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Nitin Kapoor,1,2 Stephen A Jiwanmall,3 Munaf B Nandyal,3 Dheeraj Kattula,3 Sandhiya Paravathareddy,1 Thomas V Paul,1 John Furler,4 Brian Oldenburg,2 Nihal Thomas1 1Department of Endocrinology, Diabetes and Metabolism Christian Medical College & Hospital, Vellore, Tamil Nadu, India; 2Non-Communicable Disease Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; 3Department of Psychiatry, Christian Medical College & Hospital, Vellore, Tamil Nadu, India; 4Department of General Practice, University of Melbourne, Melbourne, AustraliaCorrespondence: Nitin Kapoor Email nitin.endocrine@gmail.comBackground: Visceral adipose tissue (VAT) assessment is limited in clinical practice due to expensive, time consuming and limited availability of MRI and DXA machines. We explored the utility of a recently developed Metabolic Score for Visceral Fat (METS-VF) to assess VAT in south Asian individuals with morbid obesity.Patients and Methods: Individuals with BMI ≥ 35 kg/m2 aged between 30 and 60 years were randomly selected from a database of individuals with morbid obesity, attending a multi-disciplinary bariatric clinic in a tertiary care teaching hospital in southern India. Body composition was assessed by using a Hologic Discovery A dual-energy X-ray absorptiometry (DXA) machine. METS-VF was used to estimate VAT by using a previously published algorithm.Results: The mean age and body mass index of the study subjects (N=350) were 38.2 years and 40.1 kg/m2. The MET-VF score performed satisfactorily (AUC of 0.78 (95% CI 0.72– 0.85)) for predicting an increased visceral adipose tissue (VAT area ≥ 163 cm2) as detected by DXA. A METS-VF value of 7.3 was found to have a good sensitivity and reasonable specificity in predicting elevated VAT in this population.Conclusion: This is the first study to validate the utility of METS-VF as a surrogate measure of visceral adiposity in south Indian individuals with morbid obesity. Given the simplicity, easy availability, reliability and inexpensive nature of this obesity indicator, it may find its widespread use in lower middle-income countries.Keywords: metabolic obesity, morbid obesity, visceral adipose tissue

Background: The prevalence of obesity is increasing rapidly in India and so are its associated comorbidities. Non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, is commonly associated with obesity. However, limited data are available on its prevalence and clinical indicators among morbidly obese Indian women. The aim of our study was to find the prevalence of NAFLD in morbidly obese Indian women and study the clinically measurable obesity indicators that would best predict NAFLD., Methods: This was a cross-sectional study, conducted in the Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore. Women were enrolled who were diagnosed to have NAFLD on sonography. Anthropometric variables, such as body mass index, waist circumference, hip circumference, waist-hip ratio and waist-height ratio were measured and compared between the two groups. SPSS Statistics 21.0 software was used for analysing the data., Results: One hundred and six consecutive, morbidly obese women were recruited in this study. Nearly three-quarters (73.6%) of the 106 morbidly obese participants were found to have NAFLD. We found waist circumference, body mass index and waist-height ratio to be most useful in distinguishing between patients with and without NAFLD, and found waist-height ratio was the best screening tool for diagnosing NAFLD., Conclusion: NAFLD is present in a large proportion of morbidly obese women. Waist-height ratio could be used a surrogate screening tool to detect NAFLD in resource-constrained settings., Competing Interests: Disclosures: Avica Atri, Stephen A Jiwanmall, Munaf B Nandyal, Dheeraj Kattula, Sandhiya Paravathareddy, Thomas V Paul, Nihal Thomas and Nitin Kapoor have no financial or non-financial relationships or activities to declare in relation to this article., (© Touch Medical Media 2020.)

Objective: The global prevalence of obesity is increasing and has nearly doubled in the last decade, disproportionately impacting less-developed countries. The aim of this cross-sectional study was to analyse health-related quality of life (HRQOL) in morbidly obese women attending a bariatric clinic in India, and assess potential obesity indicators that can be utilised in under-resourced settings, to better understand HRQOL of individual patients., Methods: Anthropometric measurements were collected, including waist circumference, hip circumference, waist-hip ratio, waist-height ratio and body mass index (BMI). HRQOL was assessed using an obesity-related quality-of-life questionnaire focused on the impact of obesity on physical distress, self-esteem, sexual life and work life., Results: The average BMI of study participants was 39.6 kg/m2, with an average HRQOL of 40.2%. The strongest correlation was noted between BMI and HRQOL (R2=0.16). Exploratory analyses demonstrated that patients with higher BMI quartiles had lower scores for physical impact and psychosocial impact, and higher scores for sexual health, comfort with food, and experience with dieting compared to patients in lower quartiles., Conclusion: In South Indian, middle-aged, morbidly obese women, HRQOL is lower than average and is highly correlated with BMI, with different BMI levels having higher impacts in different subcategories, supporting the need for an individualised therapeutic focus for each patient., Competing Interests: Disclosures: Shobana Ramasamy, Mini Joseph, Stephen Amarjeet Jiwanmall, Dheeraj Kattula, Munaf Babajan Nandyal, Vijay Abraham, Inian Samarasam, Sandhiya Paravathareddy, Thomas V Paul, Simon Rajaratnam, Nihal Thomas and Nitin Kapoor have no financial or non-financial relationships or activities to declare in relation to this article., (© Touch Medical Media 2020.)

Background: Obesity is a global epidemic. Bariatric surgery is being considered as the treatment of choice in morbid obesity. Psychiatric comorbidity affects outcomes in this population. There is a dearth of data on psychiatric profile of the morbidly obese from Indian subcontinent. We studied people with morbid obesity to estimate the psychiatric burden among them and to identify factors associated for developing psychiatric disorders., Methodology: This is a cross-sectional study done in a bariatric clinic of a tertiary care teaching hospital in South India. Sixty morbidly obese patients were evaluated by psychiatrists and data from medical records were collected and analyzed. Prevalence of psychiatric disorders was estimated. They were compared with patients without psychiatric disorders using appropriate statistical tests., Results: Nearly 33.33% of the patients had a psychiatric disorder. Depression and dysthymia accounted for about half of those cases. The variables that were associated with psychiatric disorders were current suicidal ideation, past self-injurious behavior, perceived poor social support, and past psychiatric history., Conclusion: One-third of the morbidly obese patients having psychiatric disorder is suggestive of high comorbidity. Considering this active involvement of psychiatrists in bariatric clinic would be useful., Competing Interests: There are no conflicts of interest.