Abstract: IntroductionWeight bias refers to negative attitudes towards individuals because of their weight. Evidenced-based strategies to successfully reduce weight bias in medical students are lacking. The purpose of this study was to investigate the impact of a multifaceted intervention on medical students’ attitudes towards patients with obesity.MethodsThird- and fourth-year medical students (n= 79), who enrolled in an eight-week graduate course focusing on the various epidemiologic, physiological and clinical aspects of obesity, including a gamification task with bariatric weight suits (BWS), were asked to complete the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale questionnaire pre- and post-course. The inclusion period was between 09/2018 and 06/2021 and covered 4 consecutive groups of students.ResultsThe overall NEW Attitude Scale scores did not change significantly pre- versus post-intervention (pre-course: 19.59, post-course 24.21, p-value = 0.24). However, the subgroup of 4th year medical students showed a significant improvement of their attitudes (pre-course: 16.4, post-course 26.16, p-value = 0.02). The Thurstone rating of 9 out of 31 individual survey items changed significantly from pre- to post-course with a moderate strength (Cramer’s V> 0.2), including 5 items showing weight bias reduction. The disagreement with the statement “Overweight/obese individuals lack willpower” increased from 37 to 68%.Discussion/Conclusion These findings suggest that in medical students with a low level of weight bias at baseline, a semester course on obesity combined with BWS use affects only a limited number of items of the NEW Attitudes scale questionnaire. The sensitization of medical students to weight stigma has the potential to improve quality of healthcare for patients with obesity.
Abstract: Introduction: Obesity is associated with an increased risk of acute kidney injury (AKI) after trauma. However, the associations between different adipose tissue depots and AKI remain unknown. Our study aims to quantify the effect of abdominal adiposity on AKI in trauma patients.Methods: We performed a retrospective cohort study of abdominal trauma patients who were admitted into our hospital from January 2010 to March 2020. Abdominal VAT (visceral adipose tissue) and SAT (subcutaneous adipose tissue) were measured at the level of the third lumbar vertebra using computed tomography. Causal modeling based on the generalized propensity score was used to quantify the effects of BMI (body mass index), VAT and SAT on AKI.Results: Among 324 abdominal trauma patients, 67 (20.68%) patients developed AKI. Patients with AKI had higher BMI (22.46 kg/m2 vs. 22.04 kg/m2, P = 0.014), higher SAT areas (89.06 cm2 vs. 83.39 cm2, P = 0.151) and VAT areas (140.02 cm2 vs. 91.48 cm2, P = 0.001) than those without AKI. By using causal modeling, we found that the risk of developing AKI increased by 8.3% (P = 0.001) and 4.8% (P = 0.022) with one unit increase in BMI (per 1 kg/m2), and ten units increase in SAT (per 10 cm2), respectively. However, VAT did not show a significant association with AKI (P = 0.327).Conclusion: SAT, but not VAT, increased the risk of AKI among abdominal trauma patients. Measurement of SAT might help to identify patients at higher risk of AKI.
Abstract: IntroductionObesity is a risk factor for both the development of and mortality from breast cancer in postmenopausal but not in premenopausal women. However, which part of the fat mass is associated with risk remains unclear, and whether the difference in the risk for breast cancer is associated with discrepancy in the distribution of fat with menstrual status requires further study.Methods A dataset from the UK Biobank, which included 245,009 female participants, and 5402 females who developed breast cancer during a mean follow-up of 6.6 years was analyzed. Body fat mass was measured according to bioelectrical impedance at baseline by trained technicians. Age- and multivariable-adjusted hazard ratios and corresponding 95% confidence intervals for associations between body fat distribution and the risk for breast cancer were estimated using Cox proportional hazards regression. Height, age, education level, ethnicity, index of multiple deprivation, alcohol intake, smoking, physical activity, fruit consumption, age at menarche, age at first birth, number of births, hormone replacement therapy, family history of breast cancer, hysterectomy, and ovariotomy were adjusted for potential confounders.ResultsFat distribution differed between pre- and postmenopausal women. After menopause, there was an increase in fat mass in different body segments (arms, legs, and trunk). After age- and multivariable-adjustment, fat mass in different segments, BMI, and waist circumference were significantly associated with the risk for breast cancer among postmenopausal but not premenopausal women.ConclusionPostmenopausal women exhibited more fat in different body segments, which are associated with increased risk for breast cancer, compared to premenopausal women. Fat mass control throughout the body may be beneficial in mitigating the risk for breast cancer and was not limited to abdominal fat alone among postmenopausal women.
Abstract: Introduction: While the genetic and environmental underpinnings of body weight and alcohol use are fairly well-known, determinants of simultaneous changes in these traits are still poorly known. We sought to quantify the environmental and genetic components underlying parallel changes in weight and alcohol consumption, and to investigate potential covariation between them. Methods: The analysis comprised 4461 adult participants (58% women) from the Finnish Twin Cohort with four measures of alcohol consumption and body mass index (BMI) over a 36-year follow-up. Trajectories of each trait were described by growth factors, defined as intercepts (i.e., baseline) and slopes (i.e., change over follow-up), using Latent Growth Curve Modeling. Growth values were used for male (190 monozygotic pairs, 293 dizygotic pairs) and female (316 monozygotic pairs, 487 dizygotic pairs) same-sex complete twin pairs in multivariate twin modeling. The variances and covariances of growth factors were then decomposed into genetic and environmental components.Results: The baseline heritabilities were similar in men (BMI: h2=79% [95% Confidence Interval: 74,83]; alcohol consumption: h2=49% [32,67]) and women (h2=77% [73,81]; h2=45% [29,61]). Heritabilities of BMI change were similar in men (h2=52% [42,61]) and women (h2=57% [50,63]), but the heritability of change in alcohol consumption was significantly higher (p=0.03) in men (h2=45% [34,54]) than in women (h2=31% [22,38]). Significant additive genetic correlations between BMI at baseline and change in alcohol consumption were observed in both men (rA =-0.17 [-0.29,-0.04]) and women (rA=-0.18 [-0.31,-0.06]). Non-shared environmental factors affecting changes in alcohol consumption and BMI were correlated in men (rE=0.18 [0.06,0.30]). Among women, non-shared environmental factors affecting baseline alcohol consumption and the change in BMI were inversely correlated (rE=-0.11 [-0.20, -0.01]). Conclusions: Based on genetic correlations, genetic variation underlying BMI may affect change in alcohol consumption. Independent of genetic effects, change in BMI correlates with change in alcohol consumption in men, suggesting direct effects between them.
Abstract: Introduction: The public restrictions taken during the COVID-19 pandemic have substantially affected lifestyle and health behavior of children and adolescents. In Germany, little is known how these changes influenced daily life in families with children and adolescents. Methods: A cross-sectional survey was performed in April/May 2022 across Germany, similar to a survey performed in 2020. Parents (N=1,004, 20-65 years) with at least one child aged 3-17 years filled in an online questionnaire released by the Forsa Institute for Social Research and Statistical Analysis. Fifteen questions related to eating habits, dietary patterns, physical activity, media consumption, fitness, mental health, and body weight were included, and standard socioeconomic parameters were assessed. Results: Analysis of the parents’ answers indicated that there was a parental self-reported weight gain in every sixth child since the beginning of the COVID-19 pandemic. This was most obvious in children from families with lower household income and preexisting overweight. Parents also reported that lifestyle patterns had worsened: 70% reported an increase of media consumption during leisure time, 44% a decrease in daily physical activity as well as 16% the worsening of dietary habits (e.g. 27% stated to eat more cake and sweets). Children aged 10-12 years were most severely affected.Conclusion: Negative health effects related to the COVID-19 pandemic are predominantly observed in children 10-12 years of age and in children from families with low household income suggesting a worsening social disparity. Political action is urgently needed to tackle the adverse consequences of the COVID-19 pandemic on childhood lifestyle and health.
Abstract: Introduction Severe obesity often present with nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnea (OSA). Emerging researches suggest OSA plays an important role in NAFLD development and progression while the relationship between OSA and NAFLD is still conflicting . The interaction of OSA and NAFLD should be further evaluated as obesity surges. The purpose of this study was to assess the prevalence of OSA and NAFLD in patients with obesity undergoing bariatric surgery, and evaluate the association between OSA and severity of NAFLD.Methods 141 patients with severe obesity undergoing preoperative polysomnography and intraoperative liver biopsy during bariatric surgery was investigated. Clinical, anthropometric variables, liver enzymes, fasting blood glucose, fasting serum insulin, and homeostasis model assessment (HOMA-IR) were measured. The severity of NAFLD was assessed by degree of steatosis, ballooning, intralobular inflammation and NAFLD activity score (NAS). The diagnosis and severity assessment of OSA was based on an apnea/hypopnea index (AHI).Results OSA was diagnosed in 127 (90.07%), NAFLD in 124 (87.94%), and non-alcoholic steatohepatitis (NASH) in 72 (51.06%) patients. There was a statistically difference in body mass index (BMI), waist circumstance, neck circumstance, high-density lipoprotein-cholesterol (HDL), fasting insulin, and HOMA-IR among the three groups divided by the severity of AHI. In addition, the distribution of hepatic steatosis grades among the three groups was statistically different (P=0.025). AHI was significantly associated with HOMA-IR and hepatic steatosis when assessing the association between OSA parameters and liver histology in NAFLD(P< 0.05). Patients with steatosis of grade 1-3 had significantly elevated aspartate aminotransferase(AST), alanine aminotransferase(ALT), gamma glutamyl transferase (GGT),triglycerides (TG), fasting insulin, fasting glucose, HOMA-IR, and AHI compared with the patients with steatosis of grade 0. In a multivariable logistic analysis, the positive association between AHI and hepatic steatosis attenuated after adjusting for HOMA-IR.Conclusion Prevalence of OSA and NAFLD was high in patients with obesity eligible for bariatric procedures. HOMA-IR, but not AHI, was an independent risk factor for hepatic steatosis in this population.
Abstract: Introduction: The current longitudinal study aimed to investigate the association of three stable obesity phenotypes (persistent metabolically healthy normal weight (P MHNW), persistent metabolically healthy obese (P MHO), persistent metabolically unhealthy obese (P MUO)), and one transient (MHO to MUO) obesity phenotype with health-related quality of life (HRQoL) throughout an 18-year period. Methods: 1932 participants (649 men and 1283 women) who completed the HRQoL questionnaire during 2016-2019 were recruited in the current investigation. Based on the body mass index (BMI) and metabolic status, participants were classified into four obesity phenotypes, including 1) P MHNW, 2) P MHO, 3) P MUO, and 4) Transient from MHO to MUO. The HRQoL was compared between groups using analysis of covariance. Participants' age, marital status, occupation status, education level, physical activity, and smoking were adjusted. Results: After adjustment for confounder variables, a significant difference among obesity phenotypes was indicated in PCS scores of both sexes and MCS scores just in women (P value= PubDate: Thu, 09 Feb 2023 09:07:56 +010
Abstract: Introduction Children and adolescents with overweight and obesity have an impaired health-related quality of life (HRQoL). However, it is unclear which of these children are most affected in their physical, psychological and social functioning. Therefore, this study aimed to evaluate HRQoL in treatment-seeking children and adolescents with overweight, obesity and severe obesity. MethodsA cross-sectional study was performed at the Centre for Overweight Adolescent and Children’s Healthcare (COACH). Children and adolescents (8-17 years) with overweight, obesity and severe obesity were included. The primary outcome was the self-reported HRQoL measured with the KIDSCREEN-27.ResultsA total of 419 participants with overweight (N=121), obesity (N=182) and severe obesity (N=116) were included. One way ANOVA analysis showed that children and adolescents with severe obesity reported significantly lower physical wellbeing (41.25±13.14) compared to those with overweight (47.91±12.53; p PubDate: Thu, 09 Feb 2023 08:58:05 +010
Abstract: Introduction: Laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients often result in remission of type 2 diabetes (T2DM), but diabetes relapses in some of those patients. The frequency of T2DM relapse in Asians and the factors involved have not been adequately investigated. Methods: The J-SMART study was conducted on 322 Japanese subjects with body mass index (BMI) ≥ 32 kg/m2 who underwent LSG at 10 accredited centers in Japan between 2011 and 2014. Of these, 82 T2DM subjects with diabetes in complete or partial remission at 1 year after LSG and followed postoperatively for 5 years were included in the subgroup analysis, and classified into two groups: diabetes remission maintained and diabetes relapse. Results: The mean age of all included subjects was 49.2 years, median BMI was 41.5 kg/m2, and median was HbA1c 6.7%. Compared with the diabetes remission maintained group, the diabetes relapse group at 5 years after LSG had significantly higher preoperative HbA1c, number of antidiabetic medications, and high-density lipoprotein cholesterol level; and lower BMI and homeostasis model assessment-beta cell function (HOMA-β). As many as 83.0% of the subjects were able to achieve HbA1c < 7% at 5 years after LSG, but 26.8% of the subjects had diabetes relapse. Preoperative HbA1c significantly contributed to diabetes relapse (odds ratio 1.54, p = 0.049). In addition, the diabetes relapse group tended to have lower percent total weight loss (%TWL) at 1 year after LSG and higher percent weight regain (%WR) from postoperative nadir weight, compared with the diabetes remission maintained group. The hazard ratio for diabetes relapse was 3.14-fold higher in subjects with %TWL ≥ 20% and %WR ≥ 25%, and 5.46-fold higher in those with %TWL < 20% and %WR ≥ 25%, compared with %TWL ≥ 20% and %WR < 25%. Conclusion: While LSG provides a high remission rate for T2DM, relapse is not uncommon. Preoperative HbA1c, poor weight loss and excess weight regain after LSG contribute to diabetes relapse, suggesting the importance of treatment strategies focusing on these factors.
Abstract: Introduction: Proper diagnosis of obesity and effective treatment requires an interdisciplinary healthcare approach. Nevertheless, obesity remains under-identified and under-treated. Academic knowledge concerning obesity pathology, diagnosis, and treatment is advancing, it is not clear whether this translates into clinical practice. The goal of the study was to assess the knowledge of Healthcare Professionals (HCPs) on obesity, and particularly on the criteria for diagnosis as well as for conservative and surgical treatment.Methods: This cross-sectional study was conducted among active HCPs (N = 184), including physicians, nurses, physiotherapists, and paramedics who had contact with adult patients with obesity. The proprietary research survey, implemented in an online tool, was used to assess knowledge on the diagnosis and treatment of obesity and self-assessment of that knowledge. The analysis was limited to the following: body mass index (BMI) definition, BMI values, visceral obesity definition, bariatric surgery indications, choice of treatment method, role of diet and physical activity, knowledge of obesity pharmacotherapy, length of obesity pharmacotherapy, financing of bariatric procedures, and goals of bariatric treatment. The correct answers were determined according to the Polish guidelines.Results: Half of the respondents (52.2%) were doctors, 20.7% were nurses, 19.0% were physiotherapists, and 8.2% were other medical professionals. Among questions related to knowledge on obesity, 67.1% of respondents provided correct answers, with respondents answering questions concerning obesity diagnosis correctly more frequently (70.1%) than those concerning methods of treatment (64.6%). The largest number of correct answers were related to the definition of BMI and normal BMI values. The smallest number of correct answers pertained to the diagnostic criteria for visceral obesity and pharmacological treatment of obesity. There were no statistically significant impact of a responder's knowledge levels on the obesity of different HCPs. Workplace and participation in training sessions were found to have the largest impact on the level of knowledge on obesity. HCPs own assessment of their knowledge on obesity was negatively correlated with their actual level of knowledge.Conclusion: The prevalence of overweight and obesity implies that essentially every HCP has daily contact with patients with excessive body weight. Our research showed that 32.9% of HCPs did not have sufficient knowledge about how to diagnose and treat obesity.
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