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BackgroundTraditionally, weight loss (WL) trials utilize dual energy X-ray absorptiometry (DXA) to measure lean mass. This method assumes lean mass, as the sum of all non-bone and non-fat tissue, is a reasonable proxy for muscle mass. In contrast, the D3 -creatine (D3 Cr) dilution method directly measures whole body skeletal muscle mass, although this method has yet to be applied in the context of a geriatric WL trial. The purpose of this project was to (1) describe estimates of change and variability in D3 Cr muscle mass in older adults participating in an intentional WL intervention and (2) relate its change to other measures of body composition as well as muscle function and strength.MethodsThe INVEST in Bone Health trial (NCT04076618), used as a scaffold for this ancillary pilot project, is a three-armed, 12-month randomized, controlled trial designed to determine the effects of resistance training or weighted vest use during intentional WL on a battery of musculoskeletal health outcomes among 150 older adults living with obesity. A convenience sample of 24 participants (n = 8/arm) are included in this analysis. At baseline and 6 months, participants were weighed, ingested a 30 mg D3 Cr tracer dose, provided a fasted urine sample 3-6 days post-dosage, underwent DXA (total body fat and lean masses, appendicular lean mass) and computed tomography (mid-thigh and trunk muscle/intermuscular fat areas) scans, and performed 400-m walk, stair climb, knee extensor strength, and grip strength tests.ResultsParticipants were older (68.0 ± 4.4 years), mostly White (75.0%), predominantly female (66.7%), and living with obesity (body mass index: 33.8 ± 2.7 kg/m2 ). Six month total body WL was -10.3 (95% confidence interval, CI: -12.7, -7.9) kg. All DXA and computed tomography-derived body composition measures were significantly decreased from baseline, yet D3 Cr muscle mass did not change [+0.5 (95% CI: -2.0, 3.0) kg]. Of

BACKGROUND: Obesity is a major threat to public health and traditional bariatric surgery continues to have low utilization. Endoscopic treatments for obesity have emerged that offer less risk, but questions remain regarding efficacy, durability, and safety. We compared the efficacy of endoscopic bariatric procedures as compared to other existing treatments. METHODS: A literature search of Embase, Cochrane Central, and Pubmed was conducted from January 1, 2014 to December 7, 2021, including endoscopic bariatric therapies that were FDA or CE approved at the time of search to non-endoscopic treatments. Thirty-seven studies involving 15,639 patients were included. Primary outcomes included % total body weight loss (%TBWL), % excess body weight loss (%EBWL), and adverse events. Secondary outcomes included quality of life data and differences in hemoglobin A1C levels. Strength of clinical trial and observational data were graded according to the Cochrane methods. RESULTS: Intragastric balloons achieved greater %TBWL with a range of 7.6-14.1% compared to 3.3-6.7% with lifestyle modification at 6 months, and 7.5-14.0% compared to 3.1-7.9%, respectively, at 12 months. When endoscopic sleeve gastroplasty (ESG) was compared to laparoscopic sleeve gastrectomy (LSG), ESG had less %TBWL at 4.7-14.4% compared to 18.8-26.5% after LSG at 6 months, and 4.5-18.6% as compared to 28.4-29.3%, respectively, at 12 months. For the AspireAssist, there was greater %TBWL with aspiration therapy compared to lifestyle modification at 12 months, 12.1-18.3% TBWL versus 3.5-5.9% TBWL, respectively. All endoscopic interventions had higher adverse events rates compared to lifestyle modification. CONCLUSION: This review is the first to evaluate various endoscopic bariatric therapies using only RCTs and observational studies for evaluation of weight loss compared with conservative management, lifestyle modification, and bariatric surgery. Endoscopi

INTRODUCTION: Rates of overweight and obesity have increased in the military, particularly in the U.S. Navy. While the Navy has implemented weight-management programs like ShipShape, findings on the effectiveness of these programs are mixed. Further knowledge on the characteristics of service members (SMs) who participate in these programs may help inform course curricula and improve outcomes. This study aimed to (1) examine characteristics of SMs referred to the Navys ShipShape program at a large military treatment facility, (2) compare these characteristics among SMs who did and did not enroll in a randomized clinical trial of ShipShape (ShipShape study participants), and (3) compare demographic and health characteristics of ShipShape study participants to that of a random and similarly sized sample of Navy SMs who responded to the 2015 DoD Health-Related Behaviors Survey (HRBS). MATERIALS AND METHODS: Data from active duty Navy SMs referred to the ShipShape program at a large military treatment facility were evaluated (n = 225). A subset of these SMs enrolled in the ShipShape study (n = 187). Among enrolled SMs, data from 147 who completed all measures were compared to that of HRBS respondents. Univariate ANOVA and chi-square analyses were used to examine (1) demographic and motivational differences between SMs who did and did not enroll in the ShipShape study and (2) differences in demographics and medical and mental health conditions between ShipShape study participants and Navy HRBS respondents. RESULTS: The majority of SMs referred to ShipShape were female with an average age of 28.3 years. Compared to SMs who did not enroll in the ShipShape study (n = 38), ShipShape study participants were more likely to be female, less likely to be Hispanic, and had higher motivation and emotional eating scores. Compared to Navy HRBS respondents (n = 164), ShipShape study participants (n = 147) were younger, more likely to be female, non-Hispanic, enlisted, and obese. Furth

Many mHealth interventions for health behavior change are considered effective for improving health outcomes. However, there is a limited understanding of the role of the components in an intervention on its effectiveness. Insights into intervention components such as content and software features are needed to design efficient and effective interventions. In this study, we conducted an exploratory analysis of objective data from the usage of a weight management app to understand the role of intervention components in weight loss. We identified a positive correlation between weight loss and the use of the intervention. We also found differences in the app feature use among those who lost weight. To lose weight, users needed to comply with the intervention by completing a combination of tasks. They needed to complete 70% of some tasks and up to a maximum of 30% of other tasks. In the future, we hope to use other types of collected data (logged and survey data) to gain more nuanced insights into how interventions are used. With the help of data analytics, we may find optimal paths of use and determine a satisfactory level of compliance to achieve desired goals. This can deepen our understanding of what works in an intervention.

Background Epigenetic age is an estimator of biological age based on DNA methylation; its discrepancy from chronologic age warrants further investigation. We recently reported that greater polyphenol intake benefitted ectopic fats, brain function, and gut microbiota profile, corresponding with elevated urine polyphenols. The effect of polyphenol-rich dietary interventions on biological aging is yet to be determined. Methods We calculated different biological aging epigenetic clocks of different generations (Horvath2013, Hannum2013, Li2018, Horvath skin and blood2018, PhenoAge2018, PCGrimAge2022), their corresponding age and intrinsic age accelerations, and DunedinPACE, all based on DNA methylation (Illumina EPIC array; pre-specified secondary outcome) for 256 participants with abdominal obesity or dyslipidemia, before and after the 18-month DIRECT PLUS randomized controlled trial. Three interventions were assigned: healthy dietary guidelines, a Mediterranean (MED) diet, and a polyphenol-rich, low-red/processed meat Green-MED diet. Both MED groups consumed 28 g walnuts/day (+ 440 mg/day polyphenols). The Green-MED group consumed green tea (3–4 cups/day) and Mankai (Wolffia globosa strain) 500-ml green shake (+ 800 mg/day polyphenols). Adherence to the Green-MED diet was assessed by questionnaire and urine polyphenols metabolomics (high-performance liquid chromatography quadrupole time of flight). Results Baseline chronological age (51.3 ± 10.6 years) was significantly correlated with all methylation age (mAge) clocks with correlations ranging from 0.83 to 0.95; p < 2.2e − 16 for all. While all interventions did not differ in terms of changes between mAge clocks, greater Green-Med diet adherence was associated with a lower 18-month relative change (i.e., greater mAge attenuation) in Li and Hannum mAge (beta = − 0.41, p = 0.004 and beta = − 0.38, p = 0.03, respectively; multivariate models). Greater Li mAge attenuation (multivariate models adjusted for age, se

Objective: To evaluate the relationship between weight loss and markers of poor prognosis in patients hospitalized with COVID-19 in the state of Pernambuco. Methods: A multicenter, cross-sectional study coupled with prospective analysis variables involving 71 individuals with COVID-19 admitted for hospitalization in 8 public hospitals in Recife, in the State of Pernambuco. Individuals of both sexes, aged ≥ 20 years, hospitalized from June 2020 to June 2021 were included. Sociodemographic, clinical, and nutritional data and prognostic markers were collected. Results: The average age was 54.6±15.6 years, with 54.9% of individuals being male. It was found that 26.8% of the patients were diabetic and 52.1% were hypertensive. The anthropometric profile indicated that 56.3% were overweight and 5.6% were underweight. Positive screening for sarcopenia was observed in 16.9%. The median weight loss was 3.1% (0.0-6.6%), with a loss > 5% evident in 29.6% of the sample. It was found that weight loss was more frequent in men (16 (41.0%) vs. 5 (15.6%); p = 0.020) and that demographic, clinical, and nutritional variables were not associated with body weight loss. There was no statistical association between weight loss and prognostic variables (p NS). Conclusion: Although the study did not demonstrate an association between weight loss and prognostic variables, this should be considered when assessing patients with COVID-19 and should be investigated and treated as an essential health promotion measure., Objetivo: Avaliar a relação entre a perda de peso com marcadores de mau prognóstico em pacientes hospitalizados com COVID-19 no estado de Pernambuco. Métodos: Estudo multicêntrico, transversal, acoplado a algumas variáveis de análise prospectiva envolvendo 71 indivíduos com COVID-19 admitidos para internação em 8 hospitais públicos de Recife, no Estado de Pernambuco. Foram incluídos indivíduos de ambos os sexos, com idade ≥ 20 anos, hospitalizados, no período de junho de 2020 a junho de 2021. Foram coletados dados sociodemográficos, clínicos, nutricionais e marcadores prognósticos. Resultados: A média de idade foi 54,6±15,6 anos, sendo 54,9% dos indivíduos do sexo masculino. Verificou-se que 26,8% dos pacientes eram diabéticos e 52,1% eram hipertensos.  O perfil antropométrico indicou 56,3% de excesso de peso e 5,6% de baixo peso. Observou-se rastreio positivo para sarcopenia em 16,9%. A mediana da perda de peso foi 3,1% (0,0-6,6%), sendo uma perda > 5% evidenciada em 29,6% da amostra. Verificou-se que a perda de peso foi mais frequente nos homens (16 (41,0%) vs. 5 (15,6%); p = 0,020) e que as variáveis demográficas, clínicas e nutricionais não se associaram à redução do peso corporal. Não houve associação estatística entre a perda de peso e as variáveis prognósticas (p NS). Conclusão: embora o estudo não tenha demonstrado associação entre a perda de peso e variáveis prognósticas, esta deve ser considerada na avaliação do paciente com COVID-19, devendo ser investigada e tratada como uma importante medida de promoção à saúde.

Objective: To evaluate the relationship between weight loss and markers of poor prognosis in patients hospitalized with COVID-19 in the state of Pernambuco. Methods: A multicenter, cross-sectional study coupled with prospective analysis variables involving 71 individuals with COVID-19 admitted for hospitalization in 8 public hospitals in Recife, in the State of Pernambuco. Individuals of both sexes, aged ≥ 20 years, hospitalized from June 2020 to June 2021 were included. Sociodemographic, clinical, and nutritional data and prognostic markers were collected. Results: The average age was 54.6±15.6 years, with 54.9% of individuals being male. It was found that 26.8% of the patients were diabetic and 52.1% were hypertensive. The anthropometric profile indicated that 56.3% were overweight and 5.6% were underweight. Positive screening for sarcopenia was observed in 16.9%. The median weight loss was 3.1% (0.0-6.6%), with a loss > 5% evident in 29.6% of the sample. It was found that weight loss was more frequent in men (16 (41.0%) vs. 5 (15.6%); p = 0.020) and that demographic, clinical, and nutritional variables were not associated with body weight loss. There was no statistical association between weight loss and prognostic variables (p NS). Conclusion: Although the study did not demonstrate an association between weight loss and prognostic variables, this should be considered when assessing patients with COVID-19 and should be investigated and treated as an essential health promotion measure., Objetivo: Avaliar a relação entre a perda de peso com marcadores de mau prognóstico em pacientes hospitalizados com COVID-19 no estado de Pernambuco. Métodos: Estudo multicêntrico, transversal, acoplado a algumas variáveis de análise prospectiva envolvendo 71 indivíduos com COVID-19 admitidos para internação em 8 hospitais públicos de Recife, no Estado de Pernambuco. Foram incluídos indivíduos de ambos os sexos, com idade ≥ 20 anos, hospitalizados, no período de junho de 2020 a junho de 2021. Foram coletados dados sociodemográficos, clínicos, nutricionais e marcadores prognósticos. Resultados: A média de idade foi 54,6±15,6 anos, sendo 54,9% dos indivíduos do sexo masculino. Verificou-se que 26,8% dos pacientes eram diabéticos e 52,1% eram hipertensos.  O perfil antropométrico indicou 56,3% de excesso de peso e 5,6% de baixo peso. Observou-se rastreio positivo para sarcopenia em 16,9%. A mediana da perda de peso foi 3,1% (0,0-6,6%), sendo uma perda > 5% evidenciada em 29,6% da amostra. Verificou-se que a perda de peso foi mais frequente nos homens (16 (41,0%) vs. 5 (15,6%); p = 0,020) e que as variáveis demográficas, clínicas e nutricionais não se associaram à redução do peso corporal. Não houve associação estatística entre a perda de peso e as variáveis prognósticas (p NS). Conclusão: embora o estudo não tenha demonstrado associação entre a perda de peso e variáveis prognósticas, esta deve ser considerada na avaliação do paciente com COVID-19, devendo ser investigada e tratada como uma importante medida de promoção à saúde.

Background: It is common practice for fight sport athletes to use a variety of weight manipulation strategies to compete in desired weight classes. Although numerous studies have highlighted rapid weight loss (RWL) strategies and the magnitude of weight loss, few have focused specifically on weight loss in female fighters. The purpose of this study was to provide descriptive information on professional UFC female fighters engaging in RWL in all women’s UFC weight divisions: strawweight (52.2 kg): flyweight (56.7 kg); bantamweight (61.2 kg); featherweight (65.8 kg). Methods: All fighter’s weights were obtained at five separate time points: 72 hrs. pre-weigh-in, 48 hrs. pre-weigh-in, 24hrs. pre-weigh-in, official weigh-in, and 24 hrs. post-weigh-in (competition weight). Mixed effects models and random effects analysis were used to assess changes in weight and differences between weight divisions. All statistics were analyzed, and significance was set at p ≤0.05. Significant changes in weight between all time points were reported. Results: No statistical differences between weight divisions were observed. Female fighters lost 4.5–6.6% of their weight prior to the official weigh-in. Conclusion: Females engaged in RWL practices lose weight in a similar fashion irrespective of weight class.

Background Obesity and overweight are public health diseases that have increased globally over the years to the point where the WHO classifies them as an epidemic. In Sweden, every other adult suffers from one of these conditions and there are several follow up health complication related to overweight/obesity. Many studies concerning weight loss combine digital health tools where results are often positive in the short term, but not effective long-term. Different meta-analysis's lift digital tools as an opportunity to improve healthcare for people with overweight and obesity. The term “Long-term” is of the utmost importance in healthcare when it comes to maintaining weight loss. Six months has therefore been used as the starting point for what “long-term” entails. Aim The aim of this study is to highlight e-health and its effect on long-term weight loss among individuals who are overweight or obese. Method Non-systematic literature review based on 15 scientific articles with a quantitative approach. The databases PubMed and Cinahl were used to retrieve the articles using relevant search terms for the study. All articles have peer reviewed based on Sophiahemmet University assessment basis for scientific classifications and quality. An integrated data analysis was used to compile the results. Results Physical activity, diet, notices/reminders and multi-component interventions were identified categories. The result highlights that the interventions offered over longer periods of time show better results regarding long-term weight loss. Supporting the individuals through personal contact or digital reminders and messages is important and contributes to continued weight loss and weight loss management. Conclusions Personalised interventions yield better results when also targeting multiple aspects ofweight-loss and during longer periods of time. Results in the field vary and more research is needed to make conclusions in how to optimize the given interventions. Keywords, Bakgrund Fetma och övervikt är folkhälsosjukdomar som har ökat under åren globalt till den grad att WHO klassar det som en epidemi. I Sverige har varannan vuxen något av dessa tillstånd. Det finns en lång rad komplikationer till dessa tillstånd och några är till och med dödliga. Det finns många studier kring viktminskning i kombination med digitala hälsoverktyg och resultaten är ofta goda på kort sikt, men de långsiktiga resultaten är generellt sett dåliga. Olika studier lyfter de digitala verktygen som en möjlighet att förbättra vården för överviktiga människor. Begreppet "långsiktigt" är av stor betydelse inom vården när det kommer till att behålla viktreducering. Sex månader har valts som startpunkt för vad “långsiktigt” innebär. Syfte Syftet med denna studie är att belysa e-hälsa och dess påverkan på långsiktig viktnedgång hos personer med övervikt och fetma. Metod En icke-systematisk litteraturöversikt har använts baserad på 15 vetenskapliga artiklar med kvantitativ och mixad ansats. Databaserna PubMed och Cinahl har använts för att söka och hitta artiklar med hjälp av relevanta termer för arbetet. Alla artiklar har kvalitetsgranskats utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. En integrerad dataanalys har använts för att sammanställa resultaten. Resultat Fysisk aktivitet, matvanor, notiser/påminnelser och flerkomponentsinterventioner har identifierats som kategorier. Resultatet visar att de interventioner som erbjuds under längre perioder har bättre resultat kring långsiktig viktnedgång. Att individerna i interventionerna stöttas genom antingen personlig kontakt eller digitala påminnelser och meddelanden är av stor vikt och bidrar till att individerna fortsätter gå ned i vikt och bibehåller denna i högre grad. Slutsats Personligt anpassade interventioner ger bättre resultat när man riktar in sig på flera olika delar för att nå viktminskning under långa perioder. Resultaten på området varierar och mer forsknin

BACKGROUND: The optimal sleeve diameter and distance from the pylorus to the edge of the resection line in laparoscopic sleeve gastrectomy (LSG) remain controversial. OBJECTIVES: To evaluate the influence of bougie size and antral resection distance from the pylorus on postoperative complications and weight-loss results in LSG. SETTING: Nationwide registry-based study. METHODS: This study included all LSGs performed in Sweden between 2012 and 2019. Data were obtained from the Scandinavian Obesity Surgery Registry. Reference bougie size of 35-36 Fr and an antral resection distance of 5 cm from the pylorus were compared to narrower bougie size (30-32 Fr), shorter distances (1-4 cm), and extended distances (6-8 cm) from the pylorus in assessing postoperative complications and weight loss as the outcomes of LSG. RESULTS: The study included 9,360 patients with postoperative follow-up rates of 96%, 79%, and 50% at 30 days, 1 year, and 2 years, respectively. Narrow bougie and short antral resection distance from the pylorus were significantly associated with increased postoperative weight loss. Bougie size was not associated with increased early or late complications. However, short antral resection distance was associated with high risk of overall early complications [odds ratio: 1.46 (1.17-1.82, P = .001)], although no impact on late complications at 1 and 2 years was observed. CONCLUSIONS: Using a narrow bougie and initiating resection closer to the pylorus were associated with greater maximum weight loss. Although a closer resection to the pylorus was associated with an increased risk of early postoperative complications, no association was observed with the use of narrow bougie for LSG.

Background In super obesity, Roux-en-Y gastric bypass (RYGB) may be insufficient why some surgeons advocate biliopancreatic diversion with duodenal switch (BPD/DS), a more malabsorptive procedure. There is a paucity of evidence regarding results beyond 10 years, especially after BPD/DS. The aim of this randomized controlled trial was to compare the long-term outcome of BPD/DS, and RYGB in patients with super obesity, i.e., body mass index (BMI) > 50 kg/m2. Methods This is a 13- to 17-year follow-up study of a single-center, single-blinded randomized trial in which 47 patients (BMI > 48 and eligible for bariatric surgery) were randomized 1:1 to BPD/DS and RYGB (25 men, 24 BPD/DS, 39.1 ± 9.9 years, BMI 54.5 ± 6.1 kg/m2). The primary outcome was weight loss. The study was financed by Swedish governmental funding of clinical research (ALF). Trial registration number: ISRCTN10940791. Results Thirty-four (18 BPD/DS) of the living 42 patients (81.0%) participated. BPD/DS resulted in higher BMI loss (20.4 ± 7.9 vs. 12.4 ± 8.6, p = .008) and higher percent of total body weight loss (37.5% ± 12.2 vs. 22.8% ± 14.8, p = .004). BPD/DS was associated with lower fasting glucose, glycated hemoglobin (HbA1c), and low-density lipoprotein (LDL) as well as lower hemoglobin. Adverse events were more common after BPD/DS (2.7 vs. 0.9 per patient, p = .004). The global assessment tool BAROS (Bariatric Analysis and Reporting Outcome System) demonstrated superior scores for BPD/DS (p = .047). Conclusion When compared to RYGB, BPD/DS results in superior weight loss and metabolic control as well as superior BAROS score, however, at the cost of more adverse events.

Background and Objectives: Bariatric surgery (BS) is an effective treatment for obesity. However, some individuals experience insufficient weight loss after surgery. Therefore, we investigated whether cognitive control affects weight loss after Roux-en-Y gastric bypass (RYGB). Methods: Within this exploratory observational study, part of the BARICO study (BAriatric surgery Rijnstate and Radboudumc neuroImaging and Cognition in Obesity), participants aged between 35 and 55 years eligible for RYGB were included. Before and after BS, body weight, (delta) BMI and percentage total body weight loss (%TBWL) were determined. Additionally, at baseline, Stroop task-performance, -activation and -connectivity were assessed by a color-word paradigm task during functional neuroimaging to determine the ability of participants to inhibit cognitive interference. Results: Seventy-six participants were included, of whom 14 were excluded from fMRI analysis, leaving 62 participants. Participants were aged 45.0 ± 5.9 years with a mean pre-surgery BMI of 40.2 ± 3.3 kg/m2, and 86% were women. Mean decrease in BMI was 13.8 ± 2.5 kg/m2, and mean %TBWL was 34.9 ± 6.3% 1 year after BS. Stroop task performance did not correlate with (delta) BMI and %TBWL. The inferior parietal/middle occipital gyrus, inferior frontal gyrus, and supplementary motor cortex were involved in cognitive interference, although activity in these regions did not predict weight loss after surgery. Lastly, generalized psychophysiological interaction did not provide evidence for (delta) BMI- and %TBWL-dependent connectivity modulation. Discussion: Cognitive control did not predict weight loss after surgery. Future studies should focus on longer follow-up periods to understand the relation between cognitive control and weight loss. Trial Registration: NL7090 (https://www.clinicaltrialregister.nl/nl/trial/28949 ) Graphical Abstract: [Figure not available: see fulltext.].

Background: The capacity of an individual to respond to changes in food intake so that postprandial metabolic perturbations are resolved, and metabolism returns to its pre-prandial state, is called phenotypic flexibility. This ability may be a more important indicator of current health status than metabolic markers in a fasting state. Aim: In this parallel randomized controlled trial study, an energy-restricted healthy diet and 2 dietary challenges were used to assess the effect of weight loss on phenotypic flexibility. Methods: Seventy-two volunteers with overweight and obesity underwent a 12-wk dietary intervention. The participants were randomized to a weight loss group (WLG) with 20% less energy intake or a weight-maintenance group (WMG). At weeks 1 and 12, participants were assessed for body composition by MRI. Concurrently, markers of metabolism and insulin sensitivity were obtained from the analysis of plasma metabolome during 2 different dietary challenges—an oral glucose tolerance test (OGTT) and a mixed-meal tolerance test. Results: Intended weight loss was achieved in the WLG (−5.6 kg, P < 0.0001) and induced a significant reduction in total and regional adipose tissue as well as ectopic fat in the liver. Amino acid-based markers of insulin action and resistance such as leucine and glutamate were reduced in the postprandial phase of the OGTT in the WLG by 11.5% and 28%, respectively, after body weight reduction. Weight loss correlated with the magnitude of changes in metabolic responses to dietary challenges. Large interindividual variation in metabolic responses to weight loss was observed. Conclusion: Application of dietary challenges increased sensitivity to detect metabolic response to weight loss intervention. Large interindividual variation was observed across a wide range of measurements allowing the identification of distinct responses to the weight loss intervention and mechanistic insight into the metabolic response to weight loss.

Despite the fact that obesity is the main risk factor for endometrial cancer, there is limited evidence regarding the effects of body weight change on overweight and obese women treated for early‑stage endometrial can its impact on cancer outcomes. A retrospective cohort study was performed including all overweight and obese patients with early‑stage type‑I endometrial cancer that were treated at the Insular University Hospital of Las Palmas (Las Palmas de Gran Canaria, Spain) between January 2007 and December 2019. Body weight change at 12 months of treatment was evaluated, as well as its impact on cancer outcomes. Weight loss ≥5% was independently evaluated regarding its impact on survival. A total of 526 women were studied, of which 152 (28.90%) were overweight (BMI ≥25 and <30) and 374 (71.10%) were obese (BMI ≥30). The median follow‑up was 76.17 months, during which time 77 (14.64%) women died. In the survivor group, body weight at initial diagnosis was 86.4±17.9 kg compared with 84.6±16.4 kg 1 year after treatment, which corresponded to a significant mean weight loss of 1.47 kg (P<0.001). However, in the group of non‑survivors, body weight at initial diagnosis was 84.7±15.7 kg compared with 84.7±14.6 kg 1 year after treatment, which demonstrated a non‑significant mean weight loss of 0.63 kg (P=0.180). When comparing between the patients who maintained or gained ≥5% weight and those who lost ≥5% weight, there were no significant differences taking into account the whole cohort and follow‑up time; however, when adjusting for the period between 32 and 98 months, survival was significantly higher in those patients that lost ≥5% of their initial body weight (P=0.025; log‑rank test). Based on the final univariate and cer and multivariate analyses, body weight change at 12 months was not indicated to be a factor significantly affecting overall survival; adjusted hazard ratio was 1.01 (95% CI 0.97‑1.05, P=0.723). In conclusion, even if greater weight loss is observed

The prevalence of obesity is increasing worldwide despite a rise in therapeutic interventions to address this epidemic. However, there is a dearth of evidence-based non-surgical treatment guidelines for severe obesity. The aim of this three-year randomized, controlled trial was to elucidate the role of physical activity (PA) in the treatment of severe obesity. First, we studied the association of lifelong PA, aerobic fitness, and cardiac autonomic function by heart rate variability in severely obese adults. Secondly, we investigated the long-term effects of a three-month intensified behavioral modification (iBM) with exercise on glucose tolerance. Thirdly, we aimed to find out whether the timing of the exercise implemented at the weight loss phase of the intervention affects weight loss and waist circumference reduction (WC) from baseline. Finally, we evaluated whether a three-month exercise intervention combined with iBM has long-term effects on weight loss, weight maintenance, and reduction of WC over a three-year follow-up. 120 volunteers (mean BMI 36.8) were randomized into three intervention groups and a control group. All intervention groups were offered intensified behavioral weight loss guidance. According to previous studies, weight loss often stops and re-weighting begins after six months of intervention; we thus added exercise to the protocol of one group right at the beginning of the intervention and to another group after six months. Supervised three-month heart rate-controlled exercise training was implemented as circuit weight training. The weight loss period lasted 12 months, and the weight maintenance period lasted 24 months. Lifetime physical activity and aerobic fitness were positively associated with cardiac autonomic function. During the trial, iBM alone and combined with exercise led to clinically significant weight loss and long-term weight control. Increasing exercise right at the beginning of the weight loss period reduced abdominal, Tiivistelmä Lihavuus yleistyy huolimatta erilaisten hoitomuotojen kehittymisestä. Vaikean lihavuuden hoitamiseen on vain vähän tutkitusti vaikuttavia ei-leikkauksellisia vaihtoehtoja. Tämän tutkimuksen tavoitteena oli selvittää fyysisen aktiivisuuden roolia vaikean lihavuuden hoidossa. Ensimmäiseksi tutkimme elinaikaisen fyysisen aktiivisuuden ja aerobisen kunnon yhteyksiä sykevaihtelulla mitattuun sydämen autonomiseen säätelyyn vaikeasti lihavilla aikuisilla. Toisessa osatyössä selvitimme 3 kuukauden liikuntaharjoittelun ja tehostetun elintapaohjauksen pitkäaikaisia yhteisvaikutuksia sokeriaineenvaihduntaan. Kolmannessa osatyössä selvitimme, vaikuttaako painonpudotusvaiheessa toteutetun liikuntaharjoittelun ajoitus painonpudotukseen ja vyötärönympärykseen. Lopuksi tutkimme, vaikuttaako elintapaohjaukseen yhdistetty 3 kuukauden harjoittelu pitkällä aikavälillä painonpudotukseen, painonhallintaan ja vyötärönympärykseen kolmen vuoden seurannan aikana. 120 vapaaehtoista aikuista (keskimääräinen BMI 36,8) satunnaistettiin kolmeen interventioryhmään ja kontrolliryhmään. Kaikille interventioryhmien jäsenille tarjottiin tehostettua elintapaohjausta painonpudotukseen. Aiempien interventiotutkimusten perusteella painonlasku usein pysähtyy 6 kuukauden kohdalla. Tämän vuoksi sisällytimme interventioprotokollaan liikuntaharjoittelun yhdelle ryhmälle heti intervention alussa ja toiselle ryhmälle 6 kuukauden kohdalla aloittamisesta. Ohjattu 3 kuukauden liikuntaharjoittelu toteutettiin sykeohjattuna kiertoharjoitteluna. Painonpudotusvaihe kesti 12 kuukautta ja painonhallintavaihe 24 kuukautta. Elinikäinen fyysinen aktiivisuus ja aerobinen kunto olivat positiivisesti yhteydessä sydämen autonomiseen säätelyyn. Tehostettu elintapaohjaus yksin ja yhdessä liikuntaharjoittelun kanssa johti kliinisesti merkittävään painonpudotukseen ja pitkäaikaiseen painonhallintaan. Liikunnan lisääminen heti painonpudotuksen alussa pienensi keskivartalolihavuutta, edisti painonhallintaa ja paransi soke

Background In super obesity, Roux-en-Y gastric bypass (RYGB) may be insufficient why some surgeons advocate biliopancreatic diversion with duodenal switch (BPD/DS), a more malabsorptive procedure. There is a paucity of evidence regarding results beyond 10 years, especially after BPD/DS. The aim of this randomized controlled trial was to compare the long-term outcome of BPD/DS, and RYGB in patients with super obesity, i.e., body mass index (BMI) > 50 kg/m2. Methods This is a 13- to 17-year follow-up study of a single-center, single-blinded randomized trial in which 47 patients (BMI > 48 and eligible for bariatric surgery) were randomized 1:1 to BPD/DS and RYGB (25 men, 24 BPD/DS, 39.1 ± 9.9 years, BMI 54.5 ± 6.1 kg/m2). The primary outcome was weight loss. The study was financed by Swedish governmental funding of clinical research (ALF). Trial registration number: ISRCTN10940791. Results Thirty-four (18 BPD/DS) of the living 42 patients (81.0%) participated. BPD/DS resulted in higher BMI loss (20.4 ± 7.9 vs. 12.4 ± 8.6, p = .008) and higher percent of total body weight loss (37.5% ± 12.2 vs. 22.8% ± 14.8, p = .004). BPD/DS was associated with lower fasting glucose, glycated hemoglobin (HbA1c), and low-density lipoprotein (LDL) as well as lower hemoglobin. Adverse events were more common after BPD/DS (2.7 vs. 0.9 per patient, p = .004). The global assessment tool BAROS (Bariatric Analysis and Reporting Outcome System) demonstrated superior scores for BPD/DS (p = .047). Conclusion When compared to RYGB, BPD/DS results in superior weight loss and metabolic control as well as superior BAROS score, however, at the cost of more adverse events.

Background: The present study aimed to provide age-and sex-specific normative values for muscle mass parameters in Brazilian adults. Methods: Data pertaining to Brazilian adults (18+ years) who attended a nutritional clinical between January 2018 and July 2022 were analyzed. Muscle mass parameters were assessed using a bioimpedance digital scale (InBody 230, GBC BioMed NZ).Assessments were conducted under standard conditions, with participants refraining from physical exercise for 96 hours and from eating or drinking (including water) for 8 hours before evaluations. Results: A total of 18,625 Brazilian adults were analyzed. Normative values for absolute and relative (height, m 2 ) muscle mass and appendicular muscle mass (ASM) were found. In addition, specific agerelated changes in muscle mass parameters were observed. In women, muscle mass peaks between the ages of 40-49 before gradually declining at an average rate of 5.7% per decade from the sixth decade of life onwards. ASM reaches its peak earlier, during the third decade of life, and started to decline later, from 50-59 years. In contrast, absolute and ASM peaked at 40-49 years and declined from the sixth decade of life in men. Both sexes displayed a slightly higher decline in ASM than in muscle mass (13% vs 12%). Conclusions: The present study provided normative values for absolute and relative muscle mass and ASM in Brazilian adults. Furthermore, important specific age-related changes in muscle mass parameters were observed. These data have public health implications and might serve as reference tables to guide health professionals.

Background Chronic kidney disease (CKD) leads to an accumulation of waste products and causes adverse cardiometabolic effects. Objectives We investigated the health effects of the New Nordic Renal Diet (NNRD), a novel meal pattern reduced in phosphorus, protein, and sodium. Methods A 26-wk randomized trial compared the NNRD with a habitual diet. The NNRD group received weekly home deliveries of food and recipes. Monthly study visits included fasting blood samples, 24-h urine samples, blood pressure, and anthropometric measurements. Intention-to-treat analysis used linear mixed-effects models. Results Sixty patients, mean estimated glomerular filtration rate (eGFR) 34 mL/min/1.73 m2 and body mass index of 25–27 kg/m2, were included and 58 completed. Metabolic syndrome was present in 53% (NNRD group) and 57% (control group). The NNRD group (n = 30) reduced their 24-h urine phosphorus excretion by 19% (−153 mg; 95% confidence interval [CI]: −210, −95), control group (n = 30) (no change), between-group difference −171 mg (95% CI: −233, −109; P < 0.001). Proteinuria was reduced by 39% in the NNRD group (−0.33 g/d; 95% CI: −0.47, −0.18), control group (no change), between-group difference −0.34 g/d (95% CI: −0.52, −0.17; P < 0.001). Plasma urea was reduced by −1.5 mmol/L in the NNRD group (95% CI: −2.1, −0.9), control group (no change), between-group difference −1.4 mmol/L (95% CI: −2.0, −0.7; P < 0.001). Systolic blood pressure fell by −5.2 mmHg in the NNRD group (95% CI: −8.4, −2.1), control group (no change), between-group difference −3.9 mmHg (95% CI; −7.6, −0.2; P = 0.04). The NNRD group lost −1.7 kg (95% CI: −2.6, −0.8), control group (no change), between-group difference −2.0 kg (95% CI: −3.0, −1.0; P < 0.001). There were no effects on eGFR during the 26-wk intervention. Conclusion NNRD in moderate CKD reduces phosphorus excretion, proteinuria, systolic blood pressure, and weight, mainly by reducin, Background: Chronic kidney disease (CKD) leads to an accumulation of waste products and causes adverse cardiometabolic effects. Objectives: We investigated the health effects of the New Nordic Renal Diet (NNRD), a novel meal pattern reduced in phosphorus, protein, and sodium. Methods: A 26-wk randomized trial compared the NNRD with a habitual diet. The NNRD group received weekly home deliveries of food and recipes. Monthly study visits included fasting blood samples, 24-h urine samples, blood pressure, and anthropometric measurements. Intention-to-treat analysis used linear mixed-effects models. Results: Sixty patients, mean estimated glomerular filtration rate (eGFR) 34 mL/min/1.73 m2 and body mass index of 25–27 kg/m2, were included and 58 completed. Metabolic syndrome was present in 53% (NNRD group) and 57% (control group). The NNRD group (n = 30) reduced their 24-h urine phosphorus excretion by 19% (−153 mg; 95% confidence interval [CI]: −210, −95), control group (n = 30) (no change), between-group difference −171 mg (95% CI: −233, −109; P < 0.001). Proteinuria was reduced by 39% in the NNRD group (−0.33 g/d; 95% CI: −0.47, −0.18), control group (no change), between-group difference −0.34 g/d (95% CI: −0.52, −0.17; P < 0.001). Plasma urea was reduced by −1.5 mmol/L in the NNRD group (95% CI: −2.1, −0.9), control group (no change), between-group difference −1.4 mmol/L (95% CI: −2.0, −0.7; P < 0.001). Systolic blood pressure fell by −5.2 mmHg in the NNRD group (95% CI: −8.4, −2.1), control group (no change), between-group difference −3.9 mmHg (95% CI; −7.6, −0.2; P = 0.04). The NNRD group lost −1.7 kg (95% CI: −2.6, −0.8), control group (no change), between-group difference −2.0 kg (95% CI: −3.0, −1.0; P < 0.001). There were no effects on eGFR during the 26-wk intervention. Conclusion: NNRD in moderate CKD reduces phosphorus excretion, proteinuria, systolic blood pressure, and weight, mainly by reducing abdominal fat. This tria

Background: Knowledge of COVID-19 and the pandemic's effects on Danish children's body weight is limited. Objective: Objectives were to investigate (I) risk of weight changes among Danish children with and without SARS-CoV-2, (II) associations between weight changes, psychological symptoms, and long COVID symptoms, and (III) weight distribution pre- and post-pandemic. Methods: A national survey was administered to all Danish children aged 0–18 years, with prior COVID-19 (cases) and matched references including questions on weight, weight changes during the pandemic and long COVID-related symptoms. Descriptive statistics and logistic regression were used. Weight distribution was compared with a pre-pandemic database. Results: In all, 17 627 cases and 54 656 references were included. The 4–18-year-old cases had lower odds of unintended weight gain. The 2–3-year-old cases had higher odds and the 15–18-year-old cases lower odds of weight loss compared to references. Regardless of COVID-19 status, any reported long COVID-related symptom was associated with a change in body weight. No sign of increasing obesity rates was found among Danish children post-pandemic. Conclusion: COVID-19 was associated with higher odds of weight loss in 2–3-year-olds and lower odds of unintended weight gain in 4–18-year-olds. Any long COVID-related symptom was associated with higher odds of weight changes regardless of COVID-19 status.

In the past decades the use of low carb diets for weight loss and for the prevention and treatment of obesity has become popular. The Krebs cycle is the main metabolic pathway for oxidation processes involving macronutrients in animal tissue. The Krebs cycle depends on the Acetyl-CoA molecule to be initiated, a molecule generated, at first, in the processes of glycogenolysis and glycolysis. When carbohydrate deprivation occurs because of these types of diets, the activity of these two processes decreases and the body is forced to adopt two other metabolic processes for the generation of Acetyl-CoA, gluconeogenesis and ketogenesis. The present literature review aimed to describe these processes, as well as the effects of increasing their activity and their relationship with Krebs cycle activity. Materials and Methods: A search was performed in the PubMed database for scientific articles published from 2000 to 2022 using terms related to the theme. Conclusion: Low carb diets have adverse effects that require caution, in addition to contradicting the dietary recommendations proposed by health agencies., Nas últimas décadas popularizou-se o uso das dietas low carb para perda de peso e para a prevenção e tratamento da obesidade. O ciclo de Krebs é a principal via metabólica para os processos de oxidação que envolvem os macronutrientes no tecido animal. O ciclo de Krebs depende da molécula de Acetil-CoA para ser iniciado, molécula gerada, a princípio, nos processos de glicogenólise e glicólise. Quando ocorre a privação dos carboidratos por conta desses tipos de dietas, a atividade desses dois processos diminui e o organismo é obrigado a adotar dois outros processos metabólicos para geração de Acetil-CoA, a gliconeogênese e a cetogênese. A presente revisão da literatura teve como objetivo descrever esses processos, bem como os efeitos do aumento de sua atividade e sua relação com a atividade do ciclo de Krebs. Materiais e Métodos: Foi realizada uma busca na base de dados PubMed por artigos científicos publicados no período de 2000 a 2022 utilizando termos relacionados ao tema. Conclusão: As dietas low carb apresentam efeitos adversos que requerem cautela, além de contrariar as recomendações dietéticas propostas pelas agências especializadas em saúde.

Over 70% of men are overweight, and most desire weight loss; however, men are profoundly underrepresented in weight loss programs. Gamification represents a novel approach to engaging men and may enhance efficacy through two means: (1) game-based elements (e.g., streaks, badges, team-based competition) to motivate weight control behaviors and (2) arcade-style “neurotraining” to enhance neurocognitive capacities to resist the temptation of unhealthy foods and more automatically select healthy foods. This study will use a 2 × 2 factorial design to examine the independent and combinatory efficacy of gamification and inhibitory control training (ICT). Men with overweight/obesity (N = 228) will receive a 12-month mobile weight loss program that incorporates behavioral weight loss strategies (e.g., self-monitoring, goal setting, stimulus control). Men will be randomly assigned to a non-gamified or gamified version, and an active or sham ICT. A game design company will create the program, with input from a male advisory panel. Aims of the project are to test whether a gamified (versus non-gamified) weight loss program and/or ICT (versus sham) promotes greater improvements in weight, diet, and physical activity; whether these treatment factors have combinatory or synergistic effects; to test whether postulated mechanisms of action (increased engagement, for gamification, and inhibitory control, for ICT) mediate treatment effects; and whether baseline gameplay frequency and implicit preferences for ICT-targeted foods moderate effects. It is hoped this study will contribute to improved mHealth programs for men and enhance our understanding of the impact of gamified elements and neurocognitive training on weight control.

BackgroundSelf-monitoring smartphone apps and health coaching have both individually been shown to improve weight-related outcomes, but their combined effects remain unclear.ObjectiveThis study aims to examine the effectiveness of combining self-monitoring apps with health coaching on anthropometric, cardiometabolic, and lifestyle outcomes in people with overweight and obesity.MethodsRelevant articles published from inception till June 9, 2022, were searched through 8 databases (Embase, CINAHL, PubMed, PsycINFO, Scopus, The Cochrane Library, and Web of Science). Effect sizes were pooled using random-effects models. Behavioral strategies used were coded using the behavior change techniques taxonomy V1.ResultsA total of 14 articles were included, representing 2478 participants with a mean age of 39.1 years and a BMI of 31.8 kg/m2. Using combined intervention significantly improved weight loss by 2.15 kg (95% CI -3.17 kg to -1.12 kg; P<.001; I2=60.3%), waist circumference by 2.48 cm (95% CI -3.51 cm to -1.44 cm; P<.001; I2=29%), triglyceride by 0.22 mg/dL (95% CI -0.33 mg/dL to 0.11 mg/dL; P=.008; I2=0%), glycated hemoglobin by 0.12% (95% CI -0.21 to -0.02; P=.03; I2=0%), and total calorie consumption per day by 128.30 kcal (95% CI -182.67 kcal to -73.94 kcal; P=.003; I2=0%) kcal, but not BMI, blood pressure, body fat percentage, cholesterol, and physical activity. Combined interventional effectiveness was superior to receiving usual care and apps for waist circumference but only superior to usual care for weight loss.ConclusionsCombined intervention could improve weight-related outcomes, but more research is needed to examine its added benefits to using an app.Trial registrationPROSPERO CRD42022345133; https://tinyurl.com/2zxfdpay.

ObjectiveMost guidelines recommending weight loss for hip osteoarthritis are based on research on knee osteoarthritis. Prior studies found no association between weight loss and hip osteoarthritis, but no previous studies have targeted older adults. Therefore, we aimed to determine whether there is any clear benefit of weight loss for radiographic hip osteoarthritis in older adults because weight loss is associated with health risks in older adults.MethodsWe used data from white female participants aged ≥65 years from the Study of Osteoporotic Fractures. Our exposure of interest was weight change from baseline to follow-up at 8 years. Our outcomes were the development of radiographic hip osteoarthritis (RHOA) and the progression of RHOA over 8 years. Generalized estimating equations (clustering of 2 hips per participant) were used to investigate the association between exposure and outcomes adjusted for major covariates.ResultsThere was a total of 11,018 hips from 5509 participants. There was no associated benefit of weight loss for either of our outcomes. The odds ratios (95% confidence intervals) for the development and progression of RHOA were 0.99 (0.92-1.07) and 0.97 (0.86-1.09) for each 5% weight loss, respectively. The results were consistent in sensitivity analyses where participants were limited to those who reported trying to lose weight and who also had a body mass index in the overweight or obese range.ConclusionOur findings suggest no associated benefit of weight loss in older female adults in the structure of the hip joint as assessed by radiography.

BackgroundThe coronavirus pandemic has caused a worldwide health crisis. Bariatric patients require extensive pre- and post-operative follow-up, which may be less feasible during public health social distancing mandates. We assessed the impact of the pandemic on the behaviors and weight loss outcomes of our pre- and post-operative bariatric patients.MethodsA retrospective review of a prospectively maintained database identified patients who underwent either sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) at a single institution between March 2018 and May 2020. A cohort undergoing surgery within 12 months before the pandemic as well as a cohort undergoing a medically supervised diet prior to surgery was surveyed regarding pre- and post-COVID-19 lifestyle habits. Excess weight loss (EWL) outcomes from a group of pre-COVID surgical patients were compared to that of a group of post-COVID surgical patients. Primary outcome was whether the lockdown changed 1-year weight loss outcomes. Secondary outcome was whether patient lifestyle behaviors were changed during the pandemic.ResultsThere was no difference in 1-year EWL between pre- and post-COVID SG patients (51.7% versus 55.9%, p = 0.35), or between pre- and post-COVID RYGB patients (88.9% versus 80.4%, p = 0.42). Pre-stay-at-home order, 91.8% endorsed physical activity compared to 80.3% post-stay-at-home order (p = 0.0025). Mean physical activity decreased from 4.2 h/week to 2.7 h/week after the stay-at-home order (p < 0.0001). Additionally, 41.3% reported worsened dietary habits post-stay-at-home order.ConclusionThe COVID-19 pandemic has greatly impacted the behaviors of bariatric surgery patients. Despite deterioration of lifestyle habits, 1-year weight loss outcomes after bariatric surgery remained the same before and after the instatement of social distancing measures. In the short term, the biological effect of metabolic procedures may mask the effects of suboptimal diet and physical act

ObjectiveThis randomized clinical trial tested the effectiveness of an addiction-based digital weight-loss intervention, focusing on withdrawal/abstinence from self-identified problem foods, snacking and excessive amounts at meals, and discomfort displacement, with and without coaching, compared to an in-person, multi-disciplinary, care model among adolescents with obesity. We hypothesized that the digital intervention with coaching would yield greater weight loss and lower delivery burden than the standard clinical arm, and greater participant engagement than the digital arm without coaching.MethodsAdolescents were randomized to app intervention, with or without coaching, or in-person multidisciplinary obesity intervention for 6 months. The primary outcome was change in %BMIp95 at weeks 12 and 24. A mixed-effects linear regression model was used to assess the association between change in %BMIp95 and intervention arm. We were also interested in assessing delivery burden, participant engagement and evaluating the relationships between weight change and demographic characteristics, mood, executive function and eating behaviours.ResultsAll adolescents (n = 161; BMI ≥95th%, age 16 ± 2.5 year; 47% Hispanic, 65% female, 59% publicly insured) lost weight over 24-weeks (-1.29%, [-1.82, -0.76], p < 0.0001), with no significant weight loss difference between groups (p = 0.3). Girls lost more weight than boys, whereas binge eating behaviour at baseline was associated with increase in %BMIp95 when controlling for other covariates. There was no association between ethnicity, mood, timing of intervention in relation to the pandemic, or executive function and change in %BMIp95 .ConclusionsContrary with our hypothesis, our results showed no difference in the change in BMI status between treatment arms. Since efficacy of this digital intervention was not inferior to in-person, multi-disciplinary care, this could offer a reasonable weight management option for

We recently demonstrated that the consumption of mixed tree nuts (MTNs) during caloric restriction decreased cardiovascular risk factors and increased satiety. Tryptophan (Trp) metabolism has been indicated as a factor in cardiovascular disease. Here, we investigated the effect of MTNs on Trp metabolism and the link to cardiovascular risk markers. Plasma and stool were collected from 95 overweight individuals who consumed either MTNs (or pretzels) daily as part of a hypocaloric weight loss diet for 12 weeks followed by an isocaloric weight maintenance program for an additional 12 weeks. Plasma and fecal samples were evaluated for Trp metabolites by LC-MS and for gut microbiota by 16S rRNA sequencing. Trp-kynurenine metabolism was reduced only in the MTNs group during weight loss (baseline vs. week 12). Changes in Trp-serotonin (week 24) and Trp-indole (week 12) metabolism from baseline were increased in the MTNs group compared to the pretzel group. Intergroup analysis between MTN and pretzel groups does not identify significant microbial changes as indicated by alpha diversity and beta diversity. Changes in the relative abundance of genus Paludicola during intervention are statistically different between the MTNs and pretzel group with p < 0.001 (q = 0.07). Our findings suggest that consumption of MTNs affects Trp host and microbial metabolism in overweight and obese subjects.

BackgroundType 2 diabetes (T2D) has an immense disease burden, affecting millions of people worldwide and costing billions of dollars in treatment. As T2D is a multifactorial disease with both genetic and nongenetic influences, accurate risk assessments for patients are difficult to perform. Machine learning has served as a useful tool in T2D risk prediction, as it can analyze and detect patterns in large and complex data sets like that of RNA sequencing. However, before machine learning can be implemented, feature selection is a necessary step to reduce the dimensionality in high-dimensional data and optimize modeling results. Different combinations of feature selection methods and machine learning models have been used in studies reporting disease predictions and classifications with high accuracy.ObjectiveThe purpose of this study was to assess the use of feature selection and classification approaches that integrate different data types to predict weight loss for the prevention of T2D.MethodsThe data of 56 participants (ie, demographic and clinical factors, dietary scores, step counts, and transcriptomics) were obtained from a previously completed randomized clinical trial adaptation of the Diabetes Prevention Program study. Feature selection methods were used to select for subsets of transcripts to be used in the selected classification approaches: support vector machine, logistic regression, decision trees, random forest, and extremely randomized decision trees (extra-trees). Data types were included in different classification approaches in an additive manner to assess model performance for the prediction of weight loss.ResultsAverage waist and hip circumference were found to be different between those who exhibited weight loss and those who did not exhibit weight loss (P=.02 and P=.04, respectively). The incorporation of dietary and step count data did not improve modeling performance compared to classifiers that included only demographic and clinical data.

BackgroundA very low-carbohydrate (VLC) nutritional strategy may improve glycemic control and weight loss in adults with type 2 diabetes (T2D). However, the supplementary behavioral strategies that might be able to improve outcomes using this nutritional strategy are uncertain.ObjectiveThis study aims to compare the impact of adding 3 different supplementary behavioral strategies to a web-based VLC diet intervention. To our knowledge, this is the first trial to randomize participants to different frequencies of dietary self-monitoring.MethodsThe study included 112 overweight adults with T2D (hemoglobin A1c ≥6.5%) taking no antiglycemic medications or only metformin. They received a remotely delivered 12-month VLC diet intervention. Participants were randomly assigned through a full factorial 2×2×2 design to supplementary strategies: either daily or monthly dietary self-monitoring, either mindful eating training or not, and either positive affect skills training or not. Our research goal was to determine whether 3 different supplemental strategies had at least a medium effect size (Cohen d=0.5).ResultsOverall, the VLC intervention led to statistically significant improvements in glycemic control (-0.70%, 95% CI -1.04% to -0.35%; P<.001), weight loss (-6.82%, 95% CI -8.57% to -5.08%; P<.001), and depressive symptom severity (Cohen d -0.67, 95% CI -0.92 to -0.41; P<.001). Furthermore, 30% (25/83) of the participants taking metformin at baseline reduced or discontinued their metformin. Only 1 Cohen d point estimate reached 0.5; daily (vs monthly) dietary self-monitoring had a worse impact on depressive symptoms severity (Cohen d=0.47, 95% CI -0.02 to 0.95; P=.06). None of the strategies had a statistically significant effect on outcomes. For changes in our primary outcome, hemoglobin A1c, the daily (vs monthly) dietary self-monitoring impact was 0.42% (95% CI -0.28% to 1.12%); for mindful eating, it was -0.47% (95% CI -1.15% to 0.22%); and for positive affect

BackgroundMultidisciplinary approaches to weight loss have been shown to improve outcomes in bariatric patients. Few studies have been performed assessing the utility and compliance of fitness tracking devices after bariatric surgery. We aim to determine whether use of an activity tracking device assists bariatric patients in improving postoperative weight loss behaviors.MethodsA fitness wearable was offered to patients undergoing bariatric surgery from 2019 to 2022. A telephone survey was conducted to elucidate the impact of the device on the patient's postoperative weight loss efforts 6 to 12 months after surgery. Weight loss outcomes of sleeve gastrectomy (SG) patients receiving the fitness wearable (FW) were compared to those of a group of SG patients who did not receive one (non-FW).ResultsThirty-seven patients were given a fitness wearable, 20 of whom responded to our telephone survey. Five patients reported not using the device and were excluded. 88.2% reported that using the device had a positive impact on their overall lifestyle. Patients felt that using the fitness wearable to keeping track of their progress helped them both to achieve short-term fitness goals and sustain them in the long run. From the patients that utilized the device, 44.4% of those that discontinued felt like it helped them build a routine that they maintained even after they were no longer using it. Demographic data between FW and non-FW groups (age, sex, CCI, initial BMI, and surgery BMI) did not differ significantly. The FW group trended towards greater %EWL at 1 year post-operation (65.2% versus 52.4%, p = 0.066) and had significantly greater %TWL at 1 year post-operation (30.3% versus 22.3%, p = 0.02).ConclusionThe use of an activity tracking device enhances a patient's post-bariatric surgery experience, serving to keep patients informed and motivated, and leading to improved activity that may translate to better weight loss outcomes.

Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.

Obesity is a highly prevalent entity in the world, currently representing a public healthcare problem. In the pathogenesis of this disease, a role of the intestinal micro biome has been identified. Human maintains a symbiotic relationship with enteric bacteria which are responsible for catalyzing processes that influence the immune response, gastrointestinal tract functioning and absorption of nutrients. A disbiosis can promote the development of obesity. When comparing the different therapeutic strategies for obesity, bariatric surgery allows better control of comorbidities while also showing a change in enteral bacterial populations. The objective of this text is, through a critical literary review, to capture the importance of the intestinal micro biome and its behavior in obesity and the role of bariatric surgery in its changes., La obesidad es una entidad de alta prevalencia en el mundo, representando actualmente un problema de salud pública. En la etiopatogenia de la enfermedad se identifica un probable rol del microbioma intestinal, esta población bacteriana con la que el humano mantiene una relación simbiótica y se beneficia de procesos de catalización influencia la respuesta inmunitaria, funcionamiento del tracto gastrointestinal con énfasis en la absorción de nutrientes, permeabilidad enteral y homeostasis de la glucosa y la respuesta inflamatoria. Una disbiosis puede promover el desarrollo de la obesidad, así como sus comorbilidades. Al compararse las distintas estrategias terapéuticas para la obesidad, la cirugía bariátrica permite un mejor control de comorbilidades mientras también evidencia un cambio en la diversificación bacteriana enteral. Evidenciándose en el postoperatorio una disminución de Firmicutes con respecto a los Bacterioidetes, permitiendo una mejor función metabólica para el individuo. El objetivo de este texto es por medio de la revisión crítica literaria plasmar la importancia del microbioma intestinal y su comportamiento en la obesidad y el papel de la cirugía bariátrica en su resolución.

Obesity is an abnormal and excessive accumulation of fat that is detrimental to health with a negative impact on quality of life, associated with comorbidities such as arterial hypertension. In 2015, it was estimated that there were 603.7 million obese adults in the world. The NHANES data consider a progressive increase in obesity and overweight in the last 30 years, from 22.9% to 42.4%. In Ecuador 6 out of 10 people are overweight or obese. Hypertension in obesity is most often determined by vascular aging accelerated by inflammatory processes, oxidative stress, and insulin resistance. Changes in lifestyle determine that for every 1 kg of weight loss, there is a short-term reduction of 1 mmHg in systolic blood pressure. Bariatric surgery has an impact on weight loss and cardiovascular factors. Epidemiological records have shown a direct linear relationship between obesity and blood pressure: as weight increases, blood pressure increases. Similarly, the effect of blood pressure reduction on weight loss appears to be linear: the greater the weight loss, the greater the decrease in blood pressure., La obesidad es una acumulación anormal y excesiva de grasa perjudicial para la salud con impacto negativo en la calidad de vida, asociada comorbilidades como la hipertensión arterial. En 2015 se estimaba 603,7 millones de adultos con obesidad en el mundo. Los datos de NHANES consideran un aumento progresivo de obesidad y sobrepeso en los últimos 30 años que paso de 22,9% a 42,4%. En Ecuador 6 de cada 10 personas tienen sobrepeso u obesidad. La hipertensión en la obesidad está determinada con mayor frecuencia por el envejecimiento vascular acelerado por procesos inflamatorios, estrés oxidativo y resistencia a la insulina. Las modificaciones en el estilo de vida determinan que por cada 1 kg de pérdida de peso disminuye a corto plazo 1 mmHg de la presión arterial sistólica. La cirugía bariátrica posee un impacto en la pérdida de peso y los factores cardiovasculares. Los registros epidemiológicos han demostrado una relación lineal directa entre la obesidad y la presión arterial: a medida que aumenta el peso, aumenta la presión arterial. De la misma manera, el efecto de reducción de la presión arterial sobre la pérdida de peso parece ser lineal: a mayor pérdida de peso mayor disminución de la presión arterial.

Obesity is a chronic disease and a global epidemic characterized by a BMI of 30 and above. In the Netherlands alone, 51% of people are overweight and 14% are obese. Obesity is often accompanied by other conditions such as diabetes, high blood pressure and cardiovascular disease. Combined with an increased risk of cancer, it leads to a higher risk of death. Bariatric surgery is an effective and safe way to treat obesity. It provides long-term weight loss and can lead to cure conditions such as diabetes. Several types of bariatric surgery are available. However, it is not yet clear which procedure offers the best outcomes. This study was conducted using the Dutch Audit for Treatment of Obesity (DATO), a national registry, to compare outcomes between these different interventions. It also looked at hospital differences in outcomes and predicting risk after surgery. Collectively, the studies in this dissertation can provide tools for bariatric surgeons in daily practice.

BACKGROUND: Socioeconomic status (SES) is multifactorial, and its effect on post-bariatric weight recurrence is unclear. Distressed Community Index (DCI) is a composite SES score measuring community economic well-being. This study aims to evaluate the effect of DCI on long-term post-bariatric weight outcomes. METHODS: Retrospective analysis of patients undergoing primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between 2015 and 2020 was performed. All weights in the electronic medical record (EMR), including non-bariatric visits, were captured. Patients were stratified into low tier (LT) and high tier (HT) DCI groups. RESULTS: Of 583 patients, 431 (73.9%) were HT and 152 (26.1%) were LT. Average bariatric follow up was 1.78 ± 1.6 years and average postoperative weight in the EMR was 3.96 ± 2.26 years. Rates of bariatric follow up within the last year were similar (13.8% LT vs 16.2% HT, p = 0.47). LT had higher percent total body weight loss (%TWL; 26% LT vs 23% HT, p < 0.01) and percent excess weight loss (%EWL; 62% vs 57%, p = 0.04) at 1 year on univariate analysis. On multivariate linear regression adjusting for baseline characteristics and surgery type, there were no differences in %EWL between groups at 1 year (p = 0.22), ≥ 3 years (p = 0.53) or ≥ 5 years (p = 0.34) postop. While on univariate analysis LT only trended towards greater percentage of patients with > 15% increase from their 1-year weight (33.3% LT vs 21.0% HT, p = 0.06), on multivariate analysis this difference was significant (OR 2.0, LT 95%CI 1.41-2.84). There were no differences in the percentage of patients with > 15% decrease in %EWL from 1 to 3 + years postop between groups (OR 0.98, LT 95% CI 0.72-1.35). CONCLUSIONS: While low tier patients had similar weight loss at 1 year, they were twice as likely to have weight recurrence at ≥ 3 years. Further studies are needed to identify factors contributing to greater w

Adipocyte dysregulation is one mechanism linking overweight and breast cancer recurrence. Exercise and weight loss are associated with a decreased risk of breast cancer recurrence in breast cancer survivors with overweight or obesity, which may be mediated through reduced leptin levels, increased adiponectin levels, and an elevated adiponectin to leptin (A:L) ratio. The four-arm randomized controlled WISER Survivor trial examined the 12-month intervention effects of exercise, weight loss, and the combination of exercise and weight loss on adipokine levels among breast cancer survivors (n = 339) with overweight or obesity. Compared with Control, the Combination of Exercise and Weight Loss decreased leptin levels (-35.9%; 95% CI: -46.8%, -25.0%) and increased A:L ratio (11.6%; 95% CI: 5.6%, 17.6%) but did not change adiponectin levels (4.1%; 95% CI: -3.1%, 11.2%). Compared with Control, Weight Loss Alone decreased leptin levels (-35.6%; 95% CI: -46.6%, -24.5%) and increased A:L ratio (10.6%; 95% CI: 4.7%, 16.5%) but did not change adiponectin levels (0.9%; 95% CI: -6.0%, 7.9%). Compared with Control, Exercise Alone did not change leptin levels, adiponectin levels, or A:L ratio. In analyses that consolidated intervention groups, compared with Control, weight loss of ≥5% decreased leptin levels (p trend < 0.01) and increased A:L ratio (p trend < 0.01) but did not alter adiponectin levels (p trend = 0.53). Weight loss, with or without exercise, was associated with decreased leptin levels in breast cancer survivors with overweight or obesity. Improvements in the adipokine secretion profile (A:L ratio) were primarily driven by a weight loss-induced change in leptin levels.

Kroppsuppfattning påverkar vår livskvalitet. Utöver att prestera på tävling behöver tyngdlyftare och styrkelyftare delta på en invägning, där deras kroppsvikt avgör vilken viktklass de tävlar i. Syftet med studien var att undersöka om det fanns ett samband mellan lyftares kroppsuppfattning och upplevelse av att vara aktiv och tävlande inom tyngdlyftning och/eller styrkelyft. Metod: 210 svenska tyngdlyftare och styrkelyftare med tävlingserfarenhet i åldrarna 15–70 år deltog i studien. Deltagarna svarade på en digital enkät som inkluderade ett av författaren nyskapat instrument om förekomst av beteenden och upplevelser av att tävla i en viktklassidrott, samt Body Esteem Scale for Adolescents and Adults om kroppsuppfattning. Resultat: Signifikant positiva korrelationer av måttlig styrka påvisades mellan kroppsuppfattning och tävlingsupplevelse, samt mellan kroppsuppfattning och viktupplevelse. Svag positiv korrelation påvisades mellan kroppsuppfattning och invägningsupplevelse. 60 % av studiedeltagarna rapporterade positiv kroppsuppfattning och 40 % rapporterade blandad/splittrad eller negativ kroppsuppfattning. Slutsats: Studiens resultat indikerar att kroppsuppfattning och upplevelse av att tävla, upplevelse av sin kroppsvikt och att tävla i viktklass(er), samt upplevelse av invägning har ett samband. Då 40 % av populationen rapporterade blandad/splittrad eller negativ kroppsuppfattning tyder resultaten på praktiska förbättringsmöjligheter där idrottares kroppsuppfattning kan förbättras., Body image affects our quality of life. In addition to performing in competition, weightlifters and powerlifters need to participate in a weigh-in, where their body weight determines which weight class they compete in. The purpose of the study was to investigate whether there was a relationship between lifters’ body image and experience of being active and competing in weightlifting and/or powerlifting. Method: 210 Swedish weightlifters and powerlifters with competition experience aged 15–70 years participated in the study. The participants responded to a digital questionnaire that included an instrument newly created by the author on the prevalence of behaviours and experiences of competing in a weight class sport, as well as the Body Esteem Scale for Adolescents and Adults. Results: Positive correlations of statistical significance and of moderate strength were found between body image and competition experience, as well as between body image and weight experience. Weak positive correlation was demonstrated between body image and weigh-in experience. 60 % of the participants reported positive body image and 40 % reported mixed/split or negative body image. Conclusion: The results of the study indicate a relationship between body image and experience of competing, experience of one's body weight and competing in weight class(es), as well as experience of weigh-ins. As 40 % of the population reported mixed/split or negative body image, the results indicate practical opportunities where athletes’ body image can be improved.

Atypical anorexia nervosa (AAN) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM5), is characterized by meeting all criteria for anorexia nervosa (AN) except for weight being within or above the "normal" range despite significant weight loss. The current definition is plagued by several problems, resulting in widely heterogeneous operationalizations in research and clinical practice. As such, the poorly defined diagnosis of AAN negatively impacts affected individuals and frustrates research attempts to better understand the syndrome. We consider conceptual flaws in the AAN description and contend that the undefined weight range and nature of weight loss renders these two factors functionally inapplicable in research and practice. They also represent a departure from the originally intended use of the AAN category, i.e., arresting a negative weight trajectory likely to result in AN, making the target population, and the application of the label, unclear. We propose revised criteria and a new name, restrictive eating disorder (RED), intended to reduce stigma and encompass a wide but better-defined range of presentations. The RED criteria focus on clinically significant restrictive behavior that disrupts normal living (i.e., impairment), and cognitive symptoms of overevaluation, disturbed experience, and lack of recognition of illness seriousness. We believe that RED may enable more appropriate clinical application, but also inspire coordinated research toward a more valid psychiatric nosology in the eating disorders field.

Objective: To evaluate the relationship between weight loss and markers of poor prognosis in patients hospitalized with COVID-19 in the state of Pernambuco. Methods: A multicenter, cross-sectional study coupled with prospective analysis variables involving 71 individuals with COVID-19 admitted for hospitalization in 8 public hospitals in Recife, in the State of Pernambuco. Individuals of both sexes, aged ≥ 20 years, hospitalized from June 2020 to June 2021 were included. Sociodemographic, clinical, and nutritional data and prognostic markers were collected. Results: The average age was 54.6±15.6 years, with 54.9% of individuals being male. It was found that 26.8% of the patients were diabetic and 52.1% were hypertensive. The anthropometric profile indicated that 56.3% were overweight and 5.6% were underweight. Positive screening for sarcopenia was observed in 16.9%. The median weight loss was 3.1% (0.0-6.6%), with a loss > 5% evident in 29.6% of the sample. It was found that weight loss was more frequent in men (16 (41.0%) vs. 5 (15.6%); p = 0.020) and that demographic, clinical, and nutritional variables were not associated with body weight loss. There was no statistical association between weight loss and prognostic variables (p NS). Conclusion: Although the study did not demonstrate an association between weight loss and prognostic variables, this should be considered when assessing patients with COVID-19 and should be investigated and treated as an essential health promotion measure., Objetivo: Avaliar a relação entre a perda de peso com marcadores de mau prognóstico em pacientes hospitalizados com COVID-19 no estado de Pernambuco. Métodos: Estudo multicêntrico, transversal, acoplado a algumas variáveis de análise prospectiva envolvendo 71 indivíduos com COVID-19 admitidos para internação em 8 hospitais públicos de Recife, no Estado de Pernambuco. Foram incluídos indivíduos de ambos os sexos, com idade ≥ 20 anos, hospitalizados, no período de junho de 2020 a junho de 2021. Foram coletados dados sociodemográficos, clínicos, nutricionais e marcadores prognósticos. Resultados: A média de idade foi 54,6±15,6 anos, sendo 54,9% dos indivíduos do sexo masculino. Verificou-se que 26,8% dos pacientes eram diabéticos e 52,1% eram hipertensos.  O perfil antropométrico indicou 56,3% de excesso de peso e 5,6% de baixo peso. Observou-se rastreio positivo para sarcopenia em 16,9%. A mediana da perda de peso foi 3,1% (0,0-6,6%), sendo uma perda > 5% evidenciada em 29,6% da amostra. Verificou-se que a perda de peso foi mais frequente nos homens (16 (41,0%) vs. 5 (15,6%); p = 0,020) e que as variáveis demográficas, clínicas e nutricionais não se associaram à redução do peso corporal. Não houve associação estatística entre a perda de peso e as variáveis prognósticas (p NS). Conclusão: embora o estudo não tenha demonstrado associação entre a perda de peso e variáveis prognósticas, esta deve ser considerada na avaliação do paciente com COVID-19, devendo ser investigada e tratada como uma importante medida de promoção à saúde.

Objective: To compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification. Summary of Background Data: Previous studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups. Methods: Nationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention. Results: During the 2-year period before treatment, prevalence of individuals receiving >= 1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98). Conclusions: Bariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.

Objective: This study (1) investigated the effect of weight loss on whole-body and tissue-specific insulin sensitivity and on intrahepatic lipid (IHL) content and composition and (2) investigated the association between weight-loss-induced changes in insulin sensitivity and IHL content in individuals with overweight or obesity. Methods: In this secondary analysis of the European SWEET project, 50 adults (age 18–65 years) with overweight or obesity (BMI ≥ 25 kg/m2) followed a low-energy diet (LED) for 2 months. At baseline and after the LED, body composition (dual-energy x-ray absorptiometry), IHL content and composition (proton magnetic resonance spectroscopy), whole-body insulin sensitivity (Matsuda index), muscle insulin sensitivity index (MISI), and hepatic insulin resistance index (HIRI) were determined (7-point oral glucose tolerance test). Results: The LED reduced body weight (p < 0.001). This was accompanied by increased Matsuda index and reduced HIRI (both p < 0.001) but no change in MISI (p = 0.260). Weight loss decreased IHL content (mean [SEM], 3.9% [0.7%] vs. 1.6% [0.5%], p < 0.001) and the hepatic saturated fatty acid fraction (41.0% [1.5%] vs. 36.6% [1.9%], p = 0.039). The reduced IHL content was associated with an improvement in HIRI (r = 0.402, p = 0.025). Conclusions: Weight loss decreased IHL content and the hepatic saturated fatty acid fraction. The decrease in IHL content was associated with weight-loss-induced improvement in hepatic insulin sensitivity in individuals with overweight or obesity.

Scope: The New Nordic Diet (NND) has been shown to promote weight loss and lower blood pressure amongst obese people. This study investigates blood plasma metabolite and lipoprotein biomarkers differentiating subjects who followed Average Danish Diet (ADD) or NND. The study also evaluates how the individual response to the diet is reflected in the metabolic differences between NND subjects who lost or maintained their pre-intervention weight.Methods: Centrally obese Danes (BMI >25) followed NND (90 subjects) or ADD (56 subjects) for 6 months. Fasting blood plasma samples, collected at three time-points during the intervention, were screened for metabolites and lipoproteins (LPs) using proton nuclear magnetic resonance spectroscopy. In total, 154 metabolites and 65 lipoproteins were analysed.Results: The NND showed a relatively small but significant effect on the plasma metabolome and lipoprotein profiles, with explained variations ranging from 0.6% for lipoproteins to 4.8% for metabolites. A total of 38 metabolites and 11 lipoproteins were found to be affected by the NND. The primary biomarkers differentiating the two diets were found to be HDL-1 cholesterol, apolipoprotein A1, phospholipids, and ketone bodies (3-hydroxybutyric acid, acetone, and acetoacetic acid). The increased levels of ketone bodies detected in the NND group inversely associated with the decrease in diastolic blood pressure of the NND subjects. The study also showed that body weight loss among the NND subjects was weakly associated with plasma levels of citrate.Conclusion: The main plasma metabolites associated with NND were acetate, methanol and 3-hydroxybutyrate. The metabolic changes associated with the NND-driven weight loss are mostly pronounced in energy and lipid metabolism.

Aim: Postprandial secretion of the appetite-inhibiting hormones, glucagon-like peptide-1 (GLP-1), and peptide YY are reduced with obesity. It is unclear if the reduced secretion persists following weight loss (WL), if other appetite-inhibiting hormones are also reduced, and if so whether reduced secretion results from intrinsic changes in the gut. Methods: To address whether WL may restore secretion of GLP-1 and other appetite-inhibiting hormones, we performed a gut perfusion study of the small intestine in diet-induced obese (DIO) rats after WL. A 20% weight loss (means ± SEM (g): 916 ± 53 vs. 703 ± 35, p < 0.01, n = 7) was induced by calorie restriction, and maintained stable for ≥7 days prior to gut perfusion to allow for complete renewal of enteroendocrine cells. Age-matched DIO rats were used as comparator. Several gut hormones were analyzed from the venous effluent, and gene expression was performed on gut tissue along the entire length of the intestine. Results: Secretion of cholecystokinin, gastrin, glucose-dependent insulinotropic peptide, GLP-1, neurotensin, and somatostatin was not affected by WL during basal conditions (p ≥ 0.25) or in response to macronutrients and bile acids (p ≥ 0.14). Glucose absorption was indistinguishable following WL. The expression of genes encoding the studied peptides, macronutrient transporters (glucose, fructose, and di-/tripeptides) and bile acid receptors did also not differ between DIO and WL groups. Conclusions: These data suggest that the attenuated postprandial responses of GLP-1, as well as reduced responses of other appetite-inhibiting gut hormones, in people living with obesity may persist after weight loss and may contribute to their susceptibility for weight regain.

Background: The contemporary Western food environment has been implicated as a key driver of obesity and disorders of overeating, which have now reached pandemic status. This has been matched with burgeoning interest in the novel concept of food addiction (FA) and in bariatric weight loss surgeries, currently the most effective treatment for obesity. Patients who choose surgery typically exhibit relatively higher levels of obesity and maladaptive eating, struggle to control their intake of (hyper)palatable/refined foods, and have high rates of psychopathology and related health problems. Perplexingly, however, the reported rates of FA in the bariatric are relatively low or variable. Additionally, weight loss and other benefits of bariatric surgeries, although well-established, vary according to both the type of surgery and individual biopsychosocial factors. Consequently, there is a critical need for prospective research aimed at investigating interactions between these factors. Aim and Objectives: The research investigated the usefulness of the novel concept of FA in the bariatric weight loss surgery domain, with the aim of improving predictive capacity of postsurgical outcomes to ensure better patient to surgery fit and more adaptive postsurgical adjustment, including, and guiding patient education and pre and postsurgical care. Research Format: The study began with a comprehensive review of literature related to societal increases in obesity, homeostatic and hedonic mechanisms of appetite and satiety, and the novel construct of FA, together with an overview of bariatric surgery research, followed by two prospective empirical studies completed as elements of this research. Study 1 investigated the applicability and performance of Yale Food Addiction Scale (YFAS)-scored FA in a sample of presurgery candidates. Study 2 investigated outcomes of bariatric surgery over time and whether potential interactive effects between presurgical FA and type of surgery resulted in, Thesis (Professional Doctorate), Doctor of Philosophy (PhD), School of Applied Psychology, Griffith Health, Full Text

OBJECTIVE: The aim of this study was to investigate glucose tolerance, glucagon response, and beta cell function during a 1-year maintenance period with either exercise, the glucagon-like peptide-1 receptor agonist liraglutide, or the combination after diet-induced weight loss.METHODS: In this randomized placebo-controlled trial, adults with obesity (BMI: 32-43 kg/m 2 ) without diabetes underwent an 8-week low-calorie diet (800 kcal/d) and were randomized to 52 weeks of aerobic exercise, liraglutide 3.0 mg/d, exercise and liraglutide combined, or placebo. Change in glucose and glucagon response to a 3-hour mixed meal test and disposition index, as a measure of beta cell function, were measured. RESULTS: A total of 195 participants were randomized. After 1 year of treatment, the combination group had decreased postprandial glucose response by -9% (95% CI: -14% to -3%; p = 0.002), improved beta cell function by 49% (95% CI: 16% to 93%; p = 0.002), and decreased glucagon response by -18% (95% CI: -34% to -3%; p = 0.024) compared with placebo. Compared with placebo, liraglutide alone improved postprandial glucose response by -7% (95% CI: -12% to -1%; p = 0.018), but not beta cell function or glucagon. Exercise alone had similar postprandial glucose response, beta cell function, and glucagon response as placebo.CONCLUSIONS: Only the combination of exercise and liraglutide improved glucose tolerance, beta cell function, and glucagon responses after weight loss.

ObjectiveWeight regain prevention is a critical public health challenge. Digital behaviour change interventions provide a scalable platform for applying and testing behaviour change theories in this challenging context. This study's goal was to analyse reciprocal effects between psychosocial variables (i.e., needs satisfaction, eating regulation, self-efficacy) and weight over 12 months using data from a large sample of participants engaged in a weight regain prevention trial. MethodsThe NoHoW study is a three-centre, large-scale weight regain prevention trial. Adults who lost >5% of their weight in the past year (N = 1627, 68.7% female, 44.10 +/- 11.86 years, 84.47 +/- 17.03 kg) participated in a 12-month' digital behaviour change-based intervention. Weight and validated measures of basic psychological needs satisfaction, eating regulation and self-efficacy were collected at baseline, six- and 12 months. Correlational, latent growth models and cross-lagged analysis were used to identify potential reciprocal effects. ResultsBaseline higher scores of needs satisfaction and self-efficacy were associated with six- and 12-month' weight loss. Baseline weight was linked to all psychosocial variables at six months, and six-months weight was associated with needs satisfaction and self-efficacy at 12 months. During the 12 months, increases in eating regulation, needs satisfaction and self-efficacy were associated with weight loss over the same period, and reciprocal effects were observed between the variables, suggesting the existence of Weight Management Cycles. ConclusionsWhile further studies are needed, during long-term weight regain prevention, weight decrease, needs satisfaction and self-efficacy may lead to Weight Management Cycles, which, if recurrent, may provide sustained prevention of weight regain.

OBJECTIVE: The aim of this study was to investigate glucose tolerance, glucagon response, and beta cell function during a 1-year maintenance period with either exercise, the glucagon-like peptide-1 receptor agonist liraglutide, or the combination after diet-induced weight loss.METHODS: In this randomized placebo-controlled trial, adults with obesity (BMI: 32-43 kg/m 2 ) without diabetes underwent an 8-week low-calorie diet (800 kcal/d) and were randomized to 52 weeks of aerobic exercise, liraglutide 3.0 mg/d, exercise and liraglutide combined, or placebo. Change in glucose and glucagon response to a 3-hour mixed meal test and disposition index, as a measure of beta cell function, were measured. RESULTS: A total of 195 participants were randomized. After 1 year of treatment, the combination group had decreased postprandial glucose response by -9% (95% CI: -14% to -3%; p = 0.002), improved beta cell function by 49% (95% CI: 16% to 93%; p = 0.002), and decreased glucagon response by -18% (95% CI: -34% to -3%; p = 0.024) compared with placebo. Compared with placebo, liraglutide alone improved postprandial glucose response by -7% (95% CI: -12% to -1%; p = 0.018), but not beta cell function or glucagon. Exercise alone had similar postprandial glucose response, beta cell function, and glucagon response as placebo.CONCLUSIONS: Only the combination of exercise and liraglutide improved glucose tolerance, beta cell function, and glucagon responses after weight loss.

BACKGROUND: It remains unclear if a low-carbohydrate, high-fat (LCHF) diet is a possible treatment strategy for type 2 diabetes mellitus (T2DM), and the effect on nonalcoholic fatty liver disease (NAFLD) has not been investigated.OBJECTIVE: To investigate the effect of a calorie-unrestricted LCHF diet, with no intention of weight loss, on T2DM and NAFLD compared with a high-carbohydrate, low-fat (HCLF) diet.DESIGN: 6-month randomized controlled trial with a 3-month follow-up. (ClinicalTrials.gov: NCT03068078).SETTING: Odense University Hospital in Denmark from November 2016 until June 2020.PARTICIPANTS: 165 participants with T2DM.INTERVENTION: Two calorie-unrestricted diets: LCHF diet with 50 to 60 energy percent (E%) fat, less than 20E% carbohydrates, and 25E% to 30E% proteins and HCLF diet with 50E% to 60E% carbohydrates, 20E% to 30E% fats, and 20E% to 25E% proteins.MEASUREMENTS: Glycemic control, serum lipid levels, metabolic markers, and liver biopsies to assess NAFLD.RESULTS: The mean age was 56 years (SD, 10), and 58% were women. Compared with the HCLF diet, participants on the LCHF diet had greater improvements in hemoglobin A1c (mean difference in change, -6.1 mmol/mol [95% CI, -9.2 to -3.0 mmol/mol] or -0.59% [CI, -0.87% to -0.30%]) and lost more weight (mean difference in change, -3.8 kg [CI, -6.2 to -1.4 kg]). Both groups had higher high-density lipoprotein cholesterol and lower triglycerides at 6 months. Changes in low-density lipoprotein cholesterol were less favorable in the LCHF diet group than in the HCLF diet group (mean difference in change, 0.37 mmol/L [CI, 0.17 to 0.58 mmol/L] or 14.3 mg/dL [CI, 6.6 to 22.4 mg/dL]). No statistically significant between-group changes were detected in the assessment of NAFLD. Changes were not sustained at the 9-month follow-up.LIMITATION: Open-label trial, self-reported adherence, unintended weight loss, and lack of adjustment for multiple comparisons.

ObjectiveWeight regain prevention is a critical public health challenge. Digital behaviour change interventions provide a scalable platform for applying and testing behaviour change theories in this challenging context. This study's goal was to analyse reciprocal effects between psychosocial variables (i.e., needs satisfaction, eating regulation, self-efficacy) and weight over 12 months using data from a large sample of participants engaged in a weight regain prevention trial. MethodsThe NoHoW study is a three-centre, large-scale weight regain prevention trial. Adults who lost >5% of their weight in the past year (N = 1627, 68.7% female, 44.10 +/- 11.86 years, 84.47 +/- 17.03 kg) participated in a 12-month' digital behaviour change-based intervention. Weight and validated measures of basic psychological needs satisfaction, eating regulation and self-efficacy were collected at baseline, six- and 12 months. Correlational, latent growth models and cross-lagged analysis were used to identify potential reciprocal effects. ResultsBaseline higher scores of needs satisfaction and self-efficacy were associated with six- and 12-month' weight loss. Baseline weight was linked to all psychosocial variables at six months, and six-months weight was associated with needs satisfaction and self-efficacy at 12 months. During the 12 months, increases in eating regulation, needs satisfaction and self-efficacy were associated with weight loss over the same period, and reciprocal effects were observed between the variables, suggesting the existence of Weight Management Cycles. ConclusionsWhile further studies are needed, during long-term weight regain prevention, weight decrease, needs satisfaction and self-efficacy may lead to Weight Management Cycles, which, if recurrent, may provide sustained prevention of weight regain.

“Diabesity”, which combines type 2 diabetes (T2D) and obesity has emerged as a global epidemic in the modern world. Indeed, diabesity contributes significantly to increased morbidity, and the prevalence of this global health burden has steadily increased in India over the past three decades. Importantly, only a few pharmacological agents are currently available across the world, and India in particular has access to only a limited number of such agents. However, with the advent of oral glucagon-like peptide-1 receptor agonist (GLP-1RA) after its launch in India recently as an antidiabetic agent, the horizon to combat diabesity has expanded. With the available evidence from several phase 3 trials of oral GLP-1RA (PIONEER, Peptide Innovation for Early Diabetes Treatment), it is increasingly becoming apparent that oral semaglutide could have some potential to fulfil the US Food and Drug Administration criterion of an antiobesity agent.

“Diabesity”, which combines type 2 diabetes (T2D) and obesity has emerged as a global epidemic in the modern world. Indeed, diabesity contributes significantly to increased morbidity, and the prevalence of this global health burden has steadily increased in India over the past three decades. Importantly, only a few pharmacological agents are currently available across the world, and India in particular has access to only a limited number of such agents. However, with the advent of oral glucagon-like peptide-1 receptor agonist (GLP-1RA) after its launch in India recently as an antidiabetic agent, the horizon to combat diabesity has expanded. With the available evidence from several phase 3 trials of oral GLP-1RA (PIONEER, Peptide Innovation for Early Diabetes Treatment), it is increasingly becoming apparent that oral semaglutide could have some potential to fulfil the US Food and Drug Administration criterion of an antiobesity agent.