Semaglutide 2.4 mg/wk for weight loss in patients with severe obesity and with or without a history of bariatric surgery

OBJECTIVE

This retrospective cohort study aimed to assess the effectiveness of semaglutide 2.4 mg in patients with severe obesity (BMI ≥ 40 kg/m2 ) who had previously undergone bariatric surgery (BS) but failed to achieve satisfactory weight loss or experienced weight regain compared with patients without a history of BS with similar BMI.

METHODS

The authors analyzed data from 129 patients with a BMI ≥ 40 kg/m2 , including 39 with (BS+) and 90 without (BS-) a history of BS. The patients received semaglutide treatment for 24 weeks starting at 0.25 mg/wk and gradually increasing to reach a final dose of 2.4 mg/wk. The treatment outcomes were assessed based on the percentage of weight loss, changes in BMI, and waist circumference.

RESULTS

Semaglutide treatment resulted in significant 9.1% weight loss in the BS+ group, with no significant difference in weight loss between the BS+ and BS- groups.

CONCLUSIONS

This study is the first, to the authors' knowledge, to compare the effectiveness of semaglutide treatment in patients with versus those without a history of BS, providing valuable evidence of its efficacy. By focusing on individuals with severe obesity (BMI > 40 kg/m2 and associated comorbidities), it fills a gap in the current literature and highlights the potential of semaglutide 2.4 mg as a treatment option for this specific population.

Patterns of eating behavior in people with severe obesity seeking weight loss treatment: An exploratory study

Although subjects with severe obesity need specific interventions, knowledge about their eating behavior, physical and mental health profiles remains insufficient. This cross-sectional study aimed to identify profiles of individuals with severe obesity based on clinical, psychological and eating behavior characteristics. We included 126 participants (103 women; mean age: 47.2 ± 13.9 years; mean BMI: 41.0 ± 5.7 kg/m²). Cluster analyses were performed to identify profiles based on age, waist circumference, eating behavior, depressive symptoms, food-related quality of life and physical activity. Metabolic syndrome components and type 2 diabetes prevalence were compared between the clusters. Three clusters were identified. Cluster 1 labelled struggling with food (48% of the population) had high scores on both emotional eating and uncontrolled eating, low score on comfort with food and they had depressive symptoms. Cluster 2, low loss of eating control (29%), had low scores on emotional eating and uncontrolled eating, and high quality of life in the psychosocial dimension. Cluster 3, pleasure from eating (22%), had the greatest score on comfort with food, the highest physical activity level, and depressive symptoms. In cluster 2, prevalence of type 2 diabetes was higher, although not statistically significant. Otherwise, no differences were found between clusters. Conclusion: Subjects with severe obesity have different profiles, partly explained by their eating behavior, associated with clinical and behavioral patterns. Further studies should confirm this cluster structure and assess how these profiles impact the evolution of obesity and whether they can help to improve the personalization of care programs.

MACVIA-LR (Fighting Chronic Diseases for Active and Healthy Ageing in Languedoc-Roussillon): A Success Story of the European Innovation Partnership on Active and Healthy Ageing

The Région Languedoc Roussillon is the umbrella organisation for an interconnected and integrated project on active and healthy ageing (AHA). It covers the 3 pillars of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA): (A) Prevention and health promotion, (B) Care and cure, (C) and (D) Active and independent living of elderly people. All sub-activities (poly-pharmacy, falls prevention initiative, prevention of frailty, chronic respiratory diseases, chronic diseases with multimorbidities, chronic infectious diseases, active and independent living and disability) have been included in MACVIA-LR which has a strong political commitment and involves all stakeholders (public, private, patients, policy makers) including CARSAT-LR and the Eurobiomed cluster. It is a Reference Site of the EIP on AHA. The framework of MACVIA-LR has the vision that the prevention and management of chronic diseases is essential for the promotion of AHA and for the reduction of handicap. The main objectives of MACVIA-LR are: (i) to develop innovative solutions for a network of Living labs in order to reduce avoidable hospitalisations and loss of autonomy while improving quality of life, (ii) to disseminate the innovation. The three years of MACVIA-LR activities are reported in this paper.

Vitamin D status is not related to insulin resistance in different phenotypes of moderate obesity

Low plasma 25-hydroxy-vitamin D (25OHD) and high levels of parathyroid hormone (PTH) are associated with obesity and could play a role in the occurrence of complications such as insulin resistance. The objective of the study was to evaluate whether the relationship between 25OHD status and phosphocalcic parameters differs between metabolically healthy obese (MHO) and insulin-resistant obese (IRO). This cross-sectional study included 158 consecutive adults (121 females) with obesity (body mass index (BMI) 35.15 ± 2.8 kg/m²), aged 43.21 ± 13.6 years. Serum 25OHD, calcemia, phosphatemia, PTH, plasma lipids, fasting plasma glucose, insulin levels, and body composition were measured. Participants were classified as MHO (n = 65) or IRO (n = 93) based on homeostatic model assessment insulin-resistance value. IRO patients had a higher BMI (p = 0.001), waist circumference (p = 0.03), and trunk fat mass (p = 0.007) than MHO patients. Mean HbA1c (p = 0.03), triglycerides (p = 0.02), and hsCRP (p = 0.04) plasmatic levels were increased in the IRO group. No between-group difference was found on 25OHD, PTH, calcium, or phosphorus plasmatic levels. Only age-predicted 25OHD levels were identified among IRO participants, whereas no factors were identified in MHO. No predictive factors of PTH plasmatic level were identified in the IRO and MHO groups. Although MHO and IRO patients have different metabolic profiles, we did not detect any difference regarding either 25OHD or PTH. Insulin resistance was not a predictive factor of vitamin D status. Our results confirm the absence of link between vitamin D status and insulin resistance in moderate obesity.

Building Bridges for Innovation in Ageing: Synergies between Action Groups of the EIP on AHA

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

Experiential or behavioral processes: which one is prominent in physical activity? Examining the processes of change 1 year after an intervention of therapeutic education among adults with obesity

OBJECTIVE

Although physical activity (PA) is essential, most obese people will not engage in its practice. The transtheoretical model (TTM) and its processes of change (POC) contribute to the understanding of behavior change regarding PA. The present study aimed to test how POC are associated with a progression through the stages of change (SOC) and whether they predict BMI change.

METHODS

Interventional study. A total of 134 subjects participated in an education program, were called at 1 year and 62 of them provided follow-up data. Participants completed the SOC and POC questionnaires at baseline, at 1 year and were classified according to their SOC progression.

RESULTS

Participants who progressed through SOC lost more weight (p<0.001). Significant interactions were found for three out of five POC (p<0.05). Progression through SOC was associated with an increased use of POC. Weight loss was predicted by two behavioral POC.

CONCLUSION

Results support the previous cross-sectional studies showing that physically active people use more frequently POC.

PRACTICE IMPLICATIONS

The present findings support the development of TTM-grounded behavioral interventions targeted to obese patients. Identifying methods to promote POC use to improve adherence to weight guidelines may lead to improved clinical outcomes and quality of life.

Physical-activity prescription for obesity management in primary care: attitudes and practices of GPs in a southern French city

AIM

The study documented the attitudes and practices of French general practitioners (GPs) regarding the prescription of physical activity (PA) for obesity management.

METHODS

A cross-sectional survey of all 254GPs with practices in a city in the south of France was performed, of which 203 (80%) questionnaires were returned. From these, demographic, professional and personal data, beliefs, attitudes, training and barriers to prescribing PA were assessed.

RESULTS

GPs are very much aware of the importance of PA in the management of obesity, as 94% reportedly prescribed it frequently ('usually' or 'often'). However, only a minority recommended PA levels that were consistent with most guidelines. Even though most of the GPs (71%) reported a lack of training in prescribing PA, only a slight majority (52%) wished to undergo such training. Patients' non-compliance was the main obstacle for 63% of the GPs. Also, although only 1% of the GPs used software and Internet resources, 62% expressed a desire to incorporate these tools in their practices. The personal characteristics of GPs also influenced their attitudes and practices, as reflected by the fact that overweight or obese GPs favoured psychobehavioural management rather than PA (P=0.03). Younger GPs (<45 years) felt less adequately trained than their elders (P=0.01) and were more eager for additional training.

CONCLUSION

GPs play a central role in preventing the pandemic of obesity and other chronic diseases for which PA is a cornerstone. However, the need to improve GP practices in prescribing PA remains a challenge. Better medical education and the development of adequate Web-based tools should also be prioritized.