Discrimination and Stigma Associated with Obesity: A Comparative Study between Spain and Egypt. Data from the OBESTIGMA study.

INTRODUCTION: This study explores the under-investigated area of obesity-related discrimination and stigmatization across different countries, specifically comparing Spain (Europe) and Egypt (Middle East). METHODS: We conducted a cross-sectional observational study involving 2,090 participants from both countries. Participants completed three well-validated questionnaires to assess their attitudes towards obesity, experiences of weight-related stigma, and internalization of weight bias: Antifat Attitudes Scale (AFA), Stigmatizing Situations Inventory (SSI), and Weight Bias Internalization Scale (WBIS). Participants were categorized into four groups based on BMI and history bariatric surgery. RESULTS: Egyptian participants [BMI = 30.2±6.7 kg/m2 (range: 18.5 to 69.0 kg/m2)] showed significantly higher aversion towards obesity, as indicated by higher AFA score, compared to their Spanish counterparts [BMI = 35.4±10.1 kg/m2 (18.5 to 71,9 kg/m2)]. In contrast, Spanish participants reported higher levels of weight bias internalization with increasing BMI, while in Egypt, this association was negative. The association of bariatric surgery on stigma reduction also differed between the countries. Multivariate analysis revealed that residing in Egypt was an independent risk factor for higher scores in AFA and WBIS (Odds Ratio 8.20 [95% confidence interval: 6.78 to 9.62], p<0.001 and OR 6.28 [95% CI: 4.78 to 7.78], p<0.001; respectively). In contrast, Spaniards experienced more stigmatizing situations than Egyptians [OR -2.54 (95% CI: 6.78 to 9.62), p<0.001]. CONCLUSION: Our study underscore the complex and diverse nature of obesity-related attitudes across cultures. Understanding these cultural differences is crucial for developing effective, culturally sensitive strategies to tackle weight stigma. This research opens avenues for further studies and interventions tailored to cultural contexts.

Outcomes of Bariatric Surgery in Patients with Schizophrenia.

BACKGROUND: Outcomes of bariatric surgery (BS) in patients with schizophrenia are poorly understood. We aimed to analyze the effects of BS in patients with schizophrenia (SZ) or schizoaffective disorder (SZA). METHODS: This was a multicenter, retrospective case-control study in patients with SZ or SZA who had undergone BS in seven public referral hospitals in Spain. Controls without psychiatric comorbidity were selected in a 1:4 ratio. Detailed clinical and biochemical data were collected preoperatively and at 12, 24, 36, 48, and 60 months after BS. RESULTS: Twenty patients with SZ (n = 15; 75%) or SZA (n = 5; 25%) and 80 matched controls were studied. There were no differences between patients and controls concerning the evolution of the percentage of total weight loss. The remission rate of the main comorbidities was similar between groups except for hypertension, which was lower in patients with a psychotic disorder from year 3. There were no mortalities within 30 days of surgery in either group. The psychiatric medication burden did not change during follow-up. CONCLUSIONS: BS is safe and effective in carefully selected patients with SZ. The course of the psychiatric disease does not seem to be worsened by the procedure.

[Changes in weight, body composition, metabolic parameters and vitamin D in subjects with grade 3 and 4 obesity treated with liraglutide 3 mg]. / Cambios en el peso, la composición corporal, los parámetros metabólicos y la vitamina D en sujetos con obesidad de grado 3 y 4 tratados con liraglutida 3 mg.

INTRODUCTION: grade 3 and 4 obesity is a chronic and progressive disease. Liraglutide 3 mg could be an effective adjuvant therapy in these subjects. OBJECTIVES: to evaluate changes in weight loss, body composition, metabolic parameters and vitamin D levels in subjects with grade 3 and 4 obesity treated for 8 months with liraglutide 3 mg. METHODS: a total of 67 subjects with a BMI ≥ 40 kg/m2 had anthropometric parameters, body composition, metabolic parameters and vitamin D levels determined at baseline and after 8 months of treatment with liraglutide 3 mg. RESULTS: a significant reduction in weight, BMI and abdominal circumference was evident after 8 months of treatment with liraglutide (p < 0.001), with a mean percentage of weight loss of 13.04 % and a mean weight loss of 14.99 kg at the end of the intervention. The final body composition data showed a significant improvement in the percentage of fat and fat mass (kg) (p < 0.001). The average loss of muscle mass was 2.02 kg (p = 0.213). The healthy visceral fat index (VGI) (< 13) increased to 67.17 % (p < 0.001) at 8 months. There was a significant reduction in blood pressure (p < 0.001) and an improvement in the biochemical variables studied. There was a significant increase in 25-OH vitamin D (p < 0.001) at the end of the intervention. CONCLUSIONS: Treatment with liraglutide was safe and effective in patients with obesity with a positive impact on weight loss, vitamin D levels and other cardiovascular risk factors.

Influence of obesity on blood glucose control using continuous glucose monitoring data among patients with type 1 diabetes.

INTRODUCTION: The global increase in the prevalence rates of overweight or obesity has also affected patients with type 1 diabetes (T1D), where this disease had traditionally been associated with a lean phenotype. On the other hand, the effect of obesity on new glycemic control metrics obtained from continuous glucose monitoring (CGM) in T1D is poorly understood. We wanted to assess whether there is any relationship between BMI (body mass index) and the different CGM metrics or HbA1c. METHODS: Two hundred and twenty-five patients with T1D (47.1% ♀, mean age 42.9±14.7 years) with a CGM for a minimum of 6 months were analysed by downloading their CGM and collecting clinical and anthropometric variables. RESULTS: 35.1% (79/225) of the T1D patients had overweight and 17.3% (39/225) lived with obesity, while the remaining 47.6% had a normal weight. A negative correlation was found between GMI (glucose management indicator) and BMI (-0.2; p=0.008) and HbA1c (-0.2; p=0.01). In contrast, a positive correlation was observed between the total dose of insulin and the BMI (0.3; p<0.0001). No significant correlations were found between BMI and other CGM metrics. CONCLUSIONS: Overweight or obesity do not imply worse glycemic control in patients with T1D or less use of CGM. Possibly, and in order to achieve a good glycemic control, more units of insulin are necessary in these patients which, in turn, makes weight control more difficult.

Oral phytate supplementation on the progression of mild cognitive impairment, brain iron deposition and diabetic retinopathy in patients with type 2 diabetes: a concept paper for a randomized double blind placebo controlled trial (the PHYND trial).

Type 2 diabetes mellitus has a worldwide prevalence of 10.5% in the adult population (20-79 years), and by 2045, the prevalence is expected to keep rising to one in eight adults living with diabetes. Mild cognitive impairment has a global prevalence of 19.7% in adults aged 50 years. Both conditions have shown a concerning increase in prevalence rates over the past 10 years, highlighting a growing public health challenge. Future forecasts indicate that the prevalence of dementia (no estimations done for individuals with mild cognitive impairment) is expected to nearly triple by 2050. Type 2 diabetes mellitus is a risk factor for the development of cognitive impairment, and such impairment increase the likelihood of poor glycemic/metabolic control. High phytate intake has been shown to be a protective factor against the development of cognitive impairment in observational studies. Diary phytate intake might reduce the micro- and macrovascular complications of patients with type 2 diabetes mellitus through different mechanisms. We describe the protocol of the first trial (the PHYND trial) that evaluate the effect of daily phytate supplementation over 56 weeks with a two-arm double-blind placebo-controlled study on the progression of mild cognitive impairment, cerebral iron deposition, and retinal involvement in patients with type 2 diabetes mellitus. Our hypothesis proposes that phytate, by inhibiting advanced glycation end product formation and chelating transition metals, will improve cognitive function and attenuate the progression from Mild Cognitive Impairment to dementia in individuals with type 2 diabetes mellitus and mild cognitive impairment. Additionally, we predict that phytate will reduce iron accumulation in the central nervous system, mitigate neurodegenerative changes in both the central nervous system and retina, and induce alterations in biochemical markers associated with neurodegeneration.

Short-term effects of semaglutide among patients with obesity with and without food addiction: an observational study.

INTRODUCTION: Food addiction (FA) is highly prevalent among people with obesity (PwO) and may constitute a key factor in weight loss failure or weight regain. GLP-1 analogues have been shown to act on the mesolimbic system, which is related to hedonic overeating and substance abuse. We aimed to study the effects of low doses of semaglutide on FA symptomatology and to evaluate whether the presence of FA have a negative impact on weight loss despite treatment with semaglutide. METHODS: One hundred and thirteen PwO (45.5 ± 10.2 years) were evaluated anthropometrically baseline and after four months of treatment with semaglutide. PwO were evaluated for the presence of FA by completing The Spanish version of the Yale Food Addiction Scale 2.0 questionnaire (YFAS 2.0). RESULTS: Baseline BMI and fat mass (%) were greater among PwO with FA (35.8 ± 4.5 vs 33 ± 3.9 kg/m2and 44.2 ± 6.5 vs 40.1 ± 7.9%; p = .01). After four months of treatment with semaglutide, the prevalence of FA diminished from 57.5% to 4.2% (p < .001). The percentage of weight loss (6.9 ± 12.7 vs 5.3 ± 4.6%; p = .4) and the proportion of fat mass loss (2 ± 9 vs 1.6 ± 3.1%; p = .7) were comparable between PwO with and without FA. No differences regarding side effects and treatment discontinuations were seen between the two groups. CONCLUSION: Semaglutide is an effective tool for the amelioration of FA symptomatology among PwO. Despite PwO with FA had greater basal BMI and fat mass, semaglutide showed similar results compared to PwO without FA in terms of weight and fat mass loss at short term.