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Petimar J, Young JG, Yu H, Rifas-Shiman SL, Daley MF, Heerman WJ, Janicke DM, Jones WS, Lewis KH, Lin PID, Prentice C, Merriman JW, Toh S, Block JP. Medication-Induced Weight Change Across Common Antidepressant Treatments : A Target Trial Emulation Study. Ann Intern Med 2024; 177:993-1003. [PMID: 38950403 DOI: 10.7326/m23-2742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Antidepressants are among the most commonly prescribed medications, but evidence on comparative weight change for specific first-line treatments is limited. OBJECTIVE To compare weight change across common first-line antidepressant treatments by emulating a target trial. DESIGN Observational cohort study over 24 months. SETTING Electronic health record (EHR) data from 2010 to 2019 across 8 U.S. health systems. PARTICIPANTS 183 118 patients. MEASUREMENTS Prescription data determined initiation of treatment with sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine. The investigators estimated the population-level effects of initiating each treatment, relative to sertraline, on mean weight change (primary) and the probability of gaining at least 5% of baseline weight (secondary) 6 months after initiation. Inverse probability weighting of repeated outcome marginal structural models was used to account for baseline confounding and informative outcome measurement. In secondary analyses, the effects of initiating and adhering to each treatment protocol were estimated. RESULTS Compared with that for sertraline, estimated 6-month weight gain was higher for escitalopram (difference, 0.41 kg [95% CI, 0.31 to 0.52 kg]), paroxetine (difference, 0.37 kg [CI, 0.20 to 0.54 kg]), duloxetine (difference, 0.34 kg [CI, 0.22 to 0.44 kg]), venlafaxine (difference, 0.17 kg [CI, 0.03 to 0.31 kg]), and citalopram (difference, 0.12 kg [CI, 0.02 to 0.23 kg]); similar for fluoxetine (difference, -0.07 kg [CI, -0.19 to 0.04 kg]); and lower for bupropion (difference, -0.22 kg [CI, -0.33 to -0.12 kg]). Escitalopram, paroxetine, and duloxetine were associated with 10% to 15% higher risk for gaining at least 5% of baseline weight, whereas bupropion was associated with 15% reduced risk. When the effects of initiation and adherence were estimated, associations were stronger but had wider CIs. Six-month adherence ranged from 28% (duloxetine) to 41% (bupropion). LIMITATION No data on medication dispensing, low medication adherence, incomplete data on adherence, and incomplete data on weight measures across time points. CONCLUSION Small differences in mean weight change were found between 8 first-line antidepressants, with bupropion consistently showing the least weight gain, although adherence to medications over follow-up was low. Clinicians could consider potential weight gain when initiating antidepressant treatment. PRIMARY FUNDING SOURCE National Institutes of Health.
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Affiliation(s)
- Joshua Petimar
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (J.P., J.G.Y.)
| | - Jessica G Young
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (J.P., J.G.Y.)
| | - Han Yu
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado (M.F.D.)
| | - William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee (W.J.H.)
| | - David M Janicke
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida (D.M.J.)
| | - W Schuyler Jones
- Division of Cardiology, Duke University Department of Medicine, and Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina (W.S.J.)
| | - Kristina H Lewis
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina (K.H.L.)
| | - Pi-I D Lin
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
| | - Carly Prentice
- Faith Family Medical Center, Nashville, Tennessee (C.P.)
| | - John W Merriman
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida (J.W.M.)
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
| | - Jason P Block
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (H.Y., S.L.R.-S., P.-I.D.L., S.T., J.P.B.)
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Pan XH, Tan B, Chin YH, Lee ECZ, Kong G, Chong B, Kueh M, Khoo CM, Mehta A, Majety P, Grandhi GR, Dimitriadis GK, Foo R, Chew NWS, Le Roux CW, Mamas MA, Chan MY. Efficacy and safety of tirzepatide, GLP-1 receptor agonists, and other weight loss drugs in overweight and obesity: a network meta-analysis. Obesity (Silver Spring) 2024; 32:840-856. [PMID: 38413012 DOI: 10.1002/oby.24002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/14/2023] [Accepted: 12/27/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVE This network meta-analysis evaluates the efficacy and safety of tirzepatide compared to glucagon-like peptide-1 receptor agonists (GLP-1 RA) and other weight loss drugs in the treatment of overweight and obesity. METHODS MEDLINE, Embase, and Cochrane CENTRAL were searched for randomized controlled trials on tirzepatide, GLP-1 RA, and weight loss drugs approved by the US Food and Drug Administration. A network meta-analysis was performed, drawing direct and indirect comparisons between treatment groups. Network diagrams and surface under the cumulative ranking curve analysis were performed for primary (≥5%, ≥10%, ≥15%, absolute weight loss) and secondary outcomes and adverse effects. RESULTS Thirty-one randomized controlled trials, involving more than 35,000 patients, were included in this study. Tirzepatide 15 mg ranked in the top three across weight-related parameters, glycemic profile (glycated hemoglobin), lipid parameters (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides), and blood pressure. Tirzepatide 15 mg had the highest efficacy compared with placebo for achieving ≥15% weight loss (risk ratio 10.24, 95% CI: 6.42-16.34). As compared to placebo, tirzepatide and GLP-1 RA across all doses had significant increases in gastrointestinal adverse effects. CONCLUSIONS The superiority of tirzepatide and GLP-1 RA in inducing weight loss and their ability to target multiple metabolic parameters render them promising candidates in the treatment of patients with overweight and obesity.
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Affiliation(s)
- Xin-Hui Pan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Bryan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yip Han Chin
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Ethan Cheng Zhe Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gwyneth Kong
- Ministry of Health Holdings, Ministry of Health, Singapore
| | - Bryan Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Martin Kueh
- Royal College of Surgeons in Ireland & University College Dublin Malaysia Campus, George Town, Malaysia
| | - Chin Meng Khoo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Endocrinology, National University Hospital, Singapore
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Priyanka Majety
- Department of Endocrinology, Diabetes and Metabolism, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Gowtham R Grandhi
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Georgios K Dimitriadis
- Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Roger Foo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Nicholas W S Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
| | - Carel W Le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mark Y Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore
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Landry MJ, Ward CP, Cunanan KM, Fielding-Singh P, Crimarco A, Gardner CD. Switching diets after 6-months does not result in renewed weight loss: a secondary analysis of a 12-month crossover randomized trial. Sci Rep 2024; 14:9865. [PMID: 38684815 PMCID: PMC11058757 DOI: 10.1038/s41598-024-60547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
Weight change trajectory from diet and lifestyle interventions typically involves rapid weight loss followed by a weight plateau after approximately 6 months. Changing from one weight-loss diet to another at the time of the plateau could instigate renewed weight loss. Therefore, our secondary analysis aimed to assess trajectory of weight loss in a 12-month, randomized, cross-over study. Forty-two adults were randomized to eat a healthy low-fat or healthy low-carbohydrate diet for 6 months then switched to the opposite diet for an additional 6 months. Regardless of diet assignment, participants experienced rapid initial weight loss, which slowed between 3 to 6 months. After switching diets at 6 months, weight modestly decreased until 9 months, but at a rate slower than the initial 3 months and slower than the rate from 3 to 6 months. This suggests that the weight loss plateau typically seen at 6 months is physiological and cannot be overcome by simply switching to a different weight-loss diet.
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Affiliation(s)
- Matthew J Landry
- Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, USA.
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, 856 Health Sciences Rd., Irvine, CA, 92697, USA.
| | - Catherine P Ward
- Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, USA
| | - Kristen M Cunanan
- Quantitative Science Unit, School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Anthony Crimarco
- Division of Gastroenterology and Hepatology, Stanford Center for Clinical Research, Stanford University, Redwood City, CA, USA
| | - Christopher D Gardner
- Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, USA
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Heindel JJ, Lustig RH, Howard S, Corkey BE. Obesogens: a unifying theory for the global rise in obesity. Int J Obes (Lond) 2024; 48:449-460. [PMID: 38212644 PMCID: PMC10978495 DOI: 10.1038/s41366-024-01460-3] [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: 08/31/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/13/2024]
Abstract
Despite varied treatment, mitigation, and prevention efforts, the global prevalence and severity of obesity continue to worsen. Here we propose a combined model of obesity, a unifying paradigm that links four general models: the energy balance model (EBM), based on calories as the driver of weight gain; the carbohydrate-insulin model (CIM), based on insulin as a driver of energy storage; the oxidation-reduction model (REDOX), based on reactive oxygen species (ROS) as a driver of altered metabolic signaling; and the obesogens model (OBS), which proposes that environmental chemicals interfere with hormonal signaling leading to adiposity. We propose a combined OBS/REDOX model in which environmental chemicals (in air, food, food packaging, and household products) generate false autocrine and endocrine metabolic signals, including ROS, that subvert standard regulatory energy mechanisms, increase basal and stimulated insulin secretion, disrupt energy efficiency, and influence appetite and energy expenditure leading to weight gain. This combined model incorporates the data supporting the EBM and CIM models, thus creating one integrated model that covers significant aspects of all the mechanisms potentially contributing to the obesity pandemic. Importantly, the OBS/REDOX model provides a rationale and approach for future preventative efforts based on environmental chemical exposure reduction.
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Affiliation(s)
- Jerrold J Heindel
- Healthy Environment and Endocrine Disruptor Strategies (HEEDS), Bozeman, MT, 59715, USA.
| | - Robert H Lustig
- Department of Pediatrics and Institute for Health Policy Studies, University of California, San Francisco, CA, 94143, USA
| | - Sarah Howard
- Healthy Environment and Endocrine Disruptor Strategies (HEEDS), Bozeman, MT, 59715, USA
| | - Barbara E Corkey
- Department of Medicine, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA, 02118, USA
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Nunes CL, Jesus F, Rosa GB, Marianito M, Francisco R, Bosy-Westphal A, Minderico CS, Martins P, Sardinha LB, Silva AM. Interindividual variability in energy intake and expenditure during a weight loss intervention. Appetite 2024; 193:107162. [PMID: 38101517 DOI: 10.1016/j.appet.2023.107162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Behavioral compensations may occur as a response to a negative energy balance. The aim of this study was to explore the associations between changes in energy intake (EI) and changes in physical activity (PA, min/day; kcal/d) as a response to a weight loss (WL) intervention and to understand if interindividual differences occur in EI and energy expenditure (EE). METHODS Eighty-one participants [mean (SD): age = 42.8 (9.4)y, BMI = 31.2 (4.4)kg/m2, 37% females] divided in intervention (IG, n = 43) and control group (CG, n = 38) were included. The IG underwent a moderate energy restriction (300-500 kcal/d). EI was measured through the intake-balance method. Non-exercise PA (NEPA) and exercise (through logbook) were assessed by accelerometery. The EE in NEPA (NEAT) and in exercise (EiEE) was calculated by applying the Freedson Combination'98 algorithm over the time spent in these activities. Pearson correlations were performed in IG to examine associations between EE components, EI and body composition. To understand if interindividual differences were observed, the SD of individual response (SDIR) and the smallest worthwhile change (SWC, SDbaselineCG×0.2) were calculated. RESULTS Changes in EI [Δ EI, (kcal/d)] was negatively associated with Δ exercise (min/d:r = -0.413, p = 0.045; %:r = -0.846, p = 0.008) and with Δ EiEE (kcal/d:r = -0.488, p = 0.016; %:r = -0.859, p = 0.006). A negative correlation was found between Δ sedentary time and Δ NEPA (min/d:r = -0.622, p = 0.002; %:r = -0.487, p = 0.018). An interindividual variability was found for EI(SDIR = 151.6, SWC = 72.3) and EE (SDIR = 165, SWC = 134). CONCLUSIONS Decreases in EI were not associated to compensatory responses such as decreases in PA and/or increases in sedentary time. Interindividual variability was found for EI and EE. Nevertheless, behavioral compensations and the interindividual variability should be considered when implementing WL interventions, to increase the likelihood of achieving sustainable results. (clinicaltrials.gov ID: NCT03031951).
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Affiliation(s)
- Catarina L Nunes
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal; Atlântica, Instituto Universitário, Fábrica da Pólvora de Barcarena, Portugal
| | - Filipe Jesus
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal
| | - Gil B Rosa
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal
| | - Mariana Marianito
- Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Ruben Francisco
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal
| | - Anja Bosy-Westphal
- Department of Human Nutrition, Institute of Human Nutrition and Food Sciences, Christian-Albrechts University, Kiel, Germany
| | - Cláudia S Minderico
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal
| | - Paulo Martins
- Laboratory of Sport Psychology, Faculdade de Motricidade Humana da Universidade de Lisboa, 1499-002 Cruz-Quebrada, Portugal
| | - Luis B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal
| | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002 Cruz-Quebrada, Portugal.
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Samarasinghe SNS, Woods C, Miras AD. Bariatric Surgery in Women with Polycystic Ovary Syndrome. Metabolism 2024; 151:155745. [PMID: 38036245 DOI: 10.1016/j.metabol.2023.155745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
Polycystic ovary syndrome (PCOS) is the most common endocrine condition in premenopausal women and is a common cause of anovulatory subfertility. Although obesity does not form part of the diagnostic criteria, it affects a significant proportion of women with PCOS and is strongly implicated in the pathophysiology of the disease. Both PCOS and obesity are known to impact fertility in women; obesity also reduces the success of assisted reproductive technology (ART). With or without pharmacotherapy, lifestyle intervention remains the first-line treatment in women with PCOS and obesity. Bariatric surgery is still an experimental treatment in women with PCOS and subfertility. This review will present an overview of the pathophysiology of PCOS and obesity and the role of bariatric surgery. Although data are sparse regarding the impact of bariatric surgery on subfertility in women with PCOS and obesity, existing studies point to a beneficial role in treating metabolic and reproductive dysfunction.
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Coutinho W, Halpern B. Pharmacotherapy for obesity: moving towards efficacy improvement. Diabetol Metab Syndr 2024; 16:6. [PMID: 38172940 PMCID: PMC10763391 DOI: 10.1186/s13098-023-01233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024] Open
Abstract
Obesity is a chronic, recurring, progressive disease and a major public health problem associated with several other diseases that lead to disability, morbidity, and mortality. The prevalence of obesity has increased at pandemic levels, along with increasing weight-related comorbidities and deaths worldwide. Lifestyle interventions alone provide clinically significant long-term weight loss in only a small proportion of individuals, and bariatric surgery is not suitable or desirable for all patients. Historically, anti-obesity medications achieved a mean efficacy with weight loss between 5 and 10%, which significantly impacted several comorbidities and risk factors, but the average efficacy of these medications remained lower than that expected by both patients and health care professionals and eventually curbed long-term use. Moreover, there is no direct evidence on the impact of anti-obesity medications on cardiovascular outcomes. Semaglutide is a newer anti-obesity medication that changes the overall landscape, as phase 3 studies show a mean weight loss near the 15% threshold and significant proportions of patients with a weight loss of greater than 20%. In this review, we focus on the currently available anti-obesity medications, discuss the results of semaglutide, and present perspectives on the future of obesity treatment after semaglutide.
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Affiliation(s)
- Walmir Coutinho
- State Institute of Diabetes and Endocrinology, Rua Moncorvo Filho, 90, Rio de Janeiro, RJ, 20211-340, Brazil.
- Department of Medicine, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Gávea, Rio de Janeiro, RJ, 22541-041, Brazil.
| | - Bruno Halpern
- Department of Endocrinology, Obesity Unit, Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo. Av. Dr. Enéas de Carvalho Aguiar, 255, 7Th Floor, Room 7037, São Paulo, SP, 05403-000, Brazil
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Woodie LN, Melink LC, Alberto AJ, Burrows M, Fortin SM, Chan CC, Hayes MR, Lazar MA. Hindbrain REV-ERB nuclear receptors regulate sensitivity to diet-induced obesity and brown adipose tissue pathophysiology. Mol Metab 2024; 79:101861. [PMID: 38142970 PMCID: PMC10792761 DOI: 10.1016/j.molmet.2023.101861] [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: 08/26/2023] [Revised: 12/08/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023] Open
Abstract
OBJECTIVE The dorsal vagal complex (DVC) of the hindbrain is a major point of integration for central and peripheral signals that regulate a wide variety of metabolic functions to maintain energy balance. The REV-ERB nuclear receptors are important modulators of molecular metabolism, but their role in the DVC has yet to be established. METHODS Male REV-ERBα/β floxed mice received stereotaxic injections of a Cre expressing virus to the DVC to create the DVC REV-ERBα/β double knockout (DVC RDKO). Control littermates received stereotaxic injections to the DVC of a green fluorescent protein expressing virus. Animals were maintained on a normal chow diet or a 60% high-fat diet to observe the metabolic phenotype arising from DVC RDKO under healthy and metabolically stressed conditions. RESULTS DVC RDKO animals on high-fat diet exhibited increased weight gain compared to control animals maintained on the same diet. Increased weight gain in DVC RDKO animals was associated with decreased basal metabolic rate and dampened signature of brown adipose tissue activity. RDKO decreased gene expression of calcitonin receptor in the DVC and tyrosine hydroxylase in the brown adipose tissue. CONCLUSIONS These results suggest a previously unappreciated role of REV-ERB nuclear receptors in the DVC for maintaining energy balance and metabolic rate potentially through indirect sympathetic outflow to the brown adipose tissue.
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Affiliation(s)
- Lauren N Woodie
- Institute for Diabetes, Obesity, and Metabolism, and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lily C Melink
- Institute for Diabetes, Obesity, and Metabolism, and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ahren J Alberto
- Institute for Diabetes, Obesity, and Metabolism, and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Michelle Burrows
- Institute for Diabetes, Obesity, and Metabolism, and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Samantha M Fortin
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Calvin C Chan
- Institute for Diabetes, Obesity, and Metabolism, and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew R Hayes
- Institute for Diabetes, Obesity, and Metabolism, and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mitchell A Lazar
- Institute for Diabetes, Obesity, and Metabolism, and Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Ross KM, You L, Qiu P, Shankar MN, Swanson TN, Ruiz J, Anthony L, Perri MG. Predicting high-risk periods for weight regain following initial weight loss. Obesity (Silver Spring) 2024; 32:41-49. [PMID: 37919882 PMCID: PMC10872625 DOI: 10.1002/oby.23923] [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: 02/28/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The aim of this study was to develop a predictive algorithm of "high-risk" periods for weight regain after weight loss. METHODS Longitudinal mixed-effects models and random forest regression were used to select predictors and develop an algorithm to predict weight regain on a week-to-week basis, using weekly questionnaire and self-monitoring data (including daily e-scale data) collected over 40 weeks from 46 adults who lost ≥5% of baseline weight during an initial 12-week intervention (Study 1). The algorithm was evaluated in 22 adults who completed the same Study 1 intervention but lost <5% of baseline weight and in 30 adults recruited for a separate 30-week study (Study 2). RESULTS The final algorithm retained the frequency of self-monitoring caloric intake and weight plus self-report ratings of hunger and the importance of weight-management goals compared with competing life demands. In the initial training data set, the algorithm predicted weight regain the following week with a sensitivity of 75.6% and a specificity of 45.8%; performance was similar (sensitivity: 81%-82%, specificity: 30%-33%) in testing data sets. CONCLUSIONS Weight regain can be predicted on a proximal, week-to-week level. Future work should investigate the clinical utility of adaptive interventions for weight-loss maintenance and develop more sophisticated predictive models of weight regain.
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Affiliation(s)
- Kathryn M. Ross
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Lu You
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
- Health Informatics Institute, University of South Florida, Tampa, FL, USA
| | - Peihua Qiu
- Department of Biostatistics, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA
| | - Meena N. Shankar
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Taylor N. Swanson
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Jaime Ruiz
- Department of Computer and Information Science and Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Lisa Anthony
- Department of Computer and Information Science and Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA
| | - Michael G. Perri
- Department of Clinical & Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
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Bagherzadeh-Rahmani B, Marzetti E, Karami E, Campbell BI, Fakourian A, Haghighi AH, Mousavi SH, Heinrich KM, Brazzi L, Jung F, Baker JS, Patel DI. Tirzepatide and exercise training in obesity. Clin Hemorheol Microcirc 2024; 87:465-480. [PMID: 38640145 DOI: 10.3233/ch-242134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
OBJECTIVES The purpose of this study was to investigate the effects of 6 weeks of resistance training (RT) combined with aerobic training (AT) and Tirzepatide supplementation on lipid profiles, insulin resistance, anthropometric characteristics and physical fitness in prediabetic obese soldiers. METHODS 61 obese men were randomly divided into six groups: Placebo; Tirzepatide 5 mg (T5); Tirzepatide 2.5 mg (T2.5); Hypertrophy, Strength, Power-Circuit Training+Placebo (Ex+P); Hypertrophy, Strength, Power-Circuit Training+Tirzepatide 5 mg (Ex+T5); Hypertrophy, Strength, Power-Circuit Training+Tirzepatide 2.5 mg (Ex+T2.5). All training groups performed aerobic training (AT) after resistance training. Subjects trained for six weeks, three sessions per week. Before and after the intervention period, the participants were evaluated for anthropometric measures, body composition [body weight, body mass index (BMI), waist circumference (WC), waist to hip ratio (WHR) and fat mass (FM)], cardiorespiratory fitness (VO2max), and muscle strength (chest press 1RM and leg press 1RM). Blood biochemistry evaluations included triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), insulin level and insulin resistance (HOMA-IR). To evaluate the differences between the groups, ANCOVA statistical method was used along with Bonferroni's post hoc test, and the significance level was P < 0.05. RESULTS Body weight, BMI, WC, FM, FBG, LDL-C, TC, TG and HOMA-IR were significantly decreased in Ex+P, Ex+T5 and Ex+T2.5 groups compared to Placebo, T5 and T2.5 groups. WHR significantly decreased in Ex+P, Ex+T5 and Ex+T2.5 groups compared to Placebo group. HDL-C, chest press and leg press significantly increased in Ex+P, Ex+T5 and Ex+T2.5 groups compared to Placebo, T5 and T2.5 groups. VO2max significantly increased and insulin significantly decreased in Ex+P group compared to Placebo, T5 and T2.5 groups. FM, FBG and TG were significantly decreased in both the T2.5 and T5 groups compared to Placebo group. HOMA-IR, LDL-C and TC significantly decreased in the T5 group compared to Placebo group. Also, leg press significantly increased in Ex+P group compared to all other groups. CONCLUSIONS Performing six weeks of combined resistance and aerobic training in the form of RT+AT alone is more effective than the simultaneous use of Tirzepatide on cardiorespiratory fitness, strength, and modulating insulin levels. Taking Tirzepatide in doses of 5 mg and 2.5 mg in combination with exercise training did not have a significant advantage over exercise training alone. Finally, taking Tirzepatide in doses of 5 mg or 2.5 mg in combination with exercise training is not significantly superior to each other.
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Affiliation(s)
- Behnam Bagherzadeh-Rahmani
- Department of Exercise Physiology, Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - Emanuele Marzetti
- Department of Geriatrics and Orthopedics, UniversitÀ Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Esmail Karami
- Department of Physiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Bill I Campbell
- Performance & Physique Enhancement Laboratory, University of South Florida, Tampa, FL, USA
| | - Ali Fakourian
- Department of Exercise Physiology, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Amir Hossein Haghighi
- Department of Exercise Physiology, Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar, Iran
| | - Seyyed Hossein Mousavi
- Department of Cardiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Katie M Heinrich
- Department of Kinesiology, Kansas State University, Manhattan, KS, USA
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Friedrich Jung
- Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Julien S Baker
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon, Hong Kong
| | - Darpan I Patel
- School of Nursing, University of Texas Medical Branch, Galveston, TX, USA
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11
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Podestá D I, Blannin AK, Wallis GA. Post-exercise dietary macronutrient composition modulates components of energy balance in young, physically active adults. Physiol Behav 2023; 270:114320. [PMID: 37558044 DOI: 10.1016/j.physbeh.2023.114320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/14/2023] [Accepted: 08/05/2023] [Indexed: 08/11/2023]
Abstract
The effectiveness of exercise to reduce body mass is typically modest, partially due to energy compensation responses which may be linked to energy substrate availability around exercise. The present study aimed to investigate the effect of manipulating post-exercise energy substrate availability (high carbohydrate/low fat [HCLF] or low carbohydrate/high fat [LCHF] energy replacement) on energy balance components in the short-term (i.e., appetite, energy intake (EI) and energy expenditure (EE)). METHODS Appetite, EI, activity- and total- EE were measured in twelve healthy, young (21.0 ± 2.3 years) physically active participants (10 men, 2 women) on two occasions across 4 days after a 75-min run and an isocaloric energy replacement drink (HCLF and LCHF). Appetite was measured daily by visual analogue scales, EI was calculated by subtracting the energy content of food leftovers from a provided food package, activity- and total- EE determined by heart-rate accelerometery. RESULTS Composite appetite ratings between days were lower in HCLF (62.4 ± 12) compared to LCHF (68.3 ± 8.9 mm; p = 0.048). No differences between conditions were detected for EI. Cumulative activity-EE (HCLF= 20.9 ± 3.7, LCHF= 16.9 ± 3.1 MJ; p = 0.037), but not total-EE (HCLF= 44.6 ± 7.7, LCHF= 39.9 ± 4.7 MJ; p = 0.060), was higher for the HCLF condition than the LCHF across the measurement period. CONCLUSION Compared with low carbohydrate/high fat, immediate post-exercise energy replacement with a high carbohydrate/low fat drink resulted in higher short-term activity energy expenditure and lower appetite ratings.
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Affiliation(s)
- I Podestá D
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, United Kingdom of Great Britain and Northern Ireland, UK
| | - A K Blannin
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, United Kingdom of Great Britain and Northern Ireland, UK
| | - G A Wallis
- School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, United Kingdom of Great Britain and Northern Ireland, UK.
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12
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Hanssen H, Moholdt T, Bahls M, Biffi A, Siegrist M, Lewandowski AJ, Biondi-Zoccai G, Cavarretta E, Kokkvoll A, Løchen ML, Maestrini V, Pinto RS, Palermi S, Thivel D, Wojcik M, Hansen D, Van Craenenbroeck EM, Weghuber D, Kraenkel N, Tiberi M. Lifestyle interventions to change trajectories of obesity-related cardiovascular risk from childhood onset to manifestation in adulthood: a joint scientific statement of the task force for childhood health of the European Association of Preventive Cardiology and the European Childhood Obesity Group. Eur J Prev Cardiol 2023; 30:1462-1472. [PMID: 37491406 DOI: 10.1093/eurjpc/zwad152] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/20/2023] [Accepted: 05/06/2023] [Indexed: 07/27/2023]
Abstract
There is an immediate need to optimize cardiovascular (CV) risk management and primary prevention of childhood obesity to timely and more effectively combat the health hazard and socioeconomic burden of CV disease from childhood development to adulthood manifestation. Optimizing screening programs and risk management strategies for obesity-related CV risk in childhood has high potential to change disease trajectories into adulthood. Building on a holistic view on the aetiology of childhood obesity, this document reviews current concepts in primary prevention and risk management strategies by lifestyle interventions. As an additional objective, this scientific statement addresses the high potential for reversibility of CV risk in childhood and comments on the use of modern surrogate markers beyond monitoring weight and body composition. This scientific statement also highlights the clinical importance of quantifying CV risk trajectories and discusses the remaining research gaps and challenges to better promote childhood health in a population-based approach. Finally, this document provides an overview on the lessons to be learned from the presented evidence and identifies key barriers to be targeted by researchers, clinicians, and policymakers to put into practice more effective primary prevention strategies for childhood obesity early in life to combat the burden of CV disease later in life.
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Affiliation(s)
- Henner Hanssen
- Department of Sport, Exercise and Health, Medical Faculty, University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Trine Moholdt
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Martin Bahls
- Department of Internal Medicine B University Medicine Greifswald, University of Greifswald, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Alessandro Biffi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - Monika Siegrist
- Department of Prevention and Sports Medicine, School of Medicine, University Hospital 'rechts der Isar', Technical University of Munich, Munich, Germany
| | - Adam J Lewandowski
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Ane Kokkvoll
- Department of Paediatrics, Finnmark Hospital Trust, Hammerfest, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, Rome, Italy
| | | | - Stefano Palermi
- Med-Ex Medicine & Exercise, Medical Partner Scuderia Ferrari, Rome, Italy
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Malgorzata Wojcik
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Krakow, Poland
| | - Dominique Hansen
- Department of Cardiology, Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Rehabilitation Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium
| | - Emeline M Van Craenenbroeck
- Research Group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium
- Department of Cardiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, Salzburg, Austria
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Nicolle Kraenkel
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology, Angiology and Intensive Care, Campus Benjamin-Franklin (CBF), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
- Friede Springer- Cardiovascular Prevention Center @ Charité, Charite- Universitätsmedizin Berlin, Berlin, Germany
| | - Monica Tiberi
- Department of Public Health, Azienda Sanitaria Unica Regionale Marche AV 1, Pesaro, Italy
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13
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Areta JL. Physical performance during energy deficiency in humans: An evolutionary perspective. Comp Biochem Physiol A Mol Integr Physiol 2023; 284:111473. [PMID: 37406958 DOI: 10.1016/j.cbpa.2023.111473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
Energy deficiency profoundly disrupts normal endocrinology, metabolism, and physiology, resulting in an orchestrated response for energy preservation. As such, despite energy deficit is typically thought as positive for weight-loss and treatment of cardiometabolic diseases during the current obesity pandemic, in the context of contemporary sports and exercise nutrition, chronic energy deficiency is associated to negative health and athletic performance consequences. However, the evidence of energy deficit negatively affecting physical capacity and sports performance is unclear. While severe energy deficiency can negatively affect physical capacity, humans can also improve aerobic fitness and strength while facing significant energy deficit. Many athletes, also, compete at an elite and world-class level despite showing clear signs of energy deficiency. Maintenance of high physical capacity despite the suppression of energetically demanding physiological traits seems paradoxical when an evolutionary viewpoint is not considered. Humans have evolved facing intermittent periods of food scarcity in their natural habitat and are able to thrive in it. In the current perspective it is argued that when facing limited energy availability, maintenance of locomotion and physical capacity are of high priority given that they are essential for food procurement for survival in the habitat where humans evolved. When energetic resources are limited, energy may be allocated to tasks essential for survival (e.g. locomotion) while minimising energy allocation to traits that are not (e.g. growth and reproduction). The current perspective provides a model of energy allocation during energy scarcity supported by observation of physiological and metabolic responses that are congruent with this paradigm.
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Affiliation(s)
- José L Areta
- Research Institute for Sport and Exercise Sciences, School of Sport and Exercise Sciences, Liverpool John Moores University, UK.
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14
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Sørensen TIA. An adiposity force induces obesity in humans independently of a normal energy balance system-a thought experiment. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220203. [PMID: 37482783 PMCID: PMC10363699 DOI: 10.1098/rstb.2022.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Obesity in humans represents a cumulative retention of a tiny fraction of total energy intake as fat, which is accompanied by growth of the metabolically active, energy-demanding, lean body mass. Since the energy balance regulation operates irrespective of the excess fat storage, availability of the required energy supplies is a permissive condition for obesity development. It occurs predominantly among people genetically predisposed and/or living with social or mental challenges. I propose a theory in which the body responds to social disruptions as threats of a future lack of food by an adiposity force building a reserve of energy independent of the regulation of the energy balance. It is based on the assumption that our evolutionary development required collaboration in gathering and sharing of food, combined with precautionary measures against anticipated failing food supplies. Social challenges are perceived as such threats, which activate the adiposity force through the brain to instigate the growth of fat and lean mass by neuro-hormonal signalling. If both perceived social threats and food abundance continue, the adiposity force pushes the fat accretion process to continue without inhibition by feedback signals from the fat mass, eventually leading to more obesity, and more so among the genetically predisposed. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part I)'.
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Affiliation(s)
- Thorkild I. A. Sørensen
- University of Copenhagen, Novo Nordisk Foundation Centre for Basic Metabolic Research and Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
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15
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Halsey LG, Areta JL, Koehler K. Does eating less or exercising more to reduce energy availability produce distinct metabolic responses? Philos Trans R Soc Lond B Biol Sci 2023; 378:20220217. [PMID: 37482781 PMCID: PMC10363695 DOI: 10.1098/rstb.2022.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/04/2023] [Indexed: 07/25/2023] Open
Abstract
When less energy is available to consume, people often lose weight, which reduces their overall metabolic rate. Their cellular metabolic rate may also decrease (metabolic adaptation), possibly reflected in physiological and/or endocrinological changes. Reduced energy availability can result from calorie restriction or increased activity energy expenditure, raising the following question that our review explores: do the body's metabolic and physiological responses to this reduction differ or not depending on whether they are induced by dietary restriction or increased activity? First, human studies offer indirect, contentious evidence that the body metabolically adapts to reduced energy availability, both in response to either a calorie intake deficit or increased activity (exercise; without a concomitant increase in food intake). Considering individual aspects of the body's physiology as constituents of whole-body metabolic rate, similar responses to reduced energy availability are observed in terms of reproductive capacity, somatic maintenance and hormone levels. By contrast, tissue phenotypic responses differ, most evidently for skeletal tissue, which is preserved in response to exercise but not calorie restriction. Thus, while in many ways 'a calorie deficit is a calorie deficit', certain tissues respond differently depending on the energy deficit intervention. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part I)'.
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Affiliation(s)
| | - José L. Areta
- Liverpool John Moores University, Liverpool, L3 3AF, UK
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16
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Burke LM, Ackerman KE, Heikura IA, Hackney AC, Stellingwerff T. Mapping the complexities of Relative Energy Deficiency in Sport (REDs): development of a physiological model by a subgroup of the International Olympic Committee (IOC) Consensus on REDs. Br J Sports Med 2023; 57:1098-1108. [PMID: 37752007 DOI: 10.1136/bjsports-2023-107335] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/28/2023]
Abstract
The 2023 International Olympic Committee (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) notes that exposure to low energy availability (LEA) exists on a continuum between adaptable and problematic LEA, with a range of potential effects on both health and performance. However, there is variability in the outcomes of LEA exposure between and among individuals as well as the specific manifestations of REDs. We outline a framework for a 'systems biology' examination of the effect of LEA on individual body systems, with the eventual goal of creating an integrated map of body system interactions. We provide a template that systematically identifies characteristics of LEA exposure (eg, magnitude, duration, origin) and a variety of moderating factors (eg, medical history, diet and training characteristics) that could exacerbate or attenuate the type and severity of impairments to health and performance faced by an individual athlete. The REDs Physiological Model may assist the diagnosis of underlying causes of problems associated with LEA, with a personalised and nuanced treatment plan promoting compliance and treatment efficacy. It could also be used in the strategic prevention of REDs by drawing attention to scenarios of LEA in which impairments of health and performance are most likely, based on knowledge of the characteristics of the LEA exposure or moderating factors that may increase the risk of harmful outcomes. We challenge researchers and practitioners to create a unifying and dynamic physiological model for each body system that can be continuously updated and mapped as knowledge is gained.
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Affiliation(s)
- Louise M Burke
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Kathryn E Ackerman
- Wu Tsai Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ida A Heikura
- Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Anthony C Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Trent Stellingwerff
- Canadian Sport Institute Pacific, Victoria, British Columbia, Canada
- Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
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Halpern B, Mancini MC, van de Sande-Lee S, Miranda PAC. "Anti-obesity medications" or "medications to treat obesity" instead of "weight loss drugs" - why language matters - an official statement of the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM). ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2023; 67:e230174. [PMID: 37585688 PMCID: PMC10665066 DOI: 10.20945/2359-4292-2023-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/07/2023] [Indexed: 08/18/2023]
Abstract
Obesity is largely undertreated, in part because of the stigma surrounding the disease and its treatment. The use of the term "weight loss drugs" to refer to medications for the treatment of obesity may contribute to this stigma, leading to the idea that anyone who wants to lose weight could use them and that short-term use, only in the active weight loss phase would be enough. On the contrary, the use of terms such as "medications to treat obesity" or "anti-obesity medications" conveys the idea that the treatment is directed at the disease rather than the symptom. This joint statement by the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO) and the Brazilian Society of Endocrinology and Metabolism (SBEM) intends to alert the press, healthcare professionals and scientific community about the importance of the appropriate use of language, with the aim of improving obesity care.
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Affiliation(s)
- Bruno Halpern
- Associação Brasileira para o Estudo da Obesidade e Síndrome MetabólicaSão PauloSPBrasilAssociação Brasileira para o Estudo da Obesidade e Síndrome Metabólica, São Paulo, SP, Brasil
- Sociedade Brasileira de Endocrinologia e MetabologiaDepartamento de ObesidadeSão PauloSPBrasilDepartamento de Obesidade, Sociedade Brasileira de Endocrinologia e Metabologia, São Paulo, SP, Brasil
- Hospital 9 de JulhoCentro de ObesidadeSão PauloSPBrasilCentro de Obesidade, Hospital 9 de Julho, São Paulo, SP, Brasil
| | - Marcio C. Mancini
- Sociedade Brasileira de Endocrinologia e MetabologiaDepartamento de ObesidadeSão PauloSPBrasilDepartamento de Obesidade, Sociedade Brasileira de Endocrinologia e Metabologia, São Paulo, SP, Brasil
- Faculdade de Medicina da Universidade de São PauloDepartamento de Endocrinologia e MetabolismoGrupo de Obesidade e Síndrome MetabólicaSão PauloSPBrasilGrupo de Obesidade e Síndrome Metabólica, Departamento de Endocrinologia e Metabolismo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Simone van de Sande-Lee
- Sociedade Brasileira de Endocrinologia e MetabologiaDepartamento de ObesidadeSão PauloSPBrasilDepartamento de Obesidade, Sociedade Brasileira de Endocrinologia e Metabologia, São Paulo, SP, Brasil
- Universidade Federal de Santa CatarinaDepartamento de Clínica MédicaFlorianópolisSCBrasilDepartamento de Clínica Médica, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Paulo Augusto Carvalho Miranda
- Sociedade Brasileira de Endocrinologia e MetabologiaSão PauloSPBrasilSociedade Brasileira de Endocrinologia e Metabologia, São Paulo, SP, Brasil
- Santa Casa de Belo HorizonteBelo HorizonteMGBrasilSanta Casa de Belo Horizonte, Belo Horizonte, MG, Brasil
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18
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Rosenbaum M, Foster G. Differential mechanisms affecting weight loss and weight loss maintenance. Nat Metab 2023; 5:1266-1274. [PMID: 37612402 DOI: 10.1038/s42255-023-00864-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 07/13/2023] [Indexed: 08/25/2023]
Abstract
In most lifestyle, pharmacological and surgical interventions, weight loss occurs over an approximately 6- to 9-month period and is followed by a weight plateau and then weight regain. Overall, only about 15% of individuals can sustain a 10% or greater non-surgical, non-pharmacological, weight loss. A key question is the degree to which the genotypes, phenotypes and environmental correlates of success in weight loss and weight loss maintenance are continuous or dichotomous. This Perspective is a comparison of the interactions of weight loss and maintenance with genetic, behavioural, physiological and environmental homeostatic systems and a discussion of the implications of these findings for research in, and treatment of, obesity. Data suggest that weight loss and weight loss maintenance are physiologically and psychologically different in many ways. Consequently, individuals may require different interventions designed for temporarily sustaining a negative energy balance during weight loss versus permanently maintaining energy balance after weight loss.
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Affiliation(s)
- Michael Rosenbaum
- Columbia University Irving Medical Center, Departments of Pediatrics and Medicine, Division of Molecular Genetics and the Irving Center for Clinical and Translational Research (MR), New York, NY, USA.
| | - Gary Foster
- WW International, Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Weight and Eating Disorders Program (GF), New York, NY, USA
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19
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Walmsley R, Sumithran P. Current and emerging medications for the management of obesity in adults. Med J Aust 2023; 218:276-283. [PMID: 36934408 PMCID: PMC10952877 DOI: 10.5694/mja2.51871] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/20/2023]
Affiliation(s)
| | - Priya Sumithran
- University of MelbourneMelbourneVIC
- Austin HealthMelbourneVIC
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20
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Artasensi A, Mazzolari A, Pedretti A, Vistoli G, Fumagalli L. Obesity and Type 2 Diabetes: Adiposopathy as a Triggering Factor and Therapeutic Options. Molecules 2023; 28:molecules28073094. [PMID: 37049856 PMCID: PMC10095867 DOI: 10.3390/molecules28073094] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Obesity and type 2 diabetes (T2DM) are major public health concerns associated with serious morbidity and increased mortality. Both obesity and T2DM are strongly associated with adiposopathy, a term that describes the pathophysiological changes of the adipose tissue. In this review, we have highlighted adipose tissue dysfunction as a major factor in the etiology of these conditions since it promotes chronic inflammation, dysregulated glucose homeostasis, and impaired adipogenesis, leading to the accumulation of ectopic fat and insulin resistance. This dysfunctional state can be effectively ameliorated by the loss of at least 15% of body weight, that is correlated with better glycemic control, decreased likelihood of cardiometabolic disease, and an improvement in overall quality of life. Weight loss can be achieved through lifestyle modifications (healthy diet, regular physical activity) and pharmacotherapy. In this review, we summarized different effective management strategies to address weight loss, such as bariatric surgery and several classes of drugs, namely metformin, GLP-1 receptor agonists, amylin analogs, and SGLT2 inhibitors. These drugs act by targeting various mechanisms involved in the pathophysiology of obesity and T2DM, and they have been shown to induce significant weight loss and improve glycemic control in obese individuals with T2DM.
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Mode WJA, Slater T, Pinkney MG, Hough J, James RM, Varley I, James LJ, Clayton DJ. Effects of Morning Vs. Evening exercise on appetite, energy intake, performance and metabolism, in lean males and females. Appetite 2023; 182:106422. [PMID: 36539157 DOI: 10.1016/j.appet.2022.106422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/08/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Exercise is an important component of a weight management strategy. However, little is known about whether circadian variations in physiological and behavioural processes can influence the appetite and energy balance responses to exercise performed at different times of the day. This study compared the effects of morning and evening exercise on appetite, post-exercise energy intake, and voluntary performance. In randomised, counterbalanced order, 16 healthy males and females (n = 8 each) completed two trials, performing morning exercise at 10:30 (AMEx) or evening exercise at 18:30 (PMEx). Exercise consisted of 30 min steady-state cycling (60% V˙ O2peak), and a 15-min performance test. A standardised meal (543 ± 86 kcal) was consumed 2-h before exercise and ad-libitum energy intake was assessed 15 min after exercise, with subjective appetite measured throughout. Absolute ad-libitum energy intake was 152 ± 126 kcal greater during PMEx (P < 0.001), but there was no differences in subjective appetite between trials immediately pre-exercise, or immediately before the post-exercise meal (P ≥ 0.060). Resting energy expenditure (P < 0.01) and carbohydrate oxidation (P < 0.05) were greater during AMEx, but there were no differences in substrate oxidation or energy expenditure during exercise (P ≥ 0.155). Exercise performance was not different between trials (P = 0.628). In conclusion, acute morning and evening exercise prompt similar appetite responses, but post-exercise ad-libitum energy intake is greater following evening exercise. These findings demonstrate discordant responses between subjective appetite and ad-libitum energy intake but suggest that exercise might offset circadian variations in appetite. Longer-term studies are required to determine how exercise timing affects adherence and weight management outcomes to exercise interventions. TRIAL REGISTRATION: NCT04742530, February 8, 2021.
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Affiliation(s)
- William J A Mode
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Tommy Slater
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Mollie G Pinkney
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - John Hough
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Ruth M James
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Ian Varley
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Lewis J James
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - David J Clayton
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, UK.
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22
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Leptin Increases: Physiological Roles in the Control of Sympathetic Nerve Activity, Energy Balance, and the Hypothalamic-Pituitary-Thyroid Axis. Int J Mol Sci 2023; 24:ijms24032684. [PMID: 36769012 PMCID: PMC9917048 DOI: 10.3390/ijms24032684] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/17/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023] Open
Abstract
It is well established that decreases in plasma leptin levels, as with fasting, signal starvation and elicit appropriate physiological responses, such as increasing the drive to eat and decreasing energy expenditure. These responses are mediated largely by suppression of the actions of leptin in the hypothalamus, most notably on arcuate nucleus (ArcN) orexigenic neuropeptide Y neurons and anorexic pro-opiomelanocortin neurons. However, the question addressed in this review is whether the effects of increased leptin levels are also significant on the long-term control of energy balance, despite conventional wisdom to the contrary. We focus on leptin's actions (in both lean and obese individuals) to decrease food intake, increase sympathetic nerve activity, and support the hypothalamic-pituitary-thyroid axis, with particular attention to sex differences. We also elaborate on obesity-induced inflammation and its role in the altered actions of leptin during obesity.
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23
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Nunes CL, Rosa GB, Jesus F, Heymsfield SB, Minderico CS, Martins P, Sardinha LB, Silva AM. Interindividual variability in metabolic adaptation of non-exercise activity thermogenesis after a 1-year weight loss intervention in former elite athletes. Eur J Sport Sci 2022:1-10. [PMID: 36377398 DOI: 10.1080/17461391.2022.2147020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lack of efficacy of weight loss(WL) interventions is attributed in-part to low adherence to dietary/physical activity(PA) recommendations. However, some compensation may occur in PA as a response to energy restriction such as a decrease in non-exercise PA(NEPA) or non-exercise activity thermogenesis(NEAT). The current study aim was (1) to investigate whether adaptive thermogenesis(AT) in NEAT occurs after WL, and (2) to understand the associations of these compensations with WL. Ninety-four former athletes [mean±SD, age: 43.0±9.4y, BMI: 31.1±4.3 kg/m2, 34.0% female] were recruited and randomly assigned to intervention or control groups (IG, CG). The IG underwent a one-year lifestyle WL-intervention; no treatments were administered to the CG. PA was measured using accelerometery and NEAT was predicted with a model including sample baseline characteristics. AT was calculated as measuredNEAT4mo/12mo(kcal/d)-predictedNEAT4mo/12mo(kcal/d)-measuredNEATbaseline(kcal/d)-predictedNEATbaseline(kcal/d). Dual-energy x-ray absorptiometry was used to assess fat-free mass and fat mass. No differences were found in the IG for NEAT or NEPA after WL. Considering mean values, AT was not found for either group. The SD of individual response (SDIR) for AT was -2(4-months) and 24(12-months) (smallest worthwhile change = 87kcal/d), suggesting that the interindividual variability regarding AT in NEAT is not relevant and the variability in this outcome might reflect a large within-subject variability and/or a large degree of random measurement error. No associations were found between AT in NEAT and changes in body composition. Further studies are needed to clarify the mechanisms behind the large variability in AT observed in NEAT and related changes in NEPA to better implement lifestyle-induced WL interventions.Highlights No significant differences were found for non-exercise activity thermogenesis (NEAT) or non-exercise physical activity (NEPA) after the weight loss (WL) intervention;Although a large variability was found for NEAT and NEPA, the interindividual variability regarding these outcomes is not relevant. The variability in these outcomes might reflect a large within-subject variability and/or a large degree of random measurement error;Although no energy conservation was observed in NEAT after moderate WL (mean values), further studies are needed to clarify the mechanisms behind the large variability in adaptive thermogenesis observed in NEAT and related changes in NEPA to better implement lifestyle-induced WL interventions.Trial registration: ClinicalTrials.gov identifier: NCT03031951.
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Affiliation(s)
- Catarina L Nunes
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Cruz-Quebrada, Portugal
| | - Gil B Rosa
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Cruz-Quebrada, Portugal
| | - Filipe Jesus
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Cruz-Quebrada, Portugal
| | | | - Cláudia S Minderico
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Cruz-Quebrada, Portugal
| | - Paulo Martins
- Laboratory of Sport Psychology, Faculdade de Motricidade Humana da Universidade de Lisboa, Cruz-Quebrada, Portugal
| | - Luis B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Cruz-Quebrada, Portugal
| | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Cruz-Quebrada, Portugal
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24
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Rajamoorthi A, LeDuc CA, Thaker VV. The metabolic conditioning of obesity: A review of the pathogenesis of obesity and the epigenetic pathways that "program" obesity from conception. Front Endocrinol (Lausanne) 2022; 13:1032491. [PMID: 36329895 PMCID: PMC9622759 DOI: 10.3389/fendo.2022.1032491] [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: 08/30/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Understanding the developmental origins of health and disease is integral to overcome the global tide of obesity and its metabolic consequences, including atherosclerotic cardiovascular disease, type 2 diabetes, hyperlipidemia, and nonalcoholic fatty liver disease. The rising prevalence of obesity has been attributed, in part, to environmental factors including the globalization of the western diet and unhealthy lifestyle choices. In this review we argue that how and when such exposures come into play from conception significantly impact overall risk of obesity and later health outcomes. While the laws of thermodynamics dictate that obesity is caused by an imbalance between caloric intake and energy expenditure, the drivers of each of these may be laid down before the manifestation of the phenotype. We present evidence over the last half-century that suggests that the temporospatial evolution of obesity from intrauterine life and beyond is, in part, due to the conditioning of physiological processes at critical developmental periods that results in maladaptive responses to obesogenic exposures later in life. We begin the review by introducing studies that describe an association between perinatal factors and later risk of obesity. After a brief discussion of the pathogenesis of obesity, including the systemic regulation of appetite, adiposity, and basal metabolic rate, we delve into the mechanics of how intrauterine, postnatal and early childhood metabolic environments may contribute to adult obesity risk through the process of metabolic conditioning. Finally, we detail the specific epigenetic pathways identified both in preclinical and clinical studies that synergistically "program" obesity.
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Affiliation(s)
- Ananthi Rajamoorthi
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
| | - Charles A. LeDuc
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
- The Naomi Berrie Diabetes Center, Columbia University IRVING Medical Center, New York, NY, United States
| | - Vidhu V. Thaker
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
- The Naomi Berrie Diabetes Center, Columbia University IRVING Medical Center, New York, NY, United States
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
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25
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Liuzzo G, Patrono C. Dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonism for substantial body weight reduction in obese subjects. Eur Heart J 2022; 43:3288-3289. [PMID: 35866301 DOI: 10.1093/eurheartj/ehac384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giovanna Liuzzo
- Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, Rome 00168, Italy.,Cardiovascular and Pulmonary Sciences, Catholic University School of Medicine, Largo F. Vito, Rome 1-00168, Italy
| | - Carlo Patrono
- Pharmacology, Catholic University School of Medicine, Largo F. Vito, Rome 1-00168, Italy
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26
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Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med 2022; 387:205-216. [PMID: 35658024 DOI: 10.1056/nejmoa2206038] [Citation(s) in RCA: 922] [Impact Index Per Article: 461.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obesity is a chronic disease that results in substantial global morbidity and mortality. The efficacy and safety of tirzepatide, a novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, in people with obesity are not known. METHODS In this phase 3 double-blind, randomized, controlled trial, we assigned 2539 adults with a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30 or more, or 27 or more and at least one weight-related complication, excluding diabetes, in a 1:1:1:1 ratio to receive once-weekly, subcutaneous tirzepatide (5 mg, 10 mg, or 15 mg) or placebo for 72 weeks, including a 20-week dose-escalation period. Coprimary end points were the percentage change in weight from baseline and a weight reduction of 5% or more. The treatment-regimen estimand assessed effects regardless of treatment discontinuation in the intention-to-treat population. RESULTS At baseline, the mean body weight was 104.8 kg, the mean BMI was 38.0, and 94.5% of participants had a BMI of 30 or higher. The mean percentage change in weight at week 72 was -15.0% (95% confidence interval [CI], -15.9 to -14.2) with 5-mg weekly doses of tirzepatide, -19.5% (95% CI, -20.4 to -18.5) with 10-mg doses, and -20.9% (95% CI, -21.8 to -19.9) with 15-mg doses and -3.1% (95% CI, -4.3 to -1.9) with placebo (P<0.001 for all comparisons with placebo). The percentage of participants who had weight reduction of 5% or more was 85% (95% CI, 82 to 89), 89% (95% CI, 86 to 92), and 91% (95% CI, 88 to 94) with 5 mg, 10 mg, and 15 mg of tirzepatide, respectively, and 35% (95% CI, 30 to 39) with placebo; 50% (95% CI, 46 to 54) and 57% (95% CI, 53 to 61) of participants in the 10-mg and 15-mg groups had a reduction in body weight of 20% or more, as compared with 3% (95% CI, 1 to 5) in the placebo group (P<0.001 for all comparisons with placebo). Improvements in all prespecified cardiometabolic measures were observed with tirzepatide. The most common adverse events with tirzepatide were gastrointestinal, and most were mild to moderate in severity, occurring primarily during dose escalation. Adverse events caused treatment discontinuation in 4.3%, 7.1%, 6.2%, and 2.6% of participants receiving 5-mg, 10-mg, and 15-mg tirzepatide doses and placebo, respectively. CONCLUSIONS In this 72-week trial in participants with obesity, 5 mg, 10 mg, or 15 mg of tirzepatide once weekly provided substantial and sustained reductions in body weight. (Supported by Eli Lilly; SURMOUNT-1 ClinicalTrials.gov number, NCT04184622.).
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Affiliation(s)
- Ania M Jastreboff
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Louis J Aronne
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Nadia N Ahmad
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Sean Wharton
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Lisa Connery
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Breno Alves
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Arihiro Kiyosue
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Shuyu Zhang
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Bing Liu
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Mathijs C Bunck
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
| | - Adam Stefanski
- From the Section of Endocrinology and Metabolism, Department of Medicine, and the Section of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT (A.M.J.); the Comprehensive Weight Control Center, Division of Endocrinology, Diabetes, and Metabolism, Weill Cornell Medicine, New York (L.J.A.); Eli Lilly, Indianapolis (N.N.A., S.Z., B.L., M.C.B., A.S.); McMaster University, Hamilton, and York University and Wharton Weight Management Clinic, Toronto - all in Ontario, Canada (S.W.); Intend Research, Norman, OK (L.C.); Centro Paulista De Investigação Clínica (Cepic), Sao Paulo (B.A.); and Tokyo-Eki Center-Building Clinic, Tokyo (A.K.)
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Nunes CL, Jesus F, Francisco R, Hopkins M, Sardinha LB, Martins P, Minderico CS, Silva AM. Effects of a 4-month active weight loss phase followed by weight loss maintenance on adaptive thermogenesis in resting energy expenditure in former elite athletes. Eur J Nutr 2022; 61:4121-4133. [PMID: 35833970 DOI: 10.1007/s00394-022-02951-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/27/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Despite adaptive thermogenesis (AT) being studied as a barrier to weight loss (WL), few studies assessed AT in the resting energy expenditure (REE) compartment after WL maintenance. The aim of this study was twofold: (1) to understand if AT occurs after a moderate WL and if AT persists after a period of WL maintenance; and (2) if AT is associated with changes in body composition, hormones and energy intake (EI). METHODS Ninety-four participants [mean (SD); BMI, 31.1(4.3)kg/m2; 43.0(9.4)y; 34% female] were randomized to intervention (IG, n = 49) or control groups (CG, n = 45). Subjects underwent a 1-year lifestyle intervention, divided in 4 months of an active WL followed by 8 months of WL maintenance. Fat mass (FM) and fat-free mass (FFM) were measured by dual-energy X-ray absorptiometry and REE by indirect calorimetry. Predicted REE (pREE) was estimated through a model using FM, FFM. EI was measured by the "intake-balance" method. RESULTS For the IG, the weight and FM losses were - 4.8 (4.9) and - 11.3 (10.8)%, respectively (p < 0.001). A time-group interaction was found between groups for AT. After WL, the IG showed an AT of -85(29) kcal.d-1 (p < 0.001), and remained significant after 1 year [AT = - 72(31)kcal.d-1, p = 0.031]. Participants with higher degrees of restriction were those with an increased energy conservation (R = - 0.325, p = 0.036 and R = - 0.308, p = 0.047, respectively). No associations were found between diet adherence and AT. Following a sub-analysis in the IG, the group with a higher energy conservation showed a lower WL and fat loss and a higher initial EI. CONCLUSION AT in REE occurred after a moderate WL and remained significant after WL maintenance. More studies are needed to better clarify the mechanisms underlying the large variability observed in AT and providing an accurate methodological approach to avoid overstatements. Future studies on AT should consider not only changes in FM and FFM but also the FFM composition.
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Affiliation(s)
- Catarina L Nunes
- Exercise and Health 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, 1499-002, Cruz-Quebrada, Portugal
| | - Ruben Francisco
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - Mark Hopkins
- School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds, UK
| | - Luís B Sardinha
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal
| | - 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, 1499-002, Cruz-Quebrada, Portugal
| | - Analiza M Silva
- Exercise and Health Laboratory, CIPER, Faculdade Motricidade Humana, Universidade Lisboa, Estrada da Costa, 1499-002, Cruz-Quebrada, Portugal.
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Wittleder S, Jay M. Increasing Motivation for Lifestyle Change Is Not Enough to Treat Obesity. Ann Intern Med 2022; 175:901-902. [PMID: 35344377 DOI: 10.7326/m22-0715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Melanie Jay
- NYU Grossman School of Medicine, New York, New York
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Woo S, Ju YS, Seo YG, Kim YM, Lim H, Park KH. Additive Effects of Exercise or Nutrition Intervention in a 24-Month Multidisciplinary Treatment with a Booster Intervention for Children and Adolescents with Overweight or Obesity: The ICAAN Study. Nutrients 2022; 14:nu14020387. [PMID: 35057568 PMCID: PMC8781150 DOI: 10.3390/nu14020387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 02/01/2023] Open
Abstract
This study compared the effects of a real-world multidisciplinary intervention with additional exercise or nutritional elements and investigated the effectiveness of a booster intervention after weight regain. A total of 242 children and adolescents (age- and sex-specific body mass index [BMI] ≥ 85th percentile, mean age: 10.82 years, 60% male) were allocated to three groups: usual care, exercise, or nutrition. Six-month active treatment with 1:1 session and a maintenance stage with group activities were repeated twice to comprise a 24-month intervention. The primary outcome was change % of the BMI z-score (zBMI). A total of 110 (45.4%) participants completed the 24-month intervention. A mixed-effects model analysis indicated no significant interaction effect of the intervention group and treatment phase on the zBMI change % (p = 0.976). However, there was a significant main effect of the treatment phase on zBMI change % at 6 months (β = -2.98, [95% CI, -5.69-0.27]), 18 months (β = -3.99, [95% CI, -6.76-1.22]), and 24 months (β = -3.23, [95% CI, -5.94-0.52]; p = 0.042). The improvements in zBMI, body fat %, and cardiometabolic markers were observed only among males. Whereas the additive effect of intensive exercise or nutritional feedback was not detected in the long term, a booster intervention with 1:1 counseling was effective even after weight regain during the maintenance period. It may be useful to combine individualized counseling with a less intensive form of group care for long-term maintenance in a real-world setting.
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Affiliation(s)
- Sarah Woo
- Department of Medical Sciences, College of Medicine, Hallym University, Chuncheon-si 24252, Korea
| | - Young-Su Ju
- Department of Occupational Medicine, National Medical Center, Seoul 04564, Korea
| | - Young-Gyun Seo
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si 14068, Korea
| | - Yoon-Myung Kim
- University College, Yonsei University International Campus, Incheon 21983, Korea
| | - Hyunjung Lim
- Department of Medical Nutrition, Kyung Hee University, Yongin-si 17104, Korea
| | - Kyung-Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si 14068, Korea
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Breen C, O'Connell J, Geoghegan J, O'Shea D, Birney S, Tully L, Gaynor K, O'Kelly M, O'Malley G, O'Donovan C, Lyons O, Flynn M, Allen S, Arthurs N, Browne S, Byrne M, Callaghan S, Collins C, Courtney A, Crotty M, Donohue C, Donovan C, Dunlevy C, Duggan D, Fearon N, Finucane F, Fitzgerald I, Foy S, Garvey J, Gibson I, Glynn L, Gregg E, Griffin A, Harrington JM, Heary C, Heneghan H, Hogan A, Hynes M, Kearney C, Kelly D, Neff K, le Roux CW, Manning S, McAuliffe F, Moore S, Moran N, Murphy M, Murrin C, O'Brien SM, O'Donnell C, O'Dwyer S, O'Grada C, O'Malley E, O'Reilly O, O'Reilly S, Porter O, Roche HM, Rhynehart A, Ryan L, Seery S, Soare C, Shaamile F, Walsh A, Woods C, Woods C, Yoder R. Obesity in Adults: A 2022 Adapted Clinical Practice Guideline for Ireland. Obes Facts 2022; 15:736-752. [PMID: 36279848 PMCID: PMC9801383 DOI: 10.1159/000527131] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. SUMMARY It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity. KEY MESSAGES People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay.
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Affiliation(s)
- Cathy Breen
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
- *Cathy Breen,
| | - Jean O'Connell
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Justin Geoghegan
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Donal O'Shea
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
- National Clinical Programme for Obesity, Dublin, Ireland
| | - Susie Birney
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Irish Coalition for People Living with Obesity, Dublin, Ireland
| | - Louise Tully
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Obesity Research and Care Group, School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Karen Gaynor
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- National Clinical Programme for Obesity, Dublin, Ireland
| | - Mark O'Kelly
- Irish College of General Practitioners, Dublin, Ireland
| | - Grace O'Malley
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Obesity Research and Care Group, School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Clare O'Donovan
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Food Safety Authority of Ireland, Dublin, Ireland
| | - Oonagh Lyons
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Food Safety Authority of Ireland, Dublin, Ireland
| | - Mary Flynn
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Food Safety Authority of Ireland, Dublin, Ireland
| | | | - Niamh Arthurs
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Obesity Research and Care Group, School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Sarah Browne
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Molly Byrne
- School of Psychology, University of Galway, Galway, Ireland
| | - Shauna Callaghan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Chris Collins
- Bariatric Medicine Service, Galway University Hospital, Galway, Ireland
| | - Aoife Courtney
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | | | | | - Caroline Donovan
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Colin Dunlevy
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Diarmuid Duggan
- Metabolic Surgery Service, Bons Secours Hospital, Cork, Ireland
| | - Naomi Fearon
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Francis Finucane
- Bariatric Medicine Service, Galway University Hospital, Galway, Ireland
| | | | - Siobhan Foy
- Bariatric Medicine Service, Galway University Hospital, Galway, Ireland
| | - John Garvey
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Irene Gibson
- Collaborative Doctoral Programme in Chronic Disease Prevention, University of Galway, Galway, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Edward Gregg
- School of Population Health, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Anne Griffin
- School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Caroline Heary
- School of Psychology, University of Galway, Galway, Ireland
| | - Helen Heneghan
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Andrew Hogan
- Obesity Immunology Research Group, Maynooth University, Maynooth, Ireland
| | - Mary Hynes
- Bariatric Medicine Service, Galway University Hospital, Galway, Ireland
| | - Claire Kearney
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Karl Neff
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
- Obesity Research and Care Group, School of Physiotherapy, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Carel W. le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
| | - Sean Manning
- Department of Endocrinology, Cork University Hospital, Cork, Ireland
| | | | - Susan Moore
- Department of Psychiatry, St Vincent's University Hospital, Dublin, Ireland
| | - Niamh Moran
- Irish College of General Practitioners, Dublin, Ireland
| | - Maura Murphy
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- Irish Coalition for People Living with Obesity, Dublin, Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Sarah M. O'Brien
- Office of National Clinical Advisor, Integrated Care Programme for Prevention and Management of Chronic Disease, Dublin, Ireland
| | - Caitríona O'Donnell
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | | | - Cara O'Grada
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Emer O'Malley
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | | | - Sharleen O'Reilly
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Olivia Porter
- Association for the Study of Obesity on the Island of Ireland, Dublin, Ireland
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Helen M. Roche
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Amanda Rhynehart
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Leona Ryan
- School of Psychology, University of Galway, Galway, Ireland
| | - Suzanne Seery
- National Clinical Programme for Obesity, Dublin, Ireland
| | - Corina Soare
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Ferrah Shaamile
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Abigail Walsh
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
| | - Catherine Woods
- Department of Physical Education and Sports Science, University of Limerick, Limerick, Ireland
| | - Conor Woods
- Department of Endocrinology, Naas General Hospital, Kildare, and Tallaght University Hospital, Dublin, Ireland
| | - Ruth Yoder
- Level 3 and 4 Obesity Services, St Columcille's and St Vincent's University Hospitals, Dublin, Ireland
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Anton S, Das SK, McLaren C, Roberts SB. Application of social cognitive theory in weight management: Time for a biological component? Obesity (Silver Spring) 2021; 29:1982-1986. [PMID: 34705335 PMCID: PMC8612961 DOI: 10.1002/oby.23257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/22/2022]
Abstract
Despite the utility of social cognitive theory for facilitating individual behavior changes needed for initial weight loss, this model has been less effective in facilitating adherence to recommended lifestyle changes required for sustainable weight-loss maintenance. One potential reason for the limited long-term effectiveness of lifestyle interventions guided by this model is that the model does not consider the important influence that biology can have on weight-relevant behaviors, during both weight loss and weight-loss maintenance, via sensations of hunger and satiety and changes in energy metabolism (expenditure and fat oxidation). We describe here a proposed revision to social cognitive theory that allows for biological factors to exist in reciprocal determinism with behavioral, environmental, and personal factors, with the goal of creating a theoretical basis for lifestyle interventions with greater personalization in order to facilitate better long-term adherence and improve weight-loss maintenance.
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Affiliation(s)
- Stephen Anton
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
| | - Christian McLaren
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Susan B Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts, USA
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Koch CA, Sharda P, Patel J, Gubbi S, Bansal R, Bartel MJ. Climate Change and Obesity. Horm Metab Res 2021; 53:575-587. [PMID: 34496408 PMCID: PMC8440046 DOI: 10.1055/a-1533-2861] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023]
Abstract
Global warming and the rising prevalence of obesity are well described challenges of current mankind. Most recently, the COVID-19 pandemic arose as a new challenge. We here attempt to delineate their relationship with each other from our perspective. Global greenhouse gas emissions from the burning of fossil fuels have exponentially increased since 1950. The main contributors to such greenhouse gas emissions are manufacturing and construction, transport, residential, commercial, agriculture, and land use change and forestry, combined with an increasing global population growth from 1 billion in 1800 to 7.8 billion in 2020 along with rising obesity rates since the 1980s. The current Covid-19 pandemic has caused some decline in greenhouse gas emissions by limiting mobility globally via repetitive lockdowns. Following multiple lockdowns, there was further increase in obesity in wealthier populations, malnutrition from hunger in poor populations and death from severe infection with Covid-19 and its virus variants. There is a bidirectional relationship between adiposity and global warming. With rising atmospheric air temperatures, people typically will have less adaptive thermogenesis and become less physically active, while they are producing a higher carbon footprint. To reduce obesity rates, one should be willing to learn more about the environmental impact, how to minimize consumption of energy generating carbon dioxide and other greenhouse gas emissions, and to reduce food waste. Diets lower in meat such as a Mediterranean diet, have been estimated to reduce greenhouse gas emissions by 72%, land use by 58%, and energy consumption by 52%.
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Affiliation(s)
- Christian A. Koch
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA,
USA
- Department of Medicine, The University of Tennessee Health Science
Center, Memphis, TN, USA
| | - Pankaj Sharda
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA,
USA
| | - Jay Patel
- Department of Medicine, The University of Tennessee Health Science
Center, Memphis, TN, USA
| | - Sriram Gubbi
- National Institutes of Health, Bethesda, MD, USA
| | | | - Michael J. Bartel
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA,
USA
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33
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Kyle TK, Nadglowski JF, Nece PM. Recidivism: An artifact of implicit weight bias in obesity research. Obesity (Silver Spring) 2021; 29:1237. [PMID: 34128334 DOI: 10.1002/oby.23205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/24/2023]
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34
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van Baak MA, Roumans NJT, Mariman ECM. Diet Composition, Glucose Homeostasis, and Weight Regain in the YoYo Study. Nutrients 2021; 13:nu13072257. [PMID: 34208914 PMCID: PMC8308328 DOI: 10.3390/nu13072257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/14/2021] [Accepted: 06/25/2021] [Indexed: 01/21/2023] Open
Abstract
Based on several randomized clinical trials, it has been suggested that baseline glucose homeostasis interacts with the influence of diet composition on weight loss and weight loss maintenance. In this secondary analysis of the YoYo study, a study investigating predictors of weight loss maintenance, we tested the hypothesis that (self-selected) dietary carbohydrate and/or fibre intake interact with the glucose homeostasis parameters for weight loss maintenance. Sixty-one overweight or obese individuals lost around 10 kg of body weight on an energy-restricted diet and were then followed for 9 months. During this period, participants were advised to maintain their body weight and eat a healthy diet without further recommendations on calorie intake or diet composition. Contrary to our hypothesis, carbohydrate intake showed no positive association with weight regain after weight loss, and no interaction with baseline fasting glucose concentration was found. There was a non-significant negative association between fibre intake and weight regain (B = −0.274, standard error (SE) 0.158, p = 0.090), but again, no interaction with fasting plasma glucose was found. In conclusion, the data from the YoYo study do not support a role for baseline glucose homeostasis in determining the association between self-reported carbohydrate and/or fibre intake and weight regain after weight loss.
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35
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Aaseth J, Ellefsen S, Alehagen U, Sundfør TM, Alexander J. Diets and drugs for weight loss and health in obesity - An update. Biomed Pharmacother 2021; 140:111789. [PMID: 34082399 DOI: 10.1016/j.biopha.2021.111789] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 01/13/2023] Open
Abstract
Numerous combinations of diets and pharmacological agents, including lifestyle changes, have been launched to treat obesity. There are still ambiguities regarding the efficacies of different approaches despite many clinical trials and the use of animal models to study physiological mechanisms in weight management and obesity comorbidities, Here, we present an update on promising diets and pharmacological aids. Literature published after the year 2005 was searched in PubMed, Medline and Google scholar. Among recommended diets are low-fat (LF) and low-carbohydrate (LC) diets, in addition to the Mediterranean diet and the intermittent fasting approach, all of which presumably being optimized by adequate contents of dietary fibers. A basic point for weight loss is to adopt a diet that creates a permanently negative and acceptable energy balance, and prolonged dietary adherence is a crucial factor. As for pharmacological aids, obese patients with type 2 diabetes or insulin resistance seem to benefit from LC diet combined with a GLP-1 agonist, e.g. semaglutide, which may improve glycemic control, stimulate satiety, and suppress appetite. The lipase inhibitor orlistat is still used to maintain a low-fat approach, which may be favorable e.g. in hypercholesterolemia. The bupropion-naltrexone-combination appears promising for interruption of the vicious cycle of addictive over-eating. Successful weight loss seems to improve almost all biomarkers of obesity comorbidities. Until more support for specific strategies is available, clinicians should recommend an adapted lifestyle, and when necessary, a drug combination tailored to individual needs and comorbidities. Different diets may change hormonal secretion, gut-brain signaling, and influence hunger, satiety and energy expenditure. Further research is needed to clarify mechanisms and how such knowledge can be used in weight management.
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Affiliation(s)
- Jan Aaseth
- Research Department, Innlandet Hospital, PO Box 104, N-2381 Brumunddal, Norway; Inland Norway University of Applied Sciences, Faculty of Health and Social Sciences, N-2624 Lillehammer, Norway.
| | - Stian Ellefsen
- Inland Norway University of Applied Sciences, Faculty of Health and Social Sciences, N-2624 Lillehammer, Norway
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Se-581 85 Linköping, Sweden
| | - Tine M Sundfør
- Department of Endocrinology, Morbid Obesity, and Preventive Medicine, Oslo University Hospital, PO Box 4950 Nydalen, N-0424 Oslo, Norway
| | - Jan Alexander
- Norwegian Institute of Public Health, P.O. Box 222 Skøyen, N-0213 Oslo, Norway
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