The Psychosocial Burden of Obesity

Comorbidities of overweight and obesity associated risk factor in Saudi Arabia: a population-based analysis

BACKGROUND

Obesity is a significant public health challenge in the Kingdom of Saudi Arabia (KSA), with profound impacts on individual well-being and the healthcare system. Recent epidemiological studies have reported variable trends in obesity prevalence within the country. This population-based study aimed to estimate the prevalence, identify behavioral risk factors, and assess comorbidities associated with overweight and obesity using a nationally representative sample in KSA. Findings will inform targeted public health policies, optimize healthcare resource allocation, and support Saudi Vision 2030 goals by promoting healthier lifestyles and reducing chronic diseases.

METHODS

This study analyzed data from the 2019 Kingdom of Saudi Arabia World Health Survey (KSAWHS), implemented by the Ministry of Health using a nationally representative sample. A stratified, three-stage sampling design based on the 2010 Census was used to select 10,000 households from 13 administrative regions. Data collection included socio-demographic, anthropometric measurements and medical information from consenting individuals. Continuous variables were summarized as mean ± SD, and univariate analysis was performed using one-way ANOVA and Chi-square tests. Logistic regression identified predictors of obesity and overweight, reporting odds ratios (OR) with 95% confidence intervals (CI). Analyses were conducted in SPSS (v29).

RESULTS

A total of 7930 adults across different regions in KSA were included in this study. The overall prevalence of obesity and overweight was 20.3% and 38.7%, respectively. Overweight was significantly more prevalent in males (44.4%) than females (35.6%), whereas obesity was more common in females (22.1%) compared to males (18.6%) (p < 0.001). Regional differences were observed with the West region reporting the lowest prevalence of obesity (16.5%) and overweight (37.3%) (p < 0.001). Married individuals exhibited a significantly higher prevalence of both obesity and overweight (p < 0.001).

CONCLUSION

The burden of obesity and overweight in KSA is still alarming due to the associated risk of metabolic, cardiovascular, and psychological disorders, affecting both patients and the healthcare system. Urgent interventions, including targeted public health campaigns, lifestyle modifications, and policy-driven strategies, are essential to curb obesity trends and promote long-term health improvements.

The Gut Microbiome as a Key Determinant of the Heritability of Body Mass Index

The pathogenesis of obesity is complex and incompletely understood, with an underlying interplay between our genetic architecture and obesogenic environment. The public understanding of the development of obesity is shrouded in myths with widespread societal misconceptions. Body Mass Index (BMI) is a highly heritable trait. However, despite reports from recent genome-wide association studies, only a small proportion of the overall heritability of BMI is known to be lurking within the human genome. Other non-genetic heritable traits may contribute to BMI. The gut microbiome is an excellent candidate, implicating complex interlinks with hypothalamic control of appetite and metabolism via entero-endocrine, autonomic, and neuro-humeral pathways. The neonatal gut microbiome derived from the mother via transgenerational transmission (vaginal delivery and breastfeeding) tends to have a permanence within the gut. Conversely, non-maternally derived gut microbiota manifest mutability that responds to changes in lifestyle and diet. We should all strive to optimize our lifestyles and ensure a diet that is replete with varied and unprocessed plant-based foods to establish and nurture a healthy gut microbiome. Women of reproductive age should optimize their gut microbiome, particularly pre-conception, ante- and postnatally to enable the establishment of a healthy neonatal gut microbiome in their offspring. Finally, we should redouble our efforts to educate the populace on the pathogenesis of obesity, and the role of heritable (but modifiable) factors such as the gut microbiome. Such renewed understanding and insights would help to promote the widespread adoption of healthy lifestyles and diets, and facilitate a transition from our current dispassionate and stigmatized societal approach towards people living with obesity towards one that is epitomized by understanding, support, and compassion.

Systemic inflammation as a mediator in the link between obesity and depression: Evidence from a nationwide cohort study

BACKGROUND

Obesity and depression are major public health issues with a complex, bidirectional relationship potentially involving systemic inflammation.

METHODS

Using a diverse sample from the National Health and Nutrition Examination Survey (NHANES) (n = 11,324; weighted population = 456,457,366), we examined the associations between obesity, systemic inflammation, and depression. Obesity was classified by Body Mass Index (BMI), depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), and systemic inflammation was measured using markers like Neutrophil-to-Lymphocyte Ratio (NLR), Systemic Inflammation Response Index (SIRI), and Systemic Immune-Inflammation Index (SII). Weighted logistic regression models were used to assess relationships between obesity, inflammation, and depression. Linear regression evaluated BMI's association with inflammation markers, and Restricted Cubic Spline (RCS) analysis explored their interrelationships. Subgroup analyses and interaction tests were conducted, and mediation analysis examined the role of inflammation markers in mediating the obesity-depression association.

RESULTS

Class III obesity was associated with higher inflammatory marker levels and increased depression risk. Mediation analysis showed NLR, SIRI, and SII mediated 5.2%, 5.9%, and 6.1% of the obesity-depression relationship.

CONCLUSIONS

Systemic inflammation partially mediates the relationship between obesity and depression.

Clinical studies on anti-obesity medications in Arab countries

OBJECTIVES

To identify and summarize studies carried out in Arab countries on anti-obesity medications (AOMs), with a focus on the types of medications investigated, study designs, and the efficacy/effectiveness and safety metrics reported.

METHODS

We carried out a comprehensive scoping review of primary studies examining the use of AOMs in adult Arab populations. Five databases (Medline, Embase, Cochrane Library, Index Medicus for the Eastern Mediterranean Region, and e-Marefa) were searched for English-language publications up to October 2024. Data extraction was carried out on study characteristics, participant demographics, interventions, and outcomes related to weight reduction, metabolic parameters, and side effects. The risk of bias (RoB) was assessed using the Newcastle-Ottawa scale for non-randomized studies and a modified RoB tool for randomized controlled trials.

RESULTS

A total of 59 clinical studies published between 2014-2024 were included. The majority (89.8%) were observational in design. Most studies were carried out in Saudi Arabia (40.7%) and the United Arab Emirates (20.3%). Glucagon-like peptide-1 receptor agonists were investigated in 72.9% of the studies, with liraglutide being the most frequently studied agent (54.2%). The most commonly reported efficacy outcomes included changes in total body weight (45.8%), body mass index (39.0%), and the proportion of weight loss (28.8%). Gastrointestinal side effects were reported in 32.2% of patients across studies.

CONCLUSION

Despite the growing body of research on AOMs in Arab countries, most studies remain observational and focus primarily on earlier-generation agents. There is a need for randomized controlled trials to evaluate the efficacy and safety of newer AOMs, such as semaglutide and tirzepatide, within Arab populations to inform culturally and genetically tailored obesity management strategies.

Relations between trajectories of weight loss and changes in psychological health over a period of 2 years following bariatric metabolic surgery

PURPOSE

This study aimed to identify trajectories of BMI, obesity-specific health-related quality of life (HR-QoL), and depression trajectories from pre-surgery to 24 months post-bariatric metabolic surgery (BMS), and explore their associations, addressing subgroup differences often hidden in group-level analyses.

METHOD

Patients with severe obesity (n = 529) reported their HR-QoL and depression before undergoing BMS, and at 12 and 24 months post-operation. Latent Class Growth Analysis was used to identify trajectories of BMI, HR-QoL and depression.

RESULTS

BMI and HR-QoL improved significantly for all patients from pre-surgery to 24 months post-operation, though some patients deteriorated in their outcomes after 12 months. Three distinct trajectories of BMI were identified: Low (35.4%), Medium (45.5%), and High (19.2%), and of HR-QoL: High (38.4%), Medium (43.4%), and Poor (18.1%). Three trajectories of depression were extracted: Low/none (32.4%), Medium-low (45.3%), and Worsening (22.3%). The association between the trajectories of BMI and depression was significant, but not between the BMI and HR-QoL trajectories. Specifically, the Low BMI trajectory patients were more likely to follow the Worsening depression trajectory and reported poorer preoperative psychological health than the other two BMI trajectories.

CONCLUSION

Patients following the most favourable weight loss trajectory may not manifest psychologically favourable outcomes (i.e., Worsening depression), and preoperative characteristics do not consistently describe post-surgical BMI trajectories. Clinicians should tend to patients' mental wellbeing besides weight loss post-BMS. The study findings emphasize the significance of incorporating psychological health as an essential component of surgical outcomes.

Impact of child summertime obesity interventions on body mass index and weight-related behaviors: A systematic review and meta-analysis

INTRODUCTION

Obesity during childhood is a critical public health issue. The summer break from school is a time when children are prone to accelerated weight gain. We aimed to investigate how obesity prevention or treatment programs implemented over the summer affect anthropometric measures or weight-related behaviors.

METHODS

Published studies examining the impact of obesity prevention/treatment interventions targeting the summer with anthropometric or weight-related behaviors in children (5-18 years old) were identified using systematic searches of Medline, Cochrane, Scopus, CINAHL, PsycINFO, and EMBASE until April 2024. The summarized effect estimate was computed by applying the random-effects approach. The evidence certainty was assessed using GRADE.

RESULTS

Forty-seven studies were identified for inclusion. The majority of studies identified focused on physical activity and dietary habits. Only six studies that examined the effects of prevention interventions on weight, body mass index (BMI), and waist circumference (WC) were meta-analyzed. There was no evidence that prevention interventions impacted children's weight, BMI, and WC. However, most of the studies included in the systematic review indicated beneficial effects of interventions for anthropometric measures.

CONCLUSION

There was no evidence that summertime obesity interventions targeting physical activity and dietary intake were effective in the prevention of obesity in children.

Impact of obesity on functioning in society - OQI-3, a new tool pilot study results

OBJECTIVES

The objective was to develop a tool enabling better understanding of obesity impact on social functioning with focus on daily functioning and work related activities.

MATERIAL AND METHODS

Obesity Impact on Functioning in Society Questionnaire (OQI-3) was developed for use among adult population with obesity disease. It focuses on daily functioning, work related activities and emotions related to work environment social relations. The 3-part questionnaire combining qualitative and quantitative methods is gender specific and it was validated among 41 adult patients with obesity in Poland. The first part is a vignette examining patients' projected attitudes and emotions. The second is an open question related to daily activities mostly affected by obesity. The third part uses a Likert scale to assess the degree of difficulty in performing daily activities consisting of 11 actions taken in everyday life. Respondents select 1 of the answers on the scale to indicate the obesity influence on the mentioned activities.

RESULTS

The qualitative parts provided information on attitudes and emotions, where mostly negative attitudes and emotions were mentioned. The most frequently mentioned were physical activity, walking up the stairs, housework and activities related to patients' image. The quantitative part identified 2 factors (1 - relations in the further social environment, 2 - functioning in a close environment). The Likert scale was recoded for each statement as follows: 1 - 3; 2 - 1; 3 - 2; 4 - 4; 5 - 5 and Cronbach's α value was calculated confirming scale reliability. It equals 0.874 for the total of items.

CONCLUSIONS

The OQI-3 is innovative and combines various research techniques to verify people suffering from obesity well-being and disease impact on social functioning. The pilot study has proven its internal consistence. However the modified tool based on the pilot results should be tested and validated on a larger study group. Guidelines for results interpretation should be developed with the final instrument version. Int J Occup Med Environ Health. 2025;38(2):151-62.

Childhood Obesity: A Narrative Review

Obesity among children has emerged as a worldwide health issue due to childhood obesity becoming a pandemic, and it is often linked to various illnesses, fatal outcomes, and disability in adulthood. Obesity has become an epidemic issue in both developed and developing countries, particularly among youngsters. The most common factors contributing to non-communicable diseases (NCDs) are unhealthy eating habits, desk-bound games, avoidance of physical activity-requiring activities, smoking, alcohol usage, and other added items. All these factors increase NCDs, including obesity, resulting in various morbidities and early death. Additionally, childhood obesity has psychological, emotional, cognitive, societal, and communicative effects. For example, it raises the possibility of issues related to physical appearance, self-esteem, confidence level, feelings of isolation, social disengagement, stigma, depression, and a sense of inequality. Children who consume more energy-dense, high-fat, low-fiber-containing food than they need usually store the excess as body fat. Standardizing indicators and terminology for obesity-related metrics is critical for better understanding the comparability of obesity prevalence and program effectiveness within and between countries. The underlying variables must be altered to reduce or avoid harm to the target organ in children. As a result, reducing childhood obesity is a considerable public health goal for the benefit of society and the long-term well-being of individuals.

The real-life experiences of people living with overweight and obesity: A psychosocial perspective

Understanding the lived experience of obesity, just like any other chronic outcome, is essential to addressing deep routed inequalities and stigma associated with obesity, as well as creating more inclusive and effective policies and healthcare. The psychosocial aspects of obesity are vast and as such the lived experience of obesity differs between individuals and groups. However, there are consistent psychosocial issues identified within empirical studies as well as lived experience accounts that require consideration and potential adaption in the design and delivery of care including weight management and obesity services. Improving perceptions and understanding of the lived experience can also foster empathy which appears to be lacking based on research examining everyday encounters, media portrayal of people living with obesity, and in healthcare settings. Stigma and discrimination are consistent and, in some instances, occur daily in many societal settings leading to mental and physical health concerns, social disengagement and dysfunctional relationships with significant others, as well as avoidance of health promoting activities and settings. Using a narrative review approach, our aim was to examine the empirical evidence generated in countries across the world, reporting on the real-life experiences of people living with obesity. Our search strategy was informed by existing empirical evidence of the psychosocial aspects of obesity and an in-depth interview exploring the lived experience of obesity specifically conducted to inform this article. In doing so, we highlight key psychosocial aspects and provide a voice for a personal account of the challenges experienced in child and adulthood. Recommendations are offered for stakeholders including policymakers and practitioners that aim to address these real-life challenges experienced by people living with obesity. PLAIN LANGUAGE SUMMARY: In this publication, the authors provide a detailed review of the lived experiences of people living with obesity with a focus on the psychological and social factors and experiences across the life course. The paper also uniquely presents real-life experiences from Sarah, who identifies as living with obesity. In doing so, the authors highlight exposure to and experiences of weight management related behaviours and weight stigma from an early age. Experiences of weight stigma and feelings of being excluded from social settings and more generally society are evidenced throughout. Indeed, Sarah's accounts support the research evidence presented, where for instance, she highlights feeling excluded as a younger person when not being able to purchase "trendy" clothing and as an adult when buying clothing for work, experiences of weight stigma in workplaces and issues related to travelling as well as the actions she takes to avoid imposing on other people. The key lived experiences, both from the research evidence and Sarah's accounts, provide insights about the link between obesity and mental health, where for instance, the experiences of weight stigma and feeling excluded from society are associated with mental health outcomes including reduced self-worth and self-esteem, increased depression and increased risk of self-harming. The authors provide a list of ways to address weight stigma in society as well as in healthcare, a setting where weight stigma is often reported by people living with obesity, and calls for greater involvement of people living with obesity in policy, healthcare development and practice, as well as the need to address the widespread weight stigma and discrimination. [Plain language summary added March 2025, after original online publication].

How 'miracle' weight-loss semaglutide promises to change medicine but can we afford the expense?

Obesity is a complex and growing global concern, affecting one in eight individuals and compromising health, quality of life and life expectancy. It carries significant metabolic, cardiovascular, oncological, hepatorenal, skeletal and psychiatric risks, imposing substantial costs on health-care systems. Traditional treatments have often been ineffective or have led to relapse after lifestyle changes. Whereas bariatric surgery is effective, it also involves risks such as mortality and hospitalisation. Semaglutide, licensed in 2018, is a synthetic analogue of glucagon-like peptide 1 which regulates glucose metabolism and gastrointestinal (GI) motility. Studies show that semaglutide, administered either weekly and subcutaneously, or daily orally, induces an average weight loss of -11.62 kg compared to placebo and reduces waist circumference by up to -9.4 cm. It also improves blood pressure, fasting glucose levels, C-reactive protein levels and lipid profiles. The most common adverse events are mild-to-moderate GI complaints occurring more frequently with daily administration than weekly doses; hypoglycaemia is more common without lifestyle intervention. Weight regain often follows semaglutide withdrawal. Furthermore, semaglutide offers cardiovascular benefits for patients with established atherosclerotic cardiovascular disease (CVD), lowers the risk of kidney outcomes and cardiovascular-related death, resolves nonalcoholic steatohepatitis in many cases, and positively impacts mental health and quality of life. In conclusion, semaglutide therapy could significantly benefit many adults regarding CVD and mortality if made widely accessible. Ethical and financial considerations must be addressed for personalised obesity treatment approaches.

Beneath the Surface: The Emerging Role of Ultra-Processed Foods in Obesity-Related Cancer

PURPOSEOF REVIEW

Ultra-processed foods (UPFs) are becoming more and more important in daily diets around the world; in some cases, they can account for as much as 60% of daily energy intake. Epidemiological evidence suggests that this shift toward high levels of food processing may be partially responsible for the global obesity epidemic and the rise in the prevalence of chronic diseases.

RECENT FINDINGS

Few prospective studies have examined the relationship between UPF consumption and cancer outcomes. According to currently available information, UPFs may increase the risk of cancer due to their obesogenic properties and exposure to substances that can cause cancer, such as certain food additives and pollution from product processing. The complex relationship between obesity and cancer involves factors such as immune dysregulation, altered adipokine and sex hormone levels, abnormal fatty acid metabolism, extracellular matrix remodeling, and chronic inflammation. Addressing cancer risk associated with UPF consumption could involve a multifaceted approach, including consumer behavior modification programs and robust public health regulations aimed at enhancing food environments. Improved knowledge of the potential dual negative impacts of UPFs on the environment and cancer risk is one of the priority areas we identify for future research and policy implications. Various approaches could be used to prevent cancers associated with UPF consumption, such as consumer behavior change programs and stricter public health regulations needed to improve the food environment. This review examines for the first time the potential role of UPFs in cancer risk associated with obesity, exploring underlying biological mechanisms and identifying key areas for future research and policy action, including the dual environmental and health impact of UPFs.

Health behind bars: obesity and cardiometabolic risk according to different indicators in incarcerated men

PURPOSE

This study aims to evaluate the obesity and cardiometabolic disease risks of incarcerated men and to determine the related factors.

DESIGN/METHODOLOGY/APPROACH

This study was cross-sectional and 139 incarcerated men were included. Data were collected using a questionnaire containing the Descriptive Information Form and the Pittsburgh Sleep Quality Index. The incarcerated men' body mass index (BMI), waist circumference, waist-to-hip ratio and waist-to-height ratio were evaluated. The significance level of statistical tests was accepted as p < 0.05.

FINDINGS

According to BMI, the rates of incarcerated men with overweight were 53.2% and with obesity were 13.7%. Their cardiometabolic disease risk according to waist circumference, waist-to-hip ratio and waist-to-height ratio was 47.5%, 53.2% and 73.4%, respectively. The cardiometabolic disease risk was 2.66 times higher in the married and 3.71 times higher in those with senior high school or lower education according to waist circumference, and 4.16 times higher in those who were in the aged = 40 years according to the waist-to-hip ratio, 3.49 times higher in those who were in the aged = 40 years and 4.26 times higher in those with senior high school or lower education according to the waist-to-height ratio.

ORIGINALITY/VALUE

To the best of the authors' knowledge, this study is the first study in which obesity and the risk of cardiometabolic disease in incarcerated men was investigated in Türkiye. In the incarcerated individuals, there was an association between the increased cardiometabolic diseases risk and variables such as older age, being married and having senior high school or lower education.

Mapping Psychological Well-Being in Morbid Obesity: A Network Analysis Approach

Background/Objectives: Identifying key psychological well-being factors in morbid obesity is crucial for designing effective mental health and weight management interventions. This study explores the interconnections between the dimensions of psychological well-being in a large sample of adults with morbid obesity enrolled in an inpatient nutritional rehabilitation program. Methods: A sample of 3212 participants (F = 58%; mean age = 57.18 years; mean Body Mass Index = 43.40 kg/m2) completed the Psychological General Well-Being Index (PGWBI) upon admission to the clinic. A network analysis approach examined the relationships among the PGWBI dimensions (anxiety, depression, positive well-being, self-control, vitality, and general health). Results: Network analysis revealed that vitality and positive well-being exhibited the highest values across closeness (1.432; 0.353), strength (0.853; 0.917), and expected influence (0.853; 0917), indicating their key role in psychological well-being. Depression also demonstrated moderate relevance, suggesting its connection to other well-being factors, though it was not the primary determinant. In contrast, self-control and general health had negative strength and expected influence values (-0.660; -1.641), indicating a less central role in the network. Additionally, anxiety and depression displayed negative betweenness (-0.645), reinforcing their more peripheral position. Conversely, positive well-being and vitality showed the highest betweenness (1.291), highlighting their role as key connecting nodes within the well-being network. Conclusions: Findings suggest interventions targeting positive well-being and vitality may most effectively enhance psychological well-being in morbid obesity, emphasizing strength-based approaches that foster positive affect, motivation, and resilience rather than focusing solely on reducing distress or weight-related concerns.

Definition and diagnostic criteria of clinical obesity

Current BMI-based measures of obesity can both underestimate and overestimate adiposity and provide inadequate information about health at the individual level, which undermines medically-sound approaches to health care and policy. This Commission sought to define clinical obesity as a condition of illness that, akin to the notion of chronic disease in other medical specialties, directly results from the effect of excess adiposity on the function of organs and tissues. The specific aim of the Commission was to establish objective criteria for disease diagnosis, aiding clinical decision making and prioritisation of therapeutic interventions and public health strategies. To this end, a group of 58 experts—representing multiple medical specialties and countries—discussed available evidence and participated in a consensus development process. Among these commissioners were people with lived experience of obesity to ensure consideration of patients’ perspectives. The Commission defines obesity as a condition characterised by excess adiposity, with or without abnormal distribution or function of adipose tissue, and with causes that are multifactorial and still incompletely understood. We define clinical obesity as a chronic, systemic illness characterised by alterations in the function of tissues, organs, the entire individual, or a combination thereof, due to excess adiposity. Clinical obesity can lead to severe end-organ damage, causing life-altering and potentially life-threatening complications (eg, heart attack, stroke, and renal failure). We define preclinical obesity as a state of excess adiposity with preserved function of other tissues and organs and a varying, but generally increased, risk of developing clinical obesity and several other non-communicable diseases (eg, type 2 diabetes, cardiovascular disease, certain types of cancer, and mental disorders). Although the risk of mortality and obesity-associated diseases can rise as a continuum across increasing levels of fat mass, we differentiate between preclinical and clinical obesity (ie, health vs illness) for clinical and policy-related purposes. We recommend that BMI should be used only as a surrogate measure of health risk at a population level, for epidemiological studies, or for screening purposes, rather than as an individual measure of health. Excess adiposity should be confirmed by either direct measurement of body fat, where available, or at least one anthropometric criterion (eg, waist circumference, waist-to-hip ratio, or waist-to-height ratio) in addition to BMI, using validated methods and cutoff points appropriate to age, gender, and ethnicity. In people with very high BMI (ie, >40 kg/m2), however, excess adiposity can pragmatically be assumed, and no further confirmation is required. We also recommend that people with confirmed obesity status (ie, excess adiposity with or without abnormal organ or tissue function) should be assessed for clinical obesity. The diagnosis of clinical obesity requires one or both of the following main criteria: evidence of reduced organ or tissue function due to obesity (ie, signs, symptoms, or diagnostic tests showing abnormalities in the function of one or more tissue or organ system); or substantial, age-adjusted limitations of daily activities reflecting the specific effect of obesity on mobility, other basic activities of daily living (eg, bathing, dressing, toileting, continence, and eating), or both. People with clinical obesity should receive timely, evidence-based treatment, with the aim to induce improvement (or remission, when possible) of clinical manifestations of obesity and prevent progression to end-organ damage. People with preclinical obesity should undergo evidence-based health counselling, monitoring of their health status over time, and, when applicable, appropriate intervention to reduce risk of developing clinical obesity and other obesity-related diseases, as appropriate for the level of individual health risk. Policy makers and health authorities should ensure adequate and equitable access to available evidence-based treatments for individuals with clinical obesity, as appropriate for people with a chronic and potentially life-threatening illness. Public health strategies to reduce the incidence and prevalence of obesity at population levels must be based on current scientific evidence, rather than unproven assumptions that blame individual responsibility for the development of obesity. Weight-based bias and stigma are major obstacles in efforts to effectively prevent and treat obesity; health-care professionals and policy makers should receive proper training to address this important issue of obesity. All recommendations presented in this Commission have been agreed with the highest level of consensus among the commissioners (grade of agreement 90–100%) and have been endorsed by 76 organisations worldwide, including scientific societies and patient advocacy groups.

Team Approach: An Interdisciplinary Framework for Weight Loss Before Total Joint Arthroplasty Surgery

» Obesity is a public health concern, with 41.9% of the US population classified as obese. Obesity increases the risk of chronic disease, type II diabetes, cardiovascular diseases, etc., leading to increased morbidity and mortality. Obesity has been identified as an independent risk factor of postoperative complications, including infection and impaired wound healing, following elective surgery. In total joint arthroplasty, it has been well elucidated that obese patients are predisposed to higher rates of postoperative complications, longer hospital stays, and increased cost of stay.» Obesity is influenced by the interplay between many societal, behavioral, and socioeconomic factors and requires a multidisciplinary approach to treatment. The patient's care team should be well versed in nutritional counseling, behavioral health counseling, medication management, and surgery to allow for a comprehensive approach.» Orthopaedic surgeons, dietitians, nutritionists, weight-loss physicians, and bariatric surgeons all play a critical role in treating this patient population. This review highlights the roles of these practitioners in developing an interdisciplinary framework to help patients with hip and knee arthritis lose weight before joint replacement surgery. Not only will this afford more patients the quality-of-life benefits that come with a hip or knee replacement but will also serve to decrease the complication rates associated with this patient cohort.» The aim of this review was to educate orthopaedic surgeons on various strategies that can be used to best optimize these patients for successful joint replacement surgery.

Obesity and Atherosclerotic Cardiovascular Disease: A Review of Social and Biobehavioral Pathways

In the United States, two out of every five adults have obesity. The obesity epidemic is a significant public health concern and a major risk factor for atherosclerotic cardiovascular disease (ASCVD), contributing to its development through a complex interplay of social, biologic and behavioral mechanisms. It exacerbates traditional cardiovascular risk factors such as dyslipidemia, hypertension, and type 2 diabetes, while visceral and epicardial fat deposition promotes inflammation and insulin resistance, thereby accelerating atherosclerosis. Beyond traditional pathophysiologic pathways, social determinants of health (SDoH) significantly contribute to obesity-related disparities, particularly among racial and ethnic minorities. SDoH factors such as socioeconomic status, access to health care, and limited availability of nutritious food and safe spaces for physical activity not only increase obesity prevalence but also exacerbate its psychological toll, including stress and anxiety, which further elevate cardiovascular risk. Environmental factors, such as limited green spaces and air pollution, further promote obesogenic behaviors and worsen cardiovascular outcomes. In this review, we explore the association between obesity and ASCVD and key mediating pathways including the role of SDoH and environmental risk factors. We also discuss potential strategies-including patient education, community engagement to address SDoH, and establishment of dedicated cardiometabolic and cardiovascular prevention clinics-to mitigate the population burden of obesity and improve downstream cardiovascular outcomes.

Trends and determinants of obesity among ever-married women aged 15-49 in India: insights from National Family Health Surveys (NFHS 1998-2021)

BACKGROUND

Obesity has emerged as a significant public health concern in India, particularly among ever-married women of reproductive age (EMWRA). This study analyses trends in obesity among EMWRA across India and its states from 1998 to 2021 and explores the factors contributing to obesity in this group.

METHODS

Data from four National Family Health Survey (NFHS) rounds, spanning 1998-99 to 2019-21, were pooled to create a dataset of 1,117,433 participants. We analysed obesity trends in India and its states and assessed β- and σ-convergence in obesity rates during this period. Additionally, we examined changes in socioeconomic differentials in obesity over this period. Binary logistic regression was used to explore the association of obesity with socioeconomic, demographic, and temporal factors.

RESULTS

Over the study period, obesity among ever-married women of reproductive age (EMWRA) in India has shown a startling increase, tripling from 5.1% (95% CI: 4.7-5.5) in 1998-99 to 15.7% (15.4-15.9) in 2019-21. While obesity rates have surged across all states, the degree of increase varies significantly (ranging from 22.9% points in Tamil Nadu to 2.6 in Meghalaya). Presently, two prominent regions in the country exhibit high obesity rates: the southern region, including Tamil Nadu (29%), Kerala (25%), Goa (25%), and Andhra Pradesh (23%), and the northwestern region, encompassing Delhi (33%), Punjab (31%), and Haryana (24%). Moreover, the disparity in obesity rates across states has widened over time, with states initially showing higher rates experiencing a faster growth rate compared to those with lower initial rates, as highlighted by the β- and σ-convergence analyses. There was substantial variation in obesity rates across education, wealth, place of residence, and social group categories. The risk of obesity is higher among older, educated, wealthy, non-Hindu EMWRAs and TV watchers, but lower among those living in rural areas, the southern region, smaller households, and belonging to SC, ST, and OBC social groups.

CONCLUSION

The surge in obesity among Indian ever married women of reproductive age calls for immediate public health measures. Customized strategies, acknowledging regional differences, are vital to tackle diverse obesity rates across states. Prioritizing vulnerable groups, including the poor, uneducated, and urban populations, is critical for ensuring fair health outcomes.

CORRELATION BETWEEN TRAUMATIC BRAIN INJURY, OBESITY AND INSULIN-RESISTANCE - A CASE REPORT

Introduction

Traumatic brain injury is a significant global health concern. It often results from high-velocity accidents and leads to diffuse axonal injury, causing consciousness disorders and potentially permanent cognitive and behavioural changes. Individuals with traumatic brain injury often exhibit weight gain, potentially leading to obesity. This weight increase is influenced by cognitive dysfunction, reduced physical activity and metabolic changes.

Case report

A 23-year-old woman suffered a traumatic brain injury after a traffic accident, with an initial Glasgow Coma Scale score of 5/15. Positive neurological improvement was observed during her stay in the intensive care unit and the neurosurgical department. Subsequently, she was transferred to the rehabilitation department, where she faced significant challenges, including mood fluctuations, cognitive impairments and substantial weight gain. Her body mass index (BMI) increased from 23 kg/m2 pre-accident to a maximum of 36 kg/m2, despite interventions like medications and lifestyle changes. Blood tests revealed insulin-resistance and metformin initiated a successful weight reduction.

Conclusion

Managing weight gain following traumatic brain injury requires effective interventions that acknowledge its complexity and multifaceted nature, including lifestyle modifications, behavioural therapy and potentially pharmacotherapy or bariatric surgery. Further research is essential to better understand underlying mechanisms and evaluate intervention effectiveness in this specific patient population.

KDOQI US Commentary on the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of CKD

The Kidney Disease Outcomes Quality Initiative (KDOQI) convened a work group to review the 2024 KDIGO (Kidney Disease: Improving Global Outcomes) guideline for the management of chronic kidney disease (CKD). The KDOQI Work Group reviewed the KDIGO guideline statements and practice points and provided perspective for implementation within the context of clinical practice in the United States. In general, the KDOQI Work Group concurs with several recommendations and practice points proposed by the KDIGO guidelines regarding CKD evaluation, risk assessment, and management options (both lifestyle and medications) for slowing CKD progression, addressing CKD-related complications, and improving cardiovascular outcomes. The KDOQI Work Group acknowledges the growing evidence base to support the use of several novel agents such as sodium/glucose cotransporter 2 inhibitors for several CKD etiologies, and glucagon-like peptide 1 receptor agonists and nonsteroidal mineralocorticoid receptor antagonists for type 2 CKD in setting of diabetes. Further, KDIGO guidelines emphasize the importance of team-based care which was also recognized by the work group as a key factor to address the growing CKD burden. In this commentary, the Work Group has also assessed and discussed various barriers and potential opportunities for implementing the recommendations put forth in the 2024 KDIGO guidelines while the scientific community continues to focus on enhancing early identification of CKD and discovering newer therapies for managing kidney disease.

Optimised Skeletal Muscle Mass as a Key Strategy for Obesity Management

The 'Body Mass Index' (BMI) is an anachronistic and outdated ratio that is used as an internationally accepted diagnostic criterion for obesity, and to prioritise, stratify, and outcome-assess its management options. On an individual level, the BMI has the potential to mislead, including inaccuracies in cardiovascular risk assessment. Furthermore, the BMI places excessive emphasis on a reduction in overall body weight (rather than optimised body composition) and contributes towards a misunderstanding of the quiddity of obesity and a dispassionate societal perspective and response to the global obesity problem. The overall objective of this review is to provide an overview of obesity that transitions away from the BMI and towards a novel vista: viewing obesity from the perspective of the skeletal muscle (SM). We resurrect the SM as a tissue hidden in plain sight and provide an overview of the key role that the SM plays in influencing metabolic health and efficiency. We discuss the complex interlinks between the SM and the adipose tissue (AT) through key myokines and adipokines, and argue that rather than two separate tissues, the SM and AT should be considered as a single entity: the 'Adipo-Muscle Axis'. We discuss the vicious circle of sarcopenic obesity, in which aging- and obesity-related decline in SM mass contributes to a worsened metabolic status and insulin resistance, which in turn further compounds SM mass and function. We provide an overview of the approaches that can mitigate against the decline in SM mass in the context of negative energy balance, including the optimisation of dietary protein intake and resistance physical exercises, and of novel molecules in development that target the SM, which will play an important role in the future management of obesity. Finally, we argue that the Adipo-Muscle Ratio (AMR) would provide a more clinically meaningful descriptor and definition of obesity than the BMI and would help to shift our focus regarding its effective management away from merely inducing weight loss and towards optimising the AMR with proper attention to the maintenance and augmentation of SM mass and function.

Assessing the evidence for health benefits of low-level weight loss: a systematic review

Individuals with excess weight are at a higher risk for various physical and mental health conditions. Interventions targeting weight loss can improve health, with modest weight loss of five to ten percent of body weight often considered clinically meaningful for enhancing health outcomes. However, the benefits of achieving low-level weight loss ( < 5% body weight) are poorly understood. We aimed to systematically review relevant literature and synthesise the evidence that assessed the potential health benefits of losing less than five percent body weight. We searched seven academic databases and included studies in any language, from any country, with no time constraints. We included any intervention studies that assessed the impact of less than five percent weight loss on any measured physical or mental health markers or indices. 70 studies from 68 articles were included, with study participants ranging from 14 to 10,742. In total, 137 health markers were assessed, categorised into metabolic markers (n = 42), cardiovascular markers (n = 32), anthropometric measures (n = 19), quality of life indices (n = 10), inflammatory biomarkers (n = 10), renal and hepatic markers (n = 9), psychosocial and behavioural measures (n = 8), pulmonary function (n = 3), total mortality (n = 2), ovulatory function (n = 1), and muscle strength (n = 1). Overall, 60% of studies reported improvements, 37% found no change or mixed results, and 3% observed a worsening of health markers or indices. Based on the available data, 87% of participants (n = 15,839) in the studies reported improvements in health markers or indices as a result of low-level weight loss. Our findings suggest that low-level weight loss can lead to various health benefits and challenges the conventional threshold for effective weight loss.Preregistration The review protocol was pre-registered with PROSPERO (CRD42023406342).

Physical Activity before and After Bariatric Surgery

Lifestyle changes including reduced calorie intake and increased physical activity (PA) improve the prognosis associated with bariatric surgery (BS) and metabolic indices. Early implementation of exercise leads to improved physical performance, better glycemic control and lipid profile, reduces the risks associated with anesthesia, and accelerates recovery from surgery. Undertaking systematic exercise after BS is associated with a better quality of life, improves insulin sensitivity, results in additional weight loss, reduces adverse effects on bone mass, and results in better body composition. The aim of this review was to summarize recommendations for physical activity in patients undergoing BS and to highlight the key role of physical activity in this patient group.

Factors associated with weight loss response to GLP-1 analogues for obesity treatment: a retrospective cohort analysis

OBJECTIVES

The response to glucagon-like peptide-1 (GLP-1) analogues for weight loss varies significantly. We investigated the anthropometric, demographic and clinical characteristics associated with total body weight loss (TBWL) from subcutaneous GLP-1 analogue therapy in patients with obesity in a real-world setting.

DESIGN

Retrospective cohort analysis.

SETTING

An urban, multidisciplinary obesity community clinic in Vancouver, Canada, from November 2018 to April 2021.

PARTICIPANTS

483 adults with a body mass index (BMI) of ≧30 kg/m2 who had filled a new prescription for subcutaneous semaglutide or liraglutide, with at least 6-month follow-up, were included (mean follow-up: 17.3 months). Individuals with prior bariatric surgery were excluded.

OUTCOMES

The primary outcome was the %TBWL over a mean follow-up period of 520 days. Participant's TWBL was categorised as non-response (<5% TBWL), moderate response (5%-15% TBWL) or hyper-response (>15% TBWL).

RESULTS

The average %TBWL in the cohort was 12.2%. Among the participants, 17.8% had a non-response, 48.4% had a moderate response and 33.8% had a hyper-response. In the multivariable regression analysis, being a woman was associated with hyper-response (adjusted OR 1.92, CI 1.01 to 3.65, p=0.048). Age, diabetes status, baseline BMI, being sedentary, anxiety and depression were not independently associated with TBWL in response to GLP-1 analogue therapy.

CONCLUSIONS

In a real-world setting, female sex was found to be associated with a hyper-response to GLP-1 analogue therapy for obesity management. Other clinical factors evaluated, including diabetes status, were not associated with the response. Future research should assess additional variables and support the development of novel biomarkers that are associated with weight loss response.

The Power of Movement: Linking Physical Activity with Nutritional Health and Blood Sugar Balance in a Dalmatian Type 2 Diabetic Population

BACKGROUND AND OBJECTIVES

Regular physical activity (PA) and Mediterranean diet (MeDi) adherence independently improve glycemic control and clinical outcomes in type 2 diabetes mellitus (T2DM). This study examined the associations between PA, body composition (BC), MeDi adherence, and glycemic control in Dalmatian T2DM patients.

MATERIALS AND METHODS

A cross-sectional study was conducted at the University Hospital of Split (November-December 2023) during an open call for T2DM patients. Data collected included blood/urine samples, blood pressure, BC, and anthropometrics. MeDi adherence and PA were assessed via the Mediterranean Diet Service Score and the International PA Questionnaire-Short Form.

RESULTS

Among 252 participants (median age: 67 years, IQR: 60-73; 51.6% women; median T2DM duration: 10 years, IQR: 6-20), PA levels were low (31.4%, N = 79), moderate (45.2%, N = 114), and high (23.4%, N = 59), with uniformly low MeDi adherence across groups. Low PA was associated with higher body mass index (BMI) and lower phase angle (PhA). PA negatively correlated with fat mass (FM; %) and visceral adiposity. Positive BMI predictors included FM (kg), total body water, visceral fat level, and PhA, while fat-free mass, intracellular water, and FM (%) were negative predictors. The estimated glomerular filtration rate was the only positive predictor of the total metabolic equivalent of the task score.

CONCLUSIONS

PA enhances BC and metabolic health, but inadequate MeDi adherence limits these benefits in the T2DM population. To optimize glucose control and health outcomes, public health initiatives must emphasize MeDi adherence and a combination of aerobic and resistance training.

What internet- and mobile-based interventions are currently available for adults with overweight or obesity experiencing symptoms of depression? A systematic review

Given the high prevalence of overweight and obesity and high comorbidity of depressive symptoms, there is a need for low-threshold, accessible care approaches for people with overweight/obesity aimed at improving mental health. Internet and mobile-based interventions (IMI) represent an innovative complementary treatment option. This review systematically searches for IMI aimed at improving mental health in people with overweight/obesity. We conducted a systematic literature search according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria in the databases MEDLINE, Cochrane Library, PsycINFO, Web of Science and Google Scholar. Randomized controlled trials (RCTs) of IMI for adults with overweight/obesity and comorbid depressive symptoms aiming at improving mental health were screened and extracted. Study quality was assessed with RoB 2 (revised Cochrane Risk of Bias tool in RCTs). After excluding duplicates, n = 790 results were included in title and abstract screening. After full-text-screening of n = 26 studies, n = 3 RCT studies were included. All interventions aimed to reduce both weight and depressive symptoms. In two RCTs, a significant reduction in both depressive symptoms and weight was achieved. One RCT indicated a significant reduction in depressive symptoms, but not in weight. Two intervention had a duration of 6 months and were guided by health carers, the third takes 3 months and can be used without professional guidance. There is evidence that IMI are effective in improving mental health for people with overweight/obesity and comorbid depressive symptoms. However, currently there are few interventions aiming at reducing depressive symptoms, all targeting English-speaking people. As IMI for depressive symptoms can be easily integrated in the somatic therapy of obesity as additional option and has high public health potential, target group-adapted and low-threshold accessible interventions in different languages should be developed and implemented for improving mental health in people with overweight/obesity. Prospero registration number: CRD42023361771.

Psychosocial Problems in People Living with Thalassemia: A Systematic Review

Background

Thalassemia is a genetic disease that is inherited in families and has been designated as a global burden. Individuals living with thalassemia may experience impacts on their psychosocial well-being. However, there is a gap of limited study at the systematic review level regarding the extent to which psychosocial aspects contribute to the overall problems and burdens experienced by people living with thalassemia.

Aim

This study aimed to synthesize the evidence on psychosocial problems in people living with thalassemia to provide comprehensive insight.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was used to guide this systematic review. All relevant empirical studies in the English language that assessed the variety of psychosocial aspects were included. A total of 1,466 articles were identified from PubMed, CINAHL, ProQuest, PsycINFO, Scopus, Web of Science, and Cochrane databases from those inceptions to 6 March 2023. 1,443 articles were excluded due to duplication, not thalassemia- or psychosocial-related, availability of full-text, and not including patients. Finally, 13 studies were included and assessed using Mixed Methods Appraisal Tool (MMAT) appraisal tools. This study is already registered in International Prospective Register of Systematic Reviews (CRD42023431082).

Results

This review analyzed 13 full-text studies conducted between 1993 and 2022. The MMAT quality assessment rated all 13 studies as high quality. The included studies used various designs, with six non-randomized quantitative studies, five descriptive quantitative studies, and two qualitative studies. The review summarizes each study's main findings, highlighting psychosocial problems and related outcomes, such as adherence and psychosocial morbidity, anxiety, educational and social impairment, coping style, internalizing and externalizing behaviors, and adaptive behaviors and family relationships.

Discussion

The available literature globally highlights the psychosocial challenges of people living with thalassemia, particularly those who require regular blood transfusions across different timeframes. Despite inconsistent definitions across studies, it is notable that patients with thalassemia major facing physical changes associated with facial defects and experience significant psychosocial issues related to self-image, social interactions, and relationships that influence quality of life.

Free Fasciocutaneous versus Muscle Flaps in Lower Extremity Reconstruction: Implications for Functionality and Quality of Life

BACKGROUND

 Free tissue transplantations are commonly used to treat complex lower extremity defects caused by trauma, vascular disease, or malignancy, particularly when vital structures are exposed. This study aimed to expand the knowledge on patient-reported outcomes by comparing fasciocutaneous and muscle flaps, with the goal of facilitating patient counseling. Additionally, patient-level risk factors associated with decreased functioning and health-related quality of life were identified.

METHODS

 This retrospective, cross-sectional, multicenter study included patients who underwent microsurgical lower extremity reconstruction using free fasciocutaneous or muscle flaps between 2003 and 2021, with a minimum follow-up of 12 months. Data were collected from medical records, pain scores, Short-Form 36 (SF-36), and Lower Extremity Functional Scale (LEFS). Mean scores were compared between flap types and predictors of LEFS, SF-36 mental component summary (MCS), and SF-36 physical component summary (PCS) scores were determined using a backward stepwise regression model.

RESULTS

 Of the 206 patients eligible, 100 (49%) were included in the retrospective part. A total of 89 (43%) responded to the questionnaires, with 62 treated using a fasciocutaneous flap and 27 with a muscle flap. No significant differences in total LEFS, SF-36 PCS, or MCS scores were found between the two flap type. Pain was a significant predictor of decreased functional outcomes for both flap types and was also linked to poorer mental health in patients treated with fasciocutaneous flaps. Other predictors of low patient-reported outcome scores included obesity, diabetes, poorer mental health, and a follow-up of less than 2 years.

CONCLUSION

 Patients treated with fasciocutaneous and muscle flaps experience comparable levels of functionality and quality of life after surgery. Flap selection should be based on defect characteristics, along with the surgeon's individual skills and preferences. A comprehensive approach that considers physical comorbidities, pain, and mental health is essential, as these factors significantly impact patient functionality and quality of life.

BMIgap: a new tool to quantify transdiagnostic brain signatures of current and future weight

Understanding the neurobiological underpinnings of weight gain could reduce excess mortality and improve long-term trajectories of psychiatric disorders. We used support-vector machines and whole-brain voxel-wise grey matter volume to generate and validate a BMI predictor in healthy individuals (N = 1504) and applied it to individuals with schizophrenia (SCZ,N = 146), clinical high-risk states for psychosis (CHR,N = 213) and recent-onset depression (ROD,N = 200). We computed BMIgap (BMIpredicted-BMImeasured), interrogated its brain-level overlaps with SCZ and explored whether BMIgap predicted weight gain at 1- and 2-year follow-up. SCZ (BMIgap = 1.05kg/m2) and CHR individuals (BMIgap = 0.51 kg/m2) showed increased and ROD individuals (BMIgap=-0.82 kg/m2) decreased BMIgap. Shared brain patterns of BMI and SCZ were linked to illness duration, disease onset, and hospitalization frequency. Higher BMIgap predicted future weight gain, particularly in younger ROD individuals, and at 2-year follow-up. Therefore, we propose BMIgap as a potential brain-derived measure to stratify at-risk individuals and deliver tailored interventions for better metabolic risk control.

Mexican Clinical Practice Guidelines for Adult Overweight and Obesity Management

PURPOSE

To develop Mexico's first methodologically rigorous clinical practice guideline for the management of adult overweight and obesity. The target audiences are interdisciplinary healthcare professionals across healthcare systems who are the first point of contact for patients with obesity in Mexico, patients, and health system decision makers.

RECENT FINDINGS

A review of recent international obesity clinical practice guidelines and an expert consensus process identified: i) common recommendations appropriate for implementation in Mexico and ii) knowledge gaps requiring the formulation of new recommendations. In all, 20 new recommendations and 20 good practice statements were developed using the GRADE Evidence-to-Decision Framework and expert consensus. Overweight and obesity negatively impact the health and well-being of individuals and populations in Mexico. This guideline aims to establish a new evidence-based, patient-centered, non-stigmatizing, and practical treatment and management framework, based on the fundamental principles of chronic disease prevention and management.

A Novel and Comprehensive Wellness Assessment for Lifestyle-Based Interventions

Objective

While weight status and clinical laboratory measures are important in assessing obesity-related disease severity and chronic disease risk, including a broader range of emotional, psychosocial, and behavioral factors would provide greater context of an individual's overall state of wellness and could be used to better guide treatment decisions. The purpose of this research was to develop a comprehensive Lifestyle Wellness assessment for use in lifestyle-based wellness interventions and programs.

Methods

A cross-sectional exploratory factor analysis (EFA) was conducted using baseline data from N = 138 adults participating in behavioral weight loss trials. An unweighted least squares extraction method with oblique rotation was used. Twenty-one putative measures spanning constructs related to metabolic health, emotional health/wellbeing, body weight and composition, diet quality, and fitness were analyzed for retention.

Results

Mean body mass index (BMI) was 38.0 ± 6.6 kg/m2, mean age was 57.3 ± 11.1 years, and 77.5% of participants were female. The EFA produced a five-factor model with 13 items that explained 80.3% of the variance. The retained factors included: (1) Psychosocial State: mindfulness, resilience, quality of life, and happiness; (2) Blood Pressure State: systolic and diastolic blood pressure; (3) Lipid State: total cholesterol and LDL-cholesterol; (4) Fitness State: grip strength, jump height, and percent body fat; and (5) Body State: BMI and waist circumference.

Conclusions

Lifestyle Wellness is a comprehensive assessment that enables innovative wellness-related research such as metabolically healthy obese phenotypes and weight-neutral interventions. Future research should include investigations in additional populations with greater age, sex/gender, and body size diversity.

The decorin and myostatin response to acute whole body vibration: impact of adiposity, sex, and race

BACKGROUND

Traditional forms of exercise affect immune, metabolic, and myokine responses and contribute to a multitude of health benefits. Whole body vibration (WBV) has recently emerged as an exercise mimetic that may be more tolerable for those individuals that cannot perform traditional exercise. However, the myokines response to acute WBV in humans has yet to be fully elucidated.

OBJECTIVE

To characterize the decorin and myostatin response to acute whole body vibration (WBV) and determine the impact of adiposity, sex, and race.

SUBJECTS

One hundred twenty-nine adults (32.8 ± 0.4 years, 66.7% female, 53.5% non-Hispanic Black) were recruited as part of an ongoing, longitudinal twin cohort parent study. Participants were classified into three groups: those with obesity (OB: ≥30 kg/m2), those who are overweight (OW: ≥25 and <30 kg/m2), or those with normal weight (NW: <25 kg/m2) based on BMI.

METHODS

Blood was collected at baseline (PRE), immediately post (POST), and 1 h (1H), 3 h (3H), and 24 h (24H) post WBV. The acute WBV protocol consisted of 10 cycles of 1 min of vibration exercise followed by 30 s of standing rest.

RESULTS

The response was similar between NW and OW, so these groups were combined for analysis (NW/OW: BMI < 30 kg/m2). Overall, circulating concentrations of decorin were higher (p < 0.001) POST (8.80 ± 0.19 pg/mL) and significantly lower (p's ≤ 0.005) at 1H (8.66 ± 0.19 pg/mL) and 3H (8.68 ± 0.19 pg/mL), compared to PRE (8.71 ± 0.19 pg/mL). Decorin POST was greater (p = 0.016) in the OB group (8.82 ± 0.18 pg/mL) compared to the NW/OW group (8.77 ± 0.20 pg/mL). Overall, myostatin was higher (p = 0.002) POST (54.93 ± 1.04 pg/mL) and lower (p < 0.001) at 24H (49.13 ± 1.04 pg/mL) compared to PRE (53.49 ± 1.04 pg/mL). The myostatin response was lower (p's ≤ 0.001) in female and non-Hispanic White individuals compared to male and non-Hispanic Black individuals, respectively.

CONCLUSIONS

A single bout of WBV can facilitate the release of decorin and myostatin into circulation, a similar response to traditional exercise. Additionally, adiposity, sex and race should be considered when evaluating the myokines response to WBV.

Online Cognitive-Behavioral Therapy-Based Nutritional Intervention via Instagram for Overweight and Obesity

BACKGROUND/OBJECTIVES

Obesity is a multifactorial chronic disease treated through lifestyle modifications, pharmacotherapy, and surgery. With the rise of social media, platforms like Instagram have become tools for lifestyle interventions. This study evaluated the impact of a cognitive-behavioral-therapy-based nutritional intervention via Instagram on body weight, eating behavior, and mental health in individuals with overweight and obesity.

METHODS

A 5-week online intervention delivered daily nutritional, cognitive, and behavioral content via a private Instagram account using live sessions, reels, feed posts, polls, and stories. Standardized dietary plans were sent by e-mail. Self-reported weight and waist circumference and questionnaires on eating behavior, self-esteem, stress, and anxiety were collected. Engagement and interaction were measured through comments, likes, number of followers, story retention, participation in live sessions, and direct messages.

RESULTS

The final sample included 66 participants (63 women), 27 with overweight and 39 with obesity, and a mean age of 40.5 ± 10.6 years. After the intervention, body weight decreased by 1.1 kg, while waist circumference remained unchanged. Participants with obesity showed significant improvements in binge eating, uncontrolled eating, self-esteem, stress, and anxiety, while those with overweight showed improvements in binge eating and stress. Weight loss was associated with reduced binge eating and lower cognitive restriction, while lower uncontrolled eating was related to decreased emotional eating, anxiety, and stress. Additionally, participation in live sessions was associated with reduced binge eating.

CONCLUSIONS

This online intervention via Instagram was effective in improving weight loss, eating behavior, and mental health symptoms in participants with overweight and obesity.

Exploring successes, barriers, and enablers in the one-year digital Healthy Weight Coaching

INTRODUCTION

Healthcare professionals' perspectives are often overlooked in the evaluation of digital weight loss interventions. Thus, we examined how healthcare professionals perceive patient success in a one-year web-based weight management program, the Healthy Weight Coaching, aiming to identify key success factors and common challenges within the coaching process.

METHODS

Thematic analysis was conducted on ten semi-structured interviews with healthcare professionals from the Healthy Weight Coaching. Interviewees included individuals of both sexes, with an average age of 41 years, ranging from 10 months to 5 years of coaching experience, and treating 90 to 500 patients.

RESULTS

Three main themes emerged from the analysis: (1) Positive progress during the Healthy Weight Coaching, (2) Factors facilitating success, and (3) Barriers hindering progress. The coaches noted significant positive changes among patients, including increased self-compassion, reduced weight-related stress, and a shift toward holistic well-being. Improvements in eating habits, physical activity, and vegetable consumption were observed, along with reductions in binge eating behaviors. Personal factors such as internal motivation and engagement with the program were crucial for success. Additionally, aspects of the Healthy Weight Coaching program, such as its individualized and supportive environment, flexible coaching approach, and the pivotal role of coaches, were seen as facilitators of success. Patients valued being treated equally and acceptingly and fostering trust and collaboration. However, challenges such as burdensome life situations, limited resources, and inadequate support posed significant barriers to progress. Unrealistic goals and societal pressures were also observed to hinder successful weight management efforts.

CONCLUSION

A comprehensive, individualized approach addressing resource limitations and societal norms can enhance long-term success in weight management programs like the Healthy Weight Coaching, ultimately promoting overall well-being.

Waist-to-Height Ratio Cut-Off Points for Central Obesity in Individuals with Overweight Across Different Ethnic Groups in NHANES 2011-2018

BACKGROUND

The identification of surrogate measures of central obesity is of clinical importance, and the waist-to-height ratio (WtHR) has recently attracted great interest as an alternative method.

OBJECTIVE

For this reason, we aimed to establish specific WtHR cut-off points for adiposity (i.e., central obesity) in four different ethnicity groups across both sexes based on data from the National Health and Nutrition Examination Survey (NHANES) population.

METHODS

Of the total 23,037 participants who completed four cycles of the survey between the years 2011 and 2018, anthropometric measures (i.e., body weight, waist circumference, and height) and dual X-ray absorptiometry-derived visceral adipose tissue (DXA-derived VAT) results were available for 3566 individuals who were assessed in this cross-sectional study. Participants with an overweight status defined according to the World Health Organization (WHO) body mass index (BMI) cut-off points (25-29.9 kg/m2) were included. The sample was then categorized by adiposity according to the DXA-derived VAT tertiles (highest), and based on the receiver operating characteristic (ROC) curve analysis, the best sensitivity and specificity were attained for predicting central obesity using the WtHR.

RESULTS

The following WtHR cut-offs were identified as having the best discriminating ability for central obesity: 0.57 for White males and 0.58 for White females; 0.55 for Black males and 0.57 for Black females; 0.56 for Asian males and 0.59 for Asian females; and 0.57 for Hispanic males and 0.59 for Hispanic females.

CONCLUSIONS

These new WtHR cut-off points should be utilized in adults with overweight to screen for central adiposity based on their sex and ethnicity, and obesity guidelines therefore need to be revised accordingly.

Cafeteria diet and caloric restriction affect metabolic but not behavioral characteristics in male Wistar rats

This study aimed to evaluate the effects of a cafeteria diet and caloric restriction on behavioral and metabolic profiles of adult male Wistar rats. The rats were randomly divided into three groups (n = 12/group) and from 10 weeks of age fed either ad libitum standard rat chow (control group), ad libitum cafeteria diet in addition to standard chow (diet-induced obesity (DIO) group) or kept on caloric restriction (at 85% weight of controls; restricted group) for a period of 12 weeks. Body weight was assessed twice per week and glucose levels were measured at three times during the 12-week period. At week 11 the animals were behaviorally profiled using the multivariate concentric square field™ (MCSF) test. After 12 weeks of diet the animals were euthanized, blood collected, relative organ weights were assessed and plasma or serum levels of insulin, glucose, and lipid profile were measured. The DIO group gained 23% more weight than the control group (p < 0.001) and increased adipose tissue weight in comparison to the control (p < 0.001) and restricted (p < 0.001) groups. Glucose was significantly increased (p < 0.001) only during the second measurement at week 7 and insulin levels were elevated in the DIO group compared to controls and restricted groups (p < 0.01; p < 0.001, respectively). Plasma cholesterol levels were reduced for both DIO (p < 0.01) and restricted (p < 0.001) groups relative to controls. Adiponectin and leptin levels were higher for the DIO group in comparison to both the control (p < 0.001; p < 0.05) and restricted (p < 0.001; p < 0.001) groups. Thus, the two diets led to significant changes in body weight gain, adiposity, and metabolism. However, they did not alter the behavioral profiles in the MCSF test, suggesting that activity, exploration, risk assessment, risk taking or shelter seeking remained unaffected by the dietary interventions. The current findings suggest that an increase or reduction in energy intake resulted in no behavioral effects, despite the accompanying glycemic alterations potentially related to diabetes development.

What is the effect of bariatric surgery on health-related quality of life in people with obesity? Observational cohort analysis of the United Kingdom National Bariatric Surgery Registry

BACKGROUND

Previous small studies investigating health-related quality of life (HRQoL) following bariatric surgery have demonstrated heterogenous effects. This study aimed to use National Bariatric Surgery Registry (NBSR) records to investigate the relationship between weight and HRQoL in people undergoing bariatric surgery in the UK.

MATERIALS AND METHODS

In this observational study using United Kingdom National Bariatric Surgery Registry (NBSR) records between 1st June 2017 and 23rd November 2022, patients undergoing primary bariatric surgery with one baseline and at least one follow-up visit within 1 year from surgery were eligible for inclusion. Models estimated the relationship between EuroQol Five Dimension 5-level (EQ-5D) and BMI at baseline and longitudinally. Further analyses were stratified by type 2 diabetes, type of operation (adjustable gastric band, sleeve, or bypass), and domain of EQ-5D.

RESULTS

Five thousand five hundred eighty-seven observations of 2160 patients were analysed. At baseline, the mean BMI was 45.7±7.8 kg/m 2 and the mean EQ-5D was 0.78±0.22. A 1 kg/m 2 higher BMI was associated with 0.005 (95% CI [-0.006 to -0.004]) lower EQ-5D. In the month following surgery, EQ-5D increased to 0.91±0.2 while BMI decreased to 39.8±7.1 kg/m 2 ( P <0.001 for both); subsequently, EQ-5D plateaued (0.90±0.17 at 12 months) while BMI continued to decrease (31.5±6.2 kg/m 2 at 12 months, P <0.001). Each 1 kg/m 2 decrease in BMI was associated with a 0.006 (95% CI [-0.007 to -0.005]) increase in EQ-5D. Remission of T2D was independently associated with increase in EQ-5D (0.037, 95% CI [0.015-0.059]); type of operation was not. Decreases in BMI were associated with improvements in all five domains of EQ-5D.

CONCLUSIONS

In this large dataset, greater weight loss and T2D remission were independently associated with greater improvements in HRQoL following bariatric surgery. The HRQoL-BMI relationship for people undergoing bariatric surgery differs to that which has previously been estimated following behavioural interventions. The use of the estimates generated here will be important for clinical and political decision-making.

Exploring factors influencing late evening eating and barriers and enablers to changing to earlier eating patterns in adults with overweight and obesity

Late evening eating is a potential risk factor for overconsumption and weight gain. However, there is limited qualitative research investigating the complex factors that influence late evening eating in adults living with obesity. Identifying the factors that influence late evening eating can inform interventions to reduce late evening eating and associated health risks. Therefore, this study aimed to: i) explore factors that contribute to eating late, and ii) apply the Capability, Opportunity, and Motivation Behaviour (COM-B) model to understand the barriers and enablers to changing to earlier food intake timings in UK adults who report eating late. Semi-structured interviews with seventeen participants [32.47 ± 6.65 years; 34.68 ± 7.10 kg/m2; 71% female (n = 12); 41% White (n = 7)] investigated reasons for late evening eating and the potential barriers and enablers to changing to earlier eating patterns. Thematic analysis identified four main contributors to late evening eating: 1) internal signals (e.g., feeling hungry in the evening); 2) external and situational factors (e.g., work schedules and the food-rich environment); 3) social factors (e.g., interactions with family) and 4) behavioural and emotional factors (e.g., personal preferences and negative feelings in the evening). Time constraints and work schedules were identified as main barriers to changing to earlier eating patterns. Whereas, having high motivation (e.g., contentment with eating earlier in the evening) and interpersonal support were identified as main enablers to eating earlier. This study provides in-depth insights into the psychological, social, and environmental factors contributing to late evening eating. The findings highlight potential targets for future interventions to facilitate earlier eating times in individuals at risk of overweight and obesity.

Alternative Perspectives on Obesity and Hypertension

It is known that obesity and hypertension have a relationship with one another. Often, obesity is thought to directly cause hypertension, with a list of mechanisms commonly cited. This, however, does not do the relationship justice. Not only can the directionality of the relationship be flipped, but the mechanisms may be misattributed confounders, themselves. Beyond this, some argue that the results of trials using glucagon-like-peptide-1 receptor agonist (GLP1R) medications suggest a causal relationship between obesity and hypertension, but this will be debunked. The relationship is far from linear, and mainstream literature often excludes key confounders that will be discussed in this article including food insecurity, mental health, socioeconomic status (SES), and weight stigma and discrimination. The factors used to measure the risk of hypertension as well as the measurements of hypertension, itself, need to be reexamined. For instance, there may be a high amount of "false positives" among the diagnosed. Finally, current research needs to be critically evaluated for forms of weight centrism and weight bias, deciphering improper assumptions from true, evidence-based science.

Psychological well-being, food insecurity, academic performance and other risk factors in a sample of university students in Jordan during COVID-19

This research validated an Arabic version of the Psychological General Well-being Index-Short version (PGWB-S) and examined the relationship between perceived psychological well-being, and food insecurity, academic achievement, and other risk factors in a sample of university students in Amman, Jordan, during COVID-19. A cross-sectional study was conducted in two phases. Phase 1 translated and validated the Arabic copy of the PGWB-S in 122 students from the University of Jordan. In Phase 2, 414 students completed the demographic questionnaire, Arabic versions of the PGWB-S, the Ryff Psychological Well-being Scale, and the Individual Food Insecurity Experience Scale. The participants had a mean PGWB-S score of 15.82 ± 0.34, and 41.3% had a mean score below 15. Psychological well-being was better in students younger than 21 and/or who had a GPA ≥3.0, were of normal weight or overweight, physically inactive, and food secure, did not drink coffee or smoke, as well as in those whose neighbourhood contained grocery stores and/or public transportation (P < 0.05). In conclusion, during the pandemic, perceived mental well-being was moderate in a Jordanian sample of university students. Perceived psychological well-being was also positively associated with food security and academic performance. These findings suggest that improving food security and academic achievement may contribute to enhanced psychological well-being among university students. Therefore, higher education institutions with the help of the government are encouraged to facilitate the provision of mental health care services to students, mainly post the coronavirus, which according to our knowledge is limited.

Synergistic effects of glucose tolerance and BMI on cardiovascular events and all-cause mortality in a healthy population: CA.ME.LI.A study 7 years follow-up

The CA.ME.LI.A (CArdiovascular risks, MEtabolic syndrome, LIver and Autoimmune disease) epidemiological study was conducted in Abbiategrasso (Milan, Italy) to identify risk factors for metabolic and cardiovascular disease in an apparently healthy population of northern Italy. The population (n = 2,545, 1,251 men, 1,254 women) was stratified according to body mass index [normal body weight (NBW): <25 kg/m2; overweight-obese (OWO): ≥25 kg/m2] and according to fasting blood glucose [normal fasting glucose: <100 mg/dL; impaired fasting glucose (IFG): 100-125 mg/dL; diabetes mellitus (DM): ≥126 mg/dL]. The incidence of cardiovascular (CV) events and overall mortality were studied by the Kaplan-Meier method using the log rank test. Univariate analysis was conducted with time-dependent Cox models. During the 7-yr follow-up period, 80 deaths and 149 CV events occurred. IFG [hazard ratio (HR): 2.81; confidence interval (CI): 1.37-5.77; P = 0.005], DM (HR: 4.88; CI: 1.47-16; P = 0.010), or OWO (HR: 2.78; CI:1.68-4.59; P < 0.001) all produced significant increases in CV events and deaths. In the combination IFG/OWO (HR: 5.51; CI: 3.34-9.08; P < 0.001), there was an apparent additive effect of the two conditions, whereas in the combination DM/OWO (HR: 12.71; CI: 7.48-22; P < 0.001), there was an apparent multiplicative effect on the risk for CV events and deaths. In males, the DM/NBW group had a higher incidence of cardiovascular events and deaths than the IFG/OWO group. In contrast, in females, the IFG/OWO group had a higher incidence of cardiovascular events and deaths than the DM/NBW group. In women, there was a greater incidence of CV events in the IFG/OWO group (HR: 6.23; CI: 2.88-13; P < 0.001) than in men in the same group (HR: 4.27; CI: 2.15-8.47; P < 0.001). Consistent with these data, also all-cause mortality was progressively increased by IFG/DM and OWO, with an apparently exponential effect in the combination DM/OWO (HR: 11.78; CI: 6.11-23; P < 0.001). IFG/DM and OWO, alone or in combination, had major effects in increasing mortality for all causes and CV events. The relative contributions of hyperglycemia and overweight/obesity on cardiovascular events and deaths were apparently, to a certain extent, sex dependent. Females were more affected by overweight/obesity either alone or combined with IFG, as compared with males.NEW & NOTEWORTHY For the first time, the combined effects of glucose tolerance and BMI have been investigated in an apparently healthy large population sample of a city in the north of Italy. We found that there are synergistic effects of glucose levels with BMI to increase not only cardiovascular events and deaths but also cancer-related deaths and all-cause mortality.

Contribution of obesity in the association between fast-food consumption and depression: A mediation analysis

BACKGROUND

Depression is a significant mental health concern, and the ubiquitous presence of fast-food in modern diets raises questions about its impact on mental well-being. Understanding the intricate relationship between fast-food consumption, obesity, and depression is essential for addressing the complex web of factors contributing to this public health issue.

METHODS

In this study, we analyzed data from the National Health and Nutritional Examination Surveys (NHANES) spanning from 2008 to 2018, involving 31,460 participants.

RESULTS

Among the 31,460 subjects in the survey, 2871 exhibited signs of depression, with an average age of 48.2 years. Each additional weekly fast-food meal was linked to 4 % higher odds of depression, with consuming over two such meals increasing the odds by 24 %. Adjusted models exploring the relationship between body mass index (BMI), fast-food consumption, and depression indicated an increased risk with greater fast-food intake, especially within subgroups based on obesity status. Mediation analysis revealed that fast-food consumption and depression were largely independent of obesity, with obesity accounting for only 6.5 % of the total effect. No significant mediation effect was found in the overweight subgroup, but the mediated effect was increased with higher BMI in more obese patients, notably in those with BMI ≥ 30 or ≥40. Sensitivity analysis confirmed these findings with more conservative estimates across all subgroups.

CONCLUSION

This study highlights a substantial connection between fast-food consumption and depression. While obesity plays a role, it does not fully mediate the relationship, suggesting the presence of other contributing factors.

[The relationship between obesity, social isolation, and mental health-results from the LIFE adult study]

BACKGROUND

Population-based studies on the relationship between social isolation and obesity, which also include younger adults, are still lacking in Germany. The aim of this study is to investigate the prevalence of social isolation in people with and without obesity. In addition, socially isolated people with and without obesity are examined with regard to socio-demographic and socio-economic factors as well as with regard to depressive symptoms.

METHODS

This study was based on baseline data from the LIFE Adult Study (18-79 years) from the 2011-2014 study period. The sample comprised n = 8350 participants. In addition to socio-demographic characteristics and socio-economic status (SES), data on social isolation (LSNS-6), depression (ADS), and body mass index (BMI) were collected. Evaluations were carried out using inferential statistical analyses.

RESULTS

Overall, 13.1% of the total sample were affected by social isolation. Participants with obesity (20.4%) had a significantly (p < 0.001) higher prevalence compared to those without obesity (11.4%). A better social integration was significantly associated with younger age (p < 0.001), female sex (p < 0.001), being married (and cohabiting) (p < 0.001), higher socioeconomic status (p < 0.001), and lower depressive symptoms (p < 0.001).

DISCUSSION

A higher BMI was not associated per se with poorer social integration. However, the present study showed that socially isolated people with obesity represent a special risk group for impaired mental health and had twice the prevalence of social isolation compared to those without obesity.

Effect of aerobic and resistive exercise on lipid profile and quality of life in overweight breastfeeding women: A randomized controlled trial

BACKGROUND

Breastfeeding provides benefits for both mothers and babies. However, many women experience postpartum weight gain, unfavorable lipid profiles, and other postpartum problems that can adversely impact their overall quality of life (QoL).

OBJECTIVE

To examine the effect of adding aerobic and resistive exercise to faradic stimulation and nutritional counseling on lipid profile and QoL in overweight breastfeeding women.

SUBJECTS AND METHODS

Fifty-four breastfeeding women were randomly allocated into two equally sized groups. Group A underwent abdominal faradic stimulation along with nutritional counseling for 12 weeks, whereas Group B received identical faradic stimulation and nutritional counseling and engaged in a combined aerobic and resistive exercise program for the same duration. Before and after treatment, the following anthropometric measurements were evaluated: body mass index (BMI), waist-to-hip ratio (W/H); lipid profile analysis, such as high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG); and the Short Form 36 Health Survey Questionnaire (SF-36).

RESULTS

All outcome measures demonstrated significant improvements within the two groups (p < 0.05). Group B showed more significant reductions in BMI, W/H ratio, and LDL, along with greater significant increases in the SF-36 domain scores for physical functioning, physical health problems, bodily pain, general health, energy/fatigue, social activity, mental health, and the total SF-36 score (p < 0.05) compared to group A post-treatment. However, there were no significant differences in HDL, TG, and the score of the emotional wellbeing domain of the SF-36 between the groups after treatment (p > 0.05).

CONCLUSION

12-week aerobic and resistive exercise is effective in reducing the BMI, W/H ratio, and LDL levels and enhancing the QoL in overweight breastfeeding women.

The Relationship between Resting Metabolic Rate and Body Composition in People Living with Overweight and Obesity

Background/Objectives: Resting metabolic rate (RMR) is an important contributor of energy balance and displays a well-documented relationship with sex, age, race and fat-free mass (FFM) in the existing scientific literature. However, the impact of other body composition components such as fat and liver fat on RMR remains unclear. This study aims to investigate the correlation of RMR with body composition parameters in a sample of patients with overweight and obesity. Methods: Retrospective data of patients with overweight or obesity referred for magnetic resonance imaging of liver fat during the period 2018-2023 were utilized for this study. Demographic and anthropometric data were collected, including body composition parameters (body fat, muscle mass) and RMR measured by bioelectrical impedance and indirect calorimetry, respectively. Results: The final sample included 53 patients (66% male), with a mean age of 48 years (±11.2) and a mean body mass index (ΒΜΙ) of 38.5 kg/m2 (32.7, 44.7). Simple correlation models revealed that RMR was separately correlated with gender, age, BMI, muscle mass, and liver fat (all p < 0.05) but not with fat mass. When multiple regression models were employed, only muscle mass retained its statistically significant influence on RMR, while total and hepatic fat did not significantly affect RMR after controlling for other parameters (gender, age, muscle mass). Conclusions: These findings confirm the known correlation between muscle mass and RMR while highlighting the lack of association between total and hepatic fat and RMR in individuals with overweight and obesity.

The Effects of the LiiNK Intervention on Physical Activity and Obesity Rates among Children

BACKGROUND

Obesity and inactivity among children are at an all-time high and have been steadily increasing in prevalence over the last thirty years. The school environment provides the ideal setting for reaching a large number of children across diverse populations in order to reverse these trends. However, there are many inconsistent results yielded by school-based physical activity interventions due to implementation length, time for activities, and the use of structured physical activities. The LiiNK Project® is a whole-child intervention addressing these gaps by providing children 45-60 min of recess (unstructured, outdoor play) in their schools daily, while the control children are allowed to engage in recess for 30 min daily. The purpose of this study was to compare the physical activity intensity and obesity rates of third- and fourth-grade children participating in the LiiNK intervention, which provides 60 min of recess for third graders and 45 min for fourth graders, to those in a control group allowed 30 min of daily recess.

METHODS

The children were 8-10 years old (M = 9.2; 52% females and 48% males). The intervention children comprised 90 third graders and 100 fourth graders, and the control children comprised 101 third graders and 92 fourth graders. Physical activity levels were monitored using accelerometers to assess sedentary, light, and moderate-to-vigorous physical activity (MVPA). Obesity rates were evaluated using bio-electrical impedance analysis (BIA), in which body fat percentage is calculated based on normative values using age and sex in the equation.

RESULTS

The third-grade intervention children engaged in 13 more MVPA minutes and took 900 more steps daily than their control counterparts, and also presented a greater proportion of overweight children transitioning to a healthy weight status from the fall to the spring semester. Conversely, the fourth-grade control children increased their activity by 500 steps and 15 more MVPA minutes daily. Despite this, the intervention children overall demonstrated a reduction in body fat percentage, while the control children demonstrated an increase in body fat percentage.

CONCLUSIONS

Ultimately, 60 min of unstructured, outdoor play in schools provides children the best opportunity to engage in MVPA, which may positively impact body fat percentages, offering a potential strategy for combatting childhood obesity in school settings.

The Impact of Yoyo Dieting and Resistant Starch on Weight Loss and Gut Microbiome in C57Bl/6 Mice

Cyclic weight loss and subsequent regain after dieting and non-dieting periods, a phenomenon termed yoyo dieting, places individuals at greater risk of metabolic complications and alters gut microbiome composition. Resistant starch (RS) improves gut health and systemic metabolism. This study aimed to investigate the effect of yoyo dieting and RS on the metabolism and gut microbiome. C57BL/6 mice were assigned to 6 diets for 20 weeks, including control, high fat (HF), yoyo (alternating HF and control diets every 5 weeks), control with RS, HF with RS, and yoyo with RS. Metabolic outcomes and microbiota profiling using 16S rRNA sequencing were examined. Yoyo dieting resulted in short-term weight loss, which led to improved liver health and insulin tolerance but also a greater rate of weight gain compared to continuous HF feeding, as well as a different microbiota profile that was in an intermediate configuration between the control and HF states. Mice fed HF and yoyo diets supplemented with RS gained less weight than those fed without RS. RS supplementation in yoyo mice appeared to shift the gut microbiota composition closer to the control state. In conclusion, yoyo dieting leads to obesity relapse, and increased RS intake reduces weight gain and might help prevent rapid weight regain via gut microbiome restoration.

Anti-obesity effects of Beta vulgaris and Eruca sativa-based extracts

Obesity is a major source of morbidity worldwide with more than 2 billion adults being overweight or obese. The incidence of obesity has tripled in the last 50 years, leading to an increased risk for a variety of noncommunicable diseases. Previous studies have demonstrated the positive effects of green leafy vegetables on weight gain and obesity and have attributed these beneficial properties, at least in part, to nitrates and isothiocyanates. Nitrates are converted to nitric oxide (NO) and isothiocyanates are known to release hydrogen sulfide (H2S). Herein, we investigated the effect of extracts and fractions produced from Beta vulgaris and Eruca sativa for their ability to limit lipid accumulation, regulate glucose homeostasis, and reduce body weight. Extracts from the different vegetables were screened for their ability to limit lipid accumulation in adipocytes and hepatocytes and for their ability to promote glucose uptake in skeletal muscle cultures; the most effective extracts were next tested in vivo. Wild type mice were placed on high-fat diet for 8 weeks to promote weight gain; animals receiving the selected B. vulgaris and E. sativa extracts exhibited attenuated body weight. Treatment with extracts also led to reduced white adipose tissue depot mass, attenuated adipocyte size, reduced expression of Dgat2 and PPARγ expression, and improved liver steatosis. In contrast, the extracts failed to improve glucose tolerance in obese animals and did not affect blood pressure. Taken together, our data indicate that extracts produced from B. vulgaris and E. sativa exhibit anti-obesity effects, suggesting that dietary supplements containing nitrates and sulfide-releasing compounds might be useful in limiting weight gain.

Weight Loss Programs: Why Do They Fail? A Multidimensional Approach for Obesity Management

PURPOSE OF REVIEW

Despite the prevalence of weight loss programs, their success rates remain discouraging, with around half of individuals regaining lost weight within two years. The primary objective of this review is to explore the factors contributing to the failure of weight loss programs and to provide insights into effective weight management strategies.

RECENT FINDINGS

Factors contributing to the failure of weight loss programs include the impracticality of restrictive diets, potential metabolic impacts, limited focus on lifestyle changes, genetic predispositions, psychological influences, socioeconomic status, and medical conditions. A holistic approach considering these factors is crucial for safe and sustainable weight loss. Key findings indicate the importance of holistic approaches to weight management, including lifestyle modifications, medical interventions, and behavioral and psychological strategies. Effective weight loss strategies emphasize low-calorie, nutrient-rich diets, regular physical activity, and interventions tailored to individual needs. Combining multiple approaches offers the best chance of successful weight management and improved health outcomes. This review provides insights into the complexities of obesity management and the factors contributing to the failure of weight loss programs. It highlights the necessity of adopting a holistic approach that addresses dietary habits, physical activity, genetic factors, psychological well-being, and socioeconomic influences. Recommendations include implementing lifestyle modifications, medical interventions when necessary, and integrating behavioral and psychological support to achieve sustainable weight loss and mitigate the global health challenge posed by obesity.

Metabolic bariatric surgery, alcohol misuse and liver cirrhosis: a narrative review

Bariatric surgery and liver cirrhosis have considerable overlap. Bariatric procedures intend to reduce metabolic dysfunction-associated steatotic liver disease (MASLD); however, these procedures are thought to increase the propensity for alcohol misuse. This may predispose the bariatric surgical patient to a new form of liver insult in the postoperative period. This review explores the complex relationship between obesity and alcohol misuse in the context of the bariatric surgical patient. There is evidence to support the safety of bariatric procedures in compensated cirrhotic patients, with an improvement of liver function and architecture. However, data suggest that after a two-year period, these patients exhibit an increased propensity for alcohol misuse postoperatively, particularly after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) procedures. A paucity of evidence exists with respect to alcohol-induced liver dysfunction, or MASLD and increased alcohol intake (MetALD) in the post-bariatric surgery patient. This review aims to provide an overview of the current evidence and offer recommendations for further robust studies.

Dietary and Lifestyle Strategies for Obesity

The prevalence of obesity globally has tripled over the last half century, and currently affects around 650 million adults and 340 million children and adolescents (ages 5-19 years). Obesity contributes towards >50 co-morbidities and premature mortality. Obesity is a highly stigmatised condition that is associated with much mental and emotional distress and dysfunction. Thus, obesity is a major contributor to healthcare expenditure globally. Traditionally, the management of obesity stratifies into three major groups that include metabolic (bariatric) surgery, pharmacotherapies, and lifestyle (primarily dietary) strategies. Although listed as a separate category, dietary strategies for obesity remain a central component of any management plan, and often complement other surgical and pharmacotherapeutic options. Indeed, the effectiveness of any management approach for obesity relies upon successful behavioural changes, particularly relating to eating behaviours. In this concise review, we explore the foundational pillars of dietary strategies for obesity: sleep, listening, routine, de-stressing and optimisation of social conditions. We then discuss the importance of balancing dietary macronutrients (including dietary fibre, carbohydrates, protein and ultra-processed foods [UPFs]) as a key dietary strategy for obesity. Although we focus on general principles, we should provide bespoke dietary strategies for our patients, tailored to their individual needs. Rather than judging the utility of a diet based simply on its associated magnitude of weight loss, we should adopt a more holistic perspective in which a dietary strategy is valued for its overall health benefits, including the nurturing of our gut microbiota, to enable them to nurture and protect us.