Excess Weight in Spain: Current Situation, Projections for 2030, and Estimated Direct Extra Cost for the Spanish Health System

Does the Prevalence of Obesity in the Different Regions of Spain Influence the Attitudes, Perception, and Barriers to Its Treatment?

INTRODUCTION

The differences in the prevalence of obesity between the various regions of Spain, partly attributed to socioeconomic differences, may influence the approach to this disease. The aim of this study was to compare differences in attitudes, perception, and barriers to the treatment of obesity between people with obesity (PwO) and health care professionals (HCPs), between the different regions of Spain.

METHODS

Sub-analysis of the ACTION-IO Spain study, which included 1,500 PwO and 306 HCP, was performed to identify differences in PwQ and HCPs belonging to regions with high prevalence of obesity (>16%, n = 9 regions, high prevalence of obesity [HPO] group) and low prevalence of obesity (<16%, n = 8 regions, low prevalence of obesity [LPO] group) (self-reported data), according to the 2017 National Health Survey of Spain.

STATISTICS

comparison of proportions (χ2).

RESULTS

A total of 746 PwO belonged to HPO and 754 to LPO group. The PwO in HPO group were younger, had lower income, a lower level of higher education, higher unemployment rate, and fewer comorbidities. Obesity was considered a chronic disease to a higher extent in HPO compared to LPO group (62 vs. 56%), but this difference was not statistically significant. The PwO in HPO group discussed less with the HCPs about their excess weight (57 vs. 70%), did not feel motivated to lose weight in a higher percentage (26 vs. 18%), and felt less emotionally supported (16 vs. 24%). In HPO group, the preference for unhealthy food (51 vs. 36%), and the costs of healthy eating, anti-obesity drugs and bariatric surgery were perceived barriers to losing weight. A higher proportion of PwO in HPO group considered that exercise (58 vs. 40%) was more effective for achieving weight loss. In contrast, LPO group considered diet more effective (48 vs. 32%). HCPs in HPO group felt more motivated to treat obesity (83 vs. 68%) and a higher proportion (14 vs. 5%) identified the economic burden as one of the main reasons why PwO do not start conversations to lose weight.

CONCLUSIONS

There is less concern and conversation about excess weight in PwO in regions with a higher prevalence of obesity, with socioeconomic limitations being one of the main perceived barriers to treatment.

Relationship between addictions and obesity, physical activity and vascular aging in young adults (EVA-Adic study): a research protocol of a cross-sectional study

Background

Behavioral and substance addictions are prevalent health problems that, alongside obesity, are linked to reduced physical activity and increased sedentary time. Similarly, arterial stiffness and vascular aging are processes that begin gradually at an early age and are closely associated with morbidity and mortality from cardiovascular diseases. The main objective of this study is to analyze how addictions are related to obesity and body fat distribution, physical activity, sedentary time, arterial stiffness and vascular aging, as well as sleep quality, cognitive function and gender differences in young adults aged between 18 and 34 years.

Methods

This cross-sectional descriptive observational study will analyze data from 500 subjects (250 men and 250 women) aged 18-34 without cardiovascular disease, selected by simple random sampling with replacement from the urban population of the city center of Salamanca (34,044 people aged 18-34, with 18,450 women and 15,594 men). Behavioral and substance addictions, as well as sleep quality and cognitive impairment will be assessed using questionnaires. The Pittisburg Sleep Quality Index (PSQI) will be used to measure sleep quality and the Ford questionnaire will be used to measure insomnia in response to stress. For obesity, weight, height, waist and hip circumference, body composition will be measured with the Inbody 230® impedance meter. For physical activity and sedentary time, we will use the Actigraph® accelerometer alongside the international physical activity questionnaire (IPAQ) and the Marshall questionnaire. The Sphygmocor System® will be used for pulse wave analysis and carotid-femoral pulse wave velocity (cfPWV), while the Vasera VS-2000® will measure cardio ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). Vascular aging will be calculated with the 10th and 90th percentiles of cfPWV or baPWV. Demographic, analytical variables will be collected, as will data to assess vascular, cardiac, renal, and brain injury.

Discussion

Addictions are on the rise in today's society, affecting the mental health and well-being of those who suffer from them, generating important social problems such as job loss, family dysfunction, debt and social isolation. Together with obesity, they are prevalent health problems in young adults and are associated with lower physical activity and higher sedentary time. Meanwhile, arterial stiffness and vascular aging are processes that begin gradually at an early age and determine morbidity and mortality caused by cardiovascular diseases. The results of this project will allow us to understand the situation regarding behavioral and substance addictions in young adults. Better understanding of these addictions will in turn facilitate the development of more effective prevention strategies and intervention programs, which can then reduce the negative impact at both the individual and societal levels.

Clinical trial registration

[ClinicalTrials.gov], identifier [NCT05819840].

Spanish Validation of the Self-Perceived Food Literacy Scale: A Five-Factor Model Proposition

Food literacy is a combination of functional, critical, and relational skills that pave the way for navigating the food system properly, taking personally and contextually available resources into account. The aim was to validate the Spanish version of the self-perceived food literacy scale in university students to explore the factorial structure of it and to correlate food literacy with other variables. The sample was composed of 362 Spanish university students (314 women). The full questionnaire was administered online and also assessed adherence to a Mediterranean diet, impulsivity, and health-related quality of life for convergent validity testing purposes. Confirmatory factor analysis was conducted to determine the factor structure of the food literacy scale. The Spanish version of the scale showed good indices of internal consistency (Cronbach's α = 0.894). Confirmatory factor analysis revealed a five-factor model that had a better fit index than the seven-factor model of the original scale. External validity was assessed by showing significant correlations with the rest of the variables. Therefore, the Spanish version of the scale is a reliable and valid measure of food literacy. It could be used to promote policies at Spanish universities to improve the food-related behaviors of students.

Food Education, Cookery Books and School Canteens in the Fight against Malnutrition: The Case of the Spanish Edalnu Programme (1961-1986)

The Spanish population completed its nutritional transition in the 1960s and 1970s, when it overcame the problems of malnutrition. Among the initiatives that made this possible, the Food and Nutrition Education Programme (Edalnu) (1961-1986) stands out. In addition to correcting the negative influence exerted by ignorance to nourish oneself correctly, it was intended to prevent the problems of overfeeding that most developed countries showed. The objective of this research addresses, in this context and from the parameters of applied history, the condition of the complementary pedagogical instrument that the Edalnu awarded to the school canteen in the fight against malnutrition, as well as the nutritional, dietetic, culinary and gastronomic criteria used for its operation. The results show that the school canteens sought to reinforce the food knowledge acquired in the classroom. Based on the dialogue between chefs and experts in nutrition and dietetics, balanced meals adapted to regional gastronomic diversity were prepared, which helped to promote, in line with current criteria, healthy and sustainable eating habits through traditional plant-based recipes, with a predominance of seasonal and local products, and with a complementary contribution of ingredients of animal origin.

Predicting Ovarian-Cancer Burden in Catalonia by 2030: An Age-Period-Cohort Modelling

Ovarian cancer is the most lethal gynaecological cancer in very-high-human-development-index regions. Ovarian cancer incidence and mortality rates are estimated to globally rise by 2035, although incidence and mortality rates depend on the region and prevalence of the associated risk factors. The aim of this study is to assess changes in incidence and mortality of ovarian cancer in Catalonia by 2030. Bayesian autoregressive age–period–cohort models were used to predict the burden of OC incidence and mortality rates for the 2015–2030 period. Incidence and mortality rates of ovarian cancer are expected to decline in Catalonia by 2030 in women ≥ 45 years of age. A decrease in ovarian-cancer risk was observed with increasing year of birth, with a rebound in women born in the 1980s. A decrease in mortality was observed for the period of diagnosis and period of death. Nevertheless, ovarian-cancer mortality remains higher among older women compared to other age groups. Our study summarizes the most plausible scenario for ovarian-cancer changes in terms of incidence and mortality in Catalonia by 2030, which may be of interest from a public health perspective for policy implementation.

Obesity and related comorbidities in a large population-based cohort of subjects with type 1 diabetes in Catalonia

INTRODUCTION

Obesity, an increasing global health problem, can affect people with other disease conditions. The prevalence of obesity in people with type 1 diabetes (T1D) is not well known. The aim of this study was to describe extensively the characteristics and prevalence of different classes of obesity according to BMI (body mass index) categories in a large cohort of patients with T1D.

MATERIAL AND METHODS

This was a retrospective, cross-sectional study in Catalonia. We reviewed all patients with T1D diagnosis, ≥ 18 years old and with BMI data from the SIDIAP database. Sociodemographic and clinical data, cardiovascular risk factors, laboratory parameters and concomitant medications were collected.

RESULTS

A total of 6,068 patients with T1D were analyzed. The prevalence of obesity in the total sample was 18% (13.8% with class 1 obesity [BMI 30-34.9 kg/m2]). Patients with obesity had a higher prevalence of other cardiovascular risk factors (i.e. hypertension was 61.4% vs. 37.5%; dyslipidemia 63.6% vs 44%, and chronic kidney disease 38.4% vs. 24.4%; p<0.001 in all cases) and poorer control of them. The higher prevalence was regardless of sex, age and duration of diabetes. The increase in these comorbidities was noticeable from a BMI > 25 kg/m2. Patients with obesity did not have poorer glycemic control.

CONCLUSION

The presence of obesity in people with T1D is frequent and cardiovascular risk factors are more common and more poorly controlled in T1D patients with obesity.

Biological Well-Being and Inequality in Canary Islands: Lanzarote (Cohorts 1886-1982)

Developments in anthropometric history in the Iberian Peninsula have been remarkable in recent decades. In contrast, we barely know about the behavior of insular population groups and infants' and adults' growth during the nutritional transition in the Canary Islands. This paper analyzes the height, weight and body mass index of military recruits (conscripts) in a rural municipality from the eastern Canaries during the economic modernization process throughout the 20th century. The case study (municipality of San Bartolomé (SB) in Lanzarote, the island closest to the African continent) uses anthropometric data of military recruits from 1907-2001 (cohorts from 1886 to 1982). The final sample is composed of 1921 recruits' records that were measured and weighed at the ages of 19-21 years old when adolescent growth had finished. The long-term anthropometric study is carried out using two approaches: a malnutrition and growth retardation approach and an inequality perspective. In the first one, we use the methodology recommended by the World Health Organization (WHO) that is based on z-scores. In the second one, we implement several inequality dimensions such as the coefficient of variation (CV), percentiles and an analysis for height and BMI evolution by five socioeconomic categories. The data suggest that improvements in biological well-being were due to advances in nutrition since the 1960s. They show that infant nutrition is sensitively associated with economic growth and demographic and epidemiological changes.

Self-Care by Muslim Women during Ramadan Fasting to Protect Nutritional and Cardiovascular Health

The practice of Ramadan involves a series of changes in lifestyle, mainly in eating habits. The research aim of this study is to determine the prevalence of overweight-obesity, the degree of compliance with dietary recommendations and the effects of religious fasting on cardiovascular health among a population of Muslim women living in Melilla, a Spanish city in North Africa. A follow-up cohort study was conducted on 62 healthy adult women (33.6 ± 12.7 years). Anthropometric and body composition parameters were obtained using bioimpedance and dietary records. All of the participants were overweight or obese, especially due to the non-compliance with dietary recommendations; however, more than 60% considered their weight was appropriate or even low. By the end of Ramadan, the women's body mass index and fat component values had fallen significantly (p < 0.001), but this loss was later recovered. Dietary records revealed an excessive consumption of lipids and sodium, and the presence of a high waist-to-hip ratio. All of these factors are related to cardiovascular risk. In conclusion, promoting nutritional health and encouraging year-round self-care among adult Muslim women is necessary in order to ensure healthy fasting during Ramadan.

Personalized Diet in Obesity: A Quasi-Experimental Study on Fat Mass and Fat-Free Mass Changes

Considering that the prevalence of overweight and obesity in Southeast of Spain is high, the aim of this work was to analyze the relation between the adherence to a personalized diet and the effectiveness of changes in the body composition in overweight and obese adults in this region. This quasi-experimental study presents the following selection criteria: attendance at the consultation between 2006 and 2012, subjects ≥ 19 years of age with overweight or obesity. In total, 591 overweight or obese individuals were involved in this study, attending 4091 clinic consultations in total. Most of the sample consisted of subjects who attended >3 consultations (>1.5 months), and were females aged 19-64 years who obtained clinically significant changes in fat mass (FM, ≥5%) and recommended changes in fat-free mass (FFM, ≥0%). Based on the results obtained and the experience gained from this research, the following recommendations are established: (i) record fat mass and fat-free mass index as a complement to body mass index; (ii) use FM and FFM to evaluate effectiveness of interventions with the aim of obtaining body composition changes; (iii) use personalized diet to achieve significant changes in FM and avoid non-recommended changes in FFM.

Obesity, Mediterranean Diet, and Public Health: A Vision of Obesity in the Mediterranean Context from a Sociocultural Perspective

Obesity is a disease that straddles medico-nutritional, psychological, and socio-cultural boundaries. There is a clear relationship between lifestyle and obesity, and today the Mediterranean diet in the Mediterranean area may represent an interesting corrective asset. However, we should not be under any misapprehension about the model’s capacity for action in non-nutritional terms. Our societies are experiencing a process of rapid change, and the Mediterranean area is no exception. The aim of this article is to present a view of obesity in the Mediterranean context from an open, mainly socio-cultural perspective, but from different points of view (medical, nutritional), seeking points of convergence and elements that contribute to the understanding of and approach to the disease in the context of the Mediterranean diet. As a public health and a multidimensional social problem, obesity must be dealt with in a holistic, open, and cross-disciplinary manner to ensure that it can be understood coherently. The only way to keep the usefulness of the Mediterranean diet within desirable limits will be our societies’ vitality and interest in rapidly adapting the Mediterranean diet to social change, thus providing valid answers to today’s needs.

Acting against obesity: a cross-cultural analysis of prevention models in Spain, Argentina and Brazil

This article analyses and compares preventive models for obesity in Spain, Argentina and Brazil through an examination of the respective measures adopted to counter it in those countries. Based on a qualitative study of the main actions carried out since 2004, the aim is to delineate the conceptual framework and reflect on the reasons for their relative effectiveness. The results show that in contexts where prevalence has increased rapidly, sociocultural causes acquire greater explanatory power as opposed to biological and/or behavioral factors. These models premise worsening diets and sedentary lifestyles as being the main culprits, and assume that contemporary societies generate obesogenic and toxic environments. The international health bodies have developed specific strategies to control and prevent obesity based on this diagnosis, and these have been supported by member states such as Spain, Argentina and Brazil. Although the measures reflect certain particularities, they conform to a common pattern organized from platforms promoting so-called "healthy lifestyles" and articulated mainly around the twin axes of a balanced diet and regular physical exercise. The discussion suggests that the excessive emphasis on individual responsibility and the underplaying of the role of food as a complex practice, as well as changing structural factors and the differential distribution of this disease, might largely explain the limited impact of these strategies.

Effectiveness of an mHealth Intervention Combining a Smartphone App and Smart Band on Body Composition in an Overweight and Obese Population: Randomized Controlled Trial (EVIDENT 3 Study)

Background

Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear.

Objective

This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese.

Methods

A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire.

Results

The mHealth intervention produced a greater loss of body weight (–1.97 kg, 95% CI –2.39 to –1.54) relative to standard counselling at 3 months (–1.13 kg, 95% CI –1.56 to –0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; –1.84 kg, 95% CI –2.48 to –1.20), percentage of body fat (PBF; –1.22%, 95% CI –1.82% to 0.62%), and BMI (–0.77 kg/m², 95% CI –0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of –1.18 kg (95% CI –2.30 to –0.06) and BMI of –0.47 kg/m² (95% CI –0.80 to –0.13), whereas the obese group only experienced a change in BMI of –0.53 kg/m² (95% CI –0.86 to –0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of –1.03 kg (95% CI –1.74 to –0.33), PBF of –0.76% (95% CI –1.32% to –0.20%), and BMI of –0.5 kg/m² (95% CI –0.83 to –0.19).

Conclusions

The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m² and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect.

Trial Registration

Clinicaltrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614.

International Registered Report Identifier (IRRID)

RR2-10.1097/MD.0000000000009633

Use of Technology-Based Interventions in the Treatment of Patients with Overweight and Obesity: A Systematic Review

Introduction: Obesity is one of the most important health problems worldwide. The prevalence of obesity has increased dramatically in the last decades and is now recognized as a global epidemic. Given the dramatic consequences of obesity, new intervention approaches based on the potential of technologies have been developed. Methods: We conducted a systematic review of studies using PubMed, ScienceDirect, Cochrane Library, and MedLine databases to assess how different types of technologies may play an important role on weight loss in obese patients. Results: Forty-seven studies using different types of technologies including smartphones, app, websites, virtual reality and personal digital assistant were included in the review. About half of interventions (47%) found a significant effect of the technology-based interventions for weight lost in obese patients. The provision of feedback could also be effective as a complement to interventions carried out using technology to promote weight loss. Conclusions: The use of technologies can be effective to increase weight loss in patients with obesity improving treatment adherence through self-monitoring.

[Preventing obesity in precarious contexts: local responses to global strategies]

The aim of this article is to analyze the conceptual structure underlying the models of obesity prevention implemented in Argentina, Brazil, and Spain. In their culturally distinct but epidemiologically similar contexts, the three countries have devised strategies that reproduce global diagnoses of the causes of obesity and replicate some of the measures proposed at the global level. While so-called "obesogenic environments" are considered primarily responsible for these tendencies, efforts to raise awareness about food and nutrition tend to promote self-monitoring and behavior rationalization as the main tools for achieving changes in diet and physical activity. Although a variety of measures have been proposed at the local level, they have been less diverse in terms of their nature and scope, barely taking into account the constraints that hinder the adoption of healthy lifestyles. In contexts of social and food precarity, this has meant neglecting the social groups with the highest prevalence of obesity.

Improved Nutritional Knowledge in the Obese Adult Population Modifies Eating Habits and Serum and Anthropometric Markers

Multicomponent lifestyle interventions achieve good results in the management of obesity among the adult population. However, their implementation in certain populations poses difficulties. A good level of nutritional knowledge enables people to make changes in their diet that improve their health. This study aims to assess the relationship between nutritional knowledge and nutritional parameters such as dietary intake, anthropometric parameters and biomarkers. A before-after, non-randomized interventional study involving a two-monthly nutritional educational intervention was carried out over 8 months. Anthropometric and biomarker data were collected, and nutritional knowledge was evaluated using the Bach questionnaire and food frequency questionnaire (FFQ). The study comprised 66 overweight and obese adults with mean age of 50.23 years. Females predominated (84.8%). At the end of the intervention, nutritional knowledge increased significantly, with a significant reduction in the consumption of sweets, soft drinks, high-fat products, and processed meats, and an increase in the intake of lean meat and poultry. A 3% decrease in body weight was observed. An intervention for the management of obesity in the adult population based on nutritional education achieves weight loss, modifications in eating habits and reduction of fat intake. Increased nutritional knowledge is associated with healthier eating habits and a decreased cardiovascular risk.

Perceptions, Attitudes, and Barriers to Obesity Management in Spain: Results from the Spanish Cohort of the International ACTION-IO Observation Study

The prevalence of obesity is rapidly rising in Spain. The Awareness, Care and Treatment in Obesity Management—An International Observation (ACTION-IO) study (NCT03584191) was an international cross-sectional survey conducted to identify the perceptions, attitudes, behaviors, and barriers to obesity management for people with obesity (PwO) and healthcare professionals (HCPs); results from Spain are presented. In Spain, 1500 PwO (body mass index ≥30 kg/m² based on self-reported height and weight) and 306 HCPs (in direct patient care for ≥2 years) completed the survey. Fewer PwO (59%) than HCPs (93%) agreed that obesity is a chronic disease. Most PwO (80%) assumed complete responsibility for their own weight loss, whilst 19% of HCPs placed the responsibility on PwO. One-fifth of PwO stated they began struggling with weight before age 15. The mean delay in discussing weight for the first time with an HCP was 6 years. Only 24% of HCPs thought their patients were motivated to lose weight, whilst 45% of PwO reported being motivated. Of the 67% of PwO who had discussed their weight with an HCP in the last 5 years, 66% had been formally diagnosed with obesity. Our Spanish dataset reveals discrepancies in the perceptions and attitudes between PwO and HCPs, thus highlighting the need to improve education about obesity and its clinical management.

Feasibility and Clinical Usefulness of the Unified Protocol in Online Group Format for Bariatric Surgery Candidates: Study Protocol for a Multiple Baseline Experimental Design

Obesity is currently becoming a serious global public health problem due to its high prevalence and continuous increase. This condition is associated with different physical and mental health problems. The presence of emotional disorders (anxiety, depression and related disorders) among candidates for bariatric surgery is very high and predicts worse physical and psychological results. The present study aims to explore the feasibility and clinical usefulness of the Unified Protocol, a transdiagnostic emotion regulation-based intervention, delivered in an online group format to patients with emotional disorder diagnosis or symptoms, who are waiting for bariatric surgery. We will conduct a pilot study with a repeated single-case experimental design (multiple baseline design) in a public mental health service. The sample will consist of 60 participants, who will be randomized to three baseline conditions: 8, 12 or 15 evaluation days before the intervention. Diagnostic criteria, symptomatology and body mass index are the primary outcome measures, and we will include affectivity, personality, quality of life, body image, eating behavior and surgical complications like secondary measures. An analysis of treatment satisfaction will be also performed. Assessment points will include pre-treatment, baseline, treatment, post-treatment, and follow-ups every three months until two years after post-treatment. The results obtained in this study may have important clinical, social and economic implications for public mental health.

"It's Important but, on What Level?": Healthy Cooking Meanings and Barriers to Healthy Eating among University Students

The negative impact of a sedentary lifestyle and poor diet on health is evident across the lifespan, but particularly during the university period. Usually, the diet of university students is rich in sweetened drinks and processed foods and low in fruits, vegetables and legumes. Although there is an association between maintaining a healthy diet and the frequency of cooking at home, the time currently spent on cooking or learning how to cook is decreasing globally. The main aim of this study was to explore university students’ perceptions about healthy cooking and barriers to eating healthily. A group of 26 students participated in four focus groups. Content analysis was conducted using Atlas.ti v.8. Students perceived cooking healthily as a more complicated and time-consuming process than cooking in general. Individual and environmental factors were the most reported barriers. Costs and time, among others, were the main barriers pointed out by students with regard to healthy eating. This study highlights the need to develop interventions that modify these false perceptions about cooking healthily, and to train students so that they are able to cook healthy meals in a quick, easy, and cost-effective way. Further, specific actions are required in the university setting to minimize access to unhealthy options and to promote those linked to healthy eating.

Relationship between maternal body mass index with the onset of breastfeeding and its associated problems: an online survey

Background

Obesity is a worldwide public health problem that demands significant attention. Several studies have found that maternal obesity has a negative effect on the duration of breastfeeding and delayed lactogenesis. The World Health Organization has classified Body Max Index (BMI) as normal weight (normoweight) (BMI:18.5–24.9), overweight (BMI:25–29.9), obesity grade I (30.0–34.9), obesity grade II (BMI: 35.0–39.9) and obesity grade III (BMI ≥ 40.0). The objective of this study is to describe the relationship between maternal BMI and breastfeeding rates, as well as breastfeeding-associated problems and discomfort in women assisted by the Spanish Health System.

Methods

To this end, a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain was developed. The data was collected through an online survey of 54 items that was distributed through lactation associations and postpartum support groups between March and June 2019. Five thousand eight hundred seventy one women answered the survey. In the data analysis, Crude Odds Ratios (OR) and Adjusted Odds Ratios (AOR) were calculated through a multivariate analysis through binary and multinomial regression.

Results

A linear relationship was observed between the highest BMI figures and the reduction of the probability of starting skin-to-skin contact (AOR for obesity type III of 0.51 [95% CI 0.32, 0.83]), breastfeeding in the first hour (AOR for obesity type III of 0.58 [95% CI 0.36, 0.94]), and exclusive breastfeeding to hospital discharge (AOR for obesity type III of 0.57 [95% CI 0.35, 0.94]), as compared to women with normoweight.

Conclusions

Women with higher BMI are less likely to develop successful breastfeeding than women with normoweight.

Reformulation of Pastry Products to Improve Effects on Health

Obesity is increasing at an alarming rate and has been described as a global pandemic. This increase has several explanations, including an increase in caloric intake, low levels of physical activity and the nutritional composition of our diets. In addition to public health policies based on healthy dietary patterns and recommendations based on the Mediterranean and other healthy diets, food reformulation, especially of commonly consumed processed foods, such as bakery products and pastries, is needed in the fight against obesity. Among nutritional reformulation strategies, reductions in caloric density, salt, added sugar, saturated and trans-fats are important in order to reduce the associated risk of developing chronic diseases, including cardiovascular diseases, diabetes and cancer.

[Obesity as a risk factor in COVID-19: Possible mechanisms and implications]

Varios artículos recientes sugieren que la obesidad es un factor de riesgo para una enfermedad más grave por coronavirus. En este artículo se resume la evidencia científica disponible sobre el papel de la obesidad en COVID-19, con especial atención en las personas más jóvenes y los mecanismos biológicos propuestos para explicar tanto el mayor riesgo observado como la posible mayor contagiosidad de esta población. Se consideran varias implicaciones de la pandemia sobre las personas con obesidad, en relación con las posibles dificultades en el manejo de los pacientes ingresados, las implicaciones del confinamiento sobre el control y tratamiento de la obesidad, y el estigma que sufren estas personas por su condición, y que puede verse aumentado si se confirma la relación de la obesidad con COVID-19. Comprender el papel de la obesidad en COVID-19 debería ser una prioridad de salud pública, dada la alta prevalencia de esta condición en nuestro país.

A Sustainable Approach to the Metabolic Syndrome in Children and Its Economic Burden

The prevalence of obesity continues to grow, resulting in metabolic syndrome and increasing economic burden for health systems. The objectives were to measure the ability of the NIM-MetS test, previously used in the adults, for the early and sustainable detection of the Metabolic Syndrome (MetS) in children and adolescents. Moreover, to determine the economic burden of the children with MetS. Furthermore, finally, to use and implement the NIM-MetS test, via a self-created online software, as a new method to determine the risk of MetS in children. The method used was an observational study using different instruments (NIM-MetS test, International Diabetes Federation (IDF), or Cook) and measures (body mass index). Additionally, the economic burden was estimated via a research strategy in different databases, e.g., PubMed, to identify previous papers. The results (N = 265 children, age from 10–12) showed that 23.1% had obesity and 7.2% hypertension. The prevalence of MetS using the NIM-Mets was 5.7, and the cost of these children was approximate 618,253,99 euros. Finally, a model was obtained and later implemented in a web platform via simulation. The NIM-MetS obtained is a non-invasive method for the diagnosis of risk of MetS in children.

Relationship between Maternal Body Mass Index and Obstetric and Perinatal Complications

Over the past few decades, overweight and obesity have become a growing health problem of particular concern for women of reproductive age as obesity in pregnancy has been associated with increased risk of obstetric and neonatal complications. The objective of this study is to describe the incidence of obstetric and perinatal complications in relation to maternal body mass index (BMI) at the time prior to delivery within the Spanish Health System. For this purpose, a cross-sectional observational study was conducted aimed at women who have been mothers between 2013 and 2018 in Spain. Data were collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. A total of 5871 women answered the survey, with a mean age of 33.9 years (SD = 4.26 years). In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated through a multivariate analysis. A linear relationship was observed between the highest BMI figures and the highest risk of cephalopelvic disproportion (AOR of 1.79 for obesity type III (95% CI: 1.06–3.02)), preeclampsia (AOR of 6.86 for obesity type III (3.01–15.40)), labor induction (AOR of 1.78 for obesity type III (95% CI: 1.16–2.74)), emergency C-section (AOR of 2.92 for obesity type III (95% CI: 1.68–5.08)), morbidity composite in childbirth (AOR of 3.64 for obesity type III (95% CI: 2.13–6.24)), and macrosomia (AOR of 6.06 for obesity type III (95% CI: 3.17–11.60)), as compared with women with normoweight. Women with a higher BMI are more likely to develop complications during childbirth and macrosomia.

Circulating Undercarboxylated Osteocalcin as Estimator of Cardiovascular and Type 2 Diabetes Risk in Metabolic Syndrome Patients

Undercarboxylated osteocalcin (ucOC) could be a biomarker of glucose disturbances and cardiovascular risk. Our study aimed to determine the association between serum levels of ucOC and cardiovascular risk in metabolic syndrome (MetS) patients and to analyse its potential role as estimator of type 2 diabetes (T2D) risk in this population. This cross-sectional study included 235 patients with MetS, 53.2% women, aged 55–75 years. Circulating ucOC levels were measured by ELISA. Cardiovascular risk was determined as Z-score of the diagnostic criteria for MetS (CV-ZS). Linear regression model was performed to analyse the association between circulating ucOC and CV-ZS. A receiver operating curve (ROC) was performed to analyse the usefulness of ucOC as T2D risk estimator. Patients above the CV-ZS median showed significant lower ucOC levels. We found an inverse association between ucOC levels and CV-ZS in MetS patients without T2D. Patients with ucOC levels below the 25^th percentile showed worse cardiometabolic profile and higher cardiovascular and T2D risk. The area under the curve performed better when ucOC levels were included along with the classic T2D risk factors. The measurement of circulating ucOC could be a useful tool to identify increased cardiovascular and T2D risk in MetS patients without T2D.

Effectiveness of an Interdisciplinary Program Performed on Obese People Regarding Nutritional Habits and Metabolic Comorbidity: A Randomized Controlled Clinical Trial

Obesity is an important public health problem. The combined use of different therapies performed by an interdisciplinary group can improve the management of this health issue. The main goal of this research is to determine the effectiveness of a multidisciplinary program based on healthy eating, exercise, cognitive-behavioral therapy, and health education in improving metabolic comorbidity, Body Mass Index (BMI), and nutritional habits among obese adults, at short (12 months) and long term (24 months). A randomized controlled clinical trial was conducted at a community care center between February 2014 and February 2016. A random sampling was done (299), total population (3262). A sample of 74 subjects diagnosed with obesity (experimental group, n = 37 and control group, n = 37) was conducted. Inclusion criteria: obese people (BMI: >30 kg/m²) with metabolic comorbidity and bad nutritional habits. Exclusion criteria: other comorbidities. A 12-month interdisciplinary program (with pre-test, 12 months and 24 months of follow-up) was applied. Intervention is based on healthy eating, exercise, and cognitive behavioral therapy. The intervention had a positive effect on nutritional habits (F2;144 = 115.305; p < 0.001). The experimental group increased fruit and vegetable intake (F2;144 = 39.604, p < 0.001), as well as fortified foods (F2;144 = 10,076, p < 0.001) and reduced fats, oils, and sweets F2;144 = 24,086, p < 0.001). In the experimental group, a BMI reduction of 2.6 to 24 months was observed. At follow-up, no participant had inadequate nutritional habits, compared to 35.1% of the control group (χ22 = 33,398; p < 0.001). There was also a positive response of metabolic comorbidities in the intervention group. The interdisciplinary program improved all participants’ metabolic parameters, BMI, and nutritional habits while maintaining the long-term effects (24 months).

Visceral fat is associated with cirrhotic portal vein thrombosis

Background: Central obesity, due to the accumulation of visceral fat(VF), is one of the main risk factors for venous thrombosis. The aim of this study was to determine if VF may be a risk factor for development of portal vein thrombosis(PVT) in cirrhotic patients.Methods: A total of 214 cirrhotic patients at the outpatient clinic were consecutively included, undergoing an anthropometric evaluation, blood tests and bioimpedance.Results: Median MELDscore was10. Prior liver decompensation occurred in 44.9% of patients and 35.6% of patients had large esophageal varices. Mean body mass index was 28.7 Kg/m2 (39.3%were obese) and mean waist circumference(WC) was 103.8 cm. A 7.5% of patients had PVT at the time of inclusion. PVT was more frequent in males(93.8 vs. 68.2%, p = 0.03). Patients with PVT had a higher WC(111.9 vs. 103.2 cm, p = 0.02) and VF (17.1 vs. 14.5, p = 0.04). PVT was also more frequent in patients with prior decompensation (81.3 vs. 41.9%, p < 0.01) and with large esophageal varices(62.5 vs. 33.3%, p = 0.02). In the simplified multivariate analysis, PVT was independently associated with the presence of portal hypertension(OR 13, 95%CI 1.6-108.3, p = 0.02) and VF(OR 1.2, 95%CI 1.03-1.3, p = 0.01).Conclusion: VF was independently associated with PVT in cirrhotic patients. VF may be more reliable than conventional anthropometric measurements for cirrhotic patients.