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2.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372011

RESUMO

A 31-year-old woman, with a body mass index of 70.31 kg/m2, presented with progressive worsening of dyspnoea for 3 days. She had multiple comorbidities, including obesity hypoventilation syndrome. The patient developed type II respiratory failure with respiratory acidosis along with multiorgan failure. She was intubated and put on a mechanical ventilator and treated with intravenous diuretics, subcutaneous low-molecular-weight heparin and other supportive measures. Later, she was on noninvasive, continuous positive airway pressure ventilation overnight. She was prescribed a very-low-calorie diet along with physiotherapy and exercise. The patient underwent bariatric surgery 2 months after resolution of acute illness. Ten months after surgery, her body weight reduced from 180 kg to 121 kg, and her general condition improved. Successful management before and after surgical intervention depends on multidisciplinary teamwork, which includes the dietician, physiotherapist, endocrinologist, pulmonologist, nursing care and other supportive care.


Assuntos
Obesidade Mórbida/complicações , Obesidade Mórbida/terapia , Equipe de Assistência ao Paciente , Acidose Respiratória/complicações , Adulto , Cirurgia Bariátrica , Índice de Massa Corporal , Pressão Positiva Contínua nas Vias Aéreas , Dieta Redutora , Terapia por Exercício , Feminino , Humanos , Motivação , Insuficiência de Múltiplos Órgãos/complicações , Síndrome de Hipoventilação por Obesidade/terapia , Obesidade Mórbida/psicologia
3.
Eur J Endocrinol ; 183(5): R149-R166, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33107433

RESUMO

Obesity, defined by an excess of body fat impacting on health, is a complex disease resulting from the interaction between many genetic/epigenetic factors and environmental triggers. For some clinical situations with severe obesity, it has been possible to classify these obesity forms according to the molecular alterations. These include: (i) syndromic obesity, which associates severe early-onset obesity with neurodevelopmental disorders and/or polymalformative syndrome and (ii) non-syndromic monogenic obesity, due to gene variants most often located in the leptin-melanocortin pathway. In addition to severe obesity, patients affected by these diseases display complex somatic conditions, eventually including obesity comorbidities, neuropsychological and psychiatric disorders. These conditions render the clinical management of these patients particularly challenging. Patients' early diagnosis is critical to allow specialized and multidisciplinary care, with a necessary interaction between the health and social sectors. Up to now, the management of genetic obesity was only based, above all, on controlling the patient's environment, which involves limiting access to food, ensuring a reassuring daily eating environment that limits impulsiveness, and the practice of adapted, supported, and supervised physical activity. Bariatric surgery has also been undertaken in genetic obesity cases with uncertain outcomes. The context is rapidly changing, as new innovative therapies are currently being tested both for syndromic and monogenic forms of obesity. This review focuses on care management and new therapeutic opportunities in genetic obesity, including the use of the melanocortin 4 agonist, setmelanotide. The results from ongoing trials will hopefully pave the way to a future precision medicine approach for genetic obesity.


Assuntos
Cirurgia Bariátrica/tendências , Endocrinologia/tendências , Obesidade Mórbida/terapia , Obesidade/terapia , Adulto , Fármacos Antiobesidade/uso terapêutico , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Obesidade/genética , Obesidade Mórbida/genética , Síndrome , alfa-MSH/análogos & derivados , alfa-MSH/uso terapêutico
4.
PLoS One ; 15(10): e0239130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33006980

RESUMO

OBJECTIVE: Examine if adding aerobic exercise to standard medical care (EX+SC) prior to bariatric surgery improves metabolic health in relation to surgical outcomes. METHODS: Fourteen bariatric patients (age: 42.3±2.5y, BMI: 45.1±2.5 kg/m2) met inclusion criteria and were match-paired to pre-operative SC (n = 7) or EX+SC (n = 7; walking 30min/d, 5d/wk, 65-85% HRpeak) for 30d. A 120min mixed meal tolerance test was performed pre- and post-intervention (~2d prior to surgery) to assess insulin sensitivity (Matsuda Index) and metabolic flexibility (indirect calorimetry). Aerobic fitness (VO2peak), body composition (BodPod), and adipokines (adiponectin, leptin) were also measured. Omental adipose tissue was collected during surgery to quantify gene expression of adiponectin and leptin, and operating time and length of hospital stay were recorded. ANOVA and Cohen's d effect size (ES) was used to test group differences. RESULTS: SC tended to increase percent body fat (P = 0.06) after the intervention compared to EX+SC. Although SC and EX+SC tended to raise insulin sensitivity (P = 0.11), EX+SC enhanced metabolic flexibility (P = 0.01, ES = 1.55), reduced total adiponectin (P = 0.01, ES = 1.54) with no change in HMW adiponectin and decreased the length of hospital stay (P = 0.05) compared to SC. Albeit not statistically significant, EX+SC increased VO2peak 2.9% compared to a 5.9% decrease with SC (P = 0.24, ES = 0.91). This increased fitness correlated to shorter operating time (r = -0.57, P = 0.03) and length of stay (r = -0.58, P = 0.03). Less omental total adiponectin (r = 0.52, P = 0.09) and leptin (r = 0.58, P = 0.05) expression correlated with shorter operating time, and low leptin expression was linked to shorter length of stay (r = 0.70, P = 0.01), and low leptin expression was linked to shorter length of stay (r = 0.70, P = 0.01). CONCLUSION: Adding pre-operative aerobic exercise to standard care may improve surgical outcomes through a fitness and adipose tissue derived mechanism.


Assuntos
Cirurgia Bariátrica , Terapia por Exercício/métodos , Exercício Físico , Obesidade Mórbida/cirurgia , Obesidade Mórbida/terapia , Adipocinas/metabolismo , Tecido Adiposo/metabolismo , Adulto , Composição Corporal , Feminino , Humanos , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/metabolismo , Aptidão Física , Projetos Piloto , Cuidados Pré-Operatórios/métodos , Período Pré-Operatório , Resultado do Tratamento
6.
Z Evid Fortbild Qual Gesundhwes ; 153-154: 23-31, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32565062

RESUMO

BACKGROUND: Patients with severe obesity may have special challenges in regard to increasing health and well-being through physical activity (PA). The biggest challenge is maintaining the recommended PA level on a long-term basis. Yet, little focus has been put on the experiences of individuals with severe obesity during PA when physically active in everyday life after intervention has ended. OBJECTIVE: to explore the experiences of being physically active among individuals with severe obesity in everyday life 18 months after the start of a lifestyle intervention. DESIGN: a qualitative longitudinal study of individual follow-up interviews founded in hermeneutic phenomenology and an existential lifeworld theory of suffering and well-being. The study was approved by the Danish Data Protection Agency (J. no. 1-16-02-425-15). SETTING: Interviews were conducted by the same interviewer in the participants' home environment across three of five regions in Denmark. PATIENTS: Ten adults with severe obesity (BMI>40kg/m2) previously recruited from a public lifestyle intervention program. RESULTS: The analysis revealed that females and males emphasised different experiences of being active in everyday life. The females experienced 'Appreciation of process and vitality' and the males experienced 'The challenge of an active and joyful living'. One common main theme emerged: 'Fluctuating mood' was found to influence physical activity level. CONCLUSIONS: The study highlights the experiences of well-being in relation to staying physically active after lifestyle intervention. The fluctuations in mood were part of everyday life and it was an on-going challenge to balance mood in order to keep up the efforts. The ability to find settlement and modify PA expectations was part of feeling capable. Healthcare providers are suggested to address well-being in mood to help patients become and stay physically active in everyday life.


Assuntos
Obesidade Mórbida/terapia , Adulto , Exercício Físico , Feminino , Alemanha , Humanos , Estilo de Vida , Estudos Longitudinais , Masculino
7.
Intern Med ; 59(9): 1133-1139, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32378654

RESUMO

Objective Intragastric balloon (IGB) therapy is a low-invasion treatment for obesity. Recently, a low-carbohydrate diet has shown effectiveness for encouraging weight loss, but whether or not a low-carbohydrate diet improves the efficacy of IGB therapy remains unclear. Therefore, we examined the effectiveness of a low-carbohydrate diet compared with a calorie-restricted diet in combination with IGB therapy. Methods A prospective study was conducted on 51 patients who had undergone IGB therapy from October 2012 to December 2017. Overall, 31 of the 51 patients were included in this study (12-month assessment after IGB placement). These 31 cases consisted of 18 IGB plus low-carbohydrate diet and 13 IGB plus calorie-restricted diet. We compared the two groups with respect to body weight loss as outcomes. Results At 12 months after IGB placement, the body weight was significantly lower than that observed at baseline in both the IGB plus low-carbohydrate diet group (baseline 101.9±25.8 kg, 12 months 88.2±21.9 kg) (p<0.0001) and the IGB plus calorie-restricted diet group (baseline 103.5±17.0 kg, 12 months 89.1±6.2 kg) (p<0.005). The percentage of excess weight loss in the IGB plus low-carbohydrate diet group was slightly higher than that in the IGB plus calorie-restricted diet group, but there was no significant difference between the 2 groups at 12 months after IGB placement (IGB plus low-carbohydrate 49.9±60.0%, IGB plus calorie-restricted diet 33.1±27.0%). Conclusion Our study demonstrated that both a low-carbohydrate diet and a calorie-restricted diet were effective interventions for weight reduction in combination with IGB therapy.


Assuntos
Dieta com Restrição de Carboidratos , Balão Gástrico , Obesidade Mórbida/terapia , Peso Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/dietoterapia , Estudos Prospectivos , Resultado do Tratamento , Perda de Peso
8.
Medicine (Baltimore) ; 99(12): e19427, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195937

RESUMO

BACKGROUND: Severe and morbid obesity are increasing globally, particularly in women. As BMI increases, the likelihood of anovulation is higher. The primary aim of the EMOVAR clinical trial is to examine, over the short (16 weeks) and medium (12 months) term, the effects of a supervised physical exercise program (focused primarily on aerobic and resistance training) on ovarian function in women with severe/morbid obesity who have undergone bariatric surgery. Secondary objectives are to examine the effects of the intervention on chronic inflammation, insulin resistance, arterial stiffness, physical fitness, and health-related quality of life. METHODS: This is a randomized controlled trial in which ∼40 female bariatric surgery patients, aged between 18 and 45 years old, will be included. Participants assigned to the experimental group will perform a total of 48 sessions of supervised concurrent (strength and aerobic) training (3 sessions/week, 60 min/session) spread over 16 weeks. Patients assigned to the control group will receive lifestyle recommendations. Outcomes will be assessed at baseline, week 16 (i.e., after the exercise intervention) and 12 months after surgery. The primary outcome is ovarian function using the Sex-Hormone Binding Globuline, measured in serum. Secondary outcomes are serum levels of anti-mullerian hormone, TSH, T4, FSH, LH, estradiol, prolactine, and free androgen index, as well as oocyte count, the diameters of both ovaries, endometrial thickness, and uterine arterial pulsatility index (obtained from a transvaginal ultrasound), the duration of menstrual bleeding and menstrual cycle duration (obtained by personal interview) and hirsutism (Ferriman Gallwey Scale). Other secondary outcomes include serum markers of chronic inflammation and insulin resistance (i.e., C-reactive protein, interleukin 6, tumor necrosis factor-alpha, leptin, glomerular sedimentation rate, glucose, insulin and the HOMA-IR), arterial stiffness, systolic, diastolic and mean blood pressure, body composition, and total weight loss. Physical fitness (including cardiorespiratory fitness, muscular strength, and flexibility), health-related quality of life (SF-36 v2) and sexual function (Female Sexual Function Index) will also be measured. DISCUSSION: This study will provide, for the first time, relevant information on the effects of exercise training on ovarian function and underlying mechanisms in severe/morbid obese women following bariatric surgery. TRIAL REGISTRATION NUMBER: ISRCTN registry (ISRCTN27697878).


Assuntos
Cirurgia Bariátrica/reabilitação , Terapia por Exercício/métodos , Obesidade Mórbida/terapia , Adolescente , Adulto , Exercício Físico , Feminino , Humanos , Inflamação/fisiopatologia , Resistência à Insulina/fisiologia , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Testes de Função Ovariana , Aptidão Física/fisiologia , Qualidade de Vida , Método Simples-Cego , Rigidez Vascular/fisiologia , Adulto Jovem
9.
PLoS One ; 15(2): e0229138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32084189

RESUMO

INTRODUCTION: There has been a significant increase in the number of body contouring procedures performed worldwide. This study aimed to evaluate the long-term psychosocial effects of these procedures among patients who undergone weight loss surgery and maintained their body mass for a minimum of one year. MATERIAL AND METHODS: Post-bariatric patients undergoing body contouring procedures were recruited for the study consecutively. Inclusion criteria: BMI < 30 following bariatric surgery, weight maintenance for a minimum of 12 months, and completion of all follow up questionnaires (6 and 12 months). Patients were surveyed 24 hours before, 6-months, and 12-months post-procedure using a Polish validated version of BODY-Q. RESULTS: 30 consecutive patients with a mean age of 38 years (SD 5,91) were included in this study. The BODY-Q questionnaire revealed statistically significant improvements in the acceptance of body appearance after 12 months of follow up. In the abdominal area, the rise in scores achieved 90 from the starting level of 13, and the overall body image increased from 24 to 67. Moreover, in patients with postoperative complications (one hematoma and four minor wound dehiscence), the overall score did not differ from uncomplicated patients. CONCLUSIONS: Body contouring procedures after massive weight loss significantly improve the general perception of personal appearance as well as both the psychological and social aspects of life in patients, already significantly stigmatized by their appearance. Body contouring procedures have essential value and should be widely offered as a step in the treatment of morbidly obese patients.


Assuntos
Cirurgia Bariátrica , Contorno Corporal/psicologia , Obesidade Mórbida/psicologia , Obesidade Mórbida/terapia , Qualidade de Vida , Adulto , Feminino , Humanos , Masculino , Resultado do Tratamento
10.
Arthritis Rheumatol ; 72(3): 420-427, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31562683

RESUMO

OBJECTIVE: Massive weight loss leads to marked knee pain reduction in individuals with knee pain, but the reason for the reduction in pain is unknown. This study was undertaken to quantify the contribution of magnetic resonance imaging (MRI)-evidenced changes in pain-sensitive structures, bone marrow lesions (BMLs), and synovitis, and changes in pain sensitization or depressive symptoms, to knee pain improvement after substantial weight loss. METHODS: Morbidly obese patients with knee pain on most days were evaluated before bariatric surgery or medical weight management and at 1-year follow-up for BMLs and synovitis seen on MRI, the pressure pain threshold (PPT) at the patella and the right wrist, depressive symptoms (using the Center for Epidemiologic Studies Depression scale [CES-D]), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain survey. Natural-effects models were used to quantify the extent that achieving a minimum clinically important difference (MCID) of ≥18% on the WOMAC pain scale could be mediated by weight loss-induced changes in BMLs, synovitis, PPT, and depressive symptoms. RESULTS: Of 75 participants, 53.3% lost ≥20% of weight by 1 year. Of these, 75% attained the MCID for pain improvement, compared with 34.3% in those who had <20% weight loss. Mediation analyses suggested that, in those with at least 20% weight loss, the odds of pain improvement increased by 62%, 15%, and 22% through changes in patella PPT, wrist PPT, and CES-D, respectively, but pain improvement was not mediated by MRI changes in BMLs or synovitis. CONCLUSION: Weight loss-induced knee pain improvement is partially mediated by changes in pain sensitization and depressive symptoms but is independent of MRI changes in BMLs and synovitis.


Assuntos
Artralgia/fisiopatologia , Obesidade Mórbida/fisiopatologia , Perda de Peso , Adulto , Artralgia/etiologia , Artralgia/psicologia , Cirurgia Bariátrica , Medula Óssea/patologia , Doenças da Medula Óssea/etiologia , Doenças da Medula Óssea/fisiopatologia , Doenças da Medula Óssea/psicologia , Depressão/etiologia , Depressão/fisiopatologia , Feminino , Humanos , Joelho/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Manejo da Obesidade , Obesidade Mórbida/complicações , Obesidade Mórbida/terapia , Limiar da Dor/psicologia , Sinovite/etiologia , Sinovite/fisiopatologia , Sinovite/psicologia , Resultado do Tratamento
11.
Diabetes Care ; 43(1): 187-195, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31685489

RESUMO

OBJECTIVE: To compare diabetic kidney disease (DKD) rates over 5 years of follow-up in two cohorts of severely obese adolescents with type 2 diabetes (T2D) undergoing medical or surgical treatment for T2D. RESEARCH DESIGN AND METHODS: A secondary analysis was performed of data collected from obese participants of similar age and racial distribution enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. Glycemic control, BMI, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), and prevalence of hyperfiltration (eGFR ≥135 mL/min/1.73 m2) and elevated UAE (≥30 mg/g) were assessed annually. RESULTS: Participants with T2D from Teen-LABS (n = 30, mean ± SD age, 16.9 ± 1.3 years; 70% female; 60% white; BMI 54.4 ± 9.5 kg/m2) and TODAY (n = 63, age 15.3 ± 1.3 years; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. During 5 years of follow-up, hyperfiltration decreased from 21% to 18% in Teen-LABS and increased from 7% to 48% in TODAY. Elevated UAE decreased from 27% to 5% in Teen-LABS and increased from 21% to 43% in TODAY. Adjusting for baseline age, sex, BMI, and HbA1c, TODAY participants had a greater odds of hyperfiltration (odds ratio 15.7 [95% CI 2.6, 94.3]) and elevated UAE (27.3 [4.9, 149.9]) at 5 years of follow-up. CONCLUSIONS: Compared with MBS, medical treatment of obese youth with T2D was associated with a higher odds of DKD over 5 years.


Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2/terapia , Nefropatias Diabéticas/terapia , Hipoglicemiantes/administração & dosagem , Obesidade Mórbida/terapia , Obesidade Pediátrica/terapia , Programas de Redução de Peso/métodos , Adolescente , Glicemia/metabolismo , Criança , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Nefropatias Diabéticas/sangue , Nefropatias Diabéticas/complicações , Quimioterapia Combinada , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Hipoglicemiantes/efeitos adversos , Estilo de Vida , Masculino , Metformina/administração & dosagem , Metformina/efeitos adversos , Obesidade Mórbida/sangue , Obesidade Mórbida/complicações , Obesidade Pediátrica/sangue , Obesidade Pediátrica/complicações , Rosiglitazona/administração & dosagem , Rosiglitazona/efeitos adversos , Resultado do Tratamento
12.
Oxid Med Cell Longev ; 2019: 3940739, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31885787

RESUMO

Low-grade chronic inflammation plays a pivotal role among other pathophysiological mechanisms involved in obesity. Innate and adaptive immune cells undergo systemic proinflammatory polarization that gives rise to an increased secretion of proinflammatory cytokines, which in turn leads to insulin resistance. Bariatric surgery is currently the most effective treatment for obesity, as it brings on significant weight loss, glucose metabolism improvement, and a decrease in systemic inflammation biomarkers. After bariatric surgery, several changes have been reported to occur in adaptive immunity, including reduction in CD4+ and CD8+ T cell counts, a decrease in the Th1/Th2 ratio, an increase in B regulatory cells, and reduction in proinflammatory cytokine secretion. Overall, there seems to be a major shift in several lymphocyte populations from a proinflammatory to an anti-inflammatory phenotype. Furthermore, increased antioxidant activity and reduced lipid and DNA oxidation products have been reported after bariatric surgery in circulating mononuclear cells. This paper highlights the shift in the adaptive immune system in response to weight loss and improved insulin sensitivity, as well as the interplay between immunological and metabolic adaptations as a result of bariatric surgery. Finally, based on data from research, we propose several mechanisms such as changes in adaptive immune cell phenotypes and their by-products, recruitment in adipose tissue, reduced oxidative stress, and modification in metabolic substrate availability as drivers to reduce low-grade chronic inflammation after bariatric surgery in severe obesity.


Assuntos
Imunidade Adaptativa/imunologia , Cirurgia Bariátrica/métodos , Inflamação/fisiopatologia , Resistência à Insulina/imunologia , Obesidade Mórbida/etiologia , Perda de Peso/imunologia , Humanos , Obesidade Mórbida/terapia
13.
Gac Med Mex ; 155(6): 596-601, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31787775

RESUMO

Introduction: Evaluation of the patient with obesity is a challenge due to the technical difficulties to carry out measurements. Objective: To assess the association between neck circumference (NC) and waist circumference (WC) with cardio-metabolic risk markers, as well as treatment success in patients with morbid obesity. Method: Four-hundred and seventy patients of 39.3 ± 11.4 years of age and with a body mass index (BMI) of 44.1 ± 8.4 were studied; 73.5% were females. Baseline and final BMI, WC, NC, hip circumference and cardio-metabolic markers were assessed. Success was defined as weight loss ≥ 5%. Results: Significant correlations were found between WC and NC, and between these and cardio-metabolic risk markers, as well as between changes in WC and NC and treatment success. NC predicted success in logistic regression models. Conclusions: The association of WC and NC with cardio-metabolic risk indicators and the association of NC with treatment success in patients with morbid obesity was documented. Given the simplicity for obtaining it, NC might replace WC in the assessment and follow-up of patients with class III obesity.


Assuntos
Obesidade Mórbida/fisiopatologia , Obesidade/fisiopatologia , Adulto , Doenças Cardiovasculares/etiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/anatomia & histologia , Obesidade/terapia , Obesidade Mórbida/terapia , Estudos Retrospectivos , Fatores de Risco , Circunferência da Cintura/fisiologia
14.
BMC Health Serv Res ; 19(1): 748, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651309

RESUMO

BACKGROUND: Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). METHOD: Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. RESULTS: Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p < 0.001); residential distance from the clinic (21.8 versus 17.1 km, p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). CONCLUSIONS: Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services.


Assuntos
Manejo da Obesidade/estatística & dados numéricos , Obesidade Mórbida/terapia , Cooperação do Paciente/estatística & dados numéricos , Ansiedade/etiologia , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Pressão Positiva Contínua nas Vias Aéreas , Depressão/etiologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/psicologia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações
15.
Obes Res Clin Pract ; 13(5): 440-447, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31591082

RESUMO

BACKGROUND: Obesity is an independent risk factor for cardiovascular disease and diabetes weight reduction not only reduces the risk for these diseases but leads to an alteration of the circulating adipokine levels. The aim of our study was to evaluate the effect of weight loss and lifestyle changes implemented in the form of the interdisciplinary weight management programme Optifast52® on cardiovascular and diabetic risk factors and on key adipokines. METHODS: 72 morbidly obese patients were included in the programme, which consisted of a very low-calorie diet followed by incremental food introduction and dietary stabilisation, accompanied by medical surveillance, physical activity, dietary counselling and psychological support. At baseline, and after 14, 26 and 49 weeks, risk factor profiles and adipokine levels were evaluated. RESULTS: 43 patients completed the programme with an average weight reduction of about 20%. Significant improvement was observed in the lipid and diabetic laboratory panels of all patients. In addition, adiponectin levels increased significantly (7.79 vs. 12.38µg/ml, p<0.001), while leptin levels decreased (7.29 vs 3.09ng/ml, p<0.001) during the course of the programme. CONCLUSION: In this study, Optifast52®, a multidisciplinary programme focusing on diet and lifestyle changes, was found not only to affect a decrease in parameters associated with diabetes and cardiovascular disease, but also to ameliorate in part the obesity-related imbalance of pro- and anti-inflammatory adipokines.


Assuntos
Adipocinas/fisiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/prevenção & controle , Obesidade Mórbida/terapia , Perda de Peso , Adipocinas/sangue , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Feminino , Humanos , Resistência à Insulina , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Fatores de Risco , Adulto Jovem
16.
BMJ Open ; 9(9): e029473, 2019 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511284

RESUMO

OBJECTIVES: To improve our understanding of the acceptability of behavioural weight management programmes (WMPs) for adults with severe obesity. DESIGN: A systematic review of qualitative evidence. DATA SOURCES: Medline, Embase, PsycINFO, CINAHL, SCI, SSCI and CAB abstracts were searched from 1964 to May 2017. ELIGIBILITY CRITERIA: Papers that contained qualitative data from adults with body mass index (BMI) ≥35 kg/m2 (and/or the views of providers involved in their care) and considered issues about weight management. DATA EXTRACTION AND SYNTHESIS: Two reviewers read and systematically extracted data from the included papers which were compared, and contrasted according to emerging issues and themes. Papers were appraised for methodological rigour and theoretical relevance using Toye's proposed criteria for quality in relation to meta-ethnography. RESULTS: 33 papers met our inclusion criteria from seven countries published 2007-2017. Findings were presented from a total of 644 participants and 153 programme providers. Participants described being attracted to programmes that were perceived to be novel or exciting, as well as being endorsed by their healthcare provider. The sense of belonging to a group who shared similar issues, and who had similar physiques and personalities, was particularly important and seemed to foster a strong group identity and related accountability. Group-based activities were enjoyed by many and participants preferred WMPs with more intensive support. However, some described struggling with physical activities (due to a range of physical comorbidities) and not everyone enjoyed group interaction with others (sometimes due to various mental health comorbidities). Although the mean BMI reported across the papers ranged from 36.8 to 44.7 kg/m2, no quotes from participants in any of the included papers were linked to specific detail regarding BMI status. CONCLUSIONS: Although group-based interventions were favoured, people with severe obesity might be especially vulnerable to physical and mental comorbidities which could inhibit engagement with certain intervention components.


Assuntos
Obesidade Mórbida/terapia , Participação do Paciente/psicologia , Programas de Redução de Peso/métodos , Adulto , Índice de Massa Corporal , Exercício Físico , Humanos , Obesidade Mórbida/psicologia , Psicoterapia de Grupo
17.
Clin Obes ; 9(6): e12337, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31475476

RESUMO

Impaired physical capacity is common in people with severe levels of obesity. We aimed to investigate changes in physical capacity outcomes in patients with severe obesity following 12 months of physician-led multidisciplinary care from a "real world" Australian public hospital setting using a case series study design. We extracted data from medical records for all of the eligible patients referred to our clinical obesity service from 2010 to 2015 (69 of 239). We found significant (P < .05) pre-test/post-test (mean ± SD) improvements in the 6-minute walk test (6MWT) (339 ± 120 to 417 ± 112 m); 30-second sit-to-stand test (11 ± 4 to 15 ± 6 counts) and sit-and-reach test (-12 ± 13 to -8 ± 15 cm). Using linear mixed-effects models adjusting for repeated measurements over time (baseline vs 12 months) and testing for potential predictors, we found: mean 6MWT was associated with 12-month time period (56 m), body mass index (BMI, -3 m), no walking aid over 12 months (106 m) and no opioid analgesics (75 m); mean sit-to-stand was associated with 12-month time period (3 counts), age at referral (-0.2 counts), BMI (-0.2 counts), and diabetes (3 counts); and mean sit-and-reach was associated with 12-month time period (5 cm), female gender (5 cm) and total medications (-0.9 cm). Using causal mediation analysis, our results show that total exercise classes partially mediates change in walking capacity among those with cardiovascular disease. Our study shows that significant and clinically important improvements in physical capacity outcomes in patients with severe obesity can be achieved following 12 months of intensive specialist obesity services, such as ours.


Assuntos
Obesidade Mórbida/terapia , Adulto , Idoso , Índice de Massa Corporal , Terapia por Exercício , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/fisiopatologia , Médicos , Resultado do Tratamento , Caminhada
18.
Am J Gastroenterol ; 114(9): 1470-1477, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31490227

RESUMO

INTRODUCTION: Despite its recent approval by the US Food and Drug Administration and Health Canada, aspiration therapy-one of the latest weight loss treatments-remains controversial. Critics have expressed concerns that the therapy could lead to bulimia and other binge eating disorders. Meanwhile, proponents argue that the therapy is less invasive, reversible, and cheaper than bariatric surgery. Cost-effectiveness of this therapy, however, is not yet established. METHODS: We developed a Markov model to estimate the incremental cost-effectiveness of aspiration therapy relative to 2 most common bariatric surgery procedures (gastric bypass and sleeve gastrectomy) and no treatment over a lifetime horizon. Costs were estimated from the health system's perspective using US data. Effectiveness was measured in terms of quality-adjusted life-years (QALYs). RESULTS: Despite being a cheaper procedure than bariatric surgery, aspiration therapy costs more than bariatric surgery in the long term because of its high maintenance costs (i.e., periodic replacement of device parts). It also yields lower QALYs than bariatric surgery because of its smaller weight loss effects. Thus, the therapy is dominated by bariatric surgery. In particular, compared with gastric bypass, it costs US$5,318 more and yields 1.31 fewer QALYs. However, aspiration therapy is cost-effective relative to no treatment with an incremental cost-effectiveness ratio of US$17,532 per QALY gained. DISCUSSION: Given its high lifetime costs and its modest weight loss effects, aspiration therapy is not cost-effective relative to bariatric surgery. However, it is a cost-effective treatment option for patients who lack access to bariatric surgery.


Assuntos
Drenagem/métodos , Gastrectomia/métodos , Derivação Gástrica/métodos , Gastrostomia/métodos , Custos de Cuidados de Saúde , Obesidade Mórbida/terapia , Adulto , Idoso , Cirurgia Bariátrica/economia , Cirurgia Bariátrica/métodos , Análise Custo-Benefício , Drenagem/economia , Gastrectomia/economia , Derivação Gástrica/economia , Gastrostomia/economia , Humanos , Cadeias de Markov , Pessoa de Meia-Idade , Obesidade Mórbida/economia , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos , Adulto Jovem
19.
Clin Endocrinol (Oxf) ; 91(6): 750-758, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31529511

RESUMO

OBJECTIVE: Existing data are contradictory on the prevalence of polycystic ovary syndrome (PCOS) and metabolic syndrome (MetS) in women with severe obesity (body mass index [BMI] ≥ 35 kg/m2 ), and there are few studies investigating the effect of weight reduction in women with severe obesity and PCOS. The aim was to study the prevalence of PCOS and MetS among women with severe obesity and to evaluate the effect of a 12-months weight loss programme on the prevalence of PCOS and MetS. DESIGN/PARTICIPANTS: In total, 298 women with severe obesity were enrolled whereof 246 women had complete screening data for PCOS and MetS before commencing treatment. Weight loss intervention included very low energy diet. At 12-months follow-up, 72 women with complete data remained and were re-examined with baseline parameters. RESULTS: At baseline, the prevalence of PCOS was 25.6% and in this group, the prevalence of MetS was 43.4% in PCOS vs 43.3% in controls (ns). At 12-months follow-up, weight loss in women with PCOS was 12.3 ± 10.7 kg (P < .001) and in non-PCOS 13.9 ± 13.4 kg (P < .001) with no between group difference. Women without PCOS decreased in total bone mass. CONCLUSIONS: Polycystic ovary syndrome occurs in one out of four women with severe obesity. The prevalence of MetS does not differ between women with or without PCOS with severe obesity. There was a significant weight loss in both groups but no difference between groups regarding change in metabolic parameters.


Assuntos
Obesidade Mórbida/epidemiologia , Síndrome do Ovário Policístico/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/terapia , Pessoa de Meia-Idade , Obesidade Mórbida/terapia , Síndrome do Ovário Policístico/terapia , Prevalência , Programas de Redução de Peso/métodos , Adulto Jovem
20.
Nutrients ; 11(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31547312

RESUMO

Adiponectin exerts positive effects on metabolic and inflammatory processes. Adiponectin levels and some single-nucleotide polymorphisms (SNPs) seem to be associated with obesity. Here, we investigated the effects of a 4-week Hypocaloric diet and Physical exercise Program (HPP) on 268 young people with severe obesity. We evaluated the relationship between adiponectin levels and anthropometric and biochemical parameters, at baseline and after a 4-week HPP. Finally, we investigated some adiponectin gene variants and their correlation to biochemical parameters. Adiponectin levels were statistically lower in people with severe obesity than in controls. At the end of the HPP, all the people with severe obesity showed a Body Mass Index (BMI) reduction with a statistically significant increase in adiponectin levels. Genotyping, the adiponectin gene demonstrated a significant difference in 3 polymorphisms within the people with severe obesity. Besides, c.11377C>G and c.11391G>A homozygous subjects experienced more advantages by HPP. Furthermore, c.268G>A heterozygous subjects showed an enhancement in lipid profile as well in adiponectin levels. The best predictor of the changes in adiponectin levels was represented by the c.268G>A WT allele. Our study confirmed that a 4-weeks HPP in people with severe obesity results in metabolic amelioration associated with a significant increase of adiponectin levels. Importantly, we found that a specific genetic background in the ADIPOQ gene can predispose toward a more significant weight loss.


Assuntos
Adiponectina/sangue , Manejo da Obesidade/métodos , Obesidade Mórbida/genética , Obesidade Mórbida/terapia , Perda de Peso/genética , Adulto , Alelos , Antropometria , Estudos de Casos e Controles , Dieta Redutora/métodos , Terapia por Exercício/métodos , Feminino , Genótipo , Homozigoto , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Resultado do Tratamento
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