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Pepe RB, Lottenberg AM, Fujiwara CTH, Beyruti M, Cintra DE, Machado RM, Rodrigues A, Jensen NSO, Caldas APS, Fernandes AE, Rossoni C, Mattos F, Motarelli JHF, Bressan J, Saldanha J, Beda LMM, Lavrador MSF, Del Bosco M, Cruz P, Correia PE, Maximino P, Pereira S, Faria SL, Piovacari SMF. Position statement on nutrition therapy for overweight and obesity: nutrition department of the Brazilian association for the study of obesity and metabolic syndrome (ABESO-2022). Diabetol Metab Syndr 2023; 15:124. [PMID: 37296485 DOI: 10.1186/s13098-023-01037-6] [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: 06/29/2022] [Accepted: 03/23/2023] [Indexed: 06/12/2023] Open
Abstract
Obesity is a chronic disease resulting from multifactorial causes mainly related to lifestyle (sedentary lifestyle, inadequate eating habits) and to other conditions such as genetic, hereditary, psychological, cultural, and ethnic factors. The weight loss process is slow and complex, and involves lifestyle changes with an emphasis on nutritional therapy, physical activity practice, psychological interventions, and pharmacological or surgical treatment. Because the management of obesity is a long-term process, it is essential that the nutritional treatment contributes to the maintenance of the individual's global health. The main diet-related causes associated with excess weight are the high consumption of ultraprocessed foods, which are high in fats, sugars, and have high energy density; increased portion sizes; and low intake of fruits, vegetables, and grains. In addition, some situations negatively interfere with the weight loss process, such as fad diets that involve the belief in superfoods, the use of teas and phytotherapics, or even the avoidance of certain food groups, as has currently been the case for foods that are sources of carbohydrates. Individuals with obesity are often exposed to fad diets and, on a recurring basis, adhere to proposals with promises of quick solutions, which are not supported by the scientific literature. The adoption of a dietary pattern combining foods such as grains, lean meats, low-fat dairy, fruits, and vegetables, associated with an energy deficit, is the nutritional treatment recommended by the main international guidelines. Moreover, an emphasis on behavioral aspects including motivational interviewing and the encouragement for the individual to develop skills will contribute to achieve and maintain a healthy weight. Therefore, this Position Statement was prepared based on the analysis of the main randomized controlled studies and meta-analyses that tested different nutrition interventions for weight loss. Topics in the frontier of knowledge such as gut microbiota, inflammation, and nutritional genomics, as well as the processes involved in weight regain, were included in this document. This Position Statement was prepared by the Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), with the collaboration of dietitians from research and clinical fields with an emphasis on strategies for weight loss.
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Affiliation(s)
- Renata Bressan Pepe
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Ana Maria Lottenberg
- Laboratório de Lipides (LIM10), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
- Nutrition Department of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), Rua Mato Grosso 306 - cj 1711, Sao Paulo, SP, 01239-040, Brazil.
| | - Clarissa Tamie Hiwatashi Fujiwara
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Mônica Beyruti
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Dennys Esper Cintra
- Centro de Estudos em Lipídios e Nutrigenômica - CELN - University of Campinas, Campinas, SP, Brazil
| | - Roberta Marcondes Machado
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Alessandra Rodrigues
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Natália Sanchez Oliveira Jensen
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | | | - Ariana Ester Fernandes
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Carina Rossoni
- Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Fernanda Mattos
- Programa de Obesidade e Cirurgia Bariátrica do Hospital Universitário Clementino Fraga Filho da UFRJ, Rio de Janeiro, RJ, Brazil
| | - João Henrique Fabiano Motarelli
- Núcleo de Estudos e Extensão em Comportamento Alimentar e Obesidade (NEPOCA) da Universidade de São Paulo - FMRP/USP, Ribeirão Preto, Brazil
| | - Josefina Bressan
- Department of Nutrition and Health, Universidade Federal de Viçosa, Viçosa, MG, Brazil
| | | | - Lis Mie Masuzawa Beda
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Maria Sílvia Ferrari Lavrador
- Liga Acadêmica de Controle de Diabetes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Mariana Del Bosco
- Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), São Paulo, SP, Brazil
| | - Patrícia Cruz
- Grupo de Obesidade e Sindrome Metabolica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | - Priscila Maximino
- Instituto PENSI - Fundação José Luiz Egydio Setúbal, Instituto Pensi, Fundação José Luiz Egydio Setúbal, Hospital Infantil Sabará, São Paulo, SP, Brazil
| | - Silvia Pereira
- Núcleo de Saúde Alimentar da Sociedade Brasileira de Cirurgia Bariátrica e Metabólica, São Paulo, Brazil
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Hartmann-Boyce J, Theodoulou A, Oke JL, Butler AR, Bastounis A, Dunnigan A, Byadya R, Cobiac LJ, Scarborough P, Hobbs FR, Sniehotta FF, Jebb SA, Aveyard P. Long-Term Effect of Weight Regain Following Behavioral Weight Management Programs on Cardiometabolic Disease Incidence and Risk: Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2023; 16:e009348. [PMID: 36974678 PMCID: PMC10106109 DOI: 10.1161/circoutcomes.122.009348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Behavioral weight management programs (BWMPs) enhance weight loss in the short term, but longer term cardiometabolic effects are uncertain as weight is commonly regained. We assessed the impact of weight regain after BWMPs on cardiovascular risk factors, diabetes, and cardiovascular disease. METHODS Trial registries, 11 databases, and forward-citation searching (latest search, December 19) were used to identify articles published in English, from any geographical region. Randomized trials of BWMPs in adults with overweight/obesity reporting cardiometabolic outcomes at ≥12 months at and after program end were included. Differences between more intensive interventions and comparator groups were synthesized using mixed-effects, meta-regression, and time-to-event models to assess the impact of weight regain on cardiovascular disease incidence and risk. RESULTS One hundred twenty-four trials reporting on ≥1 cardiometabolic outcomes with a median follow-up of 28 (range, 11-360) months after program end were included. Median baseline participant body mass index was 33 kg/m2; median age was 51 years. Eight and 15 study arms (7889 and 4202 participants, respectively) examined the incidence of cardiovascular disease and type 2 diabetes, respectively, with imprecise evidence of a lower incidence for at least 5 years. Weight regain in BWMPs relative to comparators reduced these differences. One and 5 years after program end, total cholesterol/HDL (high-density lipoprotein) ratio was 1.5 points lower at both times (82 studies; 19 003 participants), systolic blood pressure was 1.5 mm mercury and 0.4 mm lower (84 studies; 30 836 participants), and HbA1c (%) 0.38 lower at both times (94 studies; 28 083 participants). Of the included studies, 22% were judged at high risk of bias; removing these did not meaningfully change results. CONCLUSIONS Despite weight regain, BWMPs reduce cardiometabolic risk factors with effects lasting at least 5 years after program end and dwindling with weight regain. Evidence that they reduce the incidence of cardiovascular disease or diabetes is less certain. Few studies followed participants for ≥5 years. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42018105744.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Jason L. Oke
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, United Kingdom (J.L.O.)
| | - Ailsa R. Butler
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Anastasios Bastounis
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, United Kingdom (A.B.)
| | - Anna Dunnigan
- Oxford University Hospitals NHS Foundation Trust, United Kingdom (A.D.)
- Royal Free London NHS Foundation Trust, United Kingdom (A.D.)
| | - Rimu Byadya
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
- United Nations World Food Programme, Cox’s Bazar, Bangladesh, India (R.B.)
| | - Linda J. Cobiac
- Nuffield Department of Population Health, Centre on Population Approaches for Non-Communicable Disease Prevention (L.J.C.), University of Oxford, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Population Health, Oxford Biomedical Research Centre (P.S.), University of Oxford, United Kingdom
| | - F.D. Richard Hobbs
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Falko F. Sniehotta
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, United Kingdom (F.F.S.)
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences (J.H.-B., A.T., A.R.B., A.B., R.B., F.D.R.H., S.A.J., P.A.), University of Oxford, United Kingdom
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Sponselee HCS, ter Beek L, Renders CM, Robroek SJW, Steenhuis IHM, Kroeze W. Stakeholders' Perceptions Regarding Adaptation and Implementation of Existing Individual and Environmental Workplace Health Promotion Interventions in Blue-Collar Work Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13545. [PMID: 36294131 PMCID: PMC9603088 DOI: 10.3390/ijerph192013545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
Blue-collar workers often have disadvantageous health statuses and might therefore benefit from a combination of individual and environmental workplace health promotion interventions. Exploring stakeholders' perceived facilitators and barriers regarding the combined implementation of these interventions in blue-collar work settings is important for effective implementation. A qualitative study consisting of 20 stakeholder interviews within six types of organisations in The Netherlands was conducted. The potential implementation of the evidence-based individual intervention SMARTsize and the environmental intervention company cafeteria 2.0 was discussed. Data were analysed using thematic analysis with a deductive approach. Five main themes emerged: (1) the availability of resources, (2) professional obligation, (3) expected employee cooperation, (4) the compatibility of the proposed health interventions, and (5) the content of implementation tools and procedures. Generally, stakeholders expressed a sense of professional obligation toward workplace health promotion, mentioning that the current societal focus on health and lifestyle provided the perfect opportunity to implement interventions to promote healthy eating and physical activity. However, they often perceived the high doses of employees' occupational physical activity as a barrier. We recommend co-creating interventions, implementation tools, and processes by involving stakeholders with different professional backgrounds and by adapting communication strategies at diverse organisational levels.
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Affiliation(s)
- Hanne C. S. Sponselee
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Lies ter Beek
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Carry M. Renders
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Suzan J. W. Robroek
- Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3015 GD Rotterdam, The Netherlands
| | - Ingrid H. M. Steenhuis
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
| | - Willemieke Kroeze
- Department of Health Sciences, Faculty of Sciences, VU University Amsterdam, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, 1081 HV Amsterdam, The Netherlands
- Care for Nutrition and Health Group, School of Nursing, Christian University of Applied Sciences, 6717 JS Ede, The Netherlands
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Impact of BMI, Physical Activity, and Sitting Time Levels on Health-Related Outcomes in a Group of Overweight and Obese Adults with and without Type 2 Diabetes. J Funct Morphol Kinesiol 2022; 7:jfmk7010012. [PMID: 35076606 PMCID: PMC8788475 DOI: 10.3390/jfmk7010012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
Physical activity level and sedentary behaviors affect health status in people with obesity and type 2 diabetes (DM2); their assessment is mandatory to properly prescribe exercise programs. From January 2011 to February 2014, 293 overweight/obese adults (165 women and 128 men, mean age of 51.9 ± 9.5 years and 54.6 ± 8.3 years, respectively), with and without DM2, participated in a three-month intensive exercise program. Before starting, participants were allocated into three subgroups (overweight, body mass index or BMI = 25-29.9; class 1 of obesity, BMI = 30-34.4; or class 2 (or superior) of obesity, BMI > 35). The international physical activity questionnaire (IPAQ-it) was used to evaluate participants' baseline sitting time (SIT) and physical activity level (PAL). Stratified multiple analyses were performed using four subgroups of SIT level according to Ekelund et al., 2016 (low, 8 h/day of SIT) and three subgroups for PAL (high, moderate, and low). Health-related measures such as anthropometric variables, body composition, hematic parameters, blood pressure values, and functional capacities were studied at the beginning and at the end of the training period. An overall improvement of PAL was observed in the entire sample following the three-month intensive exercise program together with a general improvement in several health-related measures. The BMI group factor influenced the VO2 max variations, leg press values, triglycerides, and anthropometric variables, while the SIT group factor impacted the sitting time, VO2 max, glycemic profile, and fat mass. In this study, baseline PAL and SIT did not seem to influence the effects of an exercise intervention. The characteristics of our educational program, which also included a physical exercise protocol, allowed us to obtain positive results.
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Yang X, Chattopadhyay K, Hubbard R, Li JL, Li L, Lin Y. 36-Month Evaluation of a Weight Management Programme in Chinese Overweight and Obese Adults. Front Public Health 2021; 9:749302. [PMID: 34746084 PMCID: PMC8566723 DOI: 10.3389/fpubh.2021.749302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Few comprehensive lifestyle intervention programmes have been investigated on overweight and obese adults in China. This study was to evaluate the effect of a 36-month weight management programme on weight loss and its maintenance among overweight and obese patients in Ningbo, China. Methods: Adults with BMI ≥24kg/m2 enrolled in this programme, including nutritional, physical activity, psychological and endocrinological counselling sessions, from July 2015 to January 2020. Adults participated in face-to-face counselling sessions and group-based education. Then, participants joined 21-day intensive programme using Bohe health APP and WeChat group to get personal advice of nutrition and lifestyle. In the end, participants were requested to join 33-month follow-ups including face-to-face counselling and personal advice on WeChat group. The main outcome was to evaluate the changes in weight at each followup from baseline weight. Results: In total, 692 adults participated in this entire weight management programme. During follow-ups, 579, 475, 299, 219, and 135 adults participated at 3, 6, 12, 24, and 36 months, respectively. All participants had a significant initial weight loss at 3 months, then maintained the weight loss during 33-month follow-ups. At 36 months, 11.0%, 6.4%, and 3.5% of all participants achieved 5%, 10%, and 15% weight loss from the baseline weight, respectively. Adjusted weight at 36 months was significantly reduced from the baseline weight in both sex (−7.2 kg). Conclusion: This weight management programme is suggested to benefit to reduce initial body weight and maintain long-term weight loss among overweight and obese adults.
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Affiliation(s)
- Xi Yang
- Department of Nutrition, Ningbo First Hospital, Ningbo, China
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Richard Hubbard
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jia-Lin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Yi Lin
- Center for Health Economics, Faculty of Humanities and Social Sciences, University of Nottingham, Ningbo, China
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Primary care-based interventions for treatment of obesity: a systematic review. Public Health 2021; 195:61-69. [PMID: 34058627 DOI: 10.1016/j.puhe.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 02/19/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to synthesise evidence from primary care-based interventions for the treatment of obesity in adults and the elderly. STUDY DESIGN Systematic review. METHODS Eight electronic databases (MEDLINE, Lilacs, Embase, Psycinfo, Cochrane, WHOLIS, Open Gray and Scholar Google) were searched. There was no limitation on publication period; articles published in English, Portuguese or Spanish were included. The selection, data extraction and quality analyses were performed by three reviewers. RESULTS A literature search retrieved 6464 publications, of which 5120 publications were excluded after reading the title/abstract and 293 after reading the full text. In total, 56 publications, representing 72 interventions were included. All studies were published between 2000 and 2020. Most studies were conducted in high-income countries. The mean duration of interventions was 11.5 months (SD: 7.5), ranging from 3 to 44 months. Most interventions were effective for body mass index reduction, weight loss and waist circumference change. CONCLUSION Our study showed that most interventions were effective for outcomes analysed in adults and the elderly. We also found some literature gaps, such as the need to implement and evaluate obesity after intervention and the requirement to carry out more studies in low- and middle-income countries.
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Taurio J, Järvinen J, Hautaniemi EJ, Eräranta A, Viitala J, Nordhausen K, Kaukinen K, Mustonen J, Pörsti IH. Team-based "Get-a-Grip" lifestyle management programme in the treatment of obesity. Prev Med Rep 2020; 19:101119. [PMID: 32461881 PMCID: PMC7242875 DOI: 10.1016/j.pmedr.2020.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022] Open
Abstract
Team-based one-year lifestyle programme led to mean weight loss of 4.8 kg. Among the participants 44% lost ≥ 5%, while 21% lost ≥ 10% of their initial weight. Beneficial changes were detected in muscle mass, body fat, and visceral fat. Systolic and diastolic blood pressure was reduced significantly.
This study examined weight loss during an extensive 1-year lifestyle programme in primary care in Finland in overweight subjects (n = 134, age 18–69 years; BMI > 30, or BMI > 25 with a comorbidity that would benefit from weight loss) between 2009 and 2013 in a single arm design. The programme included four medical doctor visits, five sessions by a dietitian (advice on diet and on-location shopping behaviour), cooking classes, exercise supervised by personal trainer, and group discussions. A motivational interview method was applied. Of the 134 participants, 92 (69%) completed the 1-year programme. Among the participants 44% lost ≥ 5%, while 21% lost ≥ 10% of their initial body weight. In intention-to-treat-analyses, the mean weight loss during one year was 4.8 kg (p < 0.001). Mean BMI decreased by 1.7 kg/m2 (p < 0.001) and waist circumference by 5.6 cm (p < 0.001). Mean muscle mass increased by 3.3% (p < 0.001), and body fat decreased by 5.0% (p < 0.001). After the programme mean visceral fat content was reduced by 6.4%, systolic blood pressure by 8 mmHg (p < 0.001), and diastolic blood pressure by 6 mmHg (p < 0.001). In conclusion, retention to the team-based lifestyle management programme resulted in moderate but significant weight loss with beneficial changes in body composition, and the trend to lose weight was maintained throughout the year. Trial registration: Clinicaltrials.gov identifier NCT04003259.
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Affiliation(s)
- Jyrki Taurio
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Jorma Järvinen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Elina J Hautaniemi
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Arttu Eräranta
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Jani Viitala
- Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Klaus Nordhausen
- Faculty of Social Sciences, Tampere University, FI-33014, Finland.,Institute of Statistics & Mathematical Methods in Economics, Vienna University of Technology, Wiedner Hauptstr. 7, A-1040 Vienna, Austria
| | - Katri Kaukinen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Jukka Mustonen
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
| | - Ilkka H Pörsti
- Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, FI-33014, Finland
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An J, Yoon SR, Lee JH, Kim H, Kim OY. Importance of Adherence to Personalized Diet Intervention in Obesity Related Metabolic Improvement in Overweight and Obese Korean Adults. Clin Nutr Res 2019; 8:171-183. [PMID: 31384596 PMCID: PMC6675957 DOI: 10.7762/cnr.2019.8.3.171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/19/2022] Open
Abstract
We investigated weight loss effect of personalized diet education in overweight/obese Korean adults. Overweight/obese Korean adults (body mass index [BMI] ≥ 23 kg/m2 or waist circumference [WC] ≥ 90 cm for men, ≥ 85 cm for women) were recruited, and 40 participants who completed the 10-week intervention were finally included in the analyses. At first visit, study participants (small group with individual counseling) were educated for optimal diet by clinical dietitian, and checked for their compliance through telephone/text message every 1-2 week during the intervention. Anthropometric and biochemical parameters and dietary intake were investigated. Body weight, BMI, WC, and body fat mass were significantly reduced in whole participants. Hemoglobin A1c, insulin, and low-density lipoprotein cholesterol were also significantly decreased after the intervention. Total energy intake (EI) during the intervention was not significantly decreased compared to the baseline value, but the proportions of energy derived from macronutrients were within the ranges recommended by 2015 Dietary Reference Intake for Koreans. Based on actual EI, participants were classified into high-adherence (HA) (prescribed EI ± 25%, n = 29), low-adherence I (LA-I) (< 75% of prescribed EI, n = 7), and low-adherence II (LA-II) group (> 125% of prescribed EI, n = 4). Only HA group showed significant improvements in anthropometric parameters, glycemic control and lipid profile. Interestingly, LA-I group showed significant increases in glucose, insulin, C-peptide and insulin resistance. In conclusion, a shift from overweight/obesity to healthy weight can be accomplished by high adherence to personalized diet modification, not by EI reduction.
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Affiliation(s)
- Juhyun An
- Department of Food Science and Nutrition, Dong-A University, Busan 49315, Korea
| | - So Ra Yoon
- Department of Food Science and Nutrition, Dong-A University, Busan 49315, Korea.,Center for Silver-targeted Biomaterials, Brain Busan 21 Plus Program, Dong-A University, Busan 49315, Korea.,Institute of Health Insurance and Clinical Research, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea
| | - Jae Hyang Lee
- Busan Cardiocerebrovascular Center, Dong-A University Hospital, College of Medicine, Busan 49201, Korea
| | - Hyunyoung Kim
- Department of Food Science and Nutrition, Dong-A University, Busan 49315, Korea.,Center for Silver-targeted Biomaterials, Brain Busan 21 Plus Program, Dong-A University, Busan 49315, Korea
| | - Oh Yoen Kim
- Department of Food Science and Nutrition, Dong-A University, Busan 49315, Korea.,Center for Silver-targeted Biomaterials, Brain Busan 21 Plus Program, Dong-A University, Busan 49315, Korea
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Zhao X, Tsujimoto T, Kim B, Katayama Y, Tanaka K. Increasing Physical Activity Might Be More Effective to Improve Foot Structure and Function Than Weight Reduction in Obese Adults. J Foot Ankle Surg 2019; 57:876-879. [PMID: 29880325 DOI: 10.1053/j.jfas.2018.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Indexed: 02/03/2023]
Abstract
Obesity is reported to be an important factor affecting foot structure and function. For obese individuals, weight reduction or increasing weight physical activity could be an effective approach to improve foot structure and function. The present study sought to determine the effect of weight reduction and increasing physical activity on foot structure and function in obese Japanese and to investigate which intervention is more beneficial. The participants were divided into the weight reduction group (n = 30; body mass index 29.0 ± 2.5 kg/m2), with the intervention consisting of dietary modification, and the increasing physical activity group (n = 15; body mass index 28.2 ± 3.1 kg/m2), with the intervention consisting of walking and jogging. A 3-dimensional foot scanner was used to measure the foot anthropometric data with the participants both sitting and standing. The dorsum height declined and the arch stiffness index increased after the weight reduction intervention, and the truncated foot length decreased and the arch stiffness index increased after the increasing physical activity intervention (p <.05). The arch height index showed a downward trend after the weight reduction intervention (p = .060) and an upward trend after the increasing physical activity intervention (p = .069). Moreover, a greater change was found in the increase of the dorsum height and arch height index and decrease of the truncated foot length in the increasing physical activity group than in the weight reduction group (p <.05). These findings suggest that increasing physical activity might be more effective to improve foot structure and function than weight reduction in obese adults.
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Affiliation(s)
- Xiaoguang Zhao
- Staff, Research Academy of Grand Health, Faculty of Sport Science, Ningbo University, Zhejiang, China.
| | | | - Bokun Kim
- Staff, Faculty of Sports Health Care, Inje University, Gimhae, Korea; Staff, Faculty of Foundation for Industry-Academy Cooperation, Dong-A University, Pusan, Korea
| | - Yasutomi Katayama
- Associate Professor, Faculty of Education, Kogakkan University, Ise, Mie, Japan
| | - Kiyoji Tanaka
- Professor, Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
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Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, Sharma P, Fraser C, MacLennan G. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ 2017; 359:j4849. [PMID: 29138133 PMCID: PMC5682593 DOI: 10.1136/bmj.j4849] [Citation(s) in RCA: 280] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To assess whether weight loss interventions for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight.Design Systematic review and meta-analysis of randomised controlled trials (RCTs) using random effects, estimating risk ratios, and mean differences. Heterogeneity investigated using Cochran's Q and I2 statistics. Quality of evidence assessed by GRADE criteria.Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials, and full texts in our trials' registry for data not evident in databases. Authors were contacted for unpublished data.Eligibility criteria for selecting studies RCTs of dietary interventions targeting weight loss, with or without exercise advice or programmes, for adults with obesity and follow-up ≥1 year.Results 54 RCTs with 30 206 participants were identified. All but one trial evaluated low fat, weight reducing diets. For the primary outcome, high quality evidence showed that weight loss interventions decrease all cause mortality (34 trials, 685 events; risk ratio 0.82, 95% confidence interval 0.71 to 0.95), with six fewer deaths per 1000 participants (95% confidence interval two to 10). For other primary outcomes moderate quality evidence showed an effect on cardiovascular mortality (eight trials, 134 events; risk ratio 0.93, 95% confidence interval 0.67 to 1.31), and very low quality evidence showed an effect on cancer mortality (eight trials, 34 events; risk ratio 0.58, 95% confidence interval 0.30 to 1.11). Twenty four trials (15 176 participants) reported high quality evidence on participants developing new cardiovascular events (1043 events; risk ratio 0.93, 95% confidence interval 0.83 to 1.04). Nineteen trials (6330 participants) provided very low quality evidence on participants developing new cancers (103 events; risk ratio 0.92, 95% confidence interval 0.63 to 1.36).Conclusions Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.Systematic review registration PROSPERO CRD42016033217.
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Affiliation(s)
- Chenhan Ma
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Mark Bolland
- Bone and Joint Research Group, Department of Medicine, University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Pawana Sharma
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
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The Effect of Prolonged Glucosamine Usage on HbA1c Levels and New-Onset Diabetes Mellitus in Overweight and Obese Middle-Aged Women. Am J Med 2017; 130:731-737.e6. [PMID: 28011309 DOI: 10.1016/j.amjmed.2016.11.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/08/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effect of a 2.5-year glucosamine sulfate intervention on hemoglobin A1c (HbA1c) levels and the incidence of new-onset diabetes mellitus over 6.5 years in middle-aged women with a body mass index ≥27 kg/m2. METHODS In total, 407 women were randomized into either oral crystalline glucosamine sulfate or placebo. At baseline, 1 year, 2.5 years, and 6.5 years, a blood sample for the HbA1c level was drawn and questionnaires were taken. After 6.5 years there were missing data for some variables, therefore, multiple imputation was used. With the imputed data, a generalized estimating equation was performed to analyze the effect of glucosamine sulfate usage over 6.5 years. Finally, these analyses were rerun for the 2 subgroups of participants with and without high HbA1c level (≥42 mmol/mol) at baseline. RESULTS There was no significant effect of a 2.5-year glucosamine sulfate intervention on mean HbA1c level or on obtaining a high HbA1c level or new-onset diabetes mellitus over 6.5 years. The subgroup analyses of participants with and without high HbA1c level at baseline were also not statistically significant. However, participants with a high HbA1c level at baseline had higher odds ratios compared with the participants with a normal HbA1c at baseline. CONCLUSIONS There was no effect of glucosamine sulfate on mean HbA1c level nor on obtaining a high HbA1c level or new-onset diabetes mellitus over 6.5 years, especially in participants with a normal HbA1c level at baseline.
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de Vos BC, Landsmeer MLA, van Middelkoop M, Oei EHG, Krul M, Bierma-Zeinstra SMA, Runhaar J. Long-term effects of a lifestyle intervention and oral glucosamine sulphate in primary care on incident knee OA in overweight women. Rheumatology (Oxford) 2017; 56:1326-1334. [DOI: 10.1093/rheumatology/kex145] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Indexed: 11/12/2022] Open
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Messier SP, Callahan LF, Beavers DP, Queen K, Mihalko SL, Miller GD, Losina E, Katz JN, Loeser RF, Quandt SA, DeVita P, Hunter DJ, Lyles MF, Newman J, Hackney B, Jordan JM. Weight-loss and exercise for communities with arthritis in North Carolina (we-can): design and rationale of a pragmatic, assessor-blinded, randomized controlled trial. BMC Musculoskelet Disord 2017; 18:91. [PMID: 28228115 PMCID: PMC5322619 DOI: 10.1186/s12891-017-1441-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recently, we determined that in a rigorously monitored environment an intensive diet-induced weight loss of 10% combined with exercise was significantly more effective at reducing pain in men and women with symptomatic knee osteoarthritis (OA) than either intervention alone. Compared to previous long-term weight loss and exercise trials of knee OA, our intensive diet-induced weight loss and exercise intervention was twice as effective at reducing pain intensity. Whether these results can be generalized to less intensively monitored cohorts is unknown. Thus, the policy relevant and clinically important question is: Can we adapt this successful solution to a pervasive public health problem in real-world clinical and community settings? This study aims to develop a systematic, practical, cost-effective diet-induced weight loss and exercise intervention implemented in community settings and to determine its effectiveness in reducing pain and improving other clinical outcomes in persons with knee OA. METHODS/DESIGN This is a Phase III, pragmatic, assessor-blinded, randomized controlled trial. Participants will include 820 ambulatory, community-dwelling, overweight and obese (BMI ≥ 27 kg/m2) men and women aged ≥ 50 years who meet the American College of Rheumatology clinical criteria for knee OA. The primary aim is to determine whether a community-based 18-month diet-induced weight loss and exercise intervention based on social cognitive theory and implemented in three North Carolina counties with diverse residential (from urban to rural) and socioeconomic composition significantly decreases knee pain in overweight and obese adults with knee OA relative to a nutrition and health attention control group. Secondary aims will determine whether this intervention improves self-reported function, health-related quality of life, mobility, and is cost-effective. DISCUSSION Many physicians who treat people with knee OA have no practical means to implement weight loss and exercise treatments as recommended by numerous OA treatment guidelines. This study will establish the effectiveness of a community program that will serve as a blueprint and exemplar for clinicians and public health officials in urban and rural communities to implement a diet-induced weight loss and exercise program designed to reduce knee pain and improve other clinical outcomes in overweight and obese adults with knee OA. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02577549 October 12, 2015.
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Affiliation(s)
- Stephen P. Messier
- J.B. Snow Biomechanics Laboratory, Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC 27109 USA
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
- Department of Rheumatology and Immunology, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Daniel P. Beavers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Kate Queen
- Haywood Regional Medical Center, Clyde, NC USA
| | - Shannon L. Mihalko
- J.B. Snow Biomechanics Laboratory, Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC 27109 USA
| | - Gary D. Miller
- J.B. Snow Biomechanics Laboratory, Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC 27109 USA
| | - Elena Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Jeffrey N. Katz
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Richard F. Loeser
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, NC USA
| | - David J. Hunter
- Rheumatology Department, Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Mary F. Lyles
- Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Jovita Newman
- J.B. Snow Biomechanics Laboratory, Department of Health & Exercise Science, Wake Forest University, Winston-Salem, NC 27109 USA
| | - Betsy Hackney
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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