (0.023–0.063)]. UNa increased BMI and BF percentage. Salt intake affects male body shape by increasing BMI-adjusted WHR, but showed no effects on female body shape. The bidirectional association between BMI and UNa suggested that salt reduction measures and weight reduction measures should be implemented simultaneously to break the vicious cycle and gain more health benefits.

Beyond BMI for self-estimates of body size and shape: A new method for developing stimuli correctly calibrated for body composition

Accurate self-assessment of body shape and size plays a key role in the prevention, diagnosis, and treatment of both obesity and eating disorders. These chronic conditions cause significant health problems, reduced quality of life, and represent a major problem for health services. Variation in body shape depends on two aspects of composition: adiposity and muscularity. However, most self-assessment tools are unidimensional. They depict variation in adiposity only, typically quantified by the body mass index. This can lead to substantial, and clinically meaningful, errors in estimates of body shape and size. To solve this problem, we detail a method of creating biometrically valid body stimuli. We obtained high-resolution 3D body shape scans and composition measures from 397 volunteers (aged 18-45 years) and produced a statistical mapping between the two. This allowed us to create 3D computer-generated models of bodies, correctly calibrated for body composition (i.e., muscularity and adiposity). We show how these stimuli, whose shape changes are based on change in composition in two dimensions, can be used to match the body size and shape participants believe themselves to have, to the stimulus they see. We also show how multivariate multiple regression can be used to model shape change predicted by these 2D outcomes, so that participants' choices can be explained by their measured body composition together with other psychometric variables. Together, this approach should substantially improve the accuracy and precision with which self-assessments of body size and shape can be made in obese individuals and those suffering from eating disorders.

The effects of taxing sugar-sweetened beverages in Ecuador: An analysis across different income and consumption groups

To analyze the effects of taxing sugar-sweetened beverages (SSBs) in Ecuador, this study estimates a Quadratic Almost Ideal Demand System model using data from the 2011–2012 National Survey of Income and Expenditure for Urban and Rural Households. We derive own- and cross-price elasticities by income quintiles and consumption deciles for five beverages, including two types of sugary drink: (i) milk, (ii) soft drinks, (iii) water, (iv) other sugary drinks, and (v) coffee and tea. Overall, results show that a 20% increase in the price of SSBs will decrease the consumption of soft drinks and other sugary drinks by 27% and 22%, respectively. Heterogeneous consumer behavior is revealed across income and consumption groups, as well as policy-relevant complementarity and substitution patterns. Policy impacts are simulated by considering an 18 cents per liter tax, implemented in Ecuador, and an ad-valorem 20% tax on the price. Estimated tax revenues and weight loss are larger for the latter. From a health perspective, high-income and heavy consumer households would benefit the most from this policy. Our study supports an evidence-based debate on how to correctly design and monitor food policy.

U.S. Children Meeting Physical Activity, Screen Time, and Sleep Guidelines

INTRODUCTION

Physical inactivity, high screen time, and short sleep are targets of public health initiatives for children. However, few data exist on how many U.S. children meet guidelines for these behaviors-data vital to inform which needs greater targeting. This study describes national prevalence estimates of U.S. children who meet physical activity, screen time, and sleep guidelines alone or in combination across each childhood year.

METHODS

This analysis (completed in 2019) used cross-sectional data from the 2016-2017 National Survey of Children's Health, a nationally representative sample of U.S. children. Child physical activity (days per week with ≥60 minutes), recreational screen time (hours per day of TV viewing and electronic device use), and sleep duration (hours per day) were assessed through parental report. Guidelines recommend ≥60 minutes per day of physical activity, ≤2 hours per day of screen time, and 9-12 hours per day of sleep for individuals aged 6-12 years (8-10 hours for those aged 13-17 years).

RESULTS

Only 8.8% (95% CI=8.2%, 9.5%) of U.S. children meet all the 3 guidelines combined. Majority of children/adolescents attain the sleep guideline (86.0%, 95% CI=85.2%, 86.7%), but a lower proportion meet physical activity (23.0%, 95% CI=22.1%, 23.9%) or screen time (32.9%, 95% CI=31.9%, 33.8%) guidelines. A substantial age effect was identified, with prevalence of meeting each distinct guideline and all the 3 declining with age (p<0.001).

CONCLUSIONS

Few U.S. children meet all the 3 movement guidelines, with prevalence rates of children meeting guidelines declining with age. Although many meet sleep guidelines, few meet physical activity or screen time guidelines. Initiatives targeting physical activity and screen time, especially for adolescents, should be pursued.

Computational Tools for the Reliability Assessment and the Engineering Design of Procedures and Devices in Bariatric Surgery

Obesity is one of the main health concerns worldwide. Bariatric Surgery (BS) is the gold standard treatment for severe obesity. Nevertheless, unsatisfactory weight loss and complications can occur. The efficacy of BS is mainly defined on experiential bases; therefore, a more rational approach is required. The here reported activities aim to show the strength of experimental and computational biomechanics in evaluating stomach functionality depending on bariatric procedure. The experimental activities consisted in insufflation tests on samples of swine stomach to assess the pressure-volume behaviour both in pre- and post-surgical configurations. The investigation pertained to two main bariatric procedures: adjustable gastric banding (AGB) and laparoscopic sleeve gastrectomy (LSG). Subsequently, a computational model of the stomach was exploited to validate and to integrate results from experimental activities, as well as to broad the investigation to a wider scenario of surgical procedures and techniques. Furthermore, the computational approach allowed analysing stress and strain fields within stomach tissues because of food ingestion. Such fields elicit mechanical stimulation of gastric receptors, contributing to release satiety signals. Pressure-volume curves assessed stomach capacity and stiffness according to the surgical procedure. Both AGB and LSG proved to reduce stomach capacity and to increase stiffness, with markedly greater effect for LSG. At an internal pressure of 5 kPa, outcomes showed that in pre-surgical configuration the inflated volume was about 1000 mL, after AGB the inflated volume was slightly lower, while after LSG it fell significantly, reaching 100 mL. Computational modelling techniques showed the influence of bariatric intervention on mechanical stimulation of gastric receptors due to food ingestion. AGB markedly enhanced the mechanical stimulation within the fundus region, while LSG significantly reduced stress and strain intensities. Further computational investigations revealed the potentialities of hybrid endoscopic procedures to induce both reduction of stomach capacity and enhancement of gastric receptors mechanical stimulation. In conclusion, biomechanics proved to be useful for the investigation of BS effects. Future exploitations of the biomechanical methods may largely improve BS reliability, efficacy and penetration rate.

Semaglutide: Charting New Horizons in GLP-1 Analogue Outcome Studies

The growing epidemic of obesity and diabetes represents a growing health emergency, exemplified by a marked increase in cardiovascular and renal disease. As such, healthcare systems are increasingly focussing on therapeutic approaches to address these challenges. Cardiovascular outcome trials (CVOTs) evaluating glucagon-like peptide-1 (GLP-1) analogues have previously observed significant improvements in major adverse cardiac events in people with type 2 diabetes (T2D). However, their impact in obese people without T2D is unknown. The SELECT study is the first pharmacotherapy study in obesity powered for cardiovascular superiority and investigates the impact of semaglutide on cardiovascular disease outcomes in overweight and obese people without T2D. The results of this study will potentially redefine obesity management, especially as secondary outcomes of the study will include evaluation of health-related quality of life and incident diabetes rates. In another potentially evolutionary therapeutic step for the incretin class of therapeutic agents, the FLOW study is the first dedicated study to investigate the effects of GLP-1 receptor analogues on renal and cardiovascular outcomes in people with renal impairment and T2D. Post-hoc analyses of GLP-1 analogue CVOTs have demonstrated reduced adverse renal outcomes associated with their use. In this review we discuss the known impact of GLP-1 analogues on cardiovascular, weight and renal outcomes in previous CVOTs. We further discuss the importance of the ongoing SELECT and FLOW studies on shifting the paradigm of obesity pharmacotherapy and in adding to our understanding of renal disease management in people with T2D.

Acute beetroot juice supplementation improves exercise tolerance and cycling efficiency in adults with obesity

BACKGROUND

Exercise training improves health outcomes in individuals with obesity (IO); however, it remains challenging for IO to adhere to exercise. Thus, it is critical to identify novel strategies that improve exercise tolerance (ET) and adherence in IO. Beetroot juice (BRJ), high in inorganic dietary nitrate, consistently improves exercise performance in athletes, individuals with cardiopulmonary diseases, and nonobese lean individuals. These improvements may be explained by reduced oxygen uptake (VO2 ) during exercise, enhanced blood flow, and greater mitochondrial efficiency. To date, we are aware of no studies that have compared the effects of BRJ, sodium nitrate (NaNO3), and nitrate-depleted BRJ (PLA) for improving ET and cardiometabolic health in IO.

PURPOSE

Determine if BRJ improves ET, exercise efficiency (EE), and cardiometabolic health in IO and identify possible mechanisms of action.

METHODS

Vascular hemodynamic, submaximal- and maximal-exercise VO2 , and time to exhaustion (TTE) were assessed in 16 participants 2.5 hr following consumption of: 1) BRJ, 2) NaNO3 , 3) PLA, or 4) CON.

RESULTS

A significant treatment effect was observed for submaximal exercise VO2 (p = .003), and TTE (p < .001). Post hoc analyses revealed lower VO2 during submaximal exercise in BRJ compared to PLA (p = .009) NaNO3 (p = .042) and CON (0.009), equating to an average improvement of ~ 7% with BRJ. TTE was greater for BRJ compared to other treatment arms, PLA (p = .008), NaNO3 (p = .038), and CON (p=<0.001), equating to ~ 15% improvement with BRJ. No significant changes were observed for other outcomes.

CONCLUSIONS

Consumption of BRJ improved EE during submaximal exercise by 7%, and TTE by 15% compared to other conditions. These results suggest that BRJ may improve EE and exercise tolerance in IO.

Weight Reduction by the Low-Insulin-Method-A Randomized Controlled Trial

Continuous high insulin levels are associated with weight gain and lead to cardiometabolic diseases. Therefore, we have developed the Low-Insulin-Method and integrated it into the multi-component, occupational healthcare program SHAPE-AND-MOTION-Medical-Accompanied-Slimming (SAMMAS) to reduce daily insulin levels for long-term weight reduction in overweight or obesity. Employees were randomized into a starting intervention group (SI, n = 15) or waiting list control group (WL, n = 15). SAMMAS consisted of group-based seminars, low-carbohydrate nutrition including formula diet, continuous glucose monitoring, telemetric monitoring, and telemedical coaching. Both groups received telemetric devices at baseline. Intention-to-treat analyses were performed after 12, 26, and 52 weeks. The estimated treatment difference in weight reduction after 12 weeks, which is the primary endpoint of the study, showed a pronounced effect in favour of SI (−6.3 kg with (95% confidence interval) (−7.4; −4.5) (p < 0.001)) after 12 weeks. Furthermore, SI improved fasting blood glucose, HbA1c, quality of life, fasting insulin, blood pressure, and eating behaviour (all p < 0.05) in the within-group analysis, while WL did not. After 26 and 52 weeks, weight reduction could be maintained in the whole group (both groups together) by −6.7 kg (−9.5; −3.8) (p < 0.001) and −6.1 kg (−9.2; −2.7) (p < 0.01). SAMMAS supports clinically relevant weight reduction and long-term weight loss maintenance in individuals with overweight or obesity.

Obesity epidemic in urban Tanzania: a public health calamity in an already overwhelmed and fragmented health system

BACKGROUND

Worldwide, the epidemiological and demographic transitions have resulted in nutrition shift characterized by an increased consumption of high energy fast food products. In just over 3 decades, overweight and obesity rates have nearly tripled to currently affecting over a third of the global population. Notwithstanding the ever present under-nutrition burden, sub Saharan Africa (SSA) is witnessing a drastic escalation of overweight and obesity. We aimed to explore the prevalence and associated factors for obesity among residents of Dar es Salaam city in Tanzania.

METHODS

Participants from this study were recruited in a community screening conducted during the Dar es Salaam International Trade Fair. Sociodemographic and clinical data were gathered using a structured questionnaire during enrollment. Dietary habits and anthropometric measurements were assessed using standard methods. All statistical analyses utilized STATA v11.0 software. Pearson Chi square and Student's T-test were used to compare categorical and continuous variables respectively. Logistic regression analyses were used to assess for factors associated with BMI ≥ 25. All tests were 2-sided and p < 0.05 was used to denote a statistical significance.

RESULTS

A total of 6691 participants were enrolled. The mean age was 43.1 years and males constituted 54.2% of all participants. Over two-thirds of participants were alcohol consumers and 6.9% had a positive smoking history. 88.3% of participants were physically inactive, 4.7% had a history of diabetes mellitus and 18.1% were known to have elevated blood pressure. Overweight and obesity were observed in 34.8 and 32.4% of participants respectively. Among overweight and obese participants, 32.8% had a misperception of having a healthy weight. Age ≥ 40, female gender, a current working status, habitual breakfast skipping, poor water intake, high soft drink consumption, regular fast food intake, low vegetable and fruit consumption, alcohol consumption and hypertension were found to be independent associated factors for obesity.

CONCLUSION

Amidst the ever present undernutrition in SSA, a significant proportion of participants had excess body weight. Concomitantly, the rates of physical inactivity and unhealthy eating are disproportionately high in Dar es Salaam. In view of this, community-based and multilevel public health strategies to promote and maintain healthy eating and physical activity require an urgent step-up in urban Tanzania.

Facing obesity in pain rehabilitation clinics: Profiles of physical activity in patients with chronic pain and obesity-A study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Background

The obesity epidemic has influenced pain rehabilitation clinics. To date, little is known about baseline level of physical activity (PA) in patients referred to pain rehabilitation clinics. We aimed to investigate the PA levels of patients referred to pain rehabilitation clinics and to evaluate the effect of excess weight on PA level.

Methods and findings

Data were obtained from the Swedish Quality Registry for Pain Rehabilitation between 2016 and 2017. These data included PA time (everyday PA and physical exercise per week), Body Mass Index (BMI), sociodemographic factors, chronic pain and psychological aspects (e.g., pain intensity, depressive and anxiety symptoms and insomnia problems). Insufficient PA was defined as less than 150 minutes per week. We performed logistic regressions as well as orthogonal partial least square regression to estimate the effects of excess weight on PA. Over one-fourth of the patients were classified as obese (BMI ≥30 kg/m², 871/3110, 25.3%) and nearly one-third of these patients were classified as severely obese (BMI ≥35 kg/m², 242/871, 27.8%). Time estimations for physical exercise varied among the BMI groups, but patients in the higher BMI category were more likely to spend less time on everyday PA. Compared to normal weight, mild obesity [odds ratio (OR) 0.65, 95% confidence interval (CI) 0.53–0.81] and severe obesity (OR 0.56, 95% CI 0.42–0.74) were associated with less PA. Mild obese patients had an elevated risk of 65% and severe obese patients had an elevated risk of 96% for insufficient PA. Increased pain intensity was positively related to insufficient PA (OR 1.17, 95% CI 1.06–1.29) among the obese patients.

Conclusion

Having low PA is very common for patients referred to pain rehabilitation clinics, especially for those with comorbid obesity. As a first step to increase PA, obese patients need to be encouraged to increase the intensity and amount of less painful daily PA.

Gender medicine: Lessons from COVID-19 and other medical conditions for designing health policy

Gender-specific differences in the prevalence, incidence, comorbidities, prognosis, severity, risk factors, drug-related aspects and outcomes of various medical conditions are well documented. We present a literature review on the extent to which research in this field has developed over the years, and reveal gaps in gender-sensitive awareness between the clinical portrayal and the translation into gender-specific treatment regimens, guidelines and into gender-oriented preventive strategies and health policies. Subsequently, through the lens of gender, we describe these domains in detail for four selected medical conditions: Asthma, obesity and overweight, chronic kidney disease and coronavirus disease 2019. As some of the key gender differences become more apparent during adolescence, we focus on this developmental stage. Finally, we propose a model which is based on three influential issues: (1) Investigating gender-specific medical profiles of related health conditions, rather than a single disease; (2) The dynamics of gender disparities across developmental stages; and (3) An integrative approach which takes into account additional risk factors (ethnicity, socio-demographic variables, minorities, lifestyle habits etc.). Increasing the awareness of gender-specific medicine in daily practice and in tailored guidelines, already among adolescents, may reduce inequities, facilitate the prediction of future trends and properly address the characteristics and needs of certain subpopulations within each gender.