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Xie L, Atem F, Mathew MS, Almandoz JP, Schellinger JN, Kapera O, Ngenge S, Francis J, Marroquin EM, McAdams C, Kukreja S, Schneider BE, Messiah SE. Factors Associated with the Decision to Complete Bariatric Metabolic Surgery among a Racially and Ethnically Diverse Sample of Adults: A Classification and Regression Tree Analysis. Obes Surg 2024; 34:1513-1522. [PMID: 38105283 DOI: 10.1007/s11695-023-06999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Less than 50% of eligible candidates who are referred complete Bariatric Metabolic Surgery (BMS). The factors influencing the decision to complete BMS, particularly how these factors vary across different racial and ethnic groups, remain largely unexplored. METHODS This prospective cohort study included adult patients referred to a bariatric surgeon or obesity medicine program between July 2019-September 2022. Sociodemographic characteristics, body mass index (BMI), anxiety, depression, body appreciation, and patient-physician relationship information were collected via survey and electronic health records. The association between BMS completion and potential decision-driving factors was examined using Classification and Regression Tree (CART) analysis. RESULTS A total of 406 BMS -eligible patients participated in the study (mean [SD] age: 47.5 [11.6] years; 87.2% women; 18.0% Hispanic, 39% non-Hispanic Black [NHB], and 39% non-Hispanic White [NHW]; mean [SD] BMI: 45.9 [10.1] kg/m2). A total of 147 participants (36.2%) completed BMS. Overall, the most influential factor driving the decision to complete BMS was younger age (< 68.4 years), higher patient satisfaction, and BMI (≥ 38.0 kg/m2). Hispanic participants prioritized age (< 55.4 years), female sex, and body appreciation. For NHB participants, the highest ranked factors were age < 56.3 years, BMI ≥ 35.8 kg/m2, and higher patient satisfaction. For NHW patients, the most influential factors were age (39.1 to 68.6 years) and higher body appreciation. CONCLUSION These findings highlight racial and ethnic group differences in the factors motivating individuals to complete BMS. By acknowledging these differences, healthcare providers can support patients from different backgrounds more effectively in their decision-making process regarding BMS.
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Affiliation(s)
- Luyu Xie
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA.
- Center for Pediatric Population Health, Dallas, TX, USA.
| | - Folefac Atem
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - M Sunil Mathew
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Olivia Kapera
- Center for Pediatric Population Health, Dallas, TX, USA
- University of Texas Health Science Center at Houston, School of Public Health, Austin, TX, USA
| | - Sophia Ngenge
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | - Jackson Francis
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
| | | | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Benjamin E Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, Dallas, TX, USA
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Dunn SH, Tejani S, Almandoz JP, Messiah SE, Schellinger J, Marroquin EM, Mathew M, Horton J, Tavakkoli A. Transoral gastric outlet reduction for post-prandial hypoglycemia after Roux-en-Y gastric bypass. Surg Endosc 2023; 37:8285-8290. [PMID: 37674055 DOI: 10.1007/s00464-023-10389-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/12/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Post-prandial hypoglycemia is an uncommon but disabling late complication of Roux-en-Y gastric bypass (RYGB). Most patients can be treated with dietary interventions and medications; however, some patients develop refractory hypoglycemia that may lead to multiple daily episodes and seizures. While RYGB reversal surgery is an effective treatment, complication rates are high, and patients inevitably experience weight regain. Transoral gastric outlet reduction (TORe) is a minimally invasive treatment that is effective for early and late dumping syndrome. However, prior studies have not distinguished the effectiveness of TORe specifically for patients with post-prandial hypoglycemia. This study aims to describe a single institution's experience of TORe for treating post-prandial hypoglycemia. METHODS This is a case series of patients with prior RYGB complicated by post-prandial hypoglycemia who underwent TORe from February 2020 to September 2021. Pre-procedural characteristics and post-procedural outcomes were obtained. Outcomes assessed included post-prandial hypoglycemia episodes, dumping syndrome symptoms, and weight change. RESULTS A total of 11 patients underwent TORe from 2020 to 2021 for post-prandial hypoglycemia. Three (27%) patients had a history of seizures due to hypoglycemia. All had been advised on dietary changes, and ten patients (91%) were on medications for dumping. All patients reported a reduction in post-prandial hypoglycemic events as well as the majority of dumping syndrome symptoms during an average follow-up time of 409 ± 125 days. Ten patients (91%) had experienced weight regain from their post-RYGB nadir weight. For these patients, the average total body weight loss 12 months post-TORe was 12.4 ± 12%. There were no complications requiring hospitalization. One patient experienced post-TORe nausea and vomiting requiring dilation of the gastrojejunal anastomosis with resolution in symptoms. CONCLUSION TORe is a safe and effective treatment for post-prandial hypoglycemia and weight regain after RYGB in patients with symptoms refractory to medications and dietary changes.
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Affiliation(s)
- Samuel Hunter Dunn
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA.
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| | - Sanaa Tejani
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Jaime P Almandoz
- Division of Endocrinology, University of Texas Southwestern, Dallas, TX, USA
| | - Sarah E Messiah
- University of Texas Health Science Center at Houston School of Public Health, Dallas Campus, Dallas, TX, USA
- Center for Pediatric Population Health, University of Texas Health Science Center at Houston School of Public Health, Dallas Campus, Dallas, TX, USA
- Department of Pediatrics, McGovern Medical School, Houston, TX, USA
| | - Jeffrey Schellinger
- Division of Endocrinology, University of Texas Southwestern, Dallas, TX, USA
| | | | - Matthew Mathew
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA
| | - Jay Horton
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA
| | - Anna Tavakkoli
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA
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Haddad JD, Almandoz JP, Gomez V, Schulman AR, Horton JD, Schellinger J, Messiah SE, Mathew MS, Marroquin EM, Tavakkoli A. Endoscopic Sleeve Gastroplasty: A Practice Pattern Survey. Obes Surg 2023; 33:2434-2442. [PMID: 37338795 DOI: 10.1007/s11695-023-06684-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Obesity is a complex, chronic disease that is strongly associated with complications which cost the US healthcare system billions of dollars per year. Endoscopic sleeve gastroplasty (ESG) has emerged as a safe and effective procedure for treatment of obesity, but without practice guidelines there are likely to be variations practice. We sought to describe current practice patterns amongst endoscopists who perform ESG to help define areas of focus for future research and guideline development. METHODS We conducted an anonymous cross-sectional survey to examine practice patterns related to ESG. The survey was organized in 5 sections: Endoscopic Practice, Training, and Resources; Pre-ESG Evaluation and Payment Model; Perioperative/Operative Period; Post-operative Period; and Endobariatric Practice Other Than ESG. RESULTS A variety of exclusion criteria were reported by physicians performing ESG. Most respondents (n = 21/32, 65.6%) would not perform ESG for BMI under 27, and 40.6% (n = 13/32) would not perform ESG on patients with BMI over 50. The majority of respondents (74.2%, n = 23/31) reported ESG was not covered in their region, and most reported patients covered residual costs (67.7%, n = 21/31). CONCLUSIONS We found significant variability with respect to practice setting, exclusion criteria, pre-procedural evaluation, and medication use. Without guidelines for the selection of patients or standards for pre- and post-ESG care, substantial barriers to coverage will remain, and ESG will remain limited to those who can meet out-of-pocket costs. Larger studies are needed to confirm our findings, and future research should be focused on establishing patient selection criteria and standards in practices to provide guidance for endobariatric programs.
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Affiliation(s)
- James D Haddad
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA.
| | - Jaime P Almandoz
- Division of Endocrinology, University of Texas Southwestern, Dallas, TX, USA
| | - Victoria Gomez
- Division of Gastroenterology and Hepatology, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Allison R Schulman
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Jay D Horton
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
- Department of Molecular Genetics, University of Texas Southwestern, Dallas, TX, USA
| | - Jeffrey Schellinger
- Division of Endocrinology, University of Texas Southwestern, Dallas, TX, USA
| | - Sarah E Messiah
- School of Public Health, University of Texas Health Science Center, Dallas, TX, USA
| | - M Sunil Mathew
- School of Public Health, University of Texas Health Science Center, Dallas, TX, USA
| | | | - Anna Tavakkoli
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA
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Murvelashvili N, Xie L, Schellinger JN, Mathew MS, Marroquin EM, Lingvay I, Messiah SE, Almandoz JP. Effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery weight recurrence. Obesity (Silver Spring) 2023; 31:1280-1289. [PMID: 36998152 DOI: 10.1002/oby.23736] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of semaglutide versus liraglutide for treating post-metabolic and bariatric surgery (MBS) weight recurrence. METHODS A retrospective analysis of 207 adults with post-MBS weight recurrence treated with semaglutide 1.0 mg weekly (n = 115) or liraglutide 3.0 mg daily (n = 92) at an academic center from January 1, 2015, through April 1, 2021, was conducted. The primary end point was percentage body weight change at 12 months of treatment with regimens containing semaglutide or liraglutide. RESULTS The mean sample age was 55.2 years; mean BMI was 40.4 kg/m2 ; 89.9% were female; and 50% completed sleeve gastrectomy, 29% completed Roux-en-Y gastric bypass, and 21% completed adjustable gastric banding. Least-squares mean weight change at 12 months was -12.92% versus -8.77% in the semaglutide and liraglutide groups, respectively (p < 0.001). The adjusted odds ratios were 2.34 (95% CI: 1.28-4.29) for ≥10% weight loss and 2.55 (95% CI: 1.22-5.36) for ≥15% weight loss over 12 months in the semaglutide group versus liraglutide group, respectively. Weight-loss efficacy of semaglutide (vs. liraglutide) did not differ by subgroups explored, including age, sex, and MBS procedure. CONCLUSIONS These results show that treatment regimens including semaglutide 1.0 mg weekly lead to superior weight loss compared with liraglutide 3.0 mg daily for treating post-MBS weight recurrence, regardless of procedure type or the magnitude of weight recurrence.
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Affiliation(s)
- Natia Murvelashvili
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Luyu Xie
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
| | - Jeffrey N Schellinger
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - M Sunil Mathew
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
| | - Elisa Morales Marroquin
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
| | - Ildiko Lingvay
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sarah E Messiah
- University of Texas Health Science Center, School of Public Health, Dallas, Texas, USA
- Center for Pediatric Population Health, UT Health School of Public Health, Dallas, Texas, USA
- Department of Pediatrics, John P. and Kathrine G. McGovern School of Medicine at UTHealth, Houston, Texas, USA
| | - Jaime P Almandoz
- Department of Internal Medicine, Division of Endocrinology, UT Southwestern Medical Center, Dallas, Texas, USA
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Xie L, Almandoz JP, Mathew MS, Schellinger JN, Kapera O, Ngenge S, Marroquin EM, McAdams C, Kukreja S, Schneider B, Messiah SE. Association Between Patient Satisfaction With Their Patient-Physician Relationship and Completion of Bariatric Surgery by Race and Ethnicity Among US Adults. JAMA Netw Open 2022; 5:e2247431. [PMID: 36534399 PMCID: PMC9856898 DOI: 10.1001/jamanetworkopen.2022.47431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Metabolic and bariatric surgery (MBS) is an effective and safe treatment for obesity and its comorbidities, but less than 50% of those who are eligible and referred for MBS complete the procedure. The patient-physician relationship could be a decisive factor in the decision to complete MBS; however, this relationship has not been explored, particularly among racially and ethnically diverse populations. OBJECTIVE To examine the association between patient-reported satisfaction with their patient-physician relationship and MBS completion by self-reported racial and ethnic group. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included 408 patients who were referred to a bariatric surgeon or obesity medicine program between July 24, 2019, and May 19, 2022. EXPOSURE Patient satisfaction with their physician was measured by 7 dimensions (general satisfaction, technical quality, interpersonal manner, communication, financial aspects, time spent with physician, and accessibility and convenience) using the Patient Satisfaction Questionnaire Short Form. MAIN OUTCOMES AND MEASURES Completion status for MBS (yes or no). RESULTS A total of 408 patients (mean [SD] age, 47.3 [11.6] years; among 366 with data available, 317 [86.6%] women and 49 [13.4%] men) were included in the study. Of 363 patients with data available on race and ethnicity, 66 were Hispanic/Latinx (18.2%), 136 (37.5%) were non-Hispanic Black, 146 (40.2%) were non-Hispanic White, and 15 (4.1%) were other race or ethnicity. A total of 124 patients (30.4%) completed MBS. Overall, the mean (SD) patient satisfaction score was significantly greater in MBS completers vs noncompleters (3.86 [0.56] vs 3.61 [0.64]; P < .001). Multivariable logistic regression analysis showed technical quality was the most significant factor for MBS completion (adjusted odds ratio [aOR], 1.99 [95% CI, 1.24-3.19]), followed by communication (aOR, 1.78 [95% CI, 1.16-2.72]) and accessibility and convenience (aOR, 1.61 [95% CI, 1.03-2.53]). The interaction between racial and ethnic groups and patient satisfaction was not significant (eg, mean [SD] score for Hispanic/Latinx completers, 3.95 [0.55] vs 3.77 [0.60] for non-Hispanic White completers; P = .46 for interaction). CONCLUSIONS AND RELEVANCE These findings suggest that there is an association between patient satisfaction with the patient-physician relationship and the decision to complete MBS regardless of race and ethnicity. These findings have important implications for strategies to improve the proportion of qualified patients who complete MBS to achieve improved health outcomes.
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Affiliation(s)
- Luyu Xie
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
| | - Jaime P. Almandoz
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - M. Sunil Mathew
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
| | - Jeffrey N. Schellinger
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Olivia Kapera
- School of Public Health, University of Texas Health Science Center, Dallas
- School of Public Health, University of Texas Health Science Center, Austin
| | - Sophia Ngenge
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
| | - Elisa Morales Marroquin
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
| | - Carrie McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | | | - Benjamin Schneider
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Sarah E. Messiah
- School of Public Health, University of Texas Health Science Center, Dallas
- Center for Pediatric Population Health, UTHealth School of Public Health, Dallas, Texas
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Almandoz JP, Xie L, Schellinger JN, Mathew MS, Marroquin EM, Murvelashvili N, Khatiwada S, Kukreja S, McAdams C, Messiah SE. Changes in body weight, health behaviors, and mental health in adults with obesity during the COVID-19 pandemic. Obesity (Silver Spring) 2022; 30:1875-1886. [PMID: 35773790 PMCID: PMC9349662 DOI: 10.1002/oby.23501] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationships between body weight changes, health behaviors, and mental health in adults with obesity during the second year of the COVID-19 pandemic. METHODS Between March 1, 2021, and November 30, 2021, adults from three obesity practices completed an online survey. The primary outcomes were ≥ 5% of body weight change since March 2020 and associated health behaviors and mental health factors. RESULTS The sample (n = 404) was 82.6% female (mean age 52.5 years, mean BMI 43.3 kg/m2 ). Mean weight change was + 4.3%. Weight gain ≥ 5% was reported by 30% of the sample, whereas 19% reported ≥ 5% body weight loss. The degree of both weight gain and weight loss correlated positively with baseline BMI. Eighty percent of the sample reported difficulties with body weight regulation. Those who gained ≥ 5% versus those who lost ≥ 5% body weight were more likely to report higher levels of stress, anxiety, and depression; less sleep and exercise; less healthy eating and home-cooked meals; and more takeout foods, comfort foods, fast foods, overeating, and binge eating. CONCLUSIONS Weight gain in adults with obesity during the COVID-19 pandemic is associated with higher baseline BMI, deteriorations in mental health, maladaptive eating behaviors, and less physical activity and sleep. Further research is needed to identify effective interventions for healthier minds, behaviors, and body weight as the pandemic continues.
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Affiliation(s)
- Jaime P. Almandoz
- Department of Internal Medicine, Division of EndocrinologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Luyu Xie
- University of Texas Health Science Center, School of Public HealthDallasTexasUSA
- Department of Surgery, Division of Pediatric Surgery, Center for Pediatric Population Health, Children's Health System of Texas and UT Health School of Public HealthUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Jeffrey N. Schellinger
- Department of Internal Medicine, Division of EndocrinologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - M. Sunil Mathew
- University of Texas Health Science Center, School of Public HealthDallasTexasUSA
- Department of Surgery, Division of Pediatric Surgery, Center for Pediatric Population Health, Children's Health System of Texas and UT Health School of Public HealthUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Elisa Morales Marroquin
- University of Texas Health Science Center, School of Public HealthDallasTexasUSA
- Department of Surgery, Division of Pediatric Surgery, Center for Pediatric Population Health, Children's Health System of Texas and UT Health School of Public HealthUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Natia Murvelashvili
- Department of Internal Medicine, Division of EndocrinologyUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Shreeya Khatiwada
- University of Texas Health Science Center, School of Public HealthDallasTexasUSA
- Department of Surgery, Division of Pediatric Surgery, Center for Pediatric Population Health, Children's Health System of Texas and UT Health School of Public HealthUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | | | - Carrie McAdams
- Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Sarah E. Messiah
- University of Texas Health Science Center, School of Public HealthDallasTexasUSA
- Department of Surgery, Division of Pediatric Surgery, Center for Pediatric Population Health, Children's Health System of Texas and UT Health School of Public HealthUniversity of Texas Southwestern Medical CenterDallasTexasUSA
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Shuval K, Marroquin EM, Li Q, Knell G, Pettee Gabriel K, Drope J, Yaroch AL, Chartier KG, Fennis BM, Qadan M. Long-term weight loss success and the health behaviours of adults in the USA: findings from a nationally representative cross-sectional study. BMJ Open 2021; 11:e047743. [PMID: 34261685 PMCID: PMC8281097 DOI: 10.1136/bmjopen-2020-047743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To describe the relationship between long-term weight loss (LTWL) success and lifestyle behaviours among US adults. DESIGN Serial cross-sectional data from National Health and Nutrition Examination Survey cycles 2007-2014. SETTING AND PARTICIPANTS Population-based nationally representative sample. The analytic sample included 3040 adults aged 20-64 years who tried to lose weight in the past year. MEASURES Participants were grouped into five LTWL categories (<5%, 5%-9.9%, 10%-14.9%, 15%-19.9% and ≥20%). Lifestyle-related behaviours included the following: alcohol intake, physical activity, smoking, fast-food consumption, dietary quality (Healthy Eating Index (HEI)) and caloric intake. Multivariable regression was employed adjusting for age, sex, race/ethnicity, marital status, education, household income and size, current body mass index and self-reported health status. RESULTS Individuals in the 15%-19.9% LTWL group differed significantly from the reference group (<5% LTWL) in their physical activity and dietary quality (HEI) but not caloric intake. Specifically, they had a higher HEI score (β=3.19; 95% CI 0.39 to 5.99) and were more likely to meet physical activity guidelines (OR=1.99; 95% CI 1.11 to 3.55). In comparison, the ≥20% LTWL group was significantly more likely to smoke (OR=1.63; 95% CI 1.03 to 2.57) and to consume lower daily calories (β=-202.91; 95% CI -345.57 to -60.25) than the reference group; however, dietary quality and physical activity did not significantly differ. CONCLUSION Among a national sample of adults, a higher level of LTWL success does not necessarily equate to healthy weight loss behaviours. Future research should attempt to design interventions aimed at facilitating weight loss success while encouraging healthy lifestyle behaviours.
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Affiliation(s)
- Kerem Shuval
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa, Israel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Cooper Institute, Dallas, Texas, USA
| | - Elisa Morales Marroquin
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
- The Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, Texas, USA
| | - Qing Li
- American Cancer Society, Atlanta, Georgia, USA
| | - Gregory Knell
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
- The Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth), Dallas, Texas, USA
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey Drope
- Department of Health Policy and Administration, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amy L Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA
| | - Karen G Chartier
- School of Social Work and Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bob M Fennis
- Department of Marketing, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Mahmoud Qadan
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa, Israel
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Abstract
Alzheimer's disease (AD) is a neurodegenerative disease that affects memory and cognitive function. Clinical evidence has put into question our current understanding of AD development, propelling researchers to look into further avenues. Gut microbiota has emerged as a potential player in AD pathophysiology. Lifestyle factors, such as diet, can have negative effects on the gut microbiota and thus host health. A Western-type diet has been highlighted as a risk factor for both gut microbiota alteration as well as AD development. The gut-derived trimethylamine N-oxide (TMAO) has been previously implied in the development of cardiovascular diseases with recent evidence suggesting a plausible role of TMAO in AD development. Therefore, the main goal of the present review is to provide the reader with potential mechanisms of action through which consumption of a Western-type diet could increase AD risk, by acting through microbiota-produced TMAO. Although a link between TMAO and AD is far from definitive, this review will serve as a call for research into this new area of research.
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Affiliation(s)
- Pablo Arrona Cardoza
- P. Arrona Cardoza is with the Tecnológico de Monterrey, School of Medicine and Health Science, Monterrey, Nuevo Leon, Mexico. M.B Spillane is with the H.C. Drew School of Health and Human Performance, McNeese State University, Lake Charles, Louisiana, USA. E. Morales Marroquin is with the School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA. E. Morales Marroquin is with the Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, Texas, USA
| | - Micheil B Spillane
- P. Arrona Cardoza is with the Tecnológico de Monterrey, School of Medicine and Health Science, Monterrey, Nuevo Leon, Mexico. M.B Spillane is with the H.C. Drew School of Health and Human Performance, McNeese State University, Lake Charles, Louisiana, USA. E. Morales Marroquin is with the School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA. E. Morales Marroquin is with the Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, Texas, USA
| | - Elisa Morales Marroquin
- P. Arrona Cardoza is with the Tecnológico de Monterrey, School of Medicine and Health Science, Monterrey, Nuevo Leon, Mexico. M.B Spillane is with the H.C. Drew School of Health and Human Performance, McNeese State University, Lake Charles, Louisiana, USA. E. Morales Marroquin is with the School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA. E. Morales Marroquin is with the Center for Pediatric Population Health, UTHealth School of Public Health and Children's Health System of Texas, Dallas, Texas, USA
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