Patients with Severe Obesity during the COVID-19 Pandemic: How to Maintain an Adequate Multidisciplinary Nutritional Rehabilitation Program?

The vital role of exercise and nutrition in COVID-19 rehabilitation: synergizing strength

Since the outset of the COVID-19 pandemic, the global healthcare community has faced the challenge of understanding and addressing the ongoing and multi-faceted SARS-CoV-2 infection outcomes. As millions of individuals worldwide continue to navigate the complexities of post-hospitalization recovery, reinfection rates, and the increasing prevalence of Long-COVID symptoms, comprehensive COVID-19 rehabilitation strategies are greatly needed. Previous studies have highlighted the potential synergy between exercise and nutrition, suggesting that their integration into patient rehabilitation programs may yield improved clinical outcomes for survivors of COVID-19. Our group aimed to consolidate existing knowledge following the implementation of patient, intervention, comparison, and outcome (PICO) search strategies on the distinct and combined impacts of exercise and nutrition interventions in facilitating the recovery of COVID-19 patients following hospitalization, with a specific focus on their implications for both public health and clinical practice. The incorporation of targeted nutritional strategies alongside exercise-based programs may expedite patient recovery, ultimately promoting independence in performing activities of daily living (ADLs). Nonetheless, an imperative for expanded scientific inquiry remains, particularly in the realm of combined interventions. This mini-review underscores the compelling prospects offered by an amalgamated approach, advocating for the seamless integration of exercise and nutrition as integral components of post-hospitalization COVID-19 rehabilitation. The pursuit of a comprehensive understanding of the synergistic effects and effectiveness of exercise and nutrition stands as a crucial objective in advancing patient care and refining recovery strategies in the wake of this enduring global health crisis.

Physiological and Environmental Factors Affecting Cancer Risk and Prognosis in Obesity

Obesity results from a chronic excessive accumulation of adipose tissue due to a long-term imbalance between energy intake and expenditure. Available epidemiological and clinical data strongly support the links between obesity and certain cancers. Emerging clinical and experimental findings have improved our understanding of the roles of key players in obesity-associated carcinogenesis such as age, sex (menopause), genetic and epigenetic factors, gut microbiota and metabolic factors, body shape trajectory over life, dietary habits, and general lifestyle. It is now widely accepted that the cancer-obesity relationship depends on the site of cancer, the systemic inflammatory status, and microenvironmental parameters such as levels of inflammation and oxidative stress in transforming tissues. We hereby review recent advances in our understanding of cancer risk and prognosis in obesity with respect to these players. We highlight how the lack of their consideration contributed to the controversy over the link between obesity and cancer in early epidemiological studies. Finally, the lessons and challenges of interventions for weight loss and better cancer prognosis, and the mechanisms of weight gain in survivors are also discussed.

A Representative Percentile Chart for Prediction of Weight Loss Trend after Sleeve Gastrectomy

INTRODUCTION

It could be valuable for surgeons and patients to use one chart in different groups and evaluate weight loss during the post-surgery period.

METHODS

This retrospective study used the Iran National Obesity Surgery Database. Patients with clinically severe obesity aged 18-70 undergoing sleeve gastrectomy participated in this study. Body mass index (BMI) reduction and 5 other metrics measured over the study period were modeled using lambda-mu-sigma method. Our data were split into the train (70%) and test (30%) sets.

RESULTS

In this study, 1,258 patients (75% female) met the eligibility criteria to participate. Mean age and initial BMI were 36.87 ± 10.51 and 42.74 (40.37-46.36), respectively. Percentile charts for various metrics have been presented for the first 2 years after surgery.

CONCLUSIONS

For sleeve surgery, all metrics are acceptable for clinical applications. Using the statistical view, BMI reduction is the most acceptable metric according to the lowest bias values and its variation between all the metrics.

Impact of COVID-19 on the Destiny of Bariatric Patients

Obese patients reported worse outcomes of COVID-19 related to prothrombotic and low-grade inflammation status. During the SARS-CoV-2 outbreak, all non-elective surgeries were postponed, including bariatric surgery (BS). This umbrella review wants to underline obesity as a condition provoking low-grade chronic inflammation, and increasing severe COVID-19 risk; to relaunch the prioritization of BS. The literature search was conducted in March 2022 via Pubmed (MEDLINE) and focused on reviews, systematic reviews, and meta-analyses published in peer-reviewed journals. Terms "bariatric surgery" OR "obesity surgery" OR "metabolic surgery" were analyzed with "COVID-19" OR "SARS-CoV-2" using the AND modifier. Only 13 studies of the 406 screened met the objective. The procrastination of BS over the past two years determined a delay in obesity treatment and severe consequences. The COVID-19 pandemic has had a huge impact on economic costs. Although BS has high costs, a lifetime cost advantage over conventional weight loss methods was demonstrated. As the pandemic continues, health policies must recognize obesity as a disease-predisposing factor for SARS-CoV-2 infection, considering COVID-19 as a new comorbidity mitigable by BS. Care pathways for obese patients in COVID/post-COVID era should be revitalized and the concept of elective surgery attributed to BS should be reformulated.

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.

Weight Loss Management and Lifestyle Changes during COVID-19 Lockdown: A Matched Italian Cohort Study

During the COVID-19 lockdown, lifestyle deterioration had a negative impact on weight, and yet no study has focused on patients already undergoing dietary therapy. We performed a cohort study among adults to evaluate the effect of lockdown on weight loss programs, and we investigated changes in eating habits and chronotype. We matched confined cases with non-confined cases among individuals who followed the same diet in 2017–2019. At baseline, all patients underwent a clinical examination and completed questionnaires on lifestyle. At follow-up, patients of the confined group were interviewed by a web call, and questionnaires were re-evaluated. We recruited 61 patients. The confined sample was mainly composed of middle-aged (52 (43,58) years) females (46 (75%)) with overweight (27 (44%)) or obesity (24 (39%)) and a moderate physical activity level (48 (81%)). Body weight at follow-up was significantly higher (1.1 (95% CI: 0.14, 2.1) kg) in the confined group adjusting for all matching variables. Adherence to the Mediterranean diet and eating behavior generally improved. Concerning chronotype, patients differentiated from Neither-types to Evening- and Morning-types. A well-monitored dietary therapy maintains weight loss during lockdown. Improvement in eating habits was observed; however, a shift of the circadian typology occurred.

The Impact of the COVID-19 Epidemic on the Mood and Diet of Patients Undergoing Bariatric Surgery

Limited social contacts, lack of professional activities, economic insecurity, and a sense of threat, as well as boredom during the COVID-19 pandemic, contributed to tension and stress. All of these increase the risk of an inappropriate diet. The aim of this cross-sectional study was to assess the impact of the COVID-19 pandemic on the mood and nutrition of patients undergoing bariatric surgery. A group of 312 patients (both before and after bariatric surgery) completed a questionnaire about their diet and mood during COVID-19 lockdown. About 70% of all respondents reacted to the epidemiological situation: irritability, anxiety about their own health, and eating without being hungry. A total of 74% of all of the subjects snacked between meals (especially sweets). The respondents who believed that obesity and its complications had a negative impact on the prognosis of the coronavirus infection had a statistically significant higher prevalence of health anxiety, feeling that important life issues were out of control, irritability, need for psychological support, and need for dietary consultation. Patients after bariatric surgery had e.g., a statistically significant lower incidence of feeling hungry, eating after meals, and eating fatty foods. The COVID-19 pandemic has been shown to negatively affect the mood and diet of bariatric patients, which may affect their health status and worsen the prognosis of COVID-19.

Clinical efficacy of a virtual reality tool for the treatment of obesity: study protocol of a randomised controlled trial

INTRODUCTION

Previous research has shown that it is feasible to integrate motivational interviewing techniques with behavioural and psychological interventions for the treatment of obesity. Moreover, these combined interventions have the potential to improve health-related outcomes of people living with obesity (PLWO) and to afford maintenance of behavioural changes over time. In addition, the use of virtual reality (VR) embodiment techniques in the treatment of eating disorders and obesity has promising preliminary effectiveness. The objective of this study is to assess the clinical efficacy of a VR intervention that uses embodiment and body-swapping techniques and has been specifically developed to cover the needs of PLWO.

METHODS AND ANALYSIS

A randomised control trial will be carried out with an estimated sample of 96 participants with body mass index (BMI)>30. The whole duration of the trial will be 12 months. Participants will be recruited from the external consultations of the Vall d'Hebron University Hospital and be randomly assigned to three groups. The experimental group 1 will engage in a virtual self-conversation using the ConVRself platform, the experimental group 2 will participate in a 'pre-established discourse' provided by the virtual counsellor, who will give psychoeducation advice, and the control group will continue with treatment as usual. Readiness to change, BMI, eating habits and physical activity, psychological well-being, body image satisfaction, quality of life in relation to body image, and weight bias internalisation will be assessed at baseline, post intervention, 1-week and 4-week follow-up. Finally, variables related to adherence and satisfaction with the VR tool will be evaluated for the experimental groups.

ETHICS AND DISSEMINATION

This study was approved by the Research Projects Committee of the Vall d'Hebron University Hospital. Findings will be disseminated through peer-reviewed journals, reports to the funding body, conferences and other events for the scientific and clinical community, and the general public.

TRIAL REGISTRATION NUMBER

NCT05094557.