Fluid-filled intragastric balloons are an effective and safe weight loss option across BMI and age ranges.

INTRODUCTION: Obesity is an expanding public health problem, resulting in more than half a billion adults worldwide. Intragastric balloon (IGB) placement is a weight loss alternative for obese patients with an inadequate weight loss response to diet and exercise. The aim of this study is to examine the efficacy and safety of the single-chamber fluid-filled IGB for weight loss and compare its results across different age groups. METHODS: We performed a database review of 239 consecutive patients from two outpatient GI clinics who underwent placement of an IGB. Our final analysis composed of 239 IGB placements in 232 patients (mean age, 44.5 ± 10.3 years; 67% female; baseline BMI 42.0 ± 9.0). Efficacy outcomes included the percentage of the total (%TWL) and excess weight loss (%EWL). Safety outcomes were measured as the number of patients who required early IGB removal (before 6 months). RESULTS: %TWL at 3 months was 10.1% and 14.4% at 6 months. Overall, 92%, 74%, and 47% of patients lost 5%, 10%, and 15% of total weight at 6 months, respectively. %EWL was 22.1% and 30.7% at 3 and 6 months post-IGB placement, respectively. The balloon was safely removed at six months after placement in most patients, whereas in 13.0% of cases early removal was performed at an average of 12.0 weeks after placement (range, 2 days-23 weeks). CONCLUSION: The use of a single-chamber fluid-filled IGB is successful in inducing a significant amount of weight loss in almost three-fourths of patients six months after its placement. This beneficial effect is seen across different BMI ranges and age groups at a similar level. IGBs should be considered an effective and safe alternative for obese patients who fail lifestyle interventions and conservative measures, fulfilling the unmet needs of many who are unwilling or unable to undergo bariatric surgery.

Building Successful Models in Primary Care to Improve the Management of Adult Patients with Obesity.

Although several obesity clinical practice guidelines are available and relevant for primary care, a practical and effective medical model for treating obesity is necessary. The aim of this study was to develop and implement a holistic population health-based framework with components to support primary care-based obesity management in US health care organizations. The Obesity Care Model Collaborative (OCMC) was conducted with guidance and expertise of an advisory committee, which selected participating health care organizations based on prespecified criteria. A committee comprising obesity and quality improvement specialists and representatives from each organization developed and refined the obesity care framework for testing and implementing guideline-based practical interventions targeting obesity. These interventions were tracked over time, from an established baseline to 18 months post implementation. Ten geographically diverse organizations, treating patients with diverse demographics, insurance coverage, and health status, participated in the collaborative. The key interventions identified for managing obesity in primary care were applicable across the 4 OCMC framework domains: community, health care organization, care team, and patient/family. Care model components were developed within each domain to guide the primary care of obesity based on each organization's structure, resources, and culture. Key interventions included development of quality monitoring systems, training of leadership and staff, identifying clinical champions, patient education, electronic health record best practice alerts, and establishment of community partnerships, including the identification of external resources. This article describes the interventions developed based on the framework, with a focus on implementation of the model and lessons learned.

Developing Integrated Clinical Pathways for the Management of Clinically Severe Adult Obesity: a Critique of NHS England Policy.

PURPOSE OF THE REVIEW: Pathways for obesity prevention and treatment are well documented, yet the prevalence of obesity is rising, and access to treatment (including bariatric surgery) is limited. This review seeks to assess the current integrated clinical pathway for obesity management in England and determine the major challenges. RECENT FINDINGS: Evidence for tier 2 (community-based lifestyle intervention) and tier 3 (specialist weight management services) is limited, and how it facilitates care and improve outcomes in tier 4 remains uncertain. Treatment access, rigidity in pathways, uncertain treatment outcomes and weight stigma seems to be major barriers to improved care. More emphasis must be placed on access to effective treatments, treatment flexibility, addressing stigma and ensuring treatment efficacy including long-term health outcomes. Prevention and treatment should both receive significant focus though should be considered to be largely separate pathways. A simplified system for weight management is needed to allow flexibility and the delivery of personalized care including post-bariatric surgery care for those who need it.

El magnesio sérico en niños normotensos, pre-hipertensos, hipertensos y obesos de edad escolar / Serum magnesium in normotensive, pre-hypertensive, hypertensive and obese school-age children

RESUMEN Introducción: la hipertensión, al igual que la obesidad, es un problema de salud a nivel mundial. En los últimos años esta situación ha aumentado en la edad infantil. Existe una estrecha relación inversa entre la ingestión del magnesio en la dieta, o en su suplementación, y los niveles de presión sanguínea. En la hipertensión hay presencia de las especies reactivas del oxígeno y las defensas antioxidantes pudieran estar afectadas. Objetivos: evaluar el comportamiento de las concentraciones del magnesio en niños pre-hipertensos, hipertensos y obesos en edad escolar. Métodos: se realizó un estudio descriptivo transversal. La muestra estuvo constituida por 501 infantes (8-11 años), los cuales se clasificaron según: los valores de presión arterial en reposo, sexo, color de la piel e índice de masa corporal. Las determinaciones del magnesio se realizaron por el método de absorción atómica con llama. Se utilizaron las pruebas: T student y U de Mann-Whinney, en la comparación de los grupos con un nivel de significación p< 0,05. Resultados: en el grupo total de niños no hubo diferencias en las concentraciones del magnesio. Los niños pre-hipertensos e hipertensos, del sexo femenino y piel blanca, de 9 años, presentaron disminución significativa de las concentraciones de magnesio. Los varones hipertensos normopesos presentaron diferencia significativa del magnesio en relación con los normotensos. No se encontró diferencia significativa en las concentraciones de magnesio al estudiar el índice de masa corporal. Conclusiones: las concentraciones de magnesio estuvieron disminuidas en los niños pre-hipertensos, hipertensos u obesos para determinados grupos de edad, sexo y color de la piel.

ABSTRACT Introduction: hypertension as obesity is considered a health problem worldwide. In recent years, this situation has increased in childhood. There is a close inverse correlation between the dietary intake of magnesium, or in its supplementation, and blood pressure levels. In hypertension, there is a presence of reactive oxygen species, as well as, antioxidant defenses may be affected. Objectives: to evaluate the manifestation of magnesium concentrations in pre-hypertensive, hypertensive and obese school-age children. Methods: a cross-sectional descriptive study was carried out. The sample consisted of 501 infants (8-11 years old), which were classified according to: blood pressure values at rest, gender, skin color and body mass index. The determinations of magnesium were made using flame atomic absorption spectrometry. Mann-Whitney U and Student's T Tests were used to compare groups with a significance level of p <0.05. Results: there were no differences in magnesium concentrations in the total group of children. Female pre-hypertensive and hypertensive white children aged 9 years showed a significant decrease in magnesium concentrations. Normal-weight hypertensive males had a significant difference in magnesium concentrations in relation to normotensive ones. No significant difference in magnesium concentrations was found when studying the body mass index. Conclusions: magnesium concentrations were decreased in pre-hypertensive, hypertensive or obese children for certain age groups, gender and skin color.

An investigation of Australian midwifery curricula for obesity management and health behaviour change training.

INTRODUCTION: Fifty percent of Australian women enter pregnancy overweight or obese. Unfortunately, few women receive weight management advice from health professionals during pregnancy. The aim of this study was to investigate current midwifery curricula from Australian universities to identify strengths and deficits in the teaching of preconception and antenatal weight management. METHODS: Midwifery courses from 20 universities were identified. Of the 568 units taught at these universities, 252 course outlines were obtained. Data were coded using the qualitative analysis technique of Framework Analysis for the following main themes: 1) the effect of weight, diet and physical activity on health outcomes for women who are pregnant or planning a pregnancy; 2) weight management advice in any population; and 3) health behaviour change techniques in any context. RESULTS: Analysis revealed a variety of teaching methods and skills training that emphasised the importance of clinical judgement and autonomous clinical practice, in conjunction with critical enquiry and sourcing reputable evidence. There was little evidence, however, that weight management advice was taught explicitly to midwifery students in the curricula. DISCUSSION: A greater emphasis on skilling midwifery students to address weight gain during pregnancy, and behavioural techniques to achieve this, is required.

Design of the Rural LEAP randomized trial: An evaluation of extended-care programs for weight management delivered via group or individual telephone counseling.

Obesity is a major contributor to the greater prevalence of chronic disease morbidity and mortality observed in rural versus nonrural areas of the U.S. Nonetheless, little research attention has been given to modifying this important driver of rural/urban disparities in health outcomes. Although lifestyle treatments produce weight reductions of sufficient magnitude to improve health, the existing research is limited with respect to the long-term maintenance of treatment effects and the dissemination of services to underserved populations. Recent studies have demonstrated the feasibility of delivering lifestyle programs through the infrastructure of the U.S. Cooperative Extension Service (CES), which has >2900 offices nationwide and whose mission includes nutrition education and health promotion. In addition, several randomized trials have shown that supplementing lifestyle treatment with extended-care programs consisting of either face-to-face sessions or individual telephone counseling can improve the maintenance of weight loss. However, both options entail relatively high costs that inhibit adoption in rural communities. The delivery of extended care via group-based telephone intervention may represent a promising, cost-effective alternative that is well suited to rural residents who tend to be isolated, have heightened concerns about privacy, and report lower quality of life. The Rural Lifestyle Eating and Activity Program (Rural LEAP) is a randomized trial, conducted via CES offices in rural communities, targeted to adults with obesity (n = 528), and designed to evaluate the effectiveness and cost-effectiveness of extended-care programs delivered via group or individual telephone counseling compared to an education control condition on long-term changes in body weight.

Capsaicin and capsiate could be appropriate agents for treatment of obesity: A meta-analysis of human studies.

Consumption of capsaicin or its nonpungent analogues, capsinoids has been reported to affect energy expenditure and fat oxidation, although available data are still controversial. The aim of the present study was to conduct a meta-analysis regarding the effects of these substances on energy expenditure and respiratory quotient, with special emphasis on the role of body mass index (BMI) of the participants. Medical databases were systematically searched for papers. Of the 627 trials identified, 9 provided results suitable to be included in analysis. Data analysis showed that after ingestion of capsaicin or capsinoids the energy expenditure increased (245 kJ/day, 58.56 kcal/day, p = 0.030) and the respiratory quotient decreased (by 0.216; p = 0.031) indicating a rise in fat oxidation. Studies with mean BMI of the participants below 25 kg/m2 failed to report any effect of capsaicin or capsinoids on the energy expenditure (p = 0.718) or on the respiratory quotient (p = 0.444), but studies with mean BMI exceeding 25 kg/m2 demonstrated an increase in energy expenditure (292 kJ/day, 69.79 kcal/day, p = 0.023) and a marked decrease in respiratory quotient (-0.257, p = 0.036). Our data clearly suggest that capsaicin or capsiate could be a new therapeutic approach in obesity promoting a negative energy balance and increased fat oxidation.

Commissioning guidance for weight assessment and management in adults and children with severe complex obesity.

The challenge of managing the epidemic of patients with severe and complex obesity disease in secondary care is largely unmet. In England, the National Institute of Health and Care Excellence and the National Health Service England have published guidance on the provision of specialist (non-surgical) weight management services. We have undertaken a systematic review of 'what evidence exists for what should happen in/commissioning of: primary or secondary care weight assessment and management clinics in patients needing specialist care for severe and complex obesity?' using an accredited methodology to produce a model for organization of multidisciplinary team clinics that could be developed in every healthcare system, as an update to a previous review. Additions to the previous guidance were multidisciplinary team pathways for children/adolescent patients and their transition to adult care, anaesthetic assessment and recommendations for ongoing shared care with general practitioners, as a chronic disease management pathway.

Appraisal of adaptive neuro-fuzzy computing technique for estimating anti-obesity properties of a medicinal plant.

This research examines the precision of an adaptive neuro-fuzzy computing technique in estimating the anti-obesity property of a potent medicinal plant in a clinical dietary intervention. Even though a number of mathematical functions such as SPSS analysis have been proposed for modeling the anti-obesity properties estimation in terms of reduction in body mass index (BMI), body fat percentage, and body weight loss, there are still disadvantages of the models like very demanding in terms of calculation time. Since it is a very crucial problem, in this paper a process was constructed which simulates the anti-obesity activities of caraway (Carum carvi) a traditional medicine on obese women with adaptive neuro-fuzzy inference (ANFIS) method. The ANFIS results are compared with the support vector regression (SVR) results using root-mean-square error (RMSE) and coefficient of determination (R(2)). The experimental results show that an improvement in predictive accuracy and capability of generalization can be achieved by the ANFIS approach. The following statistical characteristics are obtained for BMI loss estimation: RMSE=0.032118 and R(2)=0.9964 in ANFIS testing and RMSE=0.47287 and R(2)=0.361 in SVR testing. For fat loss estimation: RMSE=0.23787 and R(2)=0.8599 in ANFIS testing and RMSE=0.32822 and R(2)=0.7814 in SVR testing. For weight loss estimation: RMSE=0.00000035601 and R(2)=1 in ANFIS testing and RMSE=0.17192 and R(2)=0.6607 in SVR testing. Because of that, it can be applied for practical purposes.

The Role of Health Systems in Obesity Management and Prevention: Problems and Paradigm Shifts.

This paper provides an overview of a new section of Current Obesity Reports, called Health Services and programs. This new section seeks to better understand the problems within health systems around obesity management and prevention and to discuss the latest research on solutions. There are few health system issues that are quite as controversial as obesity and there remain several key problems inherent within existing obesity management and prevention approaches that necessitate the adoption of new paradigms and practices. Beginning with articles on addressing weight bias and stigma in health professional training, promoting new models of weight management provision, reviewing the role of regulation and generating an understanding of obesity through a complex systems lens, this new section will encourage readers to better address the challenging problems in obesity management and in doing so, overcome the 'paradigm paralysis' that has characterized the last few decades of obesity research and practice.

Effect of an abdominal obesity management program on dietary intake, stress index, and waist to hip ratio in abdominally obese women: Focus on comparison of the WHR decrease and WHR increase groups

This study was conducted to evaluate the effects of an abdominal obesity management program on dietary intake, stress index, and waist to hip ratio (WHR) in abdominally obese women. The subjects were 195 adult abdominally obese women (WHR > or = 0.80) who had been participating in a nutrition education (total of nine times) and dietary habits and life style modification programs (total of six times) for 12 weeks. The abdominal obesity management program focused on the nutrition provided by breakfast, lunch, and dinner, proper dietary habits, and practices to improve life style. The subjects were divided into a WHR decrease group and a WHR increase group according to changes in the WHR. Daily nutrient intake was assessed with a 3-day food record, body measurements and blood vessel age, stress index, and a health index that were measured at baseline and after 12 weeks. After the intervention, weight, waist circumference, hip circumference, WHR, and body mass index (BMI) decreased significantly in the WHR decrease group. Energy intake increased from 1486.2 kcal to 1541.4 kcal with a significant improvement in nutrient density for animal protein, total fat, animal fat, fiber, calcium, phosphorus, zinc, vitamin B6, vitamin C, vitamin E, and saturated fatty acids in the WHR decrease group. Additionally, dietary diversity increased significantly in the WHR decrease group compared to that in the WHR increase group. The WHR decrease group showed a significant improvement in the stress and health indices. Changes in WHR were correlated with changes in nutrient intake (animal protein, total fat, animal fat, plant fat, fiber, calcium, iron, potassium, vitamin A, vitamin B2, vitamin B6, vitamin C, and folate) and medical index profiles (stress and indices) adjusted for age, birth status, baseline BMI, and baseline WHR. These results show that an abdominal obesity management program was effective not only for reducing the WHR but also to improve dietary intake and the stress index in abdominally obese women.