Behavioral lifestyle interventions for moderate and severe obesity: A systematic review

Perioperative lifestyle and nutritional interventions' details reporting in bariatric surgery trials according to the Template for Intervention Description and Replication (TIDieR) checklist: a cross-sectional study

BACKGROUND

Metabolic and bariatric surgery (MBS) is considered the most effective treatment for people with severe obesity, and certain interventions could enhance its long-term results. The complete reporting of interventions' details is necessary for their replication in clinical settings.

OBJECTIVES

To investigate the completeness of reporting of lifestyle and nutritional interventions applied in immediate perioperative period (30-days preoperatively and postoperatively) in patients undergoing MBS using the 12-item Template for Intervention Description and Replication (TIDieR) checklist, and to explore factors associated with compliant reporting.

SETTING

A cross-sectional study.

METHODS

We searched MEDLINE, Embase, and CENTRAL up to April 14 2024. The screening, extraction, and assessments were performed independently by 2 authors.

RESULTS

Information from the manuscript, protocol, and supplementary materials in 72 trials comprising 76 interventions satisfied a mean of the 70.4% (standard deviation 16.5) of TIDieR items. Altogether, 6.6% of the interventions fulfilled all items. The lowest scoring items were adherence to intervention (item 12, reported in 51.3% of the interventions), modes of delivery (item 6, 42.1%), intervention provider (item 5, 38.3%), and fidelity assessment and maintenance planning (item 11, 23.7%). A total of 6.9% of the trials contained relevant information in the protocol or supplementary materials and 93.1% required contacting authors for clarifications. We identified the number of authors, availability of a study protocol, availability of supplementary materials, reporting of the compliance with the Consolidated Standards of Reporting Trials (CONSORT) guidelines, and reporting of a plan for dealing with missing outcome data as predictors of better reporting, while the Asian country of the corresponding author implied less compliant reporting.

CONCLUSIONS

The completeness of reporting of lifestyle and nutritional interventions applied in immediate perioperative period in patients undergoing MBS is suboptimal and, consequently, impedes their replication in clinical practice. A wider adoption of the TIDieR checklist by authors, reviewers, and journal editors should enhance the transparency, clarity, and transferability of research.

Neighborhood Characteristics Related to Changes in Anthropometrics During a Lifestyle Intervention for Persons with Obesity

BACKGROUND

Since obesity has emerged as a major public health concern, there is an urgent need to better understand factors related to weight gain and treatment success.

METHODS

This study included 118 persons with obesity who participated in a multidisciplinary combined lifestyle intervention with cognitive-behavioral therapy at the outpatient clinic of the Obesity Center CGG at Erasmus University Medical Center, Rotterdam, The Netherlands. Neighborhood characteristics were assessed using a 13-item questionnaire. Multiple regression analyses were performed to examine the association between perceived safety, social cohesion, and the availability of facilities on relative changes in body mass index and waist circumference changes, adjusted for corresponding neighborhood socioeconomic status scores.

RESULTS

Higher total scores, indicating more unfavorable neighborhood perceptions, were associated with less relative improvements in BMI and waist circumference after 1.5 years (β = 3.2, 95%CI 0.3-6.0; β = 3.4, 95%CI 0.3-6.6, respectively). Also, more neighborhood unsafety was associated with less relative improvements in BMI and waist circumference on the long term (β = 3.1, 95%CI 1.1-5.1; β = 2.8, 95%CI 0.6-5.1, respectively).

CONCLUSION

The results indicate that living in a neighborhood perceived as less favorable may lower the chances of successful weight loss in response to combined lifestyle interventions in persons with obesity.

Association between cardiometabolic index and asthma in adults: evidence from NHANES 2005-2018

OBJECTIVES

Cardiometabolic Index (CMI) is a surrogate marker for metabolic disorders. It is associated with various chronic diseases. This study aims to investigate the relationship between CMI and asthma.

METHODS

Data from seven consecutive National Health and Nutrition Examination Survey cycles between 2005 and 2018 were used. The study included adults with self-reported asthma diagnoses and complete information for CMI calculation. The formula for CMI is CMI = [WC (cm)/height (cm)] × [TG (mg/dL)/HDL-C (mg/dL)]. A multivariate logistic regression model was employed to examine the linear relationship between CMI and asthma. Subgroup analyses were conducted to explore potential influencing factors. Additionally, smooth curve fitting and threshold effect analysis were used to describe the non-linear relationship.

RESULTS

A higher CMI was possibly associated with an increased prevalence of asthma. After adjusting for various covariates including marital status, Poverty Income Ratio, Body Mass Index, hypertension, diabetes, smoking, alcohol consumption, heart attack, and stroke, the results remained significant (OR = 1.03; 95%CI, 1.00-1.05, p = 0.0178, R2 = 0.52). Participants with the highest CMI had a 38% increased risk of asthma prevalence compared to those with the lowest CMI (OR = 1.38; 95%CI, 1.19-1.60, p < 0.0001).

CONCLUSION

The findings reveal that elevated CMI levels correlate with an increased risk of asthma, highlighting CMI's potential as a predictive marker for asthma, particularly in populations with a CMI below 1.97. These results suggest that interventions aimed at improving metabolic health may prove effective in managing or preventing asthma.

Adoption of telemedicine for obesity treatment during the COVID-19 pandemic achieved comparable outcomes to in-person visits

Background

During the COVID-19 pandemic, weight loss programs rapidly transitioned to a virtual model, replacing in-person clinic visits. We sought to compare the observed weight loss and adherence to treatment between patients referred for intensive behavioral therapy (IBT) who were treated via telemedicine and those treated in person.

Methods

After IRB approval, we conducted a retrospective observational study of patients referred for clinical bariatric IBT between January 2019 and June 2021 who were followed in person or via telemedicine. The primary endpoint was the percentage of excess BMI loss (EBL%); secondary endpoints included treatment adherence, duration of follow-up, and number of completed visits.

Results

During the study period, 139 patients were seen for at least one IBT session for weight management: 62 were followed up in person (IP) and 77 via telemedicine (TM). The mean age, baseline BMI, and follow-up duration between the groups were similar. In the IP and TM groups, the EBL% was -24.7 ± 24.7 and -22.7 ± 19.5 (P = 0.989) and loss to follow-up after the first visit was 27.4% and 19.5% (P = 0.269), respectively.

Conclusion

For the management of obesity, weight loss programs delivered via telemedicine can achieve similar outcomes to those provided via classical in-person visits. This study suggests that the integration of telecare into clinical practice in bariatric medicine should be considered in the future. Emerging technologies may allow adequate patient follow-up in multiple scenarios, specifically non-critical chronic disorders, and bring unanticipated benefits for patients and healthcare providers.

SPISE INDEX (Single point insulin sensitivity estimator): indicator of insulin resistance in children and adolescents with overweight and obesity

Background

Insulin resistance in children and adolescents with obesity is linked to increased risk of type 2 diabetes mellitus and cardiovascular disease. The SPISE index, based on values of fasting triglycerides (mg/dL), HDL cholesterol (mg/dL), and BMI (kg/m2), shows promise in predicting insulin resistance in children.

Methods

This study aimed to identify a SPISE cut-off for detecting insulin resistance and evaluate its relationship with pubertal development, anthropometrics, and glycometabolic profile in 232 children and adolescents, 105 males and 127 females (median age 13.2 years) with overweight (n=48) and obesity (n=184). SPISE index was calculated with the formula: 600 x HDL Cholesterol0,185/Triglycerides0,2x BMI1,338, and patients were categorized based on Tanner stages [(Group 1 (18.8%) Tanner 1, Group 2 (44.6%) Tanner 2-3-4, Group 3 (36.6%) Tanner 5)].

Results

A SPISE cut-off ≤ 6.92 or ≤ 6.13 (based on the method used for insulin resistance detection), in subjects with Tanner stages I and II, showed good sensitivity and specificity as a marker of insulin resistance. SPISE index decreased significantly with the advancement of pubertal status (P < 0.0001) and with worsening severity of obesity (P < 0.0001). While no significant differences in SPISE marker were observed between patients with normal and abnormal glucose tolerance during OGTT within any pubertal stage, SPISE values were significantly lower in patients with confirmed insulin resistance (total sum of insulin OGTT ≥ 535 µu/mL) in all three pubertal groups (Group 1: P=0.008; Group 2: P=0.0008 and Group 3: P=0.002, respectively).

Conclusions

In children and adolescents with obesity the SPISE index can be proposed as an alternative to OGTT and other insulin-based methods for evaluating insulin resistance. Its advantage lies in using readily available and inexpensive laboratory tests, making it suitable for large-scale studies and follow-up monitoring across diverse populations.

A randomized controlled trial of a "Small Changes" behavioral weight loss treatment delivered in cardiac rehabilitation for patients with atrial fibrillation and obesity: study protocol for the BE-WEL in CR-AF study

BACKGROUND

Atrial fibrillation (AF) represents a global epidemic. Although international AF practice guidelines indicate weight loss for patients with AF and comorbid obesity (BMI ≥ 30 kg/m2) to alleviate symptom burden and improve prognosis, few cardiac rehabilitation (CR) programs include targeted weight loss treatment.

AIMS

This RCT protocol will evaluate the efficacy of a "Small Changes" behavioral weight loss treatment (BWLT) to produce clinically relevant (≥ 10%) weight loss among patients with AF and obesity undergoing CR, relative to CR alone. Secondary aims are to establish efficacy of CR + BWLT for improving AF symptoms, AF risk factors, and health-related quality of life.

METHODS

Adults (18 +) with AF and obesity will be recruited and randomized to receive CR + BWLT (intervention) or CR-only (control). Controls will receive CR consisting of supervised exercise and risk factor self-management for 12 weeks. The intervention group will receive CR plus BWLT (12 weekly, group-based virtual sessions, followed by 12 weeks of follow-up support). Weight and AF-risk factors will be assessed at pre-randomization, 12 weeks, 24 weeks, and 52 weeks. AF burden will be assessed using 30-s ECGs recorded bidaily and with AF symptoms. The primary endpoint of weight loss will be calculated from baseline to 52 weeks as a percentage of starting weight. Intention-to-treat analyses will compare the proportion in each group achieving ≥ 10% weight loss. Assuming success rates of 5% and 30% among controls and intervention groups, respectively, and a 30% loss to follow-up, 120 patients (60 per group) will provide 80% power to detect a difference using a two-sided independent test of proportions (alpha = 5%).

IMPACT

This clinical trial will be the first to demonstrate that adding BWLT to CR promotes clinically meaningful weight loss among patients with AF and comorbid obesity. Findings will inform design and execution of a large efficacy trial of long-term (e.g., 5-year) clinical endpoints (e.g., AF severity, mortality). Implementing weight control interventions designed to target the AF substrate in CR could dramatically reduce morbidity and enhance quality of life among patients living with AF in Canada.

TRIAL REGISTRATION

ClinicalTrials.gov registration number: NCT05600829. Registered October 31, 2022.

Which components of behavioral weight management programs are essential for weight loss in people living with obesity? A rapid review of systematic reviews

The optimal treatment and organization of care for people with obesity is one of the greatest challenges facing today's health services. While surgery and pharmacotherapy offer effective treatment options for some people with obesity, behavioral interventions are important to support long-term behavioral change. However, little is known about the most effective components of behavioral interventions, and this is especially the case for people with complex or severe obesity (i.e. body mass index [BMI] > 35 kg/m2). Accordingly, the current rapid review aimed to identify which behavior change techniques (BCTs) are effective for weight loss in adults with (severe) obesity. A secondary aim was to review the effects of BCTs on dietary behaviors and physical activity, and psychological outcomes, recognizing that behavioral interventions commonly target these. A search of Scopus, Ovid Medline, and Web of Science resulted in 1227 results, with 22 reviews eligible for inclusion. The most commonly reported BCTs were self-monitoring and goal setting, but these had variable effects on weight in adults with obesity. Combining these BCTs with other self-regulatory techniques led to increased weight loss. Further, for adults with severe obesity, so-called 'nudge' techniques and self-regulatory techniques were associated with greater weight loss. Three reviews also found that while self-monitoring increased physical activity, behavioral commitments increased changes to dietary behaviors. BCTs were not associated with psychological well-being. The review confirms that behavioral interventions have an impact in weight management, including for individuals with more complex or severe obesity, but highlights the need for further investigation of their use within clinical settings.

Predictive factors of weight loss in obese patients referred to an obesity specialized centre

INTRODUCTION AND AIMS

In obese patients, long-term weight loss maintenance remains challenging. Identifying factors predicting adhesion to lifestyle therapy and weight loss would help optimizing obesity management.

AIMS

to identify predictive factors of weight loss after one year of medical therapy in obese patients (primary) and predictive factors of drop-out during the year of therapy (secondary).

METHODS

In this retrospective study, obese patients consulting for the first time in an obesity specialized center were included. All patients fulfilled the criteria for obesity surgery and were managed to change their lifestyle by following a 1-year therapeutical education program based on intuitive eating. Significant weight loss was defined by ≥ 5 % after 1 year. Patients were considered as dropouts, i.e. absence of adhesion to therapy, once they missed one consultation without informing the unit. Stepwise multivariable analyses determined the predictive factors.

RESULTS

Of the 310 patients (mean age, 44.5 ± 11.9 yr, 79% women) included, 155 (50%) maintained their follow-up at 1 year and 37 (24%) experienced weight loss ≥5%. Male gender (odds ratio (OR) = 6.25 [95% confidence interval, 1.78; 21.92], P = 0.004), ≥5 consultations with intuitive eating (OR = 3.69 [1.14; 11.87], P = 0.03), and tobacco addiction (OR = 0.18 [0.04; 0.82], P = 0.03) were associated to weight loss ≥5%. Older age (OR = 0.97 [0.95; 0.99], P = 0.014), physical activity (OR = 0.11 [0.05; 0.24], P < 0.0001) and the patient desire for obesity surgery (OR = 0.22 [0.12; 0.41], P < 0.0001) were associated with a better adhesion to therapy.

CONCLUSION

The identified predictive factors would help identifying the patients with the greater chance of losing weight and adhering to therapy. Offering more therapeutic education sessions should increase therapy success in obese patients fulfilling the criteria for obesity surgery.

Emerging Therapies for Non-Alcoholic Steatohepatitis (NASH): A Comprehensive Review of Pharmacological and Non-Pharmacological Approaches

Non-alcoholic steatohepatitis (NASH) has emerged as a significant global health concern, closely linked to the obesity epidemic and metabolic syndrome. This review explores emerging therapies for NASH that go beyond traditional lifestyle modifications. The complex pathophysiology of NASH, involving insulin resistance, lipotoxicity, oxidative stress, and chronic inflammation, offers multiple targets for therapeutic intervention. While lifestyle changes remain fundamental, their limitations in achieving sustained improvements highlight the need for effective pharmacological and interventional therapies. This review discusses novel pharmacological approaches, including farnesoid X receptor (FXR) agonists, peroxisome proliferator-activated receptor (PPAR) agonists, and agents addressing metabolic dysfunction, inflammation, and fibrosis. Promising candidates such as obeticholic acid, lanifibranor, and semaglutide are highlighted, along with combination therapies targeting multiple pathways simultaneously. Non-pharmacological interventions, including bariatric surgery, endoscopic bariatric and metabolic therapies, and innovative exercise regimens, are also examined for their potential in NASH management. Despite significant advancements, NASH drug development faces challenges due to the disease's complexity, patient heterogeneity, and stringent regulatory requirements. This review also addresses these limitations and explores future directions, including personalized medicine approaches, non-invasive diagnostic tools, and the potential of microbiome modulation and regenerative therapies. The evolving landscape of NASH research emphasizes the need for multidisciplinary approaches integrating advances in diagnostics, therapeutics, and digital health technologies. As the field progresses, the focus remains on developing more effective, personalized, and accessible strategies for preventing, diagnosing, and treating NASH, with the ultimate goal of improving outcomes for patients affected by this increasingly prevalent liver disease.

Physical activity attenuates the excess mortality risk from prolonged sitting time among adults with osteoporosis or osteopenia

PURPOSE

Osteoporosis is a common generalized skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. This study aims to crystallize associations of physical activity (PA) and sedentary behaviour with the survival of adults with osteoporosis or osteopenia.

METHODS

A total of 3103 participants aged 50 years or older from the National Health and Nutrition Examination Survey (NHANES) were included in the study. All participants were diagnosed with osteopenia or osteoporosis. Multivariable Cox proportional hazards regression models were used to assess the association of PA and sedentary behaviour with overall mortality, cancer-related mortality, and cardiovascular disease (CVD)-related mortality.

RESULTS

During 21349 person-years of follow-up, 675 deaths were documented. Highly active participants had a lower risk of all-cause (hazard ratios [HR] = 0.61; 95% confidence interval [CI], 0.42-0.87; P for trend = 0.004), cancer-specific (HR = 0.64; 95%CI, 0.35-1.17; P for trend = 0.132), CVD-specific (HR = 0.75; 95%CI, 0.45-1.25; P for trend = 0.452), and other (HR, 0.51; 95%CI, 0.29-0.88; P for trend = 0.005) mortality than inactive participants. And sitting time was not associated with mortality among physically active participants; while among those who were insufficiently active or inactive, longer sitting time was associated with increased risks of all-cause (HR per 1-h increase = 1.05; 95% CI, 1.01-1.09), cancer-specific (HR per 1 h increase = 0.98; 95% CI, 0.90-1.07), CVD-specific (HR per 1-h increase = 1.11; 95% CI = 1.04-1.18), and other (HR per 1-h increase = 1.05; 95% CI, 0.98-1.13) mortality in a dose-response manner.

CONCLUSIONS

PA can attenuate the excess mortality risk from prolonged sitting for individuals with osteoporosis and/or osteopenia. The combination of prolonged sedentary behaviour with inactive (participants without any PA during a week) PA was associated with an increased risk of mortality. The all-cause mortality risk of individuals who engage in less than 150 min/wk PA and sit more than 8 h/d is 2.02 (95% CI, 1.37-2.99) times higher than that of individuals who engage in more than 150 min/wk PA and sit less than 4 h/d.

Exploring the Feasibility and Initial Impact of an mHealth-Based Disease Management Program for Chronic Ischemic Heart Disease: Formative Study

BACKGROUND

Ischemic heart disease (IHD) is a leading cause of morbidity and mortality worldwide, requiring innovative management strategies. Traditional disease management programs often struggle to maintain patient engagement and ensure long-term adherence to lifestyle modifications and treatment plans. Mobile health (mHealth) technologies have emerged as a promising approach to address these challenges by providing continuous, personalized support and monitoring. However, the reported use and effectiveness of mHealth in the management of chronic diseases, such as IHD, have not been fully explored.

OBJECTIVE

The primary aim of this study was to evaluate the feasibility and initial impact of an mHealth-based disease management program on coronary risk factors, specifically focusing on low-density lipoprotein cholesterol (LDL-C) levels, in individuals with chronic IHD. This formative study assessed changes in LDL-C and other metabolic health indicators over a 6-month period to determine the initial impact of the program on promoting cardiovascular health and lifestyle modification.

METHODS

This study was conducted using data from 266 individuals enrolled in an mHealth-based disease management program between December 2018 and October 2022. Eligibility was based on a documented history of IHD, with participants undergoing a comprehensive cardiac risk assessment before enrollment. The program included biweekly telephone sessions, health tracking via a smartphone app, and regular progress reports to physicians. The study measured change in LDL-C levels as the primary outcome, with secondary outcomes including body weight, triglyceride levels, and other metabolic health indicators. Statistical analysis used paired 2-tailed t tests and stratified analyses to assess the impact of the program.

RESULTS

Participants experienced a significant reduction in LDL-C, with LDL-C levels decreasing from a mean of 98.82 (SD 40.92) mg/dL to 86.62 (SD 39.86) mg/dL (P<.001). The intervention was particularly effective in individuals with high baseline LDL-C levels. Additional improvements were seen in body weight and triglyceride levels, suggesting a broader impact on metabolic health. Program adherence and engagement metrics suggested high participant satisfaction and compliance.

CONCLUSIONS

The results of this study suggest that the mHealth-based disease management program is feasible and has an initial positive impact on reducing LDL-C levels and improving metabolic health in individuals with chronic IHD. However, the study design does not allow for a definitive conclusion regarding whether mHealth-based disease management programs are more effective than traditional face-to-face care. Future studies are needed to further validate these findings and to examine the comparative effectiveness of these interventions in more detail.

A randomized controlled trial of a weight loss maintenance program in adults with obesity: the WLM3P study

BACKGROUND/OBJECTIVES

The escalating obesity epidemic necessitates effective, sustainable weight loss (WL) and maintenance strategies. This study aimed to evaluate the effectiveness of the Weight Loss Maintenance 3 Phases Program (WLM3P) in achieving a clinically significant long-term weight loss (WL) (≥5% initial WL at 18 months) in adults with obesity compared to a standard low-carbohydrate diet (LCD).

SUBJECTS/METHODS

In this two-phase trial, 112 participants targeting initial WL (0-6 months) and subsequent maintenance (7-18 months) were randomly assigned to either WLM3P or LCD groups. Outcomes assessed included change in body weight (kg, %), improvements in body composition, and metabolic profile.

RESULTS

Of 112 randomized participants, 69% (n = 77) completed the study. At 18 months, WL in the WLM3P group (n = 40) was 15.5 ± 8.3% compared to 9.6 ± 8.5% in the LCD group (n = 37) (p < 0.001). The odds ratio of achieving WL ≥ 10% and ≥15% were significantly higher in the WLM3P group. Complete-case analysis revealed significantly greater improvements in BMI, body fat mass, visceral fat area, waist circumference, waist-to-hip ratio, HDL, and triglyceride/HDL ratio in WLM3P than in LCD. No serious adverse events were reported.

CONCLUSION

Both programs effectively promoted clinically relevant WL and its maintenance. However, the WLM3P program was more successful in helping participants achieve greater WL targets of ≥10% and ≥15%, along with other clinical benefits, after an 18-month intervention.

TRIAL REGISTRATION NUMBER

NCT04192357.

Post-diagnostic lifestyle and mortality of cancer survivors: Results from a prospective cohort study

OBJECTIVE

Lifestyle factors after cancer diagnosis could influence cancer survival. This study aimed to investigate the joint effects of smoking, physical activity, alcohol consumption, diet and sleep duration on all-cause, cancer and non-cancer mortality of cancer survivors in UK biobank.

METHODS

The follow-up period concluded in December 2021, with post-diagnostic lifestyle factors assessed at baseline. A lifestyle score ranging from 0 to 5 was assigned based on adherence to the selected lifestyle factors. The study employed Cox regression models for hazard ratios (HRs) and Kaplan-Meier for survival rates, with stratified and sensitivity analyses to assess the robustness of our findings under various assumptions.

RESULTS

During a median follow-up of 12.7 years, 5652 deaths were documented from 34,184 cancer survivors. Compared to scoring 0-1, the HRs (95% CIs) for all-cause mortality with lifestyle scores of 2, 3, 4, and 5 were 0.70 (95% CI: 0.64, 0.76), 0.57 (0.52, 0.62), 0.50 (0.45, 0.54) and 0.43 (0.38, 0.48), respectively. Specific cancer types, particularly digestive, breast, female reproductive, non-solid, and skin cancers, showed notable benefits from adherence to healthy lifestyle, with the HRs of 0.55 (0.39, 0.79), 0.54 (0.42, 0.70), 0.32 (0.19, 0.53), 0.58 (0.39, 0.86), and 0.36 (0.28, 0.46) for lifestyle score of 5, respectively. Stratified analyses indicated the association was particularly significant among those with normal/lower BMI and higher Townsend Deprivation Index (Pinteraction = 0.001 and < 0.001, respectively).

CONCLUSIONS

Healthier lifestyles were significantly linked with reduced mortality among cancer survivors. These findings highlight the need for adherence to healthy lifestyle habits to improve survival.

Association between the transition to metabolically unhealthy obesity and lifestyle behavior: A nationwide cohort study

OBJECTIVES

To identify the characteristics of individuals transitioning from metabolically healthy obesity (MHO) to unhealthy obesity and the factors influencing the change.

DESIGN

This is a nationwide cohort study using data from the National Health Insurance Service in South Korea.

SAMPLE

Individuals with obesity but metabolically healthy in 2009 and 2010 and those still obese 4 years later were selected.

MEASUREMENTS

Sociodemographic, physical, metabolic, and health behavior variables were collected, and logistic regression was used to find an association with the transition.

RESULTS

We analyzed 1,564,467 individuals, observing significant differences in all variables and the transition from MHO to unhealthy obesity. Among males, the transition was associated with smoking and drinking positively and physical activity negatively. Among females, drinking demonstrated a negative correlation. Regardless of age, regular exercise was negatively associated with the transition for all individuals. Except for older adults, all age groups showed a positive correlation with smoking and drinking.

CONCLUSIONS

Considering the significant factors in the transition, it is essential to develop and implement interventions varied by gender and age to delay and prevent the change in metabolic status. The necessity of developing interventions enables individuals to engage in regular exercise, regardless of age and gender.

Intensive Lifestyle Intervention for Cardiometabolic Prevention Implemented in Healthcare: Higher Risk Predicts Premature Dropout

Aims

Patient characteristics and treatment setting are potential predictors of premature dropout from lifestyle interventions, but their relative importance is unknown.

Methods

From the quality registry of the unit for behavioral medicine, Umeå University hospital, we identified 2589 patients who had been enrolled in a multimodal lifestyle intervention for cardiometabolic risk reduction between 2006 and 2015. Baseline characteristics predicting dropout before 1-year follow-up were selected by a stepwise logistic regression algorithm.

Results

Better physical health and older age predicted full participation, with odds ratios for premature dropout (ORs) of .44 (95% confidence interval (CI) .31-.63), and .47 (95% CI .34-.65) in the highest compared to the lowest quartile, respectively. Odds of premature dropout were also lower among female participants, .71 (95% CI .58-.89). Premature dropout was predicted by higher BMI, snuffing tobacco, and smoking, with ORs of 1.53 (95% CI 1.13-2.08) in the highest compared to the lowest quartile of BMI, 1.37 (95% CI 1.03-1.81) comparing snuff user with non-users and 2.53 (95% CI 1.79-3.61) comparing smokers with non-smokers. Odds ratio for premature dropout among inpatients compared with outpatients was .84 (95% CI .68-1.04).

Conclusion

Higher risk at baseline predicts premature dropout.

The Impact of Metabolic Health and Obesity on Liver Transplant Candidates and Recipients

Poor metabolic health and obesity have significant impacts on the outcomes of patients suffering from chronic liver disease, particularly those with metabolic dysfunction-associated steatotic liver disease. Patients with such comorbidities who require liver transplant evaluation for advancing liver disease or liver failure require special consideration due to increased risk of cardiovascular disease, renal dysfunction, sarcopenic obesity, and cancer. Those who have had a history of prior bariatric surgery pose specific anatomical constraints and may also be at increased risk of alcohol use disorder. Pre-operative risk assessment as well as strict control of metabolic risk factors are essential to reduce intra-operative and post-liver transplant complications. As immunosuppressive therapy exacerbates metabolic dysfunction and risk for cancer, post-liver transplant care must focus on balancing the need to prevent rejection and the impact of progressive metabolic dysfunction in this unique, but growing, patient population.

Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review

(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.

The effectiveness of social-support-based weight-loss interventions-a systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis examined the effectiveness of social-support-based weight-loss interventions in adult populations with excess weight or obesity.

METHODS

We performed a systematic review of randomized controlled trials that reported on the effectiveness of weight-loss interventions which incorporated a social connectedness component. To this end, we conducted a rigorous database search of MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, and PubMed for relevant articles. The quality of eligible trials was evaluated by the Cochrane Risk-of-Bias2 tool. Five meta-analyses on intervention effectiveness in terms of weight loss were executed at 2-4-month assessment, 6-month assessment, end of intervention, and 3- and 6-month follow-up.

RESULTS

Twenty-four trials involving couples or peers targeting weight loss in 4 919 adults with BMI ≥ 25 met inclusion criteria. Meta-analyses detected no significant effect of social-support-based weight-loss interventions at either 2-4 month or 6-month assessment. There were, however, significant effects at end of intervention [95% CI 0.39, p = 0.04] and at 3-month [95% CI 0.63, p < 0.01] and 6-month [95% CI 0.34, p = 0.05] follow-up.

CONCLUSIONS

There seem to be a significant effect at the end of intervention and 3- and 6-month follow-up. However, further high-quality studies are needed before drawing any clear conclusions.

TRIAL REGISTRATION

PROSPERO 2020 CRD42020173696.

Mobile health (m-health) smartphone interventions for adolescents and adults with overweight or obesity

BACKGROUND

Obesity is considered to be a risk factor for various diseases, and its incidence has tripled worldwide since 1975. In addition to potentially being at risk for adverse health outcomes, people with overweight or obesity are often stigmatised. Behaviour change interventions are increasingly delivered as mobile health (m-health) interventions, using smartphone apps and wearables. They are believed to support healthy behaviours at the individual level in a low-threshold manner.

OBJECTIVES

To assess the effects of integrated smartphone applications for adolescents and adults with overweight or obesity.

SEARCH METHODS

We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, and LILACS, as well as the trials registers ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform on 2 October 2023 (date of last search for all databases). We placed no restrictions on the language of publication.

SELECTION CRITERIA

Participants were adolescents and adults with overweight or obesity. Eligible interventions were integrated smartphone apps using at least two behaviour change techniques. The intervention could target physical activity, cardiorespiratory fitness, weight loss, healthy diet, or self-efficacy. Comparators included no or minimal intervention (NMI), a different smartphone app, personal coaching, or usual care. Eligible studies were randomised controlled trials of any duration with a follow-up of at least three months.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology and the RoB 2 tool. Important outcomes were physical activity, body mass index (BMI) and weight, health-related quality of life, self-efficacy, well-being, change in dietary behaviour, and adverse events. We focused on presenting studies with medium- (6 to < 12 months) and long-term (≥ 12 months) outcomes in our summary of findings table, following recommendations in the core outcome set for behavioural weight management interventions.

MAIN RESULTS

We included 18 studies with 2703 participants. Interventions lasted from 2 to 24 months. The mean BMI in adults ranged from 27 to 50, and the median BMI z-score in adolescents ranged from 2.2 to 2.5. Smartphone app versus no or minimal intervention Thirteen studies compared a smartphone app versus NMI in adults; no studies were available for adolescents. The comparator comprised minimal health advice, handouts, food diaries, smartphone apps unrelated to weight loss, and waiting list. Measures of physical activity: at 12 months' follow-up, a smartphone app compared to NMI probably reduces moderate to vigorous physical activity (MVPA) slightly (mean difference (MD) -28.9 min/week (95% confidence interval (CI) -85.9 to 28; 1 study, 650 participants; moderate-certainty evidence)). We are very uncertain about the results of estimated energy expenditure and cardiorespiratory fitness at eight months' follow-up. A smartphone app compared with NMI probably results in little to no difference in changes in total activity time at 12 months' follow-up and leisure time physical activity at 24 months' follow-up. Anthropometric measures: a smartphone app compared with NMI may reduce BMI (MD of BMI change -2.6 kg/m2, 95% CI -6 to 0.8; 2 studies, 146 participants; very low-certainty evidence) at six to eight months' follow-up, but the evidence is very uncertain. At 12 months' follow-up, a smartphone app probably resulted in little to no difference in BMI change (MD -0.1 kg/m2, 95% CI -0.4 to 0.3; 1 study; 650 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in body weight change (MD -2.5 kg, 95% CI -6.8 to 1.7; 3 studies, 1044 participants; low-certainty evidence) at 12 months' follow-up. At 24 months' follow-up, a smartphone app probably resulted in little to no difference in body weight change (MD 0.7 kg, 95% CI -1.2 to 2.6; 1 study, 245 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in self-efficacy for a physical activity score at eight months' follow-up, but the results are very uncertain. A smartphone app probably results in little to no difference in quality of life and well-being at 12 months (moderate-certainty evidence) and in little to no difference in various measures used to inform dietary behaviour at 12 and 24 months' follow-up. We are very uncertain about adverse events, which were only reported narratively in two studies (very low-certainty evidence). Smartphone app versus another smartphone app Two studies compared different versions of the same app in adults, showing no or minimal differences in outcomes. One study in adults compared two different apps (calorie counting versus ketogenic diet) and suggested a slight reduction in body weight at six months in favour of the ketogenic diet app. No studies were available for adolescents. Smartphone app versus personal coaching Only one study compared a smartphone app with personal coaching in adults, presenting data at three months. Two studies compared these interventions in adolescents. A smartphone app resulted in little to no difference in BMI z-score compared to personal coaching at six months' follow-up (MD 0, 95% CI -0.2 to 0.2; 1 study; 107 participants). Smartphone app versus usual care Only one study compared an app with usual care in adults but only reported data at three months on participant satisfaction. No studies were available for adolescents. We identified 34 ongoing studies.

AUTHORS' CONCLUSIONS

The available evidence is limited and does not demonstrate a clear benefit of smartphone applications as interventions for adolescents or adults with overweight or obesity. While the number of studies is growing, the evidence remains incomplete due to the high variability of the apps' features, content and components, which complicates direct comparisons and assessment of their effectiveness. Comparisons with either no or minimal intervention or personal coaching show minor effects, which are mostly not clinically significant. Minimal data for adolescents also warrants further research. Evidence is also scarce for low- and middle-income countries as well as for people with different socio-economic and cultural backgrounds. The 34 ongoing studies suggest sustained interest in the topic, with new evidence expected to emerge within the next two years. In practice, clinicians and healthcare practitioners should carefully consider the potential benefits, limitations, and evolving research when recommending smartphone apps to adolescents and adults with overweight or obesity.

A literature review of evidence for primary prevention of overweight and obesity in healthy weight children and adolescents: A report produced by a working group of the Danish Council on Health and Disease Prevention

Primary prevention targets development of overweight in individuals with healthy weight and is a great challenge. This paper summarizes the main findings of a working group of the Danish Council on Health and Disease Prevention that reviewed the literature on primary prevention of overweight and obesity among children and adolescents. The results were presented in a Danish report, in which a 2019 Cochrane review on childhood obesity prevention was complemented by searches in PubMed to include all relevant subsequent studies published from January 2018 until March 2020. In this paper, the review was updated until June 2023. Numerous childhood overweight prevention interventions have been developed during the past decades, primarily targeting diet and/or physical activity. Several of these interventions showed positive effects on diet and physical activity level but did not show effects on risk of developing overweight. The evidence foundation is inconsistent as four out of five interventions did not show positive effects. Previously observed intervention effects may not reflect excessive weight gain prevention among children with healthy weight but rather bodyweight reduction among those with overweight or obesity. We do not have sufficient knowledge about how to prevent children with healthy weight from developing overweight, and creative solutions are urgently needed.

Rural African American Women With Severe Obesity: A Cross-Sectional Analysis of Lifestyle Behaviors and Psychosocial Characteristics

PURPOSE

To examine differences in lifestyle behavioral and psychosocial factors between rural African American women with Class 3 obesity and those with overweight, and Class 1-2 obesity.

DESIGN

Cross-sectional study.

SETTING

Rural Southeastern United States.

SUBJECTS

Participants included 289 African American women with a mean age of 56 years, 66% with a high school education or less, and a mean body mass index (BMI) of 38.6 kg/m2; 35% (n = 102) were classified with Class 3 obesity.

MEASURES

We objectively measured height, weight, and physical activity steps/day. Self-reported dietary and physical activity behaviors, general health-related quality of life, mental health, and social support were measured with validated surveys.

ANALYSIS

Chi-Square analysis for categorical variables and analysis of variance (ANOVA) - via multiple linear regression - for continuous variables.

RESULTS

There were no significant demographic differences between BMI groups, except for age, where women with Class 3 obesity were on average younger (51 vs 58 y, P < .001). Although dietary behaviors did not differ significantly between groups, we observed significant group differences in self-reported and objective measures of physical activity. The age-adjusted difference in means for self-reported total physical activity minutes/wk. was 91 minutes, with women categorized with Class 3 obesity reporting significantly fewer weekly minutes than those with overweight/Class 1-2 obesity (64.3 vs 156.4 min/wk. respectively, P < .01). Among psychosocial variables, only in the physical component scores of health-related quality of life did we find significant group differences - lower physical well-being among women with Class 3 obesity compared to those with overweight/Class 1-2 obesity (P = .02).

CONCLUSION

For African American women with Class 3 obesity living in rural setting, these findings suggest behavioral weight loss interventions may need to target physical activity strategies that address physical, psychosocial, and environmental barriers.

Mental Health Variables Impact Weight Loss, Especially in Patients with Obesity and Binge Eating: A Mediation Model on the Role of Eating Disorder Pathology

BACKGROUND

Various mental health and eating behavior variables have been independently associated with predicting weight loss in individuals with obesity. This study aims to investigate a mediation model that assesses the distinct contributions of these variables in predicting weight changes in patients with obesity following an outpatient behavioral weight loss intervention (BWLI).

METHODS

General mental health (depression, anxiety, stress, impulsivity), eating behavior (cognitive restraint, disinhibition, hunger), eating disorder pathology, and body mass index (BMI) were assessed in a group of 297 patients with obesity at the admission of a BWLI program. BMI was re-evaluated during the final treatment session. A mediation model was employed to examine whether mental health and eating behavior variables predicted BMI changes, with eating disorder pathology serving as a mediator. The model was tested both overall and within two patient subgroups: those with regular binge eating (≥four episodes/month) and those without.

RESULTS

In the overall sample (n = 238), the relationships between depression, impulsivity, and cognitive restraint with BMI change were mediated by eating disorder pathology. In the subgroup with regular binge eating (n = 99, 41.6%), the associations between stress and disinhibition with BMI change were additionally mediated by eating disorder pathology. In the subgroup without regular binge eating, eating disorder pathology showed no mediating effect.

DISCUSSION

Multiple mental health and eating behavior variables assessed at admission predicted BMI changes, particularly when mediated by eating disorder pathology in patients with regular binge eating. A comprehensive psychopathological assessment prior to starting BWLI may help identify multiple factors affecting prognosis and treatment outcomes. Long-term follow-up studies in this field are required.

Association of sugar intake from different sources with incident dementia in the prospective cohort of UK Biobank participants

BACKGROUND

Dementia is a common disease with around 55 million cases worldwide. Therefore, dietary changes and lifestyle interventions are important approaches to delay the progress of a decline in cognitive function. The study aims to explore the association of various sources of free sugars (FS) and intrinsic sugars with dementia risk in the prospective population-based UK Biobank cohort.

METHODS

Sugar consumption was assessed in 186,622 UK Biobank participants with at least one web-based dietary questionnaire (Oxford WebQ). Over a mean follow-up of 10.6 (standard deviation 1.1) years, 1498 incident dementia cases occurred. The hazard ratios (HR) for incident dementia were assessed with Cox proportional hazard regression models including sugar intake from different sources as penalized cubic splines to allow for non-linear predictor effects.

RESULTS

The intake of FS and intrinsic sugar was significantly associated with dementia risk in a J-shaped fashion with the HR-nadir observed at 9% and 8% total energy (%E), respectively. FS in beverages were significantly associated with dementia risk in an ascending approximately linear way, whereas no significant association was found for FS in solids. Assessing beverage subtypes, FS in soda/fruit drinks, milk-based drinks and to a lesser extent in juice were significantly and positively related to dementia risk, whereas no association was found for FS in tea/coffee. The association between sugar subtype consumption and dementia risk remained consistent in most sensitivity analyses but changed from a J-shape to a more linear shape when the analysis was restricted to participants with at least two Oxford WebQs.

CONCLUSIONS

A linear-shaped association between sugar subtype intake and dementia risk is most consistently found for FS in beverages and more specifically for FS in soda/fruit drinks, as well as in milk-based drinks.

The Profound Implications of the Meaning of Health for Health Care and Health Equity

Policy Points The meaning of health in health care remains poorly defined, defaulting to a narrow, biomedical disease model. A national dialogue could create a consensus regarding a holistic and humanized definition of health that promotes health care transformation and health equity. Key steps for operationalizing a holistic meaning of health in health care include national leadership by federal agencies, intersectoral collaborations that include diverse communities, organizational and cultural change in medical education, and implementation of high-quality primary care. The 2023 report by the National Academies of Sciences, Engineering, and Medicine on achieving whole health offers recommendations for action.

Self-management interventions for adults living with obesity to improve patient-relevant outcomes: An evidence map

OBJECTIVES

To conduct an evidence map on self-management interventions and patient-relevant outcomes for adults living with overweight/obesity.

METHODS

Following Arksey and O'Malley methodology, we searched in five electronical databases including randomized controlled trials (RCTs) on SMIs for overweight/obesity. We used the terms "self-management", "adult" and "obesity" for content. Two independent reviewers assessed eligible references; one reviewer extracted data, a second checked accuracy.

RESULTS

We identified 497 RCTs (58% US, 20% Europe) including 99,741 (median 112, range 11-5145) adults living with overweight/obesity. Most research evaluated clinical outcomes (617, 55%) and behaviors adherence (255, 23%). Empowerment skills, quality of life and satisfaction were less targeted (8%, 7%, 0.2%, respectively). The most frequent techniques included sharing information (858, 99%), goal setting (619, 72%) and self-monitoring training (614, 71%), provided face-to-face (386, 45%) or in combination with remote techniques (256, 30%). Emotional management, social support and shared-decision were less frequent (18%, 26%, 4%). Socio-economic status, minorities or health literacy were seldom reported.

CONCLUSION

There is a need of widening the scope of research by focusing on outcomes important to patients, assessing emotional/social/share-decision support, exploring remote techniques and including vulnerable populations.

Evaluation and Treatment of Obesity and Its Comorbidities: 2022 Update of Clinical Practice Guidelines for Obesity by the Korean Society for the Study of Obesity

The goal of the 8th edition of the Clinical Practice Guidelines for Obesity is to help primary care physician provide safe, effective care to patients with obesity by offering evidence-based recommendations to improve the quality of treatment. The Committee for Clinical Practice Guidelines comprised individuals with multidisciplinary expertise in obesity management. A steering board of seven experts oversaw the entire project. Recommendations were developed as the answers to key questions formulated in patient/problem, intervention, comparison, outcomes (PICO) format. Guidelines underwent multi-level review and cross-checking and received endorsement from relevant scientific societies. This edition of the guidelines includes criteria for diagnosing obesity, abdominal obesity, and metabolic syndrome; evaluation of obesity and its complications; weight loss goals; and treatment options such as diet, exercise, behavioral therapy, pharmacotherapy, and bariatric and metabolic surgery for Korean people with obesity. Compared to the previous edition of the guidelines, the current edition includes five new topics to keep up with the constantly evolving field of obesity: diagnosis of obesity, obesity in women, obesity in patients with mental illness, weight maintenance after weight loss, and the use of information and communication technology-based interventions for obesity treatment. This edition of the guidelines features has improved organization, more clearly linking key questions in PICO format to recommendations and key references. We are confident that these new Clinical Practice Guidelines for Obesity will be a valuable resource for all healthcare professionals as they describe the most current and evidence-based treatment options for obesity in a well-organized format.

An Assessment of Weight Loss Management in Health System Primary Care Practices

BACKGROUND

Primary care practices can help patients address obesity through weight loss; however, there are many barriers to doing so. This study examined weight management services provided and factors associated with higher reported provision of services.

METHODS

A survey was given to practice members in 18 primary care practices in a Colorado-based health system. The survey assessed weight management services to determine the amount and type of weight loss assistance provided and other factors that may be important. We used descriptive statistics to summarize responses and linear regression with generalized estimating equations to assess the association between the practice and practice member characteristics and the amount of weight management services provided.

RESULTS

The overall response rate was 64% (254/399). On average, clinicians reported performing 73% of the services, and when grouped into minimal, basic, and extensive, the clinicians on average performed 87%, 68%, and 69% of them, respectively. In a multivariable model adjusted for demographics, factors associated with performing more services included perception of overall better practice culture and perception of weight management implementation climate.

CONCLUSIONS

Practice-associated factors such as culture and implementation climate may be worth examining to understand how to implement weight management in primary care.

The effect of Tabata-style functional high-intensity interval training on cardiometabolic health and physical activity in female university students

Introduction: The increasing prevalence of metabolic syndrome and physical inactivity enhances exposure to cardiometabolic risk factors in university students. High-intensity interval training (HIIT) improved cardiometabolic health in clinical adults but the evidence in the university setting is limited. Furthermore, few studies examined the effect of low-volume HIIT on habitual physical activity (PA). Therefore, the primary aim of this study was to evaluate the efficacy of 12-week Tabata-style functional HIIT for improving multiple cardiometabolic health outcomes and habitual PA. We also investigated whether changes in habitual PA over the intervention period had an impact on exercise-induced health outcomes. Methods: 122 female freshmen were randomized into the Tabata group (n = 60) and the control (n = 62). The Tabata training protocol involved 8 × 20 s maximal repeated functional exercises followed by 10 s rest with a frequency of 3 times per week for 12 weeks. Body composition, maximal oxygen uptake (VO_2max), blood pressure (BP), blood lipids, fasting glucose and insulin, C-reactive protein and PA were objectively measured using standardized methods. Dietary intake was measured using a valid food frequency questionnaire. All variables were measured pre- and post-intervention. Results: Mixed linear modelling results showed that there were large intervention effects on VO_2max (p < 0.001, d = 2.53, 95% CI: 2.03 to 3.00 for relative VO_2max; p < 0.001, d = 2.24, 95% CI: 1.76 to 2.68 for absolute VO_2max), resting heart rate (p < 0.001, d = -1.82, 95% CI: -2.23 to -1.37), systolic BP (p < 0.001, d = -1.24, 95% CI: -1.63 to -0.84), moderate-to-vigorous intensity physical activity (MVPA) (p < 0.001, d = 2.31, 95% CI: 1.83 to 2.77), total PA (p < 0.001, d = 1.98, 95% CI: 1.53 to 2.41); moderate effects on %BF (p < 0.001, d = -1.15, 95% CI: -1.53 to -0.75), FM (p < 0.001, d = -1.08, 95% CI: -1.46 to -0.69), high-density lipoprotein (HDL) (p < 0.001, d = 1.04, 95% CI: 0.65 to 1.42), total cholesterol (p = 0.001, d = -0.64, 95% CI: -1.00 to -0.26); small effects on BMI (p = 0.011, d = -0.48, 95% CI: -0.84 to 0.11), WC (p = 0.043, d = -0.37, 95% CI: -0.74 to -0.01), low-density lipoprotein (p = 0.003, d = -0.57, 95% CI: -0.93 to -0.19), HOMA-IR (p = 0.026, d = -0.42, 95% CI: -0.78 to -0.05) and fasting insulin (p = 0.035, d = -0.40, 95% CI: -0.76 to -0.03). Regression analysis showed that only the percentage change of HDL was associated with the change of MVPA (b = 0.326, p = 0.015) and TPA (b = 0.480, p = 0.001). Conclusion: From the findings of the study we can conclude that 12-week low-volume Tabata-style functional HIIT was highly effective for university female students to improve cardiorespiratory fitness, body fat, some cardiometabolic health outcomes and habitual PA.

Improved Physical and Mental Health After a Combined Lifestyle Intervention with Cognitive Behavioural Therapy for Obesity

BACKGROUND

Obesity is a multifactorial, chronic, progressive disease associated with decreased health-related quality of life, comorbidities, and increased mortality risk. Lifestyle interventions, focusing on dietetics, physical exercise, and behavioral therapy, are a cornerstone of therapy. Despite this very multidisciplinary treatment approach, the definition of treatment success is often based only on a weight loss of ≥ 5%. However, the heterogeneous nature of obesity may necessitate a more comprehensive approach to assessing treatment effects.

OBJECTIVES

Here, we describe changes in physiological, psychological, and behavioral health after a multidisciplinary combined lifestyle intervention (CLI). Additionally, we investigated whether these changes were related to weight loss.

METHODS

This prospective observational longitudinal study comprised 96 adults with obesity (73 women, 81 Caucasian) participating in a CLI at the Obesity Center CGG, Erasmus University Medical Center, Rotterdam, the Netherlands. The 1.5-year intervention comprised multidisciplinary professional guidance towards a healthy diet, increased physical activity, and included cognitive behavioral therapy. Physiological health outcomes, psychological well-being, eating behavior, and physical activity were assessed after ten weeks and 1.5 years and compared to baseline.

RESULTS

An average of 5.2% weight loss (-6.0 kg) was accompanied by a mean 9.8% decrease in fat mass (-5.9 kg; both P < 0.001) and significant improvements in metabolism, hormonal status, and immune parameters (all P < 0.05). Moreover, we observed decreased psychopathology, increased quality of life, and decreased disordered eating (all P < 0.05). Weight loss correlated with most metabolic changes (all P < 0.05) but not with most psychological/behavioral changes.

CONCLUSIONS

Combined lifestyle intervention in patients with obesity was accompanied by significant improvements in body weight and body composition along with cardiometabolic, endocrine, immunological, psychological, and behavioral improvements. Interestingly, most changes in psychological and behavioral health occurred independently of weight loss. Obesity treatment success should be evaluated based on a combination of physical and patient-reported outcomes rather than weight loss alone.

Inpatient medical management of severe pediatric obesity: Literature review and case reports

Pediatric obesity rates continue to rise steeply with significant adverse effects on health outcomes across the lifespan. Significant obesity can affect the efficacy, side effects, and ability to use certain treatment, medication, or imaging modalities needed in the evaluation and management of acute pediatric conditions. Inpatient settings are rarely used as an opportunity for weight counseling and thus there is a paucity of clinical guidelines on how to manage severe obesity in the inpatient setting. We present a literature review and three patient cases with single-center protocol for non-surgical management of severe obesity in children admitted for other acute medical reasons. We performed a PubMed review from January 2002 to February 2022 utilizing keywords: "inpatient," "obesity," and "intervention." For our cases, we identified three patients with severe obesity acutely impacting their health while admitted for medical treatment who concurrently underwent acute, inpatient, weight loss regimens at a single children's hospital. The literature search yielded 33 articles describing inpatient weight loss treatments. Three patients met case criteria, all three of which demonstrated a decrease in their weight in excess percent of the 95th percentile after inpatient weight-management protocol implementation (% reduction BMI_p95: 16%-30%). This highlights obesity acutely limits or impacts specific medical care required during inpatient admissions in pediatric patients. It also suggests that implementation of an inpatient weight-management protocol during admission may provide an opportune setting to support acute weight loss and overall improved health outcomes in this high-risk cohort.

Validation of a Brief Dietary Questionnaire for Use in Clinical Practice: Mini-EAT (Eating Assessment Tool)

Background There is a scarcity of validated rapid dietary screening tools for patient use in the clinical setting to improve health and reduce cardiovascular risk. The Healthy Eating Index (HEI) 2015 measures compliance with the 2015 to 2020 Dietary Guidelines for Americans but requires completion of an extensive diet assessment to compute, which is time consuming and impractical. The authors hypothesize that a 19-item dietary survey assessing consumption of common food groups known to affect health will be correlated with the HEI-2015 assessed by a validated food frequency questionnaire and can be further reduced without affecting validity. Methods and Results A 19-item Eating Assessment Tool (EAT) of common food groups was created through literature review and expert consensus. A cross-sectional survey was then conducted in adult participants from a preventive cardiology clinic or cardiac rehabilitation and in healthy volunteers (n=661, mean age, 36 years; 76% women). Participants completed an online 156-item food frequency questionnaire, which was used to calculate the HEI score using standard methods. The association between each EAT question and HEI group was analyzed by Kruskal-Wallis test. Linear regression models were subsequently used to identify univariable and multivariable predictors for HEI score for further reduction in the number of items. The final 9-item model of Mini-EAT was validated by 5-fold cross validation. The 19-item EAT had a strong correlation with the HEI score (r=0.73) and was subsequently reduced to the 9 items independently predictive of the HEI score: fruits, vegetables, whole grains, refined grains, fish or seafood, legumes/nuts/seeds, low-fat dairy, high-fat dairy, and sweets consumption, without affecting the predictive ability of the tool (r=0.71). Conclusions Mini-EAT is a 9-item validated brief dietary screener that correlates well with a comprehensive food frequency questionnaire. Future studies to test the Mini-EAT's validity in diverse populations and for development of clinical decision support systems to capture changes over time are needed.

Intensive behavioral Therapy for weight loss in patients with, or At-Risk of, type 2 Diabetes: Results from the PaTH to health diabetes study

Intensive behavioral therapy (IBT) is an important component of obesity treatment and can reduce the risk of type 2 diabetes (T2DM). Objective was to compare the effectiveness of IBT to usual care in achieving weight loss in two study cohorts within PaTH Network: T2DM and At-Risk of T2DM. The TD2M cohort was defined as age 18 years and older with an indication of T2DM in the EHR based on a validated algorithm and at least 2 outpatient primary care visits. The At-Risk of T2DM cohort was defined by a BMI ≥ 25 kg/m². The primary outcome was weight change within 1-year of index date. Mixed-effects models assessed the effectiveness of IBT by comparing the changes between study groups. Between 2009 and 2020, a total of 567,908 patients were identified in the T2DM cohort and2,054,256 patients in the At-Risk of T2DM cohort. Both IBT patients and matched non-IBT patients in the T2DM cohort had decreased mean weight (primary outcome) (-1.56 lbs, 95 %CI: -1.88, -1.24 vs -1.70 lbs, 95 %CI: -1.95, -1.44) in 1-year after index date. In the At-Risk of T2DM cohort, both IBT and non-IBT patients experienced weight gain and resultant increased BMI. Patients with more than one IBT visit gained less weight than those with only one visit (1.22 lbs, 95 %CI: 0.82, 1.62 vs 6.72 lbs, 95 %CI: 6.48, 6.97; p < 0.001). IBT was unlikely to result in clinically significant weight loss. Barriers to utilizing IBT require further research to ensure broader adoption of obesity management in primary care.

Long-Term Effectiveness of a Smartphone App and a Smart Band on Arterial Stiffness and Central Hemodynamic Parameters in a Population with Overweight and Obesity (Evident 3 Study): Randomised Controlled Trial

BACKGROUND

mHealth technologies could help to improve cardiovascular health; however, their effect on arterial stiffness and hemodynamic parameters has not been explored to date.

OBJECTIVE

To evaluate the effect of a mHealth intervention, at 3 and 12 months, on arterial stiffness and central hemodynamic parameters in a sedentary population with overweight and obesity.

METHODS

Randomised controlled clinical trial (Evident 3 study). 253 subjects were included: 127 in the intervention group (IG) and 126 in the control group (CG). The IG subjects were briefed on the use of the Evident 3 app and a smart band (Mi Band 2, Xiaomi) for 3 months to promote healthy lifestyles. All measurements were recorded in the baseline visit and at 3 and 12 months. The carotid-femoral pulse wave velocity (cfPWV) and the central hemodynamic parameters were measured using a SphigmoCor System^® device, whereas the brachial-ankle pulse wave velocity (baPWV) and the Cardio Ankle Vascular Index (CAVI) were measured using a VaSera VS-2000^® device.

RESULTS

Of the 253 subjects who attended the initial visit, 237 (93.7%) completed the visit at 3 months of the intervention, and 217 (85.3%) completed the visit at 12 months of the intervention. At 12 months, IG showed a decrease in peripheral augmentation index (PAIx) (-3.60; 95% CI -7.22 to -0.00) and ejection duration (ED) (-0.82; 95% CI -1.36 to -0.27), and an increase in subendocardial viability ratio (SEVR) (5.31; 95% CI 1.18 to 9.44). In CG, cfPWV decreased at 3 months (-0.28 m/s; 95% CI -0.54 to -0.02) and at 12 months (-0.30 m/s, 95% CI -0.54 to -0.05), central diastolic pressure (cDBP) decreased at 12 months (-1.64 mm/Hg; 95% CI -3.19 to -0.10). When comparing the groups we found no differences between any variables analyzed.

CONCLUSIONS

In sedentary adults with overweight or obesity, the multicomponent intervention (Smartphone app and an activity-tracking band) for 3 months did not modify arterial stiffness or the central hemodynamic parameters, with respect to the control group. However, at 12 months, CG presented a decrease of cfPWV and cDBP, whereas IG showed a decrease of PAIx and ED and an increase of SEVR.

Relationships Between Blood Pressure Reduction, Weight Loss, and Engagement in a Digital App–Based Hypertension Care Program: Observational Study

Background

Home blood pressure (BP) monitoring is recommended for people with hypertension; however, meta-analyses have demonstrated that BP improvements are related to additional coaching support in combination with self-monitoring, with little or no effect of self-monitoring alone. High-contact coaching requires substantial resources and may be difficult to deliver via human coaching models.

Objective

This observational study assessed changes in BP and body weight following participation in a fully digital program called Lark Hypertension Care with coaching powered by artificial intelligence (AI).

Methods

Participants (N=864) had a baseline systolic BP (SBP) ≥120 mm Hg, provided their baseline body weight, and had reached at least their third month in the program. The primary outcome was the change in SBP at 3 and 6 months, with secondary outcomes of change in body weight and associations of changes in SBP and body weight with participant demographics, characteristics, and program engagement.

Results

By month 3, there was a significant drop of –5.4 mm Hg (95% CI –6.5 to –4.3; P<.001) in mean SBP from baseline. BP did not change significantly (ie, the SBP drop maintained) from 3 to 6 months for participants who provided readings at both time points (P=.49). Half of the participants achieved a clinically meaningful drop of ≥5 mm Hg by month 3 (178/349, 51.0%) and month 6 (98/199, 49.2%). The magnitude of the drop depended on starting SBP. Participants classified as hypertension stage 2 had the largest mean drop in SBP of –12.4 mm Hg (SE 1.2 mm Hg) by month 3 and –13.0 mm Hg (SE 1.6 mm Hg) by month 6; participants classified as hypertension stage 1 lowered by –5.2 mm Hg (SE 0.8) mm Hg by month 3 and –7.3 mm Hg (SE 1.3 mm Hg) by month 6; participants classified as elevated lowered by –1.1 mm Hg (SE 0.7 mm Hg) by month 3 but did not drop by month 6. Starting SBP (β=.11; P<.001), percent weight change (β=–.36; P=.02), and initial BMI (β=–.56; P<.001) were significantly associated with the likelihood of lowering SBP ≥5 mm Hg by month 3. Percent weight change acted as a mediator of the relationship between program engagement and drop in SBP. The bootstrapped unstandardized indirect effect was –0.0024 (95% CI –0.0052 to 0; P=.002).

Conclusions

A hypertension care program with coaching powered by AI was associated with a clinically meaningful reduction in SBP following 3 and 6 months of program participation. Percent weight change was significantly associated with the likelihood of achieving a ≥5 mm Hg drop in SBP. An AI-powered solution may offer a scalable approach to helping individuals with hypertension achieve clinically meaningful reductions in their BP and associated risk of cardiovascular disease and other serious adverse outcomes via healthy lifestyle changes such as weight loss.

Lifestyle choices mediate the association between educational attainment and BMI in older adults in China: A cross-sectional study

As the Chinese population ages, unhealthfully high body mass index (BMI) levels in older adults are becoming a public health concern as an unhealthfully high BMI is an ill-being condition and can contribute to the risk of disease. Education and lifestyle choices affect BMI; however, the evidence on the relationships and interactions among these factors remains unclear. This study aimed to investigate the mediating effect of lifestyle choices on educational attainment and BMI among older adults in China. Using the Chinese Family Panel Studies (CFPS) 2018 panel data, this study integrated personal- and family-level economic data libraries, including 7,359 adults aged ≥60 years. Lifestyle parameters included smoking amount and screen time. Height and weight values were used to calculate BMI. The chi-square test, binary logistic regression analysis, stepwise regression analysis, and bootstrapping mediating effect tests were used for data analysis. Single-factor chi-square test revealed differences in BMI levels among groups defined by sex, age, residence, marital status, per capita annual household income, education years, and lifestyle choices. Binary logistic regression showed that age, residence, education years, smoking amount, and screen time influenced BMI. Stepwise regression results showed that education years, smoking amount, and screen time were associated with BMI (t = 3.907, -4.902, 7.491, P < 0.001). The lifestyle variables had partial mediating effects on BMI. The mediating effect of lifestyle on BMI was 0.009, while smoking amount was 0.003, and screen time was 0.006. Unhealthfully high BMI levels are increasing among older adults in China and are affected by many factors. Lifestyle factors and educational attainment can interact, affecting BMI. Interventions should consider lifestyle factors and education attainment to help maintain healthy BMI and reduce unhealthfully high BMI incidence.

Effectiveness of (Active) Lifestyle Interventions in People With a Lower Limb Amputation: A Systematic Review

Objective

To explore the effectiveness of (active) lifestyle interventions for the health of people with a lower limb amputation in order to offer effective interventions during rehabilitation that may improve physical and psychosocial functioning of people with lower limb amputation.

Data Sources

PubMed, CINAHL and Embase were searched from inception to February 2021.

Study Selection

Inclusion criteria were (1) (quasi-)randomized controlled trial; (2) minimum of 10 participants with a lower limb amputation; (3) lifestyle intervention focusing on physical activity, smoking habits, alcohol use, nutrition, and/or stress management; (4) focus on health outcomes; (5) participants older than 18 years; (6) studies in Dutch, German, or English; and (7) primary research. Title, abstract, and full-text screening and quality assessment were performed by 2 independent assessors.

Data Extraction

Of 2460 studies identified, 13 studies were included in this review. Two studies were of moderate methodological quality, 2 studies were of medium quality, and 9 studies were of poor quality.

Data Synthesis

Lifestyle interventions in the included studies focused on physical activity and stress management. These interventions seemed effective for improving physical fitness, walking capacity, changes in body mass, quality of life, and intensity of physical activity.

Conclusion

Lifestyle interventions focusing on physical activity and stress management seem effective for improving physical and psychosocial functioning of people with a lower limb amputation. However, the findings should be interpreted with caution given the limited methodological quality of the included studies. Future research should evaluate the effectiveness of interventions on nutrition, smoking habits, and alcohol use and the effectiveness of combined interventions in people with a lower limb amputation.

Changes in pedometer-measured physical activity are associated with weight loss and changes in body composition and fat distribution in response to reduced-energy diet interventions: The POUNDS Lost trial

AIMS

To examine whether changes in objectively measured physical activity (PA) are associated with weight loss and changes in body composition and fat distribution in response to weight-loss diet interventions.

METHODS

This study included 535 participants with overweight/ obesity, who were randomly assigned to four weight-loss diets varying in macronutrients. PA was measured objectively with pedometers, and body composition and fat distribution were measured using dual-energy X-ray absorptiometry and computed tomography scans at baseline, 6 months and 24 months.

RESULTS

From baseline to 6 months, when the maximum weight loss was achieved, each 1000-steps/d increment in PA was associated with a greater reduction in body weight (β[SE] = -0.48[0.11]) and waist circumference (β[SE] = -0.49[0.12]). Similar inverse associations were found in changes in body composition and fat distribution (P < 0.05 and false discovery rate qvalue < 0.1 for all). The trajectory of the above adiposity measures across the 24-month intervention period differed between the patterns of PA change. Participants with the largest increase in PA maintained their weight loss from 6 months to 24 months, while those with a smaller increase in PA regained their weight. In addition, dietary fat or protein intake significantly modified the associations between changes in PA and changes in body weight and waist circumference over 24 months (P_∆PA*diet  < 0.05).

CONCLUSIONS

Changes in objectively measured PA were inversely related to changes in body weight, body composition and fat distribution in response to weight-loss diets, and such associations were more evident in people on a high-fat or average-protein diet compared with a low-fat or high-protein diet.

Astilbin from Smilax glabra Roxb. alleviates high-fat diet-induced metabolic dysfunction

Overweight, obesity, and related diseases are currently the major public health problems worldwide. Astilbin, extracted from the rhizome of Smilax glabra Roxb., is known to have significant anti-inflammatory activity and hepatoprotective effect. Studies have shown that it can inhibit adipogenesis in adipocytes in vitro; however, the intervention benefits of astilbin against obesity and related diseases along with its associated mechanisms remain unknown. This study aimed to demonstrate the impact of astilbin consumption on the overall biochemical pattern of high-fat diet (HFD) mice by using a combined multi-omics approach. Our data indicated that astilbin reduced body weight, insulin resistance, and inflammation in mice fed an HFD. Astilbin improved HFD-induced gut microbial dysbiosis by decreasing the Firmicutes-to-Bacteroidetes ratio, by increasing beneficial bacteria such as Alistipes and Muribaculum and decreasing harmful bacteria including Lachnospiraceae FCS020 group, Coriobacteriaceae UCG-002, and Lachnospiraceae UCG-008, resulting in enhanced intestinal carbohydrate and lipid metabolism. Meanwhile, astilbin protected the integrity of the intestinal barrier in HFD mice, increased short-chain fatty acid levels, and reduced metabolic endotoxemia. We further showed that astilbin attenuated hepatic lipid droplet aggregation and triglyceride accumulation in HFD mice, affected glutamate metabolism-related pathways, and enhanced hepatic ATP transduction pathways and attenuated xanthine metabolism pathways in mice, which were positively correlated with the abundance of Alistipes and negatively correlated with Ruminococcaceae UCG-003. The results highlighted that astilbin could be used as a prebiotic for the prevention of "gut-liver axis" damage and metabolic disruption in obese individuals.

Psychological Interventions and Bariatric Surgery among People with Clinically Severe Obesity-A Systematic Review with Bayesian Meta-Analysis

AIM

To assess the effectiveness of perioperative psychological interventions provided to patients with clinically severe obesity undergoing bariatric surgery regarding weight loss, BMI, quality of life, and psychosocial health using the Bayesian approach.

METHODS

We considered randomised trials that assessed the beneficial and harmful effects of perioperative psychological interventions in people with clinically severe obesity undergoing bariatric surgery. We searched four data sources from inception to 3 October 2021. The authors independently selected studies for inclusion, extracted data, and assessed the risk of bias. We conducted a meta-analysis using a Bayesian approach.

PROSPERO

CRD42017077724.

RESULTS

Of 13,355 identified records, we included nine studies (published in 27 papers with 1060 participants (365 males; 693 females, 2 people with missing data)). Perioperative psychological interventions may provide little or no benefit for BMI (the last reported follow-up: MD [95% credible intervals] = -0.58 [-1.32, 0.15]; BF01 = 0.65; 7 studies; very low certainty of evidence) and weight loss (the last reported follow-up: MD = -0.50 [-2.21, 0.77]; BF01 = 1.24, 9 studies, very low certainty of evidence). Regarding psychosocial outcomes, the direction of the effect was mainly inconsistent, and the certainty of the evidence was low to very low.

CONCLUSIONS

Evidence is anecdotal according to Bayesian factors and uncertain whether perioperative psychological interventions may affect weight-related and psychosocial outcomes in people with clinically severe obesity undergoing bariatric surgery. As the results are ambiguous, we suggest conducting more high-quality studies in the field to estimate the true effect, its direction, and improve confidence in the body of evidence.

Association of Alcohol Types, Coffee, and Tea Intake with Risk of Dementia: Prospective Cohort Study of UK Biobank Participants

The prevalence of dementia is increasing globally and is linked to obesity and unfavorable dietary habits. The present study analyses the association of alcohol intake from wine and non-wine alcoholic beverages (non-wine) in g/d, as well as coffee and tea in cups/d, with incident dementia. Over 4.2 million person-years, 4270 dementia cases occurred in 351,436 UK Biobank participants. Hazard ratios (HRs) for incident dementia were defined with Cox proportional hazard regression models in which beverage intake was fitted as penalized cubic splines. Wine intake showed a significant U-shaped association with the lowest risk for incident dementia (nadir) ranging from 21 to 23 g alcohol/d in all participants and in males. In contrast, non-wine consumption was significantly and dose-dependently associated with incident dementia, and the nadir was found at 0 g alcohol/d. Coffee consumption was not related to dementia risk, while moderate-to-high tea intake was negatively associated with incident dementia. Taken together, the current study shows on a population level that moderate consumption of wine and moderate-to-high tea intake is associated with a decreased risk of incident dementia. In contrast, non-wine is positively related to dementia risk in a linear fashion, and no clear association is found for coffee.

Childhood obesity: A review of current and future management options

Obesity is becoming increasingly prevalent in paediatric populations worldwide. In addition to increasing prevalence, the severity of obesity is also continuing to rise. Taken together, these findings demonstrate a worrying trend and highlight one of the most significant challenges to public health. Childhood obesity affects multiple organs in the body and is associated with both significant morbidity and ultimately premature mortality. The prevalence of complications associated with obesity, including dyslipidaemia, hypertension, fatty liver disease and psychosocial complications are becoming increasingly prevalent within the paediatric populations. Treatment guidelines currently focus on intervention with lifestyle and behavioural modifications, with pharmacotherapy and surgery reserved for patients who are refractory to such treatment. Research into adult obesity has established pharmacological novel therapies, which have been approved and established in clinical practice; however, the research and implementation of such therapies in paediatric populations have been lagging behind. Despite the relative lack of widespread research in comparison to the adult population, newer therapies are being trialled, which should allow a greater availability of treatment options for childhood obesity in the future. This review summarizes the current evidence for the management of obesity in terms of medical and surgical options. Both future therapeutic agents and those which cause weight loss but have an alternative indication are also included and discussed as part of the review. The review summarizes the most recent research for each intervention and demonstrates the potential efficacy and limitations of each treatment option.

Compliance with Health-Related Behaviors Guidelines and Its Relationship with Multiple Factors in Preschool Children Aged 3–6 Years: A National Cross-Sectional Survey in China

Purpose: To investigate the compliance rates of health-related behaviors among Chinese preschool children, and to explore how supportive family environment, parental behavior, sociodemographic and community factors affect children’s health-related behavior comprehensively. Method: Preschool children aged 3 to 6 years were chosen from 5760 villages (residential) committees from 471 counties (districts) of 31 provinces by use of a stratified random sampling procedure, with 10,967 preschool children aged 3–6 years old included. The survey was conducted from September 2020 to November 2020. Results: The proportion of Chinese preschool children who met the moderate to vigorous physical activity (MVPA), screen time behavior (ST), and sleep behavior (SLP) guidelines were 62.3%, 52.8%, and 53.8%. Among the supportive family environment factors, parents’ time with their children on weekends had the most significant impact on children’s MVPA, ST, and SLP, with the odds ratio (OR) values of 2.18 (95%CI:1.97, 2.40), 0.69 (0.63, 0.76), and 1.62 (1.48, 1.79), respectively. Among the parental behavior factors, the mother’s exercise frequency had a strong association with the children’s MVPA and SLP, with OR values of 1.65 (1.50, 1.83) and 1.24 (1.13, 1.37), respectively; the mother’s screen time was inversely associated with the children’s ST with an OR value of 0.47 (0.44, 0.51). Conclusions: Different types of family environments were associated with the different levels of MVPA, ST and SLP among Chinese preschool children. In addition to the influence of parents’ education and family income, parents could also improve their children’s behaviors by providing a supportive family environment. The more of these factors presented in a family, the more likely it was for children to meet the guidelines. Therefore, for those families whose children’s health-related behaviors needed to be improved, the parents should create supportive family environments, such as by playing less on mobile phone and spending more time with children.

Self-regulatory behaviour change techniques in interventions to promote healthy eating, physical activity, or weight loss: a meta-review

Poor quality diet, physical inactivity, and obesity are prevalent, covariant risk factors for chronic disease, suggesting that behaviour change techniques (BCTs) that effectively change one risk factor might also improve the others. To examine that question, registered meta-review CRD42019128444 synthesised evidence from 30 meta-analyses published between 2007 and 2017 aggregating data from 409,185 participants to evaluate whether inclusion of 14 self-regulatory BCTs in health promotion interventions was associated with greater improvements in outcomes. Study populations and review quality varied, with minimal overlap among summarised studies. AMSTAR-2 ratings averaged 37.31% (SD = 16.21%; range 8.33-75%). All BCTs were examined in at least one meta-analysis; goal setting and self-monitoring were evaluated in 18 and 20 reviews, respectively. No BCT was consistently related to improved outcomes. Although results might indicate that BCTs fail to benefit diet and activity self-regulation, we suggest that a Type 3 error occurred, whereby the meta-analytic research design implemented to analyse effects of multi-component intervention trials designed for a different purpose was mismatched to the question of how BCTs affect health outcomes. An understanding of independent and interactive effects of individual BCTs on different health outcomes and populations is needed urgently to ground a cumulative science of behaviour change.

How to recruit inactive residents for lifestyle interventions: participants' characteristics based on various recruitment strategies

Care Sport Connectors (CSCs) have been appointed to create a connection between primary care and physical activity (PA) sectors to stimulate inactive residents into becoming physically active. Adequate recruitment strategies are necessary to reach the intended target group in order to foster the sustainability of lifestyle interventions. The objective of this study is to explore PA behavior and health characteristics of the target group reached by CSCs and if these characteristics differ between participants when grouped based on how they were recruited. Participants from lifestyle interventions were included between September 2014 and April 2016 using a purposive sampling method. Participants were recruited through CSCs via public relations (n = 135), a personal letter (n = 136), or a referral (n = 98) and compared based on their PA level, health-related quality of life, motivation, self-efficacy, morbidity and health-related fitness. Scores were analyzed with a multi-level (mixed model) analysis measured before the intervention. The three groups were different in PA level (p = 0.002). The outcomes regarding health-related quality of life, motivation, and number of somatic disorders were also significantly different for the three groups, except for the categories of mental health (p = 0.145) and self-efficacy (p = 0.464). For all dimensions, the referral group scored the least favorable. The investment in time and money for an active recruitment strategy like referrals is worthwhile because it provides CSCs the opportunity to reach people who are inactive and at risk of chronic disease. Future studies are necessary to reveal the effect on PA levels and health in the long-term.

'Shape-Up', a Modified Cognitive-Behavioural Community Programme for Weight Management: Real-World Evaluation as an Approach for Delivering Public Health Goals

Obesity is widespread, with serious health consequences; addressing it requires considerable effort at a public health level, incorporating prevention and management along with policies to support implementation. Behavioural weight-management programmes are widely used by public health bodies to address overweight and obesity. Shape-Up is an evidence-based programme combining a structured behavioural intervention (targeting nutrition and physical activity behaviours) within a peer-learning framework. This study was a service-evaluation of Shape-Up, as delivered in Rotherham by a local leisure provider, and included a secondary analysis of data collected in the community by service providers. The RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) framework was used to explore programme effectiveness, implementation, and whom it reached. A total of 141 participants were included. Compared to local demographics, participants were older, at 48.9 (SD 14.47) years, with a lower employment rate (41% employed) and greater proportion female (67% female). Mean BMI was 38.0 (SD 7.54) kg/m2. Mean weight-change between baseline and endpoint (12 weeks, 10 group sessions) was -4.4 (SD 3.38) kg, and degree of weight change was associated with session attendance (F (9, 131) = 6.356, p < 0.0005). There were positive effects on participants' weight, health-related behaviours, and quality of life. The intervention content (including the focus of nutritional recommendations) and structure were adapted during implementation to better suit national guidelines and local population needs. RE-AIM was found to be a useful framework for evaluating and adapting an existing evidence-based weight management programme in line with local population needs. This could be a more cost-effective approach, compared to developing new programmes, for delivering public health goals relating to obesity, nutrition, and physical activity.

Towards precision cardiometabolic prevention: results from a machine learning, semi-supervised clustering approach in the nationwide population-based ORISCAV-LUX 2 study

Given the rapid increase in the incidence of cardiometabolic conditions, there is an urgent need for better approaches to prevent as many cases as possible and move from a one-size-fits-all approach to a precision cardiometabolic prevention strategy in the general population. We used data from ORISCAV-LUX 2, a nationwide, cross-sectional, population-based study. On the 1356 participants, we used a machine learning semi-supervised cluster method guided by body mass index (BMI) and glycated hemoglobin (HbA1c), and a set of 29 cardiometabolic variables, to identify subgroups of interest for cardiometabolic health. Cluster stability was assessed with the Jaccard similarity index. We have observed 4 clusters with a very high stability (ranging between 92 and 100%). Based on distinctive features that deviate from the overall population distribution, we have labeled Cluster 1 (N = 729, 53.76%) as "Healthy", Cluster 2 (N = 508, 37.46%) as "Family history-Overweight-High Cholesterol ", Cluster 3 (N = 91, 6.71%) as "Severe Obesity-Prediabetes-Inflammation" and Cluster 4 (N = 28, 2.06%) as "Diabetes-Hypertension-Poor CV Health". Our work provides an in-depth characterization and thus, a better understanding of cardiometabolic health in the general population. Our data suggest that such a clustering approach could now be used to define more targeted and tailored strategies for the prevention of cardiometabolic diseases at a population level. This study provides a first step towards precision cardiometabolic prevention and should be externally validated in other contexts.

Differences between Active and Semi-Active Students Regarding the Parameters of Body Composition Using Bioimpedance and Magnetic Bioresonance Technologies

The aim of the study was to identify differences in obesity-related parameters between active sports students and semi-active or sedentary students, differentiated by sex, in order to optimize health. The study sample included 286 students, of which the male experimental sample consisted of 86 active sports students, age X ± SD 21.25 ± 0.32 years; height X ± SD 181.08 ± 3.52 cm; control group consisting of 89 semi-active students aged X ± SD 21.07 ± 0.1.13 years; height X ± SD 182.11 ± 1.32. The female experimental sample includes 57 active sports students, age X ± SD 21.02 ± 0.92 years; height X ± SD 167.48 ± 1.34 cm; the control group includes 54 semi-active students aged X ± SD 21.57 ± 0.1.98 years; height X ± SD 168.42 ± 1.76. The study used a thalliometer, Tanita Health Ware software and Quantum Resonance Magnetic Analyzer equipment to investigate height (cm), Body Mass Index (BMI), muscle mass (kg, %), as well as the obesity analysis report, and componential analysis of body and nourishment. The differences registered between the samples of active and semi-active sports subjects were predominantly statistically significant for p < 0.05. The differences registered between the samples of active and semi-active sports subjects were predominantly statistically significant for p < 0.05. The most important parameters regarding obesity and body composition that registered significant differences between the two male groups were in favor of the group of active athletes: triglyceride content of abnormal coefficient 0.844 (CI95% 0.590–1.099), abnormal lipid metabolism coefficient 0.798 (CI95% 1.091–0.504), obesity degree of body (ODB %) 10.290 (CI95% 6.610–13.970), BMI 2.326 (CI95% 1.527–3.126), body fat (kg) 2.042 (CI95% 0.918–3.166), muscle volume (kg) 2.565 (CI95% 1.100–4.031), Lean body weight (kg) 2.841 (CI95% 5.265–0.418). In the case of female samples, the group of active sportswomen registered the biggest differences compared to the group of students who were significantly active in the parameters: abnormal lipid metabolism coefficient 1.063 (CI95% 1.380–0.746), triglyceride content of abnormal coefficient 0.807 (CI95% 0.437–1.178), obesity degree of body (ODB%) 8.082 (CI95% 2.983–13.181), BMI 2.285 (CI95% 1.247–3.324), body fat (kg) 2.586 (CI95% 0.905–4.267), muscle volume (kg) 2.570 (CI95% 0.154–4.985), lean body weight (kg) 4.118 (CI95% 1.160–7.077). The results of the study directly facilitate the understanding of the complexity of the impact of obesity on multiple parameters of body composition and health.

The association between sleep health and weight change during a 12-month behavioral weight loss intervention

BACKGROUND

Prior research on the relationship between sleep and attempted weight loss failed to recognize the multidimensional nature of sleep. We examined the relationship between a composite measure of sleep health and change in weight and body composition among adults in a weight loss intervention.

METHODS

Adults (N = 125) with overweight or obesity (50.3 ± 10.6 years, 91% female, 81% white) participated in a 12-month behavioral weight loss intervention, with assessments of sleep, weight, fat mass, and fat-free mass at baseline, 6 months, and 12 months. Six sleep dimensions (regularity, satisfaction, alertness, timing, efficiency, and duration) were categorized as "good" or "poor" using questionnaires and actigraphy. A composite score was calculated by summing the number of "good" dimensions. Obstructive sleep apnea (OSA) was assessed in a subsample (n = 117), using the apnea-hypopnea index (AHI) to determine OSA severity. Linear mixed modeling was used to examine the relationships between sleep health and outcomes of percent weight, fat mass, or fat-free mass change during the subsequent 6-month interval, adjusting for age, sex, bed partner, and race; an additional model adjusted for AHI.

RESULTS

Mean baseline and 6-month sleep health was 4.5 ± 1.1 and 4.5 ± 1.2, respectively. Mean weight, fat mass, and fat-free mass changes from 0 to 6 months were -9.3 ± 6.1%, -16.9 ± 13.5%, and -3.4 ± 3.4%, respectively, and 0.4 ± 4.8%, -0.3 ± 10.3%, and 0.7 ± 4.1% from 6 to 12 months. Better sleep health was associated with greater subsequent weight loss (P = 0.016) and fat loss (P = 0.006), but not fat-free mass loss (P = 0.232). Following AHI adjustment, the association between sleep health and weight loss was attenuated (P = 0.102) but remained significant with fat loss (P = 0.040). Regularity, satisfaction, timing, and efficiency were each associated with weight and/or fat loss (P ≤ 0.041).

CONCLUSIONS

Better sleep health was associated with greater weight and fat loss, with associations attenuated after accounting for OSA severity. Future studies should explore whether improving sleep health, OSA, or the combination improves weight loss.

Variable effects of obesity on access to total hip and knee arthroplasty

Background

Obesity is an important comorbidity affecting outcomes after total joint arthroplasty. Consequently, surgeons may delay care of obese patients to first address obesity through different care pathways. The effect of obesity on patient wait times for total joint arthroplasty has not been explored. The purpose of this study was to evaluate the effect of obesity on access to total hip (THA) and knee (TKA) arthroplasty.

Methods

The study data set was constructed from the Nova Scotia Health Authority’s Horizon Patient Folder system and the Patient Access Registry Nova Scotia. Wait time was measured as days between the decision to treat and date of surgery. Body mass index (BMI) was calculated from a preoperative assessment, and patients were grouped into BMI categories. Multivariate log-linear regression was used to test for statistical differences, controlling for confounding factors.

Results

We observed longer wait times for TKA with increasing BMI weight class. Patients with BMIs greater than 50 had 34% longer waits than reference weight patients. However, THA recipients showed no statistical difference in wait times across weight categories. Furthermore, there was variability among surgeons in the wait times experienced by patients.

Conclusion

The finding of longer wait times for TKAs, but not THAs, among patients who were obese was unexpected. This shows the variable wait times for THA and TKA that patients who are obese can experience with different surgeons. It is important to understand the variability in wait times so that efforts to standardize the patient experience can be accomplished.