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Bohorquez Caballero AD, Wall-Wieler E, Liu Y, Zheng F, Edwards MA. Statin use trajectories postbariatric surgery: a matched cohort analysis. Surg Obes Relat Dis 2024:S1550-7289(24)00807-4. [PMID: 39379259 DOI: 10.1016/j.soard.2024.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/22/2024] [Accepted: 08/31/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) is the most durable treatment of obesity and can reduce statin use. OBJECTIVE We compare statin use trajectories in patients with and without MBS. METHODS Adults with a body mass index ≥ 35kg/m2 were identified using a U.S. employer-based retrospective claims database. Individuals who had MBS were matched 1:1 with those who did not. Trajectories of statin use were stratified by statin use in the year before the index date and examined in the 2 years after the index date. SETTING University Hospital. RESULTS Sixteen thousand three hundred fifty-nine adults who had MBS and 16,359 matched adults who did not were analyzed. In both groups, 19.4% filled a statin prescription in the year before the index date. In the 2 years after the index date, individuals using statins remained similar at 20% (year 1) and 19% (year 2) among those who didn't have an MBS and decreased to 12.5% (year 1) and 9.3% (year 2) in the MBS cohort. Among baseline statin users, 35.4% of non-MBS and 60.4% of the MBS cohort stopped using statins within 2 years of the index date. Among statin naïve individuals at baseline, 9.6% of the non-MBS cohort started using statins within 2 years of the index date, compared to 2.6% of those who had MBS. CONCLUSIONS MBS results in a significant discontinuation of statins among baseline users, and significantly decreased the initiation of medications among individuals who were statin naive at baseline. This demonstrates that MBS is both a treatment and preventative measure for dyslipidemia.
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Affiliation(s)
| | - Elizabeth Wall-Wieler
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, California
| | - Yuki Liu
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, California
| | - Feibi Zheng
- Global Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, California; DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Michael A Edwards
- Division of Advanced GI And Bariatric Surgery, Mayo Clinic, Jacksonville, Florida.
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Yamazaki R, Iwai K, Azuma T, Yonenaga T, Sasai Y, Watanabe K, Obora A, Deguchi F, Kojima T, Tome W, Kitai N, Tomofuji T. Increased Waist Circumference after One-Year Is Associated with Poor Chewing Status. Healthcare (Basel) 2024; 12:1341. [PMID: 38998875 PMCID: PMC11240897 DOI: 10.3390/healthcare12131341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/26/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between an increase in waist circumference (WC) after 1 year and self-reported chewing status in 10,870 Japanese adults who had received health checkups. Subsequently, 8068 participants were included in the final analysis. METHODS We defined an increase in WC ≥ 5 cm after 1 year as an unhealthy increase; in total, 613 (7.5%) respondents met this criterion. Chewing status was evaluated using a self-reported questionnaire at baseline; 1080 (13%) respondents were diagnosed with poor chewing status. RESULTS After adjusting for age, gender, WC, body mass index (BMI), and chewing status, an increase in WC ≥ 5 cm was found to be positively associated with gender (females: odds ratios [ORs]: 1.206; 95% confidence intervals [CIs]: 1.008-1.443), WC (ORs: 0.967; 95% CIs: 0.954-0.981), BMI (≥25 kg/m2; ORs: 2.194; 95% CIs: 1.715-2.808), and chewing status (poor; ORs: 1.356; 95% CIs: 1.084-1.697). CONCLUSIONS These findings suggest that increased WC after 1 year was associated with self-reported poor chewing status in Japanese adults.
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Affiliation(s)
- Riku Yamazaki
- Department of Orthodontics, School of Dentistry, Asahi University, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
| | - Komei Iwai
- Department of Community Oral Health, School of Dentistry, Asahi University, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
| | - Tetsuji Azuma
- Department of Community Oral Health, School of Dentistry, Asahi University, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
| | - Takatoshi Yonenaga
- Department of Community Oral Health, School of Dentistry, Asahi University, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
| | - Yasuyuki Sasai
- Department of Community Oral Health, School of Dentistry, Asahi University, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
| | - Kazutoshi Watanabe
- Human Health Center, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu, Gifu 500-8523, Japan
| | - Akihiro Obora
- Human Health Center, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu, Gifu 500-8523, Japan
| | - Fumiko Deguchi
- Human Health Center, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu, Gifu 500-8523, Japan
| | - Takao Kojima
- Human Health Center, Asahi University Hospital, 3-23 Hashimoto-cho, Gifu, Gifu 500-8523, Japan
| | - Wakako Tome
- Department of Orthodontics, School of Dentistry, Asahi University, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
| | - Noriyuki Kitai
- Department of Orthodontics, School of Dentistry, Asahi University, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
| | - Takaaki Tomofuji
- Department of Community Oral Health, School of Dentistry, Asahi University, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan
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Lim PL, Goh GS, Bedair HS, Melnic CM. Weighing the Impact: The Influence of Body Mass Index on Facility Costs in Total Joint Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00625-9. [PMID: 38889808 DOI: 10.1016/j.arth.2024.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Using time-driven activity-based costing (TDABC), a novel cost calculation method that more accurately reflects true resource utilization in health care, we sought to compare the total facility costs across different body mass index (BMI) groups following total joint arthroplasty (TJA). METHODS The study consisted of 13,806 TJAs (7,340 total knee arthroplasties [TKAs] and 6,466 total hip arthroplasties [THAs]) performed between 2019 and 2023. The TDABC data from an analytics platform was employed to depict total facility costs, comprising personnel and supply costs. For the analysis, patients were stratified into four BMI categories: <30, 30 to <35, 35 to <40, and ≥40. Multivariable regression was used to determine the independent effect of BMI on facility costs. RESULTS When indexed to patients who had BMI <30, elevated BMI categories (30 to <35, 35 to <40, and ≥40) were associated with higher total personnel costs (TKA 1.03x versus 1.07x versus 1.13x, P < .001; THA 1.00x versus 1.08x versus 1.08x, P < .001), and total supply costs (TKA 1.01x versus 1.04x versus 1.04x, P < .001; THA 1.01x versus 1.02x versus 1.03x, P = .007). Total facility costs in TJAs were significantly greater in higher BMI categories (TKA 1.02x versus 1.05x versus 1.08x, P < .001; THA 1.01x versus 1.05x versus 1.05x, P < .001). Notably, when incorporating adjustments for demographics and comorbidities, BMI values of 35, 40, and 45 relative to BMI of 25, exhibit a significant association with a 2, 3, and 5% increase in total facility cost for TKAs and a 3, 5, and 7% increase for THAs. CONCLUSIONS Using TDABC methodology, this study found that overall facility costs of TJAs increase with BMI. The present study provides patient-level cost insights, indicating the potential need for reassessment of physician compensation models in this population. Further studies may facilitate the development of risk-adjusted procedural codes and compensation models for public and private payors. LEVEL OF EVIDENCE Level IV, economic and decision analyses.
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Affiliation(s)
- Perry L Lim
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Graham S Goh
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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Sudat SEK, Huang Q, Szwerinski N, Romanelli RJ, Azar KMJ. Changes in Healthcare Utilization After Lifestyle Intervention for Weight Loss. Am J Prev Med 2024; 66:619-626. [PMID: 37907133 PMCID: PMC10957326 DOI: 10.1016/j.amepre.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION This study evaluates the real-world impact of a lifestyle change program (LCP) on healthcare utilization in a large health system. METHODS Using electronic health record data from a large health system in northern California, U.S., LCP participant and propensity-score-matched nonparticipant outcomes were compared in the second year post-participation: (1) overall healthcare utilization and (2) utilization and medications related to cardiometabolic conditions and obesity. Adult LCP participants between 2010 and 2017 were identified and matched 1:1 with replacement to comparable nonparticipants. Participants without electronic health record activity in the 12-36 months before baseline, or with conditions or procedures associated with substantial weight change, were excluded. Statistical analysis and modeling were performed in 2021-22. RESULTS Compared to matched nonparticipants, LCP participants in the 12-24 months post-baseline were more likely to have specialty-care visits (+4.7%, 95% CI +1.8%, +7.6%), electronic communications (8.6%, 95% CI +5.6%, +11.7%), and urgent-care visits (+6.5%, 95% CI +3.0%, 10.0%). Participants also had more office visits for cardiometabolic conditions and obesity (+1.72 visits/patient, 95% CI +1.05, +2.39). CONCLUSIONS Compared with matched nonparticipants, LCP participation was associated with higher utilization of outpatient services post-participation. Additional research could assess whether this indicates an increase in preventive care that could lead to improved future outcomes.
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Affiliation(s)
- Sylvia E K Sudat
- Sutter Health, Center for Health Systems Research, Walnut Creek, California.
| | - Qiwen Huang
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | - Nina Szwerinski
- Sutter Health, Center for Health Systems Research, Palo Alto, California
| | | | - Kristen M J Azar
- Sutter Health, Center for Health Systems Research, Palo Alto, California; Sutter Health, Institute for Advancing Health Equity, Sacramento, California; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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Wong ES, Stechuchak KM, Smith VA, Hung A, Dennis PA, Hoerster KD, Maciejewski ML. Differences in healthcare costs over 10 years following discharge from military service by weight trajectory. Obes Res Clin Pract 2024; 18:88-93. [PMID: 38565463 DOI: 10.1016/j.orcp.2024.03.008] [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] [Received: 12/08/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/04/2024]
Abstract
The prevalence of overweight and obesity among military personnel has increased substantially in the past two decades. Following military discharge many personnel can receive integrated health care from the Veterans Health Administration. Prior research related to the economic impacts of obesity has not examined health care costs following the transition into civilian life following military discharge. To address this evidence gap, this study sought to compare longitudinal costs over 10 years across weight categories among VA enrollees recently discharged from the military.
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Affiliation(s)
- Edwin S Wong
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, MS-152, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA.
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA
| | - Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA; Division of General Internal Medicine, Department of Medicine, Duke University, 200 Morris St., Durham, NC 27701, USA
| | - Anna Hung
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA
| | - Paul A Dennis
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA
| | - Katherine D Hoerster
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, MS-152, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington, 3980 15th Ave. NE, Seattle, WA 98195, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, 508 Fulton St., Durham, NC 27705, USA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St., Durham, NC 27701, USA; Division of General Internal Medicine, Department of Medicine, Duke University, 200 Morris St., Durham, NC 27701, USA; Duke-Margolis Center for Health Policy, Duke University, 100 Fuqua Drive, Box 90120, Durham, NC 27708, USA
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Landovská P, Karbanová M. Social costs of obesity in the Czech Republic. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1321-1341. [PMID: 36449132 PMCID: PMC9709763 DOI: 10.1007/s10198-022-01545-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
Increasing prevalence of obesity (BMI > 30) is a pressing public health issue in the Czech Republic as well as world-wide, affecting up to 2.1 billion people. Increasing trend in the prevalence of obesity in adults and children generates large social costs. The main aim of this study is to estimate both direct and indirect costs of obesity in the Czech Republic. Social costs of obesity are estimated using the cost-of-illness approach. Direct costs (healthcare utilization costs and costs of pharmacotherapy of 20 comorbidities) are estimated using the top-down approach, while indirect costs (absenteeism, presenteeism and premature mortality) are estimated using the human capital approach. In aggregate, the annual costs attributable to obesity in the Czech Republic in 2018 were 40.8 bn CZK (1.6 bn EUR, 0.8% GDP). Direct costs were 14.5 bn CZK (0.6 bn EUR) and accounted for 3.4% of Czech healthcare expenditures. The highest healthcare utilization costs were attributable to type II diabetes (20.6%), ischemic heart disease (18.8%) and osteoarthritis (16.7%). The largest indirect costs were attributable to premature mortality (10 bn CZK/0.39 bn EUR), absenteeism (9.2 bn CZK/0.36 bn EUR) and presenteeism (7.1 bn CZK/0.27 bn EUR). This article demonstrates that obesity is a serious problem with considerable costs. Several preventive interventions should be applied in order to decrease the prevalence of obesity and achieve cost savings.
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Affiliation(s)
- Petra Landovská
- Faculty of Social Sciences, Charles University, Opletalova 26, 110 00, Prague, Czech Republic.
| | - Martina Karbanová
- Department of Public Health, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00, Brno, Czech Republic
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Butalia S, Luu H, Guigue A, Martins KJB, Williamson T, Klarenbach SW. Health care cost of severe obesity and obesity-related comorbidities: A retrospective cohort study from Alberta, Canada. Obes Res Clin Pract 2023; 17:421-427. [PMID: 37709630 DOI: 10.1016/j.orcp.2023.09.006] [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] [Received: 03/24/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Estimates of health care costs associated with severe obesity, and those attributable to specific health conditions among adults living with severe obesity are needed. METHODS Administrative data was used to identify adults who previously received a procedure, and had (investigational cohort) or did not have (control cohort) a body mass index ≥ 35 kg/m2. Two-part models were used to estimate the incremental health care cost of severe obesity and related health conditions during a 1-year observation period. RESULTS Adjusting for potential confounders, the total health care cost ratio was higher in the investigational (n = 220,190) versus control (n = 1,955,548) cohort (1.32 [95 % CI: 1.32, 1.33]) with a predicted incremental cost of $2221 (95 % CI $2184, $22,265) per person-year; costs were less when obesity-related health conditions were controlled for (1.13 [95 % CI: 1.13, 1.14]; $1097 [95 % CI: $1084, $1110] per person-year). Among those living with severe obesity, incremental costs associated with specific health conditions ranged from $737 (95 % CI: $747, $728) lower (dyslipidemia) to $12,996 (95 % CI: $12,512, $13,634) higher (peripheral vascular disease) per person-year. CONCLUSIONS Adults living with severe obesity had greater costs than those without, largely driven by obesity-related health conditions. For the Alberta adult population with a severe obesity prevalence of 11 %, severe obesity may account for an estimated additional $453-918 million in health care costs per year. Findings of this study provide rationale for resources and strategies to prevent and manage obesity and its complications.
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Affiliation(s)
- Sonia Butalia
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada T2N 1N4
| | - Huong Luu
- Faculty of Medicine and Dentistry, Real World Evidence Unit, University of Alberta, Edmonton, Alberta, Canada T6G 2R3
| | - Alexis Guigue
- Department of Community Health Sciences and the Centre for Health Informatics, University of Calgary, Canada T2N 1N4
| | - Karen J B Martins
- Faculty of Medicine and Dentistry, Real World Evidence Unit, University of Alberta, Edmonton, Alberta, Canada T6G 2R3
| | - Tyler Williamson
- Department of Community Health Sciences and the Centre for Health Informatics, University of Calgary, Canada T2N 1N4
| | - Scott W Klarenbach
- Faculty of Medicine and Dentistry, Real World Evidence Unit, University of Alberta, Edmonton, Alberta, Canada T6G 2R3; Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2R3.
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Maselli DB, Hoff AC, Kucera A, Weaver E, Sebring L, Gooch L, Walton K, Lee D, Cratty T, Beal S, Nanduri S, Rease K, Gainey CS, Eaton L, Coan B, McGowan CE. Endoscopic sleeve gastroplasty in class III obesity: Efficacy, safety, and durability outcomes in 404 consecutive patients. World J Gastrointest Endosc 2023; 15:469-479. [PMID: 37397974 PMCID: PMC10308273 DOI: 10.4253/wjge.v15.i6.469] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is an effective therapy for class I-II obesity, but there are knowledge gaps in the published literature about its implementation in patients with class III obesity [body mass index (BMI) ≥ 40 kg/m2].
AIM To evaluate the safety, clinical efficacy, and durability of ESG in adults with class III obesity.
METHODS This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m2 who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss (TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss (EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration.
RESULTS 404 consecutive patients (78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m2) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type II diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization (0.2% serious adverse event rate).
CONCLUSION When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class III obesity, with improvement in comorbidities and an acceptable safety profile.
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Affiliation(s)
- Daniel Barry Maselli
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Anna Carolina Hoff
- Bariatric Endoscopy, Angioskope Clinic, São José dos Campos 12243-680, São Paulo, Brazil
| | - Ashley Kucera
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Emily Weaver
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Laura Sebring
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Lori Gooch
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kathleen Walton
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Daniel Lee
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Taylor Cratty
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Selena Beal
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Srikar Nanduri
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kendall Rease
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Christina S Gainey
- Gastroenterology and Hepatology, University of North Carolina System, Chapel Hill, NC 27599, United States
| | - Laura Eaton
- UltaMed Corporation, UltaMed Corporation, Fort Lauderdale, FL 33308, United States
| | - Brian Coan
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
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Kaye E, McDonough R, Singhal A, Garcia RI, Jurasic M. Effect of Overweight and Obesity on Periodontal Treatment Intensity. JDR Clin Trans Res 2023; 8:158-167. [PMID: 35148660 PMCID: PMC10029136 DOI: 10.1177/23800844221074354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Obesity is associated with greater utilization of medical resources, but it is unclear if a similar relationship exists for dental care. OBJECTIVES This retrospective cohort study compared periodontal disease treatment among obese, overweight, and normal-weight patients attending an urban US dental school clinic. METHODS Periodontal, demographic, and medical history data for 3,443 adult patients examined between July 1, 2010, and July 31, 2019, were extracted from electronic health records. Body mass index (BMI) was computed from self-reported height and weight and categorized as obese (≥30 kg/m2), overweight (25-29.9 kg/m2), or normal (18-24.9 kg/m2). Periodontal disease was categorized using clinical probing measures. Procedure codes defined treatment type (surgical, nonsurgical, local chemotherapeutics, or none). Logistic regression models controlling for initial periodontal disease severity, age, gender, tobacco use, history of diabetes, dental insurance type, and follow-up (log of days) estimated odds ratios (ORs) and 95% confidence intervals (CIs) of any treatment among obese and overweight relative to normal-weight patients. The association between BMI and a periodontal treatment intensity score, based on treatment type, number of teeth treated, and number of visits, was evaluated with multivariable negative binomial regression. RESULTS Mean age at baseline was 44 ± 15 y, and severe periodontal disease was present in 32% of obese, 31% of overweight, and 21% of normal-weight patients. Average follow-up was 3.9 ± 1.6 y. Obese and overweight patients were more likely to have nonsurgical scaling and root planing or surgical procedures than normal-weight patients. Adjusted odds of any treatment were higher among obese (OR = 1.34; 95% CI, 1.14-1.72) and overweight (OR = 1.18; 95% CI, 0.97-1.42) relative to normal weight. Obese and overweight patients had 40% and 24% higher treatment intensity scores, respectively, than normal-weight patients. CONCLUSION These results indicate obese and overweight individuals require more intensive periodontal treatment compared to normal-weight individuals, independent of initial disease severity. KNOWLEDGE OF TRANSFER STATEMENT The results of this study can be used by dental providers and policymakers to better understand patient characteristics that influence the variability in frequency and length of periodontal treatment. Knowledge of a patient's body mass index may be useful in identifying patients who possibly will have a poorer periodontal prognosis.
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Affiliation(s)
- E Kaye
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - R McDonough
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - A Singhal
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - R I Garcia
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - M Jurasic
- Department of Health Policy and Health Services Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
- Department of General Dentistry, Director of the Center for Clinical Research, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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Labropoulos N, Raiker A, Gasparis A, Weycker D, O'Donnell T. Clinical Impact of Severe Obesity in Patients with Lymphoedema. Eur J Vasc Endovasc Surg 2023; 65:406-413. [PMID: 36403939 DOI: 10.1016/j.ejvs.2022.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE With the rate of obesity increasing worldwide, patients with lymphoedema with and without a concomitant diagnosis of severe obesity (SO) were compared in regard to their baseline demographics, health related characteristics, treatment plans, and patient outcomes. METHODS This was a retrospective observational cohort study. The IBM MarketScan database was examined (2013 - 2019) for patients with a new diagnosis of lymphoedema. Of 60 284 patients with lymphoedema identified, 6 588 had SO defined by a body mass index > 40 kg/m2. The demographics and other characteristics of SO were compared with patients with lymphoedema without SO. RESULTS SO and lymphoedema diagnosis increased two fold from 2013 to 2019. The lymphoedema SO+ group was younger (57.8 vs. 60.8 years, p < .001) and with a higher proportion of men (37.7% vs. 24.9%, p < .001) than the lymphoedema SO- group. More comorbidities were observed in the lymphoedema SO+ group than the lymphoedema SO- group: diabetes 46.0% vs. 24.9 % (p < .001), heart failure 18.3% vs. 7.4% (p < .001), hypertension 75.0% vs. 47.6% (p < .001), and renal disease 24.8% vs. 11.9% (p < .001). Use of diuretics in the lymphoedema SO+ group was greater: 57.6% vs. 38.0% (p < .001). Patients with lymphoedema SO+ had higher risk of cellulitis: 34.5% vs. 13.5% (p < .001). Specific lymphoedema treatment was given more often to lymphoedema SO-: 66.3% vs. 64.3% (p = .003). This was significant for manual lymphatic drainage (46.6% vs. 40.0%; p < .001) and physical therapy (55.4% vs. 51.6%; p<.001), but not for compression garments (18.2% vs. 17.7%; p = .38). However, more patients with lymphoedema SO+ received pneumatic compression device treatment: 20.9% vs. 13.7% (p < .001). CONCLUSION There was an increase in SO associated lymphoedema. Patients with lymphoedema SO+ have over a two and half fold increase in cellulitis incidence, with a significant increase in medical resource use and cost. Despite this, patients with lymphoedema and SO receive less specific therapy such as compression, which has proven to reduce cellulitis incidence.
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Affiliation(s)
- Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Centre, NY, USA.
| | - Ashna Raiker
- Department of Surgery, Stony Brook University Medical Centre, NY, USA
| | - Antonios Gasparis
- Department of Surgery, Stony Brook University Medical Centre, NY, USA
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Vesikansa A, Mehtälä J, Mutanen K, Lundqvist A, Laatikainen T, Ylisaukko-oja T, Saukkonen T, Pietiläinen KH. The association between body mass index groups and metabolic comorbidities with healthcare and medication costs: a nationwide biobank and registry study in Finland. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2166313. [PMID: 36684852 PMCID: PMC9858397 DOI: 10.1080/20016689.2023.2166313] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND The increasing prevalence of obesity imposes a significant cost burden on individuals and societies worldwide. OBJECTIVE In this nationally representative study, the association between body mass index (BMI) groups and the number of metabolic comorbidities (MetC) with total direct costs was investigated in the Finnish population. STUDY DESIGN, SETTING, AND PARTICIPANTS The study cohort included 5,587 adults with BMI ≥18.5 kg/m2 who participated in the cross-sectional FinHealth 2017 health examination survey conducted by the Finnish Institute for Health and Welfare. Data on healthcare resource utilization (HCRU) and drug purchases were collected from national healthcare and drug registers. MAIN OUTCOME MEASURE The primary outcome was total direct costs (costs of primary and secondary HCRU and prescription medications). RESULTS Class I (BMI 30.0-34.9 kg/m2) and class II - III (BMI ≥35.0 kg/m2) obesity were associated with 43% and 40% higher age- and sex-adjusted direct costs, respectively, compared with normal weight, mainly driven by a steeply increased comorbidity in the higher BMI groups. In all BMI groups combined, individuals with ≥2 MetCs comprised 39% of the total study population and 60% of the total costs. CONCLUSION To manage the cost burden of obesity, treatment should be given equal consideration as other chronic diseases, and BMIs ≥30.0 kg/m2 should be considered in treatment decisions.
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Affiliation(s)
| | | | | | | | - Tiina Laatikainen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Joint Municipal Authority for North Karelia Social andHealth Services (Siun Sote), Joensuu, Finland
| | - Tero Ylisaukko-oja
- MedEngine Oy, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | | | - Kirsi H. Pietiläinen
- Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki,Helsinki, Finland & Obesity Center, Abdominal Center, Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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12
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Nwana N, Taha MB, Javed Z, Gullapelli R, Nicolas JC, Jones SL, Acquah I, Khan S, Satish P, Mahajan S, Cainzos-Achirica M, Nasir K. Neighborhood deprivation and morbid obesity: Insights from the Houston Methodist Cardiovascular Disease Health System Learning Registry. Prev Med Rep 2022; 31:102100. [PMID: 36820380 PMCID: PMC9938328 DOI: 10.1016/j.pmedr.2022.102100] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
This study examined the relationship between a validated measure of socioeconomic deprivation, such as the Area Deprivation Index (ADI), and morbid obesity. We used cross-sectional data on adult patients (≥18 years) in the Houston Methodist Cardiovascular Disease Health System Learning Registry (located in Houston, Texas, USA) between June 2016 and July 2021. Each patient was grouped by quintiles of ADI, with higher quintiles signaling greater deprivation. BMI was calculated using measured height and weight with morbid obesity defined as ≥ 40 kg/m2. Multivariable logistic regression models were used to examine the association between ADI and morbid obesity adjusting for demographic (age, sex, and race/ethnicity) factors. Out of the 751,174 adults with an ADI ranking included in the analysis, 6.9 % had morbid obesity (n = 51,609). Patients in the highest ADI quintile had a higher age-adjusted prevalence (10.9 % vs 3.3 %), and about 4-fold odds (aOR, 3.8; 95 % CI = 3.6, 3.9) of morbid obesity compared to the lowest ADI quintile. We tested for and found interaction effects between ADI and each demographic factor, with stronger ADI-morbid obesity association observed for patients that were female, Hispanic, non-Hispanic White and 40-65 years old. The highest ADI quintile also had a high prevalence (44 %) of any obesity (aOR, 2.2; 95 % CI = 2.1, 2.2). In geospatial mapping, areas with higher ADI were more likely to have higher proportion of patients with morbid obesity. Census-based measures, like the ADI, may be informative for area-level obesity reduction strategies as it can help identify neighborhoods at high odds of having patients with morbid obesity.
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Key Words
- ADI, Area Deprivation Index
- BMI, Body Mass Index
- CA, Catchment Area
- CI, Confidence Interval
- CVD, Cardiovascular Diseases
- Data-driven
- ED, Emergency Department
- FIPS, Federal Information Processing Standards
- HM, Houston Methodist
- Health equity
- IRB, Internal Review Board
- Morbid obesity
- Neighborhood deprivation
- OR, Odds Ratio
- SD, Standard Deviation
- SDOH, Social Determinants of Health
- SES, Socio-Economic Status
- US, United States
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Affiliation(s)
- Nwabunie Nwana
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Mohamad B. Taha
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Zulqarnain Javed
- Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Rakesh Gullapelli
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Juan C. Nicolas
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Stephen L. Jones
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Isaac Acquah
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA
| | - Safi Khan
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Priyanka Satish
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Shivani Mahajan
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Health Disparities and Equity Research, Center for Outcomes Research, Houston Methodist, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA,Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA,Corresponding author at: Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX 77030, USA.
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13
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Diop M, Ruiz-Adame M, Gaggero A. Influence of personality traits, gender, and socio-economic factors in obesity in the English Longitudinal Study of Ageing. Personal Ment Health 2022; 17:176-183. [PMID: 36564862 DOI: 10.1002/pmh.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 12/25/2022]
Abstract
Obesity is a chronic disorder associated with high mortality rates and high morbidity. The risk of obesity is associated with certain personality traits (PTs). Some studies have found correlations among some PTs and gender. Additionally, obesity implies higher costs in daily living. The aim of this paper is to overcome this problem in the literature and estimate the association between PTs and obesity by taking into account the economic situation of the individual. This study employs data from the English Longitudinal Study of Ageing (ELSA). We focus on waves 5 and 6 of the ELSA with a sample of 6562 individuals. The results suggests that the traits of agreeableness ( β = 0.071 , se = 0.016 , p < 0.001 $$ \beta =0.071, se=0.016,\kern0.5em p<0.001 $$ ) and openness ( β = 0.028 , se : 0.014 , p < 0.001 $$ \beta =0.028, se:0.014,\kern0.5em p<0.001 $$ ) are positively and significantly associated with obesity. On the other hand, consciousness has a negative and statistically significant effect on obesity β = 0.072 , se : 0.017 , p < 0.001 $$ \left(\beta =0.072, se:0.017,\kern0.5em p<0.001\right) $$ . Results are robust to the inclusion/exclusion of different regressors.
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Affiliation(s)
- Modou Diop
- Applied Economics Department, School of Economics, University of Granada, Granada, Spain
| | - Manuel Ruiz-Adame
- Applied Economics Department, Social and Law Sciences School, University of Granada, Melilla, Spain.,Institute of Neuroscience, Trépel Lab, Trinity College Dublin, Dublin, Ireland
| | - Alessio Gaggero
- Department of Quantitative Methods for the Economy and Business, University of Granada, Granada, Spain
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14
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Morer C, Úbeda M, Ovejas A, Nogues R, Lopez S, Guillaumet A, Santos M, Comas M, Alarcon I, Romero R, Simó R, Ciudin A. Integrative and Collaborative Approach in the Chronic Management of Obesity in Primary and Tertiary Care Setting: Vall Hebron-SAP Muntanya Healthcare Route. Obes Facts 2022; 16:249-254. [PMID: 36535242 PMCID: PMC10826599 DOI: 10.1159/000528207] [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] [Received: 08/25/2022] [Accepted: 11/02/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION In the context of obesity pandemic, the health care providers involved in the primary care should have a significant role. Several guidelines for the management of obesity in primary care were proposed recently. In general lines, these guidelines include recommendation on the baseline assessment, therapy, and algorithm for referral to specialized obesity clinic and follow-up. Nevertheless, at present, there is no guideline or protocol that continuously and bidirectionally links the two settings: primary care and specialized obesity clinic. METHODS We present a model of continuous, bilateral, and integrative interaction between primary care units and reference tertiary care setting in the chronic management of obesity that is already implemented in a public health system. RESULTS The novelty of our algorithm is that incorporates the support and continuous communication with the specialized obesity clinic of the tertiary care setting from the beginning in the management of a patient with obesity, in a bidirectional manner. CONCLUSION This kind of bidirectional and continuous collaboration will help engage health care providers in the management of obesity, optimize efforts, shorten the time until proper intervention, personalize the approach and, finally, save costs for the health system.
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Affiliation(s)
- Carla Morer
- Servicio Atención Primaria (SAP) Muntanya, Àmbit d’atenció Primaria Barcelona Ciutat, Institut Català de la Salut, Departament de Salut | Generalitat de Catalunya, Barcelona, Spain
- Centro de Salud (CAP) Rio de Janeiro | Servicio Atención Primaria (SAP) Muntanya, Àmbit D'Atenció Primària Barcelona Ciutat, Barcelona, Spain
| | - Maria Úbeda
- Servicio Atención Primaria (SAP) Muntanya, Àmbit d’atenció Primaria Barcelona Ciutat, Institut Català de la Salut, Departament de Salut | Generalitat de Catalunya, Barcelona, Spain
- CAP Horta, Equipo Atención Primària (EAP)Horta 7D, Servicio Atención Primaria (SAP) Muntanya, Àmbit d'Atenció Primària Barcelona Ciutat, Barcelona, Spain
| | - Aida Ovejas
- Servicio Atención Primaria (SAP) Muntanya, Àmbit d’atenció Primaria Barcelona Ciutat, Institut Català de la Salut, Departament de Salut | Generalitat de Catalunya, Barcelona, Spain
- CAP Horta, Equipo Atención Primaria Horta 7F, Servicio Atención Primaria Muntanya, Àmbit d'Atenció Primària Barcelona Ciutat, OVEJAS, Barcelona, Spain
| | - Raquel Nogues
- Servicio Atención Primaria (SAP) Muntanya, Àmbit d’atenció Primaria Barcelona Ciutat, Institut Català de la Salut, Departament de Salut | Generalitat de Catalunya, Barcelona, Spain
- CAP Sant Rafael, Equipo Atención Primaria, Servicio Atención Primaria Muntanya, Àmbit d'Atenció Primària Barcelona Ciutat, Nogues y Santos, Barcelona, Spain
| | - Silvia Lopez
- Servicio Atención Primaria (SAP) Muntanya, Àmbit d’atenció Primaria Barcelona Ciutat, Institut Català de la Salut, Departament de Salut | Generalitat de Catalunya, Barcelona, Spain
- CAP Rio de Janeiro y Chafarinas, Equipo Nutricionistas, Servicio Atención Primaria Muntanya, Àmbit d'Atenció Primària Barcelona Ciutat, Guillaumet y Lopez, Barcelona, Spain
| | - Anna Guillaumet
- Servicio Atención Primaria (SAP) Muntanya, Àmbit d’atenció Primaria Barcelona Ciutat, Institut Català de la Salut, Departament de Salut | Generalitat de Catalunya, Barcelona, Spain
- CAP Rio de Janeiro y Chafarinas, Equipo Nutricionistas, Servicio Atención Primaria Muntanya, Àmbit d'Atenció Primària Barcelona Ciutat, Guillaumet y Lopez, Barcelona, Spain
| | - Maria Santos
- Servicio Atención Primaria (SAP) Muntanya, Àmbit d’atenció Primaria Barcelona Ciutat, Institut Català de la Salut, Departament de Salut | Generalitat de Catalunya, Barcelona, Spain
- CAP Sant Rafael, Equipo Atención Primaria, Servicio Atención Primaria Muntanya, Àmbit d'Atenció Primària Barcelona Ciutat, Nogues y Santos, Barcelona, Spain
| | - Marta Comas
- Endocrinology and Nutrition Department-Obesity Unit Vall Hebron University Hospital, Barcelona, Spain
| | - Iris Alarcon
- Servicio Atención Primaria (SAP) Muntanya, Àmbit d’atenció Primaria Barcelona Ciutat, Institut Català de la Salut, Departament de Salut | Generalitat de Catalunya, Barcelona, Spain
| | - Rosa Romero
- Servicio Atención Primaria (SAP) Muntanya, Àmbit d’atenció Primaria Barcelona Ciutat, Institut Català de la Salut, Departament de Salut | Generalitat de Catalunya, Barcelona, Spain
- Coordinació d'Atenció Ambulatòria-Subdirecció Assistencial, Vall Hebron University Hospital, Barcelona, Spain
| | - Rafael Simó
- Endocrinology and Nutrition Department-Obesity Unit Vall Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institut de Recerca (VHIR), Vall D’Hebron Barcelona Campus Hospitalari, Barcelona, Spain
| | - Andreea Ciudin
- Endocrinology and Nutrition Department-Obesity Unit Vall Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institut de Recerca (VHIR), Vall D’Hebron Barcelona Campus Hospitalari, Barcelona, Spain
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15
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Costantine MM, Sandoval GJ, Grobman WA, Reddy UM, Tita ATN, Silver RM, El-Sayed YY, Wapner RJ, Rouse DJ, Saade GR, Thorp JM, Chauhan SP, Chien EK, Casey BM, Srinivas SK, Swamy GK, Simhan HN. Association of Body Mass Index With the Use of Health Care Resources in Low-Risk Nulliparous Pregnancies After 39 Weeks of Gestation. Obstet Gynecol 2022; 139:866-876. [PMID: 35576345 PMCID: PMC9142136 DOI: 10.1097/aog.0000000000004753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/03/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare health care medical resource utilization in low-risk nulliparous pregnancies according to body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) categories. METHODS This is a secondary analysis of a multicenter randomized controlled trial of induction of labor between 39 0/7 39 and 4/7 weeks of gestation compared with expectant management in low-risk nulliparous pregnant people, defined as those without standard obstetric indications for delivery at 39 weeks. Body mass index at randomization was categorized into four groups (lower than 25, 25-29, 30-39, and 40 or higher). The primary outcome of this analysis was time spent in the labor and delivery department from admission to delivery. Secondary outcomes included length of stay (LOS) postdelivery, total hospital LOS, and antepartum, intrapartum, and postpartum resource utilization, which were defined a priori. Multivariable generalized linear modeling and logistic regressions were performed, and 99% CIs were calculated. RESULTS A total of 6,058 pregnant people were included in the analysis; 640 (10.6%) had BMIs of lower than 25, 2,222 (36.7%) had BMIs between 25 and 29, 2,577 (42.5%) had BMIs of 30-39, and 619 (10.2%) had BMIs of 40 or higher. Time spent in the labor and delivery department increased from 15.1±9.2 hours for people with BMIs of lower than 25 to 23.5±13.6 hours for people with BMIs of 40 or higher, and every 5-unit increase in BMI was associated with an average 9.8% increase in time spent in the labor and delivery department (adjusted estimate per 5-unit increase in BMI 1.10, 99% CI 1.08-1.11). Increasing BMI was not associated with an increase in antepartum resource utilization, except for blood tests and urinalysis. However, increasing BMI was associated with higher odds of intrapartum resource utilization, longer total hospital LOS, and postpartum resource utilization. For example, every 5-unit increase in BMI was associated with an increase of 26.1% in the odds of antibiotic administration, 57.6% in placement of intrauterine pressure catheter, 5.1% in total inpatient LOS, 31.0 in postpartum emergency department visit, and 23.9% in postpartum hospital admission. CONCLUSION Among low-risk nulliparous people, higher BMI was associated with longer time from admission to delivery, total hospital LOS, and more frequent utilization of intrapartum and postpartum resources. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01990612.
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Affiliation(s)
- Maged M Costantine
- Departments of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio, Northwestern University, Chicago, Illinois, University of Alabama at Birmingham, Birmingham, Alabama, University of Utah Health Sciences Center, Salt Lake City, Utah, Stanford University, Stanford, California, Columbia University, New York, New York, Brown University, Providence, Rhode Island, University of Texas Medical Branch, Galveston, Texas, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, University of Texas Southwestern Medical Center, Dallas, Texas, University of Pennsylvania, Philadelphia, Pennsylvania, Duke University, Durham, North Carolina, and University of Pittsburgh, Pittsburgh, Pennsylvania; and the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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16
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Feral-Pierssens AL, Matta J, Rives-Lange C, Goldberg M, Zins M, Carette C, Czernichow S. Health care use by adults with obesity: A French cohort study. Obesity (Silver Spring) 2022; 30:733-742. [PMID: 35142072 DOI: 10.1002/oby.23366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Studies on obesity costs have focused on global costs of people with obesity but scarcely investigated their precise use of health care. The aim of this study is to document real-life health care use across obesity classes. METHODS Data of participants with obesity and enrolled in the CONSTANCES cohort were analyzed. Health care use was defined as ≥1 visit to general practitioners, specialists, emergency departments, and inpatient hospital admissions versus none over a 3-year period prior to enrollment and was obtained from the Universal Health Insurance database. Multivariate regression models were conducted and adjusted for comorbidities and social deprivation markers with medical visits as the outcome variables and compared people with class II and III obesity versus class I obesity. RESULTS Out of the 10,774 participants with obesity, 613 (5.7%) had class III obesity, and 2,076 (19.3%) had class II obesity. Compared with participants with class I obesity, class III obesity participants had higher odds of visiting emergency departments (OR = 1.31; 95% CI: 1.07-1.61) and various specialist physicians (pneumologists, endocrinologists, cardiologists) but lower odds of visiting gynecologists (OR = 0.69; 95% CI 0.55-0.87). Participants with class II obesity had lower odds of visiting general practitioners, dentists, and psychiatrists. There was no difference with regard to hospital admissions. CONCLUSION Health care use by people with obesity differs across classes.
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Affiliation(s)
- Anne-Laure Feral-Pierssens
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Assistance Publique Hôpitaux de Paris, Emergency Department, Georges Pompidou European Hospital, Paris, France
- IMPEC Federation, Paris, France
| | - Joane Matta
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Claire Rives-Lange
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France
- Université de Paris, Paris, France
- INSERM, UMR 1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS team, Paris, France
| | - Marcel Goldberg
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Université de Paris, Paris, France
| | - Marie Zins
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
- Université de Paris, Paris, France
| | - Claire Carette
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France
- Université de Paris, Paris, France
- INSERM, CIC 1418, Georges Pompidou European Hospital, Paris, France
| | - Sébastien Czernichow
- Assistance Publique Hôpitaux de Paris, Nutrition Department, Georges Pompidou European Hospital, Centre Spécialisé Obésité, Paris, France
- Université de Paris, Paris, France
- INSERM, CIC 1418, Georges Pompidou European Hospital, Paris, France
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17
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Turri JAO, Anokye NK, Dos Santos LL, Júnior JMS, Baracat EC, Santo MA, Sarti FM. Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data. BMC Health Serv Res 2022; 22:41. [PMID: 34996426 PMCID: PMC8740498 DOI: 10.1186/s12913-021-07432-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities. Methods The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery. Results The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention. Conclusions Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.
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Affiliation(s)
- José Antonio Orellana Turri
- Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil. .,School of Public Health, University of Sao Paulo, Av Dr Arnaldo 715, Sao Paulo, SP, Brazil.
| | - Nana Kwame Anokye
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, United Kingdom
| | - Lionai Lima Dos Santos
- Department of Physiotherapy, School of Sciences and Technology, Sao Paulo State University, Rua Roberto Simonsen, Presidente Prudente, SP, 305, Brazil
| | - José Maria Soares Júnior
- Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil
| | - Marco Aurélio Santo
- Department of Gastroenterology, Digestive Disease Surgery, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil
| | - Flavia Mori Sarti
- School of Public Health, University of Sao Paulo, Av Dr Arnaldo 715, Sao Paulo, SP, Brazil.,School of Arts, Sciences and Humanities, University of Sao Paulo, Av Arlindo Bettio 1000, Sao Paulo, SP, Brazil
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18
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Severin R, Sabbahi A, Arena R, Phillips SA. Precision Medicine and Physical Therapy: A Healthy Living Medicine Approach for the Next Century. Phys Ther 2022; 102:6413905. [PMID: 34718788 DOI: 10.1093/ptj/pzab253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/27/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022]
Abstract
There is a reciprocal relationship between common health conditions encountered in physical therapist practice, disability, and healthy living factors, such as physical inactivity, blood pressure, sleep quality, diet, and obesity. This relationship is apparent across all practice settings. Physical therapists are well positioned in the health care system to mitigate chronic disease by routinely screening and addressing healthy living factors to improve overall health and lower the risk for chronic disease (healthy living medicine). However, there are several challenges to the successful implementation of this framework in physical therapist practice. This Perspective will elucidate this relationship between healthy living behaviors and physical therapist practice, review the current state of practice regarding screening and intervention of 5 key healthy living behaviors, and outline future steps the profession can take toward implementing precision medicine using a healthy living medicine approach.
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Affiliation(s)
- Richard Severin
- Department of Physical Therapy Program, University of Illinois-Chicago, Chicago, Illinois, USA.,Department of Physical Therapy, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - Ahmad Sabbahi
- Department of Physical Therapy Program, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Ross Arena
- Department of Physical Therapy Program, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Shane A Phillips
- Department of Physical Therapy Program, University of Illinois-Chicago, Chicago, Illinois, USA
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19
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Loo JH, Lim YH, Seah HL, Chong AZQ, Tay KV. Intragastric Balloon as Bridging Therapy Prior to Bariatric Surgery for Patients with Severe Obesity (BMI ≥ 50 kg/m 2): a Systematic Review and Meta-analysis. Obes Surg 2021; 32:489-502. [PMID: 34787766 DOI: 10.1007/s11695-021-05772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/15/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
Bariatric surgery for patients with severe obesity (body mass index (BMI) ≥ 50kg/m2) is technically challenging. Intragastric balloon (IGB) has been proposed for weight loss before bariatric surgery to reduce surgical risks but its efficacy remains unclear. We conducted a systematic review and meta-analysis of the effectiveness of IGB as bridging therapy and assess potential complications. Amongst 2419 citations, 13 studies were included. IGB resulted in a BMI reduction of 6.60 kg/m2 (MD=6.60, 95% CI: 5.06-8.15; I2=72%). The total post-procedural complication rate was 8.13% (95% CI: 4.04-13.17%), with majority being balloon intolerance. Overall, IGB is effective as a bridging therapy with adequate procedural safety profile, but further study is needed to evaluate the risk reduction for bariatric surgery and long-term weight-loss outcomes.
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Affiliation(s)
- Jing Hong Loo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Yao Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hwee Ling Seah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Kon Voi Tay
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.,Department of General Surgery, Woodlands Health Campus, Singapore, Singapore
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20
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Granel Villach L, Laguna Sastre JM, Ibáñez Belenguer JM, Beltrán Herrera HA, Queralt Martín R, Fortea Sanchis C, Martínez Ramos D, Escrig Sos VJ. Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure. Cir Esp 2021; 99:737-744. [PMID: 34776409 DOI: 10.1016/j.cireng.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 11/06/2020] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2 years after surgery. RESULTS 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type 2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507 euros per month (P < 0.001). CONCLUSIONS In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.
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Affiliation(s)
- Laura Granel Villach
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain.
| | - José Manuel Laguna Sastre
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain; Universitat Jaume I, Castellón, Spain
| | | | | | - Raquel Queralt Martín
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain
| | - Carlos Fortea Sanchis
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain
| | - David Martínez Ramos
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain
| | - Vicente Javier Escrig Sos
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, Spain; Universitat Jaume I, Castellón, Spain
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21
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Reilly J, Burrell D. Educating Trainees to Manage Pregnant Women With Obesity: A Primer. Clin Obstet Gynecol 2021; 64:244-249. [PMID: 33481419 DOI: 10.1097/grf.0000000000000601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review is intended to outline essential resources for trainees in order to optimize education on the care of pregnant patients with obesity. Addressing provider biases, exploring ethical considerations of care and streamlining screening and counseling of patients with obesity will provide an excellent framework for our trainees to care for women with obesity from preconception to postpartum care and beyond.
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Affiliation(s)
- Justine Reilly
- Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island
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22
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Granel Villach L, Laguna Sastre JM, Ibáñez Belenguer JM, Beltrán Herrera HA, Queralt Martín R, Fortea Sanchis C, Martínez Ramos D, Escrig Sos VJ. Analysis of the impact of bariatric surgery on medium-term pharmacological expenditure. Cir Esp 2020; 99:S0009-739X(20)30379-1. [PMID: 33358406 DOI: 10.1016/j.ciresp.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 09/26/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Obesity and associated diseases represent an important health and economic problem since pharmacological treatment for many of these pathologies needs lifelong subsidies. Theoretically, bariatric and metabolic surgery decreases the medication requirements of patients for these diseases but may result in other types of pharmacological needs. This study aims to demonstrate whether there is a real decrease in pharmacological expenditure after bariatric surgery. MATERIAL AND METHODS Retrospective cross-sectional analysis of patients who were treated in our centre between 2012 and 2016, comparing different associated comorbidities and pharmacological expenses one month before and 2years after surgery. RESULTS 400 patients were operated. The results were presented, showing the differences between the resolution of the different comorbidities and the pharmacological savings generated for each of the surgical techniques studied. The most cost-effective comorbidity in the study was type2 diabetes mellitus (DM2). The surgical technique with the best results was metabolic bypass, presenting a cost difference after surgery of 507euros per month (P<.001). CONCLUSIONS In a 2-year follow-up after bariatric surgery, a decreased prevalence of obesity-related diseases and associated pharmacological expenditure was observed, showing the efficiency of this intervention over the medium term.
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Affiliation(s)
- Laura Granel Villach
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España.
| | - José Manuel Laguna Sastre
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España; Universitat Jaume I, Castellón, España
| | | | | | - Raquel Queralt Martín
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España
| | - Carlos Fortea Sanchis
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España
| | - David Martínez Ramos
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España
| | - Vicente Javier Escrig Sos
- Cirugía General y del Aparato Digestivo, Hospital General Universitario de Castellón, Castellón, España; Universitat Jaume I, Castellón, España
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23
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Rheinwalt KP, Drebber U, Schierwagen R, Klein S, Neumann UP, Ulmer TF, Plamper A, Kroh A, Schipper S, Odenthal M, Uschner FE, Lingohr P, Trebicka J, Brol MJ. Baseline Presence of NAFLD Predicts Weight Loss after Gastric Bypass Surgery for Morbid Obesity. J Clin Med 2020; 9:jcm9113430. [PMID: 33114543 PMCID: PMC7693802 DOI: 10.3390/jcm9113430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background. Bariatric surgery is a widely used treatment for morbid obesity. Prediction of postoperative weight loss currently relies on prediction models, which mostly overestimate patients’ weight loss. Data about the influence of Non-alcoholic fatty liver disease (NAFLD) on early postoperative weight loss are scarce. Methods. This prospective, single-center cohort study included 143 patients receiving laparoscopic gastric bypass surgery (One Anastomosis-Mini Gastric Bypass (OAGB-MGB) or Roux-en-Y Gastric Bypass (RYGB)). Liver biopsies were acquired at surgery. NAFLD activity score (NAS) assigned patients to “No NAFLD”, “NAFL” or “NASH”. Follow up data were collected at 3, 6 and 12 months. Results. In total, 49.7% of patients had NASH, while 41.3% had NAFL. Compared with the No NAFLD group, NAFL and NASH showed higher body-mass-index (BMI) at follow-up (6 months: 31.0 kg/m2 vs. 36.8 kg/m2 and 36.1 kg/m2, 12 months: 27.0 kg/m2 vs. 34.4 and 32.8 kg/m2) and lower percentage of total body weight loss (%TBWL): (6 months: 27.1% vs. 23.3% and 24.4%; 12 months: 38.5% vs. 30.1 and 32.6%). Linear regression of NAS points significantly predicts percentage of excessive weight loss (%EWL) after 6 months (Cologne-weight-loss-prediction-score). Conclusions. Histopathological presence of NAFLD might lead to inferior postoperative weight reduction after gastric bypass surgery. The mechanisms underlying this observation should be further studied.
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Affiliation(s)
- Karl Peter Rheinwalt
- Department of Bariatric, Metabolic, and Plastic Surgery, St. Franziskus-Hospital, 50825 Cologne, Germany; (K.P.R.); (A.P.)
| | - Uta Drebber
- Department of Pathology, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (U.D.); (M.O.)
| | - Robert Schierwagen
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
| | - Sabine Klein
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
| | - Ulf Peter Neumann
- Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany; (U.P.N.); (T.F.U.); (A.K.); (S.S.)
- Department of Surgery, Maastricht University Medical Centre (MUMC), P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Tom Florian Ulmer
- Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany; (U.P.N.); (T.F.U.); (A.K.); (S.S.)
| | - Andreas Plamper
- Department of Bariatric, Metabolic, and Plastic Surgery, St. Franziskus-Hospital, 50825 Cologne, Germany; (K.P.R.); (A.P.)
| | - Andreas Kroh
- Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany; (U.P.N.); (T.F.U.); (A.K.); (S.S.)
| | - Sandra Schipper
- Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany; (U.P.N.); (T.F.U.); (A.K.); (S.S.)
- Department of Nanomedicine and Theranostics, Institute for Experimental Molecular Imaging, RWTH University Clinic and Helmholtz Institute for Biomedical Engineering, 52074 Aachen, Germany
| | - Margarete Odenthal
- Department of Pathology, University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany; (U.D.); (M.O.)
| | - Frank Erhard Uschner
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
| | - Philipp Lingohr
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, 53127 Bonn, Germany;
| | - Jonel Trebicka
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
- European Foundation for the Study of Chronic Liver Failure-EF Clif, 08021 Barcelona, Spain
- Correspondence: ; Tel.: +49-(0)-69-6301-4256; Fax: +49-(0)-69-6301-84441
| | - Maximilian Joseph Brol
- Translational Hepatology, Department of Internal Medicine I, University Clinic Frankfurt, 60590 Frankfurt, Germany; (R.S.); (S.K.); (F.E.U.); (M.J.B.)
- Department of Internal Medicine I, University Clinic, 53127 Bonn, Germany
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24
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Röhling M, Martin K, Ellinger S, Schreiber M, Martin S, Kempf K. Weight Reduction by the Low-Insulin-Method-A Randomized Controlled Trial. Nutrients 2020; 12:nu12103004. [PMID: 33007918 PMCID: PMC7601801 DOI: 10.3390/nu12103004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022] Open
Abstract
Continuous high insulin levels are associated with weight gain and lead to cardiometabolic diseases. Therefore, we have developed the Low-Insulin-Method and integrated it into the multi-component, occupational healthcare program SHAPE-AND-MOTION-Medical-Accompanied-Slimming (SAMMAS) to reduce daily insulin levels for long-term weight reduction in overweight or obesity. Employees were randomized into a starting intervention group (SI, n = 15) or waiting list control group (WL, n = 15). SAMMAS consisted of group-based seminars, low-carbohydrate nutrition including formula diet, continuous glucose monitoring, telemetric monitoring, and telemedical coaching. Both groups received telemetric devices at baseline. Intention-to-treat analyses were performed after 12, 26, and 52 weeks. The estimated treatment difference in weight reduction after 12 weeks, which is the primary endpoint of the study, showed a pronounced effect in favour of SI (−6.3 kg with (95% confidence interval) (−7.4; −4.5) (p < 0.001)) after 12 weeks. Furthermore, SI improved fasting blood glucose, HbA1c, quality of life, fasting insulin, blood pressure, and eating behaviour (all p < 0.05) in the within-group analysis, while WL did not. After 26 and 52 weeks, weight reduction could be maintained in the whole group (both groups together) by −6.7 kg (−9.5; −3.8) (p < 0.001) and −6.1 kg (−9.2; −2.7) (p < 0.01). SAMMAS supports clinically relevant weight reduction and long-term weight loss maintenance in individuals with overweight or obesity.
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Affiliation(s)
- Martin Röhling
- West-German Centre of Diabetes and Health, Dusseldorf Catholic Hospital Group, 40591 Dusseldorf, Germany; (S.M.); (K.K.)
- Correspondence: ; Tel.: +49-(0)-2115-6603-6066
| | - Katharina Martin
- Hochschule Niederrhein, University of Applied Sciences, 41065 Mönchengladbach, Germany; (K.M.); (S.E.)
| | - Sabine Ellinger
- Hochschule Niederrhein, University of Applied Sciences, 41065 Mönchengladbach, Germany; (K.M.); (S.E.)
| | - Michael Schreiber
- Psychiatric-Psychotherapeutic Day-Care Hospital, Dusseldorf Catholic Hospital Group, 40591 Dusseldorf, Germany;
| | - Stephan Martin
- West-German Centre of Diabetes and Health, Dusseldorf Catholic Hospital Group, 40591 Dusseldorf, Germany; (S.M.); (K.K.)
- Faculty of Medicine, Heinrich Heine University Dusseldorf, 40225 Dusseldorf, Germany
| | - Kerstin Kempf
- West-German Centre of Diabetes and Health, Dusseldorf Catholic Hospital Group, 40591 Dusseldorf, Germany; (S.M.); (K.K.)
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25
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Abstract
PURPOSE OF REVIEW This review describes the latest evidence for the impact of bariatric surgery on health-related quality of life (HRQL). RECENT FINDINGS The impact of bariatric surgery on HRQL is less well-understood than its clinical effectiveness on weight and co-morbidities. Poor-quality study design and different HRQL measures challenge systematic reviews and meta-analyses. Available limited evidence suggests that physical aspects of HRQL may improve more than mental health aspects of HRQL after bariatric surgery, reaching maximal benefits 1-2 years post-surgery. Comparative HRQL analyses between bariatric procedures cannot be made due to a lack of randomised data. Qualitative research highlights the tensions patients experience after bariatric surgery, which provides insights to observed changes in HRQL. Standardized HRQL measures are being developed and agreed to improve future evidence synthesis. Two multi-centre randomised trials of bariatric surgical procedures including detailed HRQL assessment are in progress. It is hoped that the combination of comparative high-quality HRQL data and information from qualitative studies will provide new insights into patient well-being and health after bariatric surgery.
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Affiliation(s)
- Karen D Coulman
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
- Obesity and Bariatric Surgery Service, North Bristol NHS Trust, Bristol, UK.
| | - Jane M Blazeby
- Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre Surgical Innovation Theme, Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
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26
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Xia Q, Campbell JA, Ahmad H, Si L, de Graaff B, Palmer AJ. Bariatric surgery is a cost-saving treatment for obesity-A comprehensive meta-analysis and updated systematic review of health economic evaluations of bariatric surgery. Obes Rev 2020; 21:e12932. [PMID: 31733033 DOI: 10.1111/obr.12932] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/10/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023]
Abstract
Demand for bariatric surgery to treat severe and resistant obesity far outstrips supply. We aimed to comprehensively synthesise health economic evidence regarding bariatric surgery from 1995 to 2018 (PROSPERO registration number: CRD42018094189). Meta-analyses were conducted to calculate the annual cost changes "before" and "after" surgery, and cumulative cost differences between surgical and nonsurgical groups. An updated narrative review also summarized the full and partial health economic evaluations of surgery from September 2015. N = 101 studies were eligible for the qualitative analyses since 1995, with n = 24 studies after September 2015. Quality of reporting has increased, and the inclusion of complications/reoperations was predominantly contained in the full economic evaluations after September 2015. Technical improvements in surgery were also reflected across the studies. Sixty-one studies were eligible for the quantitative meta-analyses. Compared with no/conventional treatment, surgery was cost saving over a lifetime scenario. Additionally, consideration of indirect costs through sensitivity analyses increased cost savings. Medication cost savings were dominant in the before versus after meta-analysis. Overall, bariatric surgery is cost saving over the life course even without considering indirect costs. Health economists are hearing the call to present higher quality studies and include the costs of complications/reoperations; however, indirect costs and body contouring surgery are still not appropriately considered.
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Affiliation(s)
- Qing Xia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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27
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da Fonseca ACP, da Fonseca GP, Marchesini B, Voigt DD, Campos Junior M, Zembrzuski VM, Carneiro JRI, Nogueira Neto JF, Cabello PH, Cabello GMK. Genetic Variants in the Activation of the Brown-Like Adipocyte Pathway and the Risk for Severe Obesity. Obes Facts 2020; 13:130-143. [PMID: 32325455 PMCID: PMC7250364 DOI: 10.1159/000505666] [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] [Received: 07/16/2019] [Accepted: 12/20/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Regular physical activity has an important role in energy expenditure and combats the development of obesity. During exercise, PPARGC1A is overexpressed, stimulating an increase of the expression of FNDC5. This protein is cleaved to release the hormone irisin, which activates a browning process in white adipose tissue through an increase in UCP1 expression. As a result, irisin leads to mitochondrial heat production and energy expenditure. OBJECTIVES The aim of this study was to investigate whether genetic variants in genes related to browning are associated with severe obesity and obesity-related features. This case-control study comprised 210 individuals with severe obesity (median body mass index [BMI] 45.6 [range 40.5-52.2]) and 191 normal-weight subjects (BMI 22.8 [21.1-23.9]). METHODS Genomic DNA was extracted from peripheral blood and the genotypes of the PPARGC1A(rs8192678, rs3736265, rs2970847, and rs3755863) and UCP1 (rs6536991 and rs12502572) genes were obtained using Taqman® assay. For the FNDC5 gene, screening of exons 3-5 as well as their intron-exon boundaries was performed using automatic sequencing. RESULTS Our results demonstrated that PPARGC1Ars2970847 and UCP1rs12502572 are associated with severe obesity. Furthermore, these polymorphisms influence anthropometric traits, such as BMI, body weight, and body adiposity index. Our findings also showed a dose-effect relationship between PPARGC1A rs8192678 and fasting plasma glucose. Finally, 5 rare mutations were identified in FNDC5, and 1 of these is a novel missense mutation. CONCLUSION This study shows that genetic variants in the activation of brown-like adipocyte pathway play an important role in the susceptibility to severe obesity.
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MESH Headings
- Adipocytes/physiology
- Adipocytes, Brown/physiology
- Adipose Tissue, Brown/physiology
- Adipose Tissue, White/metabolism
- Adipose Tissue, White/physiology
- Adolescent
- Adult
- Aged
- Body Mass Index
- Case-Control Studies
- Cell Transdifferentiation/genetics
- Cross-Sectional Studies
- Energy Metabolism/genetics
- Female
- Fibronectins/genetics
- Genotype
- Humans
- Male
- Middle Aged
- Muscle, Skeletal/metabolism
- Mutation, Missense
- Obesity, Morbid/genetics
- Obesity, Morbid/metabolism
- Obesity, Morbid/physiopathology
- Peroxisome Proliferator-Activated Receptor Gamma Coactivator 1-alpha/genetics
- Polymorphism, Single Nucleotide
- Young Adult
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Affiliation(s)
| | | | - Bruna Marchesini
- Human Genetics Laboratory, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro, Brazil
| | | | - Mario Campos Junior
- Human Genetics Laboratory, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro, Brazil
| | | | - João Regis Ivar Carneiro
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Pedro Hernan Cabello
- Human Genetics Laboratory, Oswaldo Cruz Institute/Fiocruz, Rio de Janeiro, Brazil
- Human Genetics Laboratory, Grande Rio University, Rio de Janeiro, Brazil
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28
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Brutman JN, Sirohi S, Davis JF. Recent Advances in the Neurobiology of Altered Motivation Following Bariatric Surgery. Curr Psychiatry Rep 2019; 21:117. [PMID: 31707546 DOI: 10.1007/s11920-019-1084-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW There is compelling evidence in the clinical population that long-term weight loss secondary to bariatric surgery is mitigated by the reemergence of maladaptive feeding behaviors and in some cases new onset substance abuse. RECENT FINDINGS A review of the current literature suggests that physical restructuring of the GI tract during WLS alters secretion of feeding peptides and nutrient-sensing mechanisms that directly target the brain's endogenous reward system, the mesolimbic dopamine system. Post-surgical changes in GI physiology augment activation of the mesolimbic system. In some patients, this process may contribute to a reduced appetite for palatable food whereas in others it may support maladaptive motivated behavior for food and chemical drugs. It is concluded that future studies are required to detail the timing and duration of surgical-induced changes in GI-mesolimbic communication to more fully understand this phenomenon.
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Affiliation(s)
- Julianna N Brutman
- Department of Integrative Physiology and Neuroscience, College of Veterinary Medicine, Washington State University, 1815 Ferdinand's Lane, Pullman, WA, 99164, USA
| | - Sunil Sirohi
- Laboratory of Endocrine and Neuropsychiatric Disorders, Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University of Louisiana, New Orleans, LA, USA
| | - Jon F Davis
- Department of Integrative Physiology and Neuroscience, College of Veterinary Medicine, Washington State University, 1815 Ferdinand's Lane, Pullman, WA, 99164, USA.
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Bridge GL, Willis TA, Evans CEL, Roberts KPJ, Rudolf M. The impact of HENRY on parenting and family lifestyle: Exploratory analysis of the mechanisms for change. Child Care Health Dev 2019; 45:850-860. [PMID: 31209923 DOI: 10.1111/cch.12694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childhood obesity is a major public health concern. In the United Kingdom, a quarter of children are overweight or obese at age 5 years. Overweight and obese children are more likely to develop serious health issues such as diabetes later in life. Consequently, there is an urgent need for effective, early obesity prevention and intervention. This study investigated the impact of an 8-week child obesity intervention-HENRY (Health Exercise Nutrition for the Really Young)-designed to help parents with preschool children develop the skills and knowledge needed to improve family lifestyle and well-being. We were particularly interested in exploring the potential mechanisms by which HENRY may have a positive impact. METHOD Focus groups (n = 7, total participants = 39) were completed with mothers attending the HENRY programme at one of seven locations across England. They took place within 2 weeks of programme completion. Follow-up telephone interviews were completed with a subsample of participants (n = 10) between 17 and 21 weeks later. RESULTS Parents consistently reported enhanced self-efficacy in terms of improved confidence in their ability to encourage healthier behaviours such as eating fruit and vegetables and increasing physical activity, and improvements to family health behaviours. Many changes were reportedly sustained at follow-up. Data provided insights into the potential mechanisms that created the conditions for the positive changes. Participants described the importance of mutual support, being listened to by facilitators, and encouragement to identify their own ideas. Their comments indicated the success of a solution-focused, strength-based, partnership approach to supporting family lifestyle change. CONCLUSION The results of this study contribute to the body of evidence suggesting that HENRY may have a positive impact on parenting and family lifestyle behaviour. Although data were collected in 2011, the findings contribute to an understanding of the components of effective obesity prevention in young children.
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Affiliation(s)
- Gemma L Bridge
- Leeds Business School, Leeds Beckett University, Leeds, UK
| | - Thomas A Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Charlotte E L Evans
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Mary Rudolf
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
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ACOG Committee Opinion No. 763: Ethical Considerations for the Care of Patients With Obesity. Obstet Gynecol 2019; 133:e90-e96. [PMID: 30575680 DOI: 10.1097/aog.0000000000003015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obesity is a medical condition that may be associated with bias among health care professionals, and this bias may result in disrespectful or inadequate care of patients with obesity. Obstetrician-gynecologists regularly care for patients with obesity and play an integral role in advocating for best practices in health care and optimizing health outcomes for patients with obesity. Obstetrician-gynecologists should be prepared to care for their patients with obesity in a nonjudgmental manner, being cognizant of the medical and societal implications of obesity. This Committee Opinion has been updated from its previous version to focus on obesity bias within the medical community and to provide practical guidance using people-first language instead of labels (ie, "patients with obesity" versus "obese patients") to help obstetrician-gynecologists deliver effective, compassionate medical care that meets the needs of patients with obesity.
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Capozzi VA, Sozzi G, Gambino G, Cianciolo A, Riccò M, Monfardini L, Gaiano M, Chiantera V, Uccella S, Berretta R. Laparoscopy versus laparotomy for surgical treatment of obese women with endometrial cancer: A cost-benefit comparative analysis. Mol Clin Oncol 2019; 11:335-342. [PMID: 31475060 PMCID: PMC6713942 DOI: 10.3892/mco.2019.1901] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/21/2019] [Indexed: 01/13/2023] Open
Abstract
The aim of the present study was to demonstrate the cost of obese patients affected by endometrial cancer undergoing open surgery compared with minimally invasive surgery. In the retrospective cohort study (Canadian Task Force classification II-2), the economic expenditure in pre-operative, intra-operative and post-operative phases of the selected patients was evaluated. Costs were analyzed for all blood tests, instrumental examinations, consultations, operating materials, drugs, gynecological examinations, hospital stay, intensive care hospitalization and management of operative complications. The average length of stay was longer for patients who underwent laparotomy, with an almost double median hospitalization cost in the open abdominal group compared with the laparoscopic group (€4,805.37 vs. €2,589.25; P<0.0001). Evaluation by another specialist (cardiologist, diabetologist, internist) was necessary in 30.9% of laparotomies vs. 10.4% of laparoscopies (P=0.003). A respiratory support was applied to 38 patients (28.8%), of whom 23 (41.8%) were in the open abdominal arm (P=0.011). Antibiotic and pain-relief therapies resulted in a significantly higher cost for the open abdominal than for the minimally-invasive approach (P=0.027). Considering all the pre-, intra- and post-operative course, the expenses for an obese patient operated by laparoscopy was €4,412.41 vs. €7,323.17 by open surgery, with an average saving of €2,911.03 in favor of minimally-invasive surgery. This study revealed that in obese patients with endometrial cancer, minimally invasive surgery is more advantageous both in terms of costs and post-operative complications. To conclude, laparoscopic surgery in obese patients allows an economic saving of ~60% less than open surgery.
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Affiliation(s)
- Vito Andrea Capozzi
- Department of Gynecology and Obstetrics, University of Parma, I-43125 Parma, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, I-90127 Palermo, Italy
| | - Giulia Gambino
- Department of Gynecology and Obstetrics, University of Parma, I-43125 Parma, Italy
| | - Alessandra Cianciolo
- Department of Gynecology and Obstetrics, University of Parma, I-43125 Parma, Italy
| | - Matteo Riccò
- Department of Public Health, Workplace Prevention and Safety Service, AUSL1-I.R.C.C.S. di Reggio Emilia, Service for Health and Safety on The Workplaces, I-42122 Reggio, Italy
| | - Luciano Monfardini
- Department of Gynecology and Obstetrics, University of Parma, I-43125 Parma, Italy
| | - Michela Gaiano
- Department of Gynecology and Obstetrics, University of Parma, I-43125 Parma, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, I-90127 Palermo, Italy
| | - Stefano Uccella
- Obstetrics and Gynecology Department, Ospedale degli Infermi, I-13875 Biella, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics, University of Parma, I-43125 Parma, Italy
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Stigall AN, Hunter RL, Evans KD, Spees CK. A Longitudinal Study to Assess Abdominal Adiposity by Sonography, DXA, and BMI. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319848746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A. Nicole Stigall
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Randee L. Hunter
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Kevin D. Evans
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - Colleen K. Spees
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
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Aaseth J, Roer GE, Lien L, Bjørklund G. Is there a relationship between PTSD and complicated obesity? A review of the literature. Biomed Pharmacother 2019; 117:108834. [PMID: 31177066 DOI: 10.1016/j.biopha.2019.108834] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/25/2019] [Accepted: 03/29/2019] [Indexed: 12/26/2022] Open
Abstract
Recent research strongly supports the hypothesis that posttraumatic stress disorder (PTSD) can be accompanied by obesity and related metabolic disturbances. The mechanisms of these associations are however still not well defined, although disturbed functions in the sympathetic-adrenergic nervous system together with the disturbed release of hormones via the endocrine HPA (hypothalamic-pituitary-adrenal) axis apparently play a role. Leptin resistance and ghrelin excesses might contribute to a disturbed hypothalamic function, and also disturb other cerebral functions, leading to dysfunctional reward signaling and uncontrolled appetite combined with a tendency to alcohol abuse. Secondarily, cortisol stimulation will contribute to the development of central obesity which is known to facilitate the development of metabolic syndrome, including slightly increased levels of inflammatory biomarkers such as C-reactive protein and fibrinogen. While previous therapeutic strategies have focused on early psychotherapeutic interventions in PTSD, the present review emphasizes the importance of better therapeutic approaches regarding the somatic correlates of the syndrome. Strict regulation of dietary meals and food composition with minimal intake of sweets and saturated fat, as well as alcohol avoidance, can provide a basic therapeutic framework. A cognitive psychotherapeutic approach with graduated desensitization toward trigging factors, combined with pharmacotherapy, is discussed in the present review.
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Affiliation(s)
- Jan Aaseth
- Research Department, Innlandet Hospital Trust, Pb 104, 2381 Brumunddal, Norway; Faculty of Health and Social Science, Inland Norway University of Applied Sciences, Elverum, Norway.
| | - Grethe Emilie Roer
- Faculty of Health and Social Science, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Lars Lien
- Faculty of Health and Social Science, Inland Norway University of Applied Sciences, Elverum, Norway; Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Ottestad, Norway
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Toften 24, 8610 Mo i Rana, Norway.
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Merrill RM, Fowers R. To what extent does sex, age and BMI impact medical and pharmacy costs? A retrospective cohort study involving employees in a large school district in the USA. BMJ Open 2019; 9:e024078. [PMID: 31142517 PMCID: PMC6549653 DOI: 10.1136/bmjopen-2018-024078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 03/13/2019] [Accepted: 03/29/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To identify the extent that sex, age and body mass index (BMI) is associated with medical and pharmacy costs. DESIGN Retrospective cohort. SETTING A school district in the Western USA involving 2531 workers continuously employed during 2011-2014. MAIN OUTCOME MEASURES Medical and pharmacy costs and BMI. RESULTS Approximately 84% of employees participated in wellness screening. Participants were 1.03 (95% CI 1.01 to 1.06) times more likely to be women and younger (M=47.8 vs 49.8, p<0.001). Median medical and pharmacy costs were higher for women than men, increased with age, and were greater in morbidly obese individuals (p<0.001). Annual pharmacy claims were 18% more likely to be filed by women than men, 23% more likely filed by those aged ≥60 versus <40 years, and 6% more likely filed by morbidly obese individuals than of normal weight (p<0.001) individuals. Greater medical and pharmacy costs in older age were most pronounced in underweight and morbidly obese groups. Higher use of medication among women than men was primarily because of drugs involving birth control, osteoporosis, thyroid disease and urinary tract infection. Higher medication use in older age was primarily related to medications used to treat gastrointestinal problems. Medication use was positively associated with BMI weight classifications for most of the 33 drug types considered, with exceptions involving birth control, herpes and osteoporosis. A J-shape relationship was observed between BMI and medication use for acne, antibiotic, cold/influenza/allergy, eye infection, oedema, muscle spasms, pain and ulcers. CONCLUSIONS Medications associated with higher medical and pharmacy costs among women, older age and underweight or obese individuals are identified. Lowering medical and pharmacy costs requires weight management in older ages, particularly for underweight and obese. Higher pharmacy costs for certain drugs among underweight individuals may be associated with poorer nutrition.
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Affiliation(s)
- Ray M Merrill
- Department of Public Health, Brigham Young University, Provo, Utah, USA
| | - Rylan Fowers
- Department of Public Health, Brigham Young University, Provo, Utah, USA
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Gunn AJ, Weiss CR. Is There a Role for Bariatric Embolization in the Treatment of the Diabetic Patient? J Vasc Interv Radiol 2019; 30:797-800. [PMID: 31126595 DOI: 10.1016/j.jvir.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andrew J Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Department of Radiology, Johns Hopkins University School of Medicine, Sheikh Zayed Tower, Suite 7203, Baltimore, MD 21287.
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Mehaffey JH, Hawkins RB, Charles EJ, Sahli ZT, Schirmer BD, Hallowell PT. Socioeconomically Distressed Communities Associated With Long-term Mortality After Bariatric Surgery. J Surg Res 2019; 243:8-13. [PMID: 31146087 DOI: 10.1016/j.jss.2019.04.081] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/14/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Surgical outcomes are affected by socioeconomic status, yet these factors are poorly accounted for in clinical databases. We sought to determine if the Distressed Communities Index (DCI), a composite ranking by zip code that quantifies socioeconomic risk, was associated with long-term survival after bariatric surgery. METHODS All patients undergoing Roux-en-Y gastric bypass (1985-2004) at a single institution were paired with DCI. Scores range from 0 (no distress) to 100 (severe distress) and account for unemployment, education, poverty, median income, housing vacancies, job growth, and business establishment growth. Distressed communities, defined as DCI ≥75, were compared with all other patients. Regression modeling was used to evaluate the effect of DCI on 10-year bariatric outcomes, whereas Cox Proportional Hazards and Kaplan-Meier analysis examined long-term survival. RESULTS Gastric bypass patients (n = 681) come from more distressed communities compared with the general public (DCI 60.5 ± 23.8 versus 50 ± 10; P < 0.0001). A total of 221 (32.3%) patients came from distressed communities (DCI ≥75). These patients had similar preoperative characteristics, including BMI (51.5 versus 51.7 kg/m2; P = 0.63). Socioeconomic status did not affect 10-year bariatric outcomes, including percent reduction in excess body mass index (57% versus 58%; P = 0.93). However, patients from distressed communities had decreased risk-adjusted long-term survival (hazard ratio, 1.38; P = 0.043). CONCLUSIONS Patients with low socioeconomic status, as determined by the DCI, have equivalent outcomes after bariatric surgery despite worse long-term survival. Future quality improvement efforts should focus on these persistent disparities in health care.
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Affiliation(s)
- J Hunter Mehaffey
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert B Hawkins
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Eric J Charles
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Zeyad T Sahli
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Bruce D Schirmer
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Peter T Hallowell
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Severin R, Sabbahi A, Mahmoud AM, Arena R, Phillips SA. Precision Medicine in Weight Loss and Healthy Living. Prog Cardiovasc Dis 2019; 62:15-20. [PMID: 30610881 PMCID: PMC6546173 DOI: 10.1016/j.pcad.2018.12.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023]
Abstract
Obesity affects 600 million people globally and over one third of the American population. Along with associated comorbidities, including cardiovascular disease, stroke, diabetes, and cancer; the direct and indirect costs of managing obesity are 21% of the total medical costs. These factors shed light on why developing effective and pragmatic strategies to reduce body weight in obese individuals is a major public health concern. An estimated 60-70% of obese Americans attempt to lose weight each year, with only a small minority able to achieve and maintain long term weight loss. To address this issue a precision medicine approach for weight loss has been considered, which places an emphasis on sustainability and real-world application to individualized therapy. In this article we review weight loss interventions in the context of precision medicine and discuss the role of genetic and epigenetic factors, pharmacological interventions, lifestyle interventions, and bariatric surgery on weight loss.
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Affiliation(s)
- Richard Severin
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America; Doctor of Physical Therapy Program, Robbins College of Health and Human Sciences, Baylor University, Waco, TX, United States of America
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America; School of Physical Therapy, South College, Knoxville, TN, United States of America
| | - Abeer M Mahmoud
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America
| | - Shane A Phillips
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States of America; Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, IL, United States of America.
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Dereppe H, Verbeke M, Debruxelles C, Boucq E, Ponzoni L, Cuvelier G. Energy expenditure of household activities and cardiorespiratory fitness in women with obesity. Clin Obes 2018; 8:391-397. [PMID: 30231189 DOI: 10.1111/cob.12276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/27/2018] [Accepted: 07/10/2018] [Indexed: 01/22/2023]
Affiliation(s)
- H Dereppe
- Service de Cardiologie, CHWAPI - Centre d'Orthonutrition, Tournai, Belgium
| | - M Verbeke
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
| | - C Debruxelles
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
| | - E Boucq
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
| | - L Ponzoni
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
| | - G Cuvelier
- Laboratoire de l'effort et du mouvement, Haute Ecole Provinciale Hainaut-Condorcet, Tournai, Belgium
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The Divergent Effect of Maternal Protein Restriction during Pregnancy and Postweaning High-Fat Diet Feeding on Blood Pressure and Adiposity in Adult Mouse Offspring. Nutrients 2018; 10:nu10121832. [PMID: 30486486 PMCID: PMC6315474 DOI: 10.3390/nu10121832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/12/2018] [Accepted: 11/16/2018] [Indexed: 12/16/2022] Open
Abstract
Obesity is a growing health crisis of pandemic proportions. Numerous animal and human studies have confirmed that obesity and related metabolic abnormalities, such as insulin resistance and cardiovascular disease, may be programmed during development by adverse maternal nutrition. We previously documented that offspring of female mice who were protein-restricted during pregnancy alone had no alterations to their body weights, but did display a considerable reduction in food intake, a finding which was linked to reduced expression levels of appetite regulatory genes in the hypothalamus. Whether such observations were accompanied by changes in metabolic and phenotypic parameters remained to be determined. Female pregnant MF-1 mice were fed, exclusively during the pregnancy period, a normal protein diet containing 18% casein (C) or an isocaloric protein-restricted diet containing 9% casein (PR). From birth, the lactating dams were fed a normal protein diet. At weaning, offspring were fed either the standard chow which contain 7% kcal fat (C) or high-fat diet (HF, 45% kcal fat). This yielded 4 experimental groups denoted by maternal diet/offspring diet: C/C, C/HF, PR/C, PR/HF. Our results showed that offspring adiposity was significantly increased in HF-fed offspring, and was not affected by the 50% reduction in protein content of the maternal diet fed during pregnancy. Similarly, blood glucose levels were higher in HF-fed offspring, regardless of protein content of the maternal diet. Systolic blood pressure, on the other hand, was significantly increased in both male and female offspring of dams fed the PR diet, and this was exacerbated by a postweaning HF diet. Our results show that maternal protein restriction leads to elevations in systolic blood pressure, which is exacerbated by a postweaning HF-diet. Our present findings suggest that, while changes in offspring adiposity brought about by exposure to maternal protein restriction during pregnancy may be restored by adequate maternal protein content during lactation, the same may not be true for systolic blood pressure, which was similarly impaired, regardless of the timing of maternal low-protein exposure.
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Cecchini M. Use of healthcare services and expenditure in the US in 2025: The effect of obesity and morbid obesity. PLoS One 2018; 13:e0206703. [PMID: 30403716 PMCID: PMC6221341 DOI: 10.1371/journal.pone.0206703] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/08/2018] [Indexed: 12/02/2022] Open
Abstract
Objective This paper explores the contribution of body-mass index (BMI) categories in shaping past trends of use of healthcare services and associated expenditure in the US and projects results to 2025. Methods The study uses Medical Expenditure Panel Survey (MEPS) data for 2000–2012, reweighted on National Health and Nutrition Survey (NHANES) data for 1972–2012 and US Census Bureau data, to carry out projections for up to 2025. A combination of logistic regressions and generalized linear models was used to model use and associated expenditure for the following healthcare services: inpatient care (with/without surgery), office-based care, outpatient-care, drug prescription and home health care. Quantile regressions were used to analyse and project BMI levels. Results 20.5 million individuals will be severely obese in 2025. Normal-weight and overweight individuals have stable trends in use for many healthcare services. Conversely, use of healthcare services in patients in class II and class III obesity will increase substantially. Total healthcare expenditure increases more quickly in the obese population than in normal-weight individuals. Conclusions Class III obesity (BMI≥40 kg/m2) significantly affects demand and expenditure for all healthcare services. Careful healthcare service planning and implementing effective policy actions to counteract such trends is crucial to meet future demand.
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Affiliation(s)
- Michele Cecchini
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
- Health Division, Organization for Economic Co-operation and Development (OECD), Paris, France
- * E-mail:
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Telemedical Coaching Improves Long-Term Weight Loss in Overweight Persons: A Randomized Controlled Trial. Int J Telemed Appl 2018; 2018:7530602. [PMID: 30271433 PMCID: PMC6151211 DOI: 10.1155/2018/7530602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/17/2018] [Accepted: 08/14/2018] [Indexed: 12/04/2022] Open
Abstract
Background Lifestyle interventions have shown to be effective when continuous personal support was provided. However, there is lack of knowledge whether a telemedical-approach with personal coaching contributes to long-term weight losses in overweight employees. We, therefore, tested the hypothesis that telemedical-based lifestyle interventions accompanied with telemedical coaching lead to larger weight losses in overweight persons in an occupational health care setting. Methods Overweight employees (n=180) with a body mass index (BMI) of >27 kg/m2 were randomized into either a telemedical (TM) group (n=61), a telemedical coaching (TMC) group (n=58), or a control group (n=61). Both intervention groups were equipped with scales and pedometers automatically transferring the data into a personalized online portal, which could be monitored from participants and coaches. Participants of the TMC group received additionally one motivational care call per week by mental coaches to discuss the current data (current weight and steps) and achieving goals such as a healthy lifestyle or weight reduction. The control group remained in routine care. Clinical and anthropometric data were determined after the 12-week intervention. Additionally, weight change was followed up after 12 months. Results Participants of TMC (-3.1 ± 4.8 kg, p<0.0001) and TM group (-1.9 ± 4.0 kg; p=0.0012) significantly reduced weight and sustained it during the 1-year follow-up, while the control group showed no change. Compared to the control group only weight loss in the TMC group was significantly different (p<0.001) after 12 months. TMC and TM group also reduced BMI, waist circumference, and LDL cholesterol. Moreover, TMC group improved additionally systolic and diastolic blood pressure, total cholesterol, HDL cholesterol, and HbA1c. Conclusions Telemedical devices in combination with telemedical coaching lead to significant long-term weight reductions in overweight persons in an occupational health care setting. This study is registered with NCT01868763, ClinicalTrials.gov.
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Souza SDA, Silva AB, Cavalcante UMB, Lima CMBL, Souza TCD. Adult obesity in different countries: an analysis via beta regression models. CAD SAUDE PUBLICA 2018; 34:e00161417. [PMID: 30133664 DOI: 10.1590/0102-311x00161417] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 03/23/2018] [Indexed: 11/21/2022] Open
Abstract
Obesity is considered a serious public health problem, as an epidemic disease with major global repercussions that is associated with the development of other chronic conditions such as hypertension, diabetes, and cardiovascular diseases. The current study examines the distribution of adult obesity in different countries using a beta regression model. This is a descriptive ecological study with a quantitative and inferential approach and a focus on beta regression analysis. Application of this method used a set of real data from public sources on adult obesity in 78 countries in 2014. Descriptive data analysis showed that 50% of the countries showed adult obesity prevalence greater than 20%. In addition, analysis of the distribution of prevalence by country showed lower adult obesity levels in countries of Asia and Africa. Meanwhile, higher values were found in countries of the Americas and Europe. Boxplot analysis also evidenced a possible difference in the proportion of obese adults between the Americas and Europe on one side and Africa and Asia on the other. Adjustment of the beta regression model with varying dispersion and 5% significance identified mean annual per capita alcohol intake, percentage of insufficient physical activity, percentage of the population living in urban areas, and life expectancy as variables associated with adult obesity.
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Mitten D, Overholt JR, Haynes FI, D’Amore CC, Ady JC. Hiking: A Low-Cost, Accessible Intervention to Promote Health Benefits. Am J Lifestyle Med 2018; 12:302-310. [PMID: 32063815 PMCID: PMC6993091 DOI: 10.1177/1559827616658229] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 11/16/2022] Open
Abstract
Research has connected sedentary lifestyles with numerous negative health outcomes, including a significant increased risk for mortality. Many health care professionals seek ways to help clients meet physical activity guidelines recommended by the Office of Disease Prevention and Health Promotion, the World Health Organization, and the American College of Sports Medicine in order to promote active lifestyles and improve overall wellness. Hiking is a cost-effective intervention that encourages people to be physically active while spending time in nature. Time in nature can lead to health benefits through contact with the natural elements, participation in physical activity, restoration of mental and emotional health, and time with social contacts. Benefits may be immediate, such as decreased blood pressure, decreased stress levels, enhanced immune system functioning, and restored attention, or transpire over time, such as weight loss, decreased depression, and overall wellness. Health care providers are ideally positioned to recommend and prescribe hiking to clients. Federal, state, and local natural resource agencies are beginning to partner with health care professionals to promote outdoor nature-related activities. Examples of successful doctor and other health care practitioner partnership programs are described, along with tips for getting started.
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Affiliation(s)
- Denise Mitten
- Denise Mitten, PhD, Sustainability
Education, Prescott College, Prescott, AZ 86301;
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Abstract
BACKGROUND Bariatric surgery has proven a successful approach in the treatment of morbid obesity and its concomitant diseases such as diabetes mellitus and arterial hypertension. Aiming for optimal management of this challenging patient cohort, tailored concepts directly guided by individual patient physiology may outperform standardized care. Implying esophageal pressure measurement and electrical impedance tomography-increasingly applied monitoring approaches to individually adjust mechanical ventilation in challenging circumstances like acute respiratory distress syndrome (ARDS) and intraabdominal hypertension-we compared our institutions standard ventilator regimen with an individually adjusted positive end expiratory pressure (PEEP) level aiming for a positive transpulmonary pressure (P L) throughout the respiratory cycle. METHODS After obtaining written informed consent, 37 patients scheduled for elective bariatric surgery were studied during mechanical ventilation in reverse Trendelenburg position. Before and after installation of capnoperitoneum, PEEP levels were gradually raised from a standard value of 10 cm H2O until a P L of 0 +/- 1 cm H2O was reached. Changes in ventilation were monitored by electrical impedance tomography (EIT) and arterial blood gases (ABGs) were obtained at the end of surgery and 5 and 60 min after extubation, respectively. RESULTS To achieve the goal of a transpulmonary pressure (P L) of 0 cm H2O at end expiration, PEEP levels of 16.7 cm H2O (95% KI 15.6-18.1) before and 23.8 cm H2O (95% KI 19.6-40.4) during capnoperitoneum were necessary. EIT measurements confirmed an optimal PEEP level between 10 and 15 cm H2O before and 20 and 25 cm H2O during capnoperitoneum, respectively. Intra- and postoperative oxygenation did not change significantly. CONCLUSION Patients during laparoscopic bariatric surgery require high levels of PEEP to maintain a positive transpulmonary pressure throughout the respiratory cycle. EIT monitoring allows for non-invasive monitoring of increasing PEEP demand during capnoperitoneum. Individually adjusted PEEP levels did not result in improved postoperative oxygenation.
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Rinne C, Orschel C, Semkowich B, Ventola L, DeBruyne D, Coleman J, Fox P, Knott K, Jaglal SB. Knowledge, Attitudes, and Practice of In-Patient Physiotherapists in Ontario Regarding Patients Who Are Super-Morbidly Obese. Physiother Can 2018; 70:102-112. [PMID: 29755166 DOI: 10.3138/ptc.2016-78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: This article describes the knowledge, attitudes, and practice of in-patient physiotherapists in Ontario regarding the treatment of patients who are super-morbidly obese (SMO; i.e., those whose BMI is >50). Method: A 62-item questionnaire was developed to assess demographics, sources of knowledge, current practice, and attitudes such as confidence, willingness, and the perceived effectiveness of treatment. It was distributed electronically using FluidSurveys. All physiotherapists working in a clinical role with adults in an in-patient setting in Ontario were eligible to participate. Results: A total of 276 physiotherapists completed the survey. Most of them had learned about the treatment from non-structured sources such as clinical experience. More than half (52%) of the participants disagreed that their place of employment was well prepared to facilitate the treatment of patients who are SMO. The majority of respondents were confident in treating these patients, were willing to treat them (82%), and believed that physiotherapy would improve at least one health outcome (96%) for them; however, 46% were reluctant to treat for fear of personal injury. Participants most commonly felt limited by lack of equipment and lack of staff to assist. Conclusions: Physiotherapists have positive attitudes toward treating patients who are SMO, and increased equipment and staff to assist, as well as appropriate education, may decrease the fear of injury for physiotherapists while treating these patients and improve health outcomes for them.
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Affiliation(s)
- Claire Rinne
- Department of Physical Therapy, University of Toronto
| | | | | | - Lisa Ventola
- Department of Physical Therapy, University of Toronto
| | | | | | - Patricia Fox
- Department of Physical Therapy, University of Toronto.,Mobility Clinic Research Unit
| | - Katey Knott
- Department of Physical Therapy, University of Toronto.,Physical Medicine Program, St. Michael's Hospital, Toronto
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The impact of obesity and overweight on medical expenditures and disease incidence in Korea from 2002 to 2013. PLoS One 2018; 13:e0197057. [PMID: 29746509 PMCID: PMC5944944 DOI: 10.1371/journal.pone.0197057] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 04/25/2018] [Indexed: 12/25/2022] Open
Abstract
Objectives Few studies have assessed the long-term medical costs and incidence of obesity and overweight in Asia. We evaluated the impact of body mass index (BMI) on medical expenditures and disease incidence and prevalence over more than 10 years in South Korea. Methods Using 2002–2013 data from the Korean National Claims Database, we analysed two population sets (initial BMI in 2002–2003; consistent BMI in 2002–2003 and 2012–2013). Obesity was defined by Asian BMI criteria. Incremental medical expenditures or Charlson Comorbidity Index (CCI) ratios for obese compared to normal weight individuals were calculated. Medical expenditure over 11 years was estimated by BMI using a generalised linear model. Individual obesity-related disease incidence was determined and adjusted hazard ratios were calculated. Results Data for 496,469 and 214,477 individuals were included in the entire and consistent BMI level populations, respectively. Average CCI score change in normal weight and the obesity III (BMI 35–59.99 kg/m2) group over 11 years were 0.94 and 1.56, respectively in the entire population, and incremental ratio in the obesity III group was 66.0% compared to the normal weight group. In consistent BMI level population, incremental ratio (92.1%) for obesity III was higher than entire population. Medical costs in the obesity III groups versus the normal weight group in the entire and consistent BMI level populations increased by 38.4% and 77.1%, respectively. Over 11 years, individuals with BMI ≥30 kg/m2 in the entire and consistent BMI level populations had post-adjustment medical expenditures of 1.13–1.20 and 1.21–1.40 times the normal weight group, respectively. Incidence rate and adjusted hazard ratio of obesity-related disease increased in the obesity groups compared to the normal weight group. Conclusions Our findings emphasize the importance of the effective and sustainable obesity management strategies, considering the dramatic increase in obesity (BMI ≥30 kg/m2) in South Korea.
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ASGE EndoVators Summit: Defining the role and value of endoscopic therapies in obesity management. Metabolism 2018; 82:47-57. [PMID: 29191455 DOI: 10.1016/j.metabol.2017.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 11/18/2022]
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Espallardo O, Busutil R, Torres A, Zozaya N, Villoro R, Hidalgo-Vega Á. The Impact of Severe Obesity on Healthcare Resource Utilisation in Spain. Obes Surg 2018; 27:2058-2066. [PMID: 28261758 DOI: 10.1007/s11695-017-2596-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Obesity is not only a health problem but also a source of increased monetary expenditures. The objectives of this study were to analyse the use of healthcare resources in the Spanish adult population with class II obesity and above (BMI ≥35 kg/m2) and to compare it with other BMI groups. METHOD We used the Spanish National Health Survey, a longitudinal population-based survey (n = 18,682), to analyse healthcare resource utilisation by BMI groups. Adjusted and unadjusted logistic regression models were used to calculate odds ratios (OR) for healthcare use among class II and over obese subjects versus normal BMI. RESULTS Persons with BMI ≥35 are more likely to attend general practitioner (GP)'s consultations (17%), to visit the emergency department (26%), to consume medications (36%), to be hospitalised (49%), to require nursing consultations (61%) and to require psychology consultations (83%). The proportion of obese people receiving home visits is 2.6 times higher than among normal BMI. After controlling for sex and age groups, people with severe obesity (BMI ≥35 kg/m2) were more prone to requiring home care visits (OR 2.3; CI [1.3; 4.2]), GP visits (OR 2.1; CI [1.5; 3.0]), psychologist visits (OR 1.96; CI [1.3; 2.99]), emergency service visits (OR 1.5; CI [1.2; 1.8]), nurse visits (OR 1.46; CI [1.2; 1.9]) and hospitalisations (OR 1.43; CI [1.1; 1.9]) and after also adjusting for relevant comorbidities like hypertension, diabetes and cardiovascular diseases: GP visits (OR 1.85; CI [1.3; 2.7]), psychologist visits (OR 1.8; CI [1.2; 2.7]), specialised care visits (OR 0.92; CI [0.7; 1.2]) and physiotherapist visits (OR 0.7; CI [0.5; 1.0]). CONCLUSIONS Severe obesity significantly increases healthcare resource utilisation in Spain. The results shed light on the real magnitude of the burden of obesity in Spain.
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Affiliation(s)
- Olga Espallardo
- Seminario de Investigación en Economía y Salud, University of Castilla-La Mancha, Toledo, Spain
| | - Rafael Busutil
- Seminario de Investigación en Economía y Salud, University of Castilla-La Mancha, Toledo, Spain
| | | | - Néboa Zozaya
- Instituto Max Weber, Majadahonda, Madrid, Spain.
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Ryou M, McQuaid KR, Thompson CC, Edmundowic S, Mergener K. ASGE EndoVators Summit: Defining the Role and Value of Endoscopic Therapies in Obesity Management. J Gastrointest Surg 2018; 22:376-387. [PMID: 29139082 DOI: 10.1007/s11605-017-3609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/06/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Marvin Ryou
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth R McQuaid
- San Francisco VA Healthcare System, Universityof California, San Francisco, San Francisco, CA, USA.
| | - Christopher C Thompson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Klaus Mergener
- University of Washington, Digestive Health Specialists, Tacoma, WA, USA
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Ryou M, McQuaid KR, Thompson CC, Edmundowicz S, Mergener K. ASGE EndoVators Summit: defining the role and value of endoscopic therapies in obesity management. Surg Endosc 2018; 32:1-13. [DOI: 10.1007/s00464-017-5934-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 12/31/2022]
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