The Financial Costs, Behaviour and Psychology of Obesity: A One Health Analysis

Prevalence and factors associated with overweight and obesity in dogs presenting to French university veterinary teaching hospitals during the COVID-19 pandemic

Pet obesity is still a major health issue, which is considered an epidemic by some researchers. Prevention is one of the cornerstones of veterinary care, emphasizing the importance of proactive measures. Human lifestyle was affected during the COVID-19 pandemic, resulting in an increased overweight prevalence in the population. The prevalence of overweight and obesity in dogs during this period has been poorly explored. This study's objectives were to assess the percentage of the French dog population with overweight and obesity, compare the results with a study conducted before the COVID-19 pandemic, and investigate any potential changes in the risk factors. The study collected data through a survey completed by dog owners during their pets' vaccination visits at university veterinary hospitals of Maisons-Alfort (Paris) and Toulouse, in France, between 2020 and 2022. The veterinarian recorded the dog's weight and the body condition score using a 9-point scale. The study included a total of 309 dogs. Of these, 1.6 % were underweight, 63.1 % had an ideal body condition, and 35.3 % were overweight, including 2.3 % of all dogs classified as obese. During the pandemic, French dog diets shifted towards increased commercial food consumption and twice-daily feedings compared to a 2003 study. Factors positively associated with overweight were being female (OR = 3.55; 95 % CI: 1.65-8.01; P=0.002), being senior (OR=4.91; 95 % CI: 2.07-12.2; P<0.001) or geriatric (OR=5.81; 95 % CI: 2.04-17.0; P=0.001) and having an owner underestimating dog's body condition (OR=74.1; 95 % CI: 29.8-215; P<0.001). Recognizing the impact of owner perception enables early intervention strategies, such as educating owners during consultations and conducting teaching sessions at the clinic. This proactive approach could contribute to improved health outcomes and help prevent the onset of obesity-related issues in dogs. The new trends in dogs' diets may have global relevance due to the pandemic's widespread impact. Although no immediate impact on overweight is evident, ongoing research is crucial to understand the pandemic's long-term effects.

A Randomized Controlled Trial Investigating the Impact of a Low-Calorie Dietary Approach to Stop Hypertension (DASH) on Anthropometric and Glycemic Measures in Patients Experiencing Weight Regain 2 Years Post Sleeve Surgery

PURPOSE

To evaluate the effect of a low-calorie dietary approach to stop hypertension (DASH) compared to a low-calorie diet on weight control, body composition and glycemic measures in post sleeve patients with weight regain.

MATERIALS AND METHODS

Participants were randomly allocated to either the low-calorie DASH diet group (intervention) or the low-calorie diet group (control) for a duration of 16 weeks. Both groups had a prescribed caloric intake of 1000-1200 calories. The DASH diet group made dietary adjustments in accordance with the DASH pattern.

RESULTS

At the end of the study, both interventions significantly reduced anthropometric and body composition parameters (P-value < 0.001), with a greater decrease observed in the low-calorie DASH diet group (P-value < 0.001). Insulin levels and homeostatic model assessment for insulin resistance (HOMA-IR) decreased significantly in both groups, but the magnitude of these changes was not statistically different between the two groups. After adjusting for confounders, a significant difference was observed in post-intervention values and changes in weight, body mass index, and fat mass and fat-free mass.

CONCLUSION

In summary, adhering to a calorie-restricted DASH diet for 16 weeks improved weight loss, body mass index, and fat mass reduction in post-bariatric patients who experienced weight regain 2 years after surgery, compared to a calorie-restricted control diet. However, there was no significant difference in the effect on blood glucose, insulin, and HOMA-IR between the two diets.

What Is the Cost of Weight Loss? An Approach to Commercial (Dry and Wet) and Homemade Diets

In the context of the rising prevalence of obesity among pets, this study aimed to assess the economic aspects of weight reduction protocols for dogs and cats, considering the lack of information and the varying costs of commercial and homemade diets. The results indicated an average weekly weight loss rate of 1.02% for dogs and 0.92% for cats, with a reduction in body fat mass (p < 0.005). The cost analysis included an evaluation of both dry and wet commercial prescription diets as well as homemade diets. The results unveiled higher expenses associated to wet commercial diets, followed by homemade and dry commercial diets (p < 0.001). The study demonstrated that despite the initial investment, the long-term benefits of weight loss, including improved health and reduced financial burdens for owners, justify the expenses incurred. This comprehensive analysis provides veterinarians and pet owners with valuable insights into the economic considerations of weight reduction protocols, facilitating informed decision making and promoting pet well-being.

Identifying the target population and preventive strategies to combat feline obesity

Feline obesity continues to be a priority health and welfare issue. Most research surrounding obesity currently focuses on obesity treatment. However, treatment for feline obesity is slow, often unsuccessful and not without consequences. Identifying high-risk populations for obesity onset is crucial for developing and implementing preventive strategies. This review identifies post-gonadectomy kittens aged 5-12 months as the primary target population for obesity prevention in domestic cats and highlights dietary and feeding management strategies to be implemented for obesity prevention.

Effects of resistant starch on anti-obesity status and nutrient digestibility in dogs

This study investigated the effects of corn resistant starch (RS) on the anti-obesity properties, nutrient digestibility, and blood parameters in healthy beagles. Four spayed and six castrated beagle dogs were divided into a control group (CON) with a diet comprising rice and chicken meal and a treatment group (TRT) with a diet comprising corn with an increased RS content by heating-cooling and chicken meal. All dogs in the CON and TRT groups were fed a 1.2-fold higher energy diet than the daily recommended energy requirement for 16 weeks. Throughout the study period, the body weight of dogs in CON increased, whereas no change in body weight was observed in TRT, resulting in a significant difference in body weight between the two groups at the end of the experiment. Moreover, a significant reduction in the apparent total tract digestibility was observed upon the analysis of dry matter, nitrogen-free extract, and organic matter in TRT compared with that in CON. The complete blood cell composition and biochemical parameters were within the reference range in both groups. A significant increase in the concentration of serum adiponectin was found in TRT at the end of the experiment. These results suggest that the corn RS may be beneficial for weight management owing to its reduced nutrient digestibility.

Assessing the Impact of a Pilot Nutrition Curriculum on Students' Confidence and Ability to Perform Nutritional Assessments on Overweight Dogs and Cats for Use in a Veterinary Outreach Program

Obesity is a growing concern for dogs and cats. Although veterinary input is critical to prevent and manage obesity, conversations addressing overweight pets are challenging and require training to perform effectively. This study assessed the impact of a nutrition curriculum developed for use in a veterinary outreach program on student confidence and ability to perform nutritional assessments, particularly on overweight pets. The curriculum was developed by students and a Board-Certified Veterinary Nutritionist focusing on (1) performing nutritional assessments and (2) discussing the findings with owners. Initial implementation and evaluation occurred with 32 students. Pre-study and post-study surveys were conducted asking students to rank their confidence in 14 aspects related to nutritional assessments, determine opportunities for change from a case summary, and describe their experience using the materials. Five students in the outreach program performed an additional nutritional assessment and developed a plan for a hypothetical case. Results were analyzed for significance via the likelihood ratios Chi-square and Wilcoxon signed-rank tests. Students showed significant increase in confidence for 11 of the 14 questions and significant improvements at determining opportunities for change (p < .05). Feedback was positive and supported the feasibility of using the materials with the outreach program. Overall, the findings support that the curriculum provides a positive learning experience and prepared veterinary students for performing nutritional assessments and creating management plans for obese pets. This article introduces the curriculum as a successful model for providing access to additional self-paced curricular units to veterinary students.

Exclusive Breastfeeding for at Least Four Months Is Associated with a Lower Prevalence of Overweight and Obesity in Mothers and Their Children after 2-5 Years from Delivery

Introduction: Obesity is a current public health concern. Higher body weight is influenced by genetic and environmental parameters, and their interplay and is associated with a greater risk for several chronic diseases. Breastfeeding has been suggested as a preventive measure against obesity, which can further reduce long-term negative health outcomes for both women and children. Aim: The aim of the present study was to evaluate the role of breastfeeding on maternal and childhood overweight and obesity. Materials and Methods: This is a cross-sectional study conducted on 2515 healthy mothers and their children, aged 2−5 years, enrolled from nine different Greek rural and urban regions. Validated, standardized questionnaires were administrated that included anthropometric indices, socio-demographic characteristics of mothers and children, as well as breastfeeding practices. Results: Overall, 68% of participated women exclusively breastfed their children for at least 4 months. Mothers that exclusively breastfed showed a significantly lower prevalence of overweight and obesity after 2−5 years from delivery (p < 0.0001). Children that had exclusively been breastfed showed a significantly lower prevalence of overweight and obesity at the age of 2−5 years (p < 0.0001). Using multivariate regression analysis, exclusive breastfeeding for at least 4 months was associated with a two-fold lower risk for maternal and childhood overweight and obesity after 2−5 years from delivery, independent from maternal age, educational and economic status, and smoking habits (p < 0.0001). Conclusion: Exclusive breastfeeding for at least 4 months had a positive effect on childhood overweight and obesity, also contributing beneficially to post-natal maternal weight control. The beneficial effects of breastfeeding should be communicated to future and new mothers, while supportive actions for all mothers to initiate and continue breastfeeding their offspring should be implemented.

Dietary choline in gonadectomized kittens improved food intake and body composition but not satiety, serum lipids, or energy expenditure

Gonadectomy is a major risk factor for feline obesity. The lipotropic effects of choline have demonstrated benefits for growth and carcass composition in livestock. The consumption of supplemental choline on body weight (BW), body composition, lipid metabolism, energy expenditure (EE), and serum satiety hormones were evaluated in 15 gonadectomized male kittens. Kittens were offered a base diet formulated for growth (3310mg choline/kg dry matter [DM]) to daily energy requirements (DER) over an 11-week acclimation. Post-gonadectomy, kittens were assigned to a base diet (CONTROL, n = 7) or choline group (base diet with additional choline at 300mg/kg BW^0.75 as a top dress) (CHOLINE, n = 8). For 12-weeks post-neuter, kittens were offered three times their DER over three meals to mimic ad libitum feeding. At week -1 and 12, body composition was assessed using dual energy x-ray absorptiometry (DXA), 24-hour indirect calorimetry was performed for EE and respiratory quotients (RQ), and fasted serum samples were analyzed for lipid compounds and satiety hormones. Daily food intake (FI) and weekly BW were measured. Data was analyzed as a repeated measures of variance (ANCOVA) using the GLIMMIX procedure with time and group as fixed effects. CHOLINE had lower mean daily FI and lower rates of BW accretion (P<0.05) in contrast to CONTROL. All absolute body composition data increased over time for both groups, with lower increases in total tissue mass (P = 0.031) and fat mass (P = 0.005) in CHOLINE. Serum satiety hormones and lipid compounds did not differ (P>0.05) between groups, but both groups experienced a decrease in low-density lipoproteins and increase in high-density lipoproteins (P<0.05). Primary substrate utilization showed lipid use when fasted and use of protein or mixed macronutrients in the fed state. Fed state EE decreased post-gonadectomy (P = 0.004), however, CHOLINE did not affect total EE or RQ. These results suggest that supplemental dietary choline reduces FI, BW, and fat mass and may help to reduce the propensity of weight gain and subsequent obesity in gonadectomized feline populations.

Weight Maintenance after Dietary Weight Loss: Systematic Review and Meta-Analysis on the Effectiveness of Behavioural Intensive Intervention

After a low-calorie diet, only 25% of patients succeed in maintaining the result of weight loss for a long time. This systematic review and meta-analysis aims to explore whether patients undergoing intensive intervention during the maintenance phase have a greater preservation of the weight achieved during the previous slimming phase than controls. A bibliographic search was conducted using PubMed, Scopus, and Cochrane databases for clinical trials and randomised, controlled trials investigating the role of choice in weight-loss-maintenance strategies. Only studies with a follow-up of at least 12 months were considered. A total of eight studies, for a total of 1454 patients, was identified, each comparing a group that followed a more intensive protocol to a control group. Our metanalysis highlighted that an intensive approach even in the maintenance phase could be important to ensure greater success in the phase following the weight-loss period. However, it should be pointed out that the improvement was not so different from the trend of the respective controls, with a non-statistically significant mean difference of the effect size (0.087; 95% CI −0.016 to 0.190 p = 0.098). This finding, along with the observation of a weight regain in half of the selected studies, suggests this is a long work that has to be started within the weight-loss phase and reinforced during the maintenance phase. The problem of weight control in patients with obesity should be understood as a process of education to a healthy lifestyle and a balanced diet to be integrated in the context of a multidisciplinary approach.

Weight loss and high-protein, high-fiber diet consumption impact blood metabolite profiles, body composition, voluntary physical activity, fecal microbiota, and fecal metabolites of adult dogs

Canine obesity is associated with reduced lifespan and metabolic dysfunction, but can be managed by dietary intervention. This study aimed to determine the effects of restricted feeding of a high-protein, high-fiber (HPHF) diet and weight loss on body composition, physical activity, blood metabolites, and fecal microbiota and metabolites of overweight dogs. Twelve spayed female dogs (age: 5.5 ± 1.1 yr; body weight [BW]: 14.8 ± 2.0 kg, body condition score [BCS]: 7.9 ± 0.8) were fed a HPHF diet during a 4-wk baseline phase to maintain BW. After baseline (week 0), dogs were first fed 80% of baseline intake and then adjusted to target 1.5% weekly weight loss for 24 wk. Body composition using dual-energy x-ray absorptiometry and blood samples (weeks 0, 6, 12, 18, and 24), voluntary physical activity (weeks 0, 7, 15, and 23), and fresh fecal samples for microbiota and metabolite analysis (weeks 0, 4, 8, 12, 16, 20, and 24) were measured over time. Microbiota data were analyzed using QIIME 2. All data were analyzed statistically over time using SAS 9.4. After 24 wk, dogs lost 31.2% of initial BW and had 1.43 ± 0.73% weight loss per week. BCS decreased (P < 0.0001) by 2.7 units, fat mass decreased (P < 0.0001) by 3.1 kg, and fat percentage decreased (P < 0.0001) by 11.7% with weight loss. Many serum metabolites and hormones were altered, with triglycerides, leptin, insulin, C-reactive protein, and interleukin-6 decreasing (P < 0.05) with weight loss. Relative abundances of fecal Bifidobacterium, Coriobacteriaceae UCG-002, undefined Muribaculaceae, Allobaculum, Eubacterium, Lachnospira, Negativivibacillus, Ruminococcus gauvreauii group, uncultured Erysipelotrichaceae, and Parasutterella increased (P < 0.05), whereas Prevotellaceae Ga6A1 group, Catenibacterium, Erysipelatoclostridium, Fusobacterium, Holdemanella, Lachnoclostridium, Lactobacillus, Megamonas, Peptoclostridium, Ruminococcus gnavus group, and Streptococcus decreased (P < 0.01) with weight loss. Despite the number of significant changes, a state of dysbiosis was not observed in overweight dogs. Fecal ammonia and secondary bile acids decreased, whereas fecal valerate increased with weight loss. Several correlations between gut microbial taxa and biological parameters were observed. Our results suggest that restricted feeding of a HPHF diet and weight loss promotes fat mass loss, minimizes lean mass loss, reduces inflammatory marker and triglyceride concentrations, and modulates fecal microbiota phylogeny and activity in overweight dogs.

A systematic approach to public health - Novel application of the human factors analysis and classification system to public health and COVID-19

In this article, we argue for a novel adaptation of the Human Factors Analysis and Classification System (HFACS) to proactive incidence prevention in the public health and in particular, during and in response to COVID-19. HFACS is a framework of causal categories of human errors typically applied for systematic retrospective incident analysis in high-risk domains. By leveraging this approach proactively, appropriate, and targeted measures can be quickly identified and established to mitigate potential errors at different levels within the public health system (from tertiary and secondary healthcare workers to primary public health officials, regulators, and policymakers).

Dynamics of the complex food environment underlying dietary intake in low-income groups: a systems map of associations extracted from a systematic umbrella literature review

Background

Inequalities in obesity pertain in part to differences in dietary intake in different socioeconomic groups. Examining the economic, social, physical and political food environment of low-income groups as a complex adaptive system – i.e. a system of multiple, interconnected factors exerting non-linear influence on an outcome, can enhance the development and assessment of effective policies and interventions by honouring the complexity of lived reality. We aimed to develop and apply novel causal loop diagramming methods in order to construct an evidence-based map of the underlying system of environmental factors that drives dietary intake in low-income groups.

Methods

A systematic umbrella review was conducted on literature examining determinants of dietary intake and food environments in low-income youths and adults in high/upper-middle income countries. Information on the determinants and associations between determinants was extracted from reviews of quantitative and qualitative studies. Determinants were organised using the Determinants of Nutrition and Eating (DONE) framework. Associations were synthesised into causal loop diagrams that were subsequently used to interpret the dynamics underlying the food environment and dietary intake. The map was reviewed by an expert panel and systems-based analysis identified the system paradigm, structure, feedback loops and goals.

Results

Findings from forty-three reviews and expert consensus were synthesised in an evidence-based map of the complex adaptive system underlying the food environment influencing dietary intake in low-income groups. The system was interpreted as operating within a supply-and-demand, economic paradigm. Five sub-systems (‘geographical accessibility’, ‘household finances’, ‘household resources’, ‘individual influences’, ‘social and cultural influences’) were presented as causal loop diagrams comprising 60 variables, conveying goals which undermine healthy dietary intake.

Conclusions

Our findings reveal how poor dietary intake in low-income groups can be presented as an emergent property of a complex adaptive system that sustains a food environment that increases the accessibility, availability, affordability and acceptability of unhealthy foods. In order to reshape system dynamics driving unhealthy food environments, simultaneous, diverse and innovative strategies are needed to facilitate longer-term management of household finances and socially-oriented practices around healthy food production, supply and intake. Ultimately, such strategies must be supported by a system paradigm which prioritises health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01164-1.

Frequency, breed predisposition and demographic risk factors for overweight status in dogs in the UK

OBJECTIVES

To evaluate the prevalence and risk factors for overweight status in dogs under primary veterinary care in the UK.

MATERIALS AND METHODS

A retrospective study design was used to estimate the 1-year (2016) period prevalence of overweight status. The clinical records were randomly ordered and manually validated for dogs with overweight status during 2016. Univariable and multivariable logistic regression modelling were used to evaluate associations between risk factors (breed, brachycephalic status, adult bodyweight, bodyweight relative to breed-sex mean, age, sex-neuter and insurance) and overweight status.

RESULTS

There were 1580 of 22,333 dogs identified as overweight during 2016. The estimated 1-year period prevalence for overweight status recorded in dogs under veterinary care was 7.1% (95% confidence interval 6.7-7.4). After accounting for confounding factors, eight breeds showed increased odds of overweight status compared with crossbred dogs. The breeds with the highest odds included the Pug (OR 3.12, 95% confidence interval 2.31 to 4.20), Beagle (OR 2.67, 1.75 to 4.08), Golden Retriever (OR 2.58, 1.79 to 3.74) and English Springer Spaniel (OR 1.98, 1.31 to 2.98). Being neutered, middle-aged and insured were additionally associated with overweight status.

CLINICAL SIGNIFICANCE

Targeted overweight prevention strategies should be prioritised for predisposed breeds, such as Pugs and Beagles. The findings additionally raise questions about further preventative efforts following neutering. The prevalence estimate suggests veterinary professionals are underreporting overweight status and therefore could be missing key welfare opportunities.

Do Hot Executive Functions Relate to BMI and Body Composition in School Age Children?

Deficits of 'hot' executive functions (EFs) involving emotional and motivational processes are considered as a risk factor for excessive weight, but few studies have tested the relationship between hot EFs and body composition in children. The aim of the study was to assess the association of the ability to delay gratification and affective decision-making with the body mass index (BMI) and body composition in children with typical neurocognitive development. The sample consisted of 553 Polish children aged between 6-12 y. The delay of gratification task (DGT) was applied to assess the ability to delay gratification. The Hungry Donkey test (HDT) was applied to assess affective decision-making. The indicators of decision-making in the HDT were net score and learning rate. The relationships between hot EFs and BMI, fat mass index (FMI), lean body mass index (LBMI) were tested. The association of the z scores of BMI and FMI, overweight/obesity, and the ability to delay gratification was found insignificant after controlling cofounding factors. Most of the results on affective decision-making and z scores for BMI, FMI and LBMI were insignificant as well. The relationship between the ability to delay gratification, affective decision-making, and adiposity is not pronounced in typically developed children.

Talking About Dog and Cat Nutrition with Clients

Veterinary health care teams understand that acceptance of, and adherence to, dietary recommendations by clients depends on effective, continuous communication. Despite decades of available research and training, and the availability of numerous balanced commercial, balanced homemade, and veterinary therapeutic diets, our collective ability across the profession to consistently help clients change behaviors and feeding practices to improve patient health remains difficult. Based on the long-standing, evidence-based approach of motivational interviewing, a paradigm shift is suggested for veterinary health care teams to empower clients to make their own arguments for change and take positive action for the health of their pet.

Canine and Feline Obesity Management

Obesity and overweight have an impact on more than half of pet cats and dogs. Effective and team-based communication is essential for creating an effective weight loss plan. The diet should meet all essential nutrient requirements during energy/calorie restriction. There are several ways to initiate a weight loss plan, and regular monitoring is essential for determining if a plan is working or needs to be adjusted.

The Relationship Between the Burnout Syndrome Dimensions and Body Mass Index as a Moderator Variable on Obese Managers in the Mexican Maquiladora Industry

Burnout syndrome (BS) and obesity are two growing conditions that affect employees' health and company productivity. Recently, several studies have pointed to a possible relationship between both phenomena. However, such a relationship has not been clearly defined. This research analyzes the relationship between BS dimensions and body mass index (BMI), the latter being treated as a moderator variable among obese senior and middle managers in the Mexican maquiladora industry through a structural equation model. A total of 361 senior and middle managers (124 of them classified as obese under the World Health Organization's criteria) completed both the Maslach Burnout Inventory-General Survey [with emotional exhaustion (EE), cynicism, and professional efficacy (PE) as subscale dimensions] and a sociodemographic questionnaire (which included BMI). The results showed a statistically significant relationship between EE and PE (P < 0.001; β = -0.320), with BMI acting as a moderator variable. The results showed that when BMI increases as a moderator variable, the strength of the relationship between EE and PE also changes. For example, although PE had a negative value of 0.14 before the moderator effect, the value increased up to 0.32 when the BMI was factored into the relationship. Therefore, maquiladora industries are being advised to increase their investments on the identification and prevention of employees' EE and obesity. Such interventions would promote a better quality of life and could prevent economic losses resulting from poor employee performance.

Use of an intragastric balloon for management of obesity in a dog

While various bariatric surgeries are commonplace in obesity medicine for humans, these techniques have not been commonly used in veterinary medicine. A technique used in humans consists in endoscopically placing an intragastric balloon. The intragastric balloon takes volume in the stomach causing a feeling of satiety and reducing food intake. A 57.6 kg, 9-year-old neutered female Labrador dog with chronic hypothyroidism was presented for overweight management. Combined levothyroxine treatment and dietary management with specific alimentation for obesity had failed to control overweight. An intragastric balloon was placed endoscopically in the stomach to allow the reduction of the gastric capacity and resulted in effective weight loss. The dog weight decreased to 40.9 kg at the time of intragastric balloon removal 198 days after placement. Further research including a larger sample size and long term follow-up is required to establish safety and effectiveness of this procedure.

Effect of a Weight Loss Program on Biochemical and Immunological Profile, Serum Leptin Levels, and Cardiovascular Parameters in Obese Dogs

This study aimed to investigate the effects of a weight loss program (WLP) on biochemical and immunological profile, and cardiovascular parameters in a cohort of dogs with naturally occurring obesity. Eleven obese dogs [body condition scoring (BCS), ≥7/9] were enrolled into the study and underwent clinical and cardiovascular examination, and blood testing before (T0) and after 6 months (T1) of WLP. Eleven normal weight (BCS, 4/5) healthy dogs were used as a control (CTR) group. Compared to the CTR group, at T0 obese dogs expressed higher serum leptin concentrations (p < 0.0005) that significantly decreased after weight loss (p < 0.005) but remained higher than the CTR group. Furthermore, obese dogs showed considerably lower levels (p < 0.0005) of regulatory T cell (Treg) compared to the CTR group, but they did not change after weight loss at T1. In obese dogs, tumor necrosis factor (TNF)-α and interleukin (IL)-6 concentrations were substantially reduced at T1 (p < 0.0001 and p < 0.005). Regarding the cardiovascular parameters, only one obese dog was hypertensive at T0, and systolic blood pressure values showed no significant differences at the end of the WLP. The ratio of interventricular septal thickness in diastole to left ventricle internal diameter in diastole (IVSd/LVIDd) was significantly greater in obese dogs at T0 than in the CTR group (p < 0.005). It decreased after weight loss (p < 0.05). In obese dogs, troponin I level significantly reduced with weight loss (p < 0.05), while endothelin-1 level did not differ statistically. The results suggest that the immune dysregulation in the presence of high leptin levels and reduced number of Treg could affect obese dogs as well as humans. Based on our findings, we may speculate that a more complete immune-regulation restore could be obtained by a greater reduction in fat mass and a longer-term WLP. Finally, left ventricular remodeling may occur in some obese dogs. However, in canine species, further studies are needed to investigate the impact of obesity and related WLP on cardiovascular system.

Effectiveness of Electroacupuncture for Simple Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To evaluate the effectiveness of electroacupuncture in the treatment of simple obesity.

METHODS

Randomized clinical trials concerning electroacupuncture as a treatment of simple obesity published prior to October 31, 2019, were searched in the following Chinese and English databases: Chinese National Knowledge Infrastructure (CNKI), WanFang Database, China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database (CBM), PubMed, Cochrane Library, Web of Science, and Scopus. After data collection and quality evaluation, meta-analysis was performed using RevMan 5.3 software and Stata 15.0 software.

RESULTS

A total of 13 studies involving 937 patients with simple obesity were included in the meta-analysis. Results revealed that the total effective rate (RR = 1.29, 95% CI [1.13, 1.48]; P=0.0002), BMI (MD = -1.82, 95% CI [-2.21, -1.43]; P < 0.000), waist circumference (MD = -2.39, 95% CI [-3.95, -0.84]; P=0.003), hip circumference (MD = 0.31, 95% CI [-2.37, 2.99]; P=0.82), waist-hip ratio (MD = -0.05, 95% CI [-0.07, -0.03]; P < 0.00), and body fat rate (MD = -1.56, 95% CI [-2.35, -0.78]; P=0.0001) in the electroacupuncture group were superior to those in the control group. Analysis of acupoint clustering and correlation using SPSS 24.0 and Clementine 12.0 revealed the highest statistical support for acupoint groups CV12-CV4 and CV12-ST25-CV4, while ST36-CV12-ST25, SP6, and ST40-ST24-SP15-ST37-CV4 were found to be validly clustered acupoints.

CONCLUSION

For treating simple obesity, electroacupuncture is superior to other interventions such as acupuncture, acupoint catgut embedding therapy, and simple lifestyle modification for improvement in body fat rate, waist circumference, and waist-hip ratio, although not hip circumference. Acupoint analysis revealed that ST25, CV12, CV4, SP6, and ST36 can form the basis for electroacupuncture therapy for the treatment of simple obesity.

A One Health Perspective on the Human-Companion Animal Relationship with Emphasis on Zoonotic Aspects

Over time the human-animal bond has been changed. For instance, the role of pets has changed from work animals (protecting houses, catching mice) to animals with a social function, giving companionship. Pets can be important for the physical and mental health of their owners but may also transmit zoonotic infections. The One Health initiative is a worldwide strategy for expanding collaborations in all aspects of health care for humans, animals, and the environment. However, in One Health communications the role of particularly dogs and cats is often underestimated.

OBJECTIVE

Evaluation of positive and negative One Health issues of the human-companion animal relationship with a focus on zoonotic aspects of cats and dogs in industrialized countries.

METHOD

Literature review.

RESULTS

Pets undoubtedly have a positive effect on human health, while owners are increasing aware of pet's health and welfare. The changing attitude of humans with regard to pets and their environment can also lead to negative effects such as changes in feeding practices, extreme breeding, and behavioral problems, and anthropozoonoses. For the human, there may be a higher risk of the transmission of zoonotic infections due to trends such as sleeping with pets, allowing pets to lick the face or wounds, bite accidents, keeping exotic animals, the importation of rescue dogs, and soil contact.

CONCLUSIONS

One Health issues need frequently re-evaluated as the close human-animal relationship with pet animals can totally differ compared to decennia ago. Because of the changed human-companion animal bond, recommendations regarding responsible pet-ownership, including normal hygienic practices, responsible breeding, feeding, housing, and mental and physical challenges conforming the biology of the animal are required. Education can be performed by vets and physicians as part of the One Health concept.

Environmental, Socioeconomic, Maternal, and Breastfeeding Factors Associated with Childhood Overweight and Obesity in Ceará, Brazil: A Population-Based Study

Childhood obesity is now an epidemic in many countries worldwide and is known to be a multifactorial condition. We aimed to examine the relationship of environmental, socioeconomic, and nutritional factors with childhood overweight and obesity. We conducted a population-based cross-sectional study of children from 2 to 6 years of age in Ceará, Brazil. Children’s nutritional status was assessed by body mass index (BMI) Z scores categorized as overweight and obesity. Ordinal logistic regression models were used to assess the relationship between the factors with overweight and obesity. A total of 2059 children participated, of which 50.4% were male. The mean age was 46 ± 17 months, with a prevalence of overweight and obesity of 12.0% (95% CI 10.7–13.6) and 8.0% (6.7–9.5), respectively. In multivariate analysis, the probability of childhood obesity increased as family income increased (adjusted hazard ratio (aHR) 0.6 (95% CI 0.37–0.95), p-value = 0.03). Moreover, families with fewer children had more than 30% fewer overweight children (aHR 0.68; 95% CI 0.48–0.96). Environmental, socioeconomic, and child nutritional factors were associated with overweight and obesity. The results provided could be used to design integrated interventions spanning from conception, or earlier, through the first years of life and may improve child nutritional outcomes.

Delaware's 1999-2017 Leading Causes of Death Information Illustrates Its Obesity and Obesity-Related Life-Limiting Disease Burdens

Using commercially available but powerful big data analytics, this non-clinical obesity and underlying causes of death observational study, analyzed the very large US Centers for Disease Control and Prevention's (CDC) State of Obesity records, the CDC WONDER data, and the US census records. Compared to the 1999-to-2017 US obesity rate increase of 29.8%, an uncontrolled increase in Delaware's obesity rate (81.7%) was observed. During the same time period, CDC WONDER death certificate archives disclosed that there was a 60.53% surge in crude Delawarean mortality rate when obesity was listed as a single underlying cause of death. When any mention of obesity was documented on the death certificate, Delaware's 1999-2017 crude mortality rate advanced by 75.69% and its age-adjusted rate rose by 53.18%. Likewise, except for one year, Delaware's African American/Black population experienced higher crude mortality rate averages but however, between the years of 1997 and 2017, its Caucasian/White inhabitants had an enormous 87.34% death rate increase. With additional available CDC mortality data, Delaware males saw substantially larger age-adjusted death rate increases (79.87%) than their female counterparts (28.92%). Diabetes, circulatory system diseases, and neoplasms (cancer), are three common obesity comorbidities. For these three conditions, Delaware's 1999-2017 mortality rate figures mimic the falling national patterns of mortality rate averages, when each disease is listed as the single underlying cause of death, including observations where there are disproportionate numbers of cases that affect the African American/Black race.

Impact of Fecal Microbiota Transplantation on Obesity and Metabolic Syndrome-A Systematic Review

Fecal microbiota transplantation (FMT) is a gut microbial-modulation strategy that has been investigated for the treatment of a variety of human diseases, including obesity-associated metabolic disorders. This study appraises current literature and provides an overview of the effectiveness and limitations of FMT as a potential therapeutic strategy for obesity and metabolic syndrome (MS). Five electronic databases and two gray literature sources were searched up to 10 December 2018. All interventional and observational studies that contained information on the relevant population (adult patients with obesity and MS), intervention (receiving allogeneic FMT) and outcomes (metabolic parameters) were eligible. From 1096 unique citations, three randomized placebo-controlled studies (76 patients with obesity and MS, body mass index = 34.8 ± 4.1 kg/m², fasting plasma glucose = 5.8 ± 0.7 mmol/L) were included for review. Studies reported mixed results with regards to improvement in metabolic parameters. Two studies reported improved peripheral insulin sensitivity (rate of glucose disappearance, RD) at 6 weeks in patients receiving donor FMT versus patients receiving the placebo control. In addition, one study observed lower HbA1c levels in FMT patients at 6 weeks. No differences in fasting plasma glucose, hepatic insulin sensitivity, body mass index (BMI), or cholesterol markers were observed between two groups across all included studies. While promising, the influence of FMT on long-term clinical endpoints needs to be further explored. Future studies are also required to better understand the mechanisms through which changes in gut microbial ecology and engraftment of microbiota affect metabolic outcomes for patients with obesity and MS. In addition, further research is needed to better define the optimal fecal microbial preparation, dosing, and method of delivery.

The efficacy and safety of liraglutide in the obese, non-diabetic individuals: a systematic review and meta-analysis

Background

Liraglutide has been shown to improve glucose tolerance and lose weight in individuals with type 2 diabetes. To date, no meta-analysis of liraglutide's safety and efficacy in individuals without diabetes has been conducted.

Objectives

The aim of this study is to carry out a meta-analysis to assess the efficacy and safety of liraglutide in the obese, non-diabetic individuals.

Methods

A literature review was performed to identify all published randomised control trials (RCT) of liraglutide for the treatment of obesity in non-diabetic individuals. The search included the following databases: EMBASE, MEDLINE and the Cochrane Controlled Trials Register.

Results

We included five publications involving a total of 4,754 patients that compared liraglutide with placebo and found that liraglutide to be an effective and safe treatment for weight loss in individuals without diabetes. Primary efficacy end points: mean weight loss (MD = -5.52, 95% CI = -5.93 to -5.11, p<0.00001); lost more than 5% of body weight (OR = 5.46, 95% CI=3.57 to 8.34, p<0.00001) and key secondary efficacy end points: SBP decreased (the MD = -2.56, 95% CI = -3.28 to -1.84, p<0.00001). Safety assessments included the proportion of individuals who were withdrawn due to AE (OR = 2.85, 95% CI= 0.84 to 9.62, p=0.009), and nausea indicated that liraglutide was well tolerated.

Conclusion

This systematic review and meta-analysis indicates that liraglutide to be an effective and safe treatment for weight loss in the obese, non-diabetic individuals.

Prevalence of comorbidities in heart failure patients and those treated with cellular therapeutics

Introduction: Changes in our daily living, particularly in work routines, diet, and physical exercise, have influenced a worldwide crisis for life-threatening comorbidities and the likelihood of cardiovascular disease diagnosis. Cardiovascular regenerative medicine researchers continue to investigate new therapeutic approaches and reexamine completed clinical trials to design more effective future studies. As the frequency of cardiovascular disease diagnosis continues to rise, investigations of how to repair and regenerate the failing myocardium remains an essential mission for human health. Areas covered: This review first examines the aging process, the rising rate of comorbidities, and the likelihood of developing heart disease. In the ongoing efforts to recapitulate human health needs in clinical trials, a review of clinical trials involving cellular therapeutics for cardiac repair, with a focus on the patient population and patients' complex medical records, is presented. Expert opinion: The expert opinion first draws attention to the changing demographics of patients diagnosed with diseases that lead to heart failure and focusing on obesity as a primary driver for increased cardiovascular disease. The opinion focuses on the importance of designing preclinical models and experimentation that better mimic the patient population and clinical situations to evaluate the effectiveness of potential future therapeutic interventions.

Association between life span and body condition in neutered client-owned dogs

Background

There is an association between overweight status and life span in kenneled dogs, but a similar association has not been reported for pet dogs.

Objectives

To examine the effects of being overweight in middle age on the life span of neutered client‐owned dogs.

Animals

Fifty‐thousand seven‐hundred eighty seven middle‐aged neutered client‐owned dogs attending a network of approximately 900 veterinary hospitals across North America.

Methods

Retrospective case‐control study. For each of 12 breeds, groups of dogs aged between 6.5 and 8.5 years were identified as being in “overweight” or “normal” body condition. Within each breed and sex, differences in life span between dogs in normal body condition and overweight body condition in the 2 groups were then analyzed by Cox proportional hazards models.

Results

For all breeds, instantaneous risk of death for dogs in overweight body condition was greater than those in normal body condition throughout the age range studied, with hazard ratios ranging from 1.35 (99.79% confidence interval [CI] 1.05‐1.73) for German Shepherd dog to 2.86 (99.79% CI 2.14‐3.83) for Yorkshire Terrier. In all breeds, median life span was shorter in overweight compared with normal weight dogs, with the difference being greatest in Yorkshire Terriers (overweight: 13.7 years, 99.79% CI 13.3‐14.2; normal: 16.2 years, 99.79% CI 15.7‐16.5) and least in German Shepherd dogs (overweight: 12.1 years, 99.79% CI 11.8‐12.4; normal: 12.5 years, 99.79% CI 12.2‐12.9).

Conclusions and Clinical Importance

Veterinary professionals should consider promoting healthy body condition for dogs, particularly from midlife onward.

Childhood emotional abuse and neglect in obese patients with and without binge eating disorder: Personality and psychopathology correlates in adulthood

The link between childhood traumatic experiences such as sexual and physical abuse and EDs in adulthood has been widely demonstrated. To date, however, little research focused on the association between emotional abuse and neglect in childhood and Binge Eating Disorder (BED) and obesity in adulthood. We enrolled 127 patients [84 with BED and 43 obese] and 45 healthy controls (HCs). All participants were administered the same battery of psychometric tests. Between-group differences were explored and the relationship between emotional abuse and neglect in childhood and personality and psychopathology in adulthood was tested. Obese patients showed higher scores in emotional abuse and neglect and sexual abuse when compared to HCs. Within obese participants, those with BED reported higher emotional abuse and emotional neglect than obese without BED and HCs; the BED group differed in physical and sexual abuse from obese participants. The association between traumatic experiences in childhood and obesity in adulthood has been confirmed independently of the type of trauma. Therapists should take into account the traumatic etiology of BED, in particular psychological abuse, even in those patients who do not recall physical or sexual abuses. Specific techniques to approach traumatic experiences could be applied to BED or non-BED patients.

An international multi-centre cohort study of weight loss in overweight cats: Differences in outcome in different geographical locations

Introduction

Feline obesity is a worldwide concern which has recently been formally classified as a disease by the veterinary community. Management involves invoking controlled weight loss by feeding a purpose-formulated food in restricted quantities and altering physical activity. Most weight loss studies conducted in cats have been undertaken in research cat colonies from single geographic locations. The aim of this multi-centre cohort study was to determine the efficacy of a short-term dietary weight loss intervention in overweight pet cats across a range of geographical locations globally.

Materials and methods

A 3-month (median 13 weeks, inter-quartile range [IQR] 12–15 weeks) weight loss programme was conducted at 188 veterinary practices in 22 countries, and involving 730 cats, 413 of which completed the programme and had complete data available. All were fed commercially available dry or wet weight loss diets, and median energy intake was 53 kcal/kg BW^0.711/day. The Royal Canin Ethics Committee approved the study, and owners gave informed consent. Owners completed behavioural questionnaires assessing begging, physical activity and quality of life (QOL). Linear mixed models were used to assess the respective influence of time, age, and initial body condition score (BCS) on weight loss and behavioural observations.

Results

At baseline, median age was 72 months (range 12–200 months) and median BCS was 8 (range 7–9). In all, 402/413 cats (97%) lost weight (mean 10.6±6.3%) during the programme at a rate of 0.8 ±0.50%/week. Based upon owner questionnaires, activity and QOL improved (both P<0.001), while begging behaviour decreased (P<0.001) during weight loss. The main factor influencing percentage weight loss was geographical location (P<0.001), with cats in North America losing less weight (median 7.2%, IQR: 4.4–10.4%) than those in both Europe (10.7%, 6-8-15.4%) and South America (10.0%, 6.2–15.4%). Differences in weight loss were also observed amongst countries (P<0.001), with cats in Argentina, Germany, and Italy losing more weight than cats in the USA, and cats in Germany also losing more weight than cats in Portugal.

Discussion/conclusion

Most of the overweight cats enrolled in this international multi-centre study successfully lost weight. The reason for the differences in percentage weight loss amongst geographical locations requires further study.

Study protocol: intervention in maternal perception of preschoolers' weight among Mexican and Mexican-American mothers

Background

Childhood obesity is a public health issue negatively affecting children’s physical and psychosocial health. Mothers are children’s primary caregivers, thus key players in childhood obesity prevention. Studies have indicated that mothers underestimate their children’s weight. If mothers are unaware of their children’s weight problem, they are less likely to participate in activities preventing and treating excess weight. The “Healthy Change” intervention is designed to change maternal perception of child’s weight (MPCW) through peer-led group health education in childcare settings.

Methods/Design

The “Healthy Change” is a multicenter two-arm randomized trial in four centers. Three centers are in Mexican States (Nuevo Leon, Tamaulipas, and Zacatecas). The fourth center is in San Antonio, Texas, USA. A total of 360 mother-child pairs (90 pairs per center) are to be randomly and evenly allocated to either the intervention or the control group. Intervention group will receive four-session group obesity prevention education. Control group will receive a four-session personal and food hygiene education. The education is delivered by trained peer-mother promotoras. Data will be collected using questionnaires and focus groups. The primary outcome is a change in proportion of mothers with accurate MPCW. Secondary outcomes include change in maternal feeding styles and practices, maternal self-efficacy and actions for managing child excessive weight gain.

McNemar’s Test will be used to test the primary outcome. The GLM Univariate procedure will be used to determine intervention effects on secondary outcomes. The models will include the secondary outcome measures as the dependent variables, treatment condition (intervention/control) as the fixed factor, and confounding factors (e.g., mother’s education, children’s gender and age) as covariates. Sub-analyses will be performed to compare intervention effects on primary and secondary outcomes between the samples from Mexico and Texas, USA. Qualitative data will be analyzed through analysis of inductive content. A combined coding model will be developed and used to code transcripts using the NVivo software.

Discussion

Healthy Change intervention could help change MPCW, an initial step for obesity prevention among preschoolers. This study presents a first of its kind intervention available in Spanish and English targeting Mexican and Mexican-American mothers in Mexico and USA.

Trial registration

ISRCTN12281648

Leaner, Healthier, Happier Together--A Family-Centred Approach to Weight Loss with the Overweight Dog and Her Caregivers

Obesity represents a one of the most significant healthcare issues facing human and companion animal populations worldwide. A complex relationship commonly exists between owners and their companion animal, particularly around feeding behaviour. Obese companion animals commonly live alongside caregivers who are also struggling with their own body weight. This case report highlights the importance of a family-centred approach to canine obesity as a way to engage with the pet's caregivers to help maximize their compliance towards the successful implementation of a tailored weight loss programme. Lara, an overweight dog weighing 35 kilos with a body condition score (BCS) of 7-7.5/9, was referred for a nutritional assessment. A comprehensive, pro-active and multidisciplinary protocol, tailored towards a family-centred approach, was established. After a 16-week programme, Lara reached the target body weight. The caregivers' compliance was assessed as being excellent; they also reassessed their individual lifestyle and were able to increase awareness towards their own nutritional issues and body weight perception, resulting in weight loss in all caregivers. Lara's case report represents how a family-centred approach can lead to successful patient weight loss and to a modification in the caregivers' way of thinking about nutrition and their own lifestyle, with the final goal of living a healthier and longer life together.