Update on treatment strategies for obesity

Experiences and overall impact reported by people living with obesity: results from a multinational study

Objectives

To explore the impact of obesity on clinical outcomes, health-related quality of life, emotional well-being, and work productivity in people/patients with obesity across six countries by body mass index and the presence of complications.

Methods

Adelphi Real World Obesity Disease Specific Programme™ captured data related to physicians and their consulting people/patients with obesity on a weight management program or anti-obesity medication in Brazil, Canada, China, Japan, Kingdom of Saudi Arabia, and the United Arab Emirates from April to December 2022. Physicians reported data for up to eight qualifying people/patients with obesity. People/patients with obesity voluntarily completed outcome measures: 36-Item Short Form Health Survey, emotional well-being, and Work Productivity and Activity Impairment.

Results

Of 1506 people/patients with obesity, 58% were female (mean ± standard deviation age: 41 ± 12.7 years; body mass index: 32.3 kg/m2 ± 7.7 kg/m2). Overall, 82% had ⩾1 complication (median and interquartile range: 2.0 (1.0-3.0)). People/patients with obesity struggled with weight for a mean ± SD of 64.1 ± 86.6 months with a median (interquartile range) of 3.0 (2.0-5.0) weight-loss attempts. Mean ± standard deviation 36-Item Short Form Health Survey scores for people/patients with obesity above the obesity threshold showed impairment in general health (42.3 ± 11.5), social functioning (44.3 ± 9.2), role-emotional (46.0 ± 9.3), and mental health (45.7 ± 9.6). People/patients with obesity with complications showed similar impairment. People/patients with obesity reported bother/embarrassment about their weight, with 72% worried about future weight gain. Work productivity and activity impairment scores among people/patients with obesity above the obesity threshold showed impairment in activity (36%), overall work (34%), and presenteeism (31%). Findings were similar for people/patients with obesity with complications.

Conclusion

Results suggest that obesity alongside the presence of complications negatively impacts health-related quality of life, emotional well-being, and work productivity, reinforcing the need for comprehensive interventions for this complex health issue.

Urine exosome biomarkers of obesity after Lekhana Basti treatment - Report of a pilot study

BACKGROUND

Obesity is a rising risk factor for various diseases including cardiovascular diseases and Cancer. The limitations of targeted obesity-treatment approaches employed in the clinic presently underscore the importance of developing integrative management strategies for identification of specific biomarkers of obesity.

OBJECTIVES

Given the specificity of exosome/extracellular vesicle (EV) biomarkers, we aimed here to identify the EV biomarkers of Ayurveda treatment - Lekhana Basti - for Obesity.

METHODOLOGY

A total of eighteen 24-h urine samples from 6 participants with BMI>30 kg/m2 were used in this study, collected over 3 time-points during the Lekhana basti (medicated enema for obesity) treatment. Urine EV were isolated using Polyethylene Glycol (PEG). The proteins were resolved by 1-d gel electrophoresis and identified using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) and quantified by label-free methods. Significant Protein-Protein Interactions, KEGG pathway analysis and enrichment, functional gene ontology (GO) annotation were identified and shortlisted in comparison to Obesity reference genes from DisGeNET.

RESULTS

With UniProt as a reference subsequent to LC-MS/MS-identification, a total of 210 exosome proteins were identified. Seventy-three proteins were overexpressed in pathway enrichment analysis. Further, GO functional annotation identified 15 common proteins involved. Finally, the 8 hub proteins associated with obesity were identified and their differential expression profile compared between three different time-points during Lekhana Basti treatment. Six protein markers overexpressed during obesity were downregulated post Lekhana Basti treatment, while 2 markers increased in abundance post-treatment.

CONCLUSION

To our knowledge, this is the first study to isolate and identify urine EV protein abundance profiles from obese female participants of India. The study results indicate significant changes in the differential expression profile of 8 hub proteins involved in obesity, after Lekhana Basti treatment. The biomarker signature of the pilot study indicates the role of Ayurveda treatment and the possible pathways involved in the treatment of Obesity. Further, this study underlines the specificity of urine exosomes/EV as diagnostic markers as well as the potential of Ayurveda treatment in effective management of obesity.

Bacterial cellulose is a desirable biological macromolecule that can prevent obesity via modulating lipid metabolism and gut microbiota

Obesity has attracted great concern because of its undesirable effects on our life quality. Bacterial cellulose (BC) is a biological macromolecule that can improve gut homeostasis and lipid metabolism. However, its potential role in preventing obesity and associated mechanisms is still poorly understood. Herein, a supplement of BC was used to fully evaluate how it prevents obesity based on physio-biochemical and gut microbial analyses. Results showed that BC consumption helped decrease body and liver weight, and fat accumulation in kidney and epididymis. Correspondingly, glucose concentrations, total triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were reversed to the control levels. Consuming BC also improved liver fat metabolism and intestinal function, and alleviated ileum and epididymis inflammation. High-throughput sequencing suggested that a high-fat diet significantly decreased gut microbiota diversity, which could be reversed by consuming BC. A decreased Firmicutes and Proteobacteria and an increased Bacteroidetes following BC consumption were observed. The OTU-based analysis identified that Lachnospiraceae, Desulfovibrio, Lachnoclostridium, Blautia, Anaerotruncus, Bacteroides, Faecalibaculum, Bacteroidales S24-7 group, Prevotellaceae UCG-001 group, and Alloprevotella might be involved in obesity development or prevention. Our data suggest that BC is a good insoluble dietary fiber to prevent obesity via regulating lipid metabolism and gut microbiota.

The effects of Cannabis sativa and cannabinoids on the inhibition of pancreatic lipase - An enzyme involved in obesity

INTRODUCTION

Obesity is a chronic noncommunicable disease characterized by excessive body fat that can have negative health consequences. Obesity is a complex disease caused by a combination of genetic, environmental, and lifestyle factors. It is characterized by a discrepancy between caloric intake and expenditure. Obesity increases the risk of acquiring major chronic diseases, including heart disease, stroke, cancer, and Type 2 diabetes mellitus (T2DM). Currently, the inhibition of pancreatic lipases (PL) is a promising pharmacological therapy for obesity and weight management. In this study, the inhibition of pancreatic lipase by Cannabis sativa (C. sativa) plant extract and cannabinoids was investigated.

METHODS

The inhibitory effect was assessed using p-nitrophenyl butyrate (pNPB), and the results were obtained by calculating the percentage relative activity and assessed using one-way analysis of variance (ANOVA). Kinetic studies and spectroscopy techniques were used to evaluate the mode of inhibition. Diet-induced; and diabetic rat models were studied to evaluate the direct effects of C. sativa extract on PL activity.

RESULTS

Kinetic analyses showed that the plant extracts inhibited pancreatic lipase, with tetrahydrocannabinol (THC) and cannabinol (CBN) being the potential cause of the inhibition noted for the C. sativa plant extract. CBN and THC inhibited the pancreatic lipase activity in a competitive manner, with the lowest residual enzyme activity of 52 % observed at a 10 μg/mL concentration of CBN and 39 % inhibition at a 25 μg/mL concentration of THC. Circular dichroism (CD) spectroscopy revealed that the inhibitors caused a change in the enzyme's secondary structure. At low concentrations, THC showed potential for synergistic inhibition with orlistat. C.sativa treatment in an in vivo rat model confirmed its inhibitory effects on pancreatic lipase activity.

CONCLUSION

The findings in this study provided insight into the use of cannabinoids as pancreatic lipase inhibitors and the possibility of using these compounds to develop new pharmacological treatments for obesity.

Relative fat mass as an estimator of body fat percentage in Chilean adults

BACKGROUND/OBJECTIVE

The Relative Fat Mass (RFM) is an alternative index to body mass index (BMI) for estimating whole body fat percentage (BF%). Our aims were to determine the accuracy of the RFM for 1) identifying individuals with elevated BF% and, 2) estimating the BF% compared to Dual-energy X-ray absorptiometry (DXA) in a Chilean adult population.

SUBJECTS/METHODS

Body composition was assessed by DXA in 270 healthy participants (125 women/145 men). Anthropometric measurements were assessed to calculate RFM and BMI. Receiver operating characteristic (ROC) curves were obtained to assess the sensitivity and specificity of both, RFM and BMI. Bland-Altman analysis between BF% measured by DXA vs. predicted BF% derived from RFM was performed to assess validity. Pearson´s correlation coefficients to analyze the association between BMI, RFM and DXA were also calculated.

RESULTS

For RFM, the cut-off for elevated BF% was ≥22.7% for men and ≥32.4% for women and for BMI was ≥24.4 kg/m2 for men and ≥24.1 kg/m2 for women. The area under the ROC curve between RFM and BMI was not significantly different in men (0.970 vs. 0.959; p = 0.420) and women (0.946 vs. 0.942, p = 0.750). The Bland-Altman analysis showed that the estimation bias is more pronounced in men than in women.

CONCLUSION

RFM is an accurate tool for identifying individuals with elevated BF%, although it was not as accurate as DXA for estimating the BF%. RFM may be an alternative method useful in primary care to select individuals for lifestyle counseling and in research to select patients for epidemiological studies.

Enhanced Anti-Obesity Effects of Euphorbia Kansui Extract through Macrophage and Gut Microbiota Modulation: A Real-World Clinical and In Vivo Study

Rising obesity and associated multi-systemic complications amplify the health burden. Euphorbia kansui (EK) extract is clinically recognized for managing obesity. In a human study, 240 obese individuals were categorized into two cohorts: those receiving solely herbal medicine (HM group) and those administered EK concomitantly with herbal medicine (EK group). An in vivo examination using C57BL/6-Lepob/Lepob mice elucidated mechanisms involving macrophages and gut microbiota with associated metabolic advantages. The clinical study revealed a significant 7.22% body weight reduction during 91.55 average treatment days and examined 16.71% weight loss at 300 days after treatment. In whole subjects, 60.4%, 21.3%, and 6.3% achieved weight reductions exceeding 5%, 10%, and 15%, respectively. Impressively, the EK group exhibited superior weight loss compared to the HM group (EK: -7.73% vs. HM: -6.27%, p = 0.012). The anti-obesity effect was positively associated with EK therapy frequency and herbal medicine duration. In the in vivo study, EK significantly improved insulin sensitivity and mitigated infiltration of adipose tissue macrophages (ATMs) by modulating the CD11c+ and CD206+ subtypes. EK also correlated with increased Bacteroidetes and Firmicutes populations and reduced Proteobacteria and Verrucomicrobia. Consequently, EK is an effective adjunctive anti-obesity therapy offering metabolic benefits by modulating ATMs and gut microbiota profiles.

An Evolutionary Model for the Ancient Origins of Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrinopathy of reproductive-aged women, characterized by hyperandrogenism, oligo-anovulation and insulin resistance and closely linked with preferential abdominal fat accumulation. As an ancestral primate trait, PCOS was likely further selected in humans when scarcity of food in hunter-gatherers of the late Pleistocene additionally programmed for enhanced fat storage to meet the metabolic demands of reproduction in later life. As an evolutionary model for PCOS, healthy normal-weight women with hyperandrogenic PCOS have subcutaneous (SC) abdominal adipose stem cells that favor fat storage through exaggerated lipid accumulation during development to adipocytes in vitro. In turn, fat storage is counterbalanced by reduced insulin sensitivity and preferential accumulation of highly lipolytic intra-abdominal fat in vivo. This metabolic adaptation in PCOS balances energy storage with glucose availability and fatty acid oxidation for optimal energy use during reproduction; its accompanying oligo-anovulation allowed PCOS women from antiquity sufficient time and strength for childrearing of fewer offspring with a greater likelihood of childhood survival. Heritable PCOS characteristics are affected by today's contemporary environment through epigenetic events that predispose women to lipotoxicity, with excess weight gain and pregnancy complications, calling for an emphasis on preventive healthcare to optimize the long-term, endocrine-metabolic health of PCOS women in today's obesogenic environment.

A pilot study of the effects of supervised exercise training on body composition, cardiometabolic risk factors, muscle strength and functional capacity in individuals with bariatric surgery

The main objective of this pilot study was to evaluate the effects of functional exercise training (FET) and home exercise training (HET) on body composition, cardiometabolic risk factors, muscle strength, and functional capacity in individuals with bariatric surgery. The sample of the study included 30 individuals who underwent bariatric surgery. The FET group had functional exercise training consisting of stretching, aerobic, strengthening, and balance exercises assigned by a physiotherapist (n = 15), and the HET group had the same exercises under supervision (n = 15). The training sessions were planned as × 3 per week for a period of 8 weeks. Body composition, cardiometabolic risk factors, cardiometabolic risk status, muscle strength, and functional capacity of all individuals were evaluated before and after training. According to the measurements, body weight (BW), body mass index (BMI), body fat mass (BFM), C-reactive protein, glycated hemoglobin, insulin resistance, cardiovascular risk total score, and ten-year cardiovascular percentage risk decreased significantly (p < 0.05), while HDL-C, leg, back, and hand grip strength (right-left), and walking distance increased significantly (p < 0.05) in the FET group. In the HET group, there were significant increases in body fat percentage (BFM %), BFM, and body muscle mass percentage (BMM %) (p < 0.05), while body muscle mass (BMM), right hand grip strength, leg and back muscle strength, and walking distance scores significantly decreased (p < 0.05). It was concluded that personalized and supervised FET has a positive effect on body composition, cardiometabolic risk factors, muscle strength, and functional capacity, and it can be recommended as a safe exercise model for bariatric surgery patients.

Tackling Dyslipidemia in Obesity from a Nanotechnology Perspective

Obesity and dyslipidemia are the main features of metabolic syndrome, expressed mainly by adipose tissue dysfunction and connected by similar pathways and pharmacotherapy. Conventional drugs used in these two associated disorders are limited due to poor drug efficiency, non-specificity, and toxic side effects. Therefore, novel solutions for tackling obesity-associated diseases and providing insights into the development of innovative or improved therapies are necessary. Targeted nanotherapy is a revolutionary technology, offering a promising solution for combatting the disadvantages of currently available therapies for treating obesity and dyslipidemia due to its superior features, which include specific cell targeting, the protection of drugs against physiological degradation, and sustained drug release. This review presents a brief assessment of obesity and dyslipidemia, their impacts on human health, current treatment, and limitations, and the role and potential use of nanotechnology coupled with targeted drug delivery and nutraceuticals as emerging therapies. To the best of our knowledge, this paper presents, for the first time in the literature, a comparison between obesity and dyslipidemia nano-formulations based on drugs and/or natural extracts applied in experimental studies.

A Miniaturized MicroRNA Sensor Identifies Targets Associated with Weight Loss in a Diet and Exercise Intervention among Healthy Overweight Individuals

Weight loss through dietary and exercise intervention is commonly prescribed but is not effective for all individuals. Recent studies have demonstrated that circulating microRNA (miR) biomarkers could potentially be used to identify individuals who will likely lose weight through diet and exercise and attain a healthy body weight. However, accurate detection of miRs in clinical samples is difficult, error-prone, and expensive. To address this issue, we recently developed iLluminate-a low-cost and highly sensitive miR sensor suitable for point-of-care testing. To investigate if miR testing and iLluminate can be used in real-world obesity applications, we developed a pilot diet and exercise intervention and utilized iLluminate to evaluate miR biomarkers. We evaluated the expression of miRs-140, -935, -let-7b, and -99a, which are biomarkers for fat loss, energy metabolism, and adipogenic differentiation. Responders lost more total mass, tissue mass, and fat mass than non-responders. miRs-140, -935, -let-7b, and -99a, collectively accounted for 6.9% and 8.8% of the explained variability in fat and lean mass, respectively. At the level of the individual coefficients, miRs-140 and -935 were significantly associated with fat loss. Collectively, miRs-140 and -935 provide an additional degree of predictive capability in body mass and fat mass alternations.

Cost-effectiveness analysis of semaglutide 2.4 mg for the treatment of adult patients with overweight and obesity in the United States

BACKGROUND: The rising prevalence and associated public health burden of obesity has led to advancements in pharmaceuticals for weight management. Semaglutide 2.4 mg, an anti-obesity medication (AOM) recently approved by the US Food and Drug Administration, has demonstrated clinically relevant weight loss in its phase 3 clinical trials. Economic evaluation comparing semaglutide 2.4 mg with other available weight management therapies is essential to inform payers for decision-making. OBJECTIVES: To assess the cost-effectiveness of semaglutide 2.4 mg in the treatment of adult patients with obesity (ie, body mass index [BMI] ≥ 30) and adult patients who are overweight (ie, BMI 27-29.9) with 1 or more weight-related comorbidities from a US third-party payer perspective. METHODS: A cohort Markov model was constructed to compare semaglutide 2.4 mg with the following comparators: no treatment, diet and exercise (D&E), and 3 branded AOMs (liraglutide 3 mg, phentermine-topiramate, and naltrexone-bupropion). All AOMs, including semaglutide 2.4 mg, were assumed to be taken in conjunction with D&E. Changes in BMI, blood pressure, cholesterol level, experience of acute and chronic obesity-related complications, costs, and quality-adjusted life years (QALYs) were simulated over 30 years based on pivotal trials of the AOMs and other relevant literature. Drug and health care prices reflect 2021 standardized values. Cost-effectiveness was examined with a willingness-to-pay (WTP) threshold of $150,000 per QALY gained. Sensitivity analyses were conducted to test the robustness of the cost-effectiveness results to plausible variation in model inputs. RESULTS: In the base-case analysis, treatment with semaglutide 2.4 mg was estimated to improve QALYs by 0.138 to 0.925 and incur higher costs by $3,254 to $25,086 over the 30-year time horizon vs comparators. Semaglutide 2.4 mg is cost-effective against all comparators at the prespecified WTP threshold, with the incremental cost per QALY gained ranging from $23,556 to $144,296 per QALY gained. In the sensitivity analysis, extended maximum treatment duration, types of subsequent treatment following therapy discontinuation, and weight-rebound rates were identified as key drivers for model results. The estimated probability of semaglutide 2.4 mg being cost-effective compared with comparators ranged from 67% to 100% when varying model parameters and assumptions. CONCLUSIONS: As a long-term weight management therapy, semaglutide 2.4 mg was estimated to be cost-effective compared with no treatment, D&E alone, and all other branded AOM comparators under a WTP threshold of $150,000 per QALY gained over a 30-year time horizon. DISCLOSURES: Financial support for this research was provided by Novo Nordisk Inc. The study sponsor was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication. Dr Kim and Ms Ramasamy are employees of Novo Nordisk Inc. Ms Kumar and Dr Burudpakdee were employees of Novo Nordisk Inc at the time this study was conducted. Dr Sullivan received research support from Novo Nordisk Inc for this study. Drs Wang, Song, Wu, Ms Xie, and Ms Sun are employees of Analysis Group, Inc, who received consultancy fees from Novo Nordisk Inc in connection with this study.

Development and preliminary validity of an Indonesian mobile application for a balanced and sustainable diet for obesity management

Background

Mobile applications such as personalized tracking tools and food choice aids may enhance weight loss programs. We developed and assessed client preferences for the content, user interface, graphics, and logic flow of a mobile application, and evaluated its validity for tracking compliance with weight control and making healthy and sustainable food choices.

Methods

Our four-stage study comprised formative research, application development, acceptance assessment, and validity. The formative research included literature reviews and six focus groups with 39 respondents aged 19–64 years at high risk for obesity. The development stage included programmer selection, defining application specifications, design, and user interface. Prototype acceptability was assessed with 53 respondents who graded 17 features of content, graphic design, and application flow (ranked as good, moderate, and poor). A feature was considered to have "good" acceptance if its mean response was higher than the mean of overall responses. The validity was assessed in 30 obese women using Bland–Altman plots to compare results from dietary intake assessment from the application to conventional paper-based methods.

Results

The application was named as EatsUp®. The focus group participants defined the key requirements of this app as being informative, easy, and exciting to use. The EatsUp® core features consisted of simple menu recommendations, health news, notifications, a food database, estimated portion sizes, and food pictures. The prototype had a "good" overall acceptance regarding content, graphics, and flow. Fourteen out of 17 parameters were graded as "good" from > 70% of respondents. There was no significant difference between the rated proportions for content, graphics, and app flow (Kolmogorov–Smirnov Z-test, p > .05). The agreement using the Bland–Altman plots between EatsUp® and the paper-based method of measuring food intake was good, with a mean difference of energy intake of only 2.63 ± 28.4 kcal/day (p > 0.05), well within the 95% confidence interval for agreement.

Conclusions

The EatsUp® mobile application had good acceptance for graphics and app flow. This application can support the monitoring of balanced and sustainable dietary practice by providing nutritional data, and is comparable with conventional dietary assessment tools, and performed well in tracking energy, macronutrient, and selected micronutrients intakes.

Trial registration

NCT03469869. The registration date was March 19, 2018.

A Smart System for the Contactless Measurement of Energy Expenditure

Energy Expenditure (EE) (kcal/day), a key element to guide obesity treatment, is measured from CO2 production, VCO2 (mL/min), and/or O2 consumption, VO2 (mL/min). Current technologies are limited due to the requirement of wearable facial accessories. A novel system, the Smart Pad, which measures EE via VCO2 from a room's ambient CO2 concentration transients was evaluated. Resting EE (REE) and exercise VCO2 measurements were recorded using Smart Pad and a reference instrument to study measurement duration's influence on accuracy. The Smart Pad displayed 90% accuracy (±1 SD) for 14-19 min of REE measurement and for 4.8-7.0 min of exercise, using known room's air exchange rate. Additionally, the Smart Pad was validated measuring subjects with a wide range of body mass indexes (BMI = 18.8 to 31.4 kg/m2), successfully validating the system accuracy across REE's measures of ~1200 to ~3000 kcal/day. Furthermore, high correlation between subjects' VCO2 and λ for CO2 accumulation was observed (p < 0.00001, R = 0.785) in a 14.0 m3 sized room. This finding led to development of a new model for REE measurement from ambient CO2 without λ calibration using a reference instrument. The model correlated in nearly 100% agreement with reference instrument measures (y = 1.06x, R = 0.937) using an independent dataset (N = 56).

Polycystic ovary syndrome as a plausible evolutionary outcome of metabolic adaptation

As a common endocrinopathy of reproductive-aged women, polycystic ovary syndrome (PCOS) is characterized by hyperandrogenism, oligo-anovulation and polycystic ovarian morphology. It is linked with insulin resistance through preferential abdominal fat accumulation that is worsened by obesity. Over the past two millennia, menstrual irregularity, male-type habitus and sub-infertility have been described in women and confirm that these clinical features of PCOS were common in antiquity. Recent findings in normal-weight hyperandrogenic PCOS women show that exaggerated lipid accumulation by subcutaneous (SC) abdominal stem cells during development to adipocytes in vitro occurs in combination with reduced insulin sensitivity and preferential accumulation of highly-lipolytic intra-abdominal fat in vivo. This PCOS phenotype may be an evolutionary metabolic adaptation to balance energy storage with glucose availability and fatty acid oxidation for optimal energy use during reproduction. This review integrates fundamental endocrine-metabolic changes in healthy, normal-weight PCOS women with similar PCOS-like traits present in animal models in which tissue differentiation is completed during fetal life as in humans to support the evolutionary concept that PCOS has common ancestral and developmental origins.

Obesity and reproduction: a committee opinion

The purpose of this American Society for Reproductive Medicine Practice Committee report is to provide clinicians with principles and strategies for the evaluation and treatment of couples with infertility associated with obesity. This revised document replaces the Practice Committee document titled "Obesity and reproduction: an educational bulletin" last published in 2015 (Fertil Steril 2015;104:1116-26).

Transcriptional characterization of subcutaneous adipose tissue in obesity affected women highlights metabolic dysfunction and implications for lncRNAs

Obesity is a complex disease with multifactorial causes, and its prevalence is becoming a serious health crisis. For this reason, there is a crucial need to identify novel targets and players. With this aim in mind, we analyzed via RNA-sequencing the subcutaneous adipose tissue of normal weight and obesity-affected women, highlighting the differential expression in the two tissues. We specifically focused on long non-coding RNAs, as 6 of these emerged as dysregulated in the diseased-tissue (COL4A2-AS2, RPS21-AS, PELATON, ITGB2-AS1, ACER2-AS and CTEPHA1). For each of them, we performed both a thorough in silico dissection and in vitro validation, to predict their function during adipogenesis. We report the lncRNAs expression during adipose derived stem cells differentiation to adipocytes as model of adipogenesis and their potential modulation by adipogenesis-related transcription factors (C/EBPs and PPARγ). Moreover, inhibiting CTEPHA1 expression we investigated its impact on adipogenesis-related transcription factors, showing its significative dysregulation of C/EBPα expression. Lastly, we dissected the subcellular localization, pathway involvement and disease-correlation for coding differentially expressed genes. Together, these findings highlight a transcriptional deregulation at the basis of obesity, impacted by both coding and long non-coding RNAs.

Imaging after laparoscopic sleeve gastrectomy - literature review with practical recommendations

In the XXI century obesity has become one of the most demanding epidemiological threats worldwide. At the same time, bariatric surgery has established itself as an effective treatment for morbidly obese patients, with laparoscopic sleeve gastrectomy (LSG) emerging as the most popular bariatric procedure. This paper reviews the role of imaging studies of patients after LSG. Computed tomography is widely considered as the method of choice in detection of complications in early postoperative period. The dynamic character of upper gastrointestinal examination allows for the assessment of passage through the gastric remnant. The paper also discusses evaluation of the shape and volume of the gastric remnant assessed by imaging studies.

Endoscopic sleeve gastroplasty (ESG) for morbid obesity: how effective is it?

INTRODUCTION

ESG is an effective treatment for classes I and II obesity. However, the benefit of ESG in patients with morbid obesity (BMI ≥ 40 kg/m²) who decline surgery is not known. The study aims to compare the effectiveness and safety of ESG in all three obesity classes at 1 year.

METHODS

We reviewed 484 patient records and identified 435 patients (class I: 105, class II: 169, class III: 161) who underwent ESG at our unit between May 2013 and March 2020. We compared their total body weight loss (%TBWL) and safety over 1 year. We used a linear mixed model (LMM) to analyse repeated measures of weight loss outcomes at 3, 6, 9, and 12 months for comparison between the three BMI groups.

RESULTS

Among the 435 patients, 396 patients (class I: 99, class II: 151, class III: 146) completed 6 months, and 211 patients reached 1 year (class I: 50, class II: 77, class III: 84). There was no difference in age between the groups. In LMM analysis, adjusting for age and sex, we found ESG had a significantly higher TBWL, %TBWL, and BMI decline in class III compared to classes I and -II obesity at all time points (p < 0.001). The adjusted mean %TBWL at 1 year with classes I, -II, and -III obesity was 16.5%, 18.2%, and 20.5%, respectively. The overall complication rate and the hospital stay was identical in the three groups.

CONCLUSION

ESG induced significant weight loss in all classes of obesity. In class III obesity, the weight loss achieved was significantly higher at 1 year. In patients declining or unsuitable for surgery, ESG could be considered as an alternative treatment option.

Effectiveness of Non-Pharmacological Interventions for Overweight or Obese Infertile Women: A Systematic Review and Meta-Analysis

Obesity is a well-known risk factor for infertility, and nonpharmacological treatments are recommended as effective and safe, but evidence is still lacking on whether nonpharmacological interventions improve fertility in overweight or obese women. The aim of this study was to systematically assess the current evidence in the literature and to evaluate the impact of nonpharmacological interventions on improving pregnancy-related outcomes in overweight or obese infertile women. Seven databases were searched for randomized controlled trials (RCTs) of nonpharmacological interventions for infertile women with overweight or obesity through August 16, 2019 with no language restriction. A meta-analysis was conducted of the primary outcomes. A total of 21 RCTs were selected and systematically reviewed. Compared to the control group, nonpharmacological interventions significantly increased the pregnancy rate (relative risk (RR), 1.37; 95% CI, 1.04–1.81; p = 0.03; I² = 58%; nine RCTs) and the natural conception rate (RR, 2.17, 95% CI, 1.41–3.34; p = 0.0004; I² = 19%, five RCTs). However, they had no significant effect on the live birth rate (RR, 1.36, 95% CI, 0.94–1.95; p=0.10, I² = 65%, eight RCTs) and increased the risk of miscarriage (RR: 1.57, 95% CI, 1.05–2.36; p = 0.03; I² = 0%). Therefore, nonpharmacological interventions could have a positive effect on the pregnancy and natural conception rates, whereas it is unclear whether they improve the live birth rate. Further research is needed to demonstrate the integrated effects of nonpharmacological interventions involving psychological outcomes, as well as pregnancy-related outcomes.

Multidimensional Cognitive Behavioral Therapy for Obesity Applied by Psychologists Using a Digital Platform: Open-Label Randomized Controlled Trial

Background

Developing effective, widely useful, weight management programs is a priority in health care because obesity is a major health problem.

Objective

This study developed and investigated a new, comprehensive, multifactorial, daily, intensive, psychologist coaching program based on cognitive behavioral therapy (CBT) modules. The program was delivered via the digital health care mobile services Noom Coach and InBody.

Methods

This was an open-label, active-comparator, randomized controlled trial. A total of 70 female participants with BMI scores above 24 kg/m² and no clinical problems besides obesity were randomized into experimental and control groups. The experimental (ie, digital CBT) group (n=45) was connected with a therapist intervention using a digital health care service that provided daily feedback and assignments for 8 weeks. The control group (n=25) also used the digital health care service, but practiced self-care without therapist intervention. The main outcomes of this study were measured objectively at baseline, 8 weeks, and 24 weeks and included weight (kg) as well as other body compositions. Differences between groups were evaluated using independent t tests and a per-protocol framework.

Results

Mean weight loss at 8 weeks in the digital CBT group was significantly higher than in the control group (–3.1%, SD 4.5, vs –0.7%, SD 3.4, P=.04). Additionally, the proportion of subjects who attained conventional 5% weight loss from baseline in the digital CBT group was significantly higher than in the control group at 8 weeks (32% [12/38] vs 4% [1/21], P=.02) but not at 24 weeks. Mean fat mass reduction in the digital CBT group at 8 weeks was also significantly greater than in the control group (–6.3%, SD 8.8, vs –0.8%, SD 8.1, P=.02). Mean leptin and insulin resistance in the digital CBT group at 8 weeks was significantly reduced compared to the control group (–15.8%, SD 29.9, vs 7.2%, SD 35.9, P=.01; and –7.1%, SD 35.1, vs 14.4%, SD 41.2, P=.04). Emotional eating behavior (ie, mean score) measured by questionnaire (ie, the Dutch Eating Behavior Questionnaire) at 8 weeks was significantly improved compared to the control group (–2.8%, SD 34.4, vs 21.6%, SD 56.9, P=.048). Mean snack calorie intake in the digital CBT group during the intervention period was significantly lower than in the control group (135.9 kcal, SD 86.4, vs 208.2 kcal, SD 166.3, P=.02). Lastly, baseline depression, anxiety, and self-esteem levels significantly predicted long-term clinical outcomes (24 weeks), while baseline motivation significantly predicted both short-term (8 weeks) and long-term clinical outcomes.

Conclusions

These findings confirm that technology-based interventions should be multidimensional and are most effective with human feedback and support. This study is innovative in successfully developing and verifying the effects of a new CBT approach with a multidisciplinary team based on digital technologies rather than standalone technology-based interventions.

Trial Registration

ClinicalTrials.gov NCT03465306; https://clinicaltrials.gov/ct2/show/NCT03465306

Genetic Networks Underlying Natural Variation in Basal and Induced Activity Levels in Drosophila melanogaster

Exercise is recommended by health professionals across the globe as part of a healthy lifestyle to prevent and/or treat the consequences of obesity. While overall, the health benefits of exercise and an active lifestyle are well understood, very little is known about how genetics impacts an individual's inclination for and response to exercise. To address this knowledge gap, we investigated the genetic architecture underlying natural variation in activity levels in the model system Drosophila melanogaster Activity levels were assayed in the Drosophila Genetics Reference Panel fly strains at baseline and in response to a gentle exercise treatment using the Rotational Exercise Quantification System. We found significant, sex-dependent variation in both activity measures and identified over 100 genes that contribute to basal and induced exercise activity levels. This gene set was enriched for genes with functions in the central nervous system and in neuromuscular junctions and included several candidate genes with known activity phenotypes such as flightlessness or uncoordinated movement. Interestingly, there were also several chromatin proteins among the candidate genes, two of which were validated and shown to impact activity levels. Thus, the study described here reveals the complex genetic architecture controlling basal and exercise-induced activity levels in D. melanogaster and provides a resource for exercise biologists.

The effects of bariatric surgery on clinical profile, DNA methylation, and ageing in severely obese patients

BACKGROUND

Severe obesity is a growing, worldwide burden and conventional therapies including radical change of diet and/or increased physical activity have limited results. Bariatric surgery has been proposed as an alternative therapy showing promising results. It leads to substantial weight loss and improvement of comorbidities such as type 2 diabetes. Increased adiposity is associated with changes in epigenetic profile, including DNA methylation. We investigated the effect of bariatric surgery on clinical profile, DNA methylation, and biological age estimated using Horvath's epigenetic clock.

RESULTS

To determine the impact of bariatric surgery and subsequent weight loss on clinical traits, a cohort of 40 severely obese individuals (BMI = 30-73 kg/m²) was examined at the time of surgery and at three follow-up visits, i.e., 3, 6, and 12 months after surgery. The majority of the individuals were women (65%) and the mean age at surgery was 45.1 ± 8.1 years. We observed a significant decrease over time in BMI, fasting glucose, HbA1c, HOMA-IR, insulin, total cholesterol, triglycerides, LDL and free fatty acids levels, and a significant small increase in HDL levels (all p values < 0.05). Epigenome-wide association analysis revealed 4857 differentially methylated CpG sites 12 months after surgery (at Bonferroni-corrected p value < 1.09 × 10^-7). Including BMI change in the model decreased the number of significantly differentially methylated CpG sites by 51%. Gene set enrichment analysis identified overrepresentation of multiple processes including regulation of transcription, RNA metabolic, and biosynthetic processes in the cell. Bariatric surgery in severely obese patients resulted in a decrease in both biological age and epigenetic age acceleration (EAA) (mean = - 0.92, p value = 0.039).

CONCLUSIONS

Our study shows that bariatric surgery leads to substantial BMI decrease and improvement of clinical outcomes observed 12 months after surgery. These changes explained part of the association between bariatric surgery and DNA methylation. We also observed a small, but significant improvement of biological age. These epigenetic changes may be modifiable by environmental lifestyle factors and could be used as potential biomarkers for obesity and in the future for obesity related comorbidities.

Resveratrol supplementation improves metabolic control in rats with induced hyperlipidemia and type 2 diabetes

Resveratrol was recognized as the major factor responsible for the beneficial properties of red wine. Several resveratrol-based dietary supplements are available, but their efficacy has not been sufficiently tested. This study was designed to examine the effect of resveratrol supplementation, using a commercially available product, on the metabolic status of experimental animals with induced hyperlipidemia or type 2 diabetes mellitus (T2DM). Hyperlipidemia was induced by feeding the rats a standard pellet diet supplemented with cholesterol. T2DM was induced by adding 10% fructose to drinking water and streptozotocin. Treatment with resveratrol-based supplement improved glycemic control in diabetic animals and significantly decreased serum low-density-lipoprotein (LDL) and triglyceride levels, concurrently increasing the high-density-lipoprotein (HDL) levels in animals with hyperlipidemia. Resveratrol-treated animals had improved tolerance to glucose loading. Supplementation did not induce alterations in parameters of liver and renal function. Findings indicate that commercial resveratrol supplement improves metabolic control in rats with induced hyperlipidemia and T2DM.

Wheat Flour, Enriched with γ-Oryzanol, Phytosterol, and Ferulic Acid, Alleviates Lipid and Glucose Metabolism in High-Fat-Fructose-Fed Rats

(1) Background: Modern dietary patterns with a high intake of fat and fructose, as well as refined carbohydrates, closely relate to lipid/glucose metabolic disorders. The main objective of this study is to provide new thoughts in designing functional food with some lipid/glucose metabolism regulating effects for obese people. (2) Methods: The alleviating abilities of γ-oryzanol, phytosterol or ferulic acid-enriched wheat flour on lipid/glucose metabolic dysfunction were evaluated in male SD rats induced by a high-fat-fructose diet. The underlying mechanisms were clarified using western blot. (3) Results: In an in vitro cell model, γ-oryzanol, phytosterol and ferulic acid regulate lipid/glucose metabolism by increasing the phosphorylation of AMPK and Akt, and PI3K expression, as well as decreasing expressions of DGAT1 and SCD. The in vivo study shows that ferulic acid and γ-oryzanol-enriched flours are beneficial for managing body weight, improving glucose metabolism, hyperlipidemia and hepatic lipid accumulation. Phytosterol-enriched flour exerted remarkable effects in regulating hyperinsulinemia, insulin resistance and hyperuricemia. Western blot analysis of proteins from liver samples reveals that these enriched flours alleviated hepatic lipid accumulation and insulin resistance through their elevation in the phosphorylation of AMPK and Akt. (4) Conclusions: Our study indicates that these enriched flours can serve as a health-promoting functional food to regulate obesity-related lipid/glucose metabolic dysfunction in rats.

A new approach to study the sex differences in adipose tissue

Obesity is one of the most invaliding and preventable diseases in the United States. Growing evidence suggests that there are sex differences in obesity in human and experimental animals. However, the specific mechanisms of this disease are unknown. Consequently, there is any particular treatment according to the sex/gender at this time. During the last decade, we observe a rise in the study of adipocyte and the possible mechanisms involved in the different roles of the fat. Furthermore, the effect of sex steroids on the adipocyte is one of the fields that need elucidation. Supporting evidence suggests that sex steroids play an essential role not only in the fat distribution, but also, in its metabolism, proliferation, and function. Thus, using in vitro and in vivo studies will contribute to our fight against this critical health public problem encompassing both sexes. In the present review, we discuss some of the recent advances in the adipocytes and the effect of the sex steroids on the adipose tissue. Also, we propose a new alternative to study the role of sex steroids on adipocyte biology through human adipose-derived stem cells.

Synergistic Effect of Bupleuri Radix and Scutellariae Radix on Adipogenesis and AMP-Activated Protein Kinase: A Network Pharmacological Approach

Obesity has become a major health threat in developed countries. However, current medications for obesity are limited because of their adverse effects. Interest in natural products for the treatment of obesity is thus rapidly growing. Korean medicine is characterized by the wide use of herbal formulas. However, the combination rule of herbal formulas in Korean medicine lacks experimental evidence. According to Shennong's Classic of Materia Medica, the earliest book of herbal medicine, Bupleuri Radix (BR) and Scutellariae Radix (SR) possess the Sangsoo relationship, which means they have synergistic features when used together. Therefore these two are frequently used together in prescriptions such as Sosiho-Tang. In this study, we used the network pharmacological method to predict the interaction between these two herbs and then investigated the effects of BR, SR, and their combination on obesity in 3T3-L1 adipocytes. BR, SR, and BR-SR mixture significantly decreased lipid accumulation and the expressions of two major adipogenic factors, peroxisome proliferator-activated receptor-gamma (PPARγ) and CCAAT/enhancer-binding protein-alpha (C/EBPα), and their downstream genes, Adipoq, aP2, and Lipin1 in 3T3-L1 cells. In addition, the BR-SR mixture had synergistic effects compared with BR or SR on inhibition of adipogenic-gene expressions. BR and SR also inhibited the protein expressions of PPARγ and C/EBPα. Furthermore, the two extracts successfully activated AMP-activated protein kinase alpha (AMPK α), the key regulator of energy metabolism. When compared to those of BR or SR, the BR-SR mixture showed higher inhibition rates of PPARγ and C/EBPα, along with higher activation rate of AMPK. These results indicate a new potential antiobese pharmacotherapy and also provide scientific evidence supporting the usage of herbal combinations instead of mixtures in Korean medicine.

Design and Efficacy of Nanogels Formulations for Intranasal Administration

Nanogels are drug delivery systems that can bypass the blood-brain barrier and deliver drugs to the desired site when administered intranasally. They have been used as a drug delivery platform for the management of brain diseases such as Alzheimer disease, migraine, schizophrenia and depression. nanogels have also been developed as vaccine carriers for the protection of bacterial infections such as influenza, meningitis, pneumonia and as veterinary vaccine carriers for the protection of animals from encephalomyelitis and mouth to foot disease. It has been developed as vaccine carriers for the prevention of lifestyle disease such as obesity. Intranasal administration of therapeutics using nanogels for the management of brain diseases revealed that the drug transportation was via the olfactory nerve pathway resulting in rapid drug delivery to the brain with excellent neuroprotective effect. The application of nanogels as vaccine carriers also induced significant responses associated with protective immunity against selected bacterial and viral infections. This review provides a detailed information on the enhanced therapeutic effects, mechanisms and biological efficacy of nanogels for intranasal administration.

Benefits and Harms in Pivotal Trials of Oral Centrally Acting Antiobesity Medicines: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the benefits and harms of oral centrally acting antiobesity medicinal products in pivotal trials.

METHODS

The European Medicines Agency and Federal Drug Administration websites, PubMed, and ClinicalTrials.gov were searched to identify pivotal trials used to gain marketing authorizations. Pivotal phase III trials on which marketing authorizations were based were included. The data were analyzed by using Cochrane Review Manager (RevMan), and quality assessments for each outcome were performed by using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE).

RESULTS

Five products (16 trials with 24,555 participants) were included. Significantly more participants who took the antiobesity products achieved ≥ 5% reduction in body weight (risk ratio [RR] 2.39; 95% CI: 2.09-2.74; GRADE = low). However, the products significantly increased the risk of adverse events (RR 1.12; 95% CI: 1.07-1.17; GRADE = very low) and the risk of discontinuation because of adverse events (RR 1.52; 95% CI: 1.33-1.74; GRADE = low). There were no significant differences for most outcomes between currently approved and withdrawn products.

CONCLUSIONS

Although oral centrally acting antiobesity products generate modest weight losses, they also increase the risks of adverse events and discontinuations because of adverse events. The premarketing benefit-to-harm profiles of currently available products and products that were later withdrawn because of harms are similar. Targeted study designs, better outcomes reporting, and improved postmarketing monitoring of harms are needed.

Deep Brain Stimulation-Possible Treatment Strategy for Pathologically Altered Body Weight?

The treatment of obesity and eating disorders such as binge-eating disorder or anorexia nervosa is challenging. Besides lifestyle changes and pharmacological options, bariatric surgery represents a well-established and effective-albeit invasive-treatment of obesity, whereas for binge-eating disorder and anorexia nervosa mostly psychotherapy options exist. Deep brain stimulation (DBS), a method that influences the neuronal network, is by now known for its safe and effective applicability in patients with Parkinson’s disease. However, the use does not seem to be restricted to these patients. Recent preclinical and first clinical evidence points towards the use of DBS in patients with obesity and eating disorders as well. Depending on the targeted area in the brain, DBS can either inhibit food intake and body weight or stimulate energy intake and subsequently body weight. The current review focuses on preclinical and clinical evidence of DBS to modulate food intake and body weight and highlight the different brain areas targeted, stimulation protocols applied and downstream signaling modulated. Lastly, this review will also critically discuss potential safety issues and gaps in knowledge to promote further studies.

Antiobesity molecular mechanisms of action: Resveratrol and pterostilbene

Obesity is a current global epidemic that has led to a marked increase in metabolic diseases. However, its treatment remains a challenge. Obesity is a multifactorial disease, which involves the dysfunction of neuropeptides, hormones, and inflammatory adipokines from the brain, gut, and adipose tissue. An understanding of the mechanisms and signal interactions in the crosstalk between organs and tissue in the coordination of whole-body energy metabolism would be helpful to provide therapeutic and putative approaches to the treatment and prevention of obesity and related complications. Resveratrol and pterostilbene are well-known stilbenes that provide various potential benefits to human health. In particular, their potential anti-obesity effects have been proven in numerous cell culture and animal studies. Both compounds act to regulate energy intake, adipocyte life cycle and function, white adipose tissue (WAT) inflammation, energy expenditure, and gut microbiota by targeting multiple molecules and signaling pathways as an intervention for obesity. Although the efficacy of both compounds in humans requires further investigation with respect to their oral bioavailability, promising scientific findings have highlighted their potential as candidates for the treatment of obesity and the improvement of obesity-related metabolic diseases. © 2018 BioFactors, 44(1):50-60, 2018.

Euphorbia kansui Attenuates Insulin Resistance in Obese Human Subjects and High-Fat Diet-Induced Obese Mice

Background

Obesity is a main cause of insulin resistance (IR), metabolic syndrome, and fatty liver diseases. This study evaluated Euphorbia kansui radix (Euphorbia) as a potential treatment option for obesity and obesity-induced IR in obese human and high-fat diet- (HFD-) induced obese mice.

Methods

In the human study, we analyzed the body weight change of 14 patients who took a single dose of 6 g of Euphorbia powder. In the animal study, male mice were divided into three groups: normal chow, HFD, and Euphorbia (high-fat diet and 100 mg/Kg Euphorbia once per week). Body weight, epididymal fat pad weight, fasting blood glucose, fasting insulin, HOMA-IR, and oral glucose tolerance test were measured. Also, macrophage infiltration and expression of CD68, tumor necrosis factor- (TNF-) α, interferon- (IFN-) γ, and interleukin- (IL-) 6 genes in the liver and adipose tissue were analyzed.

Results

The human study showed that Euphorbia has a potential effect on body weight loss. In the in vivo study, body weight, epididymal fat weight, glucose level, IR, expression of CD68, TNF-α, IFN-r, and IL-6 genes, and macrophages in liver and adipose tissue were significantly reduced by Euphorbia.

Conclusions

These results suggest that Euphorbia attenuates obesity and insulin resistance via anti-inflammatory effects.

The Effect of Consumption of Citrus Fruit and Olive Leaf Extract on Lipid Metabolism

Citrus fruit and olive leaves are a source of bioactive compounds such as biophenols which have been shown to ameliorate obesity-related conditions through their anti-hyperlipidemic and anti-inflammatory effect, and by regulating lipoproteins and cholesterol body levels. Citrolive™ is a commercial extract which is obtained from the combination of both citrus fruit and olive leaf extracts; hence, it is hypothesised that Citrolive™ may moderate metabolic disorders that are related to obesity and their complications. Initially, an in vitro study of the inhibition of pancreatic lipase activity was made, however, no effect was found. Both preliminary and long-term evaluations of Citrolive™ on lipid metabolism were conducted in an animal model using Wistar rats. In the preliminary in vivo screening, Citrolive™ was tested on postprandial plasma triglyceride level after the administration of an oil emulsion, and a significant reduction in postprandial triacylglycerol (TAG) levels was observed. In the long-term study, Citrolive™ was administered for 60 days on Wistar rats that were fed a high-fat diet. During the study, several associated lipid metabolism indicators were analysed in blood and faeces. At the end of the experiment, the livers were removed and weighed for group comparison. Citrolive™ treatment significantly reduced the liver-to-body-weight ratio, as supported by reduced plasma transaminases compared with control, but insignificantly reduced plasma low density lipoprotein (LDL) and postprandial TAG plasma levels. In addition, faecal analysis showed that the treatment significantly increased total cholesterol excretion. On the other hand, no effect was found on faecal TAG and pancreatic lipase in vitro. In conclusion, treatment ameliorates liver inflammation symptoms that are worsened by the effects of high fat diet.

Preconception consultations with Maternal Fetal Medicine for obese women: a retrospective chart review

Background

Obesity is associated with impaired fertility and pregnancy complications, and preconception weight loss may improve some of these outcomes. The purpose of this study was to evaluate the quality and effectiveness of Maternal Fetal Medicine (MFM) preconception consults for obese women.

Methods

We performed a retrospective chart review examining 162 consults at an academic medical center from 2008 to 2014. The main outcome measures included consultation content – e.g. discussion of obesity-related pregnancy complications, screening for comorbidities, and referrals for weight loss interventions – and weight loss.

Results

Screening for diabetes and hypertension occurred in 48% and 51% of consults, respectively. Discussion of obesity-related pregnancy complications was documented in 96% of consults. During follow-up (median 11 months), 27% of patients saw a nutritionist, 6% saw a provider for a medically supervised weight loss program, and 6% underwent bariatric surgery. The median weight change was a loss of 0.6% body weight.

Conclusions

In this discovery cohort, a large proportion of MFM preconception consultations lacked appropriate screening for obesity-related comorbidities. While the vast majority of consultations included a discussion of potential pregnancy complications, relatively few patients achieved significant weight loss. More emphasis is needed on weight loss resources and delaying pregnancy to achieve weight loss goals.

Effectiveness of a Group Support Lifestyle Modification (GSLiM) Programme among Obese Adults in Workplace: A Randomised Controlled Trial

BACKGROUND

There was an increasing trend in the prevalence of obesity and its comorbidities over the past decades in Malaysia. Effective intervention for obesity remains limited. This study aimed to compare the effectiveness of a group based lifestyle modification programme amongst obese individuals with an existing dietary counseling programme.

METHODS

We recruited one hundred and ninety four overweight and obese (BMI>27.5 kg/m2) employees from a local university. They were randomly allocated to either Group Support Lifestyle Modification (GSLiM) (intervention)(n = 97) or dietary counseling (comparison)(n = 97). The GSLIM activities included self monitoring, cognitive-behaviour sessions, exercise as well as dietary change advocacy, which were conducted through seminars and group sessions over 24 weeks. The comparison group was given dietary counselling once in 12 weeks. Both groups were followed up for additional 12 weeks to check for intervention effect sustenance. Anthropometric and biochemical parameters were measured at baseline, 12, 24 and 36 weeks; while dietary intake, physical activities, psychological measures and quality of life measured at baseline, 24 and 36 weeks. Data analysis was conducted using ANOVA repeated measures with intention to treat principle.

RESULTS

The participants were predominantly women with mean (standard deviation) age of 40.5 (9.3) years. A total of 19.6% of the participants in GSLiM achieved 6% weight loss compared to 4.1% in the comparison group (Risk Ratio 4.75; 95% CI: 1.68, 13.45). At 24 weeks, the retention rate was 83.5% for GSLiM and 82.5% for comparison group. GSLiM participants also achieved significant improvement in total weight self-efficacy score, negative emotions and physical discomfort subscales, MDPSS friend subscale and all domains in quality of life. Participants in the comparison group experienced reduction in negative self-thoughts.

CONCLUSION

The GSLiM programme proved to be more effective in achieving targeted weight loss, improving weight self-efficacy, friend social support, and quality of life compared to dietary counseling.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT201104056127N1.

Body Mass Index Trajectories among Middle-Aged and Elderly Canadians and Associated Health Outcomes

BACKGROUND

Whether there is heterogeneity in the development of BMI from middle-age onward is still unknown. The primary aim of this study is to analyze long-term obesity and how BMI trajectories are associated with health outcomes in midlife.

METHODS

Latent Class Growth Modelling was used to capture the changes in BMI over time. In this study, 3070 individuals from the National Population Health Survey (NPHS), aged 40-55 years at baseline, were included.

RESULTS

Four BMI trajectory groups, "Normal-Stable" (N-S), "Overweight-Stable" (OV-S), "Obese I-Stable" (OB I-S), and "Obese II-Stable" (OB II-S), were identified. Men, persons of White ancestry, and individuals who had no postsecondary education had higher odds of being in the latter three groups. Moreover, members of the OV-S, OB I-S, and OB II-S groups experienced more asthma, arthritis, hypertension, diabetes, heart disease, cognitive impairment, and reduced self-rated overall health. Individuals in the OB II-S group were at greater risk for back problems, chronic bronchitis or emphysema, and emotional issues when compared to the N-S group.

CONCLUSION

Understanding different BMI trajectories is important in order to identify people who are at the highest risk of developing comorbidities due to obesity and to establish programs to intervene appropriately.

Herbal Acupuncture for the Treatment of Obesity

Obesity is the state of excessive body fat accumulation and is mainly caused by consuming more calories than are burned through physical activity. Herbal acupuncture (HA), also known as pharmacopuncture, has been increasingly used in clinics of Korean medical to alleviate obesity. This review analyzed four clinical studies and 16 animal studies on the effectiveness of HA as a treatment for obesity. Clinical evidence suggests that various kinds of HA might be beneficial for treating obesity; however, further investigations with well-designed, evidence-based, randomized clinical trials are needed. Animal studies support the idea that HA might be beneficial for the treatment of obesity and provide possible mechanisms, such as anti-inflammation, antioxidation, modulating lipid metabolism and so on, to explain the effect of HA on obesity. This review, based on the evidence collected, suggests that HA could have a beneficial effect for alleviating obesity by modulating inflammation, oxidative stress, lipid metabolism, leptin, and the insulin signal.

Obesity and reproduction: a committee opinion

The purpose of this ASRM Practice Committee report is to provide clinicians with principles and strategies for the evaluation and treatment of couples with infertility associated with obesity. This revised document replaces the Practice Committee document titled, "Obesity and reproduction: an educational bulletin," last published in 2008 (Fertil Steril 2008;90:S21-9).

Effect of an exercise and weight control curriculum: views of obesity among exercise science students

Awareness of effective weight management strategies is necessary to prepare exercise science students for future work with obesity. Exercise science faculty members developed a course related to exercise as a therapeutic tool and options available for weight loss. The purpose of the present study was to investigate student views of weight management and obesity, which can be a difficult task using traditional methods such as Likert scale surveys. To investigate student views relative to the course content, Q methodology, which is a mixed-method research approach, was used at the beginning and end of the course. Students completed a Q sort, ranking 44 statements related to obesity in accordance to their own points of view. The pretest/posttest design enabled an opportunity to determine if course goals were accomplished and if student perceptions related to obesity were transformed. Factor analysis of precourse sorts revealed that students possessed a naïve singular view of weight-related concepts. Analysis of sorts at course completion resulted in a two-factor solution revealing changes in perspective; some students took on a health professional type of view, whereas others demonstrated antifat views. In conclusion, the findings revealed key variables that should be addressed in curricula involving therapeutic obesity interventions. An improved curriculum based on these results should better encourage students to develop a broad comprehension of multifactorial causes and treatment for weight management and obesity. Implementing the use of Q methodology may serve as a valuable asset to measure and evaluate subjectivity of obesity discrimination. Antifat attitudes among exercise science students may influence future clients' potential achievements.

Antiobesity pharmacotherapy for patients with type 2 diabetes: focus on long-term management

Type 2 diabetes and obesity have a complex relationship; obesity is linked to insulin resistance, the precursor to type 2 diabetes. The management of obesity is an important method to delay onset of diabetes and improve the glycemic durability of antidiabetic agents. However, insulin and some of the oral hypoglycemic agents used to treat diabetes cause significant weight gain, and it is difficult for patients with diabetes to reduce and maintain their weight by life-style changes alone. Thus, antiobesity medications or bariatric surgery may be a necessary adjunct for certain obese patients with diabetes. In 2012, the U.S. Food and Drug Administration (FDA) approved lorcaserin and phentermine/topiramate extended-release for the management of chronic weight, and approval for naltrexone/bupropion sustained-release as an adjunct to exercise and reduced caloric intake followed in 2014. Liraglutide is pending FDA approval for antiobesity drug. Here we review the efficacy of approved and new promising drugs for the management of obesity.

Weight loss is a useful therapeutic objective

Overweight/obesity has been associated with increased risk for several conditions, including hypertension, hypercholesterolemia, diabetes mellitus, heart disease, and stroke. The morbidity associated with overweight and obesity translates into excess mortality risk, which is observed even when increased weight is not associated with metabolic abnormalities. The achievement of moderate weight loss, regardless of the treatment strategy, is associated with favorable clinical outcomes, including significant reduction in the incidence of type 2 diabetes and blood pressure levels. These data suggest that weight loss might be a useful therapeutic objective in the prevention and management of comorbidities associated with overweight/obesity.

Update in cardiology: vascular risk and cardiac rehabilitation

Cardiovascular disease develops in a slow and subclinical manner over decades, only to manifest suddenly and unexpectedly. The role of prevention is crucial, both before and after clinical appearance, and there is ample evidence of the effectiveness and usefulness of the early detection of at-risk individuals and lifestyle modifications or pharmacological approaches. However, these approaches require time, perseverance, and continuous development. The present article reviews the developments in 2013 in epidemiological aspects related to prevention, includes relevant contributions in areas such as diet, weight control methods (obesity is now considered a disease), and physical activity recommendations (with warnings about the risk of strenuous exercise), deals with habit-related psychosocial factors such as smoking, provides an update on emerging issues such as genetics, addresses the links between cardiovascular disease and other pathologies such as kidney disease, summarizes the contributions of new, updated guidelines (3 of which have recently been released on topics of considerable clinical importance: hypertension, diabetes mellitus, and chronic kidney disease), analyzes the pharmacological advances (largely mediocre except for promising lipid-related results), and finishes by outlining developments in the oft-neglected field of cardiac rehabilitation. This article provides a briefing on controversial issues, presents interesting and somewhat surprising developments, updates established knowledge with undoubted application in clinical practice, and sheds light on potential future contributions.

Management of obesity and cardiometabolic risk - role of phentermine/extended release topiramate

The US Food and Drug Administration (FDA) recently approved lorcaserin and the combination of phentermine and extended release topiramate (phentermine/topiramate ER) for the treatment of obesity in conjunction with a lifestyle intervention, expanding the therapeutic options for long-term obesity pharmacotherapy, which was previously limited to orlistat. Combination phentermine/topiramate ER is associated with greater weight loss compared to its constituent monotherapy, with a more favorable adverse effect profile. Phentermine/topiramate ER also appears to have beneficial effects on cardiometabolic risk, although longer-term cardiovascular safety data are required. While there are no head-to-head studies among the currently available obesity pharmacotherapy agents, phentermine/topiramate ER appears to have a superior weight loss profile. This review will discuss the epidemiology, natural history, and cardiometabolic risk associated with obesity, provide an overview on current obesity pharmacotherapy, and summarize the recent clinical efficacy and safety data underpinning the FDA's approval of both phentermine/topiramate ER and lorcaserin as pharmacotherapy for a long-term obesity intervention.