-
1.
Nutrition and Exercise Interventions to Improve Body Composition for Persons with Overweight or Obesity Near Retirement Age: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
Eglseer, D, Traxler, M, Embacher, S, Reiter, L, Schoufour, JD, Weijs, PJM, Voortman, T, Boirie, Y, Cruz-Jentoft, A, Bauer, S
Advances in nutrition (Bethesda, Md.). 2023;14(3):516-538
-
-
-
Free full text
Plain language summary
Obesity is characterised by excessive fat accumulation that often occurs during the process of aging. Aging is accompanied not only by a gradual increase in body fat stores but also a decrease in muscle mass, muscle function, and water retention. The aim of this study was to assess which nutrition and exercise interventions are most effective for improving the body composition (fat mass and muscle mass), body mass index, and waist circumference in persons with overweight or obesity near retirement age (55 to 70 years of age). This study was a systematic review and network meta-analysis (NMA) of randomised controlled trials of sixty-six studies. Results of the NMA showed that the most effective strategy to improve body composition, i.e., losing fat without increasing risk of sarcopenia in persons with obesity around retirement age, was combining energy restriction with resistance training or with mixed exercise (resistance combined with aerobic exercise) and/or high-protein intake. In fact, without training, an energy-restricted diet with or without added protein helped individuals lose fat mass but also tended to result in losses of muscle mass. Authors conclude that an energy-restricted diet alone probably contributes to the development of sarcopenic obesity in persons of retirement age. Thus, to simultaneously lose weight and maintain muscle mass, authors recommend a combination of energy restriction and resistance training.
Abstract
The retirement phase is an opportunity to integrate healthy (nutrition/exercise) habits into daily life. We conducted this systematic review to assess which nutrition and exercise interventions most effectively improve body composition (fat/muscle mass), body mass index (BMI), and waist circumference (WC) in persons with obesity/overweight near retirement age (ages 55-70 y). We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials, searching 4 databases from their inception up to July 12, 2022. The NMA was based on a random effects model, pooled mean differences, standardized mean differences, their 95% confidence intervals, and correlations with multi-arm studies. Subgroup and sensitivity analyses were also conducted. Ninety-two studies were included, 66 of which with 4957 participants could be used for the NMA. Identified interventions were clustered into 12 groups: no intervention, energy restriction (i.e., 500-1000 kcal), energy restriction plus high-protein intake (1.1-1.7 g/kg/body weight), intermittent fasting, mixed exercise (aerobic and resistance), resistance training, aerobic training, high protein plus resistance training, energy restriction plus high protein plus exercise, energy restriction plus resistance training, energy restriction plus aerobic training, and energy restriction plus mixed exercise. Intervention durations ranged from 8 wk to 6 mo. Body fat was reduced with energy restriction plus any exercise or plus high-protein intake. Energy restriction alone was less effective and tended to decrease muscle mass. Muscle mass was only significantly increased with mixed exercise. All other interventions including exercise effectively preserved muscle mass. A BMI and/or WC decrease was achieved with all interventions except aerobic training/resistance training alone or resistance training plus high protein. Overall, the most effective strategy for nearly all outcomes was combining energy restriction with resistance training or mixed exercise and high protein. Health care professionals involved in the management of persons with obesity need to be aware that an energy-restricted diet alone may contribute to sarcopenic obesity in persons near retirement age. This network meta-analysis is registered at https://www.crd.york.ac.uk/prospero/ as CRD42021276465.
-
2.
Brown Adipose Crosstalk in Tissue Plasticity and Human Metabolism.
Scheele, C, Wolfrum, C
Endocrine reviews. 2020;41(1)
-
-
-
Free full text
-
Plain language summary
Brown adipose tissue (BAT) is an important contributor to the regulation of metabolism via cellular communication with organs such as liver, muscle, gut and central nervous system. BAT is important for heat generation and is at high levels in human infants. Levels of activation of BAT decline as we age and it has been shown that the amount of BAT is smaller and its activity reduced in those with obesity and type 2 diabetes. To date, there is no answer to efficiently restore functional BAT in aging and obese subjects. This review looks at experiments done on the factors secreted from active BAT (batokines). The review aims to provide a structure for the processes and cell types involved in BAT and the recent findings of BAT whole-body communication are discussed. Altogether, these findings demonstrate that BAT has an adaptive capacity. Studying batokines, offers an alternative approach to identify novel drug targets for metabolic regulation.
Abstract
Infants rely on brown adipose tissue (BAT) as a primary source of thermogenesis. In some adult humans, residuals of brown adipose tissue are adjacent to the central nervous system and acute activation increases metabolic rate. Brown adipose tissue (BAT) recruitment occurs during cold acclimation and includes secretion of factors, known as batokines, which target several different cell types within BAT, and promote adipogenesis, angiogenesis, immune cell interactions, and neurite outgrowth. All these processes seem to act in concert to promote an adapted BAT. Recent studies have also provided exciting data on whole body metabolic regulation with a broad spectrum of mechanisms involving BAT crosstalk with liver, skeletal muscle, and gut as well as the central nervous system. These widespread interactions might reflect the property of BAT of switching between an active thermogenic state where energy is highly consumed and drained from the circulation, and the passive thermoneutral state, where energy consumption is turned off. (Endocrine Reviews 41: XXX - XXX, 2020).
-
3.
Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery.
Rubino, F, Cohen, RV, Mingrone, G, le Roux, CW, Mechanick, JI, Arterburn, DE, Vidal, J, Alberti, G, Amiel, SA, Batterham, RL, et al
The lancet. Diabetes & endocrinology. 2020;8(7):640-648
-
-
-
Free full text
-
Plain language summary
Bariatric surgery has been proven for weight loss in people with severe obesity. However, during the covid-19 pandemic, surgery has been postponed for many individuals. Under normal conditions, patients who are awaiting bariatric surgery are prioritised based on weight, however this does not necessarily reflect severity of their condition. This review paper aimed to develop new criteria in order to help prioritise individuals who are awaiting bariatric surgery. The authors began by reviewing the reasons for delaying bariatric surgery and the need for beds, the risks of covid-19 transmission during the procedure and the severe covid-19 complications that individuals with obesity can experience were discussed. A recommendation was made that all patients having bariatric surgery be tested for Covid-19. Solutions were proposed for those awaiting surgery such as diets, exercise, optimal blood sugar control and the potential use of weight loss medications. Prioritisation of surgery should focus on clinical need; it should be accessible and minimise harm from delays. Individuals with obesity and type 2 diabetes should be prioritised based on those who have an increased risk of death, determined by whether the individual; has poor blood sugar control despite maximal use of medications to control it, uses insulin, has previous heart disease, has liver disease or if they have other risk factors. It was concluded that weight alone is inadequate to prioritise candidates for bariatric surgery. Disease severity should be at the centre of decisions, especially when access to surgery is reduced, as is during the Covid -19 pandemic. This paper could be used by healthcare professionals to understand how to prioritise their obese and type 2 diabetic patients who are awaiting bariatric surgery.
Abstract
The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation.
-
4.
A Scientific Perspective of Personalised Gene-Based Dietary Recommendations for Weight Management.
Drabsch, T, Holzapfel, C
Nutrients. 2019;11(3)
-
-
-
Free full text
Plain language summary
Basic recommendations of eat less, move more can have varying levels of success in weight loss depending on the individual. As a result, the focus has begun to shift to personalised nutrition based on genetics, however evidence is lacking. This review paper aimed to evaluate what evidence was available. The authors stated that the literature has no set definition for personalised nutrition but did state that it should consider social, lifestyle, genetic and metabolic factors and the microbiome. 500 genes have been recognised as associated with body morphology and although the function of most of them is still unclear, the fat mass and obesity associated (FTO) gene has the strongest effect on body weight. Individuals can carry different versions of the FTO gene, and the research has been conflicting on whether weight loss is greater depending on which version an individual carries. The regulation of food intake and the amount of fat and protein consumed may also be affected by the FTO version. The use of dietary recommendations based on genetic tests that can be bought by the general public was also reviewed and it was concluded that this science is still in its infancy. The authors concluded that personalised nutrition based on genetics is complex and further studies are warranted.
Abstract
Various studies showed that a "one size fits all" dietary recommendation for weight management is questionable. For this reason, the focus increasingly falls on personalised nutrition. Although there is no precise and uniform definition of personalised nutrition, the inclusion of genetic variants for personalised dietary recommendations is more and more favoured, whereas scientific evidence for gene-based dietary recommendations is rather limited. The purpose of this article is to provide a science-based viewpoint on gene-based personalised nutrition and weight management. Most of the studies showed no clinical evidence for gene-based personalised nutrition. The Food4Me study, e.g., investigated four different groups of personalised dietary recommendations based on dietary guidelines, and physiological, clinical, or genetic parameters, and resulted in no difference in weight loss between the levels of personalisation. Furthermore, genetic direct-to-consumer (DTC) tests are widely spread by companies. Scientific organisations clearly point out that, to date, genetic DTC tests are without scientific evidence. To date, gene-based personalised nutrition is not yet applicable for the treatment of obesity. Nevertheless, personalised dietary recommendations on the genetic landscape of a person are an innovative and promising approach for the prevention and treatment of obesity. In the future, human intervention studies are necessary to prove the clinical evidence of gene-based dietary recommendations.
-
5.
Bariatric Surgery and Precision Nutrition.
Nicoletti, CF, Cortes-Oliveira, C, Pinhel, MAS, Nonino, CB
Nutrients. 2017;9(9)
-
-
-
Free full text
Plain language summary
Bariatric surgery, including gastric bypass, is the most effective strategy to treat obesity and the associated health complications. The major goal is long-term excess body weight reduction, but weight gain after time does occur in a proportion of patients. There is a wide range of responses to bariatric surgery; the different surgical techniques and genetic background of the individual patient account for this. The interactions between nutrients and genes are complex and have not been fully elucidated. This paper summarises the main literature findings relating nutritional genomics and bariatric surgery. It also describes the importance of nutritional genomics concepts in personalized bariatric management. Points discussed are: The genetic variations associated with obesity and telemore length (a marker for cellular ageing). How bariatric surgery affects epigenetics and the expression of various genes involved in different metabolic pathways. The role of bariatric surgery on gut microbiota. The authors believe that nutritional genomics will soon enable the delivery of precise nutrition recommendations to patients undergoing bariatric surgery, to provide high-risk individuals with personalized treatment and to prevent complications.
Abstract
This review provides a literature overview of new findings relating nutritional genomics and bariatric surgery. It also describes the importance of nutritional genomics concepts in personalized bariatric management. It includes a discussion of the potential role bariatric surgery plays in altering the three pillars of nutritional genomics: nutrigenetics, nutrigenomics, and epigenetics. We present studies that show the effect of each patient's genetic and epigenetic variables on the response to surgical weight loss treatment. We include investigations that demonstrate the association of single nucleotide polymorphisms with obesity phenotypes and their influence on weight loss after bariatric surgery. We also present reports on how significant weight loss induced by bariatric surgery impacts telomere length, and we discuss studies on the existence of an epigenetic signature associated with surgery outcomes and specific gene methylation profile, which may help to predict weight loss after a surgical procedure. Finally, we show articles which evidence that bariatric surgery may affect expression of numerous genes involved in different metabolic pathways and consequently induce functional and taxonomic changes in gut microbial communities. The role nutritional genomics plays in responses to weight loss after bariatric surgery is evident. Better understanding of the molecular pathways involved in this process is necessary for successful weight management and maintenance.
-
6.
Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis.
Ma, C, Avenell, A, Bolland, M, Hudson, J, Stewart, F, Robertson, C, Sharma, P, Fraser, C, MacLennan, G
BMJ (Clinical research ed.). 2017;359:j4849
-
-
-
Free full text
-
Plain language summary
Obesity is known to increase the risk of many diseases including cardiovascular disease, various cancers and type 2 diabetes. Interestingly, there is evidence suggesting weight loss in obese adults may be harmful, particularly in older people with cardiovascular disease. The aim of this systematic review was to assess the effect of weight loss interventions for adults with obesity on mortality, cardiovascular disease, cancer and body weight. Based on the 30,000 participants identified, current evidence shows that weight loss interventions significantly decrease all cause mortality. There was also evidence to suggest weight loss is associated with developing new cardiovascular events, though fewer trials reported these outcomes so uncertainty remains around these results. Based on the current literature and this review, the authors conclude weight-reducing diets may reduce all cause mortality in adults with obesity and support public health measures to prevent weight gain and facilitate weight loss.
Abstract
Objective To assess whether weight loss interventions for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight.Design Systematic review and meta-analysis of randomised controlled trials (RCTs) using random effects, estimating risk ratios, and mean differences. Heterogeneity investigated using Cochran's Q and I2 statistics. Quality of evidence assessed by GRADE criteria.Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials, and full texts in our trials' registry for data not evident in databases. Authors were contacted for unpublished data.Eligibility criteria for selecting studies RCTs of dietary interventions targeting weight loss, with or without exercise advice or programmes, for adults with obesity and follow-up ≥1 year.Results 54 RCTs with 30 206 participants were identified. All but one trial evaluated low fat, weight reducing diets. For the primary outcome, high quality evidence showed that weight loss interventions decrease all cause mortality (34 trials, 685 events; risk ratio 0.82, 95% confidence interval 0.71 to 0.95), with six fewer deaths per 1000 participants (95% confidence interval two to 10). For other primary outcomes moderate quality evidence showed an effect on cardiovascular mortality (eight trials, 134 events; risk ratio 0.93, 95% confidence interval 0.67 to 1.31), and very low quality evidence showed an effect on cancer mortality (eight trials, 34 events; risk ratio 0.58, 95% confidence interval 0.30 to 1.11). Twenty four trials (15 176 participants) reported high quality evidence on participants developing new cardiovascular events (1043 events; risk ratio 0.93, 95% confidence interval 0.83 to 1.04). Nineteen trials (6330 participants) provided very low quality evidence on participants developing new cancers (103 events; risk ratio 0.92, 95% confidence interval 0.63 to 1.36).Conclusions Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.Systematic review registration PROSPERO CRD42016033217.
-
7.
Treatment of Obesity: Weight Loss and Bariatric Surgery.
Wolfe, BM, Kvach, E, Eckel, RH
Circulation research. 2016;118(11):1844-55
-
-
-
Free full text
-
Plain language summary
Individuals with obesity who have been unable to lose weight through non-surgical means may be candidates for bariatric surgery. Criteria was established over 20 years ago and stated that individuals with a BMI >40 and individuals with a BMI >35-40 with other related conditions who have failed to achieve weight loss medically, are appropriate for surgery. However, individuals with less severe obesity who have type 2 diabetes have now been highlighted as possible candidates also, indicating that it is an evolving process. This review of 123 papers focused on the indications, safety and reasons for bariatric surgery and its role in the reduction of heart disease. The reason for bariatric surgery is to achieve weight loss and decrease an individual’s risk of death and conditions associated with obesity. Indications for surgery were discussed and the types of surgery that are available. Safety has improved due to a number of changes such as recognition of experience of surgeons and centres, the enactment of care protocols and a switch to minimally invasive procedures. However less invasive surgeries appear to accomplish considerably less weight loss. Benefits to body fat, blood fat levels, high blood pressure, diabetes, non-alcoholic fatty liver disease, inflammation, the ability of the blood vessels to dilate and sleep apnoea were all discussed. These were all used as evidence to support the argument that surgery improves an individual’s chances of survival compared to lifestyle interventions, as sufficiently designed trials to support this have not been performed. It was concluded that bariatric surgery has greater improved heart disease and death compared to lifestyle interventions due to the significantly higher weight loss that results.
Abstract
This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD), as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health, which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by nonsurgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the comorbidities, quality of life, and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes mellitus, inflammation, obstructive sleep apnea, and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors after weight loss, it is reasonable to expect a reduction of CVD events and related mortality after weight loss in populations with obesity. The quality of the current evidence is reviewed, and future research opportunities and summaries are stated.
-
8.
Locus of control and obesity.
Neymotin, F, Nemzer, LR
Frontiers in endocrinology. 2014;5:159
-
-
-
Free full text
Plain language summary
Obesity is a multifactorial disease, which makes it a complicated issue to address. In particular psychology and a concept know as locus of control plays a huge role. Locus of control refers to an individual’s ability to acknowledge that their environment and choices are under their control. However, whether this is a cause of obesity or mutually occurring is unclear. This review of 49 papers aimed to determine the relationship between obesity and locus of control. The authors discussed that the majority of literature agrees on a correlation between locus of control and obesity, however it is not straight forward as there is no set definition for locus of control. Whether locus of control causes obesity or obesity causes locus of control was also difficult to determine, but it was stated that locus of control is difficult to change. The mechanisms behind causation were discussed and stress hormones and hormones which make you feel full or hungry were implicated. It was concluded that there is a correlation between locus of control and obesity, however which one is causal, still needs more research. This paper could be used by healthcare practitioners to understand the important role that psychology plays in the development of obesity.
Abstract
In the developed world, the hazards associated with obesity have largely outstripped the risk of starvation. Obesity remains a difficult public health issue to address, due in large part to the many disciplines involved. A full understanding requires knowledge in the fields of genetics, endocrinology, psychology, sociology, economics, and public policy - among others. In this short review, which serves as an introduction to the Frontiers in Endocrinology research topic, we address one cross-disciplinary relationship: the interaction between the hunger/satiation neural circuitry, an individual's perceived locus of control, and the risk for obesity. Mammals have evolved a complex system for modulating energy intake. Overlaid on this, in humans, there exists a wide variation in "perceived locus of control" - that is, the extent to which an individual believes to be in charge of the events that affect them. Whether one has primarily an internal or external locus of control itself affects, and is affected by, external and physiological factors and has been correlated with the risk for obesity. Thus, the path from hunger and satiation to an individual's actual behavior may often be moderated by psychological factors, included among which is locus of control.
-
9.
Patients' and professionals' experiences and perspectives of obesity in health-care settings: a synthesis of current research.
Mold, F, Forbes, A
Health expectations : an international journal of public participation in health care and health policy. 2013;16(2):119-42
-
-
-
Free full text
-
Plain language summary
Obesity is a complex condition, and likely to be the result of a range of biological, psychological, and social factors, making it one of the most difficult and challenging health problems to manage. Obesity is often stigmatised, with obese people being subject to discrimination that could affect their access to therapies or the success of such therapies. This review looked at current research examining the experiences of both obese people and health‐care professionals. The authors reviewed a total of 30 studies. From the studies that explored patient experiences and perspectives, four themes emerged: i) ambivalence of health professionals towards patients’ needs leading to a sense of personal ambivalence for obese individuals in accessing and using services; ii) experience of weight-based stigma leading to feelings of powerlessness and humiliation; iii) negative experiences with health-care professionals leading to a reluctance to access services and/or engage in positive health behaviours; and iv) experiences of stigmatisation leading to poorer psychological health and negative behaviours. The studies that explored health professionals’ experiences and perspectives found differences in how professionals view obese patients that included ambivalence, and negative attitudes and beliefs towards overweight people. One study found that overweight and obese women were less likely to undergo routine cancer screening procedures such as cervical screening and mammograms. The studies presented in this review show that obesity has a strong social effect, not only on how obese individuals view themselves, but also on how they access and interact with health‐care providers. This can impact negatively on psycho‐emotional functioning, on the uptake of health care and on the experience of care of obese people. Given the rising levels of obesity, further work is essential to improve the health‐care provision for this population.
Abstract
BACKGROUND Obesity-related stigma likely influences how obese people interact with health-care professionals and access health care. AIM: To undertake a synthesis of studies examining the views and experiences of both obese people in relation to their health-care provision and health-care professionals in providing care to obese patients. SEARCH STRATEGY A systematic search of key electronic databases relating to professional or patient experiences of, or perspectives on, obesity was performed in 2008 and updated in 2010. Reference lists of article bibliographies were searched, along with hand searches of relevant journals. INCLUSION CRITERIA Studies were screened against explicit inclusion criteria and published between 1990 and 2010. Findings were examined and organized thematically. DATA EXTRACTION Data were extracted focusing on obesity, stigma and access to health-care services. All included studies were subject to critical appraisal to assess the quality of the research. FINDINGS Thirty studies were identified. All the studies reported obesity impacting on health-care interactions. Key themes identified were experiences of stigma and feelings of powerlessness, treatment avoidance, psycho-emotional functioning, professional attitudes, confidence and training, variations in health contact time and finally, differences in treatment options and preventative measures. CONCLUSION Obesity is a stigmatized condition that impacts negatively on the relationship between patients and health-care providers. Given the increasing prevalence of obesity and the range of therapeutic options available, further work is necessary to understand how the presence of obesity affects health-care interactions and decision making.