Relationship between multiple weight cycles and early weight loss in patients with obesity: a longitudinal study.

PURPOSE: To assess the relationship between multiple weight cycling (WC) and early weight loss (e-WL). METHODS: Using a longitudinal prospective design conducted between May 2017 and November 2019, early weight loss was assessed at month 2 of a weight management programme in 100 adult participants with overweight or obesity, at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Weight cycling was defined as intentional weight loss of ≥ 3 kg followed by involuntary weight regain of ≥ 3 kg and participants were then categorized as multiple WC if they had experienced ≥ 2 cycles. RESULTS: Of the 100 participants with a median age of 34.90 (22.94-50.67) years and a median BMI of 35.25 (32.75-39.48) kg/m2, 75 met the criteria for WC and displayed a lower e-WL percentage than those without WC (4.69 ± 2.78% vs. 6.58 ± 2.80%; p = 0.006). Linear regression analysis showed that e-WL was lower by ≈ 2% (ß = - 1.935; 95% CL - 3.221, - 0.648; p = 0.004) in the WC group compared to the non-WC group after adjusting for age, gender and baseline BMI. CONCLUSION: In a 'real-world' clinical setting, multiple WC decreases e-WL rates. New strategies could be adopted for these patients to improve this early clinical outcome, since e-WL predicts longer-term success. LEVEL OF EVIDENCE: III, prospective longitudinal study.

Association between Dietary Practice and Gait Speed in Community-Dwelling Older Adults with Overweight and Obesity: A Cross-Sectional Study.

Slow gait speed is associated with poorer clinical outcomes and higher rates of functional limitation and mortality in older adults, especially when combined with overweight or obesity. Aging is also associated with nutritional deficits. The aim of our study was to assess the potential association between dietary practice and gait speed performance in community-dwelling older adults with overweight and obesity. Participants underwent body composition measurement with the Tanita MC-780MA Bioimpedance Analyzer (BIA). Dietary patterns were assessed with the Mini Nutritional Assessment (MNA) questionnaire, and a dietary adequacy (DA) score system was constructed. The four-meter gait speed test was performed in order to assess gait speed. Of 222 participants, aged 67.6 ± 6.6 years, with a body mass index (BMI) of 31.9 ± 4.5 kg/m2, 34.7% had reduced gait speed and lower DA compared to those with normal gait speed (2.99 ± 1.12 vs. 3.37 ± 1.07; p < 0.05). The DA score of participants with slower gait speed was more likely to fall below the median than that of participants with normal gait speed (70.1% vs. 51.7%; p < 0.05). Participants with slower gait speed were more likely to be nutritionally at risk of low DA (22.1% vs. 10.3%; p < 0.05). Logistic regression analysis, after adjustment for confounders, showed that the risk of having a slow gait speed was 75% lower among those with a higher DA score (OR = 0.25; 95% CI = 0.11-0.53). Older adults with overweight or obesity in community dwellings might need to be supported with nutritional interventions that can improve their gait speed.

Personalized Nutritional Strategies to Reduce Knee Osteoarthritis Severity and Ameliorate Sarcopenic Obesity Indices: A Practical Guide in an Orthopedic Setting.

Knee osteoarthritis (KOA) is one of the most common joint diseases, especially in individuals with obesity. Another condition within this population, and which presents frequently, is sarcopenic obesity (SO), defined as an increase in body fat and a decrease in muscle mass and strength. The current paper aims to describe recent nutritional strategies which can generally improve KOA clinical severity and, at the same time, ameliorate SO indices. Searches were carried out in the PubMed and Science Direct databases and data were summarized using a narrative approach. Certain key findings have been revealed. Firstly, the screening and identification of SO in patients with KOA is important, and to this end, simple physical performance tests and anthropometric measures are available in the literature. Secondly, adherence to a Mediterranean diet and the achievement of significant body weight loss by means of low-calorie diets (LCDs) remain the cornerstone nutritional treatment in this population. Thirdly, supplementation with certain micronutrients such as vitamin D, essential and non-essential amino acids, as well as whey protein, also appear to be beneficial. In conclusion, in the current review, we presented a detailed flowchart of three different nutritional tracks that can be adopted to improve both KOA and SO based on joint disease clinical severity.

Personalized Physical Activity Programs for the Management of Knee Osteoarthritis in Individuals with Obesity: A Patient-Centered Approach.

Physical activity (PA) plays a vital role in knee osteoarthritis (KOA) management. However, engaging individuals with KOA in regular exercise is challenging, especially when they are affected by obesity. The aim of the current review is to elucidate how to increase adherence to exercise in this population. When implementing a PA program with patients with KOA and obesity, a specific multi-step approach can be adopted. In phase I (the baseline assessment), the patients' eligibility for exercise is ascertained and a physical fitness assessment, sarcopenic obesity screening and quantification of the pain experienced are undertaken. Phase II adopts a patient-centered approach in implementing a PA program that combines an active lifestyle (>6000 steps/day) with land- or water-based exercise programs performed over eight to twelve weeks, with a frequency of three to five sessions per week, each lasting 60 min. In phase III, several strategies can be used to increase the patients' adherence to higher levels of PA, including the following: (i) personalizing PA goal-setting and real-time monitoring; (ii) enhancing physical fitness and the management of sarcopenic obesity; (iii) building a sustainable environment and a supportive social network for an active lifestyle; and (iv) reducing pain, which can ameliorate the clinical severity of KOA and help with weight management in this population.

Can Intentional Weight Loss Ameliorate Sarcopenia in Individuals with Obesity? A Longitudinal Interventional Study.

Little remains known regarding the impact of weight loss on sarcopenic obesity (SO), and for this reason we aimed to assess the relationship between the two during a weight management program. Body composition was measured at baseline and six-month follow-up using the Tanita BC-418, and step measurements were obtained daily over a period of six months using an Omron HJ-320 pedometer, in 41 adults of both genders with obesity. The participants were then categorized according to the presence or absence of SO. After a significant weight loss, an improvement in the appendicular skeletal mass (ASM) to weight ratio (24.5 ± 3.5 vs. 26.2 ± 3.6, p < 0.01), indicated a decrease in the prevalence of SO by 12.2%. Moreover, these findings were confirmed by logistic regression analysis revealing a significant WL% ≥ 5% combined with an active lifestyle (i.e., ≥8000 steps/day), decreased the risk of SO by 91% (OR = 0.09; 95% CI: 0.02-0.56), after adjusting for age and gender. In conclusion, in a weight management setting, a personalized program for individuals with SO that incorporates new strategies in terms of weight loss and physical activity targets may be adopted to improve the sarcopenia-related index and reduce the prevalence of SO in this population.

Approaching Sarcopenic Obesity in Young and Middle-Aged Female Adults in Weight Management Settings: A Narrative Review.

This paper presents a review of the available literature on sarcopenic obesity (SO) in young and middle-aged female adults with obesity in weight management settings. A literature review using the PubMed/Medline and Science Direct databases was conducted, and the data were summarized through a narrative approach. Firstly, some physical performance tests and questionnaires are available for screening young and middle-aged female adults with a high risk of SO. Secondly, these patients can undergo instrumental measurements such as dual-energy X-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) to confirm or reject a diagnosis of SO, applying definitions that account for body mass. Thirdly, SO is a prevalent phenotype in females seeking weight management treatment, as well as being strongly associated (vs. non-SO) with obesity-related comorbidities that need to be promptly managed, initially with nutritional programs or/and in combination with medications. Finally, patients with SO have a reduced baseline resting energy expenditure and more sedentary behaviors, which seem to account for the relationship between SO and poorer weight management outcomes, such as a higher early dropout rate and major later difficulties in weight loss maintenance. Therefore, specific strategies for personalized weight management programs for patients with SO should be incorporated to determine a successful management of this phenotype.

Exploring the effectiveness of a 1.5-Year weight management intervention for adults with obesity.

BACKGROUND & AIM: Obesity is a growing healthcare problem in Arabic-speaking countries although the effectiveness of the lifestyle modification program for weight management in this region is still lacking. Accordingly, this study aimed to assess long-term outcomes following an adapted lifestyle modification program based on cognitive behavioral therapy for obesity (CBT-OB) in Lebanon. METHODS: Forty-five adult participants with obesity were recruited consecutively at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Patients were offered an individualized form of CBT-OB lasting 18 months comprising two phases (a weight loss phase of 6 months and a weight-maintenance phase of 12 months). RESULTS: Twenty-five patients completed the treatment, with a mean weight loss of -11.58% after 6 months (-11.46% in the intention-to-treat analysis) and -8.84% after 18 months (-9.51% in the intention-to-treat analysis). Weight loss was associated with improvement in Health-Related Quality of Life (HRQoL) at six-month follow-up and in glycated hemoglobin (HbA1c) and body composition patterns at 18-month follow-up. CONCLUSION: Our findings provide evidence supporting the use of CBT-OB for obesity as a standard in 'real-world' clinical setting in Lebanon. Future studies are needed on larger samples and other populations in Arab-speaking countries.

The Relationship between Sarcopenic Obesity, Weight-Loss and Maintenance Outcomes during Obesity Management: Are Additional Strategies Required?

The lack of long-term maintenance of the weight loss achieved during weight-management programs is the major cause of failure in obesity treatments. The identification of factors related to this outcome has clinical implications. Therefore, we aimed to assess the relationship between sarcopenic obesity (SO) and the weight-loss percentage (WL%). The WL% was measured at the six-month follow-up and after more than 12 months, in 46 adult participants with obesity, during an individualized weight-management program where participants were categorized as having or not having SO at the baseline. At the six-month follow-up, participants with SO did not display a significant difference in terms of WL%, when compared to those without SO (-10.49 ± 5.75% vs. -12.73 ± 4.30%; p = 0.148). However, after a longer term (i.e., >12 months), the WL% appeared to be significantly lower in the former (SO vs. non-SO) (-7.34 ± 6.29% vs. -11.43 ± 4.31%; p = 0.024). In fact, partial correlation analysis revealed a relationship between SO at the baseline and a lower WL% after more than 12 months (ρ = -0.425, p = 0.009), after controlling for age, sex, and body mass index (BMI). Participants with SO appeared to face more difficulties in maintaining the achieved WL over a longer term (>12 months follow-up) by comparison with their counterparts (i.e., non-SO). Should this finding be replicated in larger-sample studies, new strategies should be adopted for these patients in order to improve this clinical outcome, especially during the weight-maintenance phase.

Cross-validation of prediction equations for estimating the body fat percentage in adults with obesity.

BACKGROUND & AIM: An accurate estimation of the body fat percentage (BF%) in patients with obesity is of clinical importance. Therefore, we aim to assess the validity of anthropometric-based BF predictive equations in treatment-seeking patients in an outpatient setting. METHODS: BF% was assessed by Tanita MC-780MA bioimpedance (BIA) and considered as a reference method, and anthropometric-based predictive equations were used in BF% estimations among 275 adults of both genders, in the outpatient clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). The mean differences between the measured and estimated BF% values were calculated to assess the accuracy of five equations, and the Bland-Altman method was used to assess the level of agreement. RESULTS: In both males and females, all predictive equations gave significantly different estimates of BF% when compared to those measured by BIA. On the other hand, in both genders, the mean difference between the BF% value estimated by the Jackson equation and that measured using BIA, was not significant, and agreement was confirmed using Bland-Altman plots. CONCLUSION: We suggest the Jackson equation for accurate BF% estimation in both genders of patients with obesity in the Lebanese population. However, future studies are still urgently needed to develop and validate new predictive equations suitable for BF% estimations, taking into account ethnicity (i.e., the Arab population).

Association between Levels of Physical Activity, Sarcopenia, Type 2 Diabetes and the Quality of Life of Elderly People in Community Dwellings in Lebanon.

There is a lack of data from developing countries on the link between physical activity (PA) on health outcomes. This study examines the association between the level of PA and sarcopenia, cardiovascular risk factors (i.e., dyslipidemia, type 2 diabetes (T2D), and cardiovascular diseases), and the health-related quality of life (HRQoL) among elderly people, in community dwellings in Lebanon. In this cross-sectional, observational study, body composition, levels of PA, and the HRQoL of 243 elderly people living in community dwellings, are obtained. The participants are then categorized based on a PA cut-off point of 600 metabolic equivalent task minutes per week (MET-min/week). In our sample, the prevalence of physical inactivity, defined as performing less than 600 MET-min/week, is 51.44% (125/243 participants).They displayed a higher prevalence of sarcopenia (36.0% vs. 18.6%), T2D (39.6% vs. 21.1%), as well as a lower physical (65.67 ± 20.72 vs. 75.08 ± 17.29) and mental (67.58 ± 21.51 vs. 76.95 ± 17.16) HRQoL. On the other hand, regression analysis shows that an increased rate of PA to ≥600 MET-min/week is associated with a lower risk of T2D (OR = 0.43, 95% CI: 0.22-0.84, p = 0.013) and sarcopenia (OR= 0.40, 95% CI: 0.22-0.73, p = 0.003) by 60%, and higher scores of the physical (ß = -7.65; -11.87, -3.43, p = 0.0004) and mental (ß = -8.47; -13.08, -3.85, p = 0.0004) HRQoL by nearly eight points. Our results show a high prevalence of physical inactivity in Lebanese adults over the age of 60; however, an adequate level of PA among this population seemed to be associated with a lower risk of sarcopenia and T2D, as well as a better HRQoL. However, future longitudinal studies are still needed to clarify if intervention based on increasing levels of PA can determine improvement in these clinical outcomes. If this is shown to be the case, it emphasizes the importance of implementing strategies to increase physical activity within this population.

Association between dietary practice, body composition, training volume and sport performance in 100-Km elite ultramarathon runners.

BACKGROUND & AIM: Sport performance during competitions is a central goal for athletes, and several factors have been identified that appear to have an association with better performance in different sport disciplines. However, the data are still not conclusive in ultramarathon runners. Accordingly, this study aimed to assess the potential associations between anthropometric, body composition, dietary and training factors and athletic performance in 100-Km elite ultramarathon runners. METHODS: Body mass index (BMI), body composition, training volume, Mediterranean dietary adequacy score (MDAS) and "100-Km race competition record" were assessed in 10 elite ultramarathon runners from the Italian Ultramarathon and Trail Association (IUTA) of the Italian national team. RESULTS: The study sample had a mean age of 41.1 ± 7.59 years and BMI of 21.66 ± 1.11 kg/m2. Female athletes had a lower appendicular skeletal muscle index (ASMI) and 100-Km race competition record, and a higher trunk fat percentage and MDAS compared to males. Correlation analysis revealed a significant association between the 100-Km race competition record and age, gender, ASMI, training volume, total body and trunk fat percentages. However, after correcting for confounders, partial correlation analysis confirmed only the association between training volume and 100-Km race competition record (ρ = -0.891, p = 0.009). CONCLUSION: Our findings provide evidence that a higher training volume expressed as Kilometers per week is an independent variable associated with better performance in 100-Km race competitions in elite ultramarathon runners. Future studies are needed to assess the usefulness of programs based on the increase of training volume as a strategy to improve athletic performance in 100-Km races in this specific population.

How Healthy Are Health-Related Behaviors in University Students: The HOLISTic Study.

The aim of this cross-sectional study was to assess the health-related behaviors among university students, with emphasis on health sciences students from Croatia, Italy, Lebanon, Poland, Romania, Spain and Turkey. We included 6222 students in Medicine, Dentistry, Nursing, Pharmacy, Nutrition and Dietetics, Sports Sciences, Veterinary, and Economics enrolled between April 2018 and March 2020. We assessed dietary patterns, sleeping habits, physical activity and perceived stress among students by means of validated questionnaires. The median age ranged between 19 and 24 years, smoking prevalence between 12.0% and 35.4%, and body mass index (BMI) ranged between 21.1 and 23.2 kg/m2. Breakfast was less often and more often consumed daily in Turkey (36.7%), and Italy (75.7%), respectively. The highest Mediterranean diet score was recorded in Spain and Italy, and the lowest in Turkey, followed by students from Croatia, Lebanon, Poland and Romania. Sleep duration, physical activity and stress perception also differed between countries. Multivariable regression analysis revealed a small, but positive association between BMI and several characteristics, including age, female gender, smoking, physical activity, mobile phone use, and perceived stress. A negative association was found between BMI and sleep duration on non-working days. Self-rated health perception was positively associated with female gender, breakfast, physical activity, and time spent studying, and negatively with BMI, smoking and stress. Our results demonstrated diverse habits in students from different countries, some of which were less healthy than anticipated, given their educational background. Greater emphasis needs to be placed on improving the lifestyle of these adolescents and young adults, who will be tomorrow's healthcare workers.

Lifetime Weight Cycling and Central Fat Distribution in Females With Obesity: A Brief Report.

Weight cycling (WC) is a common phenomenon in patients with obesity, however, its consequence on body composition has not yet been fully understood. Therefore, we aimed to determine whether multiple WC can negatively affect the latter, especially in terms of body fat distribution in female adults seeking treatment that are overweight or obese. Body composition was obtained using a segmental body composition analyser (MC-780MA, Tanita Corp., Tokyo, Japan) in 125 adult females who had been referred to the Department of Nutrition and Dietetics at the Beirut Arab University (Lebanon). WC was defined as intentional weight loss of ≥3 kg followed by involuntary weight regain of ≥3 kg, and participants were categorized as WC if they had experienced ≥2 cycles. Ninety of the 125 participants met the criteria for WC and displayed a higher total and trunk fat mass than those without WC. This was confirmed through linear regression analysis, showing that multiple WC were associated with increased fat mass (FM) by nearly 4.2 kg (ß = 4.23, 95%CI: 0.81-7.65, p = 0.016)-2.4 kg in the trunk region (ß = 2.35, 95%CI: 0.786-3.917, p = 0.004) when compared to the non-WC group, after adjusting for age and fat-free mass. In conclusion, multiple WC is associated with increased body fat, especially in the central region. Future studies are needed to examine the impact of this fat distribution on health outcomes in this phenotype of patients.

Understanding Sarcopenic Obesity in Terms of Definition and Health Consequences: A Clinical Review.

BACKGROUND AND AIM: Research interests in a new phenotype termed as sarcopenic obesity (SO), which refers to a decrease in lean body mass and muscle strength associated with an increase in body fat deposition, have grown. However, neither SO definition nor its impact on health outcomes is clear. In the current paper, we aim to summarize the available literature on the dilemma surrounding the definition of SO, and the potential health consequences of this phenomenon on individuals with overweight and obesity. METHODS: A literature review using the PubMed/Medline database was conducted and data were summarized by applying a narrative approach, based on clinical expertise in the interpretation of the available evidence base in the literature. RESULTS: Some definitions that account for body mass (i.e., body weight, body mass index) seem to be more suitable for screening of SO and revealed as clinically useful. The association between SO and certain health outcomes has also been investigated, especially those related to obesity; however, little is known about the association of SO with psychosocial distress and health-related quality of life impairment, as well as harsh outcomes such as mortality. CONCLUSION: International consensus regarding SO definition is needed, which would allow for a better understanding of its prevalence. Moreover, future investigations should be conducted in order to determine whether SO has an adverse effect (i.e., cause-effect relationship, in addition to association) on health. Once these issues are achieved, confirmed and clarified, evidenced-based protocols of treatment may become necessary to address the increase in the prevalence of obesity and sarcopenia worldwide.

Body Composition in Adolescents and Young Adults with Anorexia Nervosa: A Clinical Review.

BACKGROUND: Anorexia nervosa is a serious health condition characterized by a significant low body weight and alteration in body composition components. AIM: In the current paper, we aim to summarize the available literature concerning changes in body fat, lean, and bone masses, during anorexia nervosa and after complete weight restoration. METHODS: Data were summarized using a narrative approach based on clinical expertise in the interpretation of the available evidence base in the literature. RESULTS: The available data revealed three main findings. Firstly, anorexia nervosa causes a significant reduction in body fat mass, however it is completely restored after short-term weight normalization but with a central adiposity phenotype that does not seem to negatively influence treatment outcomes and appears to normalize after 1 year of normal weight maintenance. Secondly, anorexia nervosa causes a significant reduction in bone mineral density, but weight restoration is associated first (≈12 months) with stabilization of bone mineral density, followed by improvements (after ≈16 months); and finally, with complete normalization (after ≈30 months) after normal-weight maintenance. Thirdly, during anorexia nervosa loss of lean and skeletal body mass occurring in particular from the extremities rather than the central regions has been consistently reported, especially in patients with a Body Mass Index (BMI) ≤ 16.5 Kg/m2 however short-term weight restoration is associated with complete normalization. CONCLUSION: Anorexia nervosa adversely affects body composition, however this medical complication seems to be reversible through the main treatment strategy of body weight restoration followed by normal weight maintenance, and this should be openly discussed with patients.

Reduction of Resting Energy Expenditure and Sarcopenic Obesity in Adults with Overweight and Obesity: A Brief Report.

BACKGROUND AND AIM: The last decade has seen the emergence of a new condition, describing the coexistence of obesity and sarcopenia, termed Sarcopenic Obesity (SO). The aim of this study was to assess the potential association between SO and reduced Resting Energy Expenditure (REE). METHODS: Body composition and REE were measured using a bioimpedance analyser (Tanita BC-418) and Indirect Calorimeter (Vmax Encore 229), respectively in 89 adults with overweight or obesity of both genders, referred to the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Participants were then categorized on the basis of having SO or not. RESULTS: Thirty-nine of the 89 participants met the criteria for SO (43.8%), and these participants displayed a significantly lower REE per unit body weight than those in the group without SO (19.02 ± 2.26 vs. 20.87 ± 2.77; p = 0.001). Linear regression analysis showed that the presence of SO decreases REE by 1.557 kcal/day for each kg of body weight (ß = -1.557; CI = -0.261 - (-0.503); p = 0.004), after adjusting for age and gender. CONCLUSION: SO appears to be present in a high proportion of treatment-seeking adults with overweight or obesity of both genders, and it seems to be associated with a reduced REE, compared with those without SO. Future studies are needed to clarify whether this may influence clinical outcomes.

Predictive Equations Based on Body Composition for Resting Energy Expenditure Estimation in Adults with Obesity.

BACKGROUND AND AIM: An accurate estimation of Resting Energy Expenditure (REE) in patients with obesity is crucial. Therefore, our aim was to assess the validity of REE predictive equations based on body composition variables in treatment-seeking Arab adults with obesity. METHODS: Body composition and REE were measured by Tanita BC-418 bioimpedance and Vmax Encore 229 IC, respectively, and predictive equations based on fat mass and fat-free mass were used in REE estimations among 87 adults of both genders, in the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). The mean differences between the measured and estimated REE values were calculated to assess the accuracy, and the Bland-Altman method was used to assess the level of agreement. RESULTS: Ten predictive equations were included. In males, all the predictive equations gave significantly different estimates of REE when compared to that measured by IC. On the other hand, in females, the mean difference between the REE value estimated by Huang and Horie-Waitzberg equations and that measured using IC was not significant, and the agreement was confirmed using Bland-Altman plots. CONCLUSION: Huang and Horie-Waitzberg equations are suggested for accurate REE estimation in females; however, new validated REE estimation equations for males in this population are still needed.

Development of an Easy-to-Use Prediction Equation for Body Fat Percentage Based on BMI in Overweight and Obese Lebanese Adults.

An accurate estimation of body fat percentage (BF%) in patients who are overweight or obese is of clinical importance. In this study, we aimed to develop an easy-to-use BF% predictive equation based on body mass index (BMI) suitable for individuals in this population. A simplified prediction equation was developed and evaluated for validity using anthropometric measurements from 375 adults of both genders who were overweight or obese. Measurements were taken in the outpatient clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). A total of 238 participants were used for model building (training sample) and another 137 participants were used for evaluating validity (validation sample). The final predicted model included BMI and sex, with non-significant prediction bias in BF% of -0.017 ± 3.86% (p = 0.946, Cohen's d = 0.004). Moreover, a Pearson's correlation between measured and predicted BF% was strongly significant (r = 0.84, p < 0.05). We are presenting a model that accurately predicted BF% in 61% of the validation sample with an absolute percent error less than 10% and non-significant prediction bias (-0.028 ± 4.67%). We suggest the following equations: BF% females = 0.624 × BMI + 21.835 and BF% males = 1.050 × BMI - 4.001 for accurate BF% estimation in patients who are overweight or obese in a clinical setting in Lebanon.

Revising BMI Cut-Off Points for Obesity in a Weight Management Setting in Lebanon.

Obesity is defined by the World Health Organization (WHO) as a body mass index (BMI) ≥ 30 Kg/m2. This study aimed to test the validity of this BMI cut-off point for adiposity in a weight management clinical setting in Lebanon. This cross-sectional study of 442 adults of mixed gender, categorized by the WHO BMI classification, included: 66 individuals of normal weight, 110 who were overweight and 266 with obesity. The clinical sample was referred to the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (BAU) in Lebanon. All participants underwent anthropometric evaluation. The gold standard for defining obesity was based on the National Institutes of Health (NIH)/WHO guidelines for total body fat percentage (BF%). The best sensitivity and specificity were attained to predict obesity, according to the receiver operating characteristic curve (ROC) analysis. The BMI cut-off point for predicting obesity in the clinical sample was nearly 31.5 Kg/m2, and more than 90% of individuals with obesity and cardiometabolic disease were above this cut-off point. In conclusion, this new BMI cut-off point, an obesity definition higher than suggested in Western populations, was demonstrated to have clinical usefulness. Obesity guidelines in Lebanon, therefore, need revising.

Sarcopenic Obesity Predicts Early Attrition in Treatment-Seeking Patients with Obesity: A Longitudinal Pilot Study.

Attrition is a major cause of failure in obesity treatment, which is still not fully understood. The identification of factors related to this outcome is of clinical relevance. We aimed to assess the relationship between sarcopenic obesity (SO) and early attrition. Early attrition was assessed at six months, and two groups of patients were selected from a large cohort of participants with overweight or obesity enrolled at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Body composition was measured using a bioimpedance analyser (Tanita BC-418) and participants at baseline were categorized as having or not having SO. The "dropout group" included 72 participants (cases) compared to 31 participants (controls) in the "completer group", with the former displaying a higher prevalence of SO than the latter (51.0% vs. 25.8%; p = 0.016). In the same direction, Poisson regression analysis showed that SO increased the relative risk of dropout by nearly 150% (RR = 1.45; 95% CI = 1.10-1.89; p = 0.007) after adjustment for age, gender, body mass index (BMI), age at first dieting, sedentary habits and weight-loss expectation. In conclusion, in a "real-world" outpatient clinical setting, the presence of SO at baseline increases the risk of dropout at six months. New directions of future research should be focused on identifying new strategies to reduce the attrition rate in this population.