The direct and indirect costs of both overweight and obesity: a systematic review

The Determinants of Inpatient Palliative Care Use in Patients With Pancreatic Cancer

INTRODUCTION

Symptom burden management is a major goal of pancreatic cancer care given that most patients are diagnosed late. Early palliative care is recommended in addition to concurrent active treatment; however, disparities exist. We sought to determine the factors associated with inpatient palliative treatment among pancreatic cancer patients and compare treatment outcomes in terms of mortality, discharge disposition and resource utilization.

METHODS

We conducted a retrospective study of 22,053 pancreatic cancers using the National Inpatient Sample (NIS) database (January - December 2020). Patient and hospital characteristics, mortality, discharge disposition, length of stay (LOS), hospital costs and charges were compared between pancreatic cancer patients based on palliative treatment. Multivariate regression was used to evaluate patient and hospital characteristics and outcomes associated with palliative treatment.

RESULTS

A total number of 3839 (17.4%) patients received palliative care. Patients who received palliative care were more likely to be older, Medicaid insured, and nonobese. Patients were less likely to receive palliative care if they are males, Medicare insured, had a lower Charlson comorbidity score, or treated in Urban nonteaching hospitals. Patients who received palliative care displayed higher odds of in-hospital mortality and prolonged LOS. The adjusted additional mean hospital cost and charges in patients who received palliative care were lower by $1459, and $4222 respectively.

CONCLUSIONS

Inpatient palliative treatment in pancreatic cancer patients is associated with an older age, a higher comorbidity burden, non-obesity, insurance status and urban teaching hospitals. Our study suggests that inpatient palliative treatment decreased hospital resource utilization without prolonging survival.

Association between ambient temperature and economic burden of unintentional injury in Tianjin: a case-crossover study

OBJECTIVE

Unintentional injuries constitute a significant global public health issue with significant social and economic costs. Previous evidence suggests ambient temperatures are associated with unintentional injury occurrences. However, the impacts of ambient temperature on unintentional injury economic burden have received little research attention. The objective of the study was to examine the association between ambient temperature and economic burden of unintentional injury.

DESIGN

Time-stratified case-crossover study.

SETTING

This study was performed at Tianjin Hospital, the largest trauma centre in Tianjin, by applying a hospital-based time-stratified case-crossover study.

PARTICIPANTS

The 12 241 patients admitted with unintentional injuries and meteorological data were collected in Tianjin, China in 2021.

PRIMARY AND SECONDARY OUTCOME

The association between ambient temperature and unintentional injury hospitalisation was evaluated with a distributed lag non-linear model, further temperature-attributable economic burden of unintentional injuries was quantified, and adjusted for demographic characteristics, injury mechanism and injury location of injury.

RESULTS

The temperatures below 11.5°C were significantly associated with the increased risk of unintentional injury hospitalisation in Tianjin, in 2021. The effect was maximised on the current day. The relatively low temperature was responsible for 25.44% (95% CI 13.74, 33.09) of unintentional injury patients, and was associated with the number of unintentional injury patients (3114, 95% CI 1608, 4036). The relatively low temperature was associated with the excess economic burden for unintentional injury (¥197.52 million, 95% CI 102.00, 256.00; about 27.10 million dollars), accounting for 26.49% of the total economic burden. The cold temperatures generally had greater impacts on males (¥136.46 million, 95% CI 83.28, 172.42; about 18.67 million dollars) and the elderly (¥74.35 million, 95% CI 14.87, 102.14; about 10.24 million dollars).

CONCLUSION

The temperature was associated with approximately 3000 unintentional injury patients and ¥200 million (27 million dollars), accounting for 26% of the total economic burden in Tianjin, 2021.

The Energy Expenditure Associated With Body-Weight Resistance Exercises of Various Movement Patterns Performed at Different Durations

ABSTRACT

Poulios, A, Fotiou, C, Draganidis, D, Avloniti, A, Rosvoglou, A, Batrakoulis, A, Tsimeas, P, Papanikolaou, K, Deli, CK, Stampoulis, T, Douroudos, II, Chatzinikolaou, A, Jamurtas, AZ, and Fatouros, IG. The energy expenditure associated with body-weight resistance exercises of various movement patterns performed at different durations. J Strength Cond Res XX(X): 000-000, 2024-Although body-weight resistance exercises (BWRE) are popular and effective for body mass reduction and neuromuscular performance, limited information exists regarding their total energy expenditure (TEE). This study determined the energy cost associated with seven BWRE of different movement patterns plank, push-ups, squat, single-leg squat [SLS], forward lunge [FL], burpees, and jumping jacks [JJ] using 2 different durations (T30: 30-second; T45: 45-second) in 10 healthy young adults using a randomized, 2-trial, crossover, repeated-measures design. The level of significance was set at p ≤ 0.05. The burpees were associated with the highest and the plank with the lowest intensity (rates of perceived exertion [RPE] and mean heart rate [MHR]) and metabolic load (blood lactate [BL] accumulation, metabolic equivalents of task [METs], and excess post-exercise oxygen consumption [EPOC]) in both trials. In T30 and T45, TEE (kcals per minute) was 11.3/12.6 in plank, 18.6/22.0 in FL, 19.8/21.2 in SLS, 19.9/23.2 in squat, 22.0/24.9 in push-ups, 23.1/22.8 in JJ, and 32.2/40.7 in burpees. Although RPE, MHR, BL, and EPOC were comparable among T30 and T45, METs and TEE were greater in T45. These results suggest that TEE of BWRE ranges from ∼11 to 40 kcals·min-1, depending on the movement pattern and the duration of exercise. This information may be valuable for those using BWRE for body-weight management and improvement of strength performance.

Feasibility and Safety of an Eight-Week Exercise Program with the Additional Peripheral Magnetic Stimulation of the Abdominal Muscles

Peripheral magnetic stimulation has recently been introduced as a non-invasive but effective physical agent to improve muscle strength and everyday function. The aim of this study was to evaluate the feasibility and safety of an exercise program focusing on the abdominal muscles in combination with the peripheral magnetic stimulation of the abdominal muscles. Male and female overweight and obese adults (n = 19) participated in an eight-week exercise program with the additional peripheral magnetic stimulation of the abdominal muscles. Outcome measures included changes in abdominal subcutaneous fat thickness, trunk muscle strength, body composition, and self-reported body satisfaction. Subcutaneous fat thickness was significantly reduced after the intervention (p < 0.01-p < 0.001). Trunk flexion and left side flexion strength increased significantly after the intervention, although no significant changes were observed for trunk extension (p = 0.07) and right side flexion strength (p = 0.13). The body satisfaction self-assessment score significantly increased (p < 0.01), while body mass, body mass index, and fat mass significantly decreased after the intervention (p < 0.05). Our findings suggest that an exercise program with the additional peripheral magnetic stimulation is feasible and safe for overweight and obese participants. These results support the use of peripheral magnetic stimulation as a safe adjunct to the voluntary abdominal muscle contraction. Future studies are needed to evaluate the efficacy of the additional peripheral magnetic stimulation of the abdominal muscles compared to the voluntary contraction of the abdominal muscles alone.

The healthcare costs of increased body mass index-evidence from The Trøndelag Health Study

BACKGROUND

Earlier studies have estimated the impact of increased body mass index (BMI) on healthcare costs. Various methods have been used to avoid potential biases and inconsistencies. Each of these methods measure different local effects and have different strengths and weaknesses.

METHODS

In the current study we estimate the impact of increased BMI on healthcare costs using nine common methods from the literature: multivariable regression analyses (ordinary least squares, generalized linear models, and two-part models), and instrumental variable models (using previously measured BMI, offspring BMI, and three different weighted genetic risk scores as instruments for BMI). We stratified by sex, investigated the implications of confounder adjustment, and modelled both linear and non-linear associations.

RESULTS

There was a positive effect of increased BMI in both males and females in each approach. The cost of elevated BMI was higher in models that, to a greater extent, account for endogenous relations.

CONCLUSION

The study provides solid evidence that there is an association between BMI and healthcare costs, and demonstrates the importance of triangulation.

Exploring the cost-effectiveness of EBV vaccination to prevent multiple sclerosis in an Australian setting

BACKGROUND

Increasing evidence suggests the potential of Epstein-Barr virus (EBV) vaccination in preventing multiple sclerosis (MS). We aimed to explore the cost-effectiveness of a hypothetical EBV vaccination to prevent MS in an Australian setting.

METHODS

A five-state Markov model was developed to simulate the incidence and subsequent progression of MS in a general Australian population. The model inputs were derived from published Australian sources. Hypothetical vaccination costs, efficacy and strategies were derived from literature. Total lifetime costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were estimated for two hypothetical prevention strategies versus no prevention from the societal and health system payer perspectives. Costs and QALYs were discounted at 5% annually. One-way, two-way and probabilistic sensitivity analyses were performed.

RESULTS

From societal perspective, EBV vaccination targeted at aged 0 and aged 12 both dominated no prevention (ie, cost saving and increasing QALYs). However, vaccinating at age 12 was more cost-effective (total lifetime costs reduced by $A452/person, QALYs gained=0.007, ICER=-$A64 571/QALY gained) than vaccinating at age 0 (total lifetime costs reduced by $A40/person, QALYs gained=0.003, ICER=-$A13 333/QALY gained). The probabilities of being cost-effective under $A50 000/QALY gained threshold for vaccinating at ages 0 and 12 were 66% and 90%, respectively. From health system payer perspective, the EBV vaccination was cost-effective at age 12 only. Sensitivity analyses demonstrated the cost-effectiveness of EBV vaccination to prevent MS under a wide range of plausible scenarios.

CONCLUSIONS

MS prevention using future EBV vaccinations, particularly targeted at adolescence population, is highly likely to be cost-effective.

The economic burden of diseases in the Nordic countries: A systematic review

BACKGROUND

Economic burden studies can provide insights into the drivers leading to increasing healthcare costs. It can also provide a more holistic view of how diseases impact the welfare of patients and their families. Having concrete estimates of the economic burden across multiple diseases can help policymakers determine which diseases are economically more burdensome. This study aimed to review and summarise comprehensively economic burden studies across multiple diseases in the Nordic countries between 2000 and 2020.

METHODS

According to the 2020 PRISMA statement, a systematic literature review was conducted in PubMed, CINAHL, Academic Search Premier and Global Health databases using key terms related to the economic burden of any disease in Denmark, Finland, Greenland, Iceland, Norway and Sweden. Grey literature was also reviewed.

RESULTS

A total of 10,050 potential titles and abstracts were identified and screened, and 254 full-text papers that met the inclusion criteria were evaluated by two independent reviewers. Of these, 119 articles were included in a qualitative synthesis. Twenty-nine had clearly defined comparison groups, thus able to attribute the costs to the disease. Large variations concerning methodology and cost components were noted. Across diseases, the economic burden ranged from EUR 1668 per patient annually for chronic obstructive pulmonary disease to EUR 93,041 for multiple sclerosis. However, estimates varied widely, even within each disease.

CONCLUSIONS

Our review highlights the need for more comparable economic burden studies. Future studies should focus on applying robust methodology and homogeneous cost-reporting methods to inform policymakers about which diseases are economically more burdensome.

Efficacy and safety of Mazdutide on weight loss among diabetic and non-diabetic patients: a systematic review and meta-analysis of randomized controlled trials

Background

Overweight and obesity are increasing global public health problems. Mazdutide is a new dual agonist drug that can potentially reduce weight and blood glucose levels simultaneously. However, the synthesis of evidence on the efficacy and safety of this drug is scarce. Therefore, this study aimed to synthesize evidence on the efficacy and safety of Mazdutide compared to placebo on weight reduction among adults with and without diabetes.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Data were retrieved from six electronic databases: PubMed, Web of Science, Scopus, Cochrane Library, ClinicalTrial.gov, and Google Scholar, and manually searched from the included references. The data were synthesized using a random effect model. This analysis was performed in the R programming language using the Meta package.

Results

A total of seven RCTs involving 680 participants were included in this study. Mazdutide was more effective in reducing body weight (mean difference [MD]= -6.22%, 95% confidence interval [CI]: -8.02% to -4.41%, I2 = 90.0%), systolic blood pressure (MD = -7.57 mmHg, 95% CI: -11.17 to -3.98 mmHg, I2 = 46%), diastolic blood pressure (MD = -2.98 mmHg, 95% CI: -5.74 to -0.22 mmHg, I2 = 56%), total cholesterol (MD = -16.82%, 95% CI: -24.52 to -9.13%, I2 = 61%), triglycerides (MD = -43.29%, 95% CI: -61.57 to -25.01%, I2 = 68%), low-density lipoprotein (MD= -17.07%, 95% CI: -25.54 to -8.60%, I2 = 53%), and high-density lipoprotein (MD = -7.54%, 95% CI: -11.26 to -3.83%, I2 = 0%) than placebo. Mazdutide was associated with reduced hemoglobin A1c (HbA1c) and fasting plasma glucose in participants with type 2 diabetes. In the subgroup and meta-regression analyses, weight reduction was more significant in non-diabetics compared to diabetics, and in those who received a longer treatment duration (24 weeks) than in those on shorter durations (12-20 weeks). Participants who received Mazdutide had a higher risk of transient mild or moderate gastrointestinal side effects.

Conclusion

Mazdutite appears to be effective in weight reduction among patients with and without diabetes, and it has an advantage over other associated comorbidities. However, it was associated with mild or moderate gastrointestinal side effects.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403859, identifier CRD42023403859.

Robot-assisted vs laparoscopic bariatric procedures in super-obese patients: clinical and economic outcomes

The increased operative time and costs represent the main limitations of robotic technology application to bariatric surgery. Robotic platforms may help the surgeon to overcome the technical difficulties in super-obese (SO, BMI ≥ 50 kg/m2) patients, in which multi-quadrant operations could be challenging. We aimed to evaluate the effect of robot-assisted (R) versus laparoscopic (L) approaches in Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) and Roux-en-Y Gastric Bypass (RYGB) in SO and Super-Super Obese (SSO, BMI ≥ 60 kg/m2) patients in terms of outcomes and cost-effectiveness. Bariatric procedures performed from 2012 to 2023 were retrospectively reviewed. The inclusion criteria were BMI ≥ 50 kg/m2, primary SADI-S or RYGB. Operative time (OT), early complications, post-operative stay (POS), overall costs and follow-up data were analyzed. A subgroup analysis for surgical procedures and SSO patients was also performed. Among 4596 patients, 174 RYGB and 91 SADI-S in BMI ≥ 50 kg/m2 patients were selected. After Propensity Score Matching analysis, two groups of patients were identified (laparoscopic and robot-assisted), each one composed of 18 RYGB and 26 SADI-S. Intraoperative and post-operative complication rates and POS were comparable. Mean OT was longer in robotic procedures compared with laparoscopy (199.1 ± 65.7 and 109.5 ± 39.1 min, respectively, p < 0.001). The difference in OT was eliminated after only SSO patients were included in the analysis (172.7 ± 24.1 vs 152.6 ± 26.2 min for R-SADI-S and L-SADI-S, respectively, p = 0.107). Robotic surgeries were associated with higher costs (8134.6 ± 1886.7 and 2386.7 ± 388.2 € in R-RYGB and L-RYGB, respectively; 7996.6 ± 873.1 and 3954.6 ± 631.1 € in R-SADI-S and L-SADI-S). Despite increased costs, robotic approach may represent an added value in more complex cases such as SSO patients.

Economic costs of obesity: a systematic review

INTRODUCTION

Obesity is a growing public health problem leading to substantial economic impact. This study aimed to summarize the economic impact of obesity and to critically analyze the methods used in the cost-of-illness (COI) studies on obesity.

METHODS

We conducted systematic search in PubMed and Scopus from September 1, 2016, to July 22, 2022. Original COI studies estimating the economic cost of obesity and/or overweight in at least one country, published in English were included. To facilitate the comparison of estimates across countries, we converted the cost estimates of different years to 2022 purchasing power parity (PPP) values using each country's consumer price index (CPI) and PPP conversion rate.

RESULTS

Nineteen studies were included. All studies employed a prevalence-based approach using Population Attributable Fraction (PAF) methodology. About half of the included studies (53%) were conducted in high-income countries while the others (47%) were conducted in middle-income countries. The economic burden of obesity ranged between PPP 15 million in Brazil to PPP 126 billion in the USA, in the year 2022. Direct medical costs accounted for 0.7% to 17.8% of the health system expenditure. Furthermore, the total costs of obesity ranged from 0.05% to 2.42% of the country's gross domestic product (GDP). Of the seven studies that estimated both direct and indirect costs, indirect costs accounted for the largest portion of five studies. Nevertheless, a variety in methodology across studies was identified. The number of co-morbidities included in the analysis varied across studies.

CONCLUSIONS

Although there was a variety of methodologies across studies, consistent evidence indicated that the economic burden of obesity was substantial. Obesity prevention and control should be a public health priority, especially among countries with high prevalence of obesity.

Health and economic burden of sugar-sweetened beverages consumption in Brazil

Sugar-sweetened beverages (SSBs) are a major source of added sugar and are associated with noncommunicable diseases (NCDs) such as obesity and diabetes. This study assessed the impact of SSBs consumption on disease burden in Brazil, including deaths, disability-adjusted life years (DALYs), and healthcare costs. A 3-stage methodology was used to assess the direct effects of SSBs on diabetes, cardiovascular diseases, and body mass index (BMI), along with the influence of BMI on disease incidence. These assessments were then used to estimate the economic and health burden using population-attributable factors. Results showed that 2.7% and 11% of adult and children overweight/obesity cases were attributable to SSBs, respectively. SSBs consumption in Brazil led to 1,814,486 cases, 12,942 deaths, 362,088 DALYs, and USD 2,915.91 million in medical costs related to diabetes, cardiovascular diseases, oncological diseases, and other NCDs. Urgent implementation of public policies is crucial to address the consumption of SSBs, recognized as a key risk factor for NCDs.

Overweight and obesity in adulthood, sociodemographic factors, lifestyle, and the early burden of noncommunicable diseases among Americans: NHANES 2007-2018

OBJECTIVES

To evaluate the association between nutritional status in early adulthood and the burden of noncommunicable diseases (NCDs); To evaluate the influence of sociodemographic factors and lifestyle on the outcomes of BMI kg/m2  ≤24.9, ≥25.0, and ≥30.0; to estimate the population attributable fraction (PAF) to BMI elevated at 25 years old in the burden of NCDs in American adults.

METHODS

We used data from 15 721 American adults participating in the National Health and Nutrition Examination Survey from 2007 to 2018. The Hazard Ratio (HR), Incidence Rate Ratio (IRR), and 95% confidence intervals (CI) were estimated in the proportional risk regression models of Cox (entire population) and Poisson (restricted to non-patients), respectively. The proportionality of the risk between the burden of NCDs and BMI at 25 years old was drawn by the Kaplan-Meier curve, and the PAF was calculated. All analyses were adjusted taking into account the sample weights.

RESULTS

Health disparities (sex, age, race/ethnicity, education, poverty index, and education level), and lifestyle (physical activity, smoking, and alcohol consumption) influenced the current nutritional status. Cumulative survival in overweight and obese groups decreased considerably over time (p < .0001). Being overweight and obese in adulthood may increase the risk of early NCDs (HR: 1.68, 95% CI: 1.54-1.84 and HR: 2.87, 95% CI: 2.56-3.21, respectively). About 22.72% (95% CI: 19.99-25.36, p < .001) of the burden NCDs could have been avoided if overweight at age 25 had been prevented.

CONCLUSIONS

Monitoring weight change from young adulthood can provide a sensitive and useful clinical measure for early detection of adverse trends in NCDs risk.

Clinical outcomes and complications of single anastomosis duodenal-ileal bypass with sleeve gastrectomy: A 2-year follow-up study in Bogotá, Colombia

BACKGROUND

The global prevalence of obesity has increased over the past 40 years, and bariatric surgery has proven to be the most effective therapy for long-term weight loss. Its principles are based on modifying the brain-gut axis by altering the gastrointestinal anatomy and affecting the function of gastrointestinal hormones, thereby modifying satiety signals. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) combines both techniques and has become an alternative to gastric bypass and biliopancreatic diversion procedures for treating severe obesity and associated metabolic diseases in selected patients.

AIM

To describe the outcomes and complications of SADI-S.

METHODS

We retrospectively analyzed the data of patients who underwent SADI-S laparoscopically at the Clínica Reina Sofía in Bogotá, Colombia. This study assessed the therapeutic effectiveness of SADI-S in terms of short-term preoperative clinical characteristics, postoperative complications, comorbidities, nutritional defi-ciencies, and intraoperative complications during a 2-year follow-up.

RESULTS

Sixty-one patients with a mean body mass index (BMI) of 50 ± 7.1 kg/m2 underwent laparoscopic SADI-S. The mean operative time and hospital stays were 143.8 ± 42 min and 2.3 ± 0.8 d, respectively. The mean follow-up period was 18 mo, and the mean BMI decreased to 28.5 ± 12.2 kg/m2. The excess BMI loss was 41.8% ± 13.5%, and the weight loss percentage was 81.1% ± 17.0%. Resolution of obesity-related comorbidities, including type 2 diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea, was achieved and defined as complete or partial remission. No intraoperative complications were observed. Short-term complications were observed in four (6.8%) patients. However, larger studies with longer follow-up periods are required to draw definitive conclusions.

CONCLUSION

SADI-S has a low intraoperative and postoperative complication rate and is effective for weight loss and improving obesity-related comorbidities, including hypertension, type 2 diabetes mellitus, dyslipidemia, and sleep apnea syndrome.

Effects of a Web-Based Lifestyle Intervention on Weight Loss and Cardiometabolic Risk Factors in Adults With Overweight and Obesity: Randomized Controlled Clinical Trial

BACKGROUND

The high proportion of people with overweight and obesity has become a worldwide problem in recent decades, mainly due to health consequences, such as cardiovascular diseases, neoplasia, and type 2 diabetes mellitus. Regarding effective countermeasures, the digitization of health services offers numerous potentials, which, however, have not yet been sufficiently evaluated. Web-based health programs are becoming increasingly interactive and can provide individuals with effective long-term weight management support.

OBJECTIVE

The purpose of this randomized controlled clinical trial was to evaluate the effectiveness of an interactive web-based weight loss program on anthropometric, cardiometabolic, and behavioral variables and to compare it with a noninteractive web-based weight loss program.

METHODS

The randomized controlled trial included people who were aged between 18 and 65 years (mean 48.92, SD 11.17 years) and had a BMI of 27.5 to 34.9 kg/m² (mean 30.71, SD 2.13 kg/m²). Participants (n=153) were assigned to either (1) an interactive and fully automated web-based health program (intervention) or (2) a noninteractive web-based health program (control). The intervention program focused on dietary energy density and allowed for dietary documentation with appropriate feedback on energy density and nutrients. The control group only received information on weight loss and energy density, but the website did not contain interactive content. Examinations were performed at baseline (t0), at the end of the 12-week intervention (t1), and at 6 months (t2) and 12 months (t3) thereafter. The primary outcome was body weight. The secondary outcomes were cardiometabolic variables as well as dietary and physical activity behaviors. Robust linear mixed models were used to evaluate the primary and secondary outcomes.

RESULTS

The intervention group showed significant improvements in anthropometric variables, such as body weight (P=.004), waist circumference (P=.002), and fat mass (P=.02), compared with the control group over the course of the study. The mean weight loss after the 12-month follow-up was 4.18 kg (4.7%) in the intervention group versus 1.29 kg (1.5%) in the control group compared with the initial weight. The results of the nutritional analysis showed that the energy density concept was significantly better implemented in the intervention group. Significant differences in cardiometabolic variables were not detected between the 2 groups.

CONCLUSIONS

The interactive web-based health program was effective in reducing body weight and improving body composition in adults with overweight and obesity. However, these improvements were not associated with relevant changes in cardiometabolic variables, although it should be noted that the study population was predominantly metabolically healthy.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00020249; https://drks.de/search/en/trial/DRKS00020249.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.3390/ijerph19031393.

The association between health costs and physical inactivity; analysis from the Physical Activity at Work study in Thailand

Introduction

Physical inactivity increases the risks of several common yet serious non-communicable diseases, costing a tremendous amount of health expenditure globally. This study aimed to estimate the association between health costs and physical inactivity in Thailand.

Methods

Data from the Physical Activity at Work cluster randomized controlled trial participants with valid objective physical activity data were extracted. Health costs were collected using the Health and Welfare Survey and the Work Productivity and Activity Impairment Questionnaire and were categorized into past-month outpatient illness, past-year inpatient illness, and past-week presenteeism and absenteeism. Time spent in moderate-to-vigorous physical activity was used to determine the activity level according to the current guideline (i.e., ≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity equivalent physical activity per week). The primary analysis evaluated the association between direct cost (treatment and travel costs) and societal cost (direct cost plus absenteeism due to the illness) of past-month outpatient illness and physical inactivity using a two-part model.

Results

In total, 277 participants with a mean age of 38.7 were included. Average direct and societal cost due to past-month outpatient illness were 146 THB (3.99 USD) (SD = 647 THB) and 457 THB (12.5 USD) (SD = 1390 THB), respectively. Compared to active participants, direct and societal cost of past-month outpatient illness were 153 THB (4.18 USD) (95%CI: -54.7 to 360 THB) and 426 THB (11.7 USD) (95%CI: 23.3 to 829 THB) higher in physically inactive individuals, respectively, adjusted for covariates. The additional societal cost of past-month outpatient illness was 145% higher in physically inactive participants compared to active participants. On the other hand, there was no significant association in direct and societal cost of past-year inpatient illness nor past-week indirect costs between physically active and non-active participants.

Discussion

Results were similar to recent findings in different countries. However, the findings should be generalized with caution due to the small sample size and potential bias from reverse causation. Future research is crucial for clarifying the health costs of physical inactivity in Thailand and other countries.

Modern pied pipers: Child social media influencers and junk food on YouTube: A study from Germany

Kid influencers (under the age of 13) have profiles on social media platforms and create content to generate views and engagements. To reach young consumers, food companies are increasingly using kid influencers, perceived as highly trustworthy among children of the same age, to promote their (high-calorie) food products. Exposure to such content can lead to an increase in calorie intake. Therefore, this study aimed to identify which foods and beverages are featured in the videos of the four kid influencer channels most popular in Germany and, if possible, which Nutri-Score category these products receive. Of each channel, 50 of the most popular and 50 of the newest videos were analyzed regarding the food and beverage products and brands appearing in the video and the thumbnail. To analyze the number of appearances, each product was categorized as to whether it was branded or unbranded. Where possible, the Nutri-Score was then calculated for each product that appeared. Within the total video sample (N = 373), food and/or beverages appeared in almost 70% of the videos, of which 220 were branded and 178 were unbranded products. Due to incomplete nutrition labels of branded products, only 146 branded products could be analyzed, from which 66% received the worst Nutri-Score categories D and E. The unbranded foods were evaluated using products as similar as possible, of which the majority received Nutri-Score A. The most common brands included McDonald's, Kinder, and Coca-Cola, and the most frequent product categories were chocolate, candy, soft drinks, and fruit. The high number of high-calorie products in the videos shows that kid influencers might be regarded as a risk factor when it comes to childhood obesity.

Eight-year trends in obesity-related complications and health care cost progression in a US population with obesity: A retrospective cohort study

AIMS

Obesity-related complications (ORCs) impose a substantial health burden on affected individuals, and economic costs to health care systems. We examined ORCs and the progression of direct health care costs over 8 years, stratified by obesity class.

MATERIALS AND METHODS

Adults with obesity were identified in linked US medical records and administrative claims databases. The index date was the first body mass index measurement of 30 to <70 kg/m² between 1 January 2007 and 31 March 2012; a ≥8-year continuous enrolment post-index was required for inclusion. Diagnosis codes for five specific ORCs and total health care costs were recorded in each year of follow-up. Costs adjusted for clinical and demographic factors were also estimated.

RESULTS

Of 28 583 eligible individuals, 17 892 had class I obesity, 6550 had class II obesity and 4141 had class III obesity. From baseline to year 8, the presence of type 2 diabetes and knee osteoarthritis doubled in all obesity classes, with even larger increases for chronic kidney disease and heart failure. Observed and adjusted total health care costs generally increased from the baseline year to year 8. The difference in costs between obesity classes increased over time: at year 1, individuals with class III obesity had 26.8% higher costs than those in class I, but at year 8, this difference was 40.7%. Outpatient costs constituted half of the total observed costs across obesity classes.

CONCLUSIONS

ORC rates and health care costs increase over time, and are greater in higher obesity classes. This could be mitigated by approaches that limit obesity progression.

The impact of psychological distress on weight regain in post-bariatric patients during the COVID-19 pandemic: A latent profile analysis

OBJECTIVE

The COVID-19 pandemic has caused a global health crisis disrupting healthcare delivery for people with severe obesity who have undergone bariatric surgery. This study examined the role of psychological distress during the first Italian COVID-19 lockdown in predicting post-operative outcomes in post-bariatric patients reaching the end of the 12-18 months follow-up during the lockdown. By using a person-centered approach, groups of patients with different psychological distress profiles were identified. We hypothesized that compared to post-bariatric patients with low psychological distress, post-bariatric patients with high psychological distress will be more at risk of weight regain.

METHODS

A total of 67 patients (71.6% female, M_age = 45.9) participated in this observational retrospective cohort study. Patients' anthropometric data were gathered from medical records while the weight at the end of the lockdown through phone interviews. Psychological distress, operationalized with anxiety symptoms, depressive symptoms, and sleep disturbances, was assessed by an online self-report questionnaire.

RESULTS

Significant differences were highlighted in the high and low psychological distressed group in weight changes, F(1,58) = 5.2, p < 0.001, η² = 0.3. Specifically, compared to post-bariatric patients in the low psychological distress group, those in the high psychological distressed group reported weight regained (95% CI = 1.0, 2.6).

CONCLUSION

Results highlight the need to target post-bariatric patients with high psychological distress who are at risk for weight regain during the COVID-19 pandemic. Interventions mitigating psychological distress and obesogenic behaviors during future pandemics or in post-COVID times are needed in vulnerable post-bariatric patients reporting high psychological distress.

The Relative Value of Anti-Obesity Medications Compared to Similar Therapies

Purpose

To demonstrate a need for improved health insurance coverage for anti-obesity medications (AOMs) by comparing clinical and economic benefits of obesity treatments to covered medications for selected therapeutic areas.

Methods

Using a grey literature search, we identified and prioritized therapeutic areas and treatment analogues for comparison to obesity. A targeted literature review identified clinical and economic outcomes research across the therapeutic area analogues. Associated comorbidities, clinical evidence, indirect costs (ie, absenteeism and productivity loss), and direct medical costs were evaluated to determine the relative value of treating obesity.

Results

Four therapeutic areas/treatment analogues were selected for comparison to obesity: smoking cessation (varenicline), daytime sleepiness (modafinil), migraines (erenumab), and fibromyalgia (pregabalin). Obesity was associated with 17 comorbidities, more than migraine (9), smoking (8), daytime sleepiness (5), and fibromyalgia (2). Economic burden was greatest for obesity, followed by smoking, with yearly indirect and direct medical costs totaling $676 and $345 billion, respectively. AOMs resulted in cost savings of $2586 in direct medical costs per patient per year (PPPY), greater than that for varenicline at $930 PPPY, modafinil at $1045 PPPY, and erenumab at $468 PPPY; pregabalin utilization increased costs by $924 PPPY. AOMs were covered by 10-16% of United States health insurance plans, compared to 45-59% for the four comparators.

Conclusion

Compared to four therapeutic analogues, obesity represented the highest economic burden and was associated with more comorbidities. AOMs provide greater cost savings compared to selected analogues. However, AOMs have limited formulary coverage. Improved coverage of AOMs may increase access to these treatments and may help address the clinical and economic burden associated with obesity and its comorbidities.

Epidemiological correlates of overweight and obesity in the Northern Cape Province, South Africa

Background

In the past several decades, obesity has become a major public health issue worldwide, associated with increased rates of chronic disease and death. Like many developing nations, South Africa is experiencing rapid increases in BMI, and as a result, evidence-based preventive strategies are needed to reduce the increasing burden of overweight and obesity. This study aimed to determine the prevalence and predictors of overweight and obesity among a multi-ethnic cohort from the rural Northern Cape of South Africa.

Methods

These data were collected as part of a tuberculosis (TB) case-control study, with 395 healthy control participants included in the final analysis. Overweight and obesity were defined according to WHO classification. Multivariate linear models of BMI were generated using sex, age, education level, smoking, alcohol consumption, and diabetes as predictor variables. We also used multivariable logistic regression analysis to assess the relationship of these factors with overweight and obesity.

Results

The average BMI in our study cohort was 25.2. The prevalence of overweight was 18.0% and the prevalence of obesity was 25.0%. We find that female sex, being older, having more years of formal education, having diabetes, and being in a rural area are all positively associated with BMI in our dataset. Women (OR = 5.6, 95% CI [3.3-9.8]), rural individuals (OR = 3.3, 95% CI [1.9-6.0]), older individuals (OR = 1.02, 95% CI [1-1.04]), and those with more years of education (OR = 1.2, 95% CI [1.09-1.32]) were all more likely to be overweight or obese. Alternatively, being a smoker is negatively associated with BMI and decreases one's odds of being overweight or obese (OR = 0.28, 95% CI [0.16-0.46]).

Conclusions

We observed a high prevalence of overweight and obesity in this study. The odds of being overweight and obese were higher in women, those living in rural areas, and those with more education, and increases with age. Community-based interventions to control obesity in this region should pay special attention to these groups.

Estimating the healthcare cost of overweight and obesity in South Africa

Background

Overweight and obesity are major risk factors for noncommunicable diseases. This presents a major burden to health systems and to society in South Africa. Collectively, these conditions are overwhelming public healthcare. This is happening when the country has embarked on a journey to universal health coverage, hence the need to estimate the cost of overweight and obesity.

Objective

Our objective was to estimate the healthcare cost associated with treatment of weight-related conditions from the perspective of the South African public sector payer.

Methods

Using a bottom-up gross costing approach, this study draws data from multiple sources to estimate the direct healthcare cost of overweight and obesity in South Africa. Population Attributable Fractions (PAF) were calculated and multiplied by each disease’s total treatment cost to apportion costs to overweight and obesity. Annual costs were estimated for 2020.

Results

The total cost of overweight and obesity is estimated to be ZAR33,194 million in 2020. This represents 15.38% of government health expenditure and is equivalent to 0.67% of GDP. Annual per person cost of overweight and obesity is ZAR2,769. The overweight and obesity cost is disaggregated as follows: cancers (ZAR352 million), cardiovascular diseases (ZAR8,874 million), diabetes (ZAR19,861 million), musculoskeletal disorders (ZAR3,353 million), respiratory diseases (ZAR360 million) and digestive diseases (ZAR395 million). Sensitivity analyses show that the total overweight and obesity cost is between ZAR30,369 million and ZAR36,207 million.

Conclusion

This analysis has demonstrated that overweight and obesity impose a huge financial burden on the public health care system in South Africa. It suggests an urgent need for preventive, population-level interventions to reduce overweight and obesity rates. The reduction will lower the incidence, prevalence, and healthcare spending on noncommunicable diseases.

Association of Obesity with Cognitive Impairment and Depression among Oldest Old Population having Frailty syndrome

Objectives

The objectives were to estimate prevalence of obesity among frail individuals aged ≥80 years and examine the association of obesity with cognitive impairment and depression among frail individuals aged ≥80 years.

Methods

Two-hundred community-dwelling participants aged ≥80 years, were enrolled; 166 frail participants were further analyzed. Obesity and adiposity were determined by Body Mass Index (BMI), Waist Circumference (WC) and Body Fat Percentage (BF%). Cognitive impairment and Depression were assessed using Mini Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-15). Frailty was assessed by Fried criteria. Chi-Square, t-test, trend-analysis and Logistic Regression (LR) were done.

Results

Obesity among Frail individuals aged ≥80 years was 40% using BMI and 73.2% using WC. Obesity was inversely associated with cognitive impairment and depression among frail individuals. Severity of cognitive impairment and depression was lower among obese frail than non-obese frail. Trend-analysis showed decreasing cognitive impairment and depression with increasing BF%. On LR, obesity among frail individuals had inverse association with cognitive impairment and depression.

Conclusion

Obesity among frail individuals aged ≥80 years was associated with lower odds of cognitive impairment and depression in our population. Positive effects of weight gain in oldest old frail individuals and development of cognitive impairment and dementia should be explored in further researches.

A review on the beneficial effects of bariatric surgery in the management of obesity

INTRODUCTION

Obesity is a chronic disease with a complex interplay of multiple factors such as genetic, metabolic, behavioral, and environmental factors. The management of obesity includes; lifestyle modification, psychological therapy, pharmacological therapy, and bariatric surgery. To date, bariatric surgery is the most effective treatment for obesity by offering a long-term reduction in weight, remission of obesity-related complications, and improving quality of life. However, bariatric surgery is not equally effective in all patients. Thus, if we can predict who would benefit most, it will improve the risk versus benefit ratio of having surgery.

AREAS COVERED

In this narrative review, we explore the question on who will benefit the most from bariatric surgery by examining the recent evidence in the literature. In addition, we investigate the predisposing predictors of bariatric surgery response. Finally, we offer the best strategies in the clinic to explain the potential benefits of bariatric surgery to patients.

EXPERT OPINION

Bariatric surgery is an effective obesity management approach. Despite its efficacy, considerable variation of individual response exists. Thus, it is important to recognize patients that will benefit most, but at present very few predictors are available which can be clinically useful.

Targeting skeletal muscle mitochondrial health in obesity

Metabolic demands of skeletal muscle are substantial and are characterized normally as highly flexible and with a large dynamic range. Skeletal muscle composition (e.g., fiber type and mitochondrial content) and metabolism (e.g., capacity to switch between fatty acid and glucose substrates) are altered in obesity, with some changes proceeding and some following the development of the disease. Nonetheless, there are marked interindividual differences in skeletal muscle composition and metabolism in obesity, some of which have been associated with obesity risk and weight loss capacity. In this review, we discuss related molecular mechanisms and how current and novel treatment strategies may enhance weight loss capacity, particularly in diet-resistant obesity.

Obesity- attributable costs of absenteeism among working adults in Portugal

Background

Obesity leads to poor health outcomes and may adversely affect work productivity. This study, aimed to investigate the obesity- attributable costs of absenteeism among working adults in Portugal.

Methods

The study population included individuals actively working at baseline from the Epidemiology of Chronic Diseases Cohort (EpiDoC), a large Portuguese population-based prospective study. Body mass index was measured at baseline and in two follow-up interviews. Absenteeism in each wave of the EpiDoC was assessed by the question “Did you have a sick leave in the previous 12 months? yes/no”, followed by “How many days did you miss work due to sickness in the previous twelve months?”. Body mass index (BMI) was classified into underweight, normal weight, overweight, and obese, based on the standard World Health Organization definition.

Association between obesity and absenteeism was estimated with the negative binomial regression model adjusted for BMI, chronic diseases, and lifestyle. Obesity- attributable costs were calculated using lost gross income during the time absent from work, through the human-capital approach.

Results

The EpiDoC included 4338 working adults at baseline. Of these, 15.2% were obese at the beginning of the study and 22.7% of the population had been absent from work in the last 12 months. Participants with obesity missed 66% more days at work (IRR: 1.66; CI 95%:1.13–2.44; (p = 0.009.) than those with normal weight. The odds of having been absent from work were 1.4 times higher in obese compared to non-obese individuals (CI 95%: 1.18–1.67; p < 0.01) adjusted to sex and type of work. Obese individuals missed 3.8 more days per year than those with normal weight (95%CI: 3.1–4.5). Extrapolating to the entire Portuguese working population, absenteeism due to obesity incurred an additional cost of €238 million per year.

Conclusion

Obesity imposes a financial burden due to absenteeism in Portugal. Employers and national health regulators should seek effective ways to reduce these costs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13337-z.

Health Economic Aspects of Childhood Excess Weight: A Structured Review

An economic perspective is crucial to understand the broad consequences of childhood excess weight (CEW). These can manifest in the form of elevated health care and societal costs, impaired health status, or inefficiencies in the allocation of resources targeted at its prevention, management, or treatment. Although existing systematic reviews provide summaries of distinct economic research strands covering CEW, they have a restricted focus that overlooks relevant evidence. The overarching aim of this structured review was to update and enhance recent key reviews of four strands of economic evidence in this area, namely, (1) economic costs associated with CEW, (2) health utilities associated with CEW, (3) economic evaluations of interventions targeting CEW, and (4) economic determinants and broader consequences of CEW. Our de novo searches identified six additional studies for the first research strand, five studies for the second, thirty-one for the third, and two for the fourth. Most studies were conducted in a small number of high-income countries. Our review highlights knowledge gaps across all the research strands. Evidence from this structured review can act as data input into future economic evaluations in this area and highlights areas where future economic research should be targeted.

The economic burden of obesity in Italy: a cost-of-illness study

BACKGROUND

Obesity is a complex health disorder that significantly increases the risk of several chronic diseases, and it has been associated with a 5-20-year decrease in life expectancy. The prevalence of obesity is increasing steadily worldwide and Italy follows this trend with an increase of almost 30% in the adult obese population in the last 3 decades. Previous studies estimated that 2-4% of the total health expenditure in Europe is attributed to obesity and it is projected to double by 2050. Currently, there is a lack of sufficient knowledge on the burden of obesity in Italy and most relevant estimates are derived from international studies. The aim of this study is to estimate the direct and indirect costs of obesity in Italy, taking 2020 as the reference year.

METHODS

Based on data collected from the literature, a quantitative cost-of-illness (COI) study was performed from a societal perspective focussing on the adult obese population (Body Mass Index (BMI) ≥ 30 kg/m²) in Italy.

RESULTS

The study indicated that the total costs attributable to obesity in Italy amounted to €13.34 billion in 2020 (95% credible interval: €8.99 billion < µ < €17.80 billion). Direct costs were €7.89 billion, with cardiovascular diseases (CVDs) having the highest impact on costs (€6.66 billion), followed by diabetes (€0.65 billion), cancer (€0.33 billion), and bariatric surgery (€0.24 billion). Indirect costs amounted to €5.45 billion, with almost equal contribution of absenteeism (€2.62 billion) and presenteeism (€2.83 billion).

CONCLUSIONS

Obesity is associated with high direct and indirect costs, and cost-effective prevention programmes are deemed fundamental to contain this public health threat in Italy.

Using Black Feminist Theory and Methods to Uncover Best Practices in Health Promotion Programming

This study was created to uncover the social determinants of Black American women's success in health promotion programs. We used the Superwoman Schema to understand the complexities of Black womanhood and uncover best practices in the promotion of their health. The sample consisted of women ages 18-25 who attend a large southern HBCU. We collected data using qualitative focus groups. Participants reported the greatest health-related concerns Black American women facing are mental health, obesity, and relationships with Black men. When it comes to health promotion programs, respondents reported a desire for classes that are fun, interactive, informative, educational, and include group interaction, accessible, and incentivize participation. Uncovering the social determinants of Black American women's health and program success is central in decreasing extant health disparities. Future health scholars are urged to incorporate Black feminist theory and methods into their work to create health promotion interventions tailored for Black women.

Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data

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.

Burden of disease study of overweight and obesity; the societal impact in terms of cost-of-illness and health-related quality of life

BACKGROUND

Little is known about the burden that overweight and obesity impose on Dutch society. The aim of this study is to examine this burden in terms of cost-of-illness and health-related quality of life.

METHOD

A bottom-up, prevalence-based burden of disease study from a societal perspective was performed. Cost-of-illness information including healthcare costs, patient and family costs, and other costs was obtained via the Treatment Inventory of Costs in Patients with psychiatric disorders (TiC-P) questionnaire. Health-related quality of life was assessed through the EuroQol (EQ-5D-5L) and the BODY-Q instruments. Non-parametric bootstrapping was applied to test for significant differences in costs. Subgroup analyses were performed on all outcomes.

RESULTS

A total of 97 people with overweight and obesity completed the survey. Per respondent, mean healthcare costs were €2907, patient and family costs were €4037, and other costs were €4519, leading to a total societal cost of €11,463 per respondent per year. Total costs were significantly higher for respondents with obesity versus overweight and between low & intermediate versus highly educated respondents. The mean utility score of our population was 0.81. A significantly lower utility score was found for respondents with obesity in comparison with respondents with overweight. BODY-Q results show that respondents with obesity scored a significantly lower Rasch-score than did respondents with overweight in three scales. Respondents with a high education level and having paid work scored significantly higher Rasch-scores in two scales than did those with a low education level and without having paid work. The age group 19-29 have significantly higher Rasch-scores in three scales than respondents in the other two age categories.

CONCLUSIONS

Overweight and obesity have a considerable impact on the societal costs and on health-related quality of life. The results show that the impact of overweight and obesity go beyond the healthcare sector, as the other costs have the biggest share of the total costs. Another interesting finding of this study is that obesity leads to significant higher costs and lower health-related quality of life than overweight. These findings draw attention to policy making, as collective prevention and effective treatment are needed to reduce this burden.

Pain-Related Anxiety among Adults with Obesity and Chronic Pain: Relations with Pain, Opioid Misuse, and Mental Health

Obesity affect a significant proportion of the population in the United States, and is associated with numerous health consequences including anxiety, depression, and chronic pain. Additionally, pain among adults with obesity has been associated with greater mental health problems and substance use problems. Yet little work has examined psychological vulnerability factors associated with these relations, and pain-related anxiety may be one candidate psychological correlate of these relations. Therefore, the current study examined the association of pain-related anxiety with pain intensity, disability, opioid misuse, anxiety, and depression among 164 adults (81.7% female, M_age = 40.13 years, SD = 10.85) with obesity (M_BMI= 37.21, SD = 6.70) and chronic pain. Results suggested that pain-related anxiety was significantly associated with all outcomes, and these results suggest that pain-related anxiety may play an important role in physical health, mental health, and substance use outcomes among adults with obesity and chronic pain.

Metabolic Phenotyping in Mice with NASH Using Indirect Calorimetry

Obesity caused by caloric overload has assumed epidemic proportions. Obesity is frequently associated with metabolic dysfunctions, such as type 2 diabetes, non-alcoholic steatohepatitis (NASH), cardiovascular diseases, and cancer. Metabolic phenotyping is a set of techniques for studying metabolic dysfunction and behavior information including energy expenditure, body weight gain, glucose homeostasis, and lipid profile. Among different metabolic phenotyping methods, indirect calorimetry is an indispensable tool for quantifying the energy balance/imbalance in various mouse models, which enables researchers to probe the development of disease and to evaluate the therapeutic benefit from different interventions. In this chapter, we will describe the procedures of metabolic phenotyping using indirect calorimetry in db/db mouse, a metabolic disorder mouse model which develops NASH.

EphA3 deficiency in hypothalamus promotes high fat diet-induced obesity in mice

Erythropoietin-producing hepatocellular carcinoma A3 (EphA3) is a member of the largest subfamily of tyrosine kinase receptors-Eph receptors. Previous studies have shown that EphA3 is associated with tissue development. Recently, we have found that the expression of EphA3 is elevated in the hypothalamus of mice with diet-induced obesity (DIO). However, the role of EphA3 in hypothalamic-controlled energy metabolism remains unclear. In the current study, we demonstrated that the deletion of EphA3 in the hypothalamus by CRISPR/Cas9-mediated gene editing promotes obesity in male mice with high-fat diet feeding rather than those with normal chow diet feeding. Moreover, the deletion of hypothalamic EphA3 promotes high-fat DIO by increasing food intake and reducing energy expenditure. Knockdown of EphA3 leads to smaller intracellular vesicles in GT1-7 cells. The current study reveals that hypothalamic EphA3 plays important roles in promoting DIO.

The Potential Role of Digital Health in Obesity Care

Obesity is a complex, multi-factorial, chronic condition which increases the risk of a wide range of diseases including type 2 diabetes mellitus, cardiovascular disease and certain cancers. The prevalence of obesity continues to rise and this places a huge economic burden on the healthcare system. Existing approaches to obesity treatment tend to focus on individual responsibility and diet and exercise, failing to recognise the complexity of the condition and the need for a whole-system approach. A new approach is needed that recognises the complexity of obesity and provides patient-centred, multidisciplinary care which more closely meets the needs of each individual with obesity. This review will discuss the role that digital health could play in this new approach and the challenges of ensuring equitable access to digital health for obesity care. Existing technologies, such as telehealth and mobile health apps and wearable devices, offer emerging opportunities to improve access to obesity care and enhance the quality, efficiency and cost-effectiveness of weight management interventions and long-term patient support. Future application of machine learning and artificial intelligence to obesity care could see interventions become increasingly automated and personalised.

Infrastructure Design: A Critical Element in the Care of the Patient With Obesity

ABSTRACT

The worldwide rate of obesity continues to rise, causing healthcare systems to morph to meet the demands posed by the concomitant increase in comorbidities associated with this condition. Increasing patient weight imposes its own constraints on the safety of patients and providers; therefore, a sound healthcare facility infrastructure is required to properly address the medical needs of patients with obesity. Currently, most healthcare systems-in their attitudes, equipment, and facility design-are ill equipped to meet the needs of this epidemic. In this article, we discuss the facilities and equipment design considerations in providing medical care to patients with obesity. Extending beyond the physical plant, we also touch on organizational elements that enable the healthcare provider to safely care for this challenging patient population. The rising prevalence and disease burden of excess adiposity highlight the obligation to recognize that the design needs common to all of our patients must include the particular needs of the patient with obesity.

The cost of investigating weight-related comorbidities in children and adolescents in Aotearoa/New Zealand

AIM

Expert recommendations for child/adolescent obesity include extensive investigation for weight-related comorbidities, based on body mass index (BMI) percentile cut-offs. This study aimed to estimate the cost of initial investigations for weight-related comorbidities in children/adolescents with obesity, according to international expert guidelines.

METHODS

The annual mean cost of investigations for weight-related comorbidities in children/adolescents was calculated from a health-funder perspective using 2019 cost data obtained from three New Zealand District Health Boards. Prevalence data for child/adolescent obesity (aged 2-14 years) were obtained from the New Zealand Health Survey (2017/2018), and prevalence of weight-related comorbidities requiring further investigation were obtained from a previous New Zealand study of a cohort of children with obesity.

RESULTS

The cost of initial laboratory screening for weight-related comorbidities per child was NZD 28.36. Based on national prevalence data from 2018/2019 for children with BMI greater than the 98th percentile (obesity cut-off), the total annual cost for initial laboratory screening for weight-related comorbidities in children/adolescents aged 2-14 years with obesity was estimated at NZD 2,665,840. The cost of further investigation in the presence of risk factors was estimated at NZD 2,972,934.

CONCLUSIONS

Investigating weight-related comorbidities in New Zealand according to international expert guidelines is resource-intensive. Ways to further determine who warrants investigation with an individualised approach are required.

Overweight/obesity and chronic health conditions in older people with intellectual disability in Ireland

BACKGROUND

This study examines overweight/obesity and chronic health conditions (CHCs) in older people with intellectual disability (ID).

METHODS

Data for this cross-sectional observational study emanated from Wave 2 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing, a longitudinal study assessing the health and well-being of older Irish adults with ID aged ≥40 years across all levels of ID. Participation involves an interview process and collation of objective health measures. In this study, body mass index (BMI) (n = 572), used as a measure of weight status, was examined with clustered doctor's diagnosed CHCs. Descriptive analysis was conducted where counts (n) and proportions (%) were used to summarise the variables univariately, while cross-tabulations were used for bivariate summary into counts and proportions. With overweight/obesity prevalence established and patterns described using logistical regression, Pearson's chi-squared test was used to test for significant associations.

RESULTS

Overweight/obesity identified in 69% of participants occurred with greater frequency in women (72%). A higher percentage of participants aged <50 years (72.5%) were overweight/obese than those aged 50-64 (70%) and 65+ (61.4%). Level of ID and residence type were significantly associated with weight status (P < 0.001), with overweight/obesity more prevalent in mild (85.7%) than moderate (72%) or severe/profound ID (51.4%). Of those who lived independently/with family, 78.4% were overweight/obese, as were 74% living in a community group home (P < 0.001). Almost all overweight/obese participants' waist measurements were in the substantially increased risk of metabolic disease waist measurement category (92%, P < 0.001). Logistical regression used to model CHCs on BMI showed significant association between BMI and gastrointestinal tract [odds ratio (OR) = 0.57, P < 0.008, 95% confidence interval (CI) = (0.37; 0.86)], respiratory condition [OR = 8.95, P < 0.004, 95% CI = (2.57; 56.72)] and musculoskeletal disorders [OR = 0.40, P < 0.001, 95% CI = (0.25; 0.63)].

CONCLUSIONS

The findings illustrate the strong cross-sectional association between overweight/obesity and CHCs. These findings suggest a need to prioritise weight status as a health risk to people with ID as they age.

Five Years of MBSAQIP Data: Characteristics, Outcomes, and Trends for Patients with Super-obesity

PURPOSE

Incidence of super obesity (SO; BMI ≥ 50 kg/m²) is growing rapidly and confers worse metabolic complications than non-SO (BMI 30-50 kg/m²). We aim to characterize bariatric surgery patients with SO, their postoperative complications, and treatment trends over the last 5 years in hopes of informing SO-specific treatment protocols.

MATERIALS AND METHODS

The MBSAQIP database was analyzed, and two cohorts were compared, those with SO and non-SO. Univariate analysis was performed to determine between-group differences. Multivariable logistic regression analysis was performed to determine if SO was independently associated with serious complications or mortality.

RESULTS

We evaluated 751,952 patients with 173,110 (23.0%) having SO. Patients with SO were younger (42.2 ± 11.8 SO vs 45.1 ± 12.0 years non-SO, p < 0.001) and less likely to be female (74.8% vs 81.1%, p < 0.001). While comorbidities seem to be decreasing overall in bariatric surgery patients, those with SO have worse functional capacity and more endocrine, pulmonary, and vascular comorbidities. Patients with SO also have worse 30-day postoperative complications, and SO was independently associated with severe complications (OR 1.08; CI 1.05-1.11, p < 0.001) and mortality (OR 2.49; CI 2.12-2.92, p < 0.001) CONCLUSIONS: Patients with SO have significantly increased preoperative comorbidities resulting in worse postoperative outcomes. SO remains an independent risk factor for serious complications and the greatest independent risk factor for 30-day postoperative mortality. Considering the expected increase in patients with SO, substantial work is required to optimize bariatric surgery strategies specific to these patients.

Impact of metabolic surgery on cost and long-term health outcome: a cost-effectiveness approach

BACKGROUND

The increase in obesity has become a major public health concern. Morbid obesity is associated with co-morbidities, reduced quality-of-life, and death. Metabolic surgery (MS) is the most effective treatment for obesity.

OBJECTIVES

The aim of this study was to evaluate the costs and outcomes of MS compared with no surgery in patients with a body mass index ≥30 kg/m².

SETTING

Health care system, Austria METHODS: A total of 177 patients who underwent MS were documented retrospectively, based on the hospital records of 2 specialized centers in Austria, over a 1-year period. At baseline 26.0% of patients exhibited type 2 diabetes (T2D), 52.5% cardiovascular disease (CVD), 23.2% hyperlipidemia, and 23.7% depression. Following the observation period, a Markov chain simulation model was developed to analyze the long-term consequences of T2D, including diabetic complications, CVD, hyperlipidemia, depression, non-alcoholic steatohepatitis (NASH), myocardial infarction, and stroke, over a total of 20 years. Direct medical costs were expressed in 2017 euros from the payer's perspective. Quality-adjusted life years (QALYs), life years (LYs), and costs were discounted.

RESULTS

MS led to costs of €40,427 and 9.58 QALYs (15.58 LYs) per patient over 20 years. No MS was associated with €64,819 and 6.33 QALYs (13.92 LYs). Total cost-savings amounted to €24,392, which offset the cost of the procedure including re-operations. Over 20 years MS saved -6.7 patient-years per patient with T2D, -5.8 patient-years with CVD, -1.5 patient-years with hyperlipidemia, -1.8 patient-years with depression, and -3.8 patient-years with NASH.

CONCLUSION

MS is associated with substantial savings in long-term costs, expected health benefits, and reduced onset of complications. MS significantly increases quality of life.

Effect of ICT-Based Self-Management System DialBeticsLite on Treating Abdominal Obesity in the Specific Health Guidance in Japan: Randomized Controlled Trial. (Preprint)

Background

Mobile health (mHealth) interventions, a more cost-effective approach compared with traditional methods of delivering lifestyle coaching in person, have been shown to improve physical parameters and lifestyle behavior among overweight populations. In Japan, the Specific Health Checkups and Specific Health Guidance (SHG) started in 2008 to treat obesity and abdominal obesity. However, the effectiveness of SHG is limited owing to its in-person counseling. The effect of mHealth on SHG has yet to be demonstrated.

Objective

This study aims to determine whether a mobile self-management app (DialBeticsLite) could make the SHG more beneficial among patients with abdominal obesity to achieve a reduction in visceral fat area (VFA).

Methods

This study was an open-label, 2-arm, parallel-design randomized controlled trial. We recruited 122 people in September 2017 and randomly assigned them into either the intervention or control group. All participants attended an educational group session that delivered information regarding diet and exercise. In addition, participants in the intervention group were asked to use DialBeticsLite for 3 months. DialBeticsLite facilitated the daily recording of several physical parameters and lifestyle behavior and provided feedback to encourage an improvement in behavior. The primary outcome was the change in VFA from baseline to the 3-month follow-up. Secondary outcomes included changes in both physical and metabolic parameters from baseline to the 3-month follow-up. The Welch 2-tailed t test was conducted to analyze the effects of DialBeticsLite on both the primary and secondary outcomes.

Results

Of the 122 participants recruited, 75 (61.5%) were analyzed because 47 (38.5%) were excluded: 37 (30.3%) because of ineligibility and 10 (8.2%) because of withdrawal of consent. The mean age was 49.3 (SD 6.1) years in the intervention group (41/75, 55%) and 48.5 (SD 5.3) years in the control group (34/75, 45%), and all participants were men, although unintentionally. The baseline characteristics did not differ significantly between the intervention and control groups, except for VFA. The average change of VFA was −23.5 (SD 20.6) cm² in the intervention group and +1.9 (SD 16.2) cm² in the control group (P<.001). Statistically significant differences were also found for the change of body weight, BMI, and waist circumference. These findings did not change after adjusting for VFA at the baseline. The intervention had no significant effect on any of the metabolic parameters. An exploratory analysis showed significant associations between the change in VFA and steps per day and between the change in VFA and calorie intake per day within the intervention group.

Conclusions

Our findings indicate that an mHealth intervention facilitating the daily monitoring of several physical parameters and lifestyle behavior can be highly effective in inducing visceral fat loss and weight loss among adults eligible for SHG.

Trial Registration

UMIN Clinical Trials Registry UMIN000042045; https://tinyurl.com/4vat3v53

The Impact of Morbid Obesity on the Health Outcomes of Hospital Inpatients: An Observational Study

Morbid obesity poses a significant burden on the health-care system. This study determined whether morbid obesity leads to worse health-outcomes in hospitalised patients. This retrospective-study examined nutritional data of all inpatients aged 18-79 years, with a body-mass-index (BMI) ≥ 18.5 kg/m² admitted over a period of 4 years at two major hospitals in Australia. Patients were divided into 3 groups for comparison: normal/overweight (BMI 18.5-29.9 kg/m²), obese (BMI 30-39.9 kg/m²) and morbidly-obese (BMI ≥ 40 kg/m²). Outcome measures included length-of-hospital-stay (LOS), in-hospital mortality, and 30-day readmissions. Multilevel-mixed-effects regression was used to compare clinical outcomes between the groups after adjustment for potential confounders. Of 16,579 patients, 1004 (6.1%) were classified as morbidly-obese. Morbidly-obese patients had a significantly longer median (IQR) LOS than normal/overweight patients (5 (2, 12) vs. 5 (2, 11) days, p value = 0.012) and obese-patients (5 (2, 12) vs. 5 (2, 10) days, p value = 0.036). After adjusted-analysis, morbidly-obese patients had a higher incidence of a longer LOS than normal/overweight patients (IRR 1.04; 95% CI 1.02-1.07; p value < 0.001) and obese-patients (IRR 1.13; 95% CI 1.11-1.16; p value < 0.001). Other clinical outcomes were similar between the different groups. Morbid obesity leads to a longer LOS in hospitalised patients but does not adversely affect other clinical outcomes.

Heterogeneous Impacts of Body Mass Index on Work Hours

This study examined how higher body mass index (BMI) affects the work hours of men and women and how the impact varies by gender and the value of BMI. Using a longitudinal dataset of 1603 British adults (men: n = 775; women: n = 828) and a panel threshold regression model, this study estimated that BMI has significant impacts on work hours but the pattern is different by gender and BMI groups. BMI is positively associated with work hours up to the estimated BMI threshold of 30, which corresponds to the clinical cutoff point of obesity; above this point, additional increases in BMI is associated with reduced work hours. The asymmetric nonlinear relationship between BMI and work hours was more evident among women, particularly female low-skilled workers. The results imply reduced work capacity and lower labor income for women with a higher BMI above an obesity threshold, highlighting a practical role of BMI's obesity cutoff value. The findings of this study provide a new perspective regarding the economic burden of workplace obesity and point out the need to design gender-specific and BMI-based strategies to tackle productivity loss from obesity.

The association of body mass index with quality of life and working ability: a Finnish population-based study

PURPOSE

The impact of obesity on quality of life (QoL) and working ability vary in different dimensions. This study investigated the association of obesity with QoL and working ability in Finnish adults. Comorbidities as associative factors were also characterised.

METHODS

This cross-sectional study included 4956 randomly selected adults. QoL (EUROHIS-QOL 8 total score and individual components), perceived physical and psychological working ability, and sick leave days were analysed in different body mass index (BMI) groups. Regression models were used to study the role of comorbidities as associative factors.

RESULTS

EUROHIS-QOL 8 total score was significantly lower in BMI group 25.0-29.9 kg/m² (4.01; 95% confidence interval 3.97-4.05), BMI 30.0-34.9 kg/m² (3.85; 3.79-3.91), BMI 35.0-39.9 kg/m² (3.75; 3.66-3.85), and BMI ≥ 40.0 kg/m² (3.73; 3.46-4.00) compared to individuals with normal (18.5-24.9 kg/m²) BMI (4.08; 4.04-4.12). Individuals with obesity (BMI ≥ 30.0 kg/m²) rated their QoL lower than individuals with normal BMI in seven of the eight EUROHIS-QOL 8 components. A lesser proportion of individuals (53-73%) with obesity rated their physical working ability as very or fairly good compared to individuals with normal BMI (90%, p values < 0.001). The psychological working ability was rated as very or fairly good by 71-75% of individuals with obesity compared to 85% of individuals with normal BMI (p = 0.008 and p = 0.001 in individuals with BMI 30.0-34.9 and BMI 35.0-39.9 kg/m², respectively).

CONCLUSIONS

Obesity was negatively associated with both physical and psychological components of QoL, even after accounting for obesity-related comorbidities. Obesity treatment can benefit from a holistic approach that considers these multifaceted associations.

Social isolation but not deprivation involved in employment status after bariatric surgery

An increase in employment rate was observed among individuals who underwent bariatric surgery. This study assessed the relationship between employment rate and weight loss, deprivation, and Bariatric Analysis and Reporting Outcome System (BAROS) scores after bariatric surgery in a deprived area. This retrospective study evaluated the employment rate at a mean period of 2.3±0.1 years after bariatric surgery among 133 individuals. The Evaluation of Deprivation and Inequalities in Health Examination Centers (EPICES score), satisfaction scale, and BAROS (self-esteem, physical activity, social life, work conditions, and sexual activity) questionnaires were used. The mean age of the participants was 45 (range: 19–67) years. Approximately 88% were women. The initial mean body mass index (BMI) was 42.7 kg/m², and about 88% of the participants underwent sleeve gastrectomy. The mean decrease in BMI was 12 ± 0.5 kg/m². The mean EPICES score (N<30), BAROS, and satisfaction scale (range: 1–5) scores were 31.9±18, 1.3±1.1, and 4.27±1.19, respectively. After surgery, 19 participants obtained a job. However, three were unemployed. Based on a multivariate analysis, employed and unemployed participants (77 vs 52) before surgery had a lower initial BMI and better BAROS and satisfaction scale scores. After surgery, there was no difference between participants who obtained a new job and those still did not have a job in terms of questionnaire responses. Obtaining a new job was not associated with BMI, sex, or age differences. However, there was a positive correlation between social life score and weight loss. Bariatric surgery increased an individual’s chance of finding a job independently of deprivation status. Participants with a pre-operative job had a better perception of satisfaction and BAROS scores. Moreover, social isolation was correlated with unsuccessful weight loss.

The effects of income fluctuations on undernutrition and overnutrition across the lifecycle

This study uses individual level data from a 13-year, nationally representative rotating panel survey of Kyrgyzstan to estimate the effects of fluctuations in predicted income on health and nutrition outcomes from early childhood to adulthood. We consider impacts on both undernutrition and overnutrition side-by-side, and carefully consider the mechanisms at work. We address the endogeneity of income following Bartik (1991): We construct a measure of predicted income, obtained using the household's initial period share of income from different sources and aggregate national growth rates over time in each source. We find that young children (under age 5) exposed to reductions in predicted income experienced reductions in important measures of health and nutrition: weight, weight-for-age Z-scores, and weight-for-height Z-scores. We further identify reductions in both weight and height among older children (aged 5-18). Declines in child health and nutrition are most pronounced among households most dependent on agriculture and those living in rural areas. Reduced consumption of healthy foods and reduced parental time spent with children may help explain the results. A channel possibly offsetting negative impacts is increased use of contraceptives. At the same time, older children and adults experienced decreases in body mass index and-for adults-decreases in the incidence of overweight and obesity, suggesting selective health benefits for some groups.

The Association of Body Mass Index with Outcomes after Carotid Endarterectomy

BACKGROUND

Patients who are obese or underweight are traditionally at higher risk for perioperative morbidity and mortality. The effect of body mass index (BMI) on outcomes after carotid endarterectomy (CEA) is unclear. Our goal was to analyze the association of BMI with perioperative and long-term outcomes after elective CEA.

METHODS

The Vascular Quality Initiative (VQI) database was queried from 2003-2018 for patients undergoing elective CEAs. Patients were categorized into 5 BMI cohorts - underweight (UW, BMI < 18.5 kg/m²), normal weight (NW, BMI 18.5-24.9 kg/m²), overweight (OW, BMI 25-29.9 kg/m²), obese (OB, BMI 30-39.9 kg/m²), and morbidly obese (MO, BMI ≥ 40 kg/m²). Perioperative and long-term outcomes were assessed with univariable and multivariable analyses.

RESULTS

There were 89,079 patients included: 2% UW, 26% NW, 38.4% OW, 29.9% OB, and 3.6% MO. Overall, the mean age was 70.6 years, 60% were male, and 91.8% were of white race. There were significant differences among the BMI cohorts in regards to age, sex, smoking status, and comorbidities (all P < 0.05). For perioperative outcomes, the BMI cohorts differed significantly in reoperation for bleeding and 30-day mortality. On multivariable analysis, BMI was not associated with stroke or perioperative mortality. MO was associated with perioperative cardiac complications (Odds Ratios [OR] 1.26, 95% CI 1-1.57, P = 0.05). UW status was associated with increased return to the operating room (OR 1.89, 95% confidence interval [95% CI] 1.28-2.78, P = 0.001), 30-day mortality (OR 1.68, 95% CI 1-2.86, P =0.05), 1-year mortality (Hazard ratio [HR] 1.37, 95% CI 1.08-1.74, P = 0.01), and 5-year mortality (HR 1.22, 95% CI 1.06-1.41, P =0.005).

CONCLUSIONS

BMI status was not associated with perioperative stroke, cranial nerve injury, or surgical site infections. Patients with MO had higher perioperative cardiac complications. UW patients have lower short and long-term survival and should be a focus for long-term targeted risk factor stratification and modification.