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OBJECTIVES: Adults with intellectual disabilities will frequently experience sedentary behavior and excessive weight, which may cause or exacerbate a multitude of medical and behavioral problems. This study examined a program to encourage increased activity and weight loss in an outpatient service for adults with intellectual disabilities. METHODS: Behavioral methods were used to treat obesity in 33 male and 21 female adults with intellectual disabilities for a mean of 9 months. They were retrospectively analyzed to determine the effects of treatment on muscle and adiposity using body composition analysis. RESULTS: The 54 participants of the original 122 (44.3%) who did not drop out were divided into three groups: weight loss ≥3 kg/3% (n = 20, 37%), weight loss <3 kg/3% (n = 17, 31.5%), and no weight loss or weight gain (n = 17, 31.5%). Only men and women who lost ≥3 kg/3%, demonstrated significant gain of relative muscle mass. Those who gained weight lost muscle mass. CONCLUSIONS: If motivation remains high and follow-up is reasonably long, then a multicomponent obesity treatment program can lead to significant weight loss with preservation of muscle in adults with intellectual disabilities.
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Discapacidad Intelectual , Obesidad , Pérdida de Peso , Humanos , Masculino , Femenino , Adulto , Obesidad/terapia , Obesidad/complicaciones , Estudios Retrospectivos , Discapacidad Intelectual/complicaciones , Discapacidad Intelectual/terapia , Persona de Mediana Edad , Músculo Esquelético/fisiopatología , Composición CorporalRESUMEN
BACKGROUND: The number of individuals using digital health devices has grown in recent years. A higher rate of use in patients suggests that primary care providers (PCPs) may be able to leverage these tools to effectively guide and monitor physical activity (PA) for their patients. Despite evidence that remote patient monitoring (RPM) may enhance obesity interventions, few primary care practices have implemented programs that use commercial digital health tools to promote health or reduce complications of the disease. OBJECTIVE: This formative study aimed to assess the perceptions, needs, and challenges of implementation of an electronic health record (EHR)-integrated RPM program using wearable devices to promote patient PA at a large urban primary care practice to prepare for future intervention. METHODS: Our team identified existing workflows to upload wearable data to the EHR (Epic Systems), which included direct Fitbit (Google) integration that allowed for patient PA data to be uploaded to the EHR. We identified pictorial job aids describing the clinical workflow to PCPs. We then performed semistructured interviews with PCPs (n=10) and patients with obesity (n=8) at a large urban primary care clinic regarding their preferences and barriers to the program. We presented previously developed pictorial aids with instructions for (1) providers to complete an order set, set step-count goals, and receive feedback and (2) patients to set up their wearable devices and connect them to their patient portal account. We used rapid qualitative analysis during and after the interviews to code and develop key themes for both patients and providers that addressed our research objective. RESULTS: In total, 3 themes were identified from provider interviews: (1) providers' knowledge of PA prescription is focused on general guidelines with limited knowledge on how to tailor guidance to patients, (2) providers were open to receiving PA data but were worried about being overburdened by additional patient data, and (3) providers were concerned about patients being able to equitably access and participate in digital health interventions. In addition, 3 themes were also identified from patient interviews: (1) patients received limited or nonspecific guidance regarding PA from providers and other resources, (2) patients want to share exercise metrics with the health care team and receive tailored PA guidance at regular intervals, and (3) patients need written resources to support setting up an RPM program with access to live assistance on an as-needed basis. CONCLUSIONS: Implementation of an EHR-based RPM program and associated workflow is acceptable to PCPs and patients but will require attention to provider concerns of added burdensome patient data and patient concerns of receiving tailored PA guidance. Our ongoing work will pilot the RPM program and evaluate feasibility and acceptability within a primary care setting.
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Registros Electrónicos de Salud , Ejercicio Físico , Obesidad , Investigación Cualitativa , Dispositivos Electrónicos Vestibles , Humanos , Ejercicio Físico/psicología , Masculino , Femenino , Obesidad/terapia , Adulto , Persona de Mediana Edad , Atención Primaria de SaludRESUMEN
Overweight and obesity affect 71.2% of adults in the United States, with cancer survivors not far behind at 70.3%. Subgroups such as those diagnosed with acute lymphoblastic leukemia (ALL) face even greater challenges. The Exercise and Quality Diet after Leukemia (EQUAL) trial sought to address weight management issues among ALL survivors by implementing a remotely delivered weight loss intervention, leveraging the previously proven Practice-based Opportunities for Weight Reduction (POWER) program. Despite a strong foundation and design, the EQUAL trial yielded null results. Key differences in study populations and intervention contexts between the EQUAL and POWER trials, such as the lack of primary care physician involvement in EQUAL, contributed to these outcomes. EQUAL's failure to meet its accrual target and poor adherence among participants highlighted challenges in engaging this unique population. Contrary to EQUAL's conclusions, evidence from other studies supports the efficacy of remote interventions for weight loss among cancer survivors. The lack of qualitative assessment among ALL survivors and key integration to inform intervention adaptations undermined EQUAL's impact. However, EQUAL's impressive retention rate offers valuable insights. Lessons from EQUAL underscore the need for well-fitted, remotely delivered interventions and the importance of thoughtfully adapted and tailored approaches to specific survivor populations. See related article by Fiedmann et al., p. 1158.
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Supervivientes de Cáncer , Pérdida de Peso , Programas de Reducción de Peso , Humanos , Programas de Reducción de Peso/métodos , Supervivientes de Cáncer/psicología , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Obesidad/terapia , Femenino , Adulto , Masculino , Ejercicio FísicoRESUMEN
Background: Obesity of companion animals in Canada is becoming a problem in veterinary practice. Cats and dogs, in particular, are increasingly overweight. However, prevention and treatment present challenges. Challenges in treating pet obesity, such as client nonadherence and animal welfare issues arising from obesity, also affect the well-being of veterinarians - especially given the coincident high rates of burnout and compassion fatigue experienced in the profession. Objective: This study investigated how practicing veterinarians perceive the treatment of overweight companion animals and how treating obese pets affects well-being of veterinarians. Animals and procedure: We recruited veterinarians who routinely treat companion animals in private practice to participate in focus group interviews. We also interviewed veterinarians who could not attend the focus group sessions, yet still wished to contribute. Through thematic data analysis, we generated key themes that illustrated how treating obese pets negatively affects veterinarian well-being. Results: Eighteen companion animal veterinarians contributed to this study. We generated 3 themes from the analysis that illustrate negative effects of treating obese pets on veterinarian well-being: i) negative feelings such as frustration and sadness associated with treating obese pets; ii) owners' lack of comprehension of the effects of obesity on pets, including early euthanasia; and iii) client nonadherence regarding treatment. Conclusion and clinical relevance: This study contributes to the veterinary literature on companion animal obesity by focusing on how treating pet obesity affects veterinarian well-being, especially given high rates of burnout and compassion fatigue in the profession. As pet obesity increases in society, obesity prevention and treatment is becoming central to companion animal veterinary practice. Our findings suggest that veterinarian well-being is negatively affected in connection with companion animal obesity. We recommend relationship-centered communication, increased nutritional expertise, and a focus on wellness in the workplace to improve veterinarian well-being while treating pet obesity.
Quand les vétérinaires traitent des animaux en surpoids : perspectives pour la pratique vétérinaire. Contexte: L'obésité des animaux de compagnie au Canada devient un problème dans la pratique vétérinaire. Les chats et les chiens, en particulier, sont de plus en plus en surpoids. Cependant, la prévention et le traitement présentent des défis. Les défis liés au traitement de l'obésité des animaux de compagnie, tels que la non-observance des traitements par les clients et les problèmes de bien-être animal liés à l'obésité, affectent également le bien-être des vétérinaires en particulier compte tenu des taux élevés d'épuisement professionnel et de fatigue de compassion que connaît la profession. Objectif: Cette étude a examiné comment les vétérinaires en exercice perçoivent le traitement des animaux de compagnie en surpoids et comment le traitement des animaux obèses affecte le bien-être des vétérinaires. Animaux et procédure: Nous avons recruté des vétérinaires qui traitent régulièrement des animaux de compagnie en cabinet privé pour participer à des entretiens de groupe. Nous avons également interrogé des vétérinaires qui n'avaient pas pu assister aux séances de groupe de discussion, mais qui souhaitaient néanmoins contribuer. Grâce à l'analyse thématique des données, nous avons généré des thèmes clés illustrant comment le traitement des animaux obèses affecte négativement le bien-être des vétérinaires. Résultats: Dix-huit vétérinaires d'animaux de compagnie ont contribué à cette étude. Nous avons généré 3 thèmes à partir de l'analyse qui illustrent les effets négatifs du traitement des animaux obèses sur le bien-être du vétérinaire : i) les sentiments négatifs tels que la frustration et la tristesse associés au traitement des animaux obèses; ii) le manque de compréhension des propriétaires des effets de l'obésité sur les animaux de compagnie, y compris l'euthanasie précoce; et iii) la non-observance du traitement par les clients. Conclusion et pertinence clinique: Cette étude contribue à la littérature vétérinaire sur l'obésité des animaux de compagnie en se concentrant sur la façon dont le traitement de l'obésité des animaux de compagnie affecte le bien-être des vétérinaires, en particulier compte tenu des taux élevés d'épuisement professionnel et de fatigue de compassion dans la profession. À mesure que l'obésité des animaux de compagnie augmente dans la société, la prévention et le traitement de l'obésité deviennent essentiels à la pratique vétérinaire des animaux de compagnie. Nos résultats suggèrent que le bien-être des vétérinaires est affecté négativement par l'obésité des animaux de compagnie. Nous recommandons une communication centrée sur les relations, une expertise nutritionnelle accrue et une concentration sur le bien-être au travail pour améliorer le bien-être des vétérinaires tout en traitant l'obésité des animaux de compagnie.(Traduit par Dr Serge Messier).
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Obesidad , Veterinarios , Animales , Veterinarios/psicología , Humanos , Gatos , Perros , Obesidad/veterinaria , Obesidad/terapia , Obesidad/psicología , Enfermedades de los Gatos/psicología , Enfermedades de los Gatos/terapia , Mascotas , Medicina Veterinaria , Femenino , Masculino , Grupos Focales , Enfermedades de los Perros/psicología , Enfermedades de los Perros/terapia , Agotamiento Profesional/psicología , Bienestar del Animal , CanadáRESUMEN
Obesity is a known driver of endometrial cancer. In this issue of the JCI, Gómez-Banoy and colleagues investigated a cohort of patients with advanced endometrial cancer treated with immune checkpoint inhibitors targeting the interaction between programmed cell death receptor-1 (PD-1) and its ligand (PD-L1). Notably, a BMI in the overweight or obese range was paradoxically associated with improved progression-free and overall survival. A second paradox emerged from CT analyses of visceral adipose tissue, viewed as an unhealthy fat depot in most other contexts, the quantity of which was also associated with improved treatment outcomes. Though visceral adiposity may have value as a biomarker to inform personalized treatment strategies, of even greater impact would be if a therapeutic strategy emerges from the future identification of adipose-derived mediators of this putative anticancer immune-priming effect.
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Neoplasias Endometriales , Grasa Intraabdominal , Humanos , Femenino , Neoplasias Endometriales/inmunología , Neoplasias Endometriales/terapia , Neoplasias Endometriales/patología , Neoplasias Endometriales/tratamiento farmacológico , Grasa Intraabdominal/inmunología , Inmunoterapia , Inhibidores de Puntos de Control Inmunológico/uso terapéutico , Obesidad/inmunología , Obesidad/terapia , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Receptor de Muerte Celular Programada 1/inmunologíaRESUMEN
Fibroblast growth factor 21 (FGF-21) has been suggested as a potential therapeutic target for insulin resistance in health-related metabolic disorders such as type 2 diabetes. Despite the metabolic effects of resistance (RT) and aerobic training (AT) on diabetes symptoms, uncertainty exists regarding the superiority of effects manifested through these training approaches on FGF-21 and biochemical and physiological variables associated with metabolic disorders in men diagnosed with type 2 diabetes. This study aimed to investigate the impact of a 12-week RT and AT on FGF-21 levels and symptoms associated with metabolic disorders in male individuals diagnosed with type 2 diabetes. Thirty-six sedentary obese diabetic men (40 to 45 years old) were matched based on the level of FGF-1. They and were randomly divided into two training groups (RT, n = 12 and AT, n = 12) performing three days per week of moderate-intensity RT or AT for 12 weeks and an inactive control group (n = 12). Both training interventions significantly improved FGF-21, glucose metabolism, lipid profile, hormonal changes, strength, and aerobic capacity. Subgroup analysis revealed that RT had greater adaptive responses (p < 0.01) in fasting blood sugar (ES = -0.52), HOMA-IR (ES = -0.87), testosterone (ES = 0.52), cortisol (ES = -0.82), FGF-21 (ES = 0.61), and maximal strength (ES = 1.19) compared to AT. Conversely, AT showed greater changes (p < 0.01) in cholesterol (ES = -0.28), triglyceride (ES = -0.64), HDL (ES = 0.46), LDL (ES = -0.73), and aerobic capacity (ES = 1.18) compared to RT. Overall, both RT and AT interventions yielded significant moderate to large ES in FGF-21 levels and enhanced the management of biochemical variables. RT is an effective method for controlling FGF-21 levels and glucose balance, as well as for inducing hormonal changes. On the other hand, AT is more suitable for improving lipid profiles in overweight men with type 2 diabetes mellitus.
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Glucemia , Diabetes Mellitus Tipo 2 , Factores de Crecimiento de Fibroblastos , Resistencia a la Insulina , Obesidad , Entrenamiento de Fuerza , Humanos , Masculino , Factores de Crecimiento de Fibroblastos/sangre , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/sangre , Entrenamiento de Fuerza/métodos , Obesidad/terapia , Persona de Mediana Edad , Glucemia/metabolismo , Adulto , Ejercicio Físico/fisiología , Fuerza Muscular/fisiología , Lípidos/sangreRESUMEN
To investigate the release of lipolytic hormones during various high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), and their effects on fat loss. 39 young women categorized as obese (with a body fat percentage (BFP) ≥30%) were randomly allocated to one of the following groups: all-out sprint interval training (SIT, n =10); supramaximal HIIT (HIIT120, 120%VÌO2peak, n = 10); HIIT (HIIT90, 90%VÌO2peak, n = 10), or MICT, (60%VÌO2peak, n = 9) for a twelve-week observation period consisting of 3 to 4 exercise sessions per week. Serum epinephrine (EPI) and growth hormone (GH) were measured during the 1st, 20th, and 44th training sessions. Body weight (BW), body mass index (BMI), whole-body fat mass (FM) and BFP were assessed pre- and post-intervention. Following the 1st and 20th sessions, significant increases in EPI (p < 0.05) were observed post-exercise in HIIT120 and HIIT90, but not in SIT and MICT. In the 44th session, the increased EPI was found in SIT, HIIT120, and HIIT90, but not in MICT (p < 0.05). For the GH, a significant increase was observed post-exercise in all groups in the three sessions. The increased EPI and GH returned to baselines 3 hours post-exercise. After the 12-week intervention, significant reductions in FM and BFP were found in all groups, while reductions in BW and BMI were only found in the SIT and HIIT groups. Greater reductions in FM and BFP, in comparison to MICT, were observed in the SIT and HIIT groups (p < 0.05). 12-week SIT, HIIT120, and HIIT90, in comparison to MICT, were more efficacious in fat reduction in obese women, partly benefiting from the greater release of lipolytic hormones during training sessions.
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Índice de Masa Corporal , Epinefrina , Entrenamiento de Intervalos de Alta Intensidad , Obesidad , Humanos , Femenino , Entrenamiento de Intervalos de Alta Intensidad/métodos , Epinefrina/sangre , Adulto Joven , Obesidad/terapia , Obesidad/sangre , Hormona de Crecimiento Humana/sangre , Lipólisis , Consumo de Oxígeno , Tejido Adiposo/metabolismo , Adulto , Peso CorporalRESUMEN
Obesity is an important health concern that poses many public health challenges. Evidence-based treatment modalities, capable of cost-effectively reaching large patient groups are needed. In this paper, we present the design and methods of the updated national, 12-month, digital weight management program, the Healthy Weight Coaching (HWC). The major updates, as compared to the previous version, are related to the theoretical background of the obesity management and updated BMI cut-offs. The HWC is available, based on physicians' referrals, to adult Finnish citizens with BMI ≥30 kg/m2 or ≥27 kg/m2 with a comorbidity, who have a health-based need to lose weight. Rooted in the principles of behavioural therapy, the HWC focuses on teaching coping skills, guides to healthy self-reflection, and supports concrete lifestyle changes as part of healthy weight loss. The automated weekly training sessions, supplemented by 3-8 exercises, form the basis of the program. These sessions address topics such as diet, physical activity, stress management, and rest and recovery. Additionally, a personal coach is allocated to each patient to provide tailored support. At baseline, patients record their weight, height, and waist circumference, online, and complete questionnaires on lifestyle, diet, physical activity, sleep, psychological factors, and health. Thereafter weight recording is conducted at least every 4 weeks, while the questionnaires and measuring the weight circumference are repeated at 3, 6, 9, and 12 months. In addition, patients can make use of diaries and peer group chats for additional support. Data collected from the consenting patients will be used for research purposes with the weight change from baseline to 12 months as the main outcome in the real-life observational study. The study will provide invaluable insights into the application of digital modalities in the treatment of obesity.
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Tutoría , Obesidad , Programas de Reducción de Peso , Humanos , Programas de Reducción de Peso/métodos , Obesidad/terapia , Finlandia , Tutoría/métodos , Adulto , Masculino , Femenino , Pérdida de Peso , Ejercicio Físico , Persona de Mediana Edad , Índice de Masa Corporal , Estilo de VidaRESUMEN
Lifestyle management of obesity includes nutritional therapy, physical activity, and several intermittent fasting therapies. Effective nutrition therapies include optimized low-fat diets, high-quality ketogenic diets, and energy-restricted diets. Adherence to dietary change remains the most substantial barrier to success; therefore, patients engaging in lifestyle changes require intensive support and resources. Physical activity is shown to have benefits to body composition and disease risk beyond the effects on weight loss. Patients should be guided toward a regimen that is appropriate for their capacity for movement. Multiple intermittent fasting strategies have now been shown to cause substantial weight loss and metabolic health improvement.
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Ejercicio Físico , Estilo de Vida , Obesidad , Pérdida de Peso , Humanos , Obesidad/terapia , Ejercicio Físico/fisiología , Dieta Cetogénica/métodos , Ayuno , Dieta con Restricción de Grasas/métodosRESUMEN
With the growing global burden of obesity, the field of endobariatrics has emerged as a promising alternative, filling the void between lifestyle interventions with modest efficacy and more invasive surgical procedures. This article explores the latest advancements in endobariatric therapies, encompassing endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGB), endoscopic metabolic therapies, and promising pharmacologic and surgical combination approaches that integrate multiple therapeutic modalities. It also outlines the critical factors and strategic considerations necessary for the successful integration of endobariatric interventions into clinical practice.
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Cirugía Bariátrica , Humanos , Cirugía Bariátrica/métodos , Cirugía Bariátrica/instrumentación , Obesidad/cirugía , Obesidad/terapia , Balón Gástrico , Gastroplastia/métodos , Gastroplastia/instrumentación , Endoscopía Gastrointestinal/métodos , Endoscopía Gastrointestinal/instrumentación , Endoscopía Gastrointestinal/tendenciasRESUMEN
BACKGROUND: Cardiovascular disease represents a significant risk factor for mortality in individuals with type 2 diabetes mellitus (T2DM). High-density lipoprotein (HDL) is believed to play a crucial role in maintaining cardiovascular health through its multifaceted atheroprotective effects and its capacity to enhance glycemic control. The impact of dietary interventions and intermittent fasting (IF) on HDL functionality remains uncertain. The objective of this study was to assess the effects of dietary interventions and IF as a strategy to safely improve glycemic control and reduce body weight on functional parameters of HDL in individuals with T2DM. METHODS: Before the 12-week intervention, all participants (n = 41) of the INTERFAST-2 study were standardized to a uniform basal insulin regimen and randomized to an IF or non-IF group. Additionally, all participants were advised to adhere to dietary recommendations that promoted healthy eating patterns. The IF group (n = 19) followed an alternate-day fasting routine, reducing their calorie intake by 75% on fasting days. The participants' glucose levels were continuously monitored. Other parameters were measured following the intervention: Lipoprotein composition and subclass distribution were measured by nuclear magnetic resonance spectroscopy. HDL cholesterol efflux capacity, paraoxonase 1 (PON1) activity, lecithin cholesterol acyltransferase (LCAT) activity, and cholesterol ester transfer protein (CETP) activity were assessed using cell-based assays and commercially available kits. Apolipoprotein M (apoM) levels were determined by ELISA. RESULTS: Following the 12-week intervention, the IF regimen significantly elevated serum apoM levels (p = 0.0144), whereas no increase was observed in the non-IF group (p = 0.9801). ApoM levels correlated with weight loss and fasting glucose levels in the IF group. Both groups exhibited a robust enhancement in HDL cholesterol efflux capacity (p < 0.0001, p = 0.0006) after 12 weeks. Notably, only the non-IF group exhibited significantly elevated activity of PON1 (p = 0.0455) and LCAT (p = 0.0117) following the 12-week intervention. In contrast, the changes observed in the IF group did not reach statistical significance. CONCLUSIONS: A balanced diet combined with meticulous insulin management improves multiple metrics of HDL function. While additional IF increases apoM levels, it does not further enhance other aspects of HDL functionality. TRIAL REGISTRATION: The study was registered at the German Clinical Trial Register (DRKS) on 3 September 2019 under the number DRKS00018070.
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Biomarcadores , Glucemia , Diabetes Mellitus Tipo 2 , Ayuno , Obesidad , Fosfatidilcolina-Esterol O-Aciltransferasa , Humanos , Masculino , Persona de Mediana Edad , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/dietoterapia , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Ayuno/sangre , Fosfatidilcolina-Esterol O-Aciltransferasa/sangre , Resultado del Tratamiento , Obesidad/sangre , Obesidad/diagnóstico , Obesidad/dietoterapia , Obesidad/fisiopatología , Obesidad/terapia , Glucemia/metabolismo , Factores de Tiempo , Biomarcadores/sangre , Restricción Calórica , Arildialquilfosfatasa/sangre , HDL-Colesterol/sangre , Proteínas de Transferencia de Ésteres de Colesterol/sangre , Pérdida de Peso , Anciano , Adulto , Dieta Saludable , Hipoglucemiantes/uso terapéutico , Insulina/sangre , Ayuno IntermitenteRESUMEN
BACKGROUND: Current clinical guidelines for the management of type 2 diabetes mellitus (T2DM) in older adults recommend the use of antihyperglycemic medications, monitoring of blood glucose levels, regular exercise, and a healthy diet to improve glycemic control and reduce associated comorbidities. However, adherence to traditional exercise programs is poor (<35%). Common barriers to adherence include fear of hypoglycemia and the need for blood glucose level monitoring before exercise. Digital health strategies offer great promise for managing T2DM as they facilitate patient-practitioner communication, support self-management, and improve access to health care services for underserved populations. We have developed a novel web-based software program allowing practitioners to create tailored interventions and deliver them to patients via digital voice assistants (DVAs) in their own homes. OBJECTIVE: We aim to evaluate the feasibility of a 12-week, home-based, personalized lifestyle intervention delivered and monitored by DVAs for older adults with obesity and T2DM. METHODS: In total, 50 older adults with obesity aged 50-75 years with oral hypoglycemic agent-treated T2DM were randomized to the intervention (DVA, n=25) or a control group (n=25). Participants allocated to the DVA group were prescribed a home-based muscle strengthening exercise program (~20- to 30-min sessions) and healthy eating intervention, delivered via DVAs (Alexa Echo Show 8; Amazon) using newly developed software ("Buddy Link"; Great Australian Pty Ltd). Control group participants received generalized physical activity information via email. Outcomes were feasibility, DVA usability (System Usability Scale), and objectively assessed physical activity and sedentary time (wrist-worn accelerometers). RESULTS: In total, 45 (90%) out of 50 participants completed this study. Mean adherence to prescribed exercise was 85% (SD 43%) with no intervention-related adverse events. System usability was rated above average (70.4, SD 16.9 out of 100). Compared with controls, the DVA group significantly decreased sedentary time (mean difference -67, SD 23; 95% CI -113 to -21 min/d), which was represented by a medium to large effect size (d=-0.6). CONCLUSIONS: A home-based lifestyle intervention delivered and monitored by health professionals using DVAs was feasible for reducing sedentary behavior and increasing moderate-intensity activity in older adults with obesity and T2DM. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000307808; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381364&isReview=true.
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Diabetes Mellitus Tipo 2 , Terapia por Ejercicio , Estudios de Factibilidad , Obesidad , Humanos , Diabetes Mellitus Tipo 2/terapia , Masculino , Femenino , Anciano , Persona de Mediana Edad , Obesidad/terapia , Obesidad/dietoterapia , Terapia por Ejercicio/métodos , Ejercicio Físico/fisiologíaAsunto(s)
Obesidad , Humanos , Obesidad/terapia , Obesidad/complicaciones , Diabetes Mellitus Tipo 2/terapiaRESUMEN
BACKGROUND: Most of the worldwide population is overweight and suffers from the resulting musculoskeletal comorbidities such as knee osteoarthritis or back pain. Practice guidelines recommend weight loss interventions for individuals suffering from these conditions. This systematic review investigated whether including a weight loss intervention in the musculoskeletal therapy of these individuals was cost-effective compared to administering the musculoskeletal therapy alone. METHODS: This study followed the PRISMA guidelines to systematically and independently search six databases and select full health economic evaluations published up to May 2024 from health care or societal perspectives according to predefined eligibility criteria. Cost data were standardised to 2023 Belgium Euros. The methodological quality was assessed using two health economic-specific checklists. RESULTS: The searches produced 5'305 references, of which 8 studies were selected for a total of 1'726 participants. The interventions consisted of different exercise plans and nutritional targets. Six values were in the north-eastern; leading to increased quality-adjusted life year (QALY) and higher costs; and two in the south-eastern quadrant of the cost-utility plane; leading to increased QALYs and lower costs. Two studies observed no differences in QALYs. Incremental cost utility ratios (ICUR) ranged from 13'580.10 to 34'412.40 per additional QALY from a healthcare perspective. From a societal perspective, the ICUR was 30'274.84. The included studies fulfilled 86 percent of the criteria in trial-based economic evaluations and 57 percent in model-based economic evaluations. The most common limitations of the studies were related to appropriate cost measures' specifications, research questions, time horizon choices, and sensitivity analyses. CONCLUSIONS: This systematic review showed weak but consistent evidence of cost-effectiveness for adding a weight loss intervention to musculoskeletal therapy for individuals with overweight, from either perspective. Further economic evaluations should evaluate the long-term cost-effectiveness of the intervention. TRIAL REGISTRATION: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY (2022,110,122).
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Análisis Costo-Beneficio , Obesidad , Sobrepeso , Años de Vida Ajustados por Calidad de Vida , Humanos , Obesidad/terapia , Obesidad/economía , Obesidad/diagnóstico , Sobrepeso/terapia , Sobrepeso/economía , Pérdida de Peso , Enfermedades Musculoesqueléticas/terapia , Enfermedades Musculoesqueléticas/economía , Enfermedades Musculoesqueléticas/diagnóstico , Programas de Reducción de Peso/economía , Programas de Reducción de Peso/métodos , Costos de la Atención en Salud/estadística & datos numéricos , Terapia por Ejercicio/economía , Terapia por Ejercicio/métodosRESUMEN
BACKGROUND: Although the percentage of the population with a high degree of obesity (body mass index [BMI] ≥ 35 kg/m2) is low in Japan, the prevalence of obesity-related diseases in patients with high-degree obesity is greater than that in patients with a BMI < 35 kg/m2. Therefore, treatment for high-degree obesity is important. However, clinical studies have reported that 20-50% of patients with obesity discontinue weight-loss treatment in other countries. The circumstances surrounding antiobesity agents are quite different between Japan and other countries. In this study, we investigated the predictors of treatment discontinuation in Japanese patients with high-degree obesity. METHODS: We retrospectively reviewed the medical charts of 271 Japanese patients with high-degree obesity who presented at Toho University Sakura Medical Center for obesity treatment between April 1, 2014, and December 31, 2017. The patients were divided into non-dropout and dropout groups. Patients who discontinued weight-loss treatment within 24 months of the first visit were defined as "dropouts." Multivariate Cox proportional hazards regression analysis and Kaplan-Meier survival analysis were performed to examine the factors predicting treatment withdrawal. RESULTS: Among the 271 patients, 119 (43.9%) discontinued treatment within 24 months of the first visit. The decrease in BMI did not significantly differ between the two groups. No prescription of medication and residential distance from the hospital exceeding 15 km were the top contributors to treatment discontinuation, and the absence of prescription medication was the most important factor. The dropout-free rate was significantly higher in patients with medication prescriptions than in those without and in patients who lived within 15 km of the hospital than in those who lived farther than 15 km from the hospital. CONCLUSIONS: No medication prescription and longer residential distance from the hospital were associated with treatment dropout in Japanese patients with high-degree obesity; therefore, the addition of antiobesity medications and telemedicine may be necessary to prevent treatment discontinuation in such patients.
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Índice de Masa Corporal , Humanos , Estudios Retrospectivos , Masculino , Femenino , Japón , Persona de Mediana Edad , Adulto , Obesidad/terapia , Fármacos Antiobesidad/uso terapéutico , Pérdida de Peso , Anciano , Programas de Reducción de Peso/estadística & datos numéricos , Programas de Reducción de Peso/métodos , Pacientes Desistentes del Tratamiento/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Pueblos del Este de AsiaRESUMEN
OBJECTIVE: Obesity is associated with an exacerbated metabolic condition that is mediated through impairing balance in the secretion of some adipo-myokines. Therefore, the objective of the present study was to explore the impact of astaxanthin supplementation in conjunction with a 12-week CrossFit training regimen on some selected adipo-myokines, insulin insensitivity, and serum lipid levels in obese males. MATERIAL AND METHODS: This study is a randomized control trial design; 60 obese males were randomly divided into four groups of 15, including the control group (CG), supplement group (SG), training group (TG), and combined training and supplement group (TSG). The participants were subjected to 12 weeks of astaxanthin (AST) supplementation [20 mg/d capsule, once/d] or CrossFit training or a combination of both interventions. The training regimen comprised 36 sessions of CrossFit, each lasting 60 min, conducted three times per week. The metabolic indices, body composition, anthropometrical, cardio-respiratory, and also some plasma adipo-myokine factors, including decorin (DCN), activin A, myostatin (MST), transforming growth factor (TGF)-ß1, and follistatin (FST), were examined 12 and 72 h before the initiation of the main interventional protocols, and then 72 h after the final session of the training protocol. RESULTS: There was no significant difference in the baseline data between the groups (p > 0.05). There were significant interactions between group x time for DCN (η2 = 0.82), activin A (η2 = 0.50), FST (η2 = 0.92), MST (η2 = 0.75), and TGFB-1 (η2 = 0.67) (p < 0.001 for all the variables). Significantly changes showed for DCN in TSG compared to TG and SG and also TG compared to SG (p = 0.0001); for activin A in SG compared to TG (p = 0.01) and TSG (p = 0.002); for FST in SG compared to TG and TSG (p = 0.0001), also in TSG compared to TG (p = 0.0001); for MST in SG, TG, and TSG compared to CG (p = 0.0001) and also in TSG compared to SG (p = 0.0001) and TG (p = 0.001); for TGFB-1 in SG, TG, and TSG compared to CG (p = 0.0001) and also TSG compared to SG (p = 0.0001) and TG (p = 0.001). CONCLUSIONS: The 12-week CrossFit training concurrent with AST supplementation reduced anthropometric and metabolic factors and also serum lipid levels while producing positive changes in body composition and cardiovascular factors. Increased FST and DCN and reduced activin A, MST, and TGF-ß1 were other affirmative responses to both interventions.
Asunto(s)
Suplementos Dietéticos , Miostatina , Obesidad , Xantófilas , Humanos , Masculino , Xantófilas/administración & dosificación , Obesidad/terapia , Obesidad/sangre , Adulto , Miostatina/sangre , Folistatina/sangre , Factor de Crecimiento Transformador beta1/sangre , Adipoquinas/sangre , Decorina/sangre , Resistencia a la Insulina , Adulto Joven , Ejercicio Físico/fisiología , Composición Corporal , Lípidos/sangre , MioquinasRESUMEN
Recent years have seen an outstanding growth in the understanding of connections between diet-induced obesity, dysbiosis and alterations in the tumor microenvironment. Now we appreciate that gut dysbiosis can exert important effects in distant target tissues via specific microbes and metabolites. Multiple studies have examined how diet-induced obese state is associated with gut dysbiosis and how gut microbes direct various physiological processes that help maintain obese state in a bidirectional crosstalk. Another tightly linked factor is sustained low grade inflammation in tumor microenvironment that is modulated by both obese state and dysbiosis, and influences tumor growth as well as response to immunotherapy. Our review brings together these important aspects and explores their connections. In this review, we discuss how obese state modulates various components of the breast tumor microenvironment and gut microbiota to achieve sustained low-grade inflammation. We explore the crosstalk between different components of tumor microenvironment and microbes, and how they might modulate the response to immunotherapy. Discussing studies from multiple tumor types, we delve to find common microbial characteristics that may positively or negatively influence immunotherapy efficacy in breast cancer and may guide future studies.
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Disbiosis , Microbioma Gastrointestinal , Inmunoterapia , Inflamación , Obesidad , Microambiente Tumoral , Humanos , Disbiosis/inmunología , Obesidad/inmunología , Obesidad/terapia , Obesidad/microbiología , Microambiente Tumoral/inmunología , Microbioma Gastrointestinal/inmunología , Inflamación/inmunología , Inmunoterapia/métodos , Animales , Neoplasias de la Mama/inmunología , Neoplasias de la Mama/terapia , FemeninoRESUMEN
BACKGROUND: Obesity is a major public health issue in China and around the world. While acupuncture is often used in clinical practice, there is a lack of conclusive evidence for its weight-loss effect. Thus we will conduct a parallel, randomised, sham-controlled trial to evaluate the efficacy and safety of acupuncture for treating obesity. METHODS AND ANALYSIS: A total of 160 eligible participants with obesity will be randomly assigned to the verum acupuncture group or sham acupuncture group at a ratio of 1:1. All participants will be treated three times a week for a duration of 12 weeks, and followed up for another 16 weeks. The primary outcome is the percentage change in body weight from baseline to Week 12. The secondary outcomes include body mass index (BMI), waist circumference (WC), body fat percentage (BF%), blood pressure, fasting blood glucose, insulin, glycosylated haemoglobin A1c, blood lipids, and physical functioning score on the Short Form 36 Health Survey. Other secondary outcomes including psychological and social functions will also be evaluated using the body image scale, psychological function scale, and social function scale of the BODY-Q, Rosenberg Self-Esteem Scale, Patient Health Questionnaire-9, and Dutch Eating Behaviour Questionnaire. BMI, WC, BF% and blood pressure will be evaluated at Week 0, 4, 8, 12 and 28. Other secondary outcomes will be measured at Week 0, 12 and 28, respectively. Adverse events will be recorded in detail during the trial. ETHICS AND DISSEMINATION: Ethical approval of this trial was granted by the Ethics Committee of Chengdu Sport University (2023-102). Written informed consent will be obtained from study participants before enrolment. The findings will be disseminated through peer-reviewed journals. TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (ChiCTR2200062092).
Asunto(s)
Terapia por Acupuntura , Índice de Masa Corporal , Obesidad , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Obesidad/terapia , Terapia por Acupuntura/métodos , Adulto , Femenino , Masculino , Circunferencia de la Cintura , Persona de Mediana Edad , Pérdida de Peso , Adulto Joven , China , Glucemia/metabolismo , Glucemia/análisis , Presión Sanguínea , Resultado del TratamientoRESUMEN
According to the main international guidelines, patients with obesity and psychiatric/psychological disorders who cannot be addressed to surgery are recommended to follow a nutritional approach and a psychological treatment. A total of 94 patients (T0) completed a battery of self-report measures: Symptom Checklist-90-Revised (SCL-90-R), Barratt Impulsiveness Scale-11 (BIS-11), Binge-Eating Scale (BES), Obesity-Related Well-Being Questionnaire-97 (ORWELL-97), and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Then, twelve sessions of a brief psychodynamic psychotherapy were delivered, which was followed by the participants completing the follow-up evaluation (T1). Two groups of patients were identified: Group 1 (n = 65), who fully completed the assessment in both T0 and T1; and Group 2-dropout (n = 29), who fulfilled the assessment only at T0 and not at T1. Machine learning models were implemented to investigate which variables were most associated with treatment failure. The classification tree model identified patients who were dropping out of treatment with an accuracy of about 80% by considering two variables: the MMPI-2 Correction (K) scale and the SCL-90-R Phobic Anxiety (PHOB) scale. Given the limited number of studies on this topic, the present results highlight the importance of considering the patient's level of adaptation and the social context in which they are integrated in treatment planning. Cautionary notes, implications, and future directions are discussed.