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1.
N Engl J Med ; 381(25): 2440-2450, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31851800

RESUMO

BACKGROUND: Although the national obesity epidemic has been well documented, less is known about obesity at the U.S. state level. Current estimates are based on body measures reported by persons themselves that underestimate the prevalence of obesity, especially severe obesity. METHODS: We developed methods to correct for self-reporting bias and to estimate state-specific and demographic subgroup-specific trends and projections of the prevalence of categories of body-mass index (BMI). BMI data reported by 6,264,226 adults (18 years of age or older) who participated in the Behavioral Risk Factor Surveillance System Survey (1993-1994 and 1999-2016) were obtained and corrected for quantile-specific self-reporting bias with the use of measured data from 57,131 adults who participated in the National Health and Nutrition Examination Survey. We fitted multinomial regressions for each state and subgroup to estimate the prevalence of four BMI categories from 1990 through 2030: underweight or normal weight (BMI [the weight in kilograms divided by the square of the height in meters], <25), overweight (25 to <30), moderate obesity (30 to <35), and severe obesity (≥35). We evaluated the accuracy of our approach using data from 1990 through 2010 to predict 2016 outcomes. RESULTS: The findings from our approach suggest with high predictive accuracy that by 2030 nearly 1 in 2 adults will have obesity (48.9%; 95% confidence interval [CI], 47.7 to 50.1), and the prevalence will be higher than 50% in 29 states and not below 35% in any state. Nearly 1 in 4 adults is projected to have severe obesity by 2030 (24.2%; 95% CI, 22.9 to 25.5), and the prevalence will be higher than 25% in 25 states. We predict that, nationally, severe obesity is likely to become the most common BMI category among women (27.6%; 95% CI, 26.1 to 29.2), non-Hispanic black adults (31.7%; 95% CI, 29.9 to 33.4), and low-income adults (31.7%; 95% CI, 30.2 to 33.2). CONCLUSIONS: Our analysis indicates that the prevalence of adult obesity and severe obesity will continue to increase nationwide, with large disparities across states and demographic subgroups. (Funded by the JPB Foundation.).


Assuntos
Obesidade Mórbida/epidemiologia , Obesidade/epidemiologia , Adulto , Índice de Massa Corporal , Feminino , Previsões , Humanos , Renda , Masculino , Obesidade/etnologia , Obesidade Mórbida/etnologia , Prevalência , Autorrelato , Distribuição por Sexo , Estados Unidos/epidemiologia
2.
Obes Surg ; 29(1): 166-171, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30191504

RESUMO

BACKGROUND: Micronutrient deficiencies are highly prevalent in patients seeking metabolic-bariatric surgery (MBS), although literature remains scant in Asia. In this study, we assess the prevalence of nutritional deficiencies in patients with clinically severe obesity in Singapore and examine factors associated with the deficiencies. METHODS: This is a prospective, observational study of 577 consecutive patients scheduled to undergo MBS. Nutritional profile including renal panel, calcium, phosphate, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D), vitamin B12, folate, ferritin, iron studies, hemoglobin, albumin, and alkaline phosphatase were analyzed. RESULTS: Mean age was 40.6 ± 10.3 years, 61.2% female, and mean BMI 42.4 ± 8.4 kg/m2. 92.9% had suboptimal vitamin D levels; of which 25.6% had vitamin D insufficiency (25(OH)D < 30 mcg/L), 57.5% had vitamin D deficiency (25(OH)D < 20 mcg/L), and 9.8% had severe vitamin D deficiency (25(OH)D < 10 mcg/L). Younger age, female gender, and higher BMI were independent factors associated with lower 25(OH)D. There was an inverse relationship between iPTH and 25(OH)D, with an inflection point at 25(OH)D of approximately 20 mcg/L. Folate deficiency was present in 31% and vitamin B12 deficiency in 9.5% of the cohort. Serum ferritin levels were low in 29.3%. 25(OH)D, ferritin, serum iron, and albumin were also significantly higher in Chinese compared to Malay and Indian patients. CONCLUSION: Vitamin D deficiency was the most common micronutrient deficiency observed in this multi-ethnic Asian cohort presenting for MBS. Ethnic differences in nutritional status were observed.


Assuntos
Grupo com Ancestrais do Continente Asiático , Deficiências Nutricionais/epidemiologia , Obesidade Mórbida/epidemiologia , Adulto , Ásia/etnologia , Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/estatística & dados numéricos , Estudos de Coortes , Deficiências Nutricionais/etnologia , Deficiências Nutricionais/etiologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Obesidade Mórbida/complicações , Obesidade Mórbida/etnologia , Obesidade Mórbida/cirurgia , Prevalência , Estudos Prospectivos , Singapura/epidemiologia
3.
Clin Nutr ESPEN ; 28: 165-170, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30390876

RESUMO

BACKGROUND & AIMS: Asians with similar body mass index (BMI) as the Caucasians are at higher health risk as compared to their counterparts. Although the mean weight of patients admitted to the intensive care unit (ICU) is increasing but the relation between BMI with 28-day mortality and length of stay (LOS) following ICU discharge in Asian patients is not well studied. METHODS: We included all adult patients admitted to the ICU of a tertiary hospital who received mechanical ventilation (MV) for at least 48 hours between October 2013 and September 2014. Demographics, BMI, MV, comorbidities, ICU scores (Acute Physiology And Chronic Health Evaluation (APACHE) II and sequential organ failure assessment (SOFA)), use of vasopressor, renal replacement therapy and calorie supplementation were collected from the ICU database. BMI was categorized into four groups according to the World Health Organization's Asian BMI recommendation. Post-ICU LOS (days) was calculated from ICU discharge to hospital discharge in hospital survivors. We used multivariable logistic regression to identify factors associated with 28-day mortality and post-ICU LOS of more than 7 days. RESULTS: In a cohort of 273 patients (male 62%, mean age 58.4 ± 17 years), the prevalence of overweight/obesity was 53%. In the bivariate analysis, 28-day mortality was lower (p = 0.014) and post-ICU LOS longer (p = 0.01) in the overweight/obese groups. In the multivariable logistic regression analysis, APACHE II (Odds ratio, OR 1.10, CI 1.05-1.16), SOFA (OR 1.17, CI 1.05-1.31), duration of MV (days, OR 1.14, CI 1.05-1.25) were associated with increased and higher BMI groups (p < 0.001) with decreased 28-day mortality. Further analysis of 196 hospital survivors showed age (OR 1.04, CI 1.02-1.06), duration of MV (days, OR 1.14, CI 1.02-1.27) and higher Asian BMI (p = 0.042) were associated with longer post-ICU LOS. The odds of longer post-ICU LOS amongst overweight and obese patients were 1.27 (CI 0.59-2.73) and 1.62 (CI 0.69-3.81) times that of those with normal BMI respectively. CONCLUSION: In multiethnic critically ill Asian patients, the prevalence of overweight/obesity was high. Although higher BMI was associated with reduced risk of 28-day mortality, obese patients stayed significantly longer in the hospital following ICU discharge.


Assuntos
Estado Terminal , Tempo de Internação , Obesidade Mórbida/epidemiologia , APACHE , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/etnologia , Escores de Disfunção Orgânica , Alta do Paciente , Prevalência , Singapura/epidemiologia , Análise de Sobrevida , Centros de Atenção Terciária , Adulto Jovem
4.
Ethn Dis ; 28(2): 75-84, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29725191

RESUMO

Introduction: Recruiting racial, ethnic, and other underserved minorities into conventional clinic-based and other trials is known to be challenging. The Sistas Inspiring Sistas Through Activity and Support (SISTAS) Program was a one-year randomized controlled trial (RCT) to promote physical activity and healthy eating among AA women in SC to reduce inflammatory biomarkers, which are linked to increased breast cancer (BrCa) risk and mortality. This study describes the development, recruitment, and implementation of the SISTAS clinical trial and provides baseline characteristics of the study participants. Methods: SISTAS was developed using community-based participatory research (CBPR) approaches. At baseline, study participants completed assessments and underwent clinical measurements and blood draws to measure C-reactive protein (CRP) and interleukin-6 (IL-6). Participants randomized to the intervention received 12 weekly classes followed by nine monthly booster sessions. Post-intervention measurements were assessed at 12-week and 12-month follow-ups. Results: We recruited a total of 337 women who tended to: be middle-aged (mean age 48.2 years); have some college education; be employed full-time; have Medicare as their primary insurance; be non-smokers; and perceive their personal health as good. On average, the women were pre-hypertensive at baseline (mean systolic blood pressure = 133.9 mm Hg; mean diastolic blood pressure = 84.0 mm Hg) and morbidly obese (mean BMI >40.0 kg/m2); the mean fat mass and fat-free mass among participants were 106.4 lb and 121.0 lb, respectively. Conclusion: The SISTAS RCT addresses some of the gaps in the literature with respect to CBPR interventions targeting AA women, such as implementing diet and physical activity in CBPR-based studies to decrease BrCa risk.


Assuntos
Exercício , Obesidade Mórbida , Afro-Americanos/psicologia , Afro-Americanos/estatística & dados numéricos , Pesquisa Participativa Baseada na Comunidade , /psicologia , Exercício/fisiologia , Exercício/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Humanos , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/etnologia , Obesidade Mórbida/psicologia , Seleção de Pacientes , Estados Unidos/epidemiologia
5.
Am J Cardiol ; 121(10): 1177-1181, 2018 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-29526273

RESUMO

No previous studies have examined the interaction between body mass index (BMI) and race/ethnicity with the risk of atrial fibrillation (AF). We retrospectively followed 48,323 persons free of AF (43% Hispanic, 37% black, and 20% white; median age 60 years) for subsequent incident AF (ascertained from electrocardiograms). BMI categories included very severely underweight (BMI <15 kg/m2), severely underweight (BMI 15.1 to 15.9 kg/m2), underweight (BMI 16 to 18.4 kg/m2), normal (BMI 18.5 to 24.9 kg/m2), overweight (BMI 25.0 to 29.9 kg/m2), moderately obese (BMI 30 to 34.9 kg/m2), severely obese (BMI 35 to 39.9 kg/m2), and very severely obese (BMI >40 kg/m2). Cox regression analysis controlled for baseline covariates: heart failure, gender, age, treatment for hypertension, diabetes, PR length, systolic blood pressure, left ventricular hypertrophy, socioeconomic status, use of ß blockers, calcium channel blockers, and digoxin. Over a follow-up of 13 years, 4,744 AF cases occurred. BMI in units of 10 was associated with the development of AF (adjusted hazard ratio 1.088, 95% confidence interval 1.048 to 1.130, p <0.01). When stratified by race/ethnicity, non-Hispanic whites compared with blacks and Hispanics had a higher risk of developing AF, noted in those whom BMI classes were overweight to severely obese. In conclusion, our study demonstrates that there exists a relation between obesity and race/ethnicity for the development of AF. Non-Hispanic whites had a higher risk of developing AF compared with blacks and Hispanics.


Assuntos
Afro-Americanos/estatística & dados numéricos , Fibrilação Atrial/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Obesidade Mórbida/epidemiologia , Magreza/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etnologia , Índice de Massa Corporal , Eletrocardiografia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade/etnologia , Obesidade Mórbida/etnologia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Magreza/etnologia , Estados Unidos/epidemiologia
6.
Obes Surg ; 28(7): 1960-1965, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29417486

RESUMO

OBJECTIVE: The study was designed to examine changes of body fat distribution after laparoscopic sleeve gastrectomy (LSG) in obese male patients and to confirm whether these changes are correlated with increased testosterone. METHODS: A total of 30 obese male patients with body mass index (BMI) 30-45 kg/m2 were enrolled in this study. Data on demographic characteristics, anthropometry, metabolic parameters, and body fat distribution were collected at baseline and 6 months after LSG. Body fat distribution was assessed by dual-energy X-ray absorptiometry (DXA). RESULTS: Six months after surgery, the BMI of participants (age 33.0 ± 9.5) decreased from 40.2 ± 5.2 to 30.8 ± 4.4 kg/m2, total testosterone increased from 2.4 ± 1.2 to 4.5 ± 1.8 ng/mL, and the percentage of testosterone deficiency in these patients decreased from 82.7 to 23.1%. Fat mass was significantly decreased in all regions, but the loss of fat mass in the android region was more than that in any other body region. After adjusting age and the BMI, the changes in android FM% and gynoid FM% were significantly correlated with an increase in total testosterone concentration (R2 = 0.187, R2 = 0.282, respectively). CONCLUSION: In obese male patients with BMI 30-45 kg/m2, an increase of total testosterone correlated to the changes in android FM% and gynoid FM% at the sixth month after LSG surgery.


Assuntos
Distribuição da Gordura Corporal , Gastrectomia , Obesidade Mórbida/cirurgia , Somatotipos/fisiologia , Testosterona/sangue , Absorciometria de Fóton , Adulto , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Composição Corporal , Índice de Massa Corporal , Feminino , Seguimentos , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/etnologia , Obesidade Mórbida/metabolismo , Adulto Jovem
7.
Surg Obes Relat Dis ; 14(1): 106-111, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29100900

RESUMO

BACKGROUND: Achieving weight loss after bariatric surgery depends on the individual's ability to sustain lifestyle changes involving dietary modifications. Presurgical dietary assessment is critical to evaluate usual dietary habits and identify the need for intervention before surgery. OBJECTIVES: The objective of this study was to identify usual dietary habits of black and white women seeking bariatric surgery and to examine potential differences between these ethnic groups. An additional aim was to describe participants' plans to change dietary behaviors after surgery. SETTING: This study examined data from an observational study sponsored by a benefits management group in Louisiana. METHODS: In this cross-sectional study, a presurgical dietary assessment interview questionnaire collected information on dietary habits. Participants (n = 200) were adult women being screened for bariatric surgery; 54% were white, and 46% were black. Descriptive statistics were calculated and differences between groups were tested using 2-way analysis of the variance. RESULTS: Participants reported consuming fast food 2.9 ± 2.6 times per week, fried foods 2.1 ± 1.8 times per week, and desserts 3.4 ± 3.2 times per week. Blacks reported more frequent consumption of fast food (P<.01), sugar-sweetened sodas (P<.05), and sugar-sweetened tea (P<.01) compared with whites. Plans for changing dietary behaviors after surgery were similar between ethnic groups. CONCLUSIONS: Findings indicated that frequent consumption of fast foods, fried foods, desserts, and sugar-sweetened beverages was common among women seeking bariatric surgery. Blacks tended to consume these foods and beverages more often than whites. Current dietary habits and future plans to change dietary behaviors should be addressed before surgery for success. Follow-up studies investigating the assessment instrument's ability to predict dietary adherence and weight loss after surgery are warranted.


Assuntos
Afro-Americanos/psicologia , Cirurgia Bariátrica/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Comportamento Alimentar , Obesidade Mórbida/psicologia , Afro-Americanos/etnologia , Cirurgia Bariátrica/estatística & dados numéricos , Culinária/estatística & dados numéricos , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/etnologia , Fast Foods/estatística & dados numéricos , Feminino , Estilo de Vida Saudável , Humanos , Intenção , Pessoa de Meia-Idade , Obesidade Mórbida/etnologia , Obesidade Mórbida/cirurgia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Cuidados Pré-Operatórios , Restaurantes/estatística & dados numéricos , Estados Unidos/epidemiologia , Perda de Peso/etnologia
8.
Asian J Endosc Surg ; 11(3): 238-243, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29227039

RESUMO

INTRODUCTION: Bariatric surgery is recognized as an effective treatment for type 2 diabetes mellitus, but data on its efficacy for type 1 diabetes mellitus, especially slowly progressive insulin-dependent diabetes mellitus, are limited. METHODS: We investigated five Japanese patients with slowly progressive insulin-dependent diabetes mellitus who underwent bariatric surgery at our center. RESULTS: Five morbidly obese glutamic acid decarboxylase antibody-positive diabetic patients underwent two different types of bariatric surgery. The mean titer of anti-glutamic acid decarboxylase antibody was 4.6 U/mL, and the mean preoperative bodyweight and BMI were 113 kg and 39.6 kg/m2 , respectively. The mean hemoglobin A1c was 8.4%. The mean fasting serum C-peptide was 5.0 ng/mL. Laparoscopic sleeve gastrectomy was performed in two patients, while laparoscopic sleeve gastrectomy with duodenojejunal bypass was performed in three patients. At one year after surgery, the mean bodyweight and BMI significantly dropped, and the mean percentage of excess weight loss was 96.4%. The mean hemoglobin A1c was 5.7%. This favorable trend was maintained at mid-term. CONCLUSION: Bariatric surgery for morbidly obese patients with anti-glutamic acid decarboxylase antibody-positive type 1 diabetes mellitus, especially slow progressive autoimmune diabetes, seemed effective in achieving mid-term glycemic control. Longer follow-up with a larger number of patients, as well as validation with more advanced patients with slowly progressive insulin-dependent diabetes mellitus, will be needed.


Assuntos
Grupo com Ancestrais do Continente Asiático , Diabetes Mellitus Tipo 1/complicações , Gastrectomia , Derivação Gástrica , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Adulto , Estudos de Coortes , Diabetes Mellitus Tipo 1/etnologia , Feminino , Humanos , Japão , Laparoscopia , Masculino , Obesidade Mórbida/etnologia , Resultado do Tratamento
9.
Pediatr Diabetes ; 19(4): 622-629, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29282818

RESUMO

OBJECTIVES: The risk of early-onset type 2 diabetes associated with the severity of obesity in youth is not well understood. This study aims to determine metabolic alterations and type 2 diabetes risk among American Indian children who are obese or severely obese. METHODS: Incidence rates of diabetes before 20 years (youth-onset) and 45 years were computed in 2728 children who were from 5 to <10 years and 4317 adolescents who were from 10 to <18 years without diabetes examined between 1965 and 2007. Obesity was defined as age-sex-adjusted body mass index (BMI) ≥95th percentile, and its severity was quantified as the percentage of the 95th percentile (%BMIp95 ). RESULTS: In the younger cohort, 0.9% of those non-obese and 2.9% of those with 100% to <120%BMIp95 had impaired glucose tolerance (IGT) compared to 8.6% of those with ≥140%BMIp95 . In the older cohort, 2.9% of those non-obese and 9.8% of those with 100% to <120%BMIp95 had IGT compared to 13.3% of those with ≥160%BMIp95 . The incidence of youth-onset diabetes was 3.8 and 4.9/1000 person-years in the child and adolescent cohorts, respectively, and before the age of 45 was 12.3 and 16.8/1000 person-years, respectively. Incidence rates of youth-onset diabetes in those with the most severe obesity (≥140%BMIp95 ) were 2.3 to 5.1 times as high as in those with the least severe obesity (100 to <120%BMIp95 ), and for onset of diabetes before the age of 45 were 1.6 to 2.2 times as high. CONCLUSIONS: Severe obesity in an American Indian population is a major driver of type 2 diabetes developing in adolescents and young adults.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Índios Norte-Americanos/estatística & dados numéricos , Obesidade Mórbida/epidemiologia , Obesidade Pediátrica/epidemiologia , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos de Coortes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Feminino , Intolerância à Glucose/complicações , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/etnologia , Humanos , Masculino , Obesidade Mórbida/complicações , Obesidade Mórbida/etnologia , Obesidade Pediátrica/complicações , Obesidade Pediátrica/etnologia , Fatores de Risco
10.
Surg Obes Relat Dis ; 14(4): 462-468, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29254689

RESUMO

BACKGROUND: Obesity and type 2 diabetes (T2D) are recognized as risk factors for hypogonadism in males. Serum sex hormone profiles have not been assessed adequately in obese Chinese males with T2D who have undergone Roux-en-Y gastric bypass (RYGB). OBJECTIVE: This study was conducted to examine the changes in sex hormone profiles, anthropometric parameters, and metabolic indexes before and after RYGB. SETTING: University Hospital, China. METHODS: There were 45 obese males with T2D who had undergone RYGB enrolled in this retrospective study, focusing on anthropometric parameters, metabolic indexes, and sex hormone profiles before and after surgery. RESULTS: The baseline prevalence of hypogonadism (defined by total testosterone [TT] levels<8 nM) was 33.33%. After surgery, both the levels of TT and sex hormone-binding globulin increased, while the levels of estradiol decreased. However, the calculated free testosterone, follicle-stimulating hormone, and luteinizing hormone levels remained unchanged. Multiple linear regression analysis showed that the visceral fat area was the only significant and independent parameter associated with TT levels at baseline (ß = -.479, P = .001). After surgery, decreases in the visceral fat area continued to be negatively associated with increases in TT (r = -.411, P = .024). CONCLUSION: These preliminary results demonstrated that TT could be significantly increased in obese Chinese males with T2D after RYGB; this occurs in part via a reduction in adipose tissue, especially visceral fat. Therefore, RYGB might be a promising therapy to treat hypogonadism in obese men with T2D.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Derivação Gástrica , Obesidade Mórbida/cirurgia , Testosterona/metabolismo , Adolescente , Adulto , Glicemia/metabolismo , China/etnologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Hemoglobina A Glicada/metabolismo , Humanos , Hipogonadismo/etnologia , Hipogonadismo/cirurgia , Gordura Intra-Abdominal/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/etnologia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Retrospectivos , Adulto Jovem
11.
ANZ J Surg ; 88(5): E366-E369, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29044970

RESUMO

BACKGROUND: Publicly funded bariatric surgery in New Zealand (NZ) is steadily on the rise to meet the obesity epidemic. Ethnic disparities in obesity rates exist in NZ with Maori and Pacific people having three to five times higher rates than all other ethnic groups within NZ. Ethnic disparities in rates of bariatric surgery have been reported internationally. This research sought to describe rates of publically funded bariatric surgery by self-identified ethnicity in NZ. METHODS: Using reported census and hospitalization discharge data from Statistics NZ and the NZ Ministry of Health, we calculated estimate rates of publicly funded bariatric surgery in the morbidly obese population from June 2009 to July 2014. RESULTS: The average number of publicly funded bariatric procedures performed per 1000 morbidly obese patients from June 2009 to July 2014 was 3.0 for European, 1.4 for Maori and 0.7 for Pacific ethnicities. CONCLUSION: While these data should be interpreted cautiously due to data limitations, the estimated rates may indicate that bariatric services are currently being provided inequitably across the major ethnic groups within NZ. We suggest that further studies should be performed to explore potential patient, healthcare provider and system-level factors that may contribute to ethnic disparities in the rates of publicly funded bariatric surgery in NZ.


Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu , Disparidades em Assistência à Saúde/etnologia , Obesidade Mórbida/etnologia , Obesidade Mórbida/cirurgia , Grupo com Ancestrais Oceânicos , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Masculino , Nova Zelândia , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos
12.
Surg Obes Relat Dis ; 13(12): 1966-1972, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28764918

RESUMO

BACKGROUND: Laparoscopic sleeve gastrectomy (SG) is a popular bariatric procedure in morbidly obese Asians. OBJECTIVES: To investigate the effect of initial weight loss on midterm weight maintenance and remission of co-morbidities after laparoscopic SG in morbidly obese Asians. SETTING: University Hospital, Singapore. METHODS: Data of patients who underwent laparoscopic SG were analyzed. Change in body mass index (BMI), percentage of total weight loss (%WL), and of excess weight loss (%EWL) was calculated and remission of obesity-related co-morbidities was examined. Linear regression analysis was performed to determine the effect of initial weight loss on successful weight maintenance. Receiver operative characteristic curve analysis was used to define optimal cutoff values. RESULTS: Two hundred and seventy-two patients were included in this study. Mean preoperative weight and BMI were 115.4±25.5 kg and 42.5±8.0 kg/m2, respectively. Mean follow-up duration was 27.6±16.4 months. Successful weight loss of>50% EWL was achieved by 65.7%, 65.5%, and 50.8% of patients at 1, 2, and 3 years, postoperatively. There was a significant correlation of %EWL at 3 months with %EWL up to 3 years (P≤.005). Receiver operative characteristic analysis showed initial EWL of 35% at 3 months best predicted successful weight loss at 1 year (sensitivity 73.1%, specificity 81.4%). Patients achieving>35% EWL were significantly more likely to achieve remission of co-morbidities (P≤.005) at 1 year after surgery. CONCLUSION: Early weight loss at 3 months predicts weight maintenance up to 3 years and remission of co-morbidities at 1 year after laparoscopic SG in Asians.


Assuntos
Grupo com Ancestrais do Continente Asiático , Gastrectomia , Laparoscopia , Obesidade Mórbida/cirurgia , Perda de Peso , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/etnologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Singapura , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Ethn Dis ; 27(3): 265-272, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28811738

RESUMO

INTRODUCTION: Retention of racial/ethnic minority groups into research trials is necessary to fully understand and address health disparities. This study was conducted to identify participants' characteristics associated with retention of African Americans (AAs) in a randomized controlled trial (RCT) of a behavioral intervention. METHODS: Using data from an RCT conducted from 2009 to 2012 among AAs, participant-level factors were examined for associations with retention between three measurement points (ie, baseline, 3-month, and 12-month). Chi-square tests and logistic regression analyses were conducted to compare retained participants to those who were not retained in order to identify important predictors of retention. RESULTS: About 57% of participants (n=238) were retained at 12 months. Baseline characteristics that showed a statistically significant association with retention status were age, marital status, body mass index (BMI), intervention group, enrollment of a partner in the study, and perceived stress score (PSS). Multivariable logistic regression that adjusted for age, BMI, and PSS showed the odds of being retained among participants who enrolled with a partner was 2.95 (95% CI: 1.87-4.65) compared with participants who had no study partner enrolled. The odds of being retained among participants who were obese and morbidly obese were .32 and .27 (95% CI: .14-.74 and .11-.69), respectively, compared with participants who had normal weight. CONCLUSION: Having a partner enrolled in behavioral interventions may improve retention of study participants. Researchers also need to be cognizant of participants' obesity status and potentially target retention efforts toward these individuals.


Assuntos
Atividades Cotidianas , Afro-Americanos , Cura pela Fé/métodos , Obesidade Mórbida/prevenção & controle , Adulto , Índice de Massa Corporal , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Obesidade Mórbida/etnologia , Estados Unidos/epidemiologia
15.
Curr Obes Rep ; 6(3): 314-323, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28755178

RESUMO

PURPOSE OF REVIEW: This review examines the risk of obesity in migrant groups-specifically migrants from countries with lower prevalence of obesity to countries with higher prevalence of obesity. We examine obesity prevalence within migrant groups compared with native populations and the evidence on factors that might shape obesity risk in these migrant groups. RECENT FINDINGS: Migrants may arrive in new countries with a health advantage including generally a healthier body weight. Genetic and epi-genetic factors, as well as body size preference, socio-economic factors, and stress exposure, may play a role in increasing unhealthy weight gain in migrant populations. This unhealthy weight gain leads to similar or greater obesity risk in migrant populations compared with native populations 10-15 years after migration. Meeting the challenge of prevention and treatment of obesity in diverse populations will require greater attention to minority groups in research in the future.


Assuntos
Emigrantes e Imigrantes , Obesidade Mórbida/epidemiologia , Adolescente , Adulto , Fatores Etários , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Obesidade Mórbida/etnologia , Obesidade Mórbida/etiologia , Prevalência , Fatores de Risco , Fatores Sexuais , Adulto Jovem
17.
South Med J ; 110(7): 486-490, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28679019

RESUMO

OBJECTIVE: To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. METHODS: A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. RESULTS: Time, resources, comfort, and cultural issues were reported by providers as the biggest barriers in screening and the treatment of pediatric obesity. All providers reported lack of time as a barrier to providing the care needed for obese children. Cultural barriers of both the provider and client were identified as factors, which negatively affect the care and treatment of obese children. CONCLUSIONS: Primary care providers continue to experience challenges when addressing pediatric obesity. In this study, a lack of adequate time to address obesity was identified as the most significant current barrier and may likely be tied to physician resources. Although reimbursement for obesity is increasing, the level of reimbursement does not support the time or the resources needed to treat patients. Many providers reported their patients' cultural view of obesity influenced how they counsel their patients. Increasing providers' knowledge concerning differences in how weight is viewed or valued may assist them in the assessment and care of obese pediatric patients. The challenges identified in previous research continue to limit providers when addressing obesity. Although progress has been made regarding knowledge of guidelines, continuing effort is needed to tackle the remaining challenges. This will allow for earlier identification and intervention, resulting in improved outcomes in pediatric obesity.


Assuntos
Aconselhamento Diretivo/tendências , Obesidade Pediátrica/terapia , Atenção Primária à Saúde/tendências , Adolescente , Arkansas , Criança , Pré-Escolar , Competência Cultural , Diagnóstico Precoce , Intervenção Médica Precoce , Feminino , Necessidades e Demandas de Serviços de Saúde/tendências , Inquéritos Epidemiológicos , Humanos , Masculino , Programas de Rastreamento/normas , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/etnologia , Obesidade Mórbida/terapia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Sobrepeso/terapia , Obesidade Pediátrica/diagnóstico , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/etnologia , Mecanismo de Reembolso/tendências , Fatores de Tempo
18.
Surg Laparosc Endosc Percutan Tech ; 27(4): e66-e68, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28654507

RESUMO

BACKGROUND: Changes in thyroid function following bariatric surgery in euthyroid obese patients have yielded inconsistent results. Nevertheless, no data exist on changes in thyroid function after bariatric surgery in Chinese obese subjects. OBJECTIVES: The objective of this study is to evaluate the influence of weight reduction on thyroid function following laparoscopic sleeve gastrectomy (LSG) in patients with normal thyroid function. PATIENTS AND METHODS: Serum free thyroxine (FT4), free triiodothyronine (FT3), and thyroid-stimulating hormone (TSH) levels were retrospectively analyzed before and 12 months after LSG in euthyroid patients with morbid obesity. Correlation between weight loss after LSG and changes in thyroid function were investigated. RESULTS: In total, 16 patients who underwent LSG were included in the study. Mean BMI change from 35.78 to 23.66 kg/m (P<0.000) after LSG was associated with a mean reduction in the TSH from 2.31 to 1.54 mU/L (P=0.022), whereas FT4 (15.19±0.33 pmol/L at baseline and 14.85±0.58 pmol/L at 12 mo after LSG; P=0.583) and FT3 (4.98±0.15 pmol/L at baseline and 4.77±0.60 pmol/L at 12 mo after surgery; P=0.406) levels remained steady. Decrease in TSH was significantly correlated with decrease in BMI at 12 months after surgery but did not correlate with excess weight loss and total weight loss. CONCLUSIONS: Weight loss after LSG is accompanied by significant decrease in serum TSH level but no change in serum FT4 and FT3 levels. However, further work is required to elucidate the mechanism.


Assuntos
Cirurgia Bariátrica/métodos , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Glândula Tireoide/fisiologia , Adulto , Grupo com Ancestrais do Continente Asiático/etnologia , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/etnologia , Obesidade Mórbida/fisiopatologia , Estudos Retrospectivos , Tireotropina/metabolismo , Tiroxina/metabolismo , Tri-Iodotironina/metabolismo , Perda de Peso/fisiologia , Adulto Jovem
19.
Obes Surg ; 27(11): 2873-2884, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28500418

RESUMO

BACKGROUND: Prior studies have suggested less weight loss among African American compared to Caucasian patients; however, few studies have been able to simultaneously account for baseline differences in other demographic, clinical, or behavioral factors. METHODS: We interviewed patients at two weight loss surgery (WLS) centers and conducted chart reviews before and after WLS. We compared weight loss post-WLS by race/ethnicity and examined baseline demographic, clinical (BMI, comorbidities, quality of life), and behavioral (eating behavior, physical activity level, alcohol intake) factors that might explain observed racial differences in weight loss at 1 and 2 years after WLS. RESULTS: Of 537 participants who underwent either Roux-en-Y Gastric Bypass (54%) or gastric banding (46%), 85% completed 1-year follow-up and 73% completed 2-year follow-up. Patients lost a mean of 33.00% of initial weight at year 1 and 32.43% at year 2 after bypass and 16.07% and 17.56 % respectively after banding. After adjustment for other demographic characteristics and type of surgery, African Americans lost an absolute 5.93 ± 1.49% less weight than Caucasian patients after bypass (p < 0.001) and 4.72 ± 1.96% less weight after banding. Of the other demographic, clinical, behavioral factors considered, having diabetes and perceived difficulty making dietary changes at baseline were associated with less weight loss among gastric bypass patients whereas having a diagnosis of anxiety disorder was associated with less weight loss among gastric banding patients. The association between race and weight loss did not substantially attenuate with additional adjustment for these clinical and behavioral factors, however. CONCLUSION: African American patients lost significantly less weight than Caucasian patients. Racial differences could not be explained by baseline demographic, clinical, or behavioral characteristics we examined.


Assuntos
Cirurgia Bariátrica , Grupos de Populações Continentais , Comportamento Alimentar , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Perda de Peso , Adulto , Afro-Americanos/estatística & dados numéricos , Cirurgia Bariátrica/reabilitação , Cirurgia Bariátrica/estatística & dados numéricos , Comorbidade , Grupos de Populações Continentais/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Comportamento Alimentar/etnologia , Comportamento Alimentar/fisiologia , Feminino , Humanos , Laparoscopia/reabilitação , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/etnologia , Qualidade de Vida , Estudos Retrospectivos , Fatores Socioeconômicos , Perda de Peso/etnologia
20.
Child Obes ; 13(3): 236-241, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28398850

RESUMO

BACKGROUND: Ethnic differences in lipid profiles exist in children and adolescents. This study assessed whether variations in lipid profiles present in overweight and obese youth were also observed in severely obese youth. Variations could explain the lower prevalence of the metabolic syndrome in certain ethnic groups at even severe levels of obesity. METHODS: Data were obtained from the National Health and Nutrition Examination Survey for the years of 2001 through 2012. Subjects were divided into groups according to BMI classification. Normal weight was defined as a BMI less than the 85th percentile. Overweight was defined as a BMI between the 85th and 95th percentile. Class 1 obesity was defined as a BMI greater than the 95th percentile up to 120% of the 95th percentile. A BMI between 120% and 140% of the 95th percentile was defined as Class 2 obesity. Class 3 was defined as a BMI above 140% of the 95th percentile. Primary outcomes were mean total cholesterol, triglyceride, low-density lipoprotein, and high-density lipoprotein levels (HDL). RESULTS: The sample included 14,481 non-Hispanic black (NHB) (N = 4710), non-Hispanic white (N = 4910), and Mexican American (N = 4861) subjects. Across all BMI categories, the NHB group had significantly lower mean TG and higher mean HDL levels (p < 0.0001). CONCLUSIONS: Ethnic variations in lipid profiles were found in severely obese youth. These findings could explain the lower prevalence of the metabolic syndrome in NHB youth. Ethnic-specific guidelines are necessary for improved identification of those at risk at all levels of obesity.


Assuntos
Grupos Étnicos , Lipídeos/sangue , Obesidade Pediátrica/etnologia , Adolescente , Grupo com Ancestrais do Continente Africano , Índice de Massa Corporal , Criança , Colesterol/sangue , HDL-Colesterol/sangue , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etnologia , Americanos Mexicanos , Inquéritos Nutricionais , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/etnologia , Obesidade Pediátrica/epidemiologia , Triglicerídeos/sangue , Adulto Jovem
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