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Koutoukidis DA, Jebb SA, Foster C, Wheatstone P, Horne A, Hill TM, Taylor A, Realpe A, Achana F, Buczacki SJA. CARE: Protocol of a randomised trial evaluating the feasibility of preoperative intentional weight loss to support postoperative recovery in patients with excess weight and colorectal cancer. Colorectal Dis 2023; 25:1910-1920. [PMID: 37525408 DOI: 10.1111/codi.16687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/02/2023]
Abstract
AIM Excess weight increases the risk of morbidity following colorectal cancer surgery. Weight loss may improve morbidity, but it is uncertain whether patients can follow an intensive weight loss intervention while waiting for surgery and there are concerns about muscle mass loss. The aim of this trial is to assess the feasibility of intentional weight loss in this setting and determine progression to a definitive trial. METHODS CARE is a prospectively registered, multicentre, feasibility, parallel, randomised controlled trial with embedded evaluation and optimisation of the recruitment process. Participants with excess weight awaiting curative colorectal resection for cancer are randomised 1:1 to care as usual or a low-energy nutritionally-replete total diet replacement programme with weekly remote behavioural support by a dietitian. Progression criteria will be based on the recruitment, engagement, adherence, and retention rates. Data will be collected on the 30-day postoperative morbidity, the typical primary outcome of prehabilitation trials. Secondary outcomes will include, among others, length of hospital stay, health-related quality of life, and body composition. Qualitative interviews will be used to understand patients' experiences of and attitudes towards trial participation and intervention engagement and adherence. CONCLUSION CARE will evaluate the feasibility of intensive intentional weight loss as prehabilitation before colorectal cancer surgery. The results will determine the planning of a definitive trial.
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Affiliation(s)
- Dimitrios A Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC+ in Health Sciences, University of Southampton, Southampton, UK
| | | | - Alison Horne
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - T Martyn Hill
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Amy Taylor
- Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
| | - Felix Achana
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon J A Buczacki
- NIHR Oxford Biomedical Research Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Tariq MNM, Stojanovska L, Dhaheri ASA, Cheikh Ismail L, Apostolopoulos V, Ali HI. Lifestyle Interventions for Prevention and Management of Diet-Linked Non-Communicable Diseases among Adults in Arab Countries. Healthcare (Basel) 2022; 11:healthcare11010045. [PMID: 36611505 PMCID: PMC9819169 DOI: 10.3390/healthcare11010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
The increased incidences of diet-related non-communicable diseases (NCDs) such as diabetes, obesity, and cardiovascular diseases among adults are becoming the chief public health concern in most Arab countries. Economic expansion has contributed to a nutrition shift from a traditional seasonal diet to Westernized eating habits coupled with a sedentary lifestyle. Despite the rising concern for NCD mortality, public health policies are inadequately addressed. This narrative review aims to discuss the effectiveness of nutritional interventions focusing on diet and physical activity in the management of NCDs among Arab adults. A comprehensive literature search was performed using different database platforms such as Cochrane reviews, Scopus, and PubMed for articles published between 1 December 2012 and 31 December 2021. Fifteen recent research articles addressing NCDs, mainly diabetes and obesity, from different Arab countries were included in this review. Structured lifestyle interventions involving behavioral therapy approaches and personalized goals for diet and physical activity were found to improve specific health outcomes in most studies. Significant improvements in health outcomes were reported for longer-duration interventions with follow-ups. A combination of both online and face-to-face sessions was found to be effective. It is important to identify barriers to physical activity for a culturally acceptable lifestyle intervention and conduct further studies to evaluate interventions for the long-term maintenance of health outcomes.
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Affiliation(s)
- Maryam Naveed Muhammad Tariq
- Department of Nutrition & Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Lily Stojanovska
- Department of Nutrition & Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia
| | - Ayesha S. Al Dhaheri
- Department of Nutrition & Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX1 2JD, UK
| | - Vasso Apostolopoulos
- Institute for Health and Sport, Victoria University, Melbourne, VIC 3030, Australia
| | - Habiba I. Ali
- Department of Nutrition & Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
- Correspondence: ; Tel.: +971-03-713-6556
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Effectiveness of a Two-Year Multicomponent Intervention for the Treatment of Overweight and Obesity in Older People. Nutrients 2022; 14:nu14224762. [PMID: 36432449 PMCID: PMC9696506 DOI: 10.3390/nu14224762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to assess the effectiveness of a two-year intervention based on the Mediterranean diet for the treatment of overweight and obesity in a sample of 51 older people from the Mediterranean city of Alicante (Spain). We also examined the effects of the intervention on psychological well-being. The participants were randomly assigned to the experimental and control groups. The experimental group received group nutritional education sessions, an individualized dietary-nutritional treatment based on a Mediterranean diet, and a physical activity program; the control group received Mediterranean nutritional education in a written format. The experimental group showed a greater loss in weight (p = 0.017) and percentage of fat mass (p = 0.049), and a greater reduction in body mass index (BMI) (p = 0.014) and waist circumference (p = 0.010). Both groups improved their depression scores using the PHQ-9; however, no significant improvement was seen in adherence to the Mediterranean diet (PREDIMED) and anxiety level (GAD-7). These results suggest that a two-year intervention based on the Mediterranean diet allows an older population with overweight or obesity to achieve greater weight loss and a greater decrease in BMI, waist circumference, and fat mass percentage. In relation to psychological well-being, depression levels improved at the end of said intervention.
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Adaptive thermogenesis after moderate weight loss: magnitude and methodological issues. Eur J Nutr 2021; 61:1405-1416. [PMID: 34839398 DOI: 10.1007/s00394-021-02742-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was (1) to assess AT through 13 different mathematical approaches and to compare their results; and (2) to understand if AT occurs after moderate WL. METHODS Ninety-four participants [mean (SD); BMI, 31.1 (4.3) kg/m2; age, 43.0 (9.4) years; 34% females] underwent a 1-year lifestyle intervention (clinicaltrials.gov ID: NCT03031951) and were randomized to intervention (IG, n = 49) or control groups (CG, n = 45), and all measurements were made at baseline and after 4 months. Fat mass (FM) and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry and REE by indirect calorimetry. AT was assessed through 13 different approaches, varying in how REE was predicted and/or how AT was assessed. RESULTS IG underwent a mean negative energy balance (EB) of 270 (289) kcal/day, p < 0.001), resulting in a WL of - 4.8 (4.9)% and an FM loss of - 11.3 (10.8)%. Regardless of approach, AT occurred in the IG, ranging from ~ - 65 to ~ - 230 kcal/day and three approaches showed significant AT in the CG. CONCLUSIONS Regardless of approach, AT occurred after moderate WL in the IG. AT assessment should be standardized and comparisons among studies with different methodologies to assess AT must be avoided.
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Hopstock LA, Deraas TS, Henriksen A, Martiny-Huenger T, Grimsgaard S. Changes in adiposity, physical activity, cardiometabolic risk factors, diet, physical capacity and well-being in inactive women and men aged 57-74 years with obesity and cardiovascular risk - A 6-month complex lifestyle intervention with 6-month follow-up. PLoS One 2021; 16:e0256631. [PMID: 34432850 PMCID: PMC8386855 DOI: 10.1371/journal.pone.0256631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 08/06/2021] [Indexed: 12/16/2022] Open
Abstract
A key challenge in lifestyle interventions is long-term maintenance of favorable lifestyle changes. Middle-aged and older adults are important target groups. The purpose of this analysis was to investigate changes in adiposity, physical activity, cardiometabolic risk factors, diet, physical capacity, and well-being, in inactive middle-aged and older women and men with obesity and elevated cardiovascular disease risk, participating in an interdisciplinary single-arm complex lifestyle intervention pilot study. Participants were recruited from the population-based Tromsø Study 2015-2016 with inclusion criteria age 55-74 years, body mass index (BMI) ≥30kg/m2, sedentary lifestyle, no prior myocardial infarction and elevated cardiovascular risk. Participants (11 men and 5 women aged 57-74 years) underwent a 6-month intervention of two 1-hour group-sessions per week with instructor-led gradually intensified exercise (endurance and strength), one individual and three 2-hour group counselling sessions with nutritionist (Nordic Nutrition Recommendations) and psychologist (Implementation intention strategies). We investigated changes in adiposity (weight, BMI, body composition, waist circumference), physical activity (self-reported and via physical activity trackers), cardiometabolic risk factors (blood pressure, HbA1c, blood lipids), diet (intake of energy, nutrients, foods), physical capacity (aerobic capacity, muscle strength), and psychological well-being, measured at baseline and end-of-intervention, using mean-comparison paired t-tests. Further, we investigated self-reported healthy lifestyle maintenance six months after end-of-intervention, and monthly changes in daily step count, moderate-to-vigorous physical activity (MVPA) and total energy expenditure. From baseline to end-of-intervention, there was a mean decrease in weight, BMI, fat mass, waist circumference, intake of total- and saturated fat, and increase in lean mass, lateral pulldown and leg press. We detected no changes in mean levels of physical activity, cardiometabolic risk factors or well-being. Six months after end-of-intervention, 25% responded healthy lifestyle achievement and maintenance, while objectively measured physical activity remained unchanged. The results are useful for development of a protocol for a full-scale trial. Trial registration: The study was registered at www.ClinicalTrials.gov registry (NCT03807323).
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Affiliation(s)
- Laila A. Hopstock
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Trygve S. Deraas
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Andre Henriksen
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torsten Martiny-Huenger
- Faculty of Health Sciences, Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Perumal KV, Ja’afar NL, Mat Taib CN, Shafie NH, Bahari H. Antiobesity Activity of Elateriospermum tapos Shell Extract in Obesity-Induced Sprague Dawley Rats. Molecules 2021; 26:molecules26020321. [PMID: 33435518 PMCID: PMC7827679 DOI: 10.3390/molecules26020321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
Obesity is one of the risk factors associated with cardiovascular diseases, hypertension, abnormal liver function, diabetes, and cancers. Orlistat is currently available to treat obesity, but it is associated with adverse side effects. Natural resources are widely used for obesity treatment. Hence, this study aimed to investigate the anti-obesity activity of Elateriospermum tapos (E. tapos) shell extract in obesity induced Sprague Dawley rats. The rats' obesity was induced by a high-fat (HF) diet made up of 50% standard rat pellet, 20% milk powder, 6% corn starch, and 24% ghee and a cafeteria (CAF) diet such as chicken rolls, salty biscuits, cakes, and cheese snacks. A hot aqueous method for the extraction of E. tapos shells was applied by using 500 mL of distilled water for about 24 h. Various dosages of E. tapos shell extract (10 mg/kg, 100 mg/kg, and 200 mg/kg) were used. At the end of the study, body weight, caloric intake, organ weight, lipid profile, lipoprotein lipase (LPL) activity, and histopathology analysis were carried out. E. tapos shell extract treated groups showed a reduction in body weight, positive lipid-lowering effect, decrements in triglyceride accumulation and LPL activity, and positive improvement in histopathology analysis. A dose of 200 mg/kg showed the most effective result compared to 10 mg/kg and 100 mg/kg doses.
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Affiliation(s)
- Kokila Vani Perumal
- Department of Human Anatomy, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (K.V.P.); (N.L.J.); (C.N.M.T.)
| | - Nor Liyana Ja’afar
- Department of Human Anatomy, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (K.V.P.); (N.L.J.); (C.N.M.T.)
| | - Che Norma Mat Taib
- Department of Human Anatomy, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (K.V.P.); (N.L.J.); (C.N.M.T.)
| | - Nurul Husna Shafie
- Department of Nutrition and Dietetics, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia;
| | - Hasnah Bahari
- Department of Human Anatomy, Universiti Putra Malaysia, Serdang 43400, Selangor, Malaysia; (K.V.P.); (N.L.J.); (C.N.M.T.)
- Correspondence: ; Tel.: +603-9769-2769
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Torbahn G, Schoene D, Schwingshackl L, Rücker G, Knüttel H, Kemmler W, Sieber CC, Batsis JA, Villareal DT, Stroebele-Benschop N, Volkert D, Kiesswetter E. Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol. BMJ Open 2020; 10:e038330. [PMID: 33033022 PMCID: PMC7542917 DOI: 10.1136/bmjopen-2020-038330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Obesity is highly prevalent in older adults aged 65 years or older. Different lifestyle interventions (diet, exercise, self-management) are available but benefits and harms have not been fully quantified comparing all available health promotion interventions. Special consideration must be given to functional outcomes and possible adverse effects (loss of muscle and bone mass, hypoglycaemia) of weight loss interventions in this age group. The objective of this study is to synthesise the evidence regarding the effects of different types and modalities of lifestyle interventions, or their combinations, on physical function and obesity-related outcomes such as body composition in older adults with obesity. METHODS AND ANALYSES Six databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Psychinfo and Web of Science) and two trial registries (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) will be searched for randomised controlled trials of lifestyle interventions in older adults with obesity. Screening (title/abstract and full-text) and data extraction of references as well as assessment of risk of bias and rating of the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation for network meta-analyses) will be performed by two reviewers independently. Frequentist random-effects network meta-analyses will be conducted to determine the pooled effects from each intervention. ETHICS AND DISSEMINATION We will submit our findings to peer-reviewed journals and present at national and international conferences as well as in scientific medical societies. Patient-targeted dissemination will involve local and national advocate groups. PROSPERO REGISTRATION NUMBER CRD42019147286.
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Affiliation(s)
- Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Medical Informatics, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, Regensburg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - John A Batsis
- Division of Geriatric Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dennis T Villareal
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, Texas, USA
| | - Nanette Stroebele-Benschop
- Department of Nutritional Psychology, Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
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Cranney L, O'Hara B, Gale J, Rissel C, Bauman A, Phongsavan P. Telephone based coaching for adults at risk of diabetes: impact of Australia's Get Healthy Service. Transl Behav Med 2020; 9:1178-1185. [PMID: 30753699 DOI: 10.1093/tbm/ibz007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The Get Healthy Information and Coaching Service (GHS), an effective 6-month telephone-based healthy lifestyle coaching service, includes a population-targeted diabetes prevention module (DPM) tailored for adults at risk for type 2 diabetes. This study determined DPM's reach and impact on anthropometric and lifestyle risk factors. Pre-post evaluation design examined self-reported anthropometric (body weight, waist circumference) and lifestyle risk factors (physical activity and dietary behaviors) of DPM participants. Descriptive and chi-square analyses were performed on sociodemographic variables. Behavioral changes were assessed using matched pairs analysis, independent samples analysis, and multivariate analysis. There were 4,222 DPM participants (76.0% female; 75.9% aged ≥ 50; 95.4% spoke English at home). The DPM included higher proportions of older adults (≥50) (75.9% vs. 46.5%; p < .001), retirees (28.7% vs. 18.5%; p < .0001), less educated (33.3% vs. 24.9%; p < .0001), more disadvantaged (41.7% vs. 34.8%; p < .001) and living in regional or rural areas (43.2% vs. 39.8%; p < .001) than the GHS program. DPM participants reported significant improvements at six months for all anthropometric (-3.3 kg weight; -1.2 BMI units; -4.3 cm waist circumference) and behavioral risk factors (+0.2 fruit serves/day; +0.7 vegetables serves/day; -0.2 sweetened drinks/day; -0.2 takeaway meals/week; +1.1 30-min walking sessions/week; +0.7 30-min moderate activity sessions/week; +0.2 20-min vigorous activity sessions/week). Nearly one-third (31.1%) of participants lost ≥5% body weight. The DPM reached priority population groups, those typically underrepresented in diabetes prevention programs and resulted in clinically relevant improvements in anthropometric and lifestyle risk factors in adults at increased risk for type 2 diabetes.
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Affiliation(s)
- Leonie Cranney
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Blythe O'Hara
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Joanne Gale
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Chris Rissel
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia.,NSW Office of Preventive Health, Liverpool, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Philayrath Phongsavan
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
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Silva AM, Nunes CL, Matias CN, Jesus F, Francisco R, Cardoso M, Santos I, Carraça EV, Silva MN, Sardinha LB, Martins P, Minderico CS. Champ4life Study Protocol: A One-Year Randomized Controlled Trial of a Lifestyle Intervention for Inactive Former Elite Athletes with Overweight/Obesity. Nutrients 2020; 12:nu12020286. [PMID: 31973208 PMCID: PMC7070918 DOI: 10.3390/nu12020286] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/15/2020] [Accepted: 01/19/2020] [Indexed: 01/15/2023] Open
Abstract
Preventive and educational programs directed to former elite athletes in the areas of healthy living are required. This is particularly relevant as obesity and health-related problems are observed in retired athletes, especially in those whose current levels of physical activity are below the recommendations. During their sports career, elite athletes are supported by a multidisciplinary team; upon retirement, no support is provided for the transition to a different lifestyle. So far, no program has been implemented to promote sustained healthy lifestyle behaviors in the post-career transition and evidence is lacking for such an intervention. Firstly, we aim to determine if Champ4life, a 1-year lifestyle intervention targeting inactive former athletes with overweight and obesity, is effective for reducing total and abdominal fat. Secondly, our purpose is to assess the effectiveness of the intervention on the levels of physical activity and sedentary behavior, resting energy expenditure, cardio-metabolic markers, physical fitness, energy balance components, eating self-regulation markers, and quality of life over 12 months. Champ4life is an evidence- and theory-based program using a randomized control trial design (intervention vs. control group) that will be conducted on 94 inactive former elite athletes with overweight and obesity. The first four months of the Champ4Life program include a nutritional appointment and 12 weekly, 90-min sessions. Classroom sessions seek to provide participants with key information and a toolbox of behavior change techniques to initiate and sustain long-term lifestyle changes. Participants will undergo baseline, 4-month, and 12-month measurements of body composition (primary outcomes), resting energy expenditure, physical fitness, metabolic markers, energy balance related-markers, and quality of life (secondary outcome). This trial will provide evidence on the effectiveness of the Champ4life program, a pioneer lifestyle intervention for retired athletes, offering tools for sustained changes in physical activity, sedentary behavior and diet, aiming to improve body composition and overall health-related markers.
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Affiliation(s)
- Analiza M. Silva
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
- Correspondence: ; Tel.: +35-121-414-9174; Fax: +35-121-414-9193
| | - Catarina L. Nunes
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
| | - Catarina N. Matias
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
- Physiology and Biochemistry Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal
| | - Filipe Jesus
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
| | - Rúben Francisco
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
| | - Miguel Cardoso
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
| | - Inês Santos
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
- Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Eliana V. Carraça
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
- Faculdade de Educação Física e Desporto, Universidade Lusófona de Humanidades e Tecnologias, 1749-024 Lisboa, Portugal
| | - Marlene N. Silva
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
- Faculdade de Educação Física e Desporto, Universidade Lusófona de Humanidades e Tecnologias, 1749-024 Lisboa, Portugal
| | - Luís B. Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
| | - Paulo Martins
- Laboratory of Sport Psychology, Faculdade de Motricidade Humana da Universidade de Lisboa, 1499-002 Cruz-Quebrada, Portugal;
| | - Cláudia S. Minderico
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-688 Cruz-Quebrada, Portugal; (C.L.N.); (C.N.M.); (F.J.); (R.F.); (M.C.); (I.S.); (E.V.C.); (M.N.S.); (L.B.S.); (C.S.M.)
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10
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Abstract
PURPOSE OF REVIEW Obesity in the older adult is a burgeoning health epidemic that leads to increased morbidity, disability, and institutionalization. This review presents a brief overview of geriatric-specific consequences of obesity by highlighting the risks and benefits of intentional weight loss. RECENT FINDINGS Intentional weight loss reduces the extent of adiposity-related illnesses, yet the approach in older adults is fraught with challenges. Interventions combining caloric restriction and physical exercise (aerobic and resistance) maximize fat loss and minimize loss of muscle and bone. Interventions are also effective at improving physical function, reducing medication burden, and improving symptomatic osteoarthritis in this population. Approaches can mitigate the risks of isolated caloric restriction on muscle and bone in a safe and effective manner. Effective weight loss strategies should be considered in older adults. While there are potential risks, practical clinical approaches can minimize the potential harms while maximizing their benefits.
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Affiliation(s)
- Peter R DiMilia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA
- Collaboratory for Implementation Science at Dartmouth, Lebanon, NH, USA
| | - Alexander C Mittman
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - John A Batsis
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.
- Collaboratory for Implementation Science at Dartmouth, Lebanon, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
- Section of Weight & Wellness, Department of Medicine, Dartmouth-Hitchcock, Lebanon, NH, USA.
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11
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Chen F, Su W, Ramasamy A, Zvenyach T, Kahan S, Kyle T, Ganguly R. Ten-year Medicare budget impact of increased coverage for anti-obesity intervention. J Med Econ 2019; 22:1096-1104. [PMID: 31378108 DOI: 10.1080/13696998.2019.1652185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: To estimate the long-term budget impact of expanding Medicare coverage of anti-obesity interventions among adults aged 65 and older in the US. Materials and methods: This study analyzed a representative sample of Medicare beneficiaries from the combined 2008-2016 National Health and Nutrition Examination Surveys. Population characteristics, cost and effectiveness of anti-obesity interventions, and the sustainability of weight loss in real-life were modeled to project the budgetary impact on gross Medicare outlay over 10 years. Hypothetical scenarios of 50% and 67% increases in intervention participation above base case were used to model moderate and extensive Medicare coverage expansion of intensive behavior therapy and pharmacotherapy. Results: For each Medicare beneficiary receiving anti-obesity treatment, we estimate Medicare savings of $6,842 and $7,155 over 10 years under moderate and extensive coverage utilization assumptions, respectively. The average cost of intervention is $1,798 and $1,886 per treated participant. Taking the entire Medicare population (treated and untreated) into consideration, the estimated 10-year budget savings per beneficiary are $308 and $339 under moderate and extensive assumptions, respectively. Sensitivity analysis of drug adherence rate and weight-loss efficacy indicated a potential variation of budget savings within 7% and 22% of the base case, respectively. Most of the projected cost savings come from lower utilization of ambulatory services and prescription drugs. Limitations: Due to the scarcity of studies on the efficacy of pharmacotherapy among older adults with obesity, the simulated weight loss and long-term maintenance effects were derived from clinical trial outcomes, in which older adults were mostly excluded from participation. The model did not include potential side-effects from anti-obesity medications and associated costs. Conclusions: This analysis suggests that expanding coverage of anti-obesity interventions to eligible individuals could generate $20-$23 billion budgetary savings to Medicare over 10 years.
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Affiliation(s)
| | | | | | | | - Scott Kahan
- National Center for Weight and Wellness , Washington , DC , USA
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12
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Lartey ST, Magnussen CG, Si L, Boateng GO, de Graaff B, Biritwum RB, Minicuci N, Kowal P, Blizzard L, Palmer AJ. Rapidly increasing prevalence of overweight and obesity in older Ghanaian adults from 2007-2015: Evidence from WHO-SAGE Waves 1 & 2. PLoS One 2019; 14:e0215045. [PMID: 31425568 PMCID: PMC6699701 DOI: 10.1371/journal.pone.0215045] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies on changes in the prevalence and determinants of obesity in older adults living in sub-Saharan Africa are scarce. We examined recent changes in obesity prevalence and associated factors for older adults in Ghana between 2007/08 and 2014/15. METHODS Data on adults aged 50 years and older in Ghana were drawn from the WHO SAGE 2007/08 (Wave 1; n = 4158) and 2014/15 (Wave 2; n = 1663). The weighted prevalence of obesity, overweight, normal weight and underweight, and of high central adiposity were compared in 2007/08 and 2014/15. Multinomial and binomial logistic regressions were used to examine whether the determinants of weight status based on objectively measured body mass index and waist circumference changed between the two time periods. RESULTS The prevalence of overweight (2007/08 = 19.6%, 95% CI: 18.0-21.4%; 2014/15 = 24.5%, 95% CI: 21.7-27.5%) and obesity (2007/08 = 10.2%, 95% CI: 8.9-11.7%; 2014/15 = 15.0%, 95% CI: 12.6-17.7%) was higher in 2014/15 than 2007/08 and more than half of the population had high central adiposity (2007/08 = 57.7%, 95% CI: 55.4-60.1%; 2014/15 = 66.9%, 95% CI: 63.7-70.0%) in both study periods. While the prevalence of overweight increased in both sexes, obesity prevalence was 16% lower in males and 55% higher in females comparing 2007/08 to 2014/15. Female sex, urban residence, and high household wealth were associated with higher odds of overweight/obesity and high central adiposity. Those aged 70+ years had lower odds of obesity in both study waves. In 2014/15, females who did not meet the recommended physical activity were more likely to be obese. CONCLUSION Over the 7-year period between the surveys, the prevalence of underweight decreased and overweight increased in both sexes, while obesity decreased in males but increased in females. The difference in obesity prevalence may point to differential impacts of past initiatives to reduce overweight and obesity, potential high-risk groups in Ghana, and the need to increase surveillance.
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Affiliation(s)
- Stella T. Lartey
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G. Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- The George Institute for Global Health, University of New South Wales, Kensington, NSW, Australia
| | - Godfred O. Boateng
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Padova, Italy
| | - Paul Kowal
- World Health Organization (WHO), Geneva, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Andrew J. Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Haywood C, Sumithran P. Treatment of obesity in older persons-A systematic review. Obes Rev 2019; 20:588-598. [PMID: 30645010 DOI: 10.1111/obr.12815] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 02/06/2023]
Abstract
The study aims to systematically review the available evidence regarding weight loss interventions (lifestyle, surgical, and pharmacological) for obesity in adults aged over 60 years. A search of prospective, randomized studies took place in January 2018, on Medline (Web of Science) and PubMed databases. Search terms included the following: elderly, obese, hypocaloric, pharmacotherapy, and bariatric surgery. Abstracts were screened for eligibility. A total of 256 publications regarding lifestyle interventions were identified; of these, 69 studies were eligible. As no eligible studies were identified for pharmacotherapy or bariatric surgery, the search was broadened to include non- randomized studies. Four pharmacotherapy and 66 surgery studies were included. Lifestyle intervention had similar weight loss efficacy in older compared with younger people, with positive effects on a number of relevant outcomes, including physical function and cardiovascular parameters. There was little data regarding obesity pharmacotherapy in older persons. The available data for bariatric surgery indicate comparable weight loss and resolution of type 2 diabetes, with similar or slightly higher complication rates in older compared with younger people. Older age alone should not be considered a contraindication to intensive lifestyle or surgical intervention for obesity. There are insufficient data to guide clinical decisions regarding obesity pharmacotherapy in older people.
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Affiliation(s)
- Cilla Haywood
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.,Department of Aged Care, Austin Health, Heidelberg, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
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14
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Jackson SE, Holter L, Beeken RJ. 'Just because I'm old it doesn't mean I have to be fat': a qualitative study exploring older adults' views and experiences of weight management. BMJ Open 2019; 9:e025680. [PMID: 30782939 PMCID: PMC6377572 DOI: 10.1136/bmjopen-2018-025680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore older adults' beliefs about the appropriateness of weight management, and how their experiences and expectations of weight management have changed as they have got older. DESIGN Qualitative semistructured interview study. SETTING UK. PARTICIPANTS Older adults (≥65 years) in the UK who had recent (<5 years) experience of trying to manage their weight (n=15; 12 women; 73% white British). RESULTS Data were analysed using thematic analysis. Emergent themes highlighted that weight remained a concern for many older adults, although having a high body weight was seen to be more acceptable at older than younger ages. Excess weight was reported to have negative consequences for health and well-being which participants felt could be alleviated by losing weight. Participants were motivated to lose weight for appearance and health reasons, but mentioned finding it harder to lose weight as they had got older and generally felt they had received limited guidance on weight management from health professionals. CONCLUSIONS The views of our participants highlight the need for further research into safe and effective methods of weight loss for older people and indicate that advice and support from health professionals would be welcomed.
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Affiliation(s)
- Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Linn Holter
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Department of Behavioural Science and Health, University College London, London, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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15
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Hurkmans E, Matthys C, Bogaerts A, Scheys L, Devloo K, Seghers J. Face-to-Face Versus Mobile Versus Blended Weight Loss Program: Randomized Clinical Trial. JMIR Mhealth Uhealth 2018; 6:e14. [PMID: 29326093 PMCID: PMC5785684 DOI: 10.2196/mhealth.7713] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 10/03/2017] [Accepted: 11/16/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Conventional face-to-face weight loss and weight control programs are very labor intensive for both the patient and the provider. It is unclear to what extent conventional programs can be (partially) completed by mobile health (mHealth) apps. OBJECTIVE The aim of this study was to compare the effectiveness of different weight loss programs using a combination of conventional and mobile programs among adults who are overweight (body mass index [BMI]>29 kg/m²). METHODS A single-blinded randomized controlled trial among obese adults was performed from September 2015 to March 2016. The study took place in Leuven, Belgium. Of the 102 eligible (BMI >29 kg/m²) adults, 81 (79%) completed the study. The three intervention groups consisted of a conventional face-to-face weight loss program, a weight loss app program (app group), and a partial face-to-face and partial app program (combi group). All intervention groups received the same advice from a dietician and a physical activity coach during a 12-week period. The control group did not receive any information during the same period. Primary outcomes were weight reduction (5% decrease of baseline weight in kg), BMI, metabolic risk factors, dietary pattern, and physical activity. RESULTS Significant more participants in all three intervention groups lost at least 5% or more of their weight at baseline compared with the control group. No significant difference was found between the combi group and the conventional group. A trend was found that more participants in the combi group lost 5% or more compared with the app group (19%), P=.06. A significant time x group effect was found for BMI and metabolic risk factors, with the control group having the worst results and the combi group being significantly better with regard to BMI compared with the app group. No significant group x time effects were found for the intake of different food and drinks and moderate to vigorous physical activity (MVPA). CONCLUSIONS The results of this study show that a conventional weight loss program could partially be completed with an mHealth program without affecting the effectiveness. TRIAL REGISTRATION Clinicaltrials.gov NCT02595671; https://clinicaltrials.gov/ct2/show/NCT02595671 (Archived by WebCite at http://www.webcitation.org/6w1H0x1Q6).
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Affiliation(s)
- Emalie Hurkmans
- Department of Movement Sciences, University of Leuven, Leuven, Belgium.,Department of Social Affairs and Health, Ecorys, Rotterdam, Netherlands
| | - Christophe Matthys
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, University of Leuven, Leuven, Belgium.,Department of Clinical and Experimental Endocrinology, University of Leuven, Leuven, Belgium
| | - An Bogaerts
- Faculty of Movement and Rehabilitation Sciences, University of Leuven, Leuven, Belgium
| | - Leonie Scheys
- Department of Chronic Diseases, Metabolism and Ageing, University of Leuven, Leuven, Belgium.,Department of Clinical and Experimental Endocrinology, University of Leuven, Leuven, Belgium
| | - Karlien Devloo
- Department of Movement Sciences, University of Leuven, Leuven, Belgium
| | - Jan Seghers
- Department of Movement Sciences, University of Leuven, Leuven, Belgium
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16
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Kreps DJ, Halperin F, Desai SP, Zhang ZZ, Losina E, Olson AT, Karlson EW, Bermas BL, Sparks JA. Association of weight loss with improved disease activity in patients with rheumatoid arthritis: A retrospective analysis using electronic medical record data. ACTA ACUST UNITED AC 2018; 13:1-10. [PMID: 29606976 DOI: 10.4172/1758-4272.1000154] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Objective To evaluate the association between weight loss and rheumatoid arthritis (RA) disease activity. Methods We conducted a retrospective cohort study of RA patients seen at routine clinic visits at an academic medical center, 2012-2015. We included patients who had ≥2 clinical disease activity index (CDAI) measures. We identified visits during follow-up where the maximum and minimum weights occurred and defined weight change and CDAI change as the differences of these measures at these visits. We defined disease activity improvement as CDAI decrease of ≥5 and clinically relevant weight loss as ≥5 kg. We performed logistic regression analyses to establish the association between improved disease activity and weight loss and baseline BMI category (≥25 kg/m2 or <25 kg/m2). We built linear regression models to investigate the association between continuous weight loss and CDAI change among patients who were overweight/obese at baseline and who lost weight during follow-up. Results We analyzed data from 174 RA patients with a median follow-up of 1.9 years (IQR 1.3-2.4); 117 (67%) were overweight/obese at baseline, and 53 (31%) lost ≥5 kg during follow-up. Patients who were overweight/obese and lost ≥5 kg had three-fold increased odds of disease activity improvement compared to those who did not (OR 3.03, 95%CI 1.18-7.83). Among those who were overweight/obese at baseline, each kilogram weight loss was associated with CDAI improvement of 1.15 (95%CI 0.42-1.88). Our study was limited by using clinical data from a single center without fixed intervals for assessments. Conclusion Clinically relevant weight loss (≥5 kg) was associated with improved RA disease activity in the routine clinical setting. Further studies are needed for replication and to evaluate the effect of prospective weight loss interventions on RA disease activity.
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Affiliation(s)
- David J Kreps
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Florencia Halperin
- Harvard Medical School, Boston, MA.,Center for Weight Management and Metabolic Surgery, Department of Medicine, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA
| | - Sonali P Desai
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Zhi Z Zhang
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Elena Losina
- Harvard Medical School, Boston, MA.,Orthopedic and Arthritis Center for Outcomes Research, Policy and Innovation evaluation of Orthopedic Treatments (PIVOT) Center, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Amber T Olson
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA
| | - Elizabeth W Karlson
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Bonnie L Bermas
- Univerisity of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey A Sparks
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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17
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Fanning J, Walkup MP, Ambrosius WT, Brawley LR, Ip EH, Marsh AP, Rejeski WJ. Change in health-related quality of life and social cognitive outcomes in obese, older adults in a randomized controlled weight loss trial: Does physical activity behavior matter? J Behav Med 2017; 41:299-308. [PMID: 29168052 DOI: 10.1007/s10865-017-9903-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/15/2017] [Indexed: 01/17/2023]
Abstract
This article compared the effect of dietary weight loss administered alone (WL) or in combination with aerobic training (WL + AT) or resistance training (WL + RT) on health related quality of life, walking self-efficacy, stair climb self-efficacy, and satisfaction with physical function in older adults with cardiovascular disease or the metabolic syndrome. Participants (N = 249; M age = 66.9) engaged in baseline assessments and were randomly assigned to one of three interventions, each including a 6-month intensive phase and a 12-month follow-up. Those in WL + AT and WL + RT engaged in 4 days of exercise training weekly. All participants engaged in weekly group behavioral weight loss sessions with a goal of 7-10% reduction in body weight. Participants in WL + AT and WL + RT reported better quality of life and satisfaction with physical function at 6- and 18-months relative to WL. At month 6, WL + AT reported greater walking self-efficacy relative to WL + RT and WL, and maintained higher scores compared to WL at month 18. WL + AT and WL + RT reported greater stair climbing efficacy at month 6, and WL + RT remained significantly greater than WL at month 18. The addition of either AT or RT to WL differentially improved HRQOL and key psychosocial outcomes associated with maintenance of physical activity and weight loss. This underscores the important role of exercise in WL for older adults, and suggests health care providers should give careful consideration to exercise mode when designing interventions.
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Affiliation(s)
- Jason Fanning
- Department of Health and Exercise Science, Wake Forest University, PO Box 7868, Winston-Salem, NC, 27106, USA.
- Section on Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Michael P Walkup
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Walter T Ambrosius
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lawrence R Brawley
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Edward H Ip
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, PO Box 7868, Winston-Salem, NC, 27106, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, PO Box 7868, Winston-Salem, NC, 27106, USA
- Section on Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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18
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Trickett KH, Matiaco PM, Jones K, Howlett B, Early KB. Effectiveness of Shared Medical Appointments Targeting the Triple Aim Among Patients With Overweight, Obesity, or Diabetes. J Osteopath Med 2017; 116:780-787. [PMID: 27893144 DOI: 10.7556/jaoa.2016.153] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Obesity and diabetes are epidemic in the United States, with many treatment options having limited long-term efficacy. A possible effective medical management tool is the shared medical appointment (SMA), which offers an efficient and cost-effective approach to behavior change and aligns with the Triple Aim (reduce costs, improve population health, and improve patient care experience) set forth by the Institute for Healthcare Improvement. OBJECTIVES To assess the effectiveness of SMAs to achieve the Triple Aim and to improve the management of overweight/obesity or diabetes. METHODS Peer-reviewed literature from PubMed was searched by the keywords shared medical appointments, group medical appointment, and group medical visit, with no date restrictions and limited to English publications with sample sizes greater than or equal to 20. RESULTS Eight articles met inclusion criteria. The Triple Aim was not referenced in the studies, but most reported some combination of reduced costs, improved care, and improved outcomes or patient satisfaction. CONCLUSIONS Potential benefits of SMAs include improved patient outcomes and satisfaction. Osteopathic and, in particular, primary care medicine could likely benefit from moving toward greater adoption of SMAs; however, more randomized controlled trials are needed to assess their effectiveness with regard to the Triple Aim.
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19
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Abstract
The prevalence of obesity and disability in older adults has significant public health implications. This case review discusses the benefits and risks of weight loss in older adults and outlines treatment options available to Medicare beneficiaries. The importance of preserving lean muscle mass in weight management is emphasized.
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20
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Baruth M, Schlaff RA. Behavioral Mediators of Weight Loss in Two Group-based Behavioral Interventions in Older Adults. AMERICAN JOURNAL OF HEALTH EDUCATION 2017. [DOI: 10.1080/19325037.2016.1271371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Abstract
The percentage of older obese adults is on the rise. Many clinicians underestimate the health consequences of obesity in the elderly, citing scarce evidence and concerns that weight loss might be detrimental to the health of older adults. Although overweight and obese elders are not at the same risk for morbidity and mortality as younger individuals, quality of life and function are adversely impacted. Weight loss plans in the elderly should include aerobic activities as well as balance and resistance activities to maintain optimal physical function.
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Affiliation(s)
- Virginia B Kalish
- Department of Family Medicine, National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, 9300 Dewitt Loop, Fort Belvoir, VA 22060, USA.
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22
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Canavan ME, Cherlin E, Boegeman S, Bradley EH, Talbert-Slagle KM. Community factors related to healthy eating & active living in counties with lower than expected adult obesity rates. BMC OBESITY 2016; 3:49. [PMID: 27891242 PMCID: PMC5114811 DOI: 10.1186/s40608-016-0129-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/02/2016] [Indexed: 11/29/2022]
Abstract
Background Adult obesity rates in the United States have reached epidemic proportions, yet vary considerably across states and counties. We sought to explore community-level factors that may be associated with reduced adult obesity rates at the county level. Methods We identified six U.S. counties that were positive deviants for adult obesity and conducted semi-structured interviews with community leaders and government officials involved in efforts to promote healthier lifestyles. Using site visits and in-depth qualitative interviews, we identified several recurrent themes and strategies. Results Participants: 1) developed a nuanced understanding of their communities; 2) recognized the complex nature of obesity, and 3) implemented a county-wide strategic approach for promoting healthy living. This county-wide approachwas used to a) break down silos and build partnerships, b) access community resources and connections, and c) transfer ownership to community members. Conclusions We found that county leaders focused on establishing a county-wide structure to connect and support community-led initiatives to promote healthy living, reduce obesity, and foster sustainability. Findings from this study can help inform county-level efforts to improve healthy living and combat the multi-faceted challenges of adult obesity across the U.S.
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Affiliation(s)
- Maureen E Canavan
- Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA ; Yale Global Health Leadership Institute, 2 Church Street South, Suite 409, New Haven, 06529 CT USA
| | - Emily Cherlin
- Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA ; Yale Global Health Leadership Institute, 2 Church Street South, Suite 409, New Haven, 06529 CT USA
| | - Stephanie Boegeman
- Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA
| | - Elizabeth H Bradley
- Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA ; Yale Global Health Leadership Institute, 2 Church Street South, Suite 409, New Haven, 06529 CT USA
| | - Kristina M Talbert-Slagle
- Department of Health Policy and Management, Yale University School of Public Health, 60 College St, New Haven, 06520 CT USA ; Yale Global Health Leadership Institute, 2 Church Street South, Suite 409, New Haven, 06529 CT USA
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Chen F, Su W, Becker SH, Payne M, Castro Sweet CM, Peters AL, Dall TM. Clinical and Economic Impact of a Digital, Remotely-Delivered Intensive Behavioral Counseling Program on Medicare Beneficiaries at Risk for Diabetes and Cardiovascular Disease. PLoS One 2016; 11:e0163627. [PMID: 27706216 PMCID: PMC5051965 DOI: 10.1371/journal.pone.0163627] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 09/12/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Type 2 diabetes and cardiovascular disease impose substantial clinical and economic burdens for seniors (age 65 and above) and the Medicare program. Intensive Behavioral Counseling (IBC) interventions like the National Diabetes Prevention Program (NDPP), have demonstrated effectiveness in reducing excess body weight and lowering or delaying morbidity onset. This paper estimated the potential health implications and medical savings of a digital version of IBC modeled after the NDPP. METHODS AND FINDINGS Participants in this digital IBC intervention, the Omada program, include 1,121 overweight or obese seniors with additional risk factors for diabetes or heart disease. Weight changes were objectively measured via participant use of a networked weight scale. Participants averaged 6.8% reduction in body weight within 26 weeks, and 89% of participants completed 9 or more of the 16 core phase lessons. We used a Markov-based microsimulation model to simulate the impact of weight loss on future health states and medical expenditures over 10 years. Cumulative per capita medical expenditure savings over 3, 5 and 10 years ranged from $1,720 to 1,770 (3 years), $3,840 to $4,240 (5 years) and $11,550 to $14,200 (10 years). The range reflects assumptions of weight re-gain similar to that seen in the DPP clinical trial (lower bound) or minimal weight re-gain aligned with age-adjusted national averages (upper bound). The estimated net economic benefit after IBC costs is $10,250 to $12,840 cumulative over 10 years. Simulation outcomes suggest reduced incidence of diabetes by 27-41% for participants with prediabetes, and stroke by approximately 15% over 5 years. CONCLUSIONS A digital, remotely-delivered IBC program can help seniors at risk for diabetes and cardiovascular disease achieve significant weight loss, reduces risk for diabetes and cardiovascular disease, and achieve meaningful medical cost savings. These findings affirm recommendations for IBC coverage by the U.S. Preventive Services Task Force.
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Affiliation(s)
- Fang Chen
- IHS Life Sciences, Washington, District of Columbia, United States of America
- * E-mail:
| | - Wenqing Su
- IHS Life Sciences, Washington, District of Columbia, United States of America
| | - Shawn H. Becker
- Silvercat Advisors, LLC, Burlingame, California, United States of America
| | - Mike Payne
- Omada Health, Inc., San Francisco, California, United States of America
| | | | - Anne L. Peters
- Keck School of Medicine of University of Southern California, Los Angeles, California, United States of America
| | - Timothy M. Dall
- IHS Life Sciences, Washington, District of Columbia, United States of America
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Batsis JA, Gill LE, Masutani RK, Adachi-Mejia AM, Blunt HB, Bagley PJ, Lopez-Jimenez F, Bartels SJ. Weight Loss Interventions in Older Adults with Obesity: A Systematic Review of Randomized Controlled Trials Since 2005. J Am Geriatr Soc 2016; 65:257-268. [PMID: 27641543 DOI: 10.1111/jgs.14514] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To identify geriatric obesity interventions that can guide clinical recommendations. DESIGN Systematic review using Medline (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, EMBASE (Ovid), and PsycINFO (Proquest) from January 1, 2005, to October 12, 2015, to identify English-language randomized controlled trials. PARTICIPANTS Individuals aged 60 and older (mean age ≥65) and classified as having obesity (body mass index ≥30 kg/m2 ). INTERVENTIONS Behavioral weight loss interventions not involving pharmacological or procedural therapies lasting 6 months or longer. MEASUREMENTS Two investigators performed the systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and achieved a high concordance rate (97.3%) in summarizing the primary outcomes. The three primary outcomes were weight loss, physical performance, and quality of life. RESULTS Of 5,741 citations, 19 were included. (Six studies were unique, and the remaining 13 were based on the same study population.) Duration ranged from 6 to 18 months (n = 405 participants, age range 66.7-71.1). Weight loss in the intervention groups ranged from 0.5 to 10.7 kg (0.1-9.3%). Five studies had a resistance exercise program accompanying a dietary component. Greater weight loss was observed in groups with a dietary component than those with exercise alone. Exercise alone led to better physical function but no significant weight loss. Combined dietary and exercise components led to the greatest improvement in physical performance measures and quality of life and mitigated reductions in muscle and bone mass observed in diet-only study arms. Heterogeneous outcomes were observed, which limited the ability to synthesize the data quantitatively. CONCLUSIONS The evidence supporting geriatric obesity interventions to improve physical function and quality of life is of low to moderate quality. Well-designed trials are needed in this population.
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Affiliation(s)
- John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Weight & Wellness Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
| | - Lydia E Gill
- Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Rebecca K Masutani
- Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire
| | - Anna M Adachi-Mejia
- Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
| | - Heather B Blunt
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire
| | - Pamela J Bagley
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire
| | - Francisco Lopez-Jimenez
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen J Bartels
- Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
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25
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Deveza LA, Hunter DJ. Pain Relief for an Osteoarthritic Knee in the Elderly: A Practical Guide. Drugs Aging 2016; 33:11-20. [PMID: 26659733 DOI: 10.1007/s40266-015-0331-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In view of the increasing prevalence of knee osteoarthritis (OA) in the population worldwide, optimal management is critical to decrease the burden of this condition and minimize disability and personal suffering. Current care is based on a sequence of non-pharmacological, pharmacological, and surgical modalities, targeted to improving pain and function in the elderly population. The aim of this article is to provide a practical view of the efficacy of therapeutic options available along with clinically relevant considerations on the management of knee OA in this demographic group.
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Affiliation(s)
- Leticia A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW, 2065, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Reserve Road, St. Leonards, Sydney, NSW, 2065, Australia.
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Abstract
AbstractThere is conflicting evidence for the effect of BMI on mortality at older ages, and little information on its effect on healthy life expectancy (HLE). Longitudinal data were from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health (n 11 119), over 18 years of follow-up. Self-rated health status was measured at each survey, and BMI was measured at baseline. Multi-state models were fitted to estimate the effect of BMI on total life expectancy (TLE) and HLE. Compared with women of normal weight, overweight women at the age of 75 years had similar TLE but fewer years healthy (−0·79; 95 % CI −1·21, −0·37) and more years unhealthy (0·99; 95 % CI 0·56, 1·42). Obese women at the age of 75 years lived fewer years in total than normal-weight women (−1·09; 95 % CI −1·77, −0·41), and had more unhealthy years (1·46; 95 % CI 0·97, 1·95 years). Underweight women had the lowest TLE and the fewest years of healthy life. Women should aim to enter old age at a normal weight and in good health, as the slight benefit on mortality of being overweight is offset by spending fewer years healthy. All outcomes were better for those who began in good health. The relationship between weight and HLE has important implications for nutrition for older people, particularly maintenance of lean body mass and prevention of obesity. The benefit of weight loss in obese older women remains unclear, but we support the recommendation that weight-loss advice be individualised, as any benefits may not outweigh the risks in healthy obese older adults.
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27
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McGinty EE, Baller J, Azrin ST, Juliano-Bult D, Daumit GL. Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review. Schizophr Bull 2016; 42. [PMID: 26221050 PMCID: PMC4681556 DOI: 10.1093/schbul/sbv101] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.
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Affiliation(s)
- Emma E. McGinty
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;,*To whom correspondence should be addressed; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, US; tel: 410-614-4018, e-mail:
| | - Julia Baller
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Gail L. Daumit
- Division of General Internal Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
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28
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Goisser S, Kemmler W, Porzel S, Volkert D, Sieber CC, Bollheimer LC, Freiberger E. Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons--a narrative review. Clin Interv Aging 2015; 10:1267-82. [PMID: 26346071 PMCID: PMC4531044 DOI: 10.2147/cia.s82454] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
One of the many threats to independent life is the age-related loss of muscle mass and muscle function commonly referred to as sarcopenia. Another important health risk in old age leading to functional decline is obesity. Obesity prevalence in older persons is increasing, and like sarcopenia, severe obesity has been consistently associated with several negative health outcomes, disabilities, falls, and mobility limitations. Both sarcopenia and obesity pose a health risk for older persons per se, but in combination, they synergistically increase the risk for negative health outcomes and an earlier onset of disability. This combination of sarcopenia and obesity is commonly referred to as sarcopenic obesity. The present narrative review reports the current knowledge on the effects of complex interventions containing nutrition and exercise interventions in community-dwelling older persons with sarcopenic obesity. To date, several complex interventions with different outcomes have been conducted and have shown promise in counteracting either sarcopenia or obesity, but only a few studies have addressed the complex syndrome of sarcopenic obesity. Strong evidence exists on exercise interventions in sarcopenia, especially on strength training, and for obese older persons, strength exercise in combination with a dietary weight loss intervention demonstrated positive effects on muscle function and body fat. The differences in study protocols and target populations make it impossible at the moment to extract data for a meta-analysis or give state-of-the-art recommendations based on reliable evidence. A conclusion that can be drawn from this narrative review is that more exercise programs containing strength and aerobic exercise in combination with dietary interventions including a supervised weight loss program and/or protein supplements should be conducted in order to investigate possible positive effects on sarcopenic obesity.
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Affiliation(s)
- Sabine Goisser
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Simone Porzel
- Nutricia GmbH, Danone Medical Nutrition, Erlangen, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany
| | - Cornel Christian Sieber
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany ; Department of Internal Medicine and Geriatrics, St John of God Hospital (Barmherzige Brüder), Regensburg, Germany
| | - Leo Cornelius Bollheimer
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany ; Department of Internal Medicine and Geriatrics, St John of God Hospital (Barmherzige Brüder), Regensburg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany
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29
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Allen L, Thorpe K, Joski P. The Effect of Obesity and Chronic Conditions on Medicare Spending, 1987-2011. PHARMACOECONOMICS 2015; 33:691-697. [PMID: 25943686 DOI: 10.1007/s40273-015-0284-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Slowing the growth in Medicare expenditure is a key policy goal. Rising chronic disease prevalence is responsible for much of this growth. OBJECTIVE The first goal of this study is to estimate the percentage of Medicare spending growth that is attributable to increasing disease prevalence rates of diabetes, hyperlipidaemia, hypertension and heart disease. Second, we estimate how much of this prevalence-related spending growth is attributable to rising obesity rates. METHODS We employ spending decomposition equations to estimate the percentage of Medicare spending growth that is attributable to rising chronic disease prevalence, and we use two-part models to estimate the portion of prevalence-related spending that is potentially due to obesity. RESULTS For our four conditions of interest, growing disease prevalence accounted for between 13.6 % (in heart disease) and 58.9 % (in hyperlipidaemia) of Medicare expenditure growth. Up to 17.0 % (in diabetes) of the expenditure growth due to prevalence increases may be attributable to obesity and therefore may be modifiable. CONCLUSIONS Rising obesity rates contribute to chronic disease prevalence, which, in turn, can lead to higher Medicare expenditures. To slow the growth in spending, policy makers should consider targeting obesity, using approaches such as improving pharmacotherapy coverage and providing intensive care coordination services to Medicare enrollees.
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Affiliation(s)
- Lindsay Allen
- Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA,
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30
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Evaluation of older Adults with obesity for bariatric surgery: Geriatricians' perspective. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jcgg.2015.01.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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31
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Koutoukidis DA, Knobf MT, Lanceley A. Obesity, diet, physical activity, and health-related quality of life in endometrial cancer survivors. Nutr Rev 2015; 73:399-408. [PMID: 26011914 PMCID: PMC4477700 DOI: 10.1093/nutrit/nuu063] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Obesity, low-quality diet, and inactivity are all prevalent among survivors of endometrial cancer. The present review was conducted to assess whether these characteristics are associated with health-related quality of life (HRQoL). Electronic databases, conference abstracts, and reference lists were searched, and researchers were contacted for preliminary results of ongoing studies. The quality of the methodology and reporting was evaluated using appropriate checklists. Standardized mean differences were calculated, and data were synthesized narratively. Eight of the 4385 reports retrieved from the literature were included in the analysis. Four of the 8 studies were cross-sectional, 1 was retrospective, 1 was prospective, and 2 were randomized controlled trials. Obesity was negatively associated with overall HRQoL in 4 of 4 studies and with physical well-being in 6 of 6 studies, while it was positively associated with fatigue in 2 of 4 studies. Meeting the recommendations for being physically active, eating a diet high in fruit and vegetables, and abstaining from smoking were positively associated with overall HRQoL in 2 of 2 studies, with physical well-being in 2 of 3 studies, and with fatigue in 1 of 3 studies. Improvements in fatigue and physical well-being were evident after lifestyle interventions. The findings indicate a healthy lifestyle is positively associated with HRQoL in this population, but the number of studies is limited. Additional randomized controlled trials to test effective and practical interventions promoting a healthy lifestyle in survivors of endometrial cancer are warranted.
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Affiliation(s)
- Dimitrios A Koutoukidis
- D.A. Koutoukidis, A. Lanceley, and M.T. Knobf are with the Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK. M.T. Knobf is with the Acute Care/Health Systems Division, Yale University School of Nursing, New Haven, Connecticut, USA.
| | - M Tish Knobf
- D.A. Koutoukidis, A. Lanceley, and M.T. Knobf are with the Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK. M.T. Knobf is with the Acute Care/Health Systems Division, Yale University School of Nursing, New Haven, Connecticut, USA
| | - Anne Lanceley
- D.A. Koutoukidis, A. Lanceley, and M.T. Knobf are with the Department of Women's Cancer, UCL EGA Institute for Women's Health, University College London, London, UK. M.T. Knobf is with the Acute Care/Health Systems Division, Yale University School of Nursing, New Haven, Connecticut, USA
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Xu F, Letendre J, Bekke J, Beebe N, Mahler L, Lofgren IE, Delmonico MJ. Impact of a program of Tai Chi plus behaviorally based dietary weight loss on physical functioning and coronary heart disease risk factors: a community-based study in obese older women. J Nutr Gerontol Geriatr 2015; 34:50-65. [PMID: 25803604 DOI: 10.1080/21551197.2014.1003672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study employed a quasi-experimental design in a community-based study translating the results of our recent findings on the combined effects of Tai Chi and weight loss on physical function and coronary heart disease (CHD) risk factors. A 16-week intervention was conducted to assess the impact of Tai Chi plus a behavioral weight loss program (TCWL, n = 29) on obese (body mass index [BMI] = 35.4 ± 0.8 kg/m²) older (68.2 ± 1.5 yr.) women compared to a control group (CON, n = 9, BMI = 38.0 ± 1.5 kg/m², 65.6 ± 2.7 yr.), which was asked to maintain their normal lifestyle. The TCWL group lost weight (1.6 ± 2.9 kg, P = 0.006) while the CON group did not (1.2 ± 1.9 kg, P = 0.106). Physical functioning as measured by the short physical performance battery improved in TCWL when compared to the CON group (β = 1.94, 95% Confidence Interval [CI]: 1.12, 2.76, P < 0.001). TCWL also improved in sit-and-reach flexibility (β = -2.27, 95% CI: -4.09, -0.46, P = 0.016), body fat mass (BMI, β = -0.65, 95% CI: -1.03, -0.26, P = 0.002), waist circumference (β = -1.78, 95% CI: -2.83, -0.72, P = 0.002), systolic blood pressure (β = -16.41, 95% CI: -21.35, -11.48, P < 0.001), and diastolic blood pressure (β = -9.52, 95% CI: -12.65, -6.39, P < 0.001). Thus, TCWL intervention may represent an effective strategy to improve physical function and ameliorate CHD risk in the older adult population.
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Affiliation(s)
- Furong Xu
- a Department of Kinesiology , University of Rhode Island , Kingston , Rhode Island , USA
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33
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Peirson L, Douketis J, Ciliska D, Fitzpatrick-Lewis D, Ali MU, Raina P. Treatment for overweight and obesity in adult populations: a systematic review and meta-analysis. CMAJ Open 2014; 2:E306-17. [PMID: 25485258 PMCID: PMC4251513 DOI: 10.9778/cmajo.20140012] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Obesity is a major public health issue. This review updates the evidence on the effectiveness of behavioural and pharmacologic treatments for overweight and obesity in adults. METHODS We updated the search conducted in a previous review. Randomized trials of primary-care-relevant behavioural (diet, exercise and lifestyle) and pharmacologic (orlistat and metformin) with or without behavioural treatments in overweight and obese adults were included if 12-month, postbaseline data were provided for weight outcomes. Studies reporting harms were included regardless of design. Data were extracted and pooled wherever possible for 5 weight outcomes, 6 secondary health outcomes and 4 adverse events categories. RESULTS We identified 68 studies, most consisted of short-term (≤ 12 mo) treatments using diet (n = 8), exercise (n = 4), diet and exercise (n = 10), lifestyle (n = 19), orlistat (n = 25) or metformin (n = 4). Compared with the control groups, intervention participants had a greater weight loss of -3.02 kg (95% confidence interval [CI] -3.52 to -2.52), a greater reduction in waist circumference of -2.78 cm (95% CI -3.34 to -2.22) and a greater reduction in body mass index of -1.11 kg/m(2) (95% CI -1.39 to -0.84). The relative risk for loss of ≥ 5% body weight was 1.77 (95% CI 1.58-1.99, [number needed to treat 5, 95% CI 4-7]), and the relative risk for loss of ≥ 10% body weight was 1.91 (95% CI 1.69-2.16, [number needed to treat 9, 95% CI 7-12]). Incidence of type 2 diabetes was lower among pre-diabetic intervention participants (relative risk 0.62 [95% CI 0.50-0.77], number needed to treat 17 [95% CI 13-29]). With prevalence rates for type 2 diabetes on the rise, weight loss coupled with a reduction in the incidence of type 2 diabetes could potentially have a significant benefit on population health and a possible reduction in need for drug treatments for glycemic control. INTERPRETATION There is moderate quality evidence that behavioural and pharmacologic plus behvioural, treatments for overweight and obesity in adults lead to clinically important reductions in weight and incidence of type 2 diabetes in pre-diabetic populations. REGISTRATION PROSPERO no. CRD42012002753.
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Affiliation(s)
- Leslea Peirson
- McMaster Evidence Review and Synthesis Centre, McMaster University Hamilton, Ont
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, Ont
- St. Joseph’s HealthCare, Hamilton, Ont
| | - Donna Ciliska
- McMaster Evidence Review and Synthesis Centre, McMaster University Hamilton, Ont
| | | | - Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Centre, McMaster University Hamilton, Ont
| | - Parminder Raina
- McMaster Evidence Review and Synthesis Centre, McMaster University Hamilton, Ont
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34
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Ellis A, Crowe K, Lawrence J. Obesity-related inflammation: implications for older adults. J Nutr Gerontol Geriatr 2014; 32:263-90. [PMID: 24224937 DOI: 10.1080/21551197.2013.842199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The combination of age-related increases in obesity and inflammation can lead to chronic disease, decreased strength, and physical disability. Lifestyle interventions that include moderate caloric restriction along with aerobic and resistance exercise have shown improvements in metabolic outcomes, strength, and physical function in obese older adults. Although few weight loss studies have addressed diet quality, evidence summarized in this review suggests that encouraging intake of antioxidant-rich fruits and vegetables, high-quality protein, low-glycemic index carbohydrates, and omega-3 fatty acids may further ameliorate obesity-related inflammation. Future controlled trials are indicated to examine the effects of incorporating these foods into multimodal weight loss interventions.
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Affiliation(s)
- Amy Ellis
- a Department of Human Nutrition , University of Alabama , Tuscaloosa , Alabama , USA
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35
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Jackson SE, Beeken RJ, Wardle J. Predictors of weight loss in obese older adults: findings from the USA and the UK. Obes Facts 2014; 7:102-10. [PMID: 24685619 PMCID: PMC5644890 DOI: 10.1159/000362196] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 09/11/2013] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine the prevalence and demographic predictors of clinically meaningful weight loss in community samples of obese older adults in the USA and the UK. METHODS Data were from obese older adults (BMI ≥ 30 kg/m(2); age ≥ 52 years), free of a cancer diagnosis, from the Health and Retirement Study (HRS; n = 3398) and the English Longitudinal Study of Ageing (ELSA; n = 998). Weight change was assessed from 2004 to 2008. Multivariable logistic regression tested whether age, sex, ethnicity, marital status, education, or BMI predicted ≥ 5% weight loss. RESULTS Over a quarter (28.7%) of obese participants from HRS and 16.6% from ELSA lost ≥ 5% weight. Being female (odds ratio (OR) = 1.31, 95% confidence interval (CI) = 1.11-1.54) and heavier (BMI ≥ 35 kg/m(2)) (OR = 1.60, 95% CI = 1.37-1.87) predicted weight loss in HRS. Trends were similar in ELSA (female: OR = 1.18, 95% CI = 0.83-1.69; BMI ≥ 35 kg/m(2): OR = 1.24, 95% CI = 0.85-1.82). ORs were increased in ≥ 65-year-olds in HRS (OR = 1.55, 95% CI = 1.33-1.81), and reduced in married people in ELSA (OR = 0.69, 95% CI = 0.48-1.00). Neither education nor ethnicity predicted weight loss in either cohort. CONCLUSION A high proportion of obese older adults experience clinically meaningful weight loss, but few demographic variables consistently predict weight loss in this population.
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Affiliation(s)
| | | | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
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36
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Lechleitner M. [Obesity in the elderly: clinical relevance and therapy options]. Z Gerontol Geriatr 2014; 46:398-402. [PMID: 23780631 DOI: 10.1007/s00391-013-0511-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The prevalence of obesity is increasing, also in the elderly population. During advancing age in adulthood body weight continues to increase up to peak values at about 65 years of age followed by a decline in older age. Overweight and obesity are related to an increase in the cardiometabolic risk, but also to an increased incidence of degenerative joint disease, functional limitations, and immobility. An increase in mortality risk was demonstrated for BMI values > 30 kg/m(2), which are in the range of obesity. It is therefore suggested to consider weight reduction in obese elderly primarily with respect to weight-related comorbidities and functional limitations that may benefit from weight loss. The central aim of weight loss in the obese elderly is to improve quality of life. Nutritional recommendations combined with individually adapted exercise programs are helpful to prevent malnutrition, sarcopenia, and osteoporosis. No data are available about the safety of drug therapy for weight reduction in the elderly.
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Affiliation(s)
- M Lechleitner
- Abteilung für Innere Medizin, Landeskrankenhaus Hochzirl, Anna-Dengel-Haus, 6170, Zirl, Österreich.
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37
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Marihart CL, Brunt AR, Geraci AA. Older adults fighting obesity with bariatric surgery: Benefits, side effects, and outcomes. SAGE Open Med 2014; 2:2050312114530917. [PMID: 26770722 PMCID: PMC4607185 DOI: 10.1177/2050312114530917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/12/2014] [Indexed: 12/14/2022] Open
Abstract
The aging population is growing exponentially worldwide. Associated with this greater life expectancy is the increased burden of chronic health conditions, many of which are exacerbated by the continued rise in obesity. In the US, the prevalence of obesity in adults aged 60 years and older increased from 23.6% to 37% in 2010.
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Affiliation(s)
- Cindy L Marihart
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Ardith R Brunt
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Angela A Geraci
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
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38
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Smith-Ray RL, Fitzgibbon ML, Tussing-Humphreys L, Schiffer L, Shah A, Huber GM, Braunschweig C, Campbell RT, Hughes SL. Fit and Strong! Plus: design of a comparative effectiveness evaluation of a weight management program for older adults with osteoarthritis. Contemp Clin Trials 2013; 37:178-88. [PMID: 24316240 DOI: 10.1016/j.cct.2013.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 11/27/2013] [Accepted: 11/30/2013] [Indexed: 01/06/2023]
Abstract
Osteoarthritis (OA) is the most common chronic condition and principal cause of disability among older adults. The current obesity epidemic has contributed to this high prevalence rate. Fortunately both OA symptoms and obesity can be ameliorated through lifestyle modifications. Physical activity (PA) combined with weight management improves physical function among obese persons with knee OA but evidence-based interventions that combine PA and weight management are limited for this population. This paper describes a comparative effectiveness trial testing an evidence-based PA program for adults with lower extremity (LE) OA, Fit and Strong!, against an enhanced version that also addresses weight management based on the evidence-based Obesity Reduction Black Intervention Trial (ORBIT). Adult participants (n=400) with LE OA, age 60+, overweight/obese, and not meeting PA requirements of ≥ 150 min per week, are randomized to one of the two programs. Both 8-week interventions meet 3 times per week and include 60 min of strength, flexibility, and aerobic exercise instruction followed by 30 min of education/group discussion. The Fit and Strong! education sessions focus on using PA to manage OA; whereas Fit and Strong! Plus addresses PA and weight loss management strategies. Maintenance of behavior change is reinforced in both groups during months 3-24 through telephone calls and mailed newsletters. Outcomes are assessed at baseline, and 2, 6, 12, 18, and 24 months. Primary outcomes are dietary change at 2 months followed by weight loss at 6 months that is maintained at 24 months. Secondary outcomes assess PA, physical performance, and anxiety/depression.
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Affiliation(s)
- Renae L Smith-Ray
- University of Illinois at Chicago, Institute for Health Research and Policy, Center for Research on Health and Aging, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, United States.
| | - Marian L Fitzgibbon
- University of Illinois at Chicago, Department of Medicine, Division of Health Promotion Research, 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois at Chicago, Institute for Health Research and Policy, Health Promotion Research Program, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois Cancer Center, Population Health, Behavior and Outcomes Program, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Lisa Tussing-Humphreys
- University of Illinois at Chicago, Department of Medicine, Division of Health Promotion Research, 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois at Chicago, Institute for Health Research and Policy, Health Promotion Research Program, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois Cancer Center, Population Health, Behavior and Outcomes Program, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Linda Schiffer
- University of Illinois at Chicago, Department of Medicine, Division of Health Promotion Research, 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Amy Shah
- University of Illinois at Chicago, Institute for Health Research and Policy, Center for Research on Health and Aging, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Gail M Huber
- Northwestern University, Feinberg School of Medicine, Physical Therapy and Human Movement Sciences, 645 N Michigan Avenue, Suite 1100, Chicago, IL 60611, United States
| | - Carol Braunschweig
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 646 Applied Health Sciences Building, 1919 West Taylor Street, Chicago, IL 60612, United States
| | - Richard T Campbell
- University of Illinois at Chicago, Institute for Health Research and Policy, Center for Research on Health and Aging, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois at Chicago, Institute for Health Research and Policy, Health Promotion Research Program, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, United States
| | - Susan L Hughes
- University of Illinois at Chicago, Institute for Health Research and Policy, Center for Research on Health and Aging, 486 Westside Research Office Bldg., 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois Cancer Center, Population Health, Behavior and Outcomes Program, 1747 West Roosevelt Road, Chicago, IL 60608, United States; University of Illinois at Chicago, Department of Kinesiology and Nutrition, 646 Applied Health Sciences Building, 1919 West Taylor Street, Chicago, IL 60612, United States
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