[From GLP1 receptor agonists to triple hormone receptor activation supplemented with glucagon receptor agonism.]

Following the introduction of mono- and then dual hormone (incretin) receptor agonists into therapy, attention was turned to multiple receptor stimulation, with the additional activation of the glucagon receptor, as a new option for the pharmaceutical treatment of type 2 diabetes and obesity. In addition to its role in carbohydrate metabolism, the article reviews the other important physiological tasks of glucagon, especially its participation in intrainsular paracrine regulation, energy expenditure and the shaping of appetite and food consumption. It covers the potential benefits of the triple combination and briefly touches data on the efficacy and safety of the first triple receptor agonist drug, retatrutide, in preclinical human studies. Further confirmation of the promising results may represent progress in the treatment of these forms of disease and their accompanying conditions, such as steatosis hepatis. Orv Hetil. 2023; 164(42): 1656-1664.

Therapy and prevention of obesity: nutrition, physical activity and medical treatment

Összefoglaló. Az elhízás és következményes megbetegedései fontos népegészségügyi problémát jelentenek hazánkban is. Kezelése komoly szakmai kihívás, ugyanakkor prevenciója eredményesebb lehet. Az elhízott betegekkel leggyakrabban találkozó háziorvosok, más szakorvosok és egészségügyi szakemberek részéről nagy igény van egy viszonylag rövid, áttekinthető, naprakész gyakorlatias útmutatóra. A különböző orvosszakmai társaságokban tevékenykedő, évtizedes szakmai tapasztalatokkal rendelkező szerzők összefoglalják tudományosan megalapozott, bizonyítékokon alapuló ismereteiket. Az elhízás kezelését lépcsőzetesen célszerű megkezdeni, előtte felmérve a beteg motivációját, általános állapotát, lehetőségeit. A szerzők leírják az energiaszükséglet meghatározásával, az étrenddel és a fizikai aktivitás megtervezésével kapcsolatos alapvető szempontokat. Felsorolják a hazánkban elérhető gyógyszereket és metabolikus sebészeti beavatkozásokat, az életmódi támogatás igényét. Az elhízás megelőzésében az élet első 1000 napjának táplálkozása, a későbbiekben a szülői minta a meghatározó. Sok kihasználatlan lehetősége van a háziorvosok, a lakóközösségek, az állami szervek koordinált együttműködésének, helyi kezdeményezéseknek. Az elhízás betegségként való meghatározása egyaránt igényel egészségpolitikai és kormányzati támogatást, az elhízottak ellátására szakosodott multidiszciplináris centrumok számának és kompetenciájának növelését. Orv Hetil. 2021; 162(9): 323-335. Summary. Obesity and related morbidities have a high public health impact in Hungary. The treatment is a challenge, but prevention seems more effective. General practitioners, other specialists and health care professionals who are treating obese persons require short, summarized, updated and practical guideline. Hungarian medical professionals of different scientific societies, having decennial practices, are summarizing their evidence-based knowledge. Obesity management requires step by step approach, evaluating previously the general health condition, motivation and options of the patients. The measurement of energy requirement, planning of diet and physical activities, available surgical methods and medications are described in detail with life style and mental support needed. The most important period in the prevention of obesity is the first 1000 days from conception. Other significant factors are the life style habits of the parents. Proper obesity prevention requires better coordination of primary health care, community and governmental activities. Obesity should be defined as morbidity, therefore stronger governmental support and more health-policy initiatives are needed, beside increasing number and developing of multidisciplinary centres. Orv Hetil. 2021; 162(9): 323-335.

Current and future burden of obesity in the Hungarian Roma population II

INTRODUCTION

Population-specific obesity in different age groups and in the Roma population as well as the presence of noncommunicable diseases that are linked to obesity necessitate the development of ethnical-specific prevention and intervention programmes.

AIM

Our goal is to model the effects on nutritional status of interventional programmes of different intensities carried out in various age groups of the Roma population.

METHOD

We defined the effect of different public health interventions on the state of health of the Roma population by use of the Dynamic Modeling for Health Impact Assessment software. Two models of interventions were studied throughout our research: one that focuses on only one aspect of lifestyle changes; and one that includes radical prevention programmes that aim to change lifestyles as a whole and have an impact on nutritional status.

RESULTS

Nearly 20% of Roma men and women are obese, and by 2070, one third of the Roma population will be overweight or obese without any public health intervention. Not even when the most efficient proceedings of the scientific literature are applied do prevention-intervention programmes of moderate-intensity offer a perceptible result about the incidence and prevalence of diseases linked to obesity. In the case of application of these programs, not more than a ten-person order of magnitude decrease can be achieved. This is not enough to prove a statistical detectability on the population level. Whereas, complex intervention programmes, based on a comprehensive transformation of lifestyle and food consumption patterns can present perceptible outcome primarily among the middle-aged and the elderly.

CONCLUSION

The survey results direct attention to the fact that reducing the burden of disease in the Roma population caused by obesity is only to be achieved as a complex, all-councils act that requires resources much greater than what is available now. Orv Hetil. 2020; 161(27): 1137-1145.

[Tools for increasing adherence in weight control]

Long-term successful weight control poses a huge challenge to people who are overweight and treat them in the obesogenic environment. After reaching a clinically significant (5-10%) weight loss, the goal is to maintain the weight loss achieved. However, this requires virtually constant resistance to temptations and requires sustained effort in terms of dietary restriction and physical activity, which requires a strong motivational base. From the point of view of behavior, motivation is the probability that the patient starts, pursues, or persistently follows a strategy that triggers change, that is, in the case of obesity, is committed to health-related behaviors that support weight management and abandons health risk behaviors that hinders weight control efforts. The present study describes the transtheoretical model of behavioral change and provides examples of practical ways to increase motivation and adherence at all stages of behavioral change. All this can contribute to the work of primary care and outpatient care professionals in supporting weight loss patients with excess weight. Orv Hetil. 2019; 160(43): 1687-1697.

[Musculoskeletal relevance of obesity: a new approach to an old topic]

Authors discuss the musculoskeletal aspects of obesity by applying a novel approach. Biochemical changes associated with obesity and especially metabolic syndrome, may have a great impact on the function of bones, joints and muscles. Therefore we need a new view and new strategies in rheumatic diseases. Obesity-associated metabolic changes should be considered during the progress of as well as the selection of treatment in inflammatory rheumatic diseases. Individualised treatment is necessary due to associated comorbidities as well. Orv Hetil. 2019; 160(44): 1727-1734.

[Poor sleep quality and inadequate sleep duration related to obesity in two Roma subgroups in Transylvania]

Introduction: Short sleep duration and poor sleep quality may be associated with weight gain; this association has not yet been studied in Roma (Gipsy) population. Aim: Our aim was to study sleep patterns in two adult Roma subgroups (the wealthy Gabor and the poor Lovari Roma), compared to the majority of Hungarian population, in relation to obesity, knowing that Roma population has specific socio-cultural characteristics, with a rapidly changing lifestyle. Method: A population-based cross-sectional survey was conducted in a rural region in Transylvania, where the above groups are cohabiting. The groups were age- and gender-matched. Results: Sleep duration was 7.18 ± 1.6 hours in the Gabor Roma, 7.67 ± 1.5 hours in the Lovari Roma and 7.37 ± 1.5 hours in the non-Roma group. In average, 70% of them had enough sleep (≥7 hours). 38.6% of Gabor Roma, 27.1% of Lovari Roma and 23.5% of non-Roma had poor-quality sleep (p = 0.05). Gabor Roma had significantly higher body mass index (31.1 ± 4.6 versus 27.4 ± 5.2 and 28.66 ± 5.7 kg/m², p = 0.004), and this correlated inversely with sleep duration (F = 14.85, p<0.000). Conclusion: Gabor Roma had significantly higher percentage of poor-quality sleep. Sleep duration and sleep quality were linked with obesity, mainly in the Roma population. Orv Hetil. 2019; 160(32): 1279-1283.

[Current and future burden of obesity at the Hungarian Roma population I]

Introduction: The Roma population rapidly gains in importance in the social structure of Hungary. An adverse consequence of the multiple disadvantageous position of this minority is the unhealthy nutrition, which leads to obesity and high prevalence of its co-diseases. Aim: Based on primer anthropometric data collection, we will determine the nutritional status of the Hungarian Roma population, then on the basis of official statistical data, an estimation and prognoses will be prepared on the disease burden of obesity according to genders and age. Method: A long-range forecast of the population size of the Roma minority's prognosis has been prepared on the basis of official statistics and time-series by Spectrum 5.0 demographic software. On this basis, applying the Dynamic Modeling for Health Impact Assessment software, we have prepared a forecast for the incidence and prevalence of the most important diseases attributable to obesity. Results: In the next decades, the number of the Roma population will be doubled, but there is a high level of uncertainty of different forecasts. The nutritional status of the Hungarian roma population is less favorable, than the indicators, characterizing the Hungarian population as a whole. In the next half a century, the prevalence of co-morbidities of obesity will be increasing from 6 thousand up to 26 thousand in the case of women, while in the case of men from nearly 6 thousand up to 17 thousand. Conclusions: The rapidly increasing number of the Roma population is an increasing challenge for the Hungarian healthcare system, which highlights the importance of evidence-based prevention and intervention programs. Orv Hetil. 2019; 160(28): 1097-1104.

[Psychological assessment of candidates for bariatric surgery]

Nowadays, the number of bariatric surgery for treating morbid obesity is significant. There is strong evidence about the influence of mental state (depression, anxiety, eating disorder, etc.) on patient's cooperation with the medical team and the outcome, and on the short or long-term effectiveness of surgery. However, no protocol or recommendation exist for screening patients before bariatric procedures in Hungary. Thus, even if the surgeon or the hospital requires psychological expertise, neither doctors are familiar with the expectable results of such an expertise, nor psychologists know exactly what the most important areas are to talk through with patients. This article shortly reviews the mostly used bariatric surgery procedures and presents a protocol that was developed by the Ochsner Clinic, New Orleans in detail. Based on the protocol, the core parts of the psychological interview are the following: reasons for seeking surgery (I.), weight and diet history (II.), current eating behaviors (III.), understanding of the surgery and its associated lifestyle changes (IV.), social supports (V.), and history and psychiatric symptoms (current and past) (VI.). The original protocol was completed with newer, more recent studies, statements, and with examples by the authors. Orv Hetil. 2019; 160(12): 448-455.

[The addictive model of obesity: psychoneurobiological relationships]

Among the various etiological theories (e.g., psychosomatic stress) the addictive model of obesity has also been described. Those suffering from eating disorders triggered by emotional causes (in consequence of the reward system) tend to grab a snack mostly out of happiness. The aim of the present study was to examine the addictive model of obesity so that the relationships identified here could help provide more accurate treatments to those suffering from being overweight. This study identifies the anatomical, neurobiological and psychic relationships between the etiological factors from the aspect of the addictive model of obesity so that further logical relationships could be confirmed based on the conclusions drawn here. Another system participating in energy homeostasis besides the rewarding or dopamine controlling circles is the hypothalamic pro-opiomelanocortin (POMC) system. The effects and efficiency of these systems can be modified by different biological factors and molecules. By exploring these neurobiochemical processes it may become understandable why someone who is not hungry will eat and have a tendency to overeat while others will not and why someone is unable to lose weight permanently without relapse. Therefore in the light of the findings further opportunities for intervention and treatment could be identified (with drugs or by psychotherapy) which would allow us to develop more sophisticated and tailor-made therapeutic solutions for the clinical picture of obesity as well. Orv Hetil. 2018; 159(27): 1095-1102.

[Motivation for weight loss among weight loss treatment participants]

INTRODUCTION

Unrealistic expectations about weight goal and about weight loss-related benefits can hinder the effort for a successful long-term weight control.

AIM

To explore weight loss-related goals and their background among overweight/obese patients.

METHOD

Study sample consisted of patients who participated in the inpatient weight loss treatment in the Lipidological Department of Szent Imre Hospital (n = 339, 19% men). Mean age: 50.2 years (SD = 13.47 years), mean BMI: 38.6 (SD = 7.58).

MEASURES

self-reported anthropometric data, type and number of treated illnesses, Goals and Relative Weights Questionnaire, Motivations for Weight Loss Scale, Body Shape Questionnaire.

RESULTS

Participants would feel disappointed with a possible 10% weight loss in a half-year time span. The acceptable weight loss percentage was higher among women, younger participants and among those who had more excess weight. Motivation regarding the increase in social desirability by weight loss is in association with body dissatisfaction, health related motivation is in association with the number of treated illnesses.

CONCLUSIONS

Our results are contributing to the understanding of motivational factors behind weight reduction efforts, considering these can improve treatment success rates. Orv Hetil. 2017; 158(49): 1960-1967.

[Experiences with the Three-Factor Eating Questionnaire-R21 in young men]

INTRODUCTION

Eating behaviours play a crucial role in the development of obesity.

AIMS

To conduct a psychometric analysis of the Three-Factor Eating Questionnaire-R21 and to investigate the correlates of obesogenic eating behaviours among males.

METHOD

Participants of the cross-sectional questionnaire-based study were male university students (n = 239, mean of age: 20.3 years, SD = 2.78 years).

MEASURES

self-reported body weight and body height, Three-Factor Eating Questionnaire-R21, Trait Anxiety Scale of the State-Trait Anxiety Inventory.

RESULTS

Results of confirmatory factor analysis supported the theoretical model of the Three-Factor Eating Questionnaire-R21 (χ²₍₁₈₆₎ = 366.1, p<0.001, CFI = 0.959, TLI = 0.954, RMSEA = 0.064). Internal consistency of the scales was adequate (Cronbach's α: 0.79-0.88). Body Mass Index and trait anxiety showed significant, positive associations with eating behaviours, such as uncontrolled eating, cognitive restraint, and emotional eating.

CONCLUSIONS

Results support the construct validity and reliability of the Three-Factor Eating Questionnaire-R21 among males and highlight the importance of taking psychological factors into account in the prevention of obesity. Orv Hetil. 2017; 158(37): 1469-1477.

[Hungarian Diet and Nutritional Status Survey 2014. I. Nutritional status of the Hungarian adult population]

INTRODUCTION AND AIM

The Hungarian Diet and Nutritional Status Survey examines the obesity prevalence, dietary habits and, since 2014, physical activity in Hungarian adults in every 5 years.

METHOD

The survey provides national data representative by age and gender, based on anthropometric measurements and international standards.

RESULTS

In 2014, nearly two-thirds of adults were overweight or obese. 28.2% of men and 31.5% of women were obese. Prevalence of morbid obesity were 2.6% and 3.3% in men and women, respectively. Abdominal obesity was more prevalent among women than men (55% vs. 38%), and the rate was increasing with age in both genders. In elderly, 55% of men and almost 80% of women were abdominally obese.

CONCLUSION

In conclusion, the prevalence of overweight, obesity, and abdominal obesity is high in Hungarian adults. In order to tackle obesity, we need to obtain representative and measured data, which form the basis of targeted interventions and the assessment of their impact. Orv. Hetil., 2017, 158(14), 533-540.

[Relationship of infant feeding on childhood obesity. A literature review]

The increasing frequency of childhood obesity is a serious public health concern. Today it is recognized that the infant feeding during critical periods of early human development ("the first 1000 days") can be a long-term impact for future health. Authors deal with with the infant period of the first 1000 days of life starting from the conception, based on literature review. Since 2010 a large number of publications have appeared in which the relationship between infant feeding, early weight gain and later obesity are investigated. The majority of studies have demonstrated, that breastfeeding has a marked effect on early growth and reduces the risk of obesity in the long-term. The health benefits of breastfeeding over infant formula feeding are accepted, however, the relationship between infant feeding and later obesity, there is no clear consensus in the literature. The authors investigated this contradiction reviewing the newly published articles over the last few years. In summary they established, that duration of breastfeeding for at least 4 months have an important role in lowering of childhood adiposity risk. The different or ambiguous statements in the relevant publications can be explained by the fact that the development and the prevention of obesity are multifactorial. Orv Hetil. 2017; 158(24): 938-943.

[Analysis of plantar pressure patterns among obese population]

INTRODUCTION

Although the role of body weight on foot health and load has been widely documented in research, the effect of the extra load due to body weight on plantar pressure characteristics is not well known.

AIM

The aim of this study was to evaluate the impact of obesity on plantar pressure patterns among the working-age population.

METHOD

180 participants were involved. Two groups were evaluated according to body mass index categories regarding eight regions of the plantar area, focusing on the following parameters: contact area, maximum pressure and peak pressure.

RESULTS

Compared with non-obese subjects, the peak pressure was the highest on the midfoot (p<0.001) and the forefoot (p<0.001). Regarding the maximum force, significant statistical difference was detected on the toes (p<0.001), with a value lower among the obese group. The contact area on the total foot and the midfoot was lower among the non-obese subjects (p<0.001).

CONCLUSIONS

Loading is greatly increasing on the whole plantar area, especially at the midfoot and the forefoot region. Orv. Hetil., 2016, 157(48), 1919-1925.

[Plant-based diets: a review]

Plant-based diet is an old-new trend in nutrition. In this review based on a historical context, we wish to introduce this popular nutritional trend. Our aim is to present plant-based diet as a primary measure for prevention. We intend to critically analyse some past stereotypes related to plant-based diet - whose main components include fruits, vegetables, whole grains, legumes, nuts and seeds - according to the literature (e.g. protein, vitamin B₁₂, folic acid, and iron intake) by doing so we wish to create an adequate conceptual basis for its interpretation. We discuss positive physiological effects of plant-based diet and its possible role in diseases risk reduction. Cardiovascular and metabolic diseases developing due to obesity could be prevented by a properly compiled plant-based diet. For patients with cancer minimizing the intake of foods of animal origin - as opposed to plant-based ones - has proved to have positive effects. Our review suggests this diet can be used in a number of diseases and it also provides long-term sustainable solutions for the health care challenges of the newest era. Orv. Hetil., 2016, 157(47), 1859-1865.

[Obese Hungary. Trend and prevalence of overweight and obesity in Hungary, 2015]

INTRODUCTION

The prevalence of obesity is growing continuously worldwide, even in Hungary. Since 1988, when the first professional wide-range evaluation was performed, only limited data are available.

AIM

Authors present the results of the ever largest Hungarian obesity-prevalence surveys, performed by family and occupational physicians.

METHOD

Data from 0.55% of the population above 18 year were registered in all geographical regions of Hungary (43,287 persons; 17,901 males and 25,386 females), close to the proper national representativeness. Age, body mass index, waist circumference, educational level, presence of hypertension and/or diabetes were analyzed statistically and compared with previous data.

RESULTS

The overall prevalence rate of overweight and obesity among men was 40% and 32%, respectively, while overweight and obesity occurred in 32% of women. In the different age groups of men, the prevalence of overweight and obesity was: 32.7% and 18.2% in 18-34 years; 40.1% and 34.4% in 35-59 years; 43.5% and 38.8% in over 60 years, respectively. In the same age groups of women, overweight and obesity occurred in 19.6% and 15.7%, 36.8% and 38.7%, and 36.5% and 39.7%, respectively. Body mass index and waist-circumference were presented according to age, by decades and by type of residency as well. The highest ratio of overweight was registered among men with the highest educational level, while highest ratio of obesity among women having the lowest education. Obesity according to Body mass index and abdominal obesity was the highest in the villages, especially among females. Registered metabolic morbidities were strongly correlated with body mass index and both were inversely related to the level of urbanization.

CONCLUSIONS

Over the previous decades, the ratio of the overweight and even the number of obese persons increased significantly, and it was most prominent among males, mainly in younger generation. Obesity means a serious medical, public health and economic problem, and it requires higher public awareness and political support. Orv. Hetil., 2016, 157(31), 1248-1255.

[Ayurveda for the treatment of obesity]

Obesity is an increasing problem all over the world as the lifestyle changes and fast food chains gain popularity. In India, 31% of men and 29% of women are overweight, which is a growing trend over the last 11 years. Obesity increases the risk of many diseases such as cardiovascular diseases, reflux disease, gastrointestinal tumors, and sleep apnea. Obesity without complications can also cause serious complications during surgery. In Ayurveda the formation of diseases depends on the balance of the three doshas - vata, pitta, kapha. The rate of three doshas varies depending on the body constitution of the indvidual. Studies of an Indian research group have shown that Ayurvedic body type classification may be associated with genes of inflammation and oxidative stress factors, the rate of DNA methylation and development of cardiovascular diseases. Orv. Hetil., 2016, 157(34), 1349-1352.

[Hyper-free fatty acidemia - insulin resistance and β-cell death]

The increasing prevalence of type 2 diabetes correlates with the rapid spread of obesity worldwide. Adipocytes are strained by the demand of excessive storage, and the local inflammation accelerates triglyceride turnover, which elevates the plasma levels of free fatty acids. Sustained hyper-free fatty acidemia leads to disturbances in cellular functions (lipotoxicity) or even to programmed cell death. Activated stress kinases interfere with insulin signaling, and often facilitate apoptosis. Hyper-free fatty acidemia, therefore, links obesity to diabetes through insulin resistance and β-cell damage. Lipotoxicity research - including the comparison of the effects exerted by saturated, unsaturated and trans fatty acids - provides explanations for long-known phenomena. Our widening knowledge in the field offers new strategies for prevention and treatment of the metabolic syndrome and diabetes.

[Invasive methods in the treatment of obesity]

Treatment of obesity and concomitant diseases have a significant burden on the health care system. Due to the lack of efficacy of conservative treatment methods, attention has shifted towards invasive methods. Surgical and endoscopic treatments of obesity are based on two different methods: restrictive and malabsorptive procedures or their combination. The author reviews the most effective surgical and endoscopic procedures in the treatment of obesity.

[Options for stress management in obesity treatment]

Overeating and physical inactivity are of great importance in the etiology of obesity. Psychological factors are often found in the background of life style. Chronic stress can contribute to physical inactivity and behaviors that hinder the keeping of a diet (e.g., irregular eating pattern, emotional eating). Results of randomized controlled trials show that relaxation can reduce emotional eating, improve cognitive restraint, and thereby reduce weight. However, stress management is more than relaxation. It consists of adaptive emotion-focused and problem-focused coping strategies and skills to improve relationships. Deflection skills may help in replacing emotional eating with other behaviors. Cognitive restructuring, saying no, and problem solving help to prevent or manage conflicts and difficulties otherwise would result in overeating due to distress. Developing stress management skills may result in greater compliance with the treatment. The techniques presented in the study can be easily applied by general practitioners or specialists, and provide tools for optimizing obesity treatment.

[Effect of healthy diet and physical activity on the level of non-HDL cholesterol in obese subjects without cardiovascular disease and diabetes mellitus]

INTRODUCTION

Prevention program including lifestyle changes was initiated with the participation of obese and overweight subjects recruited from the practices of 29 family doctors.

AIM

The aim of the author was to analyse changes of non-HDL-cholesterol levels, especially when triglyceride levels were above 2.26 mmol/l, and when non-HDL cholesterol levels were high in association with low HDL-cholesterol levels in overweight or obese subjects who had no cardiovascular disease and diabetes mellitus.

METHOD

Data obtained from 1192 subjects (424 men and 768 women) before and 12 month after inclusion into the prevention program was analysed.

RESULTS

The average level of non-HDL-cholesterol in the whole group of subjects decreased from 4.74 to 4.64 mmol/l, but the change was not significant. However, the average concentration of non-HDL-cholesterol was reduced significantly from 4.87 to 4.4 mmol/l in men, whereas no significant change was detected in women. In cases when triglyceride levels were higher than 2.26 mmol/l, the non-HDL-cholesterol level was reduced by 0.65 mmol/l. In cases when the non-HDL-cholesterol level was high in association with low HDL-cholesterol level, the non-HDL-cholesterol was significantly decreased from 5.22 to 4.48 mmol/l. In addition, in cases when HDL-cholesterol levels were low, the average level of the HDL-cholesterol significantly increased from 0.84 to 1.3 mmol/l.

CONCLUSIONS

Lifestyle changes decrease the level of atherogenic lipid fractions, particularly in men with high triglyceride levels. Improvement of the atherogenic lipid profile in response to lifestyle changes is related not only to the reduction of atherogenic lipid fractions, but also to the increase of HDL-cholesterol level.

[Metabolic complications of obesity during adolescence, particularly regarding elevated uric acid levels]

INTRODUCTION

Obesity is a social problem worldwide that leads to several diseases, including metabolic syndrome, hypertension and cardiovascular diseases. It is known that hyperuricemia in adults may be associated with these disorders.

AIM

The aim of the authors was to investigate the frequency of metabolic syndrome and hyperuricemia and their relationship among obese adolescents.

METHOD

This was a cross-sectional study. The authors analysed the data of 162 overweight or obese adolescents (100 boys and 62 girls) who were previously investigated in a paediatric endocrinology consultation. Anthropometric and metabolic parameters were evaluated in all subjects. Healthy, age-matched, non obese girls (n = 20) and boys (n = 26) were used as controls. The age of overweight or obese boys was: 12 ± 2.1 and overweight or obese girls was 11 ± 2.5 years. In the control group the age of boys was 12.9 ± 2.5 years and the age of girls was 13.2 ± 1.6 years. Linear regression was used to evaluate associations between uric acid and clinical and laboratory findings associated with metabolic syndrome.

RESULTS

Obese or overweight subjects had greater BMI SDS (boys, 3.4 ± 1.3 vs 0.05 ± 0.4 in controls, p<0.0001; girls, 3.75 ± 1.4 vs 0.72 ± 0.9 in controls, p = 0.0001), waist circumference (boys, 90.1 ± 9.2 vs 82.3 ± 6.4 cm in controls; girls, 90.2 ± 8.6 vs 78.1 ± 7.2 cm in controls, p<0.001), higher systolic blood pressure (boys, 125 ± 14.3 vs 118.2 ± 10.8 mmHg in controls, p = 0.02; girls, 125.8 ± 11.8 vs 119.8 ± 8.8 mmHg in controls, p<0.01), diastolic blood pressure (boys, 78.4 ± 9.1 vs 71.2 ± 8.0 mmHg in controls, p = 0.0003; girls, 76.45 ± 7.2 vs 73.2 ± 6.3 mmHg in controls, p = 0.0453). The prevalence of metabolic syndrome was 45/162 (27.8%) and the prevalence of hyperuricemia was 62/162 (38.3%). Of the 45 subjects with metabolic syndrome, 30 (66.7%) had hyperuricemia.

CONCLUSIONS

It can be concluded that hyperuricemia is strongly associated with metabolic syndrome. The high concentration of uric acid predicts cardiovascular risk in adulthood. It is important for paediatricians to determine and assess uric acid levels in overweight or obese adolescents.

[The estimated economic burden of overweight and obesity in Hungary]

INTRODUCTION

The pandemic of obesity has a great impact on the health care system, and it accounts for an increasing ratio of health care expenses.

AIM

The aim of this study was to estimate the economic burden of overweight and obesity including both the health care budget and financial contribution of patients.

METHOD

Data of the Hungarian National Health Insurance Fund were analyzed in the financial year of 2012. Expenses related to inpatient (hospital) and outpatient services and sick-leave finances related to obesity, diabetes and hypertension were analyzed. The incidence of obesity was calculated as high as 80% in diabetics and 60% in patients with hypertension.

RESULTS

According to this method of estimation, 207,000 million HUF (680 million EUR) was spent for treatment, which accounts for 11.6% of the total Hungarian health budget and corresponds to 0.73% of the gross domestic product. Additionally, at least 22,000 million HUF was paid by the patients as contribution to treatment. However, expenses related to overweight and obesity may be even higher considering a higher prevalence rate of overweight and obesity, and the occurrence of co-morbidities with higher costs (between 15% and 18% of the total health expenditure and at least 1% of the gross domestic product).

CONCLUSIONS

The results confirm that obesity- and overweight-related expenses represent a significant proportion of health care expenditure.

[Surgical options for reducing body weight]

Obesity is a leading preventable cause of death worldwide, with increasing prevalence in adults and children, and authorities view it as one of the most serious public health problems of the 21st century. Sixty-two percent of the Hungarian adult population has overweight and 27% is morbidly obese and, therefore, it is a significant interest to treat this condition. The authors review the diagnosis and the associated diseases of morbid obesity. The initial enthusiasm with the gastric band has settled now, as the long-term outcome showed only very limited reduction in the excess body weight and the complication rate was as high as 50%. The sleeve gastrectomy may induce 60-70% of excess weight loss, however, the long term follow-up data is very limited. The Roux-en-Y gastric bypass is the gold-standard of the bariatric procedures, with proven 60-75% excess weight loss and 80% type 2 diabetes remission. The body image usually changes with weight loss, and frequently a body contouring procedure is required to improve it. Multi-disciplinary team of super-specialised doctors is required to perform these procedures.

[Outcome of a one-year behavior therapy weight loss program]

INTRODUCTION

Treatment of obesity has become one of the most challenging issues.

AIM

The aims of the authors were to present the results of standard behavior therapy weight loss program combined with self-help and the results of one-year follow-up.

METHOD

The 24-week program involved 41 participants of which 33 subjects participated in the follow-up. Anthropometric data were obtained and the participants were asked to fill questionnaires (the 21 items Three Factor Eating Questionnair Revised 21 items; Physical Exercise: Steps of change [Short Form].

RESULTS

87.8% of participants achieved a minimum weight loss of 5% which is the rate expected in professional therapies for obesity. Significant changes in maladaptive eating pattern and an increase in the rate of regular exercise were observed. Significant association was found between the increase of cognitive restraint and the rate of weight loss during treatment. At one-year follow-up the majority of participants (75.8%) did keep their minimum weight loss of 5% and they showed significant change in eating pattern.

CONCLUSIONS

The results suggest that standard behavior therapy extended with self-help elements may be a cost-effective treatment of obesity.