Gut peptides before and following Roux-En-Y gastric bypass: A systematic review and meta-analysis

A systematic search was conducted in Medline Ovid, Embase, Scopus, and Cochrane Central Register of Controlled Trials up until March 2021 following PRISMA guidelines. Studies included evaluated ghrelin, GLP-1, PYY or appetite sensation via visual analogue scales (VASs) before and after Roux-en-Y gastric bypass (RYGB) in adults. A multilevel model with random effects for study and follow-up time points nested in study was fit to the data. The model included kcal consumption as a covariate and time points as moderators. Among the 2559 articles identified, k = 47 were included, among which k = 19 evaluated ghrelin, k = 40 GLP-1, k = 22 PYY, and k = 8 appetite sensation. Our results indicate that fasting ghrelin levels are decreased 2 weeks post-RYGB (p = 0.005) but do not differ from baseline from 6 weeks to 1-year post-RYGB. Postprandial ghrelin and fasting GLP-1 levels were not different from pre-surgical values. Postprandial levels of GLP-1 increased significantly from 1 week (p < 0.001) to 2 years post-RYGB (p < 0.01) compared with pre-RYGB. Fasting PYY increased at 6 months (p = 0.034) and 1 year (p = 0.029) post-surgery; also, postprandial levels increased up to 1 year (p < 0.01). Insufficient data on appetite sensation were available to be meta-analyzed.

Acceptability and Feasibility of the Telehealth Bariatric Behavioral Intervention to Increase Physical Activity Before Bariatric Surgery: A Single-Case Experimental Study (Part I)

BACKGROUND

Physical activity (PA) can play an important role in optimizing metabolic/bariatric surgery (MBS) outcomes. However, many MBS patients have difficulty increasing PA, necessitating the development of theory-driven counseling interventions. This study aimed to (1) assess the feasibility and acceptability of the TELEhealth BARIatric behavioral intervention (TELE-BariACTIV) trial protocol/methods and intervention, which was designed to increase moderate-to-vigorous intensity physical activity (MVPA) in adults awaiting MBS and (2) estimate the effect of the intervention on MVPA.

METHODS

This trial used a repeated single-case experimental design. Twelve insufficiently active adults awaiting MBS received 6 weekly 45-min PA videoconferencing counseling sessions. Feasibility and acceptability data (i.e., refusal, recruitment, retention, attendance, and attrition rates) were tracked and collected via online surveys, and interviews. MVPA was assessed via accelerometry pre-, during, and post-intervention.

RESULTS

Among the 24 patients referred to the research team; five declined to participate (refusal rate = 20.8%) and seven were ineligible or unreachable. The recruitment rate was 1.2 participants per month between 2021-09 and 2022-07. One participant withdrew during the baseline phase, and one after the intervention (retention rate = 83.3%). No participant dropouts occurred during the intervention and 98.6% of sessions were completed. Participants' anticipated and retrospective acceptability of the intervention was 3.2/4 (IQR, 0.5) and 3.0/4 (IQR, 0.2), respectively. There was a statistically significant increase in MVPA [Tau-U = 0.32(0.11; 0.51)] from pre- to post-intervention.

CONCLUSION

Despite a low recruitment rate, which could be explained by circumstances (COVID-19 pandemic), results support feasibility, acceptability, and preliminary efficacy of the TELE-Bari-ACTIV intervention for increasing MVPA in patients awaiting MBS.

Feasibility and acceptability of study methods and psychosocial interventions for body image among women diagnosed with breast cancer: A systematic review and narrative synthesis

OBJECTIVE

This systematic review aimed to summarize evidence for the feasibility and acceptability of psychosocial interventions for body image among women diagnosed with breast cancer and the study methods used to evaluate the interventions in question.

METHODS

Articles were identified via MEDLINE, CINAHL, CENTRAL, PsychINFO, and EMBASE. Inclusion criteria were: (1) peer-reviewed publication in English from 2000 onward with accessible full-text, (2) reported data on the feasibility and/or acceptability of psychosocial interventions and/or study methods, (3) included at least one measure of body image or reported a body-related theme, and (4) sample comprised women diagnosed with breast cancer. All study designs were eligible. Two reviewers independently performed study selection, data extraction, and quality assessment.

RESULTS

Sixty-two articles were included. Participants and comparator groups varied as did interventions. Feasibility and acceptability of the interventions and study methods were inconsistently operationalized and reported across studies. Evidence of feasibility and acceptability was heterogeneous within and across studies, though mostly positive.

CONCLUSION

Published psychosocial interventions for body image and study methods are generally feasible and acceptable. Findings should be used to advance the development, implementation, and evaluation of interventions designed to improve outcomes (body image or otherwise) for women diagnosed with breast cancer.

SYSTEMATIC REVIEW REGISTRATION

This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; ID: CRD42021269062, 11 September 2021).

Validation of a Virtual Environment to Induce State Social Physique Anxiety in Women with Obesity and Social Physique Anxiety

State Social Physique Anxiety (SPA), in contrast to Trait SPA, is triggered by specific situations that elicit SPA. To date, no research has used virtual reality (VR) to recreate a situation that may elicit State SPA. The purpose of this study is to validate a virtual environment (VE) that simulates an anxiogenic situation to induce State SPA in women with obesity and high SPA. The high SPA group consisted of 25 self-identified women living with obesity and high Trait SPA. The low SPA group consisted of 20 self-identified women with low SPA. All participants were immersed in a virtual swimming pool environment for 10 min using a virtual reality headset. After the immersion, State SPA and fear of being negatively judged felt during immersion were measured with self-report questionnaires. A questionnaire assessing unwanted negative side effects was administered before and after the immersion. Using an ANCOVA with Trait SPA as covariate, State SPA was found to be significantly higher in the high SPA group. Fear of being judged negatively was also significantly higher in the high SPA group. Unwanted negative side effects scores did not increase post-immersion in either group. This study documents the validity of a novel VE for inducing State SPA in women with obesity and high SPA.

Factors Associated with Excess Skin After Bariatric Surgery: a Mixed-Method Study

PURPOSE

After metabolic and bariatric surgery (MBS), many patients have excess skin (ES), which can cause inconveniences. Identifying factors related to ES quantity and inconveniences is crucial to inform interventions. The aim of this study was to identify sociodemographic, physical, psychosocial, and behavioral factors associated with ES quantity and inconveniences.

MATERIALS AND METHODS

A mixed-method study with a sequential explanatory design was conducted with 124 adults (92% women, Mage 46.5 ± 9.9 years, Mtime post-MBS 34.2 ± 27.6 months). During phase I, ES quantity (arms, abdomen, thighs) and inconveniences and sociodemographic, anthropometric, clinical, and behavioral outcomes were assessed. In phase II, 7 focus groups were performed with 37 participants from phase I. A triangulation protocol was completed to identify convergences, complementarities, and dissonances from quantitative and qualitative data.

RESULTS

Quantitative data indicate only ES quantity on arms was associated with ES inconveniences on arms (r = .36, p < .01). Total ES quantity was associated with maximal body mass index (BMI) reached pre-MBS (r = .48, p < .05) and current BMI (r = .35, p < .05). Greater ES inconvenience was associated with higher social physique anxiety and age (R2 = .50, p < .01). Qualitative data were summarized into 4 themes: psychosocial experiences living with ES, physical ailments due to ES, essential support and unmet needs, and beliefs of ES quantity causes.

CONCLUSION

Measured ES quantity is related to higher BMI, but not reported inconveniences. Greater self-reported ES quantity and inconveniences were associated with body image concerns.

Associations of weather and air pollution with objective physical activity and sedentary time before and after bariatric surgery: a secondary analysis of a prospective cohort study

Background--

Most metabolic and bariatric surgery (MBS) patients perform too little moderate-to-vigorous intensity physical activity (MVPA) and too much sedentary time (ST). Identifying factors that influence MVPA and ST in MBS patients is necessary to inform the development of interventions to target these behaviors. Research has focused on individual-level factors and neglected those related to the physical environment (e.g., weather and pollution). These factors may be especially important considering rapid climate change and emerging data that suggest adverse effects of weather and pollution on physical activity are more severe in people with obesity.

Objectives--

To examine the associations of weather (maximal, average and Wet Bulb Globe Temperatures), and air pollution indices (air quality index [AQI]) with daily physical activity (PA) of both light (LPA) and MVPA and ST before and after MBS.

Methods--

Participants (n=77) wore an accelerometer at pre- and 3, 6, and 12-months post-MBS to assess LPA/MVPA/ST (min/d). These data were combined with participants' local (Boston, MA or Providence, RI, USA) daily weather and AQI data (extracted from federal weather and environmental websites).

Results--

Multilevel generalized additive models showed inverted U-shaped associations between weather indices and MVPA (R2≥.63, p<.001), with a marked reduction in MVPA for daily maximal temperatures ≥20°C. Sensitivity analysis showed a less marked decrease of MVPA (min/d) during higher temperatures after versus before MBS. Both MVPA before and after MBS (R2=0.64, p<.001) and ST before MBS (R2=0.395; p≤.05) were negatively impacted by higher AQI levels.

Discussion--

This study is the first to show that weather and air pollution indices are related to variability in activity behaviors, particularly MVPA, during pre- and post-MBS. Weather/environmental conditions should be considered in MVPA prescription/strategies for MBS patients, especially in the context of climate change.

Impacts of social restrictions on mental health and health behaviours of individuals with multimorbidity during Covid-19 pandemic

Background

Social restrictions and their possible impact on lifestyle make people with multimorbidity (≥2 co-existing chronic conditions) more vulnerable to poor perceived mental health and health behaviours modifications during the COVID-19 pandemic.

Objective

To understand the mental health status and health behaviour modifications among individuals with multimorbidity during different levels of COVID-19 social restrictions.

Methods

Longitudinal multinational cohort study consisting of two online questionnaires with its first wave taken place while social restrictions were imposed (May 2020), and its second wave with less social restrictions in place (November 2020). Including 559 participants (wave 1) and 147 participants from wave 1 (wave 2) with an average age of 34.30±12.35 and 36.21±13.07 years old. Mostly females living in Canada, France, India and Lebanon.

Results

The prevalence of multimorbidity was 27.68% (wave 1) and 35.37% (wave 2). While social restrictions were imposed, people with multimorbidity were 2 to 3 times more likely to experience psychological distress, depressive symptoms, increased stress or isolation than those without multimorbidity. Health behaviours were also modified during this period with people with multimorbidity being more likely to reduce their physical activity and increased their fruit and vegetable consumption. In wave 2, regardless of multimorbidity status, sexual desire continuously decreased while stress and psychological distress increased.

Conclusion

Mental health and health behaviours modifications occurred while social restrictions were imposed and people with multimorbidity were more severely impacted than those without multimorbidity, indicating a need for a more adapted approach of care during socially restrictive periods for this population.

Exercise for counteracting weight recurrence after bariatric surgery: a systematic review and meta-analysis of randomized controlled trials

Exercise is recommended to prevent post-surgical weight recurrence. Yet, whether exercise interventions are efficacious in this regard has not been systematically evaluated. Moreover, clinicians lack evidence-based information to advise patients on appropriate exercise frequency, intensity, time, and type (FITT) for preventing weight recurrence. Thus, we conducted a meta-analysis of randomized controlled trials (RCTs) involving exercise interventions specifying FITT and weight measurement ≥12 months post-surgery. We reviewed scientific databases up through February 2022 for RCTs comparing exercise interventions reporting FITT and a nonexercise control group on weight ≥12 months post-surgery. Procedures following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were registered at the international prospective register of systematic reviews (PROSPERO: CRD42022342337). Of 1368 studies reviewed, 5 met inclusion criteria (n = 189; 47.8 ± 4.2 yr, 36.1 6 ± 3.8 kg·m2, 83.2 ± 9.5% female; 61.7% underwent Roux-en-Y gastric bypass). Exercise interventions were largely supervised, lasted 12-26 weeks, and prescribed 80-210 minutes/week of moderate-to-vigorous intensity combined aerobic and resistance exercise over ≤5 days. Within-group effects showed non-statistically significant weight loss for exercise (d = - .15, 95% confidence interval [CI]: -1.96, 1.65; -1.4 kg; P = .87) and weight gain for control (d = .11, 95% CI: -1.70,1.92; +1.0 kg; P = .90), with no difference between these groups (d = -2.26, 95% CI: -2.07, 1.55; -2.4 kg; P = .78). Exercise elicited an additional 2.4 kg weight loss versus control, although this effect was small and statistically non-significant. Ability to draw definitive conclusions regarding efficacy of exercise interventions for counteracting post-surgical weight recurrence was limited by the small number of trials and methodological issues. Findings highlight the need for more rigorous RCTs of exercise interventions specifically designed to reduce post-surgical weight recurrence.

Health associations with meeting the new Canadian 24-Hour Movement Guidelines recommendations according to body mass index classes in Canadian adults

Background

Data on meeting the Canadian 24-Hour Movement Guidelines for adults (24-H Guidelines) and associations with health indicators by body mass index (BMI) class are needed to support public health surveillance. The aim of this study was to describe the proportion of Canadian adults meeting individual and various combinations of the 24-H Guidelines by BMI class and their association with health indicators.

Data and methods

Data from the cross-sectional Canadian Health Measures Survey cycles 1 to 4 (2007 to 2015, n = 10,515 adults aged 18 to 79 years) were used. Daily time spent in moderate-to-vigorous physical activity (MVPA) and sedentary behaviour were assessed using accelerometry. Sleep duration, recreational screen time, chronic conditions, sociodemographic characteristics, and general and mental health were self-reported. The BMI, waist circumference, blood pressure and aerobic fitness were directly measured. Respondents were classified as meeting the 24-H Guidelines when: • the MVPA was 150 minutes per week or more; • sedentary time was nine hours or less per day; • recreational screen time was three hours or less per day; • sleep duration was seven to nine hours per day for individuals aged 18 to 64 years or seven to eight hours per day for individuals aged 65 years and older.

Results

Significantly fewer adults with overweight (6.1%) or class I (4.3%) and class II or III (3.9%) obesity met all three 24-H Guidelines compared with those with normal weight (9.5%). Meeting all three or two recommendations of the 24-H Guidelines was generally associated with a lower waist circumference, higher aerobic physical fitness and self-perceived general health regardless of BMI class.

Interpretation

Canadian adults living with overweight and obesity are less likely to meet the 24-H Guidelines. Most of the benefits associated with meeting the 24-H Guidelines are observed regardless of BMI status.

Exercise and bariatric surgery: A systematic review and meta-analysis of the feasibility and acceptability of exercise and controlled trial methods

This systematic review and meta-analysis assessed the feasibility and acceptability of exercise and controlled trial methods in adults awaiting or having undergone bariatric surgery (BS). Search methods used to identify relevant articles were inclusion of articles identified in a systematic review, new database search of articles published 2019-2021, and hand searching reference lists. Titles/abstracts and full-texts were screened by two reviewers independently against inclusion criteria: adults awaiting or having undergone BS, controlled trial, exercise group compared with a comparison group without exercise. Twenty-eight articles were reviewed; most interventions were supervised, performed after BS, and lasted ≤13 weeks. Pooled data for exercise intervention attendance and dropout rates were 84% (k = 10) and 5% (k = 19), respectively, though possibly misestimated due to poor/selective reporting. Median study and recruitment duration were 18 weeks and 24 months, respectively, with a pooled enrollment rate of 2.5 participants/month. Pooled data for refusal to participate, enrollment, and retention rates were 23% (k = 16), 43% (k = 18), and 87% (k = 26), respectively. Despite the lack of data available in studies included, exercise and controlled trial methods seem feasible and acceptable for adults awaiting or having undergone BS. To better identify methodological or practical challenges, and assess bias, better reporting of feasibility and acceptability indicators is needed in future studies.

Acceptability and feasibility of the TELEhealth BARIatric behavioural intervention to increase physical ACTIVity (TELE-BariACTIV): A single-case experimental study protocol (Preprint)

Background

Regular physical activity (PA) is recommended to optimize weight and health outcomes in patients who have undergone metabolic and bariatric surgery (MBS). However, >70% of patients have low PA levels before MBS that persist after MBS. Although behavioral interventions delivered face-to-face have shown promise for increasing PA among patients who have undergone MBS, many may experience barriers, preventing enrollment into and adherence to such interventions. Delivering PA behavior change interventions via telehealth to patients who have undergone MBS may be an effective strategy to increase accessibility and reach, as well as adherence.

Objective

This paper reports the protocol for a study that aims to assess the feasibility and acceptability of the protocol or methods and the Telehealth Bariatric Behavioral Intervention (TELE-BariACTIV). The intervention is designed to increase moderate-to-vigorous intensity PA (MVPA) in patients awaiting bariatric surgery and is guided by a multitheory approach and a patient perspective. Another objective is to estimate the effect of the TELE-BariACTIV intervention on presurgical MVPA to determine the appropriate sample size for a multicenter trial.

Methods

This study is a multicenter trial using a repeated (ABAB’A) single-case experimental design. The A phases are observational phases without intervention (A1=pre-MBS phase; A2=length personalized according to the MBS date; A3=7 months post-MBS phase). The B phases are interventional phases with PA counseling (B1=6 weekly pre-MBS sessions; B2=3 monthly sessions starting 3 months after MBS). The target sample size is set to 12. Participants are inactive adults awaiting sleeve gastrectomy who have access to a computer with internet and an interface with a camera. The participants are randomly allocated to a 1- or 2-week baseline period (A1). Protocol and intervention feasibility and acceptability (primary outcomes) will be assessed by recording missing data, refusal, recruitment, retention, attendance, and attrition rates, as well as via web-based acceptability questionnaires and semistructured interviews. Data collected via accelerometry (7-14 days) on 8 occasions and via questionnaires on 10 occasions will be analyzed to estimate the effect of the intervention on MVPA. Generalization measures assessing the quality of life, anxiety and depressive symptoms, and theory-based constructs (ie, motivational regulations for PA, self-efficacy to overcome barriers to PA, basic psychological needs satisfaction and frustration, PA enjoyment, and social support for PA; secondary outcomes for a future large-scale trial) will be completed via web-based questionnaires on 6-10 occasions. The institutional review board provided ethics approval for the study in June 2021.

Results

Recruitment began in September 2021, and all the participants were enrolled (n=12). Data collection is expected to end in fall 2023, depending on the MBS date of the recruited participants.

Conclusions

The TELE-BariACTIV intervention has the potential for implementation across multiple settings owing to its collaborative construction that can be offered remotely.

International Registered Report Identifier (IRRID)

DERR1-10.2196/39633

Living with severe obesity: adults' physical activity preferences, self-efficacy to overcome barriers and motives

BACKGROUND

This study aimed to explore the preferences, self-efficacy to overcome barriers and motives for physical activity of individuals with severe obesity (body mass index ≥35 kg/m²).

METHODS

44 adults with severe obesity (50.5 ± 13.3 years, 80% female) consented to participate in this study. Accelerometers, the 6-minute walking test, and questionnaires were used to collect data on participants' sociodemographic and medical characteristics, physical fitness, physical activity behaviour, preferences for physical activity, self-efficacy to overcome physical activity barriers and motives for physical activity.

RESULTS

A preference for walking (89%) and engaging in supervised physical activity (61%) at moderate intensity (46%) was reported. Most participants (71%) preferred engaging in physical activity outdoors for a duration of 30 to 60 min (84%), either in the morning (64%) or in the evening (48%). Participants had the lowest self-efficacy to overcome physical activity barriers when they had poor health and pain. The two most frequently reported physical activity motives were: preventing health problems and having better health.

CONCLUSIONS

A preference-based program focusing on health motives and addressing health and pain issues may help to promote physical activity behaviour among adults with severe obesity. Nevertheless, experimental studies are needed to determine if such strategies effectively increase physical activity behaviour in this population.Implications for rehabilitationPhysical activity preferences (i.e., walking, biking and swimming performed at a moderate intensity and outdoors for a duration of 30 minutes to 1 hour with supervision) can be used to enhance motivation in people with severe obesity.Addressing the main barriers of regular physical activity (e.g., poor health, pain, depression) could ensure better adherence to physical activity in people with severe obesity.Using motives of health improvement and health problems prevention could lead to increased physical activity in people with severe obesity.

Physical activity motives, barriers, and preferences in people with obesity: A systematic review

Background

Although the benefits of physical activity (PA) are well known, physical inactivity is highly prevalent among people with obesity. The objective of this systematic review was to i) appraise knowledge on PA motives, barriers, and preferences in individuals with obesity, and ii) quantify the most frequently reported PA motives, barriers and preferences in this population.

Methods

Six databases (Pubmed, CINAHL, Psyarticle, SportDiscus, Web of science and Proquest) were searched by independent reviewers to identify relevant quantitative or qualitative articles reporting PA motives, barriers or preferences in adults with body mass index ≥ 30 kg/m² (last searched in June 2020). Risk of bias for each study was assessed by two independent reviewers with the Mixed Methods Appraisal Tool (MMAT).

Results

From 5,899 papers identified, a total of 27 studies, 14 quantitative, 10 qualitative and 3 mixed studies were included. About 30% of studies have a MMAT score below 50% (k = 8). The three most reported PA motives in people with obesity were weight management, energy/physical fitness, and social support. The three most common PA barriers were lack of self-discipline/motivation, pain or physical discomfort, and lack of time. Based on the only 4 studies available, walking seems to be the preferred mode of PA in people with obesity.

Conclusions

Weight management, lack of motivation and pain are key PA motives and barriers in people with obesity, and should be addressed in future interventions to facilitate PA initiation and maintenance. Further research is needed to investigate the PA preferences of people with obesity.

Climate Change, Physical Activity and Sport: A Systematic Review

BACKGROUND

Climate change impacts are associated with dramatic consequences for human health and threaten physical activity (PA) behaviors.

OBJECTIVE

The aims of this systematic review were to present the potential bidirectional associations between climate change impacts and PA behaviors in humans and to propose a synthesis of the literature through a conceptual model of climate change and PA.

METHODS

Studies published before October 2020 were identified through database searches in PubMed, PsycARTICLES, CINAHL, SPORTDiscus, GreenFILE, GeoRef, Scopus, JSTOR and Transportation Research Information Services. Studies examining the associations between PA domains and climate change (e.g., natural disasters, air pollution, and carbon footprint) were included.

RESULTS

A narrative synthesis was performed and the 74 identified articles were classified into 6 topics: air pollution and PA, extreme weather conditions and PA, greenhouse gas emissions and PA, carbon footprint among sport participants, natural disasters and PA and the future of PA and sport practices in a changing world. Then, a conceptual model was proposed to identify the multidimensional associations between climate change and PA as well as sport practices. Results indicated a consistent negative effect of air pollution, extreme temperatures and natural disasters on PA levels. This PA reduction is more severe in adults with chronic diseases, higher body mass index and the elderly. Sport and PA communities can play an important mitigating role in post-natural disaster contexts. However, transport related to sport practices is also a source of greenhouse gas emissions.

CONCLUSION

Climate change impacts affect PA at a worldwide scale. PA is observed to play both a mitigation and an amplification role in climate changes.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42019128314.

Biopsychosocial correlates of physical activity and sedentary time in adults with severe obesity

Adults with severe obesity have poorer health, are less active and spend more time sedentary compared to people with a lower body mass index (BMI). There is a pressing need to understand the factors associated with low physical activity (PA) and excessive sedentary time to develop more effective behaviour change interventions for this population. The purpose of this study was to identify biopsychosocial correlates of PA and sedentary time in adults living with severe obesity. Forty-four adults living with severe obesity (age = 50.5 ± 13.3 years; BMI = 44.3 ± 7.8 kg/m² ) completed a survey including questions on sociodemographic characteristics, comorbidities, psychosocial factors (eg, social physique anxiety [SPA], social support for PA, PA level self-perception), quality of life, daily pain and self-reported moderate-to-vigorous intensity PA (MVPA). Participants also completed the 6-minute walk test (6MWT) to assess physical fitness and wore an accelerometer to assess objective PA and sedentary time. In stepwise linear multivariate analyses, higher objective MVPA was associated with higher 6MWT distance, being single and lower SPA (R² = 0.46, P < .001), whereas higher self-reported MVPA was associated with greater PA level self-perceptions (R² = 0.47, P < .001). Greater objective light intensity PA was associated with greater quality of life and self-efficacy for PA (R² = 0.26, P = .001). Greater sedentary time was associated with having more comorbidities (R² = 0.25, P < .001). This study shows that adults living with severe obesity who have more comorbidities, poorer quality of life and/or lower self-efficacy perception for PA are more likely to be sedentary and to practice less light intensity PA. Additionally, those who were in a relationship, had higher SPA and/or had lower physical fitness practiced less MVPA. Future research is needed to determine causal effects.

Health behaviours, intentions and barriers to change among obesity classes I, II and III

Health behaviour change is a cornerstone in the management of obesity, and data on health behaviours, intentions and barriers to change would be useful to inform the development of interventions. The aim of this study was to describe these variables in individuals with obesity, and to compare obesity classes. The study obtained data from the Canadian Community Health Survey 2011-2012 including 5614 adults with body mass index (BMI) ≥30 kg m^-2 . The majority of participants reported eating four or more fruits and vegetables daily (65.3% [95% confidence interval {CI}: 64.1-66.6]), being a regular drinker (59.6% [95% CI: 58.4-61.0]) and inactive (58.0% [95% CI: 56.7-59.3]). About 84% of participants answered they should do and/or intend to do something in the next year to improve their health, with increasing exercise being the most reported choice (69.2% [95% CI: 67.1-71.5]). Among the 58.0% (95% CI: 55.9-60.2) of participants facing barriers to change, the lack of willpower was the most reported (37.0% [95% CI: 34.2-39.7]). No difference between classes for intention to change and barriers were found. Comorbidities were the most important factor explaining several health behaviours and barriers to change. The vast majority of participants, regardless of the severity of obesity, know they should do and also want to do something to improve their health, but faced a lack of willpower. Thus, the most important thing to consider during an obesity intervention is the lack of motivation to modify health behaviours and beyond BMI, the presence of comorbidities.

Effects of a Pre-surgery Supervised Exercise Training 1 Year After Bariatric Surgery: a Randomized Controlled Study

BACKGROUND

We have previously reported on the benefits of Pre-Surgical Exercise Training (PreSET) on physical fitness and social interactions in subjects awaiting bariatric surgery (BS). However, data are needed to know whether these benefits are maintained post-BS.

OBJECTIVES

The purpose of this paper was to evaluate the effect of PreSET on physical activity (PA) level, physical fitness, PA barriers, and quality of life (QoL) 1 year (1-Y) after BS.

METHODS

Of the 30 participants randomized into two groups (PreSET and usual care), 25 were included in the final analysis. One year after BS, time spent in different PA intensities and number of steps were assessed with an accelerometer. Before BS and until 1-Y after BS, physical fitness was assessed with symptom-limited cardiac exercise test, 6-min walk test (6MWT), and sit-to-stand, half-squat, and arm curl tests. QoL, PA barriers, and PA level were evaluated with questionnaires.

RESULTS

The number of steps (7460 vs 4287) and time spent in light (3.2 vs 2.2 h/day) and moderate (0.6 vs 0.3 h/day) PA were higher in the PreSET group 1-Y after BS. The changes in 6MWT heart cost (1.3 vs 0.6 m/beats/min), half-squat test (38.8 vs 10.3 s), and BMI (- 16.8 vs - 13.5 kg/m²) were significantly greater in the PreSET group compared to those in the usual care group. No other significant difference between groups was observed.

CONCLUSION

The addition of the PreSET to individual lifestyle counseling seems effective to improve PA level and submaximal physical fitness 1-Y after BS. Studies with larger cohorts are now required to confirm these results. The trial was registered at clinicaltrials.gov (NCT01452230).

Physical activity assessment and counseling in Quebec family medicine groups

OBJECTIVE

To determine how often primary health care providers (PHCPs) in family medicine groups (FMGs) assess physical activity (PA) levels, provide PA counseling (PAC), and refer patients to exercise professionals; to describe patients' PA levels, physical fitness, and satisfaction regarding their PA management in FMGs; to describe available PA materials in FMGs and PHCPs' PAC self-efficacy and PA knowledge; and to identify characteristics of patients and PHCPs that determine the assessment of PA and PAC provided by PHCPs.

DESIGN

Cross-sectional study using questionnaires and a medical chart audit.

SETTING

Ten FMGs within the Integrated University Health Network of the Centre hospitalier universitaire de Sherbrooke in Quebec.

PARTICIPANTS

Forty FPs, 24 nurses, and 439 patients.

MAIN OUTCOME MEASURES

Assessment of PA level and PAC provided by PHCPs.

RESULTS

Overall, 51.9% of the patients had had their PA level assessed during the past 18 months, but only 21.6% received PAC from at least 1 of the PHCPs. Similar percentages were found among the inactive (n = 244) and more active (n = 195) patients. The median PAC self-efficacy score of PHCPs was 70.2% (interquartile range 52.0% to 84.7%) and the median PA knowledge score was 45.8% (interquartile range 41.7% to 54.2%), with no significant differences between nurses and FPs. In multivariate analysis, 34% of the variance in PAC provided was explained by assessment of PA level, overweight or obese status, type 2 diabetes or prediabetes, less FP experience, lower patient annual family income, more nurse encounters, and a higher patient physical component summary of quality of life.

CONCLUSION

The rates of assessment of PA and provision of PAC in Quebec FMGs were low, even though most of the patients were inactive. Initiatives to support PHCPs and more resources to assess PA levels and provide PAC should be implemented.

Effectiveness of interventions on breastfeeding self-efficacy and perceived insufficient milk supply: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to assess the efficacy on an intervention on breastfeeding self-efficacy and perceived insufficient milk supply outcomes. The literature search was conducted among 6 databases (CINAHL, Medline, PsyncInfo, Scopus, Cochrane, and ProQuest) in between January 2000 to June 2016. Two reviewers independently assessed the articles for the following inclusion criteria: experimental or quasi-experimental studies; healthy pregnant women participants intending to breastfeed or healthy breastfeeding women who gave birth to a term singleton and healthy baby; intervention administered could have been educational, support, psycho-social, or breastfeeding self-efficacy based, offered in prenatal or postnatal or both, in person, over the phone, or with the support of e-technologies; breastfeeding self-efficacy or perceived insufficient milk supply as outcomes. Seventeen studies were included in this review; 12 were randomized controlled trials. Most interventions were self-efficacy based provided on 1-to-1 format. Meta-analysis of RCTs revealed that interventions significantly improved breastfeeding self-efficacy during the first 4 to 6 weeks (SMD = 0.40, 95% CI 0.11-0.69, p = 0.006). This further impact exclusive breastfeeding duration. Only 1 study reported data on perceived insufficient milk supply. Women who have made the choice to breastfeed should be offered breastfeeding self-efficacy-based interventions during the perinatal period. Although significant effect of the interventions in improving maternal breastfeeding self-efficacy was revealed by this review, there is still a paucity of evidence on the mode, format, and intensity of interventions. Research on the modalities of breastfeeding self-efficacy should be pursued.

Impact of obesity and mood disorders on physical comorbidities, psychological well-being, health behaviours and use of health services

BACKGROUND

Albeit obesity and mood disorders frequently co-occur, few studies examined the impacts of this co-occurrence. The aim was to compare individuals with obesity and mood disorders (ObMD) to those with obesity without mood disorder in terms of physical comorbidities, psychological well-being, health behaviours and use of health services.

METHODS

Cross-sectional study using the Canadian Community Health Survey including a weighted sample of individuals with obesity (n = 1298) representing inhabitants from the province of Quebec (Canada).

RESULTS

Adjusted multivariate logistic regressions indicated that ObMD reported more physical conditions with odds ratio (OR) ranging from 1.8 [95%CI: 1.1 - 2.8] (hypertension) to 2.8 [95%CI: 1.3 - 6.0] (stomach ulcer). Also, ObMD reported poorer psychological well-being with OR ranging from 2.1 [95%CI: 1.4 - 3.3] (stress) to 25.6 [95%CI: 14.7 - 45.0] (poor perceived mental health). ObMD also reported more consultations with health professionals with OR ranging from 1.9 [95%CI: 1.0 - 3.5] (physicians) to 7.7 [95%CI: 4.2 - 14.3] (psychologists), and less healthy behaviours with OR ranging from 1.7 [95%CI: 1.1 - 2.6] (fruits and vegetables intake) to 2.1 [95%CI: 1.3 - 3.3] (tobacco).

LIMITATIONS

Self-reported data so we cannot discard the possibility of a bias in reporting. Also, given the cross-sectional design, no directional conclusion or causality about our results is possible.

DISCUSSION

The co-occurrence of mood disorder and obesity seems to be an aggravating factor of obesity-related factors because it is associated with poorer health in several areas. Interventions to prevent or manage obesity in mood disorders are necessary.

Impacts of Supervised Exercise Training in Addition to Interdisciplinary Lifestyle Management in Subjects Awaiting Bariatric Surgery: a Randomized Controlled Study

BACKGROUND

Experts recommend physical activity (PA) to optimize bariatric surgery (BS) results. However, evidence on the effect of PA before BS is missing. The aim of this study was to assess the impact of adding a Pre-Surgical Exercise Training (PreSET) to an interdisciplinary lifestyle intervention on physical fitness, quality of life, PA barriers, and anthropometric parameters of subjects awaiting BS.

METHODS

Thirty candidates for BS (43.2 ± 9.2 years, 47.5 ± 8.1 kg/m²) have been randomized in two groups: one group following the PreSET (endurance and strength training) and another receiving usual care. Before and after 12 weeks, we assessed physical fitness with a battery of tests (symptom-limited exercise test, 6-min walk test (6MWT), sit-to-stand test, half-squat test, and arm curl test), quality of life with the laval questionnaire, and PA barriers with the physical exercise belief questionnaire.

RESULTS

One control group subject abandoned the study. Subjects in the PreSET group participated in 60.0 % of the supervised exercise sessions proposed. Results showed significant improvements in the 6MWT (17.4 ± 27.2 vs. -16.4 ± 42.4 m; p = 0.03), half-squat test (17.1 ± 17.9 vs. -0.9 ± 14.5 s; p = 0.05), arm curl repetitions (4.8 ± 2.3 vs. 1.0 ± 4.1; p = 0.01), social interaction score (10.7 ± 12.5 vs. -2.1 ± 11.0 %; p = 0.02), and embarrassment (-15.6 ± 10.2 vs. -3.1 ± 17.8 %; p = 0.02) in completers (n = 8) compared to the non-completers (n = 21). No significant difference between groups in BMI and other outcomes studied was observed after the intervention.

CONCLUSIONS

Adding a PreSET to an individual lifestyle counselling intervention improved physical fitness, social interactions, and embarrassment. Post-surgery data would be interesting to confirm these benefits on the long term.

Cardiometabolic risk improvement in response to a 3-yr lifestyle modification program in men: contribution of improved cardiorespiratory fitness vs. weight loss

Our objective was to examine the respective contributions of changes in visceral adiposity, subcutaneous adiposity, liver fat, and cardiorespiratory fitness (CRF) to the improvements in cardiometabolic risk markers in response to a 3-yr healthy eating/physical activity lifestyle intervention. Ninety-four out of 144 viscerally obese healthy men completed a 3-yr lifestyle intervention. Body weight, body composition, and fat distribution were assessed by anthropometry and DEXA/computed tomography. CRF, adipokines, lipoprotein/lipid profile, and 75 g of oral glucose tolerance were assessed. CRF and visceral and subcutaneous adiposity significantly improved over the 3-yr intervention, with a nadir in year 1 and a partial regain in year 3 Liver fat (estimated by insulin hepatic extraction) stabilized from year 1 to year 3, whereas HOMA-IR, ISI-Matsuda index, and adiponectin continued to improve. Multivariate analysis revealed that both visceral adiposity and estimated liver fat reductions contributed to the improved ISI-Matsuda index observed over 3 yr (r² = 0.28, P < 0.001). Three-year changes in fat mass and CRF were independently associated with changes in visceral fat (adjusted r² = 0.40, P < 0.001), whereas only changes in CRF were associated with changes in estimated liver fat (adjusted r² = 0.18, P < 0.001). A long-term (3 yr) healthy eating/physical activity intervention in men improves several cardiometabolic risk markers over the long term (3 yr) despite a partial body weight regain observed between year 1 and year 3 The improvement in CRF contributes to visceral and estimated liver fat losses over the long term, which in turn explain the benefits of the lifestyle intervention on cardiometabolic risk profile.

Feasibility and effect of in-home physical exercise training delivered via telehealth before bariatric surgery

Optimal physical activity (PA) interventions are needed to increase PA in individuals with severe obesity, and optimize the results of bariatric surgery (BS). The aim of this study was to assess the feasibility and effect of Pre-Surgical Exercise Training (PreSET) delivered in-home via telehealth (TelePreSET) in subjects awaiting BS. Six women following the TelePreSET were compared to the women from a previous study (12 performing the PreSET in a gymnasium and 11 receiving usual care). In-home TelePreSET (12-weeks of endurance and strength training) was supervised twice weekly using videoconferencing. Physical fitness, quality of life, exercise beliefs, anthropometric measures and telehealth perception were assessed before and after 12-weeks. Satisfaction was evaluated with questionnaires at the end of the intervention. The TelePreSET participants attended 96% of the exercise sessions, and were very satisfied by the TelePreSET. The baseline telehealth perception score was high, and increased significantly after the intervention. The TelePreSET group significantly increased their physical fitness compared to the usual care group. No significant change was noted in other outcomes. The TelePreSET is feasible and seems effective to improve the physical fitness of women awaiting BS. Further studies are needed to confirm beneficial effects of this innovative mode of delivery.

[Female obesity and physical activity: a better understanding of the stakes linked to stigmatization]

<ce:para>Obesity remains a major public health concern in Western societies. In most industrialized countries, this condition, which is now associated with numerous chronic diseases and incapacities, is more prevalent in women than in men. While regular physical activity is highly recommended in the management of obesity, very few obese women invest in regular physical activity. Various social factors have been identified as influencing investment in preventive health practices such as physical activity. Weight stigmatization is now considered to be one of them. In order to contribute to a better understanding of the factors related to the investment of obese women in physical activity, this narrative review will focus on the stigmatization of obesity as a potential factor compromising their investment in regular physical activity and threatening their health. Messages from public health and exercise specialists targeting obesity have been recognized as contributing to weight stigmatization and Western women are more vulnerable than men to this type of discrimination. The authors discuss the various alternatives allowing public health and exercise professionals to review some of their interventions in order to help decrease weight stigmatization and its impacts on obese women in Western societies. Health and exercise professionals are influent actors who can collaborate in such initiatives in order to improve health and wellbeing of obese women.</ce:para>.

Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis

BACKGROUND

In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA) component on health outcomes of class II and III obese individuals.

METHODS

An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus). Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism), behaviour modification (PA and nutritional changes), and quality of life in adults with body mass index (BMI) ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method). Heterogeneity between studies was assessed by the Cochran's chi-square test and quantified through an estimation of the I².

RESULTS

Of the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%). The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2-7.7; p < 0.01) and 2.8 kg/m² in BMI loss (95% CI, 3.4-2.2; p < 0.01). Long-term interventions produced superior weight loss (11.3 kg) compared to short-term (7.2 kg) and intermediate-term (8.0 kg) interventions. A significant global effect of lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (p<0.01), without significant effect on HDL-C and fasting blood glucose.

CONCLUSIONS

Lifestyle interventions incorporating a PA component can improve weight and various cardiometabolic risk factors in class II and III obese individuals. However, further high quality trials are needed to confirm this evidence, especially beyond weight loss.

The 6-min Walk Test Reflects Functional Capacity in Primary Care and Obese Patients

The main purpose of this study was to determine the association between the 6-min walk test distance (6MWTD) and physical functional capacity (PF) in primary care patients, as well as in obese individuals. We studied 351 subjects (age=56.8±14.6 years; BMI=29.4±5.7 kg/m(2); 68% women), including 141 obese subjects (BMI≥30 kg/m(2)), recruited in 10 different family practices. Physical (PCS) and mental component summary of the health-related quality of life (HRQOL) and the 8 sub-scores were measured using the Short Form-36 Health Survey. Anthropometry, vital signs and physical testing were measured according to standardized protocols. Recreational physical activity (LPA) and sedentary levels were determined using the Canadian Community Health Survey. In a stepwise multivariate analysis, 65% of the 6MWTD variance was explained by PF of the HRQOL, age, quadriceps strength, number of chronic diseases, LPA categories, BMI, resting heart rate, PCS, height and TV-viewing categories in primary care subjects. In the obese individuals, PF, age, quadriceps strength and BMI explained 57% of the 6MWTD variance. In these 2 groups, 44% of the 6MWTD variance is explained by PF only. To conclude, the 6MWTD is strongly associated with PF of the HRQOL. Thus, it adequately reflects physical limitations in daily life activities of primary care patients, including obese individuals.

Impact of physical activity and fitness in class II and III obese individuals: a systematic review

The objective of this systematic review was to appraise current knowledge on the impact of physical activity (PA) and physical fitness (PF) on the health of class II and III obese subjects and bariatric surgery (BS) patients. All original studies were searched using four databases (Medline®, Scopus®, CINAHL and Sportdiscus). Two independent investigators selected studies assessing the impact of PA or PF on specific health outcomes (anthropometric parameters, body composition, cardiometabolic risk factors, PF, wellness) in adults with a body mass index ≥35 kg m(-2) or in BS patients. Conclusions were drawn based on a rating system of evidence. From 3,170 papers identified, 40 papers met the inclusion criteria. The vast majority of studies were recently carried out with a predominance of women. Less than one-third of these studies were experimental and only three of them were of high quality. Each study reported at least one beneficial effect of PA or PF. However, a lack of high-quality studies and heterogeneity in designs prevented us from finding high levels of evidence. In conclusion, although results support the importance of PA and PF to improve the health of this population, higher-quality trials are required to strengthen evidence-based recommendations.

Profile of adults with type 2 diabetes and uptake of clinical care best practices: results from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component

AIMS

This study aimed to (1) describe the profile of adults with type 2 diabetes (T2D) in Canada and (2) assess the uptake of clinical care best practices, as defined by the Canadian Diabetes Association (CDA) Clinical Practice Guidelines (CPGs).

METHODS

We used data from the 2011 Survey on Living with Chronic Diseases in Canada - Diabetes component. Participants were aged 20 years and older, living in the 10 Canadian provinces, with self-reported T2D. Descriptive analyses present the prevalence of complications and comorbidities, as well as the level of clinical monitoring and self-monitoring/lifestyle management recommendations participants received.

RESULTS

We included 2335 participants with T2D, a mean age of 62.9 years, and high prevalence of complications/comorbidities and prescription medication use. Most participants reported being monitored as recommended for eye disease (73.9%), weight (81.0%), blood pressure (89.0%) and blood cholesterol levels (94.3%), but only 65.5% reported having at least two HbA1c tests during the last year and 46.5% reported an annual foot examination by a health professional. About two-thirds of the participants reported having received recommendations on weight management (59.9%) and physical activity (64.7%) from a health professional in the previous year; only 47.8% of the participants reported having received diet counseling to improve diabetes control.

CONCLUSION

Although the uptake of CDA CPGs for clinical and self-monitoring was high, with the majority of the participants reporting meeting most indicators, it was lower for HbA1c measurement and foot examination. Uptake of lifestyle management recommendations provided by health professionals was also significantly lower.

Changes in steroid hormones during an international powerlifting competition

The purpose of this study was to assess changes in the steroid hormone levels of elite athletes during an international powerlifting competition. Baseline cortisol, DHEA and testosterone were determined in saliva samples in 19 (8 men, 11 women) junior and sub-junior athletes on the day before competition, and then on the competition day during the official weighing and in the hour after competition. Performance was determined by total output and the Wilks formula. No change in saliva steroid concentrations was observed between samples collected on the day before competition and the weighing samples. There was no gender effect on cortisol concentrations but saliva testosterone levels were always significantly higher in men than in women (p<0.01), as was end-competition DHEA (p<0.05). Cortisol and DHEA were significantly increased in male and female athletes after the competition (respectively, p<0.01 and p<0.05), whereas end-competition testosterone concentrations were only significantly increased in men (p<0.01). Significant relationships were demonstrated between performance and end-competition cortisol levels in women and end-competition testosterone levels in men. These data indicate that workouts during an international powerlifting competition produce a significant increase in adrenal steroid hormones in both genders, with an increase in male gonadal steroid hormone. Further studies are necessary to examine the changes in oestradiol and progesterone in women and their potential impact on performance during international powerlifting competition.

Effects of an 8-week aerobic exercise training on saliva steroid hormones, physical capacity, and quality of life in diabetic obese men

The purpose of the study was to assess the effects of aerobic exercise training on saliva steroid hormones [i. e., cortisol, dehydroepiandrosterone (DHEA), and testosterone], physical capacity, and quality of life in obese diabetic men. 8 abdominally obese type 2 diabetic men (59.5±1.7 years old, BMI=35.5±1.6 kg/m(2), waist circumference=119.4±3.3 cm) and 9 healthy men (57.4±1.5 years old, BMI=24.5±0.8 kg/m(2), waist circumference=92.3±1.9 cm) participated in the study. The obese diabetic men underwent 8 weeks of aerobic exercise training: twice a week 45 min sessions at 75% of peak heart rate and once a week 45 min session of intermittent exercise. Before and after training, steroid hormone concentrations were analyzed from saliva samples, physical capacity was assessed by the 6-minute walking test, and quality of life was estimated by a specific questionnaire for obese subjects. These data were compared with the data from the healthy untrained men. The basal saliva DHEA and testosterone concentrations, physical capacity, and quality of life scores of the obese diabetic men were significantly lower than those of the healthy men. Aerobic training induces a significant increase in the 6-min walking distance and improve the psychosocial impact dimension of quality of life, without modifying significantly any other parameter investigated. These data suggest that an 8-week aerobic exercise program improves physical capacity and quality of life in obese diabetic men, but was insufficient to correct the anthropometric and hormonal alterations observed in this population.

Serum and saliva adrenocortical hormones in obese diabetic men during submaximal exercise

The aim of this study was to evaluate serum and saliva adrenocortical hormones and their relationships at rest and during submaximal exercise and recovery in 9 obese diabetic middle-aged men (BMI: 35.2 ± 1.6 kg/m (2)). Blood and saliva samples were taken at rest, every 10 min of a 30-min cycling exercise at 70% of maximal heart rate, and after 10 min of recovery in order to analyze cortisol, dehydroepiandrosterone sulfate (DHEA-S) and dehydroepiandrosterone (DHEA). Serum and saliva cortisol increased significantly during recovery (p<0.05), but no significant difference was observed between the rest, exercise, and recovery DHEA-S and DHEA concentrations. A strong correlation was found at rest between both serum and saliva cortisol (r=0.72, p<0.001) and DHEA-S and DHEA (r=0.93, p<0.001). Serum DHEA-S and saliva DHEA remained strongly correlated during and after the submaximal exercise (r=0.81, p<0.001), whereas a weaker but still significant relationship was observed between serum and saliva cortisol during and after the exercise (r=0.52, p<0.001). In conclusion, these results suggest that saliva adrenocortical hormones, and especially saliva DHEA, may offer a practical surrogate for serum concentrations during both rest and exercise in obese diabetic men.