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Charlot A, Bringolf A, Mallard J, Charles AL, Niederhoffer N, Duteil D, Pagano AF, Geny B, Zoll J. Hypercaloric low-carbohydrate high-fat diet protects against the development of nonalcoholic fatty liver disease in obese mice in contrast to isocaloric Western diet. Front Nutr 2024; 11:1366883. [PMID: 38571752 PMCID: PMC10987868 DOI: 10.3389/fnut.2024.1366883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Objective Obesity and metabolic complications, such as type 2 diabetes and nonalcoholic fatty liver disease (NAFLD), are one of the greatest public health challenges of the 21st century. The major role of high sugar and carbohydrate consumption rather than caloric intake in obesity and NAFLD pathophysiology remains a subject of debate. A low-carbohydrate but high-fat diet (LCHFD) has shown promising results in obesity management, but its effects in preventing NAFLD need to be detailed. This study aims to compare the effects of a LCHFD with a high-fat high-sugar obesogenic Western diet (WD) on the progression of obesity, type 2 diabetes, and nonalcoholic fatty liver disease. Methods Male C57BL/6J mice were initially fed a WD for 10 weeks. Subsequently, they were either switched to a LCHFD or maintained on the WD for an additional 6 weeks. Hepatic effects of the diet were explored by histological staining and RT-qPCR. Results After the initial 10 weeks WD feeding, LCHF diet demonstrated effectiveness in halting weight gain, maintaining a normal glucose tolerance and insulin levels, in comparison to the WD-fed mice, which developed obesity, glucose intolerance, increased insulin levels and induced NAFLD. In the liver, LCHFD mitigated the accumulation of hepatic triglycerides and the increase in Fasn relative gene expression compared to the WD mice. Beneficial effects of the LCHFD occurred despite a similar calorie intake compared to the WD mice. Conclusion Our results emphasize the negative impact of a high sugar/carbohydrate and lipid association for obesity progression and NAFLD development. LCHFD has shown beneficial effects for NAFLD management, notably improving weight management, and maintaining a normal glucose tolerance and liver health.
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Affiliation(s)
- Anouk Charlot
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondrie, Stress oxydant et Plasticité musculaire”, University of Strasbourg, Strasbourg, France
- Faculty of Sport Sciences, University of Strasbourg, Strasbourg, France
| | - Anthony Bringolf
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondrie, Stress oxydant et Plasticité musculaire”, University of Strasbourg, Strasbourg, France
| | - Joris Mallard
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondrie, Stress oxydant et Plasticité musculaire”, University of Strasbourg, Strasbourg, France
- Faculty of Sport Sciences, University of Strasbourg, Strasbourg, France
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Anne-Laure Charles
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondrie, Stress oxydant et Plasticité musculaire”, University of Strasbourg, Strasbourg, France
- Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Nathalie Niederhoffer
- Biomedicine Research Center of Strasbourg (CRBS), UR7296, NeuroCardiovascular Pharmacology and Toxicology Laboratory (LPTNC), University of Strasbourg, Strasbourg, France
| | - Delphine Duteil
- University of Strasbourg, CNRS, Inserm, IGBMC UMR 7104-UMR-S 1258, Illkirch, France
| | - Allan F. Pagano
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondrie, Stress oxydant et Plasticité musculaire”, University of Strasbourg, Strasbourg, France
- Faculty of Sport Sciences, University of Strasbourg, Strasbourg, France
| | - Bernard Geny
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondrie, Stress oxydant et Plasticité musculaire”, University of Strasbourg, Strasbourg, France
- Service de Physiologie et explorations fonctionnelles, University Hospital of Strasbourg, Strasbourg, France
| | - Joffrey Zoll
- Biomedicine Research Center of Strasbourg (CRBS), UR 3072, “Mitochondrie, Stress oxydant et Plasticité musculaire”, University of Strasbourg, Strasbourg, France
- Faculty of Medicine, University of Strasbourg, Strasbourg, France
- Service de Physiologie et explorations fonctionnelles, University Hospital of Strasbourg, Strasbourg, France
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Bayram F, Sonmez A, Kiyici S, Akbas F, Yetgin MK, Yazici D, Cingi A, Sargin M, Unal S, Iseri C, Mahmutoglu FS, Yumuk VD. Expert Opinion on the Utility of Telemedicine in Obesity Care: Recommendations on a Hybrid Multidisciplinary Integrated Care Follow-Up Algorithm. Curr Obes Rep 2024; 13:167-182. [PMID: 38172478 DOI: 10.1007/s13679-023-00541-0] [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] [Accepted: 11/03/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW The proposed expert opinion was prepared by a panel of obesity and law specialists from Turkey to review the utility of telemedicine in obesity care and to provide a guidance document with recommendations on a hybrid multidisciplinary integrated care follow-up algorithm and the legislation governing telemedicine practice to assist obesity specialists in practicing the telemedicine. RECENT FINDINGS The efficacy and feasibility of telemedicine interventions in supporting obesity management programs even during pandemics confirm that obesity is a particularly well-suited field for telemedicine, emphasizing the strong likelihood of continued utilization of telemedicine in obesity management, beyond the pandemic period. Telemedicine has great potential to address several barriers to ongoing weight-management care, such as challenges of access to specialized care, cost, and time limitations as well as patient adherence to treatment. However, telemedicine practice should complement rather than replace the in-person visits which are unique in building rapport and offering social support. Accordingly, the participating experts recommend the use of a hybrid integrated care model in the management of obesity, with the use of telemedicine, as an adjunct to in-person visits, to enable the provision of suggested intensive obesity management via frequent visits by a multidisciplinary team of obesity specialists. Further research addressing the utility of telemedicine in terms of optimal modality and duration for successful long-term obesity management outcomes is necessary to develop specific guidelines on telemedicine practice. In addition, the legislation governing the norms and protocols on confidentiality, privacy, access, and liability needs to be improved.
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Affiliation(s)
- Fahri Bayram
- Department of Endocrinology and Metabolism, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Alper Sonmez
- Department of Endocrinology and Metabolism, Ankara Guven Hospital, Ankara, Turkey
| | - Sinem Kiyici
- Department of Endocrinology and Metabolism, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
| | - Feray Akbas
- Department of Internal Medicine, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Meral Kucuk Yetgin
- Department of Coaching Education, Sport Health Sciences, Marmara University Faculty of Sports Science, Istanbul, Turkey
| | - Dilek Yazici
- Department of Endocrinology and Metabolism, Koc University Faculty of Medicine, Istanbul, Turkey
| | - Asim Cingi
- Department of General Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Sargin
- Department of Family Medicine, Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
| | - Seniz Unal
- Private Clinical Psychology Office, Istanbul, Turkey
| | - Ceren Iseri
- Department of Internal Medicine, Nutrition Science, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Fatih Selami Mahmutoglu
- Department of Criminal Law and Criminal Procedure Law, Turkish-German University Faculty of Law, Istanbul, Turkey
| | - Volkan Demirhan Yumuk
- Department of Endocrinology and Metabolism, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
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Camajani E, Feraco A, Verde L, Moriconi E, Marchetti M, Colao A, Caprio M, Muscogiuri G, Barrea L. Ketogenic Diet as a Possible Non-pharmacological Therapy in Main Endocrine Diseases of the Female Reproductive System: A Practical Guide for Nutritionists. Curr Obes Rep 2023; 12:231-249. [PMID: 37405618 PMCID: PMC10482777 DOI: 10.1007/s13679-023-00516-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/06/2023]
Abstract
PURPOSEOF REVIEW This narrative review explored the role of ketogenic diets (KDs) in improving fertility outcomes, low-grade inflammation, body weight, visceral adipose tissue, and its potential use in certain types of cancer, through its favorable actions on mitochondrial function, reactive oxygen species generation, chronic inflammation, and tumor growth inhibition. RECENT FINDINGS : Nutrition is crucial to maintain the female reproductive system's health. Evidence on the association between diet and female reproductive system has greatly expanded over the last decade, leading to the identification of specific diet therapy, particularly KDs. KDs has been proved to be an effective weight-loss tool. To date, KDs is being increasingly used in the treatment of many diseases, such as obesity, type 2 diabetes mellitus. KDs is a dietary intervention capable of ameliorating the inflammatory state and oxidative stress through several mechanisms. Due to the increasing use of KDs beyond obesity, this literature review will provide the latest scientific evidence of its possible use in common disorders of the female endocrine-reproductive tract, and a practical guide to its use in these patients.
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Affiliation(s)
- Elisabetta Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166, Rome, Italy
| | - Alessandra Feraco
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166, Rome, Italy
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | - Ludovica Verde
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Unit of Endocrinology, Università Degli Studi Di Napoli Federico II, Naples, Italy
- Department of Public Health, University "Federico II" of Naples, 80138, Naples, Italy
| | - Eleonora Moriconi
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | - Marco Marchetti
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Annamaria Colao
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Unit of Endocrinology, Università Degli Studi Di Napoli Federico II, Naples, Italy
- Dipartimento Di Medicina Clinica E Chirurgia, Unità Di Diabetologia E Andrologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131Naples, , Endocrinologia, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Massimiliano Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, 00166, Rome, Italy
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
| | - Giovanna Muscogiuri
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Unit of Endocrinology, Università Degli Studi Di Napoli Federico II, Naples, Italy.
- Dipartimento Di Medicina Clinica E Chirurgia, Unità Di Diabetologia E Andrologia, Università Degli Studi Di Napoli Federico II, Via Sergio Pansini 5, 80131Naples, , Endocrinologia, Italy.
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", Università Degli Studi Di Napoli Federico II, Naples, Italy.
| | - Luigi Barrea
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Medicina Clinica E Chirurgia, Unit of Endocrinology, Università Degli Studi Di Napoli Federico II, Naples, Italy
- Dipartimento Di Scienze Umanistiche, Centro Direzionale, Università Telematica Pegaso, Via Porzio Isola F2, 80143, Naples, Italy
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Prior SJ, Luccisano SP, Kilpatrick ML, Murfet GO. Assessment and Management of Obesity and Self-Maintenance (AMOS): An Evaluation of a Rural, Regional Multidisciplinary Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12894. [PMID: 36232191 PMCID: PMC9565125 DOI: 10.3390/ijerph191912894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Obesity is common in rural areas, and reduced specialist healthcare access impedes its management. A pilot nurse-practitioner-led Assessment and Management of Obesity and Self-Maintenance (AMOS) Clinic focused on individualised obesity care in people living with type 2 diabetes delivered in a rural setting. This study aimed to explore participant and staff experiences of the multidisciplinary obesity clinic to identify barriers and facilitators to self-care, health, and well-being. A two-stage, mixed-method design was used. Initially, three focus groups involving a sample of AMOS participants and semi-structured staff interviews helped identify key barriers/facilitators. These findings informed a survey delivered to all AMOS participants. Qualitative data were analysed using an inductive two-step thematic networks technique to identify themes. Quantitative data were summarised using descriptive statistics. A total of 54 AMOS participants and 4 staff participated in the study. Four themes were identified to describe AMOS participant experiences': 1. affordability; 2. multidisciplinary care; 3. person-centred care; and 4. motivation. Specialised, multidisciplinary and individualised obesity care available through one clinic facilitated self-care and improved health and well-being. Dedicated multidisciplinary obesity clinics are recommended in rural and remote areas.
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Affiliation(s)
- Sarah J. Prior
- Tasmanian School of Medicine, University of Tasmania, Burnie, TAS 7320, Australia
| | - Sharon P. Luccisano
- Diabetes Centre, Tasmanian Health Service—North West, Burnie, TAS 7320, Australia
| | - Michelle L. Kilpatrick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia
| | - Giuliana O. Murfet
- Diabetes Centre, Tasmanian Health Service—North West, Burnie, TAS 7320, Australia
- School of Public Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Kim H, Kim KW, Chung WS. Effects of moxibustion for obesity: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27910. [PMID: 35049193 PMCID: PMC9191312 DOI: 10.1097/md.0000000000027910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Obesity is a chronic disease associated with lethal health conditions. Moxibustion, a frequently used treatment in traditional Chinese medicine, is effective and safe for the treatment of obesity. However, the evidence has not been systematically collected and combined to date. This systematic review and meta-analysis will analyze the effects of moxibustion on obesity. METHODS The following databases will be searched: Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, EMBASE, 1 Chinese database (Chinese National Knowledge Infrastructure), 1 Japanese database (Citation Information by the National Institute of Informatics), and 3 Korean databases (Oriental Medicine Advanced Searching Integrated System, ScienceON, and KoreaMed). The quality of the included studies will be assessed according to the Cochrane Assessment Tool for Risk of Bias. Data from the included studies will be synthesized for meta-analysis. The primary outcome will be body weight, and the secondary outcomes will be body mass index, waist-hip ratio, waist circumference, hip circumference, and effective rate. RESULTS AND CONCLUSION Ethical approval is not necessary for this study because it will not include any patient information. The results of this systematic review and meta-analysis will be publicly available and published in a peer-reviewed journal. REGISTRATION NUMBER DOI 10.17605/OSF.IO/NTKDF (https://osf.io/ntkdf).
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Affiliation(s)
- Hyungsuk Kim
- Department of Korean Medicine Rehabilitation, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, Korea
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Koh-Woon Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Won-Seok Chung
- Department of Korean Medicine Rehabilitation, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, Korea
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
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6
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Staudenmann DA, Sui Z, Saxena P, Kaffes AJ, Marinos G, Kumbhari V, Aepli P, Sartoretto A. Endoscopic bariatric therapies for obesity: a review. Med J Aust 2021; 215:183-188. [PMID: 34333788 DOI: 10.5694/mja2.51179] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
▪ Obesity is reaching pandemic proportions globally, with overweight or obesity affecting at least two-thirds of Australian adults. ▪ Bariatric surgery is an effective weight loss strategy but is constrained by high resource requirements and low patient acceptance. ▪ Multiple endoscopic bariatric therapies have matured, with well established and favourable safety and efficacy profiles in multiple randomised controlled trials (RCTs), and are best used within a multidisciplinary setting as an adjuvant to lifestyle intervention. ▪ Three types of intragastric balloon are currently in use in Australia offering average total weight loss ranging from 10% to 18%, with others available internationally. ▪ Endoscopic sleeve gastroplasty produces average total weight loss of 15-20% with low rates of severe complications, with RCT data anticipated in December 2021. ▪Bariatric and metabolic endoscopy is rapidly evolving, with many novel, promising therapies currently under investigation.
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Affiliation(s)
- Dominic A Staudenmann
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW.,Praxis Balsiger Seibold und Partner, Bern, Switzerland.,Université de Fribourg, Fribourg, Switzerland
| | | | | | - Arthur J Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
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Koutras Y, Chrysostomou S, Giannakou K, Yannakoulia M. Weight-related behaviors and weight loss maintenance: a cross-sectional study in Cyprus. BMC Public Health 2021; 21:1115. [PMID: 34112132 PMCID: PMC8194136 DOI: 10.1186/s12889-021-11153-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/25/2021] [Indexed: 01/15/2023] Open
Abstract
Background This study examined the differences between maintainers and regainers regarding obesity related eating behaviors. A secondary objective was to develop an eating behavior index predicting the likelihood of successful weight loss maintenance. Methods The current cross-sectional evaluation conducted in Cyprus was part of the MedWeight (Greek) study. Eligible for participation were Cypriot (maintainers = 145; regainers = 87) adult men and women who reported being at least overweight (BMI ≥25 kg/m2) and experienced an intentional weight loss of ≥10% of their maximum lifetime weight, at least 1 year before participation. Among other assessments, weight-related behaviors were evaluated through Weight-Related Behaviors Index (WRBI). Results Statistically significant differences between the two groups were observed regarding meals per day (P = 0.008), frequency of eating home cooked meals (P = 0.004) and WRBI total score (P = 0.022). Results from logistic regression models indicated that the odds of maintaining weight loss increase at 30% (Model 1: P < 0.05, Odds ratio 1.306, 1.095–1.556 95% C.I., Model 2: P < 0.05, OR 1.308, 1.097–1.560 95% C.I.) and at 38% after adjusting for physical activity (Model 3: P < 0.05, OR 1.377, 1.114–1.701 95% C.I..) for each point scored in WRBI total score. Conclusions Eating more frequently home cooked meals and less eating away from home meals may be beneficially associated with weight loss maintenance. WRBI seems to be a useful tool when dealing with patients who have previously lost significant weight. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11153-5.
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Affiliation(s)
- Yiannis Koutras
- Department of Life Sciences, School of Sciences, European University Cyprus, 2404, Nicosia, Cyprus.,Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - S Chrysostomou
- Department of Life Sciences, School of Sciences, European University Cyprus, 2404, Nicosia, Cyprus.
| | - K Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - M Yannakoulia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University Athens, Kallithea, Greece
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Pfoh ER, Flench R, Varghai NH, King M, Heinberg LJ. Patients Desire Personalized, Specific, and Continuous Advice on Weight Management. South Med J 2021; 114:41-45. [PMID: 33398360 DOI: 10.14423/smj.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To deliver effective care, healthcare systems should understand patients' preferences for weight management across a spectrum of needs. Our objective was to describe patients' perceptions of what helps or hinders weight loss and maintenance. METHODS Semistructured interviews were conducted with patients who accessed weight management services at a large integrated health system in 2018. The interview guide was developed and iteratively refined through a literature search and by consulting experts. Questions included the respondent's weight history, interactions with the health system, and current health status. The analysis used a grounded theory approach, and each transcript was double-coded in 2019. Codes were sorted into themes. All discrepancies were resolved through team discussion. RESULTS Fifteen patients were interviewed. The majority of respondents (87%) reported multiple weight loss attempts. Three themes were identified. First, advice should be matched to a patient's knowledge and prior experience (eg, using bariatric deck cards). As patients progressed, clinician advice also needed to advance (eg, explaining how to expand food options instead of defining a healthy diet). Second, respondents had a variety of motivating factors, and understanding where motivation is generated from can inform how to design a weight management approach. Third, patients need continual and long-term advice. Some respondents feared becoming ineligible for services if their weight dropped too much. CONCLUSIONS Health systems can support patients by developing processes for identifying the extent of a patient's knowledge and giving personalized advice based on the patient's preferences and experiences. Reassessing needs at defined intervals may help patients attain and sustain their goals.
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Affiliation(s)
- Elizabeth R Pfoh
- From the Center for Value-Based Care Research and the Department of Family Medicine, Cleveland Clinic Community Care, the Strategy Office, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Russell Flench
- From the Center for Value-Based Care Research and the Department of Family Medicine, Cleveland Clinic Community Care, the Strategy Office, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - N Homa Varghai
- From the Center for Value-Based Care Research and the Department of Family Medicine, Cleveland Clinic Community Care, the Strategy Office, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Michelle King
- From the Center for Value-Based Care Research and the Department of Family Medicine, Cleveland Clinic Community Care, the Strategy Office, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Leslie J Heinberg
- From the Center for Value-Based Care Research and the Department of Family Medicine, Cleveland Clinic Community Care, the Strategy Office, Cleveland Clinic, and the Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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Kuchkuntla AR, Shah M, Velapati S, Gershuni VM, Rajjo T, Nanda S, Hurt RT, Mundi MS. Ketogenic Diet: an Endocrinologist Perspective. Curr Nutr Rep 2020; 8:402-410. [PMID: 31705484 DOI: 10.1007/s13668-019-00297-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Obesity and its related comorbidities make up a large part of healthcare expenditures. Despite a wide array of options for treatment of obesity, rates of sustained weight loss continue to be low, leading patients to seek alternative treatment options. Although the first medically utilized ketogenic diet was described nearly 100 years ago, it has made a resurgence as a treatment option for obesity. Despite increased popularity in the lay public and increased use of ketogenic dietary strategies for metabolic therapy, we are still beginning to unravel the metabolic impact of long-term dietary ketosis. RECENT FINDINGS There are a number of recent trials that have highlighted the short- and long-term benefits of ketogenic diet on weight, glycemic control, and other endocrine functions including reproductive hormones. This review is a summary of available data on the effectiveness and durability of the ketogenic diet when compared to conventional interventions. Ketogenic dietary strategies may play a role in short-term improvement of important metabolic parameters with potential for long-term benefit. However, response may vary due to inter-individual ability to maintain long-term carbohydrate restriction.
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Affiliation(s)
| | - Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Saketh Velapati
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Victoria M Gershuni
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tamim Rajjo
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sanjeev Nanda
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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10
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Kaiser KA, Carson TL, Dhurandhar EJ, Neumeier WH, Cardel MI. Biobehavioural approaches to prevention and treatment: A call for implementation science in obesity research. Obes Sci Pract 2020; 6:3-9. [PMID: 32128237 PMCID: PMC7042105 DOI: 10.1002/osp4.384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/11/2019] [Accepted: 10/24/2019] [Indexed: 12/31/2022] Open
Abstract
Much progress has been made in the last 30 years in understanding the causes and mechanisms that contribute to obesity, yet widely available and successful strategies for prevention and treatment remain elusive at population levels. This paper discusses the biobehavioural framework and provides suggestions for applying it to enable greater progress in the science of obesity prevention and treatment, including an increased focus on implementation of science strategies. The objective is to promote a re-evaluation of current views about preventing and treating obesity within a unified biobehavioural framework. Further integration of research exploring how both behavioural and biological components interact is a critical step forward.
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Affiliation(s)
- Kathryn A. Kaiser
- Department of Health Behavior, School of Public HealthUniversity of Alabama at BirminghamBirminghamAlabama
- Nutrition Obesity Research CenterUniversity of Alabama at BirminghamBirminghamAlabama
| | - Tiffany L. Carson
- Nutrition Obesity Research CenterUniversity of Alabama at BirminghamBirminghamAlabama
- Division of Preventive Medicine, School of MedicineUniversity of Alabama at BirminghamBirminghamAlabama
| | - Emily J. Dhurandhar
- Department of Kinesiology and Sport ManagementTexas Tech UniversityLubbockTexas
| | - William H. Neumeier
- United States Army Research Institute of Environmental MedicineNatickMassachusetts
| | - Michelle I. Cardel
- Department of Health Outcomes & Biomedical Informatics, College of MedicineUniversity of FloridaGainesvilleFlorida
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Cohn I, Raman J, Sui Z. Patient motivations and expectations prior to bariatric surgery: A qualitative systematic review. Obes Rev 2019; 20:1608-1618. [PMID: 31419379 DOI: 10.1111/obr.12919] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/20/2019] [Accepted: 07/07/2019] [Indexed: 12/23/2022]
Abstract
Bariatric surgery is the most effective treatment for weight loss in individuals with severe and complex obesity. While the extant literature has mostly explored clinical outcomes of surgery, recent research has also examined patients' experiences prior to treatment. This systematic review synthesized findings from qualitative studies investigating patients' motives and expectations prior to undergoing bariatric surgery for weight loss. Twenty-eight studies published in English involving 580 participants were identified for inclusion. Data extraction and thematic synthesis yielded four global themes: physiological, emotional, cognitive, and interpersonal/environmental. These represented seven subthemes describing patients' presurgery experiences: relationship with food, physical health, activities of living, personal identity, social relations, presurgery information, and beliefs about surgery. In addition to improving physical and medical comorbidities associated with obesity, participants believed that postsurgery weight loss would produce positive psychosocial impacts by strengthening their personal identities, their relationships, and improving their engagement in public and professional life. The complex and widespread nature of the changes patients expected would result from bariatric surgery highlights the importance of providing pretreatment education focused on psychosocial well-being, as well as concurrent psychological support alongside surgery, to best inform individual treatment selection and clinical practice.
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Affiliation(s)
- Ilana Cohn
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Jayanthi Raman
- Graduate School of Health, University of Technology Sydney, Sydney, Australia.,Australian College of Applied Psychology, Sydney, Australia
| | - Zhixian Sui
- School of Public Health and Community Medicine, University of New South Wales, Kensington, Australia.,The BMI Clinic, Double Bay, Australia
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12
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Caprio M, Infante M, Moriconi E, Armani A, Fabbri A, Mantovani G, Mariani S, Lubrano C, Poggiogalle E, Migliaccio S, Donini LM, Basciani S, Cignarelli A, Conte E, Ceccarini G, Bogazzi F, Cimino L, Condorelli RA, La Vignera S, Calogero AE, Gambineri A, Vignozzi L, Prodam F, Aimaretti G, Linsalata G, Buralli S, Monzani F, Aversa A, Vettor R, Santini F, Vitti P, Gnessi L, Pagotto U, Giorgino F, Colao A, Lenzi A. Very-low-calorie ketogenic diet (VLCKD) in the management of metabolic diseases: systematic review and consensus statement from the Italian Society of Endocrinology (SIE). J Endocrinol Invest 2019; 42:1365-1386. [PMID: 31111407 DOI: 10.1007/s40618-019-01061-2] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Weight loss is a milestone in the prevention of chronic diseases associated with high morbility and mortality in industrialized countries. Very-low calorie ketogenic diets (VLCKDs) are increasingly used in clinical practice for weight loss and management of obesity-related comorbidities. Despite evidence on the clinical benefits of VLCKDs is rapidly emerging, some concern still exists about their potential risks and their use in the long-term, due to paucity of clinical studies. Notably, there is an important lack of guidelines on this topic, and the use and implementation of VLCKDs occurs vastly in the absence of clear evidence-based indications. PURPOSE We describe here the biochemistry, benefits and risks of VLCKDs, and provide recommendations on the correct use of this therapeutic approach for weight loss and management of metabolic diseases at different stages of life.
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Affiliation(s)
- M Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
| | - M Infante
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University of Rome Tor Vergata, Rome, Italy
| | - E Moriconi
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Armani
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele Pisana, Via di Val Cannuta 247, 00166, Rome, Italy
| | - A Fabbri
- Unit of Endocrinology and Metabolic Diseases, Department of Systems Medicine, CTO A. Alesini Hospital, ASL Roma 2, University of Rome Tor Vergata, Rome, Italy
| | - G Mantovani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinology and Diabetology Unit, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - S Mariani
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - C Lubrano
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Poggiogalle
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Migliaccio
- Section of Health Sciences, Department of Movement, Human and Health Sciences, "Foro Italico" University of Rome, Rome, Italy
| | - L M Donini
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Basciani
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Cignarelli
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - E Conte
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - G Ceccarini
- Endocrinology Unit, Obesity and Lipodystrophy Center, University Hospital of Pisa, Pisa, Italy
| | - F Bogazzi
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Cimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - A Gambineri
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Biomedical, Experimental and Clinical Sciences, University of Florence, AOU Careggi, Florence, Italy
| | - F Prodam
- Endocrinology, Department of Translational Medicine and Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - G Aimaretti
- Endocrinology, Department of Translational Medicine and Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - G Linsalata
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Buralli
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - R Vettor
- Department of Medicine, Internal Medicine 3, University Hospital of Padova, Padua, Italy
| | - F Santini
- Endocrinology Unit, Obesity and Lipodystrophy Center, University Hospital of Pisa, Pisa, Italy
| | - P Vitti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Gnessi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - U Pagotto
- Endocrinology Unit and Center for Applied Biomedical Research, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - F Giorgino
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - A Colao
- Section of Endocrinology, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - A Lenzi
- Section of Medical Pathophysiology, Food Science and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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13
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Nogué M, Nogué E, Molinari N, Macioce V, Avignon A, Sultan A. Intuitive eating is associated with weight loss after bariatric surgery in women. Am J Clin Nutr 2019; 110:10-15. [PMID: 31161219 DOI: 10.1093/ajcn/nqz046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although the data on eating behavior after bariatric surgery are substantial, data on "intuitive eating" are lacking. OBJECTIVE The aim of this study was to evaluate the link between intuitive eating and weight loss after bariatric surgery. METHODS This cross-sectional study used a self-administered questionnaire freely available on social networks and targeted women who had undergone bariatric surgery. Intuitive eating was evaluated with the Intuitive Eating Scale-2 (IES-2). The 3 questionnaire subscores (Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Unconditional Permission to Eat) were also analyzed. The relation between IES-2 scores and the relative variation in body mass index [BMI (in kg/m2)] was assessed with linear regression models. Adjusted β (βAdj) and standardized β $( {{\rm{\beta }}_{{\rm{Adj}}}^{{\rm{STD}}}} )$ were reported. RESULTS We analyzed the responses of 401 women with a mean age of 39 ± 11 y, a mean preoperative BMI of 45.5 ± 7.9, and a mean current BMI of 30.5 ± 7. The mean relative BMI loss was 32.7 ± 12.9%, and the mean IES-2 score was 3.3 ± 0.6. The total IES-2 score was associated with the relative BMI loss, with ∼2.6% BMI loss for each 1-point increase in the IES-2 score [PAdj = 0.007; βAdj = -2.57 (95% CI: -4.44, -0.70); ${\rm{\beta }}_{{\rm{Adj}}}^{{\rm{STD}}}$= -0.12] after adjusting for elapsed time since surgery and type of surgery. Eating for Physical Rather than Emotional Reasons was the subscore most strongly associated with BMI change after adjustment [PAdj = 0.002; βAdj = -2.08 (95% CI: -3.37, 0.79); ${\rm{\beta }}_{{\rm{Adj}}}^{{\rm{STD}}}$ = -0.14]. CONCLUSIONS This study highlights a significant association between intuitive eating and BMI decrease after bariatric surgery. Furthermore, eating behaviors changed with increasing time since surgery. An intuitive nutritional approach may be complementary with bariatric surgery in the postoperative phase, which should prompt complementary prospective studies to evaluate the effectiveness of therapeutic education programs centered on intuitive eating in the postoperative period.
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Affiliation(s)
- Muriel Nogué
- Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Montpellier, Montpellier, France
| | - Erika Nogué
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Molinari
- The Alexander Grothendieck Institute of Montpellier, Montpellier, France.,Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Valérie Macioce
- Department of Medical Information, University Hospital of Montpellier, Montpellier, France
| | - Antoine Avignon
- Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Montpellier, Montpellier, France.,Joint Unit Research Center, Physiology and Experimental Medicine of the Heart and Muscles, National Center for Scientific Research, University of Montpellier, Montpellier, France.,University of Montpellier, Montpellier, France
| | - Ariane Sultan
- Department of Endocrinology, Diabetes, and Nutrition, University Hospital of Montpellier, Montpellier, France.,Joint Unit Research Center, Physiology and Experimental Medicine of the Heart and Muscles, National Center for Scientific Research, University of Montpellier, Montpellier, France.,University of Montpellier, Montpellier, France
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14
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Recent trends in intensive treatments of obesity: Is academic research matching public interest? Surg Obes Relat Dis 2019; 15:766-776. [DOI: 10.1016/j.soard.2019.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/06/2018] [Accepted: 01/15/2019] [Indexed: 12/17/2022]
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15
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Exploring the role of physical activity and exercise for managing vascular comorbidities in people with multiple sclerosis: A scoping review. Mult Scler Relat Disord 2018; 26:19-32. [DOI: 10.1016/j.msard.2018.08.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 01/06/2023]
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16
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Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image 2018; 25:139-147. [PMID: 29574257 DOI: 10.1016/j.bodyim.2018.03.001] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 11/22/2022]
Abstract
Studies show that women with high BMI are less likely than thinner women to seek healthcare. We aimed to determine the mechanisms linking women's weight status to their healthcare avoidance. Women (N = 313) were surveyed from a U.S. health-panel database. We tested a theory-driven model containing multiple stigma and body-related constructs linking BMI to healthcare avoidance. The model had a good fit to the data. Higher BMI was related to greater experienced and internalized weight stigma, which were linked to greater body-related shame. Internalized weight stigma was also related to greater body-related guilt, which was associated with higher body-related shame. Body-related shame was associated with healthcare stress which ultimately contributed to healthcare avoidance. We discuss recommendations for a Weight Inclusive Approach to healthcare and the importance of enhancing education for health professionals in weight bias in order to increase appropriate use of preventive healthcare in higher weight women.
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17
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Zheng Y, Ma AG, Zheng MC, Wang QZ, Liang H, Han XX, Schouten EG. B Vitamins Can Reduce Body Weight Gain by Increasing Metabolism-related Enzyme Activities in Rats Fed on a High-Fat Diet. Curr Med Sci 2018; 38:174-183. [DOI: 10.1007/s11596-018-1862-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/07/2017] [Indexed: 12/11/2022]
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18
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Welbourn R, Hopkins J, Dixon JB, Finer N, Hughes C, Viner R, Wass J. Commissioning guidance for weight assessment and management in adults and children with severe complex obesity. Obes Rev 2018; 19:14-27. [PMID: 29024367 DOI: 10.1111/obr.12601] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/26/2022]
Abstract
The challenge of managing the epidemic of patients with severe and complex obesity disease in secondary care is largely unmet. In England, the National Institute of Health and Care Excellence and the National Health Service England have published guidance on the provision of specialist (non-surgical) weight management services. We have undertaken a systematic review of 'what evidence exists for what should happen in/commissioning of: primary or secondary care weight assessment and management clinics in patients needing specialist care for severe and complex obesity?' using an accredited methodology to produce a model for organization of multidisciplinary team clinics that could be developed in every healthcare system, as an update to a previous review. Additions to the previous guidance were multidisciplinary team pathways for children/adolescent patients and their transition to adult care, anaesthetic assessment and recommendations for ongoing shared care with general practitioners, as a chronic disease management pathway.
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Affiliation(s)
- R Welbourn
- Department of Upper GI and Bariatric Surgery, Musgrove Park Hospital, Taunton, UK
| | - J Hopkins
- North Bristol Centre for Weight Loss, Metabolic and Bariatric Surgery, Southmead Hospital, Bristol, UK
| | - J B Dixon
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - N Finer
- UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery, University College London Hospitals, London, UK
| | - C Hughes
- Fakenham Weight Management Service, Norfolk, UK.,University of East Anglia, Norwich, UK
| | - R Viner
- Royal College of Paediatrics and Child Health, UCL GOS Institute of Child Health, University College London, London, UK
| | - J Wass
- Royal College of Physicians, London, UK
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19
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Dong Z, Xu L, Liu H, Lv Y, Zheng Q, Li L. Comparative efficacy of five long-term weight loss drugs: quantitative information for medication guidelines. Obes Rev 2017; 18:1377-1385. [PMID: 29024559 DOI: 10.1111/obr.12606] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/24/2017] [Accepted: 08/03/2017] [Indexed: 12/22/2022]
Abstract
Quantitative information is scarce in current obesity medication guidelines, and they do not clearly reflect the differences in the efficacy characteristics among various drugs. This study quantitatively assessed the efficacy characteristics of five FDA-approved long-term weight loss drugs. Potentially eligible studies were obtained from public databases. Using the differences in the weight change from baseline between the drug group and the corresponding placebo group as the major indicator of efficacy, a time-effect model was established, and crucial pharmacodynamic parameters, such as the maximal efficacy, drug onset time and rate of body weight regain after the maximal efficacy point, were used to reflect the differences in efficacy among the five drugs. Finally, 50 reports (involving 43,443 participants) were included. After deducting the placebo effects, the maximal efficacies (95% CI) of orlistat (120 mg), lorcaserin, naltrexone-bupropion, phentermine-topiramate (PT, 7.5/46 mg) and liraglutide were -2.94 (-5.82, -1.27), -3.06 (-4.39, -1.71), -6.15 (-9.78, -3.25), -7.45 (-9.76, -3.88) and -5.50 (-10.62, -2.97) kg at weeks 60, 54, 67, 59 and 65 respectively, and their rates of body weight regain were 0.51, 0.48, 0.91, 1.27and 0.43 kg per year respectively. The 1-year dropout rates of orlistat, lorcaserin, naltrexone-bupropion, PT and liraglutide were 29.0, 40.9, 49.1, 34.9 and 24.3% respectively. In addition, a significant dose-effect correlation was observed for orlistat and PT. This study provides valid quantitative information for medication guidelines.
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Affiliation(s)
- Z Dong
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - L Xu
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - H Liu
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Y Lv
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Q Zheng
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - L Li
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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20
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Foster D, Sanchez-Collins S, Cheskin LJ. Multidisciplinary Team-Based Obesity Treatment in Patients With Diabetes: Current Practices and the State of the Science. Diabetes Spectr 2017; 30:244-249. [PMID: 29151714 PMCID: PMC5687103 DOI: 10.2337/ds17-0045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IN BRIEF Rates of obesity and diabetes are growing, as are their costs. Because the two diseases share many key determinants, the paradigms for their treatment overlap. For both, optimal treatment involves a multidisciplinary team following the Chronic Care Model of health care delivery. Combined treatment programs that include 1) a low-calorie diet individualized to patients' preferences, 2) structured exercise that is also tailored to each patient, and 3) psychotherapy induce the largest weight changes in patients with diabetes. Although diet alone can achieve weight loss, exercise and cognitive behavioral therapy components can enhance the effects of dietary modification. A multidisciplinary team that includes a physician with expertise in pharmacotherapy, a nurse and/or nurse practitioner, a dietitian, an exercise physiologist, and a psychologist can provide a comprehensive weight loss program combining the most effective interventions from each discipline.
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21
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Paz-Filho GJ. Metabolic syndrome in children and teenagers: worth assessing it, but how? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:1-4. [PMID: 28273200 PMCID: PMC10522121 DOI: 10.1590/2359-3997000000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Gilberto J. Paz-Filho
- John Curtin School of Medical ResearchThe Australian National UniversityCanberraACTAustralia John Curtin School of Medical Research, The Australian National University, Canberra, ACT, Australia
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