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Sumithran P, Finucane FM, Cohen RV. Obesity drug shortages are symptomatic of wider malaise. Lancet 2024; 403:1613-1615. [PMID: 37783217 DOI: 10.1016/s0140-6736(23)01963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Priya Sumithran
- Department of Surgery, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia.
| | - Francis M Finucane
- Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland; Department of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland; Cúram, University of Galway, Galway, Ireland
| | - Ricardo V Cohen
- Center for the Treatment of Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
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2
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Allison K, Jones S, Hinman RS, Pardo J, Li P, DeSilva A, Quicke JG, Sumithran P, Prendergast J, George E, Holden MA, Foster NE, Bennell KL. Alternative models to support weight loss in chronic musculoskeletal conditions: effectiveness of a physiotherapist-delivered intensive diet programme for knee osteoarthritis, the POWER randomised controlled trial. Br J Sports Med 2024:bjsports-2023-107793. [PMID: 38637135 DOI: 10.1136/bjsports-2023-107793] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To determine if physiotherapists can deliver a clinically effective very low energy diet (VLED) supplementary to exercise in people with knee osteoarthritis (OA) and overweight or obesity. METHODS 88 participants with knee OA and body mass index (BMI) >27 kg/m2 were randomised to either intervention (n=42: VLED including two daily meal replacement products supplementary to control) or control (n=46: exercise). Both interventions were delivered by unblinded physiotherapists via six videoconference sessions over 6 months. The primary outcome was the percentage change in body weight at 6 months, measured by a blinded assessor. Secondary outcomes included BMI, waist circumference, waist-to-hip ratio, self-reported measures of pain, function, satisfaction and perceived global change, and physical performance tests. RESULTS The intervention group lost a mean (SD) of 8.1% (5.2) body weight compared with 1.0% (3.2) in the control group (mean (95% CI) between-group difference 7.2% (95% CI 5.1 to 9.3), p<0.001), with significantly lower BMI and waist circumference compared with control group at follow-up. 76% of participants in the intervention group achieved ≥5% body weight loss and 37% acheived ≥10%, compared with 12% and 0%, respectively, in the control group. More participants in the intervention group (27/38 (71.1%)) reported global knee improvement than in the control group (20/42 (47.6%)) (p=0.02). There were no between-group differences in any other secondary outcomes. No serious adverse events were reported. CONCLUSION A VLED delivered by physiotherapists achieved clinically relevant weight loss and was safe for people with knee OA who were overweight or obese. The results have potential implications for future service models of care for OA and obesity. TRIAL REGISTRATION NUMBER NIH, US National Library of Medicine, Clinicaltrials.gov NCT04733053 (1 February 2021).
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Affiliation(s)
- Kim Allison
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Jones
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jesse Pardo
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peixuan Li
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
- Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anurika DeSilva
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia
- Methods and Implementation Support for Clinical and Health Research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan George Quicke
- Primary Care and Health Sciences, School of Medicine, Keele University, Keele, UK
- Chartered Society of Physiotherapy, Chancery Exchange, London, UK
| | - Priya Sumithran
- Department of Surgery, Division of Clinical Sciences, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
| | | | - Elena George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Melanie A Holden
- Primary Care and Health Sciences, School of Medicine, Keele University, Keele, UK
| | - Nadine E Foster
- Primary Care and Health Sciences, School of Medicine, Keele University, Keele, UK
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, St Lucia, Queensland, Australia
| | - Kim L Bennell
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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3
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Walmsley R, Chong L, Hii MW, Brown RM, Sumithran P. The effect of bariatric surgery on the expression of gastrointestinal taste receptors: A systematic review. Rev Endocr Metab Disord 2024; 25:421-446. [PMID: 38206483 PMCID: PMC10942945 DOI: 10.1007/s11154-023-09865-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
Gastrointestinal nutrient sensing via taste receptors may contribute to weight loss, metabolic improvements, and a reduced preference for sweet and fatty foods following bariatric surgery. This review aimed to investigate the effect of bariatric surgery on the expression of oral and post-oral gastrointestinal taste receptors and associations between taste receptor alterations and clinical outcomes of bariatric surgery. A systematic review was conducted to capture data from both human and animal studies on changes in the expression of taste receptors in oral or post-oral gastrointestinal tissue following any type of bariatric surgery. Databases searched included Medline, Embase, Emcare, APA PsychInfo, Cochrane Library, and CINAHL. Two human and 21 animal studies were included. Bariatric surgery alters the quantity of many sweet, umami, and fatty acid taste receptors in the gastrointestinal tract. Changes to the expression of sweet and amino acid receptors occur most often in intestinal segments surgically repositioned more proximally, such as the alimentary limb after gastric bypass. Conversely, changes to fatty acid receptors were observed more frequently in the colon than in the small intestine. Significant heterogeneity in the methodology of included studies limited conclusions regarding the direction of change in taste receptor expression induced by bariatric surgeries. Few studies have investigated associations between taste receptor expression and clinical outcomes of bariatric surgery. As such, future studies should look to investigate the relationship between bariatric surgery-induced changes to gut taste receptor expression and function and the impact of surgery on taste preferences, food palatability, and eating behaviour.Registration code in PROSPERO: CRD42022313992.
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Affiliation(s)
- Rosalind Walmsley
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Parkville, VIC, 3052, Australia
- Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Lynn Chong
- Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Michael W Hii
- Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Victoria, Australia
| | - Robyn M Brown
- Department of Pharmacology and Biochemistry, University of Melbourne, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine, St Vincent's Hospital Melbourne, University of Melbourne, Parkville, VIC, 3052, Australia.
- Department of Surgery, Central Clinical School, Monash University, Victoria, Australia.
- Department of Endocrinology and Diabetes, Alfred Health, Victoria, Australia.
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4
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Colman BD, Boonstra F, Nguyen MN, Raviskanthan S, Sumithran P, White O, Hutton EJ, Fielding J, van der Walt A. Understanding the pathophysiology of idiopathic intracranial hypertension (IIH): a review of recent developments. J Neurol Neurosurg Psychiatry 2024; 95:375-383. [PMID: 37798095 DOI: 10.1136/jnnp-2023-332222] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023]
Abstract
Idiopathic intracranial hypertension (IIH) is a condition of significant morbidity and rising prevalence. It typically affects young people living with obesity, mostly women of reproductive age, and can present with headaches, visual abnormalities, tinnitus and cognitive dysfunction. Raised intracranial pressure without a secondary identified cause remains a key diagnostic feature of this condition, however, the underlying pathophysiological mechanisms that drive this increase are poorly understood. Previous theories have focused on cerebrospinal fluid (CSF) hypersecretion or impaired reabsorption, however, the recent characterisation of the glymphatic system in many other neurological conditions necessitates a re-evaluation of these hypotheses. Further, the impact of metabolic dysfunction and hormonal dysregulation in this population group must also be considered. Given the emerging evidence, it is likely that IIH is triggered by the interaction of multiple aetiological factors that ultimately results in the disruption of CSF dynamics. This review aims to provide a comprehensive update on the current theories regarding the pathogenesis of IIH.
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Affiliation(s)
- Blake D Colman
- Department of Neuroscience, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Frederique Boonstra
- Department of Neuroscience, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Minh Nl Nguyen
- Department of Neuroscience, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Priya Sumithran
- Department of Surgery, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
- Department of Endocrinology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Owen White
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Neuroscience, Monash University Central Clinical School, Clayton, Victoria, Australia
| | - Elspeth J Hutton
- Department of Neuroscience, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Joanne Fielding
- Department of Neuroscience, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
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5
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Zoungas S, Sumithran P. Remission of type 2 diabetes is achievable in primary care with intensive lifestyle intervention. Evid Based Nurs 2024:ebnurs-2023-103923. [PMID: 38458652 DOI: 10.1136/ebnurs-2023-103923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Sophia Zoungas
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Priya Sumithran
- School of Translational Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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6
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Bennell KL, Keating C, Lawford B, Graham B, Hall M, Simpson JA, McManus F, Hosking B, Sumithran P, Harris A, Woode ME, Francis JJ, Marlow J, Poh S, Hinman RS. Effectiveness of a telehealth-delivered clinician-supported exercise and weight loss program for hip osteoarthritis - protocol for the Better Hip randomised controlled trial. BMC Musculoskelet Disord 2024; 25:138. [PMID: 38350917 PMCID: PMC10863299 DOI: 10.1186/s12891-023-07131-0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/18/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Hip osteoarthritis (OA) is a leading cause of chronic pain and disability worldwide. Self-management is vital with education, exercise and weight loss core recommended treatments. However, evidence-practice gaps exist, and service models that increase patient accessibility to clinicians who can support lifestyle management are needed. The primary aim of this study is to determine the effectiveness of a telehealth-delivered clinician-supported exercise and weight loss program (Better Hip) on the primary outcomes of hip pain on walking and physical function at 6 months, compared with an information-only control for people with hip OA. METHODS A two-arm, parallel-design, superiority pragmatic randomised controlled trial. 212 members from a health insurance fund aged 45 years and over, with painful hip OA will be recruited. Participants will be randomly allocated to receive: i) Better Hip; or ii) web-based information only (control). Participants randomised to the Better Hip program will have six videoconferencing physiotherapist consultations for education about OA, prescription of individualised home-based strengthening and physical activity programs, behaviour change support, and facilitation of other self-management strategies. Those with a body mass index > 27 kg/m2, aged < 80 years and no specific health conditions, will also be offered six videoconferencing dietitian consultations to undertake a weight loss program. Participants in the control group will be provided with similar educational information about managing hip OA via a custom website. All participants will be reassessed at 6 and 12 months. Primary outcomes are hip pain on walking and physical function. Secondary outcomes include measures of pain; hip function; weight; health-related quality of life; physical activity levels; global change in hip problem; willingness to undergo hip replacement surgery; rates of hip replacement; and use of oral pain medications. A health economic evaluation at 12 months will be conducted and reported separately. DISCUSSION Findings will determine whether a telehealth-delivered clinician-supported lifestyle management program including education, exercise/physical activity and, for those with overweight or obesity, weight loss, is more effective than information only in people with hip OA. Results will inform the implementation of such programs to increase access to core recommended treatments. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry (ACTRN12622000461796).
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia.
| | | | - Belinda Lawford
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Bridget Graham
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic, Melbourne, Australia
| | - Fiona McManus
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Vic, Melbourne, Australia
| | | | - Priya Sumithran
- Department of Medicine, The University of Melbourne, Vic, Melbourne, Australia
- Department of Endocrinology, Austin Health, Vic, Melbourne, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash University, Vic, Melbourne, Australia
| | - Maame Esi Woode
- Centre for Health Economics, Monash University, Vic, Melbourne, Australia
| | - Jill J Francis
- School of Health Sciences, The University of Melbourne, Vic, Melbourne, Australia
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jennifer Marlow
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Sharon Poh
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Vic, Melbourne, Australia
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MacIsaac RJ, Deed G, D'Emden M, Ekinci EI, Hocking S, Sumithran P, Rasalam R. Challenging Clinical Perspectives in Type 2 Diabetes with Tirzepatide, a First-in-Class Twincretin. Diabetes Ther 2023; 14:1997-2014. [PMID: 37824027 PMCID: PMC10597955 DOI: 10.1007/s13300-023-01475-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/08/2023] [Indexed: 10/13/2023] Open
Abstract
Tirzepatide is a first-in-class GIP/GLP-1 receptor agonist ('twincretin')-a single molecule that acts as an agonist at both glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors. In the SURPASS clinical trial program in type 2 diabetes mellitus (T2D), tirzepatide was associated with unprecedented reductions in HbA1c, clinically significant weight loss and other metabolic benefits, combined with low rates of hypoglycaemia across a wide range of patient characteristics. The safety and adverse event rate for tirzepatide appears comparable to that of GLP-1 receptor agonists. Although results from dedicated cardiovascular (CV) and kidney trials are currently not available, information to date suggests that tirzepatide may have CV and kidney benefits in people with T2D. Tirzepatide has been approved for the treatment of T2D in the USA, United Arab Emirates, European Union, Japan and Australia. Here, we review how tirzepatide will fit into the T2D treatment continuum. We also consider future directions with tirzepatide in T2D, including its potential for targeting cardio-renal-metabolic disease in T2D, and discuss how tirzepatide-and other co-agonists in development-may challenge current approaches for management of T2D.
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Affiliation(s)
- Richard J MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.
- The Australian Centre for Accelerating Diabetes Innovations, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia.
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia.
- Department of Endocrinology and Diabetes, Level 4 Daly Wing, 35 Victoria Pde, PO Box 2900, Fitzroy, VIC, 3065, Australia.
| | - Gary Deed
- Monash University, Brisbane, QLD, Australia
| | - Michael D'Emden
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Queensland Health, Brisbane, QLD, Australia
| | - Elif I Ekinci
- The Australian Centre for Accelerating Diabetes Innovations, Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia
- Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Samantha Hocking
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Priya Sumithran
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia
| | - Roy Rasalam
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, VIC, Australia.
- University of Melbourne, Parkville, VIC, 3010, Australia.
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Cohen RV, Lingvay I, le Roux CW, Sumithran P. Correction: Is Metabolic Surgery Having an Identity Crisis? Obes Surg 2023; 33:3716. [PMID: 37801241 DOI: 10.1007/s11695-023-06878-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, Rua Treze de Maio, 1.815 - Torre D - 1, Andar, Bela Vista, São Paulo, CEP: 01327-001, Brazil.
| | - Ildiko Lingvay
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Priya Sumithran
- Central Clinical School, Monash University, Melbourne, VIC, Australia
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Cohen RV, Lingay I, Le Roux C, Sumithran P. Is Metabolic Surgery Having an Identity Crisis? Obes Surg 2023; 33:3327-3329. [PMID: 37584852 DOI: 10.1007/s11695-023-06786-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023]
Affiliation(s)
- Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, Rua Treze de Maio, 1.815 - Torre D - 1, Andar, Bela Vista, São Paulo, CEP: 01327-001, Brazil.
| | - Ildiko Lingay
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carel Le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Priya Sumithran
- Monash University, Central Clinical School, Melbourne, VIC, Australia
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Hocking S, Sumithran P. Individualised prescription of medications for treatment of obesity in adults. Rev Endocr Metab Disord 2023; 24:951-960. [PMID: 37202547 PMCID: PMC10492708 DOI: 10.1007/s11154-023-09808-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Obesity continues to increase in prevalence globally, driven by changes in environmental factors which have accelerated the development of obesity in individuals with an underlying predisposition to weight gain. The adverse health effects and increased risk for chronic disease associated with obesity are ameliorated by weight loss, with greater benefits from larger amounts of weight reduction. Obesity is a heterogeneous condition, with the drivers, phenotype and complications differing substantially between individuals. This raises the question of whether treatments for obesity, specifically pharmacotherapy, can be targeted based on individual characteristics. This review examines the rationale and the clinical data evaluating this strategy in adults. Individualised prescribing of obesity medication has been successful in rare cases of monogenic obesity where medications have been developed to target dysfunctions in leptin/melanocortin signalling pathways but has been unsuccessful in polygenic obesity due to a lack of understanding of how the gene variants associated with body mass index affect phenotype. At present, the only factor consistently associated with longer-term efficacy of obesity pharmacotherapy is early weight loss outcome, which cannot inform choice of therapy at the time of medication initiation. The concept of matching a therapy for obesity to the characteristics of the individual is appealing but as yet unproven in randomised clinical trials. With increasing technology allowing deeper phenotyping of individuals, increased sophistication in the analysis of big data and the emergence of new treatments, it is possible that precision medicine for obesity will eventuate. For now, a personalised approach that takes into account the person's context, preferences, comorbidities and contraindications is recommended.
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Affiliation(s)
- Samantha Hocking
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Priya Sumithran
- Department of Medicine, (St Vincent's Hospital), University of Melbourne, VIC, Fitzroy, Australia.
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia.
- Department of Surgery, Central Clinical School, Monash University, Level 6, 99 Commercial Rd, Melbourne, Victoria, 3004, Australia.
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Sharp G, Girolamo T, Hay P, Mitchison D, Cooper K, Sumithran P, Jebeile H. New anti-obesity medications: Considerations and future directions in people with concurrent eating disorders. Aust J Gen Pract 2023; 52:651-653. [PMID: 37666788 DOI: 10.31128/ajgp-02-23-6731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Gemma Sharp
- PhD, Associate Professor and National Health and Medical Research Council (NHMRC) Emerging Leadership Fellow, Department of Neuroscience, Monash University, Melbourne, Vic; Senior Clinical Psychologist, Alfred Health, Melbourne, Vic
| | - Teresa Girolamo
- MBBS, DCH, FRACGP, Director and Co-Founder Re:You Health, Adelaide Weight Management Solutions, Adelaide, SA
| | - Phillipa Hay
- DPhil, MD, MBChB, Foundation Chair of Mental Health and Academic Lead: Eating Disorders and Body Image, Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW; Director Mental Health Research, South West Sydney Local Health District, Sydney, NSW
| | - Deborah Mitchison
- PhD, Associate Professor in Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW; Adjunct Associate Professor, Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW; Clinical Psychologist, Basten and Associates, Sydney, NSW; Adjunct Fellow, Centre for Emotional Health, Macquarie University, Sydney, NSW
| | - Kelly Cooper
- APD, Program Manager, The Obesity Collective, Sydney, NSW
| | - Priya Sumithran
- MBBS, FRACP, PhD, Senior Research Fellow, Department of Medicine (St Vincent@s), The University of Melbourne, Fitzroy, Vic; Head, Obesity Medicine, Department of Endocrinology, Austin Health, Heidelberg, Vic
| | - Hiba Jebeile
- PhD, NHMRC Emerging Leadership Fellow Children@s Hospital at Westmead Clinical School, The University of Sydney, Westmead, NSW
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12
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Mooney SS, Sumithran P. Does weight loss in women with obesity induce regression of endometrial hyperplasia? A systematic review. Eur J Obstet Gynecol Reprod Biol 2023; 288:49-55. [PMID: 37423122 DOI: 10.1016/j.ejogrb.2023.06.028] [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: 02/16/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
Obesity is a leading risk factor for endometrial cancer and its precursor, endometrial hyperplasia (EH). Currently, weight loss is recommended for people with EH and obesity, but evidence to guide weight management as primary or adjunctive therapy is limited. This systematic review aims to assess the role of weight loss in inducing histopathological regression of EH in women with obesity. A systematic search of Medline, PubMed, Embase and The Cochrane Library databases was conducted in January 2022. Studies reporting on participants with EH who underwent weight loss interventions, incorporating comparisons of pre- and post-intervention histology, were included. Studies were limited to those published in English with full text available. Six studies met the inclusion criteria, all of which reported outcomes after bariatric surgery. Three studies reported outcomes for the same group of participants, therefore only one outcome set was included. Pre-operative endometrial biopsy results were available for 167 women, and 81 had post-operative biopsies reported. Nineteen women (11.4% of those biopsied) had EH pre-operatively; 17 underwent repeat sampling post-operatively. Twelve (71%) had complete histological resolution, 1 (6%) had partial regression from complex hyperplasia to simple hyperplasia, 1 (6%) had persistent atypical hyperplasia, and 3 (18%) had persistent simple hyperplasia. One patient with a normal pre-intervention biopsy had simple hyperplasia post-operatively. Due to poor quality and overall scarcity of data, the role of weight loss in the primary or adjunctive treatment of EH is unknown. Future studies should prospectively assess weight loss modalities and targets, as well as use of concurrent therapies.
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Affiliation(s)
- Samantha S Mooney
- Endosurgery (Gynaecology) Department, Mercy Hospital for Women, Heidelberg, Melbourne, VIC, Australia; University of Melbourne, Department of Obstetrics & Gynaecology, Heidelberg, Melbourne, VIC, Australia.
| | - Priya Sumithran
- University of Melbourne, Department of Medicine (St Vincent's), Fitzroy, VIC, Australia; Alfred Health, Department of Endocrinology, Melbourne, VIC, Australia; Monash University, Department of Surgery, Central Clinical School, Melbourne, VIC, Australia
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13
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Walmsley R, Sumithran P. Current and emerging medications for the management of obesity in adults. Med J Aust 2023; 219:188. [PMID: 37402483 DOI: 10.5694/mja2.52031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023]
Affiliation(s)
| | - Priya Sumithran
- Monash University, Melbourne, VIC
- Alfred Health, Melbourne, VIC
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14
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Lingvay I, Sumithran P, le Roux CW, Cohen RV. There is no magic bullet for obesity. Lancet Diabetes Endocrinol 2023; 11:541. [PMID: 37500191 DOI: 10.1016/s2213-8587(23)00191-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Affiliation(s)
- Ildiko Lingvay
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Priya Sumithran
- Monash University, Central Clinical School, Melbourne, VIC, Australia
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Ireland; Diabetes Research Centre, Ulster University, Coleraine, UK
| | - Ricardo V Cohen
- The Center for the Treatment of Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo 01327-001, Brazil.
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15
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Mansi IA, Sumithran P, Kinaan M. Authors' reply to Braithwaite. BMJ 2023; 382:p1723. [PMID: 37495236 DOI: 10.1136/bmj.p1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Ishak A Mansi
- Department of Education, Orlando VA Health Care System, Orlando, Florida, USA
| | - Priya Sumithran
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Australia
| | - Mustafa Kinaan
- Department of Internal Medicine, University of Central Florida, Orlando
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16
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Sumithran P, Roberts L, Caterson ID, Brown RM, Spittal MJ, Brown WA. Incidence of adverse mental health outcomes after sleeve gastrectomy compared with gastric bypass and restrictive bariatric procedures: a retrospective cohort study. Obesity (Silver Spring) 2023; 31:1913-1923. [PMID: 37368518 PMCID: PMC10946809 DOI: 10.1002/oby.23757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE This study examined rates of suicide and hospitalization with psychiatric diagnoses after sleeve gastrectomy compared with gastric bypass and restrictive procedures (gastric banding/gastroplasty). METHODS This was a longitudinal retrospective cohort study comprising all patients who underwent primary bariatric surgery in New South Wales or Queensland, Australia, between July 2001 and December 2020. Hospital admission records, death registration, and cause of death records (if applicable) within these dates were extracted and linked. Primary outcome was death by suicide. Secondary outcomes were admissions with self-harm; substance-use disorder, schizophrenia, mood, anxiety, behavioral, and personality disorders; any of these; and psychiatric inpatient admission. RESULTS A total of 121,203 patients were included, with median follow-up of 4.5 years per patient. There were 77 suicides, with no evidence of difference in rates by surgery type (rates [95% CI] per 100,000 person years: 9.6 [5.0-18.4] restrictive, 10.8 [8.4-13.9] sleeve gastrectomy, 20.4 [9.7-42.8] gastric bypass; p = 0.18). Rates of admission with self-harm declined after restrictive and sleeve procedures. Admission with anxiety disorders, any psychiatric diagnosis, and as a psychiatric inpatient increased after sleeve gastrectomy and gastric bypass, but not restrictive procedures. Admissions with substance-use disorder increased after all surgery types. CONCLUSIONS Variable associations between bariatric surgeries and hospitalization with psychiatric diagnoses might indicate distinct vulnerabilities among patient cohorts or that differing anatomical and/or functional changes may contribute to effects on mental health.
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Affiliation(s)
- Priya Sumithran
- Department of Medicine (St Vincent's)University of MelbourneFitzroyVictoriaAustralia
- Department of EndocrinologyAustin HealthHeidelbergVictoriaAustralia
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
| | - Leo Roberts
- Centre for Mental Health, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Ian D. Caterson
- Boden Initiative, Charles Perkins Centre, University of SydneyNew South WalesAustralia
| | - Robyn M. Brown
- Department of Biochemistry and PharmacologyUniversity of MelbourneParkvilleVictoriaAustralia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global HealthUniversity of MelbourneParkvilleVictoriaAustralia
| | - Wendy A. Brown
- Department of SurgeryMonash UniversityMelbourneVictoriaAustralia
- Department of SurgeryAlfred HospitalMelbourneVictoriaAustralia
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17
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Brown WA, Rigas G, Williams K, Sumithran P, Caterson ID. Barriers to progression through Australian obesity management pathways: Survey data from the ACTION-IO study. Aust J Gen Pract 2023; 52:472-480. [PMID: 37423245 DOI: 10.31128/ajgp-07-22-6501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND AND OBJECTIVES Our previous work uncovered a nine-year delay, from when Australian people with obesity (PwO) first began struggling with excess weight and first discussed weight with a healthcare professional (HCP). In this study we explore barriers to having an obesity consultation, making and discussing the diagnosis of obesity and arranging a management plan, including a follow-up appointment. METHOD Australian PwO (n = 1000) and HCPs (n = 200; 50% general practitioners [GPs]), completed the Awareness, Care & Treatment In Obesity Management - An International Observation (ACTION-IO) online survey. RESULTS Of Australian PwO, 53% had discussed weight with an HCP in the past five years, 25% were informed of their obesity diagnosis and 15% had weight-related follow-up appointments scheduled. Fewer GPs than other specialists reported recording obesity diagnoses, but GPs scheduled more follow-up appointments. Receiving formal obesity training was reported by 22% of GPs and 44% of other specialists. DISCUSSION Barriers to obesity care in Australia include unrealistic expectations from both PwO and HCPs, lack of evidence-based strategies and insufficient training. Further exploration of barriers is required.
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Affiliation(s)
- Wendy A Brown
- MBBS(Hons), PhD, FACS, FRACS,@Professor and Chair, Monash University Department@of Surgery, Central Clinical School, Melbourne, Vic;@Alfred Health Program Director of Surgical Services,@Alfred Health Director, Oesophago-Gastric and@Bariatric Unit, Alfred Health, Melbourne, Vic
| | - Georgia Rigas
- MBBS, BSc(Med), FRACGP, VMO GPObesity Doctor, St George Private Hospital, Kogarah, Sydney, NSW; Senior Bariatric Medical Practitioner, St George Private Hospital, Kogarah, Sydney, NSW
| | - Kathryn Williams
- BMed(Sci), MBBS(Hons I), PhD, FRACP, Senior Staff Specialist and Head of Department, Endocrinology, Nepean Hospital, Nepean Blue Mountains Local Health District, Penrith, NSW; Senior Lecturer (conjoint), Nepean Clinical School, Faculty of Medicine and Health/ Charles Perkins Centre, University of Sydney, Camperdown, NSW
| | - Priya Sumithran
- MBBS, FRACP, PhD, Senior Research Fellow, Department of Medicine (St Vincent@s), The University of Melbourne, Fitzroy, Vic; Head, Obesity Medicine, Department of Endocrinology, Austin Health, Heidelberg, Vic
| | - Ian D Caterson
- MBBS, BSc(Med), PhD, FRACP, Professor Emeritus, SoLES, University of Sydney and Boden Initiative, Charles Perkins Centre, University of Sydney, Camperdown, NSW; Senior Staff Specialist, Royal Prince Alfred Hospital, Camperdown, NSW
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18
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Sumithran P. The Physiological Regulation of Body Fat Mass. Gastroenterol Clin North Am 2023; 52:295-310. [PMID: 37197874 DOI: 10.1016/j.gtc.2023.03.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Disturbances inbody weight and adiposity in both humans and animals are met by compensatory adjustments in energy intake and energy expenditure, suggesting that body weight or fat is regulated. From a clinical viewpoint, this is likely to contribute to the difficulty that many people with obesity have in maintaining weight loss. Finding ways to modify these physiologic responses is likely to improve the long-term success of obesity treatments.
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Affiliation(s)
- Priya Sumithran
- Department of Medicine (St Vincent's), University of Melbourne, St Vincent's Hospital, Clinical Science Building Level 4, 29 Regent Street, Fitzroy, Victoria 3065, Australia; Department of Endocrinology, Austin Health.
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Harris A, Hinman RS, Lawford BJ, Egerton T, Keating C, Brown C, Metcalf B, Spiers L, Sumithran P, Quicke JG, Bennell KL. Cost-Effectiveness of Telehealth-Delivered Exercise and Dietary Weight Loss Programs for Knee Osteoarthritis Within a Twelve-Month Randomized Trial. Arthritis Care Res (Hoboken) 2023; 75:1311-1319. [PMID: 36106928 PMCID: PMC10953202 DOI: 10.1002/acr.25022] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of telehealth-delivered exercise and diet-plus-exercise programs within 12 months. METHODS An economic evaluation within a 12-month, 3-arm, parallel randomized trial of two 6-month telehealth-delivered exercise programs, with and without a dietary component. A total of 415 people with knee osteoarthritis ages 45-80 years and body mass index of 28-40 kg/m2 were assigned to 1 of 2 telehealth-delivered exercise programs, 1 without (n = 172) and 1 with (n = 175) a dietary component (ketogenic very low calorie diet), or to an education control (n = 67), for 6 months, with 6 months follow-up. The primary economic outcomes were quality-adjusted life years (QALYs) and health system costs. Measured costs were the direct intervention (consultations, equipment/resources, and meal replacements) and health care use in 2020 Australian dollars ($AU1.5 = $US1). Secondary analysis included weight loss and work productivity gains. RESULTS The clinical trial demonstrated greater improvements in pain and function compared to information only for individuals with knee osteoarthritis and overweight/obesity. We can be 88% confident that diet plus exercise is cost effective ($45,500 per QALY), 53% confident that exercise is cost-effective ($67,600 per QALY) compared to the control, and 86% confident that augmenting exercise with the diet program is cost effective ($21,100 per QALY). CONCLUSION Telehealth-delivered programs targeting exercise with dietary intervention for people with knee osteoarthritis who have overweight/obesity are likely to be cost-effective, particularly if potential long-term gains from weight loss and work productivity are realized.
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Affiliation(s)
| | | | | | | | | | | | - Ben Metcalf
- University of MelbourneMelbourneVictoriaAustralia
| | - Libby Spiers
- University of MelbourneMelbourneVictoriaAustralia
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Affiliation(s)
- Ishak A Mansi
- Department of Education, Orlando VA Health Care System, Orlando, Florida
| | - Priya Sumithran
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Australia
| | - Mustafa Kinaan
- Department of Internal Medicine, University of Central Florida, Orlando
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21
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Walmsley R, Sumithran P. Current and emerging medications for the management of obesity in adults. Med J Aust 2023; 218:276-283. [PMID: 36934408 PMCID: PMC10952877 DOI: 10.5694/mja2.51871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 03/20/2023]
Affiliation(s)
| | - Priya Sumithran
- University of MelbourneMelbourneVIC
- Austin HealthMelbourneVIC
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22
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Perdomo CM, Cohen RV, Sumithran P, Clément K, Frühbeck G. Contemporary medical, device, and surgical therapies for obesity in adults. Lancet 2023; 401:1116-1130. [PMID: 36774932 DOI: 10.1016/s0140-6736(22)02403-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [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: 06/24/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 02/11/2023]
Abstract
The goal of obesity management is to improve health. Sustained weight loss of more than 10% overall bodyweight improves many of the complications associated with obesity (eg, prevention and control of type 2 diabetes, hypertension, fatty liver disease, and obstructive sleep apnoea), as well as quality of life. Maintenance of weight loss is the major challenge of obesity management. Like all chronic diseases, managing obesity requires a long-term, multimodal approach, taking into account each individual's treatment goals, and the benefit and risk of different therapies. In conjunction with lifestyle interventions, anti-obesity medications and bariatric surgery improve the maintenance of weight loss and associated health gains. Most available anti-obesity medications act on central appetite pathways to reduce hunger and food reward. In the past 5 years, therapeutic advances have seen the development of targeted treatments for monogenic obesities and a new generation of anti-obesity medications. These highly effective anti-obesity medications are associated with weight losses of more than 10% of overall bodyweight in more than two-thirds of clinical trial participants. Long-term data on safety, efficacy, and cardiovascular outcomes are awaited. Long-term studies have shown that bariatric surgical procedures typically lead to a durable weight loss of 25% and rapid, sustained improvements in complications of obesity, although they have not yet been compared with new-generation highly effective anti-obesity medications. Further work is required to determine optimal patient-specific treatment strategies, including combinations of lifestyle interventions, anti-obesity medications, endoscopic and bariatric surgical procedures, and to ensure equitable access to effective treatments.
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Affiliation(s)
- Carolina M Perdomo
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; Metabolic Research Laboratory, CIBEROBN, ISCIII, IdiSNA, Clínica Universidad de Navarra, Pamplona, Spain
| | - Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Priya Sumithran
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Karine Clément
- Sorbonne Université, INSERM, Nutrition and obesities: systemic approach research group, Nutriomics, Paris, France; Assistance Publique-Hôpitaux de Paris, Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Gema Frühbeck
- Department of Endocrinology and Nutrition, Clínica Universidad de Navarra, Pamplona, Spain; Metabolic Research Laboratory, CIBEROBN, ISCIII, IdiSNA, Clínica Universidad de Navarra, Pamplona, Spain.
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23
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Petre T, Bauman A, Sumithran P, Sacks G, Lobstein T, Le Roux C, Mullen C, Oldfield B. A better understanding of the science and reality of obesity is urgently needed. Public Health Res Pract 2022; 32:3232220. [PMID: 36220556 DOI: 10.17061/phrp3232220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Efforts to prevent and treat obesity need to be grounded in science. A historical focus on individual responsibility has been ineffective in halting the rise in obesity prevalence. There needs to be a better understanding of environmental and biological drivers of weight gain to help reduce weight bias and stigma and identify more effective policies for action.
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Affiliation(s)
| | - Adrian Bauman
- School of Public Health and Charles Perkins Centre, University of Sydney, NSW, Australia
| | - Priya Sumithran
- University of Melbourne, Department of Medicine (St Vincent's) and Austin Health, Department of Endocrinology, VIC, Australia
| | - Gary Sacks
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Australia
| | - Tim Lobstein
- World Obesity Federation, London, UK; The Boden Initiative, University of Sydney, NSW, Australia
| | - Carel Le Roux
- Conway Institute, University College Dublin, Ireland
| | - Clare Mullen
- Health Consumers' Council WA, Perth, Australia; Weight Issues Network, Australia
| | - Brian Oldfield
- Department of Physiology, Monash University, Victoria, Australia
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24
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Guerrero-Hreins E, Stammers L, Wong L, Brown RM, Sumithran P. A Comparison of Emotional Triggers for Eating in Men and Women with Obesity. Nutrients 2022; 14:nu14194144. [PMID: 36235796 PMCID: PMC9570591 DOI: 10.3390/nu14194144] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Emotional eating (EE) is prevalent in people seeking obesity treatment and is a contributor to poor weight loss outcomes. We aimed to delineate the emotions most associated with this type of eating, and whether they differ by sex in people undergoing obesity treatment. METHODS A cross-sectional study recruiting 387 adults from a hospital obesity management service. Emotional eating was measured using the Emotional Eating Scale (EES). Separate analyses included all participants, and those undergoing lifestyle interventions alone or in combination with obesity medication and/or bariatric surgery. RESULTS A total of 387 people (71% women) participated in the study (n = 187 receiving lifestyle modification alone; n = 200 in combination with additional treatments). Feeling 'bored' was most commonly and most strongly associated with the urge to eat, regardless of sex or treatment. Women had higher scores for total EES, for subscales of depression and anger, and individual feelings of 'blue', 'sad' and 'upset' compared to men. CONCLUSIONS Understanding why certain emotions differentially trigger an urge to eat in men and women, and finding strategies to break the link between boredom and eating may enable better personalisation of lifestyle interventions for people with obesity.
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Affiliation(s)
- Eva Guerrero-Hreins
- Department of Biochemistry and Pharmacology, University of Melbourne, Parkville 3010, Australia;
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville 3010, Australia
| | - Lauren Stammers
- Department of Medicine, Melbourne Medical School, University of Melbourne, Parkville 3010, Australia; (L.S.); (L.W.)
| | - Lisa Wong
- Department of Medicine, Melbourne Medical School, University of Melbourne, Parkville 3010, Australia; (L.S.); (L.W.)
| | - Robyn M. Brown
- Department of Biochemistry and Pharmacology, University of Melbourne, Parkville 3010, Australia;
- Correspondence: (R.M.B.); (P.S.)
| | - Priya Sumithran
- Department of Medicine (St. Vincent’s), University of Melbourne, Fitzroy 3065, Australia
- Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
- Correspondence: (R.M.B.); (P.S.)
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25
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Sketriene D, Battista D, Lalert L, Kraiwattanapirom N, Thai HN, Leeboonngam T, Knackstedt LA, Nithianantharajah J, Sumithran P, Lawrence AJ, Brown RM. Compulsive‐like eating of high‐fat high‐sugar food is associated with ‘addiction‐like’ glutamatergic dysfunction in obesity prone rats. Addict Biol 2022; 27:e13206. [PMID: 36001420 PMCID: PMC9541933 DOI: 10.1111/adb.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/13/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
Chronic overeating is a core feature of diet‐induced obesity. There is increasing evidence that in vulnerable individuals, such overeating could become compulsive, resembling an addictive disorder. The transition to compulsive substance use has been linked with changes at glutamatergic synapses in the nucleus accumbens. In this study, we investigated a potential link between such glutamatergic dysregulation and compulsive‐like eating using a rat model of diet‐induced obesity. A conditioned suppression task demonstrated that diet‐induced obese rats display eating despite negative consequences, as their consumption was insensitive to an aversive cue. Moreover, nucleus accumbens expression of GluA1 and xCT proteins was upregulated in diet‐induced obese animals. Lastly, both a computed ‘addiction score’ (based on performance across three criteria) and weight gain were positively correlated with changes in GluA1 and xCT expression in the nucleus accumbens. These data demonstrate that the propensity for diet‐induced obesity is associated with compulsive‐like eating of highly palatable food and is accompanied by ‘addiction‐like’ glutamatergic dysregulation in the nucleus accumbens, thus providing neurobiological evidence of addiction‐like pathology in this model of obesity.
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Affiliation(s)
- Diana Sketriene
- Mental Health Research Theme The Florey Institute of Neuroscience and Mental Health Parkville Melbourne Australia
- The Florey Department of Neuroscience and Mental Health University of Melbourne Parkville Melbourne Australia
| | - Damien Battista
- Mental Health Research Theme The Florey Institute of Neuroscience and Mental Health Parkville Melbourne Australia
| | - Laddawan Lalert
- Mental Health Research Theme The Florey Institute of Neuroscience and Mental Health Parkville Melbourne Australia
- School of Medicine Walailak University Nakhon Si Thammarat Thailand
| | - Natcharee Kraiwattanapirom
- Mental Health Research Theme The Florey Institute of Neuroscience and Mental Health Parkville Melbourne Australia
- Institute of Molecular Biosciences Mahidol University Nakhon Pathom Thailand
| | - Han Ngoc Thai
- Mental Health Research Theme The Florey Institute of Neuroscience and Mental Health Parkville Melbourne Australia
| | - Tanawan Leeboonngam
- Mental Health Research Theme The Florey Institute of Neuroscience and Mental Health Parkville Melbourne Australia
- The Florey Department of Neuroscience and Mental Health University of Melbourne Parkville Melbourne Australia
| | | | - Jess Nithianantharajah
- Mental Health Research Theme The Florey Institute of Neuroscience and Mental Health Parkville Melbourne Australia
| | - Priya Sumithran
- Department of Medicine (St Vincent's) University of Melbourne Melbourne Australia
- Department of Endocrinology Austin Health Melbourne Australia
| | - Andrew J. Lawrence
- Mental Health Research Theme The Florey Institute of Neuroscience and Mental Health Parkville Melbourne Australia
| | - Robyn M. Brown
- Mental Health Research Theme The Florey Institute of Neuroscience and Mental Health Parkville Melbourne Australia
- The Florey Department of Neuroscience and Mental Health University of Melbourne Parkville Melbourne Australia
- Department of Biochemistry and Pharmacology University of Melbourne Parkville Melbourne Australia
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26
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Nolan BJ, Proietto J, Sumithran P. Single-center real-life experience with testosterone treatment in adult men with Prader-Willi syndrome. Am J Med Genet A 2022; 188:2637-2641. [PMID: 35532976 PMCID: PMC9541274 DOI: 10.1002/ajmg.a.62770] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/16/2022] [Accepted: 04/08/2022] [Indexed: 01/24/2023]
Abstract
Hypogonadism is the most frequent hormonal deficiency in individuals with Prader-Willi syndrome (PWS). This often necessitates testosterone treatment, but limited data are available to guide testosterone treatment in adult men with PWS. We aimed to evaluate the serum testosterone concentrations and adverse effects of testosterone treatment in individuals with PWS attending a specialist obesity management service. A retrospective audit was undertaken at Austin Health, Melbourne between January 2010 and April 2021. Main outcome measures were testosterone formulation and dose, serum total testosterone concentration, and prevalence of polycythemia and behavioral disturbance. Data were available for eight individuals with median baseline age 19 years (range, 19-42) and BMI 37 kg/m2 (range, 27-71). Six men had obstructive sleep apnea; none were smokers. Baseline testosterone concentration was 1.8 nmol/L (IQR, 1.1-3.3) with hematocrit 0.43. Testosterone formulations were intramuscular testosterone undecanoate (TU) 1000 mg (n = 5), transdermal testosterone gel 50 mg daily (n = 1), and oral TU 80-120 mg daily (n = 2). Median total testosterone concentration was 9.7 nmol/L (IQR, 8.5-14.7). Nine of 25 (36%) hematocrit results in six patients measured >0.50 (range, 0.50-0.56). Intramuscular TU was well tolerated and was the only formulation to achieve serum total testosterone concentrations in the adult male reference range. Worsening behavioral disturbance resulted in treatment discontinuation in one individual. Our experience reinforces the need to regular monitoring of hematocrit in men with PWS treated with testosterone. However, a worsening of behavior problems was uncommon in this series.
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Affiliation(s)
- Brendan J. Nolan
- Department of Medicine (Austin Health)University of MelbourneMelbourneVictoria
- Department of EndocrinologyAustin HealthMelbourneVictoria
| | - Joseph Proietto
- Department of Medicine (Austin Health)University of MelbourneMelbourneVictoria
- Department of EndocrinologyAustin HealthMelbourneVictoria
| | - Priya Sumithran
- Department of EndocrinologyAustin HealthMelbourneVictoria
- Department of Medicine (St Vincent's)University of MelbourneMelbourneVictoriaAustralia
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27
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Guerrero-Hreins E, Foldi CJ, Oldfield BJ, Stefanidis A, Sumithran P, Brown RM. Gut-brain mechanisms underlying changes in disordered eating behaviour after bariatric surgery: a review. Rev Endocr Metab Disord 2022; 23:733-751. [PMID: 34851508 DOI: 10.1007/s11154-021-09696-4] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Abstract
Bariatric surgery results in long-term weight loss and an improved metabolic phenotype due to changes in the gut-brain axis regulating appetite and glycaemia. Neuroendocrine alterations associated with bariatric surgery may also influence hedonic aspects of eating by inducing changes in taste preferences and central reward reactivity towards palatable food. However, the impact of bariatric surgery on disordered eating behaviours (e.g.: binge eating, loss-of-control eating, emotional eating and 'addictive eating'), which are commonly present in people with obesity are not well understood. Increasing evidence suggests gut-derived signals, such as appetitive hormones, bile acid profiles, microbiota concentrations and associated neuromodulatory metabolites, can influence pathways in the brain implicated in food intake, including brain areas involved in sensorimotor, reward-motivational, emotional-arousal and executive control components of food intake. As disordered eating prevalence is a key mediator of weight-loss success and patient well-being after bariatric surgery, understanding how changes in the gut-brain axis contribute to disordered eating incidence and severity after bariatric surgery is crucial to better improve treatment outcomes in people with obesity.
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Affiliation(s)
- Eva Guerrero-Hreins
- Department of Biochemistry and Pharmacology, University of Melbourne, Parkville, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Claire J Foldi
- Department of Physiology, Monash University, Clayton, Melbourne, Australia
- Biomedicine Discovery Institute, Monash University, Clayton, Melbourne, Australia
| | - Brian J Oldfield
- Department of Physiology, Monash University, Clayton, Melbourne, Australia
- Biomedicine Discovery Institute, Monash University, Clayton, Melbourne, Australia
| | - Aneta Stefanidis
- Department of Physiology, Monash University, Clayton, Melbourne, Australia
- Biomedicine Discovery Institute, Monash University, Clayton, Melbourne, Australia
| | - Priya Sumithran
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Australia
- Department of Endocrinology, Austin Health, Melbourne, Australia
| | - Robyn M Brown
- Department of Biochemistry and Pharmacology, University of Melbourne, Parkville, Melbourne, Australia.
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Melbourne, Australia.
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Bennell KL, Jones SE, Hinman RS, McManus F, Lamb KE, Quicke JG, Sumithran P, Prendergast J, George ES, Holden MA, Foster NE, Allison K. Effectiveness of a telehealth physiotherapist-delivered intensive dietary weight loss program combined with exercise in people with knee osteoarthritis and overweight or obesity: study protocol for the POWER randomized controlled trial. BMC Musculoskelet Disord 2022; 23:733. [PMID: 35907828 PMCID: PMC9338658 DOI: 10.1186/s12891-022-05685-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obesity is associated with knee osteoarthritis (OA). Weight loss, alongside exercise, is a recommended treatment for individuals with knee OA and overweight/obesity. However, many patients cannot access weight loss specialists such as dietitians. Innovative care models expanding roles of other clinicians may increase access to weight loss support for people with knee OA. Physiotherapists may be well placed to deliver such support. This two-group parallel, superiority randomized controlled trial aims to compare a physiotherapist-delivered diet and exercise program to an exercise program alone, over 6 months. The primary hypothesis is that the physiotherapist-delivered diet plus exercise program will lead to greater weight loss than the exercise program. METHODS 88 participants with painful knee OA and body mass index (BMI) > 27 kg/m2 will be recruited from the community. Following baseline assessment, participants will be randomised to either exercise alone or diet plus exercise groups. Participants in the exercise group will have 6 consultations (20-30 min) via videoconference with a physiotherapist over 6 months for a strengthening exercise program, physical activity plan and educational/exercise resources. Participants in the diet plus exercise group will have 6 consultations (50-75 min) via videoconference with a physiotherapist prescribing a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating, plus the intervention of the exercise only group. Outcomes are measured at baseline and 6 months. The primary outcome is percentage change in body weight measured by a blinded assessor. Secondary outcomes include self-reported knee pain, physical function, global change in knee problems, quality of life, physical activity levels, and internalised weight stigma, as well as BMI, waist circumference, waist-to-hip ratio, physical performance measures and quadriceps strength, measured by a blinded assessor. Additional measures include adherence, adverse events, fidelity and process measures. DISCUSSION This trial will determine whether a physiotherapist-delivered diet plus exercise program is more effective for weight loss than an exercise only program. Findings will inform the development and implementation of innovative health service models addressing weight management and exercise for patients with knee OA and overweight/obesity. TRIAL REGISTRATION NIH US National Library of Medicine, Clinicaltrials.gov NCT04733053 (Feb 1 2021).
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia.
| | - Sarah E Jones
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Fiona McManus
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Karen E Lamb
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Methods and Implementation Support for Clinical Health research Hub, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jonathan G Quicke
- School of Medicine, Keele University, Keele, UK.,Chartered Society of Physiotherapy, Chancery Exchange, London, UK
| | - Priya Sumithran
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | | | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | | | - Nadine E Foster
- School of Medicine, Keele University, Keele, UK.,STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Brisbane, Australia
| | - Kim Allison
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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Lingvay I, Sumithran P, Cohen RV, Roux CWL. Obesity definition for personalised treatment of type 2 diabetes Authors' reply. Lancet 2022; 399:2189-2190. [PMID: 35691319 DOI: 10.1016/s0140-6736(22)00890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/06/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Ildiko Lingvay
- Division of Endocrinology, Department of Internal Medicine and Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390-9302, USA.
| | - Priya Sumithran
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, Sao Paulo, Brazil
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, Dublin, Ireland; Diabetes Research Centre, Ulster University, Coleraine, UK
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Nolan BJ, Proietto J, Sumithran P. Intensive management of obesity in people with Prader-Willi syndrome. Endocrine 2022; 77:57-62. [PMID: 35524875 PMCID: PMC9242929 DOI: 10.1007/s12020-022-03064-1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Prader-Willi syndrome (PWS) is characterised by childhood-onset hyperphagia and obesity however limited data are available to guide treatment of obesity in this population. We aimed to evaluate the safety, tolerability, and efficacy of intensive medical weight loss interventions (very-low-energy diets [VLED] and/or pharmacotherapy) in individuals with PWS attending a specialist obesity management service. METHODS A retrospective audit was undertaken of individuals with PWS attending the Austin Health Weight Control Clinic between January 2010-April 2021. Main outcome measures were weight outcomes, duration of use, and adverse effects. RESULTS Data were available for 18 patients, of whom 15 were treated with intensive weight loss interventions. Median (interquartile range, IQR) age at baseline was 20 years (19-32) with median body weight 90 kg (75-118) and BMI 37 kg/m2 (30-51). Median weight loss during VLED (n = 7) was 14 kg (1-20 kg) over 60 weeks. Median weight loss with phentermine-topiramate (n = 7) was 17 kg (IQR 9-19 kg) over 56 weeks. Median weight loss with liraglutide 0.6-3 mg (n = 7), prescribed with topiramate in 3 individuals, was 9 kg (2-14 kg) over 96 weeks. Naltrexone-bupropion resulted in weight loss in 2 of 4 individuals. Thirteen individuals achieved ≥10% weight loss but only 5 individuals maintained ≥10% weight loss at last follow-up. Five individuals discontinued pharmacotherapy due to adverse effects. CONCLUSIONS VLED and pharmacotherapy can achieve substantial weight loss in some individuals with PWS though non-adherence results in substantial weight regain. Adverse effects were ascribed to phentermine and topiramate, whereas liraglutide was well-tolerated in this population.
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Affiliation(s)
- Brendan J Nolan
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, VIC, Australia.
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia.
| | - Joseph Proietto
- Department of Medicine (Austin Health), University of Melbourne, Melbourne, VIC, Australia
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Priya Sumithran
- Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, VIC, Australia
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Tan A, Wilson S, Sumithran P. The application of body mass index-based eligibility criteria may represent an unjustified barrier to renal transplantation in people with obesity. Clin Obes 2022; 12:e12505. [PMID: 34964256 DOI: 10.1111/cob.12505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 12/22/2022]
Abstract
The prevalence of both obesity and end-stage kidney disease is increasing. In many centres, obesity is considered a relative contraindication to kidney transplantation due to an association with short- and longer-term adverse outcomes. This leads to delayed transplant waitlisting and longer organ waiting times for people with obesity. This review evaluates whether intentional pre-transplant weight loss in people with obesity improves kidney transplant outcomes. There are currently no data showing that non-surgical weight loss of 10% or more improves graft or patient survival over 4-5 years. Outcomes from bariatric surgery cohorts have been generally neutral or favourable after pre-transplant weight loss of ~25%. Given the survival benefit of kidney transplantation compared to maintenance dialysis, and the difficulty of achieving and maintaining weight loss, the common practice of recommending weight loss to achieve arbitrary targets prior to waiting list activation needs to be carefully considered.
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Affiliation(s)
- Alanna Tan
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Scott Wilson
- Department of Nephrology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Priya Sumithran
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Victoria, Australia
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Edwards KL, Prendergast LA, Kalfas S, Sumithran P, Proietto J. Impact of starting BMI and degree of weight loss on changes in appetite-regulating hormones during diet-induced weight loss. Obesity (Silver Spring) 2022; 30:911-919. [PMID: 35253406 PMCID: PMC9310603 DOI: 10.1002/oby.23404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether the hormone changes following weight loss are proportional to the degree of weight loss and to starting BMI. METHODS A very low-energy diet was used to achieve 15% weight loss. Fasting and postprandial gut hormones and leptin were measured during a meal test at baseline and at 5% (1%), 10% (2%), and 15% (2.5%) weight loss. Linear mixed-effects models were used to analyze hormone changes. RESULTS From baseline to 5% weight loss, decreases were seen in fasting concentrations of leptin (-8.25 ng/mL; p < 0.001), amylin (-21.3 pg/mL; p < 0.001), and glucagon-like peptide 1 (-59.55 pg/mL; p < 0.001). There was a small further reduction in leptin between 5% and 15% weight loss (-1.88 ng/mL; p = 0.019) but not in glucagon-like peptide 1 and amylin. Fasting ghrelin showed a significant increase at 10% weight loss (41.64 pg/mL; p = 0.002), with a nonsignificant increase from 10% to 15% loss (26.03 pg/mL; p = 0.065). Postprandial changes in hormone levels were variable. There was no correlation between baseline weight and the degree of hormone changes. CONCLUSIONS The majority of changes in fasting gut hormones and leptin occurred in early weight loss, with minor further changes up to 15% weight loss. Starting weight did not affect the degree of hormone change.
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Affiliation(s)
- Kira‐Ann L. Edwards
- Department of Medicine (Austin Health)University of MelbourneMelbourneVictoriaAustralia
| | - Luke A. Prendergast
- Department of Mathematics and StatisticsLa Trobe UniversityMelbourneVictoriaAustralia
| | - Stefanie Kalfas
- Department of Medicine (Austin Health)University of MelbourneMelbourneVictoriaAustralia
| | - Priya Sumithran
- Department of Medicine (St Vincent’s)University of MelbourneMelbourneVictoriaAustralia
| | - Joseph Proietto
- Department of Medicine (Austin Health)University of MelbourneMelbourneVictoriaAustralia
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Hall M, Hinman RS, Knox G, Spiers L, Sumithran P, Murphy NJ, McManus F, Lamb KE, Cicuittini F, Hunter DJ, Messier SP, Bennell KL. Effects of adding a diet intervention to exercise on hip osteoarthritis pain: protocol for the ECHO randomized controlled trial. BMC Musculoskelet Disord 2022; 23:215. [PMID: 35248012 PMCID: PMC8898434 DOI: 10.1186/s12891-022-05128-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hip osteoarthritis (OA) is a leading cause of musculoskeletal pain. Exercise is a core recommended treatment. Despite some clinical guidelines also recommending weight loss for hip OA, there is no evidence from randomised controlled trials (RCT) to substantiate these recommendations. This superiority, 2-group, parallel RCT will compare a combined diet and exercise program to an exercise only program, over 6 months. Methods One hundred people with symptomatic and radiographic hip OA will be recruited from the community. Following baseline assessment, participants will be randomly allocated to either, i) diet and exercise or; ii) exercise only. Participants in the diet and exercise group will have six consultations with a dietitian and five consultations with a physiotherapist via videoconferencing over 6 months. The exercise only group will have five consultations with a physiotherapist via videoconferencing over 6 months. The exercise program for both groups will include prescription of strengthening exercise and a physical activity plan, advice about OA management and additional educational resources. The diet intervention includes prescription of a ketogenic very low-calorie diet with meal replacements and educational resources to support weight loss and healthy eating. Primary outcome is self-reported hip pain via an 11-point numeric rating scale (0 = ‘no pain’ and 10 = ‘worst pain possible’) at 6 months. Secondary outcomes include self-reported body weight (at 0, 6 and 12 months) and body mass index (at 0, 6 and 12 months), visceral fat (measured using dual energy x-ray absorptiometry at 0 and 6 months), pain, physical function, quality of life (all measured using subscales of the Hip Osteoarthritis Outcome Scale at 0, 6 and 12 months), and change in pain and physical activity (measured using 7-point global rating of change Likert scale at 6 and 12 months). Additional measures include adherence, adverse events and cost-effectiveness. Discussion This study will determine whether a diet intervention in addition to exercise provides greater hip pain-relief, compared to exercise alone. Findings will assist clinicians in providing evidence-based advice regarding the effect of a dietary intervention on hip OA pain. Trial registration ClinicalTrials.gov . Identifier: NCT04825483. Registered 31st March 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05128-9.
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Bennell KL, Lawford BJ, Keating C, Brown C, Kasza J, Mackenzie D, Metcalf B, Kimp AJ, Egerton T, Spiers L, Proietto J, Sumithran P, Harris A, Quicke JG, Hinman RS. Comparing Video-Based, Telehealth-Delivered Exercise and Weight Loss Programs With Online Education on Outcomes of Knee Osteoarthritis : A Randomized Trial. Ann Intern Med 2022; 175:198-209. [PMID: 34843383 DOI: 10.7326/m21-2388] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Scalable knee osteoarthritis programs are needed to deliver recommended education, exercise, and weight loss interventions. OBJECTIVE To evaluate two 6-month, telehealth-delivered exercise programs, 1 with and 1 without dietary intervention. DESIGN 3-group, parallel randomized (5:5:2) trial. (Australian New Zealand Clinical Trials Registry: ACTRN12618000930280). SETTING Australian private health insurance members. PARTICIPANTS 415 persons with symptomatic knee osteoarthritis and a body mass index between 28 and 40 kg/m2 who were aged 45 to 80 years. INTERVENTION All groups received access to electronic osteoarthritis information (control). The exercise program comprised 6 physiotherapist consultations via videoconference for exercise, self-management advice, and behavioral counseling, plus exercise equipment and resources. The diet and exercise program included an additional 6 dietitian consultations for a ketogenic very-low-calorie diet (2 formulated meal replacements and a low-carbohydrate meal daily) followed by a transition to healthy eating, as well as nutrition and behavioral resources. MEASUREMENTS Primary outcomes were changes in knee pain (numerical rating scale [NRS] of 0 to 10, higher indicating worse) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]; scale, 0 to 68, higher indicating worse) at 6 months (primary time point) and 12 months. Secondary outcomes were weight, physical activity, quality of life, mental health, global change, satisfaction, willingness to have surgery, orthopedic appointments, and knee surgery. RESULTS A total of 379 participants (91%) provided 6-month primary outcomes, and 372 (90%) provided 12-month primary outcomes. At 6 months, both programs were superior to control for pain (between-group mean difference in change on NRS: diet and exercise, -1.5 [95% CI, -2.1 to -0.8]; exercise, -0.8 [CI, -1.5 to -0.2]) and function (between-group mean difference in change on WOMAC: diet and exercise, -9.8 [CI, -12.5 to -7.0]; exercise, -7.0 [CI, -9.7 to -4.2]). The diet and exercise program was superior to exercise (pain, -0.6 [CI, -1.1 to -0.2]; function, -2.8 [CI, -4.7 to -0.8]). Findings were similar at 12 months. LIMITATION Participants and clinicians were unblinded. CONCLUSION Telehealth-delivered exercise and diet programs improved pain and function in people with knee osteoarthritis and overweight or obesity. A dietary intervention conferred modest additional pain and function benefits over exercise. PRIMARY FUNDING SOURCE Medibank, the Medibank Better Health Foundation Research Fund, and a National Health and Medical Research Council Centre of Research Excellence.
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Belinda J Lawford
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | | | | | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.K.)
| | - Dave Mackenzie
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Ben Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Alexander J Kimp
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Thorlene Egerton
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Libby Spiers
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
| | - Joseph Proietto
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia (J.P., P.S.)
| | - Priya Sumithran
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia (J.P., P.S.)
| | - Anthony Harris
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia (A.H.)
| | - Jonathan G Quicke
- School of Medicine, Keele University, Keele, United Kingdom (J.G.Q.)
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia (K.L.B., B.J.L., D.M., B.M., A.J.K., T.E., L.S., R.S.H.)
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Lingvay I, Sumithran P, Cohen RV, le Roux CW. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. Lancet 2022; 399:394-405. [PMID: 34600604 DOI: 10.1016/s0140-6736(21)01919-x] [Citation(s) in RCA: 178] [Impact Index Per Article: 89.0] [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: 05/06/2021] [Revised: 08/05/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
Obesity is now recognised as a disease that is associated with serious morbidity and increased mortality. One of its main metabolic complications is type 2 diabetes, as the two conditions share key pathophysiological mechanisms. Weight loss is known to reverse the underlying metabolic abnormalities of type 2 diabetes and, as such, improve glucose control; loss of 15% or more of bodyweight can have a disease-modifying effect in people with type 2 diabetes, an outcome that is not attainable by any other glucose-lowering intervention. Furthermore, weight loss in this population exerts benefits that extend beyond glycaemic control to improve risk factors for cardiometabolic disease and quality of life. We review the evidence supporting the role of weight loss in the management of type 2 diabetes and propose that many patients with type 2 diabetes would benefit from having a primary weight-centric approach to diabetes treatment. We discuss the logistical challenges to implementing a new weight-centric primary treatment goal in people with type 2 diabetes.
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Affiliation(s)
- Ildiko Lingvay
- Division of Endocrinology, Department of Internal Medicine and Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Priya Sumithran
- Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia
| | - Ricardo V Cohen
- The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine, University College Dublin, Dublin, Ireland; Diabetes Research Centre, Ulster University, Coleraine, UK
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Allison K, Jones S, Hinman RS, Briggs AM, Sumithran P, Quicke J, Holden M, Chiavaroli N, Crofts S, George E, Foster N, Bennell K. Effects of an Online Education Program on Physical Therapists' Confidence in Weight Management for People With Osteoarthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2021; 75:835-847. [PMID: 34931477 DOI: 10.1002/acr.24828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/20/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate effects of an online education program about weight management for osteoarthritis on physical therapists' self-reported confidence in knowledge and skills in weight management and attitudes toward obesity. METHODS In a 2-group randomized controlled trial, 80 physical therapists (58 female physical therapists) were randomized to education or control groups. The theoretically informed and evidence-informed online self-directed training program covered biopsychosocial elements of obesity and weight management. The primary outcome was self-reported confidence in knowledge in weight management using a customized validated tool (scale 14-70, higher scores indicating higher confidence) assessed at baseline and 6 weeks. Secondary measures included confidence in nutrition care, clinical skills in weight management, and weight stigma. Process measures evaluated participant experience. Differences in change between groups were compared using linear regression models adjusted for baseline scores and stratifying variables (clinical setting; confidence in weight management). Moderation analysis was performed using an interaction approach in a linear regression model and multivariable fractional polynomial interaction approach. RESULTS A total of 79 participants (99%) completed outcome measures at 6 weeks. The education group demonstrated greater improvement in confidence in knowledge than the control group (adjusted mean difference 22.6 units, 95% confidence interval 19.6, 25.5). Greater improvement in knowledge was associated with lower baseline values (interaction P = 0.002). Secondary outcomes showed greater improvements in confidence in skills and nutrition care and in weight stigma domains favoring the education group. Over 90% of participants would recommend the program to peers. CONCLUSION An online education program improves physical therapists' short-term confidence in knowledge and skills in weight management for people with osteoarthritis and reduces weight-stigmatized attitudes.
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Affiliation(s)
- Kim Allison
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Jones
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew M Briggs
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | | | - Jonathan Quicke
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Melanie Holden
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK
| | - Neville Chiavaroli
- Australian Council for Educational Research, Camberwell, Victoria, Australia
| | - Sam Crofts
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elena George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Nadine Foster
- Primary Care Centre Versus Arthritis, Keele University, Keele, UK, and Surgical Treatment and Rehabilitation Service, The University of Queensland and Metro North Health, Herston, Queensland, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Stammers L, Wong L, Churilov L, Price S, Ekinci E, Sumithran P. Comparison of two questionnaires for assessment of emotional eating in people undergoing treatment for obesity. Eat Weight Disord 2021; 26:2353-2360. [PMID: 33392954 DOI: 10.1007/s40519-020-01084-2] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Emotional eating may contribute to weight gain and difficulty with weight loss. Questionnaires are currently the primary method used to identify this behaviour but there is no gold standard for detecting emotional eating, making it difficult to know which questionnaire to use for this purpose. This study assesses two questionnaires validated for assessment of emotional eating in patients with obesity, with the aim of investigating their interchangeability in the clinical setting. METHODS 387 adult participants were recruited from the obesity treatment service at a tertiary metropolitan hospital. Responses were obtained for the 25-item Emotional Eating Scale (EES) and the 4-item coping subscale of the Palatable Eating Motives Scale (PEMS). Agreement was analysed using quadratically weighted Cohen's κ scores. Substantial agreement was defined as κ 0.61-0.80. RESULTS The median (interquartile range) body mass index and age of participants was 42.1 kg/m2 (36.4-48.9 kg/m2) and 51.6 years (41.1-61.4 years), respectively, and 70.5% of participants were female. The EES and PEMS were found to have substantial agreement (κ 0.71; 95% CI 0.65-0.76). Agreement remained substantial when analysing responses from men (0.61; 95% CI 0.47-0.73), women (0.73; 95% CI 0.67-0.79) and post-bariatric surgery patients (0.72; 95% CI 0.62-0.82) separately. CONCLUSION Despite focusing on different elements of emotional eating behaviour, the substantial agreement between the EES and PEMS coping subscale suggests that they identify respondents' susceptibility to emotional eating with consistency, including in people who have undergone bariatric surgery. LEVEL V Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees. CLINICAL TRIAL REGISTRATION This observational study has not been registered as a clinical trial.
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Affiliation(s)
- Lauren Stammers
- Department of Medicine (Austin Health), University of Melbourne, 145 Studley Road, Heidelberg, VIC, Australia.,Department of Endocrinology, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
| | - Lisa Wong
- Department of Medicine (Austin Health), University of Melbourne, 145 Studley Road, Heidelberg, VIC, Australia.,Department of Endocrinology, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health), University of Melbourne, 145 Studley Road, Heidelberg, VIC, Australia
| | - Sarah Price
- Department of Medicine (Austin Health), University of Melbourne, 145 Studley Road, Heidelberg, VIC, Australia
| | - Elif Ekinci
- Department of Medicine (Austin Health), University of Melbourne, 145 Studley Road, Heidelberg, VIC, Australia.,Department of Endocrinology, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, 145 Studley Road, Heidelberg, VIC, Australia. .,Department of Endocrinology, Austin Health, 300 Waterdale Road, Heidelberg Heights, VIC, 3081, Australia.
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Brown RM, Guerrero-Hreins E, Brown WA, le Roux CW, Sumithran P. Potential gut-brain mechanisms behind adverse mental health outcomes of bariatric surgery. Nat Rev Endocrinol 2021; 17:549-559. [PMID: 34262156 DOI: 10.1038/s41574-021-00520-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Accepted: 06/03/2021] [Indexed: 02/06/2023]
Abstract
Bariatric surgery induces sustained weight loss and metabolic benefits via notable effects on the gut-brain axis that lead to alterations in the neuroendocrine regulation of appetite and glycaemia. However, in a subset of patients, bariatric surgery is associated with adverse effects on mental health, including increased risk of suicide or self-harm as well as the emergence of depression and substance use disorders. The contributing factors behind these adverse effects are not well understood. Accumulating evidence indicates that there are important links between gut-derived hormones, microbial and bile acid profiles, and disorders of mood and substance use, which warrant further exploration in the context of changes in gut-brain signalling after bariatric surgery. Understanding the basis of these adverse effects is essential in order to optimize the health and well-being of people undergoing treatment for obesity.
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Affiliation(s)
- Robyn M Brown
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Eva Guerrero-Hreins
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Wendy A Brown
- Department of Surgery, Central Clinical School, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, School of Medicine and Medical Sciences, University College, Dublin, Ireland
| | - Priya Sumithran
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Victoria, Australia.
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.
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Hall M, Spiers L, Knox G, Hinman RS, Sumithran P, Bennell KL. Feasibility of exercise and weight management for people with hip osteoarthritis and overweight or obesity: A pilot study. Osteoarthritis and Cartilage Open 2021; 3:100174. [DOI: 10.1016/j.ocarto.2021.100174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 12/30/2022] Open
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Price SAL, Sumithran P, Nankervis AJ, Permezel M, Prendergast LA, Proietto J. Impact of preconception weight loss on fasting glucose and pregnancy outcomes in women with obesity: A randomized trial. Obesity (Silver Spring) 2021; 29:1445-1457. [PMID: 34431233 DOI: 10.1002/oby.23200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/17/2020] [Revised: 04/04/2021] [Accepted: 04/13/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined the effectiveness of a nonsurgical, preconception weight loss intervention on pregnancy outcomes in women with obesity. METHODS This was a two-arm, parallel-group randomized controlled trial. A total of 164 women with BMI 30 to 55 kg/m2 who were aged 18 to 38 years and planning pregnancy were randomized to a 12-week standard dietary intervention (SDI; n = 79) or a modified very low-energy diet (VLED; n = 85). Participants were observed for ≤48 weeks while trying for pregnancy and then during pregnancy. The primary outcome was maternal fasting plasma glucose at 26 to 28 weeks' gestation. Exploratory outcomes were individual and composite obesity-related adverse pregnancy outcomes. RESULTS Weight loss was greater in the VLED group (SDI 3.2 [0.6] kg vs. VLED 13.0 [0.5] kg, p < 0.01). In completers who had a singleton live birth (SDI 22/79 vs. VLED 35/85, p = 0.10), there was no difference in fasting glucose at 26 to 28 weeks' gestation (SDI 4.8[0.2] mmol/L vs. VLED 4.6 [0.1] mmol/L, p = 0.42). However, the composite of adverse pregnancy outcomes was significantly lower in the VLED group (p < 0.001). CONCLUSIONS Substantial prepregnancy weight loss in women with obesity does not alter fasting glucose at 26 to 28 weeks' gestation but does reduce a composite of adverse pregnancy outcomes. A better understanding of metabolic changes in pregnancy after preconception weight loss may assist in improving maternal and neonatal health outcomes.
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Affiliation(s)
- Sarah A L Price
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
- Department of Endocrinology (Austin Health), Heidelberg Heights, Victoria, Australia
| | - Alison J Nankervis
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Michael Permezel
- Department of Obstetrics and Gynaecology, Mercy Hospital, Heidelberg, Victoria, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Joseph Proietto
- Department of Medicine (Austin Health), University of Melbourne, Heidelberg Heights, Victoria, Australia
- Department of Endocrinology (Austin Health), Heidelberg Heights, Victoria, Australia
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Guerrero-Hreins E, Goldstone AP, Brown RM, Sumithran P. The therapeutic potential of GLP-1 analogues for stress-related eating and role of GLP-1 in stress, emotion and mood: a review. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110303. [PMID: 33741445 DOI: 10.1016/j.pnpbp.2021.110303] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/19/2021] [Accepted: 03/09/2021] [Indexed: 01/11/2023]
Abstract
Stress and low mood are powerful triggers for compulsive overeating, a maladaptive form of eating leading to negative physical and mental health consequences. Stress-vulnerable individuals, such as people with obesity, are particularly prone to overconsumption of high energy foods and may use it as a coping mechanism for general life stressors. Recent advances in the treatment of obesity and related co-morbidities have focused on the therapeutic potential of anorexigenic gut hormones, such as glucagon-like peptide 1 (GLP-1), which acts both peripherally and centrally to reduce energy intake. Besides its appetite suppressing effect, GLP-1 acts on areas of the brain involved in stress response and emotion regulation. However, the role of GLP-1 in emotion and stress regulation, and whether it is a viable treatment for stress-induced compulsive overeating, has yet to be established. A thorough review of the pre-clinical literature measuring markers of stress, anxiety and mood after GLP-1 exposure points to potential divergent effects based on temporality. Specifically, acute GLP-1 injection consistently stimulates the physiological stress response in rodents whereas long-term exposure indicates anxiolytic and anti-depressive benefits. However, the limited clinical evidence is not as clear cut. While prolonged GLP-1 analogue treatment in people with type 2 diabetes improved measures of mood and general psychological wellbeing, the mechanisms underlying this may be confounded by associated weight loss and improved blood glucose control. There is a paucity of longitudinal clinical literature on mechanistic pathways by which stress influences eating behavior and how centrally-acting gut hormones such as GLP-1, can modify these. (250).
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Affiliation(s)
- Eva Guerrero-Hreins
- The Florey Institute of Neuroscience and Mental Health, Mental Health Theme, Parkville, Melbourne, Australia; The Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Melbourne, Australia; PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Anthony P Goldstone
- PsychoNeuroEndocrinology Research Group, Centre for Neuropsychopharmacology, Division of Psychiatry, and Computational, Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Robyn M Brown
- The Florey Institute of Neuroscience and Mental Health, Mental Health Theme, Parkville, Melbourne, Australia; The Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Melbourne, Australia
| | - Priya Sumithran
- Department of Medicine (St Vincent's), University of Melbourne, Victoria, Australia; Dept. of Endocrinology, Austin Health, Victoria, Australia.
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Song R, Nolan BJ, Harb H, Sumithran P. Intensive management of obesity in people with severe chronic kidney disease: A review. Diabetes Obes Metab 2021; 23:1733-1745. [PMID: 33904629 DOI: 10.1111/dom.14409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/06/2021] [Accepted: 04/22/2021] [Indexed: 12/24/2022]
Abstract
Obesity is highly prevalent worldwide, including among people with chronic kidney disease (CKD). The presence of severe and/or end-stage kidney disease complicates the treatment of obesity for several reasons, including restrictions on protein and fluid intake and renal excretion of several medications indicated for the treatment of obesity. The aim of this review is to assess the safety of intensive obesity treatments, such as very-low-energy diets (VLEDs), obesity pharmacotherapy and/or bariatric surgery, in people with end-stage kidney disease. A literature search was conducted to identify studies reporting safety outcomes for VLEDs, liraglutide, phentermine, phentermine-topiramate, naltrexone-bupropion and bariatric surgery in people with an estimated glomerular filtration rate of less than 30 mL/min/1.73m2 or on dialysis. Limited data were insufficient to recommend VLEDs but highlighted their potential efficacy and the need for close clinical and biochemical monitoring. There were no data regarding centrally acting obesity pharmacotherapy in this population, although some glucagon-like peptide-1 analogues appear to safely induce weight loss at doses used for the treatment of type 2 diabetes. Some studies suggest an increased rate of complications of bariatric surgery in individuals with severe or end-stage CKD. Further prospective evaluation of intensive obesity management in the growing population with obesity and severe, end-stage and dialysis-dependent CKD is required.
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Affiliation(s)
- Richard Song
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Brendan J Nolan
- Department of Medicine (Austin), University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Hecham Harb
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Priya Sumithran
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Victoria, Australia
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Sketriene D, Battista D, Perry CJ, Sumithran P, Lawrence AJ, Brown RM. N-acetylcysteine reduces addiction-like behaviour towards high-fat high-sugar food in diet-induced obese rats. Eur J Neurosci 2021; 54:4877-4887. [PMID: 34028895 DOI: 10.1111/ejn.15321] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/05/2021] [Accepted: 05/20/2021] [Indexed: 01/15/2023]
Abstract
Compulsive forms of eating displayed by some obese individuals share similarities with compulsive drug-taking behaviour, a hallmark feature of substance use disorder. This raises the possibility that drug addiction treatments may show utility in the treatment of compulsive overeating. N-Acetylcysteine (NAC) is a cysteine pro-drug which has experienced some success in clinical trials, reducing cocaine, marijuana and cigarette use, as well as compulsive behaviours such as gambling and trichotillomania. We assessed the impact of NAC on addiction-like behaviour towards highly palatable food in a rat model of diet-induced obesity. Adult male Sprague-Dawley rats were placed on a high-fat high-sugar diet for 8 weeks and then assigned to diet-induced obesity-prone (DIO) or diet-induced obesity-resistant (DR) groups based on weight gain. DIO and DR rats were subjected to an operant conditioning paradigm whereby rats could lever press for high-fat high-sugar food pellets. This alternated with periods of signalled reward unavailability. Before treatment DIO rats ate more in their home cage, earned more food pellets in operant sessions, and responded more during periods that signalled reward unavailability (suggestive of compulsive-like food seeking) compared with DR rats. This persistent responding in the absence of reward displayed by DIO rats was ameliorated by daily injections of NAC (100 mg/kg, i.p.) for 14 days. By the end of the treatment period, lever-pressing by NAC-treated DIO rats resembled that of DR rats. These findings suggest that NAC reduces addiction-like behaviour towards food in rats and supports the potential use of this compound in compulsive overeating.
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Affiliation(s)
- Diana Sketriene
- The Florey Institute of Neuroscience and Mental Health, Mental Health Research Theme, Parkville/Melbourne, Victoria, Australia.,The Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville/Melbourne, Victoria, Australia
| | - Damien Battista
- The Florey Institute of Neuroscience and Mental Health, Mental Health Research Theme, Parkville/Melbourne, Victoria, Australia
| | - Christina J Perry
- The Florey Institute of Neuroscience and Mental Health, Mental Health Research Theme, Parkville/Melbourne, Victoria, Australia
| | - Priya Sumithran
- Department of Medicine (Austin), University of Melbourne, Melbourne, Victoria, Australia.,Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
| | - Andrew J Lawrence
- The Florey Institute of Neuroscience and Mental Health, Mental Health Research Theme, Parkville/Melbourne, Victoria, Australia
| | - Robyn M Brown
- The Florey Institute of Neuroscience and Mental Health, Mental Health Research Theme, Parkville/Melbourne, Victoria, Australia.,The Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville/Melbourne, Victoria, Australia
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Whatnall M, Skinner J, Verdejo-Garcia A, Carter A, Brown RM, Andrews ZB, Dayas CV, Hardman CA, Loxton N, Sumithran P, Burrows T. Symptoms of Addictive Eating: What Do Different Health Professions Think? Behav Sci (Basel) 2021; 11:bs11050060. [PMID: 33925846 PMCID: PMC8145409 DOI: 10.3390/bs11050060] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
The symptoms of addictive eating are often debated, with some overlap in symptoms with substance addictions or other disorders such as binge eating disorder. This study explored the levels of agreement with symptoms of addictive eating among different health professions, the conditions they provide advice for, and the population group/s they work with. An online cross-sectional survey was conducted in February-April 2020 including 142 health professionals (87% female, 65% residing in Australia, 28% each working in private practice/hospital settings). Of these, 47% were dietitians, 20% psychologists/psychotherapists/counsellors, 16% other health practitioners (e.g., social workers), 13% health researchers, and 5% medical professionals. Agreement with 11 statements relating to addictive eating symptoms was assessed on a scale of 1/strongly disagree to 5/strongly agree (e.g., certain foods produce physiological effects in the brain rewards system). Differences in agreement by health profession were assessed by one-way analysis of variance. There were significant differences in agreement with individual statements between health professions. Psychologists, psychotherapists, and counsellors reported lower agreement to statements relating to physiological effects in the reward system, withdrawal symptoms, and over-eating to alleviate stress/anxiety, than other professions (p < 0.05). Those providing advice for disordered eating only reported lower agreement across statements compared with those providing advice for overweight/obesity or both (p < 0.001). There were minimal differences based on the population group/s that health professionals work with. There is some agreement among health professionals regarding addictive eating symptoms, however, this differs by profession and the conditions they treat. This study provides a novel perspective on health professionals' views on addictive eating symptoms, and there is a need for more research to explore the concepts further.
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Affiliation(s)
- Megan Whatnall
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (M.W.); (J.S.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Janelle Skinner
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (M.W.); (J.S.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia; (A.V.-G.); (A.C.)
| | - Adrian Carter
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia; (A.V.-G.); (A.C.)
| | - Robyn M. Brown
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; (R.M.B.); (Z.B.A.)
| | - Zane B. Andrews
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; (R.M.B.); (Z.B.A.)
- Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, VIC 3800, Australia
| | - Chris V. Dayas
- School of Biomedical Sciences & Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW 2305, Australia
| | - Charlotte A. Hardman
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK;
| | - Natalie Loxton
- School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia;
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD 4072, Australia
| | - Priya Sumithran
- Department of Medicine (Austin), University of Melbourne, Heidelberg, VIC 3084, Australia;
- Department of Endocrinology, Austin Health, Heidelberg Heights, VIC 3081, Australia
| | - Tracy Burrows
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (M.W.); (J.S.)
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence:
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Muthmainah M, Gogos A, Sumithran P, Brown RM. Orexins (hypocretins): The intersection between homeostatic and hedonic feeding. J Neurochem 2021; 157:1473-1494. [PMID: 33608877 DOI: 10.1111/jnc.15328] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022]
Abstract
Orexins are hypothalamic neuropeptides originally discovered to play a role in the regulation of feeding behaviour. The broad connections of orexin neurons to mesocorticolimbic circuitry suggest they may play a role in mediating reward-related behaviour beyond homeostatic feeding. Here, we review the role of orexin in a variety of eating-related behaviour, with a focus on reward and motivation, and the neural circuits driving these effects. One emerging finding is the involvement of orexins in hedonic and appetitive behaviour towards palatable food, in addition to their role in homeostatic feeding. This review discusses the brain circuitry and possible mechanisms underlying the role of orexins in these behaviours. Overall, there is a marked bias in the literature towards studies involving male subjects. As such, future work needs to be done to involve female subjects. In summary, orexins play an important role in driving motivation for high salient rewards such as highly palatable food and may serve as the intersection between homeostatic and hedonic feeding.
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Affiliation(s)
- Muthmainah Muthmainah
- The Florey Institute of Neuroscience and Mental Health, Mental Health Research Theme, Parkville, Melbourne, Vic., Australia.,The Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Melbourne, Vic., Australia.,Department of Anatomy, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Andrea Gogos
- The Florey Institute of Neuroscience and Mental Health, Mental Health Research Theme, Parkville, Melbourne, Vic., Australia
| | - Priya Sumithran
- Department of Medicine (Austin), University of Melbourne, Heidelberg, Vic., Australia.,Department of Endocrinology, Austin Health, Heidelberg, Vic., Australia
| | - Robyn M Brown
- The Florey Institute of Neuroscience and Mental Health, Mental Health Research Theme, Parkville, Melbourne, Vic., Australia.,The Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, Melbourne, Vic., Australia
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Tabesh M, Hachem M, Lau LH, Borschmann K, Churilov L, Price SAL, Sumithran P, Donnan G, Zajac J, Thijs V, Ekinci EI. Feasibility trial of metformin XR in people with pre-diabetes and stroke (MIPPS)-randomised open blinded endpoint controlled trial. J Clin Neurosci 2021; 86:103-109. [PMID: 33775312 DOI: 10.1016/j.jocn.2021.01.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/26/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
AIMS Pre-diabetes is a common condition that affects about 16.4% of Australian adults. Hyperglycaemia is a strong risk factor for the development of stroke. Metformin XR is an approved medication to treat type 2 diabetes in Australia but not pre-diabetes. Additionally, whether it is tolerated following a stroke is unclear. In this pilot study, we aimed to assess the feasibility of Metformin XR in people with stroke and pre-diabetes. METHODS In this PROBE design trial, people who had recent stroke (within 3 months) with pre-diabetes were randomized to either the active arm (n = 13) receiving usual care plus Metformin XR (500 mg daily increased to a total daily dose of 1500 mg) or the control group receiving only usual care (n = 13). At baseline & after four months of intervention, clinical and biomedical characteristics, cardiovascular risk factors and medication data were recorded. At one month and 2.5 months into the study, compliance rateandside effects were determined. RESULTS This trial showed that it is feasible to recruit, retain and monitor participants. However, the compliance rate was low. Adherence to metformin XR was 52% (IQR:42% to 61%) based on the remaining tablets in the container after 4 months of intervention. None of the reported side effects were deemed to be related to the study treatment and no significant differences were observed between the metformin XR and the control group. CONCLUSION Treatment with Metformin XR in participants admitted with stroke and with pre-diabetes is feasible and safe. Strategies are needed to improve adherence in future trials.
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Affiliation(s)
- Marjan Tabesh
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Mariam Hachem
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Lik-Hui Lau
- Austin Health, Endocrinology Unit, Heidelberg, VIC, Australia
| | - Karen Borschmann
- Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Leonid Churilov
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia; Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Sarah A L Price
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Priya Sumithran
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia; Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Geoffrey Donnan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Jeffrey Zajac
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia; Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia
| | - Vincent Thijs
- The Florey Institute of Neuroscience & Mental Health University of Melbourne, Heidelberg, VIC, Australia; Department of Neurology, Austin Health, Heidelberg, VIC, Australia
| | - Elif I Ekinci
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, VIC, Australia; Department of Endocrinology, Austin Health, Heidelberg, VIC, Australia.
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Price SA, Sumithran P, Prendergast LA, Nankervis AJ, Permezel M, Proietto J. Time to pregnancy after a prepregnancy very-low-energy diet program in women with obesity: substudy of a randomized controlled trial. Fertil Steril 2020; 114:1256-1262. [PMID: 33077241 DOI: 10.1016/j.fertnstert.2020.06.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the impact of a prepregnancy very-low-energy diet (VLED) program on time to pregnancy in women with obesity. DESIGN Substudy of a two-arm parallel group randomized controlled trial. SETTING Multiple tertiary care centers. PATIENT(S) Women 18-38 years old with obesity (body mass index 30-55 kg/m2) and planning conception. INTERVENTION(S) One hundred sixty-four normoglycemic women with body mass index 30-55 kg/m2, aged 18-38 years, and planning pregnancy were recruited through a social media platform for a two-arm randomized controlled trial. Women were allocated to a 12-week standard dietary intervention (SDI) or modified VLED. Completers of the intervention were observed for up to 48 weeks, and time to pregnancy was recorded. MAIN OUTCOME MEASURE(S) The prespecified exploratory outcome for this substudy was time to pregnancy between the completion of the 12-week intervention and the date of conception. RESULT(S) Maternal weight loss at the end of the 12-week intervention was 3.1% in the SDI group and 11.9% in the VLED group. In completers of the 12-week intervention, time to pregnancy was significantly shorter in the women allocated to the VLED group than in the SDI group. Post hoc analysis showed that this difference in time to conception was particularly overt within 90 days of the intervention. CONCLUSION(S) A VLED program that achieves substantial weight loss before conception reduces time to pregnancy compared with an SDI in women with obesity. TRIAL REGISTRATION NUMBER ACTRN12614001160628.
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Affiliation(s)
- Sarah A Price
- Department of Medicine (Austin), University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia; Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Victoria, Australia.
| | - Priya Sumithran
- Department of Medicine (Austin), University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia
| | - Alison J Nankervis
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Michael Permezel
- Department of Obstetrics and Gynaecology, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Joseph Proietto
- Department of Medicine (Austin), University of Melbourne, Melbourne, Victoria, Australia; Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
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Burrows T, Verdejo-Garcia A, Carter A, Brown RM, Andrews ZB, Dayas CV, Hardman CA, Loxton N, Sumithran P, Whatnall M. Health Professionals' and Health Professional Trainees' Views on Addictive Eating Behaviours: A Cross-Sectional Survey. Nutrients 2020; 12:nu12092860. [PMID: 32962008 PMCID: PMC7551788 DOI: 10.3390/nu12092860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/08/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Despite increasing research on the concept of addictive eating, there is currently no published evidence on the views of health professionals who potentially consult with patients presenting with addictive eating behaviours, or of students training to become health professionals. This study aimed to explore the views and understanding of addictive eating behaviours among health professionals and health professionals in training and to identify potential gaps in professional development training. An international online cross-sectional survey was conducted in February–April 2020. The survey (70 questions, 6 key areas) assessed participants’ opinions and clinical experience of addictive eating; opinions on control, responsibility, and stigma relating to addictive eating; and knowledge of addictive eating and opinions on professional development training. In total, 142 health professionals and 33 health professionals in training completed the survey (mean age 38.1 ± 12.5 years, 65% from Australia/16% from the U.K.) Of the health professionals, 47% were dietitians and 16% were psychologists. Most participants (n = 126, 72%) reported that they have been asked by individuals about addictive eating. Half of the participants reported that they consider the term food addiction to be stigmatising for individuals (n = 88). Sixty percent (n = 105) reported that they were interested/very interested in receiving addictive eating training, with the top two preferred formats being online and self-paced, and face-to-face. These results demonstrate that addictive eating is supported by health professionals as they consult with patients presenting with this behaviour, which supports the views of the general community and demonstrates a need for health professional training.
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Affiliation(s)
- Tracy Burrows
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia;
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence:
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia; (A.V.-G.); (A.C.)
| | - Adrian Carter
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia; (A.V.-G.); (A.C.)
| | - Robyn M. Brown
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; (R.M.B.); (Z.B.A.)
| | - Zane B. Andrews
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia; (R.M.B.); (Z.B.A.)
- Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Clayton, VIC 3800, Australia
| | - Chris V. Dayas
- School of Biomedical Sciences & Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia;
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW 2305, Australia
| | - Charlotte A. Hardman
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK;
| | - Natalie Loxton
- School of Applied Psychology, Griffith University, Brisbane, QLD 4122, Australia;
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD 4072, Australia
| | - Priya Sumithran
- Department of Medicine (Austin), University of Melbourne, Heidelberg, VIC 3084, Australia;
- Department of Endocrinology, Austin Health, Heidelberg Heights, VIC 3081, Australia
| | - Megan Whatnall
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia;
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia
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Rigas G, Williams K, Sumithran P, Brown WA, Swinbourne J, Purcell K, Caterson ID. Delays in healthcare consultations about obesity - Barriers and implications. Obes Res Clin Pract 2020; 14:487-490. [PMID: 32888856 DOI: 10.1016/j.orcp.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prevalence of obesity continues to rise, affecting nearly a third of Australian adults in 2017-18. The stigma and bias people with obesity (PwO) experience is one of the barriers hindering the dialogue between PwO and their Health Care Professionals (HCPs). The results from the ACTION IO Australian cohort are reported here. Identification of local barriers can inform strategies to improve access to quality obesity care within Australia. METHODS The ACTION-IO study was an online cross-sectional survey conducted in 11 countries during June-October 2018. In Australia 1,000 community based adult PwO (body mass index ≥30 kg/m based on self-reported height and weight) and 200 HCPs involved with direct patient care (seeing ≥10 patients with obesity/month) completed the survey. RESULTS There was a mean delay of 8.9 years from when a PwO first started to struggle with their weight, and the initial discussion with an HCP about this. HCPs acknowledged weight loss efforts in only 38.5% of their patients, although 74.6% of PwO had attempted weight loss. Most PwO (82.0%) assumed full responsibility for their weight loss. HCPs identified short appointment times (60.5%) and the cost of obesity medication, programmes and services (58.5%) as barriers to weight management conversations and weight loss, respectively. Most PwO want their HCP to raise the issue of weight with 64 % reporting finding such conversations positive and helpful. CONCLUSION Compared to global results, Australian PwO took 3 years longer to seek medical care about their weight. Better recognition of obesity's impact and targeting barriers to care are needed.
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Affiliation(s)
- Georgia Rigas
- Department of Bariatric Surgery, St. George Private Hospital, Kogarah, Sydney, Australia.
| | - Kathryn Williams
- Department of Bariatric Surgery, St. George Private Hospital, Kogarah, Sydney, Australia; Nepean Hospital, Nepean Blue Mountains Local Health District, Kingswood, New South Wales, Australia.
| | - Priya Sumithran
- Department of Medicine (Austin), University of Melbourne, Heidelberg, Australia
| | - Wendy A Brown
- Department of Surgery, Monash University, Melbourne, Australia
| | - Jessica Swinbourne
- Boden Collaboration, Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | | | - Ian D Caterson
- Boden Collaboration, Charles Perkins Centre, University of Sydney, New South Wales, Australia
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Stammers L, Wong L, Brown R, Price S, Ekinci E, Sumithran P. Identifying stress-related eating in behavioural research: A review. Horm Behav 2020; 124:104752. [PMID: 32305343 DOI: 10.1016/j.yhbeh.2020.104752] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 11/29/2022]
Abstract
Stress is a commonly reported precipitant of overeating. Understanding the relationship between stress and food intake is important, particularly in view of the increasing prevalence of obesity. The purpose of this review is to examine how stress-related eating has been defined and measured in the literature to date. There are no established diagnostic criteria or gold standards for quantification of stress-related eating. Questionnaires relying on the accuracy of self-report are the mainstay of identifying people who tend to eat in response to stress and emotions. There is a paucity of clinical research linking objective measurements of stress and appetite with self-reported eating behaviour. Limitations of the methodological approaches used and the heterogeneity between studies leave significant knowledge gaps in our understanding of the mechanism of stress related eating, and how best to identify it. These issues are discussed, and areas for further research are explored.
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Affiliation(s)
- Lauren Stammers
- Department of Medicine (Austin), University of Melbourne, 145 Studley Road, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, 300 Waterdale Road, Heidelberg Heights, Victoria, Australia.
| | - Lisa Wong
- Department of Medicine (Austin), University of Melbourne, 145 Studley Road, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, 300 Waterdale Road, Heidelberg Heights, Victoria, Australia.
| | - Robyn Brown
- Florey Institute of Neuroscience and Mental Health, 30 Royal Parade, University of Melbourne, Parkville, Victoria, Australia.
| | - Sarah Price
- Department of Medicine (Austin), University of Melbourne, 145 Studley Road, Heidelberg, Victoria, Australia.
| | - Elif Ekinci
- Department of Medicine (Austin), University of Melbourne, 145 Studley Road, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, 300 Waterdale Road, Heidelberg Heights, Victoria, Australia.
| | - Priya Sumithran
- Department of Medicine (Austin), University of Melbourne, 145 Studley Road, Heidelberg, Victoria, Australia; Department of Endocrinology, Austin Health, 300 Waterdale Road, Heidelberg Heights, Victoria, Australia.
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