ArticleLiterature Review

Obesity as a Disease

October 2017
Medical Clinics of North America 102(1)

DOI:10.1016/j.mcna.2017.08.004

Authors:

Jagriti Upadhyay

Beth Israel Deaconess Medical Center

Olivia Farr

Harvard Medical School/Beth Israel Deaconess Medical Center

Nikolaos Perakakis

Beth Israel Deaconess Medical Center

Wael Ghaly

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Obesity is a complex disease with many causal factors, associated with multiple comorbidities that contribute to significant morbidity and mortality. It is a highly prevalent disease that poses an enormous health and economic burden to society. This article reviews the mechanisms of obesity and its related comorbidities.

Sedentary work and expanding waistlines: a cross-sectional study on occupational roles and abdominal obesity in India

Article

Full-text available

Feb 2025
BMC PUBLIC HEALTH

Background Low- and middle-income countries are undergoing epidemiological and demographic transitions alongside economic growth, contributing to a rise in abdominal obesity. In India, the increase in sedentary occupations and insufficient physical activity are key drivers of this growing health concern. This study investigates the relationship between occupational types and abdominal obesity markers in well-characterised adults, accounting for a wide range of confounders. Methods Using a nationally representative sample of 99,653 women and 91,990 men, occupations were categorised into sedentary work (SW), non-sedentary work (NSW), and not working (NW). Two outcomes were assessed: abdominal obesity, measured via waist-to-hip ratio (WHR) using WHO cutoffs, and a higher-risk threshold of WHR ≥ 1. Bivariate analyses and multivariable logistic regression, adjusted for socioeconomic and demographic factors, were conducted to evaluate the risk of abdominal obesity by occupation type. Results Among women, abdominal obesity prevalence based on WHO criteria was 56% (95% CI: 55.60–56.46), highest in NW (57.3%; 95% CI: 56.80–57.83), followed by SW (57.1%; 95% CI: 55.39–58.78) and NSW (51.5%; 95% CI: 50.63–52.43). Among men, prevalence was 48.9% (95% CI: 48.31–49.46), highest in SW (57.8%; 95% CI: 56.51–59.14), followed by NSW (49.9%; 95% CI: 49.15–50.63) and NW (37.3%; 95% CI: 36.14–38.43). Adjusted odds of abdominal obesity were significantly higher for SW compared to NSW (women: aOR 1.08, 95% CI: 1.02–1.14; men: aOR 1.20, 95% CI: 1.16–1.25). Conclusions High prevalence of abdominal obesity among both men and women implies an emerging health risk in India. The findings that contributed to associations between sedentary occupation and abdominal obesity may inform occupation-related health risks and development of interventions to limit daily sitting at work place which may reduce metabolic disease risk.

Clinical Impact of Obesity on Postoperative Outcomes of Patients With Thyroid Cancer Undergoing Thyroidectomy: A 5‐Year Retrospective Analysis From the US National Inpatient Sample

Article

Full-text available

Oct 2024

Background The clinical impact of obesity on postoperative outcomes of patients undergoing thyroidectomy remains controversial. Methods Patients aged ≥ 18 years who were diagnosed with thyroid malignancy and underwent thyroidectomy between 2016 and 2020 were included, and divided into two groups: patients with body mass index (BMI) < 30 kg/m² and those with BMI ≥ 30 kg/m². Patients in the obese group were then subdivided into four groups: Group 1 (BMI 30.0–34.9 kg/m²), Group 2 (BMI 35.0–39.9 kg/m²), Group 3 (BMI 40.0–44.9 kg/m²), and Group 4 (BMI ≥ 45.0 kg/m²) to evaluate the association between degree of obesity and clinical outcomes. We performed propensity score matching, compared outcome variables between the groups, and conducted adjusted multivariate logistic regression analyses of postoperative outcomes. Results A total of 6778 patients diagnosed with thyroid cancer who underwent thyroidectomy were screened, of whom 1299 (19.2%) patients were obese. Patients in the obese group had higher total hospital charges (p < 0.001) and an increased risk of overall postoperative complications (34.7% vs. 30.5%, p = 0.023). Specifically, patients in the obese group had increased odds of respiratory complication (adjusted odds ratio (aOR) 1.66, 95% confidence interval (CI) [1.26–2.19]), acute renal failure (aOR 1.87, 95% CI [1.13–3.09]), and wound complication (aOR 2.77, 95% CI [1.21–6.37]) than those in the non‐obese group. Moreover, trend tests showed that the risks of unfavorable discharge, infection, acute renal failure, and respiratory complication all exhibited an upward trend with increased BMI. Conclusion Obesity is associated with an increased risk of postoperative complications in patients with thyroid cancer undergoing thyroidectomy. This finding suggests that obese patients should be treated with more caution during postoperative recovery.

The Role of Stress in Obesity and Relevant Interventions

Article

Full-text available

Sep 2024

Menglin Guan

The prevalence of obesity is on the rise, which significantly increases the burden on global healthcare expenditures and profoundly impacting both physical and mental health. It has become a major public health challenge that urgently needs to be addressed in todays society. Obesity is influenced by multiple factors, including stress, genetics, hormones, and neuroendocrine elements, with lifestyle and epigenetic changes also playing significant roles. Stress impacts various physiological systems, including the brain, memory, cognition, immune response, cardiovascular health, and endocrine function. It can also trigger obesity by affecting appetite regulation, reward sensitivity, and hormonal balance. Understanding the relationship between stress and obesity is crucial for developing effective interventions. Recent research highlights that stress significantly affects eating behaviors, leading to weight gain, while obesity can exacerbate stress and disrupt life balance. Effective interventions include mindfulness training, which improves self-awareness, positive emotions, and psychological flexibility, and reduces stress, anxiety, and depression. Stress management programs and physical activity are also beneficial for weight loss and overall health. However, the limitations of small sample sizes, short intervention periods, limited participant diversity, and reliance on self-reported measures may undermine the generalizability and accuracy of the findings of previous research. Future research should focus on larger, diverse samples, long-term studies, and incorporate both objective measures of stress and self-reported data to better understand and manage obesity and stress.

Current knowledge and scientific trends in myokines and exercise research in the context of obesity

Article

Full-text available

Sep 2024

The relationship between exercise and obesity has attracted increasing attention from researchers worldwide in recent years. The aim of the present study was to analyze the current knowledge and scientific trends of research into myokines and exercise in the context of obesity and provide ideas for future research strategies to prevent obesity. The study conducted a comprehensive bibliometric analysis of 300 scientific publications related to myokines, exercise, and obesity from 2004 to 2024. Applying the VOSviewer tool, the analysis revealed a significant increase over time in the number of publications on these topics, with a total of 1,142 related keywords identified. Key themes identified in the analysis included molecular processes, new organokines, skeletal muscle research, model organism studies, and human studies based on sex and age differences. The study highlighted the growing interest in the molecular mechanisms of obesity and role of myokines. Results showed a substantial increase in publications from 2014 to 2024, with a focus on new organokines (myokines, adipokines) and animal models. The analysis underscored the importance of myokines in modulating metabolic processes and their potential therapeutic implications in managing non-communicable diseases such as obesity. Furthermore, the study revealed the close relationship between exercise, myokine production, and regulation of metabolism, stress response, and inflammation. In conclusion, over the last years, increasing research interest has been focused on the molecular mechanisms of obesity and benefits of exercise, and probably will be focused on a set of myokines released during muscle contraction. A newly identified myokines has emerged as a promising marker for the prevention and control of obesity.

Triglyceride/high-density cholesterol ratio as a predictor of cardiometabolic risk in young population

Article

Full-text available

Jul 2024

Cardiovascular disease remains a leading cause of morbidity and mortality worldwide. Understanding and detecting risk factors are crucial for early diagnosis and prevention strategies. Obesity, dyslipidemia, hypertension, and insulin resistance, among others, have been described as modifiable risk factors. Among these, the triglycerides-to-HDL cholesterol (TG/HDL) ratio has been described as a marker of insulin resistance and a predictor of cardiovascular disease. Our objective was to investigate the association between the TG/HDL ratio and various cardiometabolic risk factors. A total of 239 young adults aged 18-24 years were recruited. We assessed anthropometric measurements, lipid profiles, glucose levels, insulin, the HOMA index, and the TG/HDL ratio. Participants were stratified based on their BMI and TG/HDL ratio. Our findings revealed that individuals with an elevated TG/HDL ratio had higher blood pressure, BMI, waist circumference, cholesterol, and triglyceride levels compared to those with a normal ratio. Specifically, the TG/HDL ratio was associated with an odds ratio (OR) of 9.3 for overweight, 27.5 for obesity, and 4.41 for abdominal obesity. Additionally, the HOMA index, which measures insulin resistance, was higher in those with an elevated TG/HDL ratio, with a prevalence of 45.6%. In conclusion, the TG/HDL ratio is a predictive marker of insulin resistance in young individuals and is associated with modifiable risk factors for cardiometabolic disease.

The Effect of Administering Kelor Flower (Moringa Oleifera) Extract on Reducing Cholesterol Levels and Histopathological Features of The Testis of White Rats (Rattus norvegicus) Male Wistar Strain Obesity

Article

Full-text available

Feb 2024

Obesity and high cholesterol levels have garnered clinical attention for male infertility. The numerous compounds in Kelor flowers or Moringa make it a potential cholesterol medication. The research data were analyzed using SPSS, and the study was conducted as a true experiment using test animal samples of twenty-four male Wistar rats (Rattus norvegicus). The purpose of this study was to examine the histopathological features of obese male Wistar rats (Rattus norvegicus) and to determine whether or not the administration of Kelor flower extract (Moringa ternatea) reduced cholesterol levels and improved testicular function. Obese white Wistar rats had their total cholesterol levels decreased by 400 mg/kgBW and 600 mg/kgBW of Kelor flower extract, respectively, according to the study's results. The group that received 600 mg/kgBW of Kelor flower extract showed the most improvement and was the most similar to the control group in testicular histopathology studies. The substances found in Kelor or Moringa flowers have been found to improve testicular function and lower total cholesterol levels in people who suffer from obesity, according to the research.

Application of Health Belief Model on Obesity Prevention Behavior in Adolescents

Article

Full-text available

Jul 2024

Background: Adolescent obesity is a global challenge with serious health impacts. This study aimed to explore the application of the Health Belief Model (HBM) in the context of preventing obesity in adolescents. Subjects and Method: This research uses an observational analytical design with a cross sectional approach. The population consists of teenagers aged 15-19 years in the city of Surakarta, with a sample of 200 teenagers chosen randomly. The dependent variable is obesity prevention behavior. The independent variable is the HBM construct (perceived vulnerability, perceived seriousness, perceived benefits, perceived barriers, cues to action, and self-efficacy). Data was collected using a questionnaire, and analyzed using multiple linear regression. Results: There is a positive and statistically significant relationship between perceived vulnerability (b= 0.08; 95% CI= 0.03 to 0.13; p = 0.004), perceived seriousness (b= 0.37; 95% CI= 0.29 to 0.46; p<0.001), perceived benefits (b= 0.22; 95% CI= 0.14 to 0.29; p<0.001), cues to action (b= 0.15; 95% CI= 0.05 to 0.25; p= 0.005) and self-efficacy (b= 0.05; 95% CI = 0.01 to 0.10; p= 0.027) on obesity prevention behavior. Adjusted R-squared= 72.15%. This means that the HBM construct includes perceptions of vulnerability, perceptions of severity, perceptions of benefits, cues to action, and self-efficacy, together they are able to explain variations in obesity preventive behavior in adolescents by 72.15%. Conclusion: The results of this study indicate that the Health Belief Model construct includes perceptions of vulnerability, perceptions of seriousness, perceptions of benefits, cues to action, and self-efficacy, which play a role together in shaping obesity prevention behavior in adolescents.

Emerging Pharmacotherapies for Obesity: A Systematic Review

Article

Full-text available

Sep 2024

The history of anti-obesity pharmacotherapies is marked by disappointments, often entangled with societal pressure promoting weight loss and the conviction that excess body weight signifies a lack of willpower. However, categories of emerging pharmacotherapies generate hope to reduce obesity rates. This systematic review of phase 2 and phase 3 trials in adults with overweight/obesity investigates the effect of novel weight loss pharmacotherapies, compared to placebo/control or Food and Drug Administration-approved weight loss medication, through searching Medline, Embase, and ClinicalTrials.gov (2012-2024). We identified 53 phase 3 and phase 2 trials, with 36 emerging anti-obesity drugs or combinations thereof and four withdrawn or terminated trials. Oral semaglutide 50 mg is the only medication that has completed a phase 3 trial. There are 14 ongoing phase 3 trials on glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) (ecnoglutide, orforglipron, TG103), GLP-1 RA/amylin agonist (CagriSema), GLP-1/glucagon RAs (mazdutide, survodutide), GLP-1/glucose-dependent insulinotropic polypeptide and glucagon RA (retatrutide), dapagliflozin, and the combination sibutramine/topiramate. Completed phase 2 trials on incretin-based therapies showed a mean percent weight loss of 7.4-24.2%. Almost half of the drugs undergoing phase 2 trials were incretin analogs. The obesity drug pipeline is expanding rapidly, with the most promising results reported with incretin analogs. Data on mortality and obesity-related complications, such as cardio-renal-metabolic events, are needed. Moreover, long-term follow-up data on the safety and efficacy of weight maintenance with novel obesity pharmacotherapies, along with studies focused on under-represented populations, cost-effectiveness assessments, and drug availability, are needed to bridge the care gap for patients with obesity. Significance Statement Obesity is the epidemic of the 21st century. Except for the newer injectable medications, drugs with suboptimal efficacy have been available in the clinician's armamentarium. However, emerging alternatives of novel agents and combinations populate the obesity therapeutic pipeline. This systematic review identifies the state and mechanism of action of emerging pharmacotherapies undergoing or having completed phase 2 and phase 3 clinical trials. The information provided herein furthers the understanding of obesity management, implying direct clinical implications and stimulating research initiatives.

Correlation of Working Style to Stress, Coping Mechanism and Metabolic Syndrome Risk in Sedentary Workers

Article

Full-text available

Apr 2025

Introduction: Emotional eating, as a method of stress coping mechanism in workers, makes a person tend to consume more energy daily. Uncontrolled daily intake will lead to a high probability of a person developing metabolic syndrome in the future. The aim of this study is to analyze the relationship between working style to stress, coping mechanisms, and metabolic syndrome risk in sedentary workers. Method: This research is a cross-sectional study conducted at Kalla Group. Measurement of blood biochemistry (total cholesterol, blood glucose and uric acid) used FORA 6 Plus, blood pressure was measured using Omron digital sphygmomanometer 7130, waist circumference using Seca 201 measuring tape, and height using GEA microtoise. Measurements of body composition used Omron Karada Scan Hbf 375 Body Fat Composition Monitor Bioimpedance Analyzer. Stress was measured using Kessler Psychological Distress Scale K10 instrument. Coping mechanism was measured using Carver’s COPE Inventory. Result: Significant correlations were found for cholesterol levels (p = 0.044), waist circumference (p = 0.036), blood pressure (p = 0.042), and muscular percentage (p = 0.032). No significant correlations were found between working style for stress level (p = 0.683), coping mechanisms (p = 0.744), blood glucose (p = 0.128), uric acid (p = 0.380), visceral fat percentage (p = 0.128), and fat mass (p = 0.547). Conclusion: Significant correlations were found between working style for cholesterol levels, waist circumference, blood pressure, and muscular percentage, suggesting that different working styles may influence these health aspects.

Broader Validation of New Zealand Eating Behavior Questionnaire as Clinical Assessment Tool to Identify Actionable Eating Behavior Traits

Article

Full-text available

Mar 2025

Background/Objectives: The New Zealand Eating Behavior Questionnaire (NZ-EBQ) is a validated questionnaire that comprises three distinct scales that measure satiation at mealtimes, satiety in the post-eating period, and emotional eating behavior. This study evaluated the model validity of the NZ-EBQ across two additional samples of demographically diverse participants using confirmatory factor analysis. Methods: We compared the classification of the eating behavior (EB) type with that of the initial cohort used to develop the three-factor model. Two cohorts of 81 and 214 participants provided complete data sets for analysis. Cohort 1 was characterized by the use of more weight management medications, and participants in Cohort 2 were significantly heavier. Confirmatory factor analysis was performed using combined data from both cohorts to maximize the sample size. Results: Except for one item, all items demonstrated a factor loading consistent with the established three-factor model. After removing one item from the emotional eating scale, the model fit statistics did not change significantly. Participants were assigned to one of the three EB types based on their highest median score, and most could be classified into one of the three EB types, with only a few who could not be classified (Cohort 1:12.3%; Cohort 2:13.0%). The test-retest reliability performed in a subset of participants was comparable to that of the initial validation cohort. A significant positive correlation was found between BMI and the individual EB scores. Conclusions: The NZ-EBQ may serve as a screening tool for identifying actionable EB traits that help select targeted interventions based on EB, supporting precision medicine-based approaches.

Assessment of six insulin resistance surrogate indexes for predicting stroke incidence in Chinese middle-aged and elderly populations with abnormal glucose metabolism: a nationwide prospective cohort study

Article

Full-text available

Feb 2025
CARDIOVASC DIABETOL

Background Estimate glucose disposal rate (eGDR), Chinese visceral adiposity index (CVAI), triglyceride-glucose (TyG), TyG-body mass index (TyG-BMI), metabolic score for insulin resistance (METS-IR), and atherogenic index of plasma (AIP) are considered surrogate indexes of insulin resistance (IR). There is a lack of studies comparing the predictive values of different IR surrogate indexes for stroke risk among individuals with abnormal glucose metabolism. This study aimed to investigate the relationships between six IR surrogate indexes and stroke risk in individuals with abnormal glucose metabolism, evaluate their predictive abilities for stroke risk. Methods Data from the China Health and Retirement Longitudinal Study (CHARLS) were analysed in this study. Multivariate logistic regression models were applied to analyse the relationships of IR surrogate indexes with stroke risk. The dose-response relationships between IR surrogate indexes and stroke risk were explored using restricted cubic splines. The areas under the curve (AUCs) of IR surrogate indexes were calculated by receiver operating characteristic (ROC) analysis. Results After adjusting for potential confounders, we observed that each standard deviation (SD) increase in eGDR was associated with a reduced risk of stroke, with an adjusted odds ratio (OR) of 0.746 [95% confidence interval (CI): 0.661–0.842]. In contrast, each SD increase in CVAI, TyG, TyG-BMI, METS-IR, and AIP were associated with an increased risk of stroke, with adjusted ORs (95% CIs) of 1.232 (1.106–1.373), 1.246 (1.050–1.479), 1.186 (1.022–1.376), 1.222 (1.069–1.396), and 1.193 (1.050–1.355), respectively. Dose-response analyses showed that eGDR, CVAI, TyG-BMI and METS-IR were linearly associated with stroke risk (Pnonlinear ≥ 0.05), whereas TyG and AIP were nonlinearly associated with stroke risk (Pnonlinear < 0.05). According to ROC analysis, The AUC of eGDR for predicting stroke risk in the overall population with abnormal glucose metabolism (AUC: 0.612, 95% CI: 0.584–0.640) was significantly higher than that of other indexes. Conclusion The six IR surrogate indexes were closely associated with high risk of stroke in individuals with abnormal glucose metabolism. The eGDR showed promising potential in predicting stroke risk in Chinese middle-aged and elderly populations with abnormal glucose metabolism.

Cost to develop persuasion in health behavior change support systems: A weight management app scenario ⋆

Conference Paper

Full-text available

Jan 2025

Health Behavior Change Support Systems (HBCSS) have garnered popularity due to their intentional design to influence lifestyles and foster lasting behavioral changes. The Persuasive Systems Design (PSD) model highlights the capacity of persuasive software features to enhance the systems' ability to influence people's behavior, which holds significant promise, for instance, in reducing the prevalence of non-communicable diseases. In the medical field, HBCSS have been recognized as efficient, cost-effective, and scalable with minimal costs compared to traditional face-to-face interventions for preventing such diseases. However, every new technology comes with significant development and maintenance costs, which can either facilitate or hinder its wider adoption. The development cost may even be neglected altogether. Even if the cost was addressed somehow, evaluation methods often focus on the overall cost rather than carefully addressing the development cost of specific software functionalities and features. It is critical to make well-informed design choices rather than develop all the features that come into the designers' minds. This study conducted semi-structured expert interviews and applied the Weight Sum Model (WSM) to investigate the perceived cost implications for developing persuasive features in a weight management app. The results highlight that social and primary support features may require more financial resources to be developed than dialogue and credibility support features. Personalization and tailoring were perceived as the most expensive features due to their complex development nature. Furthermore, the results provide insights for developing HBCSS and cost-saving strategies that are important for healthcare providers, policymakers, and stakeholders in making informed decisions.

Optimizing Machine Learning Classifiers and Feature Selection Techniques for Obesity Levels Estimation Using Physical Habits and Dietary Data

Article

Full-text available

Dec 2024

According to the World Health Organization, obesity is defined as a BMI exceeding 30 which is considered a global epidemic with significant public health risks linked to severe acute conditions such as diabetes, cardiovascular diseases, and cancers. Traditional diagnostic tools such as BMI calculator often fails to consider important factors such as physical activities, dietary habits, and genetic predispositions. This paper adopts machine learning (ML) approach to improve the prediction of obesity with the utilization of dataset from Mexico, Peru, and Colombia, incorporating critical characteristics such as lifestyle, physical conditions, and eating habits. The proposed methodology incorporates efficient pre-processing such as SMOTE to address data imbalance, while feature scaling is applied to handle data normalization, and finally, feature selection methods such as Boruta, Recursive Feature Elimination, and LASSO are optimized to achieve enhanced performance. This study optimized eight different machine learning classifiers such as K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Bagging, Stacking, and Voting, Logistic Regression (LR), Decision Trees (DT), and AdaBoost using GridSearchCV to fine-tune the hyperparameters. These models are evaluated across different evaluation metrics such as accuracy, recall, precision, ROC-AUC, and F1-score. The results obtained show that LR and Bagging constantly outperformed the other classifiers, achieving 93.97% and 93.13% accuracy respectively when feature selection was not utilized, whereas stacking ensemble classifier demonstrates high efficiency with optimized feature selection. Conversely, AdaBoost underperforms across all metrics, due to its sensitivity to dataset characteristics and feature reduction methods. This paper highlights the necessity of optimizing feature selection in improving the overall performance of the ML models, as reported by the results obtained with Boruta, RFE, and LASSO. In conclusion, this paper ascertains the capability of machine learning in promoting obesity level prediction by incorporating several data characteristics and feature selection optimization. This paper contributes meaningful insights into the adoption of ML models to mitigate the increasing obesity related health challenges, offering an alternative for more accurate and efficient health interventions.

Absence of MCJ/DnaJC15 promotes brown adipose tissue thermogenesis

Article

Full-text available

Jan 2025

Obesity poses a global health challenge, demanding a deeper understanding of adipose tissue (AT) and its mitochondria. This study describes the role of the mitochondrial protein Methylation-controlled J protein (MCJ/DnaJC15) in orchestrating brown adipose tissue (BAT) thermogenesis. Here we show how MCJ expression decreases during obesity, as evident in human and mouse adipose tissue samples. MCJKO mice, even without UCP1, a fundamental thermogenic protein, exhibit elevated BAT thermogenesis. Electron microscopy unveils changes in mitochondrial morphology resembling BAT activation. Proteomic analysis confirms these findings and suggests involvement of the eIF2α mediated stress response. The pivotal role of eIF2α is scrutinized by in vivo CRISPR deletion of eIF2α in MCJKO mice, abrogating thermogenesis. These findings uncover the importance of MCJ as a regulator of BAT thermogenesis, presenting it as a promising target for obesity therapy.

A novel human specific lncRNA MEK6-AS1 regulates adipogenesis and fatty acid biosynthesis by stabilizing MEK6 mRNA

Article

Full-text available

Jan 2025
J BIOMED SCI

Background Obesity is becoming one of the major non-communicable diseases with increasing incidence and risks that cannot be ignored. However effective and safe clinical treatment strategies still need to be deeply explored. Increased number and volume of adipocytes lead to overweight and obesity. The aim of our work is to identify lncRNAs that have important regulatory in differentiation of human mesenchymal stem cells (MSCs) into adipocytes, and to provide effective targets for clinical prevention and treatment of obesity and related metabolic disorders. Methods We extracted primary MSCs from human adipose tissue, and conducted expression profile analysis of lncRNAs during adipogenic differentiation of MSCs to screen changed lncRNAs. Characteristics of lncRNA were revealed mainly by RACE and RNA FISH. Loss- and gain-of function experiments in vivo and in vitro were used to analyze effects of lncRNA. Targeted metabolomics was utilized to detect levels of free fatty acids. RNA pull-down, mRNA stability tests, etc. were employed to explore mechanisms of lncRNA. Results Human-specific lncRNA, we named it MEK6-AS1, was the most up-regulated transcript during adipogenic differentiation of MSCs. MEK6-AS1 was highly expressed in adipose tissue samples from individuals with BMI ≥ 25 and positively correlated with adipogenic marker genes in these samples. Knocking down lncRNA inhibited expression of adipogenic differentiation markers and ectopic adipogenesis, reducing contents of various free fatty acids, as well as promoting osteogenic differentiation. Overexpression of lncRNA had the opposite effects to the above processes. We also found that MEK6-AS1 was elevated during hepatic steatosis organoid generation. Mechanistically, MEK6-AS1 worked partially through stabilization of MEK6 mRNA by NAT10. Conclusions We have identified a human-specific lncRNA (MEK6-AS1) with position information in the genomic database but has not been extensively reported. We demonstrated that MEK6-AS1 as a novel lncRNA involved in adipogenic differentiation and adipogenesis, fatty acid metabolism, and osteogenic differentiation. We found that MEK6-AS1 may exert its effect by enhancing MEK6 mRNA stability through NAT10. Our study may provide insights into implication of lncRNAs in stem cell biology and offer a new potential therapeutic target for the prevention and treatment of obesity and other related disease.

Obesity: Global Epidemiology, Trends, Risk Factors, and Clinical Aspects

Article

Full-text available

Dec 2024

Objectives: To review the current literature on obesity risk factors, epidemiology, and trends, providing insights for effective prevention and intervention strategies. Design: Review article. Setting(s): Global. Outcome Measures: A systematic search was performed using MEDLINE (via PubMed), Scopus, Web of Science, and Google Scholar up to January 2024. Studies on obesity’s history, epidemiology, risk factors, health impacts, and preventive or therapeutic approaches were included. Both primary and secondary studies were considered, excluding those in languages other than English, in vitro studies, and animal studies. No restrictions were applied regarding publication date or article type. Results: The overweight- and obesity-attributable burden of diseases has significantly increased, particularly among adults aged 60 and older, with the most severe effects observed in women aged≥75, highlighting a growing public health challenge and a markedly greater rate of increase in older adults compared to those under 60. The causes of obesity were found to be multifaceted, predominantly influenced by behavioral and environmental factors, with an imbalance between calorie intake and expenditure being the primary issue. The adverse health consequences of obesity have been well documented, with associations noted in various non-communicable diseases, including diabetes, cardiovascular diseases (CVDs), and musculoskeletal disorders. Conclusions: Understanding obesity-comorbidity links is vital to identifying high-risk individuals and prioritizing interventions. Limited access to effective weight management treatments remains a key barrier to improving health outcomes for those affected by obesity.

Characterization of healthy habits and physical activity in adolescent students from Chile

Article

Full-text available

Dec 2024

This study aimed to characterize the physical activity levels and their association with healthy and unhealthy behaviors in adolescent students in Chile. It was a non-experimental, cross-sectional, and descriptive study. The non-probabilistic sample consisted of 175 high school students from public schools (n=103 females, age: 14.4±1.48 years; n=72 males, age: 14.2±1.56 years) who completed the World Health Organization's Global School-based Student Health Survey during the second semester of the year 2023. The main findings revealed a 32.5% prevalence of overweight and obesity and an 8.6% compliance with the World Health Organization physical activity recommendation. Those who engage in at least 60 minutes of physical activity per day show higher consumption of fruits and vegetables and fewer absences from classes, while those who use active transportation also demonstrate higher consumption of fruits and vegetables. Adolescent students are mostly physically inactive, with a higher level of inactivity among females, and those who met the physical activity recommendations consumed more fruits and vegetables than those who did not. From a gender perspective, females exhibited higher drug and marijuana consumption, increased feelings of loneliness, worry, suicidal ideation, and higher rates of absenteeism compared to males. These results highlight the necessity of developing intervention strategies targeting the adolescent school population with a gender perspective, focusing on promoting physical activity, active transportation, as well as healthy habits in both physical and mental domains.

Caracterización de hábitos saludables y actividad física en estudiantes adolescentes de Chile

Article

Full-text available

Dec 2024

Introduction: Healthy lifestyle habits in school-aged children are crucial for their physical, emotional, and cognitive health and development. Objective: to characterize physical activity levels and their association with healthy and unhealthy behaviors in adolescent students in Chile. Methodology: It was a non-experimental, cross-sectional, and descriptive study. The non-probabilistic sample consisted of 175 high school students from public schools (n=103 females, age: 14.4±1.48 years; n=72 males, age: 14.2±1.56 years) who completed the World Health Organization's Global School-based Student Health Survey during the second semester of the year 2023. Results: The main findings revealed a 32.5% prevalence of overweight and obesity and an 8.6% compliance with the World Health Organization's physical activity recommendation. Those who engage in at least 60 minutes of physical activity per day show higher consumption of fruits and vegetables and fewer absences from classes, while those who use active transportation also demonstrate higher consumption of fruits and vegetables. Discussion: Adolescent students are mostly physically inactive, with a higher level of inactivity among females, and those who met the physical activity recommendations consumed more fruits and vegetables than those who did not. From a gender perspective, females exhibited higher drug and marijuana consumption, increased feelings of loneliness, worry, suicidal ideation, and higher rates of absenteeism compared to males. Conclusions: These results highlight the necessity of developing intervention strategies targeting the adolescent school population with a gender perspective, focusing on promoting physical activity, active transportation, as well as healthy habits in both physical and mental domains.

Effect of Slimming Drips on Body Mass Index and Physical Appearance of Obese Population

Article

Full-text available

Dec 2023

Objective: The purpose of this study is to determine the effects of slimming drip approach by mixing cartinex 1g/5ml, Liponex 300gm/12ml and Arginex 5g/10ml with a 500ml of normal saline being administered to patients for twice a week and to determine its effects on Body Mass Index and physical appearance of patients after one month of intervention. Study Design : A quasi experimental study Study Setting: Out Patient department of dermatology Clinic of Isra University Hospital, Hyderabad. Methodology: A total number of n=400 participants were recruited. Informed consent was taken prior to induction and initial body mass index in kg/m2 was monitored. Results: The findings of this study had revealed that slimming drip had significantly p<0.005 reduced the body mass index of the participants where the mean values of BMI before the start of treatment were 38.12±4.85kg/m2 that had been reduced to 34.49±5.36 after one month of treatment. Conclusion: The study had concluded that slimming drip treatment had produced a beneficial effects on hormonal levels and patient’s appearance.

Impact of weight and health-behavior information on evaluations of girls’ health

Article

Full-text available

Dec 2024
J BEHAV MED

The dominant public health narrative equates excess weight with poor health, and previous research has demonstrated that people judge adults with higher body weights as being in poor health, even when they engage in healthy lifestyles. The present study investigated whether the same pattern of beliefs holds for perceptions of children’s health. Participants (n = 445) viewed the health profile of a female child that varied in terms of weight status (normal weight, obese), health behaviors (good, poor), and age (younger, older), and then rated the child’s overall health and indicated their agreement with suggested behavior recommendations. For older children, targets with obesity were perceived as less healthy and were recommended to engage in more healthy and weight control behaviors than were the targets with normal weight. Health behaviors did influence perceptions of health and behavioral recommendations, but much less so for the target with obesity than for the target with normal weight. For younger children, participants placed a greater emphasis on health behaviors than on weight in their perceptions of the target’s health and healthy behavior recommendations, but the target’s weight did play a greater role in weight-control behavior recommendations. Overall, perceptions of older children reflect the mainstream weight-centric health beliefs that are perpetuated in public health messaging, whereas perceptions of younger children seem to be more aligned with the scientific evidence supporting the importance of health behaviors to overall health. Public health messaging, particularly messaging targeting parents, should be reframed to focus on the importance of engagement with health behaviors without reference to weight.

Comparative Study of Human Serum Paraoxonase-1 (PON-1) Activity in Type 2 Diabetes Mellitus: Insights into Oxidative Stress and Antioxidant Defence

Article

Full-text available

Nov 2024

Diabetes mellitus is a disease characterized by chronic high blood sugar levels resulting from defects in insulin secretion, insulin action, or both. Prolonged high blood glucose can increase production of reactive oxygen species, leading to elevated oxidative stress. The enzyme paraoxonase-1 (PON1), made in the liver and transported on high-density lipoprotein (HDL), acts as an antioxidant and can counter oxidative stress. This study aimed to compare PON1 activity between healthy controls, obese type 2 diabetics, and non-obese type 2 diabetics. There were 30 healthy controls, 30 obese type 2 diabetics (group I), and 30 non-obese type. Additionally, fasting lipid profiles, fasting plasma glucose, uric acid, albumin, and total bilirubin levels were determined using a clinical chemistry analyzer. The goal was to evaluate differences in PON1 activity as well as metabolic parameters between the three study groups. The results In comparison to the healthy control group, the diabetes group had Significantly higher blood sugar, serum cholesterol, serum triglycerides, serum LDL, and serum uric acid levels, Compared to the healthy control group, PON was Significantly lower in group II patients, Conclusion that Obese type 2 DM patients had significantly lower PON1 and HDL-C levels, which may indicate That the overweight has lessened biochemical functions for these substances. As dyslipidemia, insulin resistance, and high blood pressure are thought to be crucial factors in the cause of metabolic conditions in obese people, the reduced paraoxonase level may increase their likelihood of developing these conditions.

Anti-inflammatory and antioxidant effects of sea cucumber extract in mitigating hepatic TNF-α elevation induced by high-fat diet

Article

Full-text available

Nov 2024

High-fat diets contribute to the generation of free radicals, which subsequently induce oxidative stress. Prolonged oxidative stress can lead to cellular necrosis and initiate inflammatory processes. The sea cucumber (Phyllophorus sp.) is known to contain flavonoids with antioxidant and anti-inflammatory properties. This study aims to evaluate the effect of ethanol extract from the sea cucumber on TNFα levels in the livers of rats subjected to a high-fat diet. A total of thirty male Wistar rats (Rattus norvegicus), were randomly assigned to five groups: Negative Control (K-), Positive Control (K+), Treatment Group 1 (KP1), Treatment Group 2 (KP2), and Treatment Group 3 (KP3). The rats were subjected to a high-fat diet from day 8 to day 35. The ethanol extract of sea cucumber was administered at doses of 8.5 mg/kg BW (KP1) and 17 mg/kg BW (KP2), while simvastatin was administered to the KP3 group, from day 28 to day 35. On day 36 rat’s liver tissues were harvested for the quantification of TNFα levels using an ELISA. Data were analyzed using SPSS. The mean TNFα levels in the rat liver were recorded as follows: K(-) 65.20 ± 10.29, K(+) 172.08 ± 52.22, KP1 155.60 ± 47.75, KP2 71.79 ± 24.15, and KP3 79.90 ± 24.15. The high-fat diet significantly elevated hepatic TNFα levels in the K(+) group compared to the K(-) group. Additionally, there was no significant difference in TNFα levels between the KP2 group and both the negative control group and the simvastatin-treated group. The ethanol extract of sea cucumber demonstrates potential as an anti-inflammatory and antioxidant agent, reducing hepatic TNFα levels in rats subjected to a high-fat diet.

The relationships between sleep and adiposity amongst multi-ethnic Asian populations: a cross-sectional analysis of the Health for Life in Singapore (HELIOS) study

Article

Full-text available

Nov 2024
INT J OBESITY

Background Short sleep duration and poor sleep quality have been associated with obesity. Asian populations report shorter sleep duration compared to other groups. We therefore aimed to explore the relationships between sleep duration, sleep quality, dozing, daytime napping, snoring, insomnia and adiposity in a multi-ethnic Asian population, and investigate the potential contribution of disturbed sleep to the risk of obesity amongst Asian populations. Methods We studied 8876 participants of the HELIOS study, a multi-ethnic population-based cohort comprising Chinese, Malay, and Indian Asian men and women living in Singapore. Sleep traits and psychological symptoms were assessed using validated tools which included the Pittsburg Sleep Quality Index, Generalised Anxiety Disorder-7, and Patient Health Questionnaire-9. We employed multivariable regression models to examine the associations between sleep and adiposity, while also conducting sub-group and sensitivity analyses to strengthen the reliability of our results. Results The 8876 participants were 69.3% Chinese, 12.5% Malays, and 18.2% Indians, with mean age: 51.7 ± 11.8 years (standard deviation). Malays had the shortest sleep duration, while Chinese had the best sleep quality. Short sleep duration, poor sleep quality, and snoring were associated with higher BMI and waist circumference, independent of age, sex, ethnicity, and various confounding factors (education, household income, current smoking, regular alcohol drinking status, presence of diabetes and hypertension, and markers for anxiety and depression; P < 0.005). The estimated population attributable fraction for short sleep and snoring as contributors to obesity were 6.6% (95% CI: 2.5–10.6%) and 18.6% (95% CI: 17.0–20.2%), respectively. Conclusion Sleep duration, sleep quality, and snoring are associated with adiposity in a multi-ethnic Asian population of Chinese, Malays, and Indians. Our findings suggest that a substantial portion of obesity in Asian populations could be averted through public health interventions aimed at improving sleep duration and quality.

OUTCOME OF CO-ADMINISTRATION OF SEA BUCKTHORN FRUIT IN HIGH FAT DIET WISTAR RATS

Article

Jun 2024
FARMACIA

Olivia Carmen Timnea

Impact of body weight on the relationships between sleep quality in healthcare workers and their somatic health, sexual life, occupational burnout and stress

Article

Full-text available

Nov 2024

Objectives: Sleep disorders can significantly affect the performance and well-being of healthcare workers. This study explores the influence of body weight on the links between sleep quality and various self-reported health indicators - including somatic and mental health, sexual life, and workrelated stress - among healthcare workers. Material and methods: A national cross-sectional survey was conducted in February - April 2022 using a predominantly online, self-administered questionnaire. The group analyzed for this study included 1478 healthcare workers from 99 hospitals and specialized clinics across Poland. Results: Sleep disturbances, assessed via the 4-item Jenkins Sleep Scale scale, were reported by 16% of the participants. Over half (54.7%) of the respondents were categorized as overweight or obese based on their body mass index (BMI). A higher BMI was found to be associated with being male, age >50 years, working as a paramedic, possessing over ten years of work experience, and reporting poorer health and sexual life (p < 0.001). Sleep quality showed significant correlations with assessments of sexual life, stress levels, and occupational burnout (p < 0.001). These correlations remained significant after adjusting for BMI. Notably, in both univariate and adjusted models, sexual life assessment was a robust predictor of sleep quality across all BMI groups. For non-obese individuals, the impact of sexual life on sleep quality persisted even after adjusting for health indicators. Conclusions: The findings suggest that body weight may modulate how sleep quality is influenced by sexual life assessments, work-related stress, and somatic and mental health in healthcare workers. Int J Occup Med Environ Health. 2024;37(5):545-56.

Controversial Anti-Obesity Actions of Epicatechin in Male and Female Mice Kept at Thermoneutrality

Preprint

Full-text available

Nov 2024

Recent reports have highlighted the potential anti-obesity effects of epicatechin (EC) in regulating metabolism. Most studies have primarily used rodent models housed at standard temperatures (ST) 22°C ± 2°C. However, these mice may experience chronic cold exposure at ST, which can influence energy metabolism. Housing mice at thermoneutrality (TN) 28°C ± 2°C could provide a more accurate representation of human temperature conditions. Additionally, many studies focus solely on male animals, overlooking the significance of considering sex differences in the investigation of physiological and metabolic dysregulation. In our trial, we used both male and female C57Bl/6 mice, including lean and obese individuals. The mice were treated with either 12 mg or 20 mg of EC/kg of body weight (administered by gavage) over 12 weeks, five days a week, and were housed at either ST or TN. Contrary to previous reports, we found no anti-obesity effects from EC in either male or female mice at both doses. The mice exhibited similar weight gain, adipose tissue sizes, biochemical profiles, and liver fat accumulation when compared to obese, untreated animals. Furthermore, obese male mice supplemented with 20 mg of EC and housed at TN showed increased subcutaneous white adipose tissue (scWAT) weight and worsened glucose tolerance compared to their non-EC-treated counterparts. In conclusion, epicatechin administered by gavage did not improve obesity, liver steatosis, or insulin resistance in either male or female obese mice housed at ST or TN. This suggests that the route of administration and the EC dosage could influence its anti-obesity effects.

Interaction between green tea and metformin and its effects on oxidative stress and inflammation in overweight women: a randomised clinical trial

Article

Nov 2024

This study evaluated the effect of green tea extract and metformin and its interaction on markers of oxidative stress and inflammation in overweight women with insulin resistance. After screening, 120 women were randomly allocated in 4 groups: Placebo (PC): 1g of microcrystalline cellulose/day; Green tea (GT): 1 g (558 mg polyphenols) of standardized dry extract of green tea/day and 1 g of placebo/day; Metformin (MF): 1 g of metformin/day and 1 g of placebo/day; Green Tea and Metformin (GTMF): 1 g (558 mg polyphenols) and 1 g of metformin/day. All groups were followed-up for 12 weeks with assessment of oxidative damage to lipids and proteins, specific activity of antioxidant enzymes and inflammatory cytokine serum levels. The association of green tea with metformin significantly reduced IL-6 (GTMF: –29.7((–62.6)–20.2))( p = 0.004). Green tea and metformin isolated reduced TNF-α (GT: –12.1((–18.0)–(–3.5)); MF: –24.5((–38.60)–(–4.4)) compared to placebo (PB: 13.8 (1.2–29.2))( P < 0.001). Also, isolated metformin reduced TGF-β (MF: –25.1((–64.4)–0.04)) in comparison to placebo (PB: 6.3((–1.0)–16.3))( p = 0.038). However, when combined, their effects were nullified either for TNF-α (GTMF: 6.0((–5.7)–23.9) and for TGF-β (GTMF: –1.8((–32.1)–8.5). This study showed that there is a drug-nutrient interaction between green tea and metformin that is dependent on the cytokine analyzed.

INVESTIGATING ZINGIBER OFFICINALE RHIZOME'S PHYTOCHEMICAL MAKE- UP AND BIOACTIVITY: A COMPARISON OF AQUEOUS AND ETHANOL EXTRACTS FOR ANTIFUNGAL, ANTI-INFLAMMATORY, AND ANTIBACTERIAL PROPERTIES

Article

Full-text available

Oct 2024

Zingiber officinale or ginger is used to treat many ailments, including cancer, heartburn, inflammation, nausea, and vomiting, as it is enriched in polyphenols, terpenes, flavonoids and essential oils. The study uses ethanol and water extracts of Zingiber officinale rhizome to analyze the phytochemical composition and antibacterial, anti-dandruff, and anti-inflammatory properties. The extracts were prepared by maceration. Using reference techniques, proximate analysis and phytochemical evaluation were conducted. Malassezia furfur was used for anti-dandruff testing, while antibacterial sensitivity was assessed against Streptococcus pneumoniae and Pseudomonas aeruginosa. For anti-inflammatory activity, the protein denaturation method was employed. The extract with the highest activity underwent GC/Mass analysis to understand its phytochemical profiling. The study demonstrated the presence of valuable phytochemicals such as polyphenols, glycosides, flavonoids, and tannins. The ethanol extract exhibited larger inhibition zones (mm) than the water extract at all concentrations, the most significant differences (p < 0.05) occurring at 200 mg/mL: antifungal activity was 19.4±0.77 vs 12.8±0.65, and antibacterial activity was 19.4±0.49 vs 17.2±0.58 for Pseudomonas aeruginosa and 20.1±0.75 vs 18.3±0.89 for Streptococcus pneumoniae. The ethanol extract (86.8%±0.038) and the water extract (80.2%±0.029) substantially reduced inflammation (p < 0.05). The findings of these assays were comparable to relative standard drugs, including fluconazole (20.7±0.81 mm), ciprofloxacin (21.5±0.67 mm), and diclofenac (90.1%±0.003). The GC/Mass analysis of the ethanol extract revealed significant amounts of gingerol, gingerdione, sitosterol, and zingerone. This study highlights Zingiber officinale's potential therapeutic effects, advocating its use as a beneficial alternative to synthetic drugs.

Evaluation of Labour Care Guide: Labor progression in obese women from Basra, Iraq

Article

Sep 2024

The prevalence of maternal obesity has emerged as a significant global public health issue. The World Health Organization (WHO) has just introduced a revolutionary tool known as the WHO Labour Care Guide for the purpose of monitoring the well-being of mothers and infants throughout the process of labor. The study aims to evaluate the impact of obesity on the progression of labor, mode of delivery, and subsequent neonatal complications. Our research was conducted on 176 women who fulfilled the inclusion criteria at Basra Maternity and Child Hospital, the number of women with normal BMI was 100, while the class 1 obese was 76 cases. The results show the risk of emergency caesarean section is significantly increased among the class 1 obese woman, the percentages were 40.7%, and 14% respectively (p-value <0.001), regarding the neonatal outcome assessed by the APGAR scoring system, there was a relatively low APGAR score among the total deliveries of class 1 obese women regardless of the mode of delivery, (p-value was significant <0.001) compared with the average Body Mass Index women, the neonatal birth weight was significantly different between the two Body Mass Index groups, there is an increase in the birth weight among class 1 obese women (p-value <0.001). The study concludes obesity has a substantial influence on the increased incidence of caesarean section deliveries among women classified as having obesity class I, and there is a positive correlation between body mass index and the desire for oxytocin administration among obese women.

Epidemiology of gastrointestinal cancers: a systematic analysis from the Global Burden of Disease Study 2021

Article

Sep 2024

Background Gastrointestinal cancers comprise nearly one-third of global mortality from cancer, yet the comprehensive global burden of these cancers remains uninvestigated. Objective We aimed to assess the global, regional and national burden of gastrointestinal cancers. Designs Data on oesophagus, gastric, colorectal, liver, pancreas and biliary tract cancers were extracted from the Global Burden of Disease 2021 database. Age-standardised incidence rate (ASIR) and age-standardised death rate (ASDR) were calculated by sex, region and Sociodemographic Index (SDI). Results In 2021, there were 5.26 million incidences and 3.70 million deaths from gastrointestinal cancer. The greatest burden is from colorectal, followed by gastric, oesophageal, pancreatic, liver and biliary tract cancer. We noted geographical and socioeconomic differences in ASIR and ASDR across all types of cancers. From 2000 to 2021, ASIR increased for colorectal cancer (annual percent change (APC): 0.10%, 95% CI 0.05% to 0.14%), pancreatic cancer (APC: 0.27%, 95% CI 0.14% to 0.41%), and liver cancer from metabolic dysfunction-associated steatotic liver disease (APC: 0.62%, 95% CI 0.58% to 0.67%) and alcohol-related liver disease (APC: 0.26%, 95% CI 0.22% to 0.30%). ASDR increased for pancreatic cancer (APC: 0.18%, 95% CI 0.02% to 0.34%). Higher SDI countries had higher incidence rates for most types of gastrointestinal cancer. Conclusions Although the ASIR of oesophageal, gastric and biliary tract cancer has decreased, the ASIR still increased in colorectal, pancreatic and liver cancer from steatotic liver disease. Public policies are important for controlling gastrointestinal cancers—most importantly, reducing alcohol consumption, hepatitis B immunisation and tackling the burden of metabolic diseases.

Connecting bone metastasis, adipose tissue and adipokines: How does physical activity fit?

Article

Aug 2024

Lesson on obesity and anatomy of adipose tissue: new models of study in the era of clinical and translational research

Article

Full-text available

Aug 2024
J TRANSL MED

Obesity is a serious global illness that is frequently associated with metabolic syndrome. Adipocytes are the typical cells of adipose organ, which is composed of at least two different tissues, white and brown adipose tissue. They functionally cooperate, interconverting each other under physiological conditions, but differ in their anatomy, physiology, and endocrine functions. Different cellular models have been proposed to study adipose tissue in vitro. They are also useful for elucidating the mechanisms that are responsible for a pathological condition, such as obesity, and for testing therapeutic strategies. Each cell model has its own characteristics, culture conditions, advantages and disadvantages. The choice of one model rather than another depends on the specific study the researcher is conducting. In recent decades, three-dimensional cultures, such as adipose spheroids, have become very attractive because they more closely resemble the phenotype of freshly isolated cells. The use of such models has developed in parallel with the evolution of translational research, an interdisciplinary branch of the biomedical field, which aims to learn a scientific translational approach to improve human health and longevity. The focus of the present review is on the growing body of data linking the use of new cell models and the spread of translational research. Also, we discuss the possibility, for the future, to employ new three-dimensional adipose tissue cell models to promote the transition from benchside to bedsite and vice versa, allowing translational research to become routine, with the final goal of obtaining clinical benefits in the prevention and treatment of obesity and related disorders.

Insights into the interplay between gut microbiota and lipid metabolism in the obesity management of canines and felines

Article

Full-text available

Aug 2024

Obesity is a prevalent chronic disease that has significant negative impacts on humans and our companion animals, including dogs and cats. Obesity occurs with multiple comorbidities, such as diabetes, hypertension, heart disease and osteoarthritis in dogs and cats. A direct link between lipid metabolism dysregulation and obesity-associated diseases has been implicated. However, the understanding of such pathophysiology in companion animals is limited. This review aims to address the role of lipid metabolism in various metabolic disorders associated with obesity, emphasizing the involvement of the gut microbiota. Furthermore, we also discuss the management of obesity, including approaches like nutritional interventions, thus providing novel insights into obesity prevention and treatment for canines and felines.

Correlation of Body Mass Index with Foot Posture Types Among Geriatric Population

Article

Jul 2024

Presenting Structural Model of Emotional Eating in People with Obesity based on Self-Regulation with the Mediating Role of Emotional Processing

Article

Jan 2023

The purpose of this study was to Presenting Structural Model of Emotional Eating in People with Obesity based on self-regulation with the Mediating Role of Emotional processing. The research method is correlation using structural equation modeling. The statistical population of this study consisted of all people with obesity in Tehran in 1397, out of whom 378 were selected by stage sampling. Research tools were Emotional Eating Duch's (1986), self-regulation Carey & et al, (2004) and Emotional Processing Bakker et al.'s (2010) Questionnaire. Structural equation modeling was used to answer the research hypotheses. The results showed that there was a direct and negative effect between self-regulation and emotional eating. There is an indirect and positive effect between self-regulation and emotional processing. And there is an indirect and negative effect between emotional processing and emotional eating. Therefore, it can be concluded from the results that self-regulation affects emotional eating with the mediating role of emotional processing in obese people. Therefore, attention to the mentioned variables in the prevention and design of appropriate therapies helps researchers and therapists.

Obez hastaların antrum dokusunda sleeve gastrektomi uygulama öncesi ve sonrasında GKN1 ve TP53 genlerinin ekspresyon düzeylerinin araştırılması / Investigation of expression levels of gkn1 and TP53 genes before and after sleeve gastrectomy in antrum tissue of obese patients

Thesis

Full-text available

Aug 2022

Mehmet Sarı

Obezite, adiposit olarak adlandırılan yağ depo hücrelerinin hipertrofisi veya hiperplazisidir. Obez hastalarda diyet veya ilaç tedavisi ile hedeflenen kilo kaybına ulaşılamaması halinde operasyon ölçütlerine uygun hastalar cerrahi tedavilere yönlendirilmektedir. Bu kapsamda, son zamanlarda bariatrik cerrahi (BC) yöntemleri sıklıkla kullanılmaya başlanmıştır. Bu yöntemler arasında en sık kullanılan yöntem laparoskopik sleeve gastrektomi (LSG) yöntemidir. Kullanılan bu yöntemin hasta açısından uzun vadede birçok avantajı olmakla beraber dezavantajları da bulunmaktadır. Sleeve gastrektomi (SG) ya da diğer bilinen ismiyle tüp mide operasyonu yöntemi güvenli ve etkili biçimde kilo vermeyi sağlamasının yanı sıra obeziteyle ilgili komorbiditeleri de azaltmaktadır. Ancak uygulama sonrasında komplikasyonlara bağlı olarak mortalitede artışlar gözlenmektedir. Bariatrik cerrahi ile mide kanseri arasındaki ilişkileri inceleyen çalışmalarda çelişkili sonuçlar elde edilmiştir. Buna göre bazı çalışmalarda cerrahi operasyon nedeniyle kilo kaybı sonrasında, obeziteye bağlı kanserlerde azalma olduğu vurgulanmıştır. Bazı çalışmalarda da obeziteye bağlı kanserlerde (özofagus, bağırsak) azalma olmasına rağmen mide kanserinin gelişmesinde daha farklı sonuçlar elde edildiği ifade edilmektedir. Mide kanseri dünyada büyük bir sağlık problemidir. SG ameliyatları sonrası, gözlemlenen komplikasyonlar göz önüne alındığında operasyon sonrası oluşabilecek uzun vadeli, gastrik mukozal epiteldeki, hücre proliferasyonu ve hücre ölümü arasındaki homeostatik dengesizlik hücresel farklılaşmalara yol açabilir. Bu amaçla normal çalışan bir midenin antrumun da düzenli miktarda Gastrokin 1 (GKN1) ekspresyonu olmasına rağmen, intestinal metaplazi ve mide kanseri dokularında ekspresyonu azalan GKN1’in ekspresyon düzeyleri araştırılmıştır. GKN1, mideye özgü bir proteindir. Yüzey lümen epitel hücre tabakasının yenilenmesinde, mukozal bütünlüğün korunmasında, hücre çoğalması ve farklılaşmasında rol oynamaktadır. Mide mukozasında neoplastik veya inflamatuar lezyonların varlığının gösterilmesinde bir aracı olarak kullanılabilir görünmektedir. GKN1 ekspresyonu, mide tümör dokularında ve türetilmiş hücre dizilerinde azalır, hücreyi apoptoza indükler. Bu nedenle bir tümör baskılayıcı olarak çalışır ve mide mukozal savunmasında önemli bir rolü bulunmaktadır. Aynı şekilde Tümor Protein p53 (TP53) geninin de hücre çoğalması ve farklılaşmasındaki anahtar rolü ve bir tümör supresör gen olması itibari ile bu çalışma içerisinde ekspresyon düzeyleri araştırılmıştır. Hücre döngüsünü denetleme mekanizmalarından biri olan TP53 meydana gelen mutasyonlar sonrası tamir mekanizmalarının çalışmasını sağlayarak DNA stabilitesini korur. Aksi durumlarda hücreyi apoptoza yönlendirir. Elde edilinen bilgilere göre istatiksel olarak insanlarda ortaya çıkan kanserlerin % 50’sinde TP53 mutasyonları görülmektedir. Araştırmamız kapsamında, operasyon sonrası artan hücre proliferasyonu sırasında ortaya çıkan genetik değişikliklerin hastalık patogenezindeki etkilerini belirlemek için, SG operasyonu geçirmiş hastalarda; GKN1 ve TP53 genlerinin ekspresyon düzeyleri araştırılmıştır. Araştırmaya Bakırköy Dr. Sadi Konuk Eğitim Araştırma Hastanesinin Genel Cerrahi polikliniğine başvuran, obez olan ve SG prosedürü uygulanan bireyler dahil edilmiştir. Bu amaçla, ameliyat öncesinde ve 6 ay sonrasında alınan biyopsilerden rutin patolojik inceleme yapıldıktan sonra kalan materyallerden genetik analizler yapılmıştır. Bu çalışma için 33 birey çalışmaya dâhil edilmiştir. Çalışma sonucunda elde edilen veriler incelendiğinde; Ameliyat öncesi ve sonrası TP53 ekspresyon düzeyleri arasında istatistiksel olarak anlamlı farklılık tespit edilmemiştir (p=0,184). Ancak ameliyat öncesi ve sonrası GKN1 ekspresyon düzeyleri arasında istatistiksel olarak anlamlı farklılık tespit edilmiştir (p=0,020). Buna göre ameliyat sonrası GKN1 ameliyat öncesine kıyasla 1,61 kat down regüle olmuştur. GKN1 geninin ekspresyonunun kontrollere göre azaldığı saptanmıştır. Eksresyon düzeyinin bu azalışının midenin % 80’ninin çıkarılması sonrasında bozulan mukozal bütünlük ile ilişkili olduğu sonucuna varılmıştır. İyileşme süresi içerisinde rezeksiyona bağlı olarak oluşan hücresel onarım ve koruma mekanizmasının bir parçası olarak GKN1 ekspresyonunun azalması, litaratür verileride göz önüne alındığında, bu değişiklik maling farklılaşmalara karşı hücreyi savunmasız bir durumda bırakmaktadır. Genin azalan ekspresyonu ile birlikte etkilerini yitirmesi ile beraber hücre proliferasyonu sırasında farklılaşmalar olabilir. Elde edilen sonuçlarda Preop ve postop Helicobakter Pilori (HP) oranları ise farklılık göstermemektedir (p=0,219). Yine HP varlığına göre ameliyat öncesi TP53 ve GKN1 ekspresyonlarına farklılık göstermemektedir (p>0,05). Sonuç olarak SG sonrası yan etkilere bağlı ortaya çıkabilecek genetik değişikliklere ilişkin GKN1 ve TP53 ekspresyon seviyelerinin araştırılmasının SG operasyonu öncesi değerlendirmede, karar vermede belirleyici rolü oynayacağı kanaatine varılmıştır. Bulguların daha geniş bir şekilde değerlendirebilmesi için planlı kapsamlı çalışmalara ihtiyaç bulunmaktadır. Bu çalışma, tedavi kılavuzlarının iyileştirilmesi, operasyon öncesi ve sonrası operasyona bağlı olarak hastada oluşabilecek genetik ve patofizyolojik özelliklerinin ortaya çıkarılması adına bilime katkı sağlayacaktır.

Facing Challenges for Reducing Weight Stigma in Public Health Policy and Practice

Article

Apr 2025
ANNU REV PUBL HEALTH

Rebecca M Puhl

The prevalence and harms of societal weight stigma have increased attention to its presence in public health approaches and communication. Calls to action from scholars, advocates, and health professionals emphasize the need to address weight stigma as a social justice issue and eliminate harmful narratives that perpetuate weight bias and discrimination in public health messages, practices, and policies. However, debates surrounding issues of weight stigma in public health complicate, and at times impair, efforts to effectively address this problem. Different (and sometimes opposing) perspectives include views about the health risks versus stigma effects of high body weight, the use of body mass index (BMI) as a metric of health, weight-normative (i.e., weight-centric) versus weight-inclusive treatment approaches, stigmatizing language used to describe body weight, and potential challenges when framing obesity as a disease. This review summarizes the current evidence, debates, and best practices related to weight stigma in public health efforts.

Prevalence Of Obesity Among Middle Aged Women Associated With Lifestyle And Demography

Article

Full-text available

Mar 2025

Background: Obesity is a significant global public health problem, and middle-aged women are a high-risk group. This study was undertaken to identify the prevalence of obesity in middle-aged women in Puducherry. Methods: A cross-sectional study was done among 100middle-aged women (40-60 years) selected by a multi-stage sampling method. A pre-tested questionnaire was used to collect data, and anthropometric measurements were made. Obesity was diagnosed as a body mass index (BMI) ≥ 30 kg/m². Results: The prevalence of obesity was 34.5%. The prevalence of obesity rose with age, from 28.5% in women aged 40-44 years to 41.2% in those aged 55-60 years. The factors that were significantly related to obesity were increased education level, physical inactivity, and chronic diseases. Conclusion: The incidence of obesity in middle-aged women of Puducherry is high, and therefore, there is a need for specific interventions to encourage healthy lifestyle practices and avert obesity complications.

Early-Onset Gastrointestinal Cancers and Metabolic Risk Factors: Global Trends From the Global Burden of Disease Study 2021

Article

Feb 2025
MAYO CLIN PROC

Anti-obesity mechanisms elucidation of essential oil components from Artemisiae Argyi Folium (Aiye) by the integration of GC-MS, network pharmacology, and molecular docking

Article

Full-text available

Jan 2025

Recently, the global epidemic of obesity is increasing significantly. Obesity is treated with anti-obesity medications and surgery and complications related to these treatments prompt the search of phytochemicals that confer anti-obesity effects. Artemisiae Argyi Folium (Aiye), a Chinese herb used as both food and medicine, exhibits potent anti-obesity effects. Aiye essential oil components are responsible for lipase activity inhibition, intestinal barrier protection, and blood lipid regulation effects. The current research aims to identify the anti-obesity essential oil components of Aiye through the integration of GC-MS, network pharmacology, and molecular docking. In present study, the Aiye essential oil components were identified by GC-MS analysis. Network pharmacology and molecular docking were integrated to predict the anti-obesity mechanisms of Aiye essential oil components. In total, 49 essential oil components were identified, containing 308 anti-obesity targets. The network pharmacology analysis revealed that the essential oil components may combat obesity through the Wnt signaling pathway, PI3K-Akt signaling pathway, MAPK signaling pathway, prolactin signaling pathway, and cAMP signaling pathway, etc. For molecular docking, there were 99 out of 140 with a binding affinity of less than −5 kcal/mol, indicating a moderate binding between essential oil components and targets. The present study revealed 308 potential anti-obesity targets of 49 essential oil components of Aiye. More than 70% of the binding between components and targets had moderate interaction. More than five anti-obesity signaling pathways of 49 Aiye essential oil components were identified. Therefore, the current research indicated that the essential oil components of Aiye may confer anti-obesity benefits.

Self-Nanoemulsifying Formulation Improves Oral Bioavailability and Insulin Sensitizing Potency of Formononetin-Vitamin E Conjugate in Type 2 Diabetic Mice

Article

Dec 2024
MOL PHARMACEUT

Global Trend of MASH-associated Liver Cancer: A Systematic Analysis From the Global Burden of Disease 2021

Article

Dec 2024
CLIN GASTROENTEROL H

Molecular Mechanisms of Oxidative Stress-Induced Diseases

Chapter

Nov 2024

Low-grade chronic systemic inflammation plays a crucial role in the development of chronic diseases including metabolic syndrome, cancer, type 2 diabetes, and cardiovascular disease (CVD). Accumulation of fat is often linked to systemic oxidative stress via the elevation of reactive oxygen species (ROS). Elevation of oxidative stress can lead to chronic inflammation and thus may modulate chronic disease. Indeed, oxidative stress can trigger many transcriptional factors including Wnt/β-catenin, nuclear factor-kappa B (NF-κB), and nuclear factor E2-related factor 2 (Nrf2), and thereby activates inflammatory pathways. In this chapter, we highlighted the underlying mechanisms of action involved in oxidative stress-induced diseases.

Introduction and Background

Chapter

Nov 2024

There are various sources of nutritionally mediated oxidative stress that cause inflammation. Substantial evidence highlights that excessive consumption of macronutrients can cause oxidative stress leading to inflammation through nuclear factor-kappa B- (NF-κB-) mediated cell signaling pathways. Animal-based proteins, dietary carbohydrates, and fats are crucial to highlight here because they may cause the long-term consequences of nutritionally mediated inflammation. Oxidative stress plays a significant role in metabolic disorders associated with diets high in animal-based proteins, carbohydrates, and fats. Obesity has reached epidemic proportions and is a major risk factor for numerous chronic diseases. Epidemiological studies have shown a link between high body mass index (BMI) and several chronic conditions, including chronic kidney disease, musculoskeletal disorders, various cancers, diabetes mellitus, cardiovascular disease (CVD), and non-alcoholic fatty liver disease. These conditions adversely affect quality of life and increase healthcare costs. However, the biological mechanisms underlying nutritionally mediated oxidative stress are complex and merit further discussion. This book aims to explore several issues related to nutrients and oxidative stress, including the fundamentals of oxidative metabolism, nutritionally mediated oxidative stress, molecular mechanisms of oxidative stress-induced diseases, high carbohydrate intake and type 2 diabetes, high animal-based protein consumption and cancer, excessive fat intake and cardiovascular disease, the role of food sources in oxidative stress-induced diseases, and future prospects.

Comparison the effectiveness of emotion-focused therapy and self-compassion-focused therapy on self-esteem and shame in women with binge eating

Article

Full-text available

Nov 2024

The purpose of this study was to compare the effectiveness of emotion-focused therapy and self-compassion-focused therapy on self-esteem and shame experienced in women with binge eating. The present study is a semi-experimental pre-test post-test design with a two-month follow-up. The statistical population was all women with binge eating disorder in Tehran city in the year 2023. First 45 people were selected and then replaced by a simple random method in 2 experimental groups and 1 control group. The tools of this research included Gomali et al.'s binge eating severity (BES, 1982), Rosenberg's self-esteem (RSEs, 1989), Cook's internal shame (1998), and Goss' external shame (1994) scales. Variance analysis with repeated measures was used for data analysis. The results showed that there was a significant difference between the mean of self-esteem and the shame experience in both emotion-focused and self-compassion groups in the post-test and control groups (P<0.05). That is, two interventions have significantly increased self-esteem and reduced shame experience compared to the control group. Also, the results of the Bonferroni test for comparing the mean effectiveness of the two groups showed no significant difference between them in increasing self-esteem and reducing shame in these individuals (P>0.05). Therefore, it can be concluded that despite the effectiveness of both interventions in increasing self-esteem and reducing shame in women with binge eating disorders, the superiority of one intervention over the other is not statistically significant.

The effect of mindfulness-based stress reduction on caregiving in romantic relationships of overweight women: A quasi-experimental design

Article

Aug 2024

Relationship between Systemic Biomarker of Lipid Peroxidation 4-Hydroxynonenal and Lipidomic Profile of Morbidly Obese Patients undergoing Bariatric Surgery

Article

Sep 2024
FREE RADICAL BIO MED

Moringa (Moringa oleifera) leaves aqueous extract enhances fibronectin type III domain-containing protein 5 gene expression and serum irisin liberation in an obesity model

Article

Jan 2021

Background Obesity, a risk agent for many chronic diseases, leads to increased mortality and poses one of the major public health problems. Objective This study aimed to investigate the thermogenic and antiobese efficiency of Moringa aqueous extract (MAE) on obese-modeled rats. Materials and methods Adult male rats (150–170 g) were randomly divided into four groups, with 10 animals each, as follows: (a) healthy rats served as control, (b) healthy rats administrated with MAE (400 mg/kg/day), (c) obese-modeled rats, and (d) obese-modeled rats treated with MAE. Results After 30 consecutive days of treatment, the obtained results declared that MAE possessed antiobesity, thermogenic, antilipidemic, and antiinflammatory potential. MAE succeeded significantly in reduction of the BMI and serum leptin level coupled with up-regulation of fibronectin type III domain-containing protein 5 gene mRNA expression and serum irisin level. It clearly increased serum paraoxonase-1 activity and improved lipid profile values. Moreover, it markedly reduced serum tumor necrosis factor α and increased antioxidant activity, which was achieved from the marked improvement in malondialdehyde, nitric oxide, catalase, superoxide dismutase, and glutathione values in cardio-hepatic tissues. These findings were confirmed by the regeneration of the hepatic histopathological structure. Conclusion MAE, as a food supplement, could play a beneficial role in management of obesity and restoring its complications. This could be exhibited through multiple pathways, mainly via upregulation of fibronectin type III domain-containing protein 5 gene expression and production of the soluble myokine ‘irisin,’ which is responsible for browning of white adipose tissue as well as increment of total body energy expenditure.

A novel structured, volume‐based, weight‐loss and health programme combined with respiratory muscle training helps reduce weight and cardiovascular risk in people with obesity

Article

Jul 2024

The Mediating Role of Attitude To Physical Activity in the Relationship Between E-Health Literacy and Obesity Awareness

Preprint

Full-text available

Jul 2024

Background: The study aims to examine the mediating role of physical activity attitudes in the relationship between university students' e-health literacy levels and obesity awareness. Methodology: The study was designed with a relational research model, one of the quantitative research methods. A total of 333 university students, 159 males and 174 females, participated in the study. Pearson correlation analysis was applied to examine the relationship between e-health literacy, obesity awareness, and physical activity attitudes. In the study, e-health literacy was employed as the independent variable; obesity awareness was used as the dependent variable, and positive and negative attitudes toward physical activity were used as the mediating variables. The bias-corrected bootstrapping 5000 method was employed to ascertain the significance of the mediating variable, with the lower and upper limit intervals being checked to ensure that no zero values were present. Results: The mediating effect of positive physical activity attitudes between e-health literacy and obesity awareness was found to be positive and significant (β=0.0112, t=4.259, p=<.001, CI=[0.060-0.163]. The mediating effect of negative attitudes toward physical activity between e-health literacy and obesity awareness was insignificant (β=0.0162, t=0.913, p=0.361, CI=[-0.018-0.049]). A predictive effect of e-health literacy and physical activity attitudes on obesity awareness was identified, with a value of 57%. The study revealed that e-health literacy accounted for 25% of the negative attitudes toward physical activity and 42% of the positive attitudes toward physical activity. Ethics approval number: Date: 13/02/2024, session no: 03 Decision: 03.14 Conclusion: The study has demonstrated a correlation between e-health literacy and obesity awareness. As e-health literacy levels increase, so too does obesity awareness. On the other side, the current study found a positive and significant relationship between e-health literacy and positive attitudes toward physical activity. It was ultimately determined that positive attitudes toward physical activity had a mediating effect on the relationship between e-health literacy and obesity awareness.

Prevalence and associated factors of obstructive sleep apnea in morbidly obese patients undergoing bariatric surgery

Article

Full-text available

Mar 2018
SLEEP BREATH

PurposeOur goal in this study is to determine the prevalence and associated factors of obstructive sleep apnea (OSA) in morbidly obese patients undergoing bariatric surgery. Methods This descriptive study was conducted at King Chulalongkorn Memorial Hospital from 2007 to 2015. Data of morbidly obese patients who underwent bariatric surgery were included using ICD-10 code for principle diagnosis “morbid obesity” (E668) and ICD-9 code for “bariatric surgery” (4389, 4438, 4439). ResultsBaseline characteristics of 238 patients who met the inclusion criteria demonstrated 49.2% male, mean age of 33.9 ± 10.8 years, and mean BMI of 52.6 ± 11.6. Sleeve gastrectomy and Roux-en Y gastric bypass surgery were performed in 51.5 and 48.5%; respectively. High risk for OSA using STOP-Bang as a screening questionnaire (≥3 points) was 92.7%. The prevalence of OSA using respiratory disturbance index (RDI) ≥ 5 was demonstrated at 85.7%. Mild, moderate, and severe OSA was observed in 8.8, 15.3, and 75.9%, respectively. Snoring, STOP-Bang score ≥ 3, fatty liver, and BMI were significantly correlated with OSA compared to the group without OSA with the odds ratio of 17.04 (p = <0.0001, 95% CI = 6.67–43.49), 16 (p = 0.01, 95% CI = 1.95–131.11), 4.75 (p = 0.001, 95% CI = 1.82–12.37), and 1.04 (p = 0.045, 95% CI = 1.0009–1.09), respectively. Comparison between non-severe and severe OSA groups demonstrated dyslipidemia and BMI to be correlated with OSA severity (odds ratio = 3.06, 95% CI 1.36–6.89, p = 0.007 and odds ratio = 1.07, 95% CI 1.03–1.13, p = 0.001, respectively). Conclusions Obstructive sleep apnea is frequently observed in morbidly obese patients undergoing bariatric surgery and the severity tends to be severe. Snoring, STOP-Bang score ≥ 3, fatty liver, and BMI were significantly correlated with OSA. Dyslipidemia and BMI were demonstrated to be associated factors for severity of OSA in this population.

Assessing gene-environment interaction effects of FTO, MC4R and lifestyle factors on obesity using an extreme phenotype sampling design: Results from the HUNT study

Article

Full-text available

Apr 2017
PLOS ONE

Background Our aim was to assess the influence of age, gender and lifestyle factors on the effect of the obesity-promoting alleles of FTO and MCR4. Methods The HUNT study comprises health information on the population of Nord-Trøndelag county, Norway. Extreme phenotype participants (gender-wise lower and upper quartiles of waist-hip-ratio and BMI ≥ 35 kg/m²) in the third survey, HUNT3 (2006–08), were genotyped for the single-nucleotide polymorphisms rs9939609 (FTO) and rs17782313 (MC4R); 25686 participants were successfully genotyped. Extreme sampling was chosen to increase power to detect genetic and gene-environment effects on waist-hip-ratio and BMI. Statistical inference was based on linear regression models and a missing-covariate likelihood approach for the extreme phenotype sampling design. Environmental factors were physical activity, diet (artificially sweetened beverages) and smoking. Longitudinal analysis was performed using material from HUNT2 (1995–97). Results Cross-sectional and longitudinal genetic effects indicated stronger genetic associations with obesity in young than in old, as well as differences between women and men. We observed larger genetic effects among physically inactive compared to active individuals. This interaction was age-dependent and seen mainly in 20–40 year olds. We observed a greater FTO effect among men with a regular intake of artificially sweetened beverages, compared to non-drinkers. Interaction analysis of smoking was mainly inconclusive. Conclusions In a large all-adult and area-based population survey the effects of obesity-promoting minor-alleles of FTO and MCR4, and interactions with life style factors are age- and gender-related. These findings appear relevant when designing individualized treatment for and prophylaxis against obesity.

Snack Food, Satiety, and Weight

Article

Full-text available

Sep 2016

In today's society, snacking contributes close to one-third of daily energy intake, with many snacks consisting of energy-dense and nutrient-poor foods. Choices made with regard to snacking are affected by a multitude of factors on individual, social, and environmental levels. Social norms, for example, that emphasize healthful eating are likely to increase the intake of nutrient-rich snacks. In addition, satiety, the feeling of fullness that persists after eating, is an important factor in suppressing overconsumption, which can lead to overweight and obesity. Thus, eating snacks between meals has the potential to promote satiety and suppress overconsumption at the subsequent meal. Numerous studies have explored the relation between snack foods and satiety. These studies concluded that whole foods high in protein, fiber, and whole grains (e.g., nuts, yogurt, prunes, and popcorn) enhance satiety when consumed as snacks. Other foods that are processed to include protein, fiber, or complex carbohydrates might also facilitate satiety when consumed as snacks. However, studies that examined the effects of snack foods on obesity did not always account for satiety and the dietary quality and portion size of the snacks consumed. Thus, the evidence concerning the effects of snack foods on obesity has been mixed, with a number of interventional and observational studies not finding a link between snack foods and increased weight status. Although further prospective studies are warranted to conclusively determine the effects of snack foods on obesity risk, the consumption of healthful snacks likely affects satiety and promotes appetite control, which could reduce obesity.

Obesity as a Disease: Current Policies and Implications for the Future

Article

Full-text available

Jun 2016

The recognition of obesity as a chronic disease is increasing. However, there is variable acknowledgment of it as a disease in health policies across the USA. The objective of this review is to describe how obesity meets the definition of a disease, explain its interpretation in current health policies, and explore implications for obesity in future health policy adoption and development. Perspectives are presented from scientific evidence, clinical practice, and health policy areas including Medicare, Medicaid, the Affordable Care Act, federal government agency guidance, and healthcare quality.

NIH working group report - Using genomic information to guide weight management: From universal to precision treatment

Article

Full-text available

Jan 2016

Objective Precision medicine utilizes genomic and other data to optimize and personalize treatment. Although more than 2,500 genetic tests are currently available, largely for extreme and/or rare phenotypes, the question remains whether this approach can be used for the treatment of common, complex conditions like obesity, inflammation, and insulin resistance, which underlie a host of metabolic diseases. Methods This review, developed from a Trans-NIH Conference titled Genes, Behaviors, and Response to Weight Loss Interventions, provides an overview of the state of genetic and genomic research in the area of weight change and identifies key areas for future research. ResultsAlthough many loci have been identified that are associated with cross-sectional measures of obesity/body size, relatively little is known regarding the genes/loci that influence dynamic measures of weight change over time. Although successful short-term weight loss has been achieved using many different strategies, sustainable weight loss has proven elusive for many, and there are important gaps in our understanding of energy balance regulation. Conclusions Elucidating the molecular basis of variability in weight change has the potential to improve treatment outcomes and inform innovative approaches that can simultaneously take into account information from genomic and other sources in devising individualized treatment plans.

Common Medications Which Lead to Unintended Alterations in Weight Gain or Organ Lipotoxicity

Article

Full-text available

Dec 2015
Curr Gastroenterol Rep

Obesity is one of the most common chronic conditions in the world. Its management is difficult, partly due to the multiple associated comorbidities including fatty liver, diabetes, hypertension, and hyperlipidemia. As a result, the choice of prescription medications in overweight and obese patients has important implications as some of them can actually worsen the fat accumulation and its associated metabolic complications. Several prescription medications are associated with weight gain with mechanisms that are often poorly understood and under-recognized. Even less data are available on the distribution of fat and lipotoxicity (the organ damage related to fat accumulation). The present review will discuss the drugs associated with weight gain, their mechanism of action, and the magnitude and timing of their effect.

Associations of Different Adipose Tissue Depots with Insulin Resistance: A Systematic Review and Meta-analysis of Observational Studies

Article

Full-text available

Dec 2015

Fat distribution is strongly associated with insulin resistance, a risk factor for type 2 diabetes and cardiovascular diseases. However, associations of different adipose tissue depots or/and obesity indices with insulin resistance have not been systematically evaluated. In this study we examined associations of different adipose tissue depots/obesity indices with insulin resistance, as measured by homeostatic model assessment of insulin resistance (HOMA-IR) in observational studies. A total of 40 studies with 56 populations and 29 adipose tissue depots/obesity indices were included in the meta-analysis. There were strong correlation between HOMA-IR and visceral fat mass (r = 0.570, 95% confidence interval(CI): 0.424~0.687), total fat mass (r = 0.492, 95%CI: 0.407~0.570), body mass index (r = 0.482, 95%CI: 0.445~0.518) and waist circumference (r = 0.466, 95%CI: 0.432~0.500), except lower extremity fat (r = 0.088, 95%CI: −0.116~0.285). Sample size, diabetic status, gender, mean of body mass index, and race contributed to heterogeneity of these associations. This study showed a positive correlation between insulin resistance and most adipose tissue depots/obesity indices, and the strongest association is for visceral fat mass.

Sweetening of the global diet, particularly beverages: Patterns, trends, and policy responses

Article

Full-text available

Dec 2015

Evidence suggests that excessive intake of added sugars has adverse effects on cardiometabolic health, which is consistent with many reviews and consensus reports from WHO and other unbiased sources. 74% of products in the US food supply contain caloric or low-calorie sweeteners, or both. Of all packaged foods and beverages purchased by a nationally representative sample of US households in 2013, 68% (by proportion of calories) contain caloric sweeteners and 2% contain low-calorie sweeteners. We believe that in the absence of intervention, the rest of the world will move towards this pervasiveness of added sugars in the food supply. Our analysis of trends in sales of sugar-sweetened beverages around the world, in terms of calories sold per person per day and volume sold per person per day, shows that the four regions with the highest consumption are North America, Latin America, Australasia, and western Europe. The fastest absolute growth in sales of sugar-sweetened beverages by country in 2009-14 was seen in Chile. We believe that action is needed to tackle the high levels and continuing growth in sales of such beverages worldwide. Many governments have initiated actions to reduce consumption of sugar-sweetened beverages in the past few years, including taxation (eg, in Mexico); reduction of their availability in schools; restrictions on marketing of sugary foods to children; public awareness campaigns; and positive and negative front-of-pack labelling. In our opinion, evidence of the effectiveness of these actions shows that they are moving in the right direction, but governments should view them as a learning process and improve their design over time. A key challenge for policy makers and researchers is the absence of a consensus on the relation of beverages containing low-calorie sweeteners and fruit juices with cardiometabolic outcomes, since decisions about whether these are healthy substitutes for sugar-sweetened beverages are an integral part of policy design.

Inhibitory Control Is Associated With Psychosocial, Cognitive, and Weight Outcomes in a Longitudinal Sample of Girls

Article

Full-text available

Sep 2015

Early self-regulation abilities have been highlighted as a robust predictor of adaptive development, but the extant literature has typically focused on outcomes in different developmental domains separately. The aim of the current study was to expand upon this research by testing pathways from girls’ inhibitory control at age 7 years, an aspect of self-regulation, to their psychosocial, cognitive, and weight outcomes from ages 9 to 15 years (n = 192). Results supported the hypothesis that greater inhibitory control is independently associated with better subsequent psychosocial, cognitive, and weight outcomes. These findings, combined with evidence that self-regulatory capacities are modifiable in early childhood, offer opportunities for interdisciplinary preventive interventions aiming to promote child health and well-being across domains and over time.

Obesity and the Neurocognitive Basis of Food Reward and the Control of Intake

Article

Full-text available

Jul 2015

With the rising prevalence of obesity, hedonic eating has become an important theme in obesity research. Hedonic eating is thought to be that driven by the reward of food consumption and not metabolic need, and this has focused attention on the brain reward system and how its dysregulation may cause overeating and obesity. Here, we begin by examining the brain reward system and the evidence for its dysregulation in human obesity. We then consider the issue of how individuals are able to control their hedonic eating in the present obesogenic environment and compare 2 contrasting perspectives on the control of hedonic eating, specifically, enhanced control of intake via higher cognitive control and loss of control over intake as captured by the food addiction model. We conclude by considering what these perspectives offer in terms of directions for future research and for potential interventions to improve control over food intake at the population and the individual levels. © 2015 American Society for Nutrition.

Polycystic Ovary Syndrome: Important Underrecognised Cardiometabolic Risk Factor in Reproductive-Age Women

Article

Full-text available

Jun 2015

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder amongst women of reproductive age. Although PCOS is diagnosed exclusively based on reproductive criteria, it is also a metabolic disorder. Insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, obesity, and dyslipidemia are more common in women with PCOS than in age-comparable women without PCOS. Many of the metabolic abnormalities that manifest in PCOS are worsened by the concurrent incidence of obesity. However, some of these metabolic perturbations occur even in lean women with PCOS and therefore are rightfully recognized as intrinsic to PCOS. The intrinsic factors that produce these metabolic disturbances are reviewed in this paper. The consequences of obesity and the other metabolic aberrations are also discussed. The metabolic perturbations in PCOS patients lead to chronic low-grade inflammation and to cardiovascular impairments that heighten the risk of having cardiovascular disease. Even though many studies have shown an elevation in surrogate biomarkers of cardiovascular disease in PCOS women, it is still not clear to what extent and magnitude the elevation precipitates more frequent and earlier events.

The Relationship between Total Water Intake and Cognitive Control among Prepubertal Children

Article

Full-text available

Jun 2015
ANN NUTR METAB

Cognitive control (also known as executive function) encompasses mental processes that underlie goal-directed behavior, and it enables us to adjust our behavior according to changing environmental demands. Previous research among children has demonstrated that aerobic fitness and obesity have contrasting and selective effects on cognitive control. However, the relationship between water intake and childhood cognitive control remains inadequately studied. This study investigated the relationship between total water intake and cognitive control among prepubertal children (8-9-year olds). Children between 8 and 9 years of age (n = 63) performed a modified flanker task to assess cognitive control related to inhibition (ability to resist distractions and maintain focus). Diet was measured using 3-day food records. Total water was defined as water consumed from drinking water, beverages, and food. A comparison of task performance across the median intake of total water revealed that children above the median exhibited shorter reaction times across multiple conditions of the flanker task, requiring variable amounts of cognitive control. Further, after adjustment of age, IQ, socioeconomic status, weight status, and aerobic fitness level, the proportion of intake comprised of water (%TW) was negatively correlated with reaction time interference, that is, the ability to maintain task performance when task conditions demanded greater inhibition. These results indicate an association between water intake and cognitive control using a task that modulates inhibition. Specifically, higher water intake correlated with greater ability to maintain task performance when inhibitory demands are increased. Future work is needed to determine the mechanism by which water influences cognitive control among children. © 2015 S. Karger AG, Basel.

Inhibitory control in otherwise healthy overweight 10-year-old children

Article

Full-text available

Apr 2015
INT J OBESITY

Preventing obesity is a worldwide public health priority. In vulnerable children living in obesogenic environments, with easy access to high-caloric food, alterations in inhibitory control functions might favor excessive food intake and affect energy regulation. We hypothesized that overweight/obese children would present lower inhibitory control in comparison to normal weight children. We measured inhibitory control functions in 93 otherwise healthy overweight/obese and 92 normal weight 10-year-old children using the Stroop test and the Go/No-Go task. Event-related potentials were recorded during the Go/No-Go task. Overweight/obese children showed slower reaction times (1248.6 ms [95% CI: 1182.9-1314.3] vs 1149.0 ms [95% CI: 1083.0-1215.1]) on the Stroop test, higher reaction time variability (0.25 [95% CI: 0.22-0.27] vs 0.21 [95% CI: 0.19-0.24]) on the Go/No-Go task and decreased P300 amplitude (4.1 μV [95% CI: 3.0-5.2] vs 6.4 μV [95% CI: 5.2-7.6]) on event-related potentials compared to normal weight children. Our results indicate altered inhibitory control functions in otherwise healthy overweight/obese children, which might contribute to their excessive food consumption.International Journal of Obesity accepted article preview online, 14 April 2015. doi:10.1038/ijo.2015.49.

Immune Regulation of Metabolic Homeostasis in Health and Disease

Article

Full-text available

Mar 2015

Obesity is an increasingly prevalent disease worldwide. While genetic and environmental factors are known to regulate the development of obesity and associated metabolic diseases, emerging studies indicate that innate and adaptive immune cell responses in adipose tissue have critical roles in the regulation of metabolic homeostasis. In the lean state, type 2 cytokine-associated immune cell responses predominate in white adipose tissue and protect against weight gain and insulin resistance through direct effects on adipocytes and elicitation of beige adipose. In obesity, these metabolically beneficial immune pathways become dysregulated, and adipocytes and other factors initiate metabolically deleterious type 1 inflammation that impairs glucose metabolism. This review discusses our current understanding of the functions of different types of adipose tissue and how immune cells regulate adipocyte function and metabolic homeostasis in the context of health and disease and highlights. We also highlight the potential of targeting immuno-metabolic pathways as a therapeutic strategy to treat obesity and associated diseases. Copyright © 2015 Elsevier Inc. All rights reserved.

Selective Insulin Resistance in Homeostatic and Cognitive Control Brain Areas in Overweight and Obese Adults

Article

Full-text available

Mar 2015

Impaired brain insulin action has been linked to obesity, type 2 diabetes, and neurodegenerative diseases. To date, the central nervous effects of insulin in obese humans still remain ill-defined, and no study thus far has evaluated the specific brain areas affected by insulin resistance. In 25 healthy lean and 23 overweight/obese participants, we performed magnetic resonance imaging to measure cerebral blood flow (CBF) before and 15 and 30 min after application of intranasal insulin or placebo. Additionally, participants explicitly rated pictures of high-caloric savory and sweet food 60 min after the spray for wanting and liking. In response to insulin compared with placebo, we found a significant CBF decrease in the hypothalamus in both lean and overweight/obese participants. The magnitude of this response correlated with visceral adipose tissue independent of other fat compartments. Furthermore, we observed a differential response in the lean compared with the overweight/obese group in the prefrontal cortex, resulting in an insulin-induced CBF reduction in lean participants only. This prefrontal cortex response significantly correlated with peripheral insulin sensitivity and eating behavior measures as disinhibition and food craving. Behaviorally, we were able to observe a significant reduction for the wanting of sweet foods after insulin application in lean men only. Brain insulin action was selectively impaired in the prefrontal cortex in overweight and obese adults and in the hypothalamus in participants with high visceral adipose tissue, potentially promoting an altered homeostatic set point and reduced inhibitory control contributing to overeating behavior. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Current review of genetics of human obesity: from molecular mechanisms to an evolutionary perspective

Article

Full-text available

Mar 2015

It is well-known that obesity is a complex multifactorial and heterogeneous condition with an important genetic component. Recently, major advances in obesity research emerged concerning the molecular mechanisms contributing to the obese condition. This review outlines several studies and data concerning the genetics and other important factors in the susceptibility risk to develop obesity. Based in the genetic etiology three main categories of obesity are considered: monogenic, syndromic, and common obesity. For the monogenic forms of obesity, the gene causing the phenotype is clearly identified, whereas for the common obesity the loci architecture underlying the phenotype is still being characterized. Given that, in this review we focus mainly in this obesity form, reviewing loci found until now by genome-wide association studies related with the susceptibility risk to develop obesity. Moreover, we also detail the obesity-related loci identified in children and in different ethnic groups, trying to highlight the complexity of the genetics underlying the common obese phenotype. Importantly, we also focus in the evolutionary hypotheses that have been proposed trying to explain how natural selection favored the spread of genes that increase the risk for an obese phenotype and how this predisposition to obesity evolved. Other factors are important in the obesity condition, and thus, we also discuss the epigenetic mechanisms involved in the susceptibility and development of obesity. Covering all these topics we expect to provide a complete and recent perspective about the underlying mechanisms involved in the development and origin of obesity. Only with a full understanding of the factors and mechanisms contributing to obesity, it will be possible to provide and allow the development of new therapeutic approaches to this condition.

Neural Circuits for Cognitive Appetite Control in Healthy and Obese Individuals: An fMRI Study

Article

Full-text available

Feb 2015
PLOS ONE

The mere sight of foods may activate the brain's reward circuitry, and humans often experience difficulties in inhibiting urges to eat upon encountering visual food signals. Imbalance between the reward circuit and those supporting inhibitory control may underlie obesity, yet brain circuits supporting volitional control of appetite and their possible dysfunction that can lead to obesity remain poorly specified. Here we delineated the brain basis of volitional appetite control in healthy and obese individuals with functional magnetic resonance imaging (fMRI). Twenty-seven morbidly obese women (mean BMI = 41.4) and fourteen age-matched normal-weight women (mean BMI = 22.6) were scanned with 1.5 Tesla fMRI while viewing food pictures. They were instructed to inhibit their urge to eat the foods, view the stimuli passively or imagine eating the foods. Across all subjects, a frontal cortical control circuit was activated during appetite inhibition versus passive viewing of the foods. Inhibition minus imagined eating (appetite control) activated bilateral precunei and parietal cortices and frontal regions spanning anterior cingulate and superior medial frontal cortices. During appetite control, obese subjects had lower responses in the medial frontal, middle cingulate and dorsal caudate nuclei. Functional connectivity of the control circuit was increased in morbidly obese versus control subjects during appetite control, which might reflect impaired integrative and executive function in obesity.

Obesity and dissociable forms of impulsivity in young adults

Article

Full-text available

Feb 2015

Obesity is one of the leading causes of preventable morbidity and mortality, and young people are increasingly affected. The aim of this study was to examine relationships between obesity and dissociable forms of impulsivity in young adults. A group of young adults (511) was recruited from city areas in the United States using media advertisements. These young adults were administered careful and extensive clinical and neurocognitive assessment in order to quantify different aspects of impulsivity (behavioral/phenomenological-, cognitive-, and personality-related measures). Associations between obesity and impulsivity were explored using multivariate analysis of variance and discriminant function analysis. 10.8% of the sample was obese, and 21.5% was overweight. Compared to controls, subjects with obesity showed significantly elevated rates of maladaptive gambling behaviors, monetary amounts lost to gambling, nicotine consumption, impulsive action (prolonged stop-signal reaction times in the Stop-Signal Test), and impulsive decision-making (reduced modulation of behavior as a function of risk in the Cambridge Gamble Test). Even accounting for potential confounding variables, obesity was significantly predicted by female gender, older age, more maladaptive gambling behaviors, and worse inhibitory control (stop-signal reaction times). Obesity is associated with several dissociable forms of impulsivity in young people, especially gambling and impulse dyscontrol. Family doctors should screen for gambling problems in obese young adults. Successful treatment of nicotine dependence in young obese people is likely to require intensive weight management support. Neuropsychological deficits relating to impulsivity occur in obese people in early adulthood, and may represent vulnerability markers rather than being due to chronic untoward metabolic effects on brain function.

The Natural Course of Healthy Obesity Over 20 Years

Article

Full-text available

Jan 2015
J AM COLL CARDIOL

Intense interest surrounds the “healthy” obese phenotype, which is defined as obesity in the absence of metabolic risk factor clustering (1). Efforts to understand the cardiovascular consequences of healthy obesity are ongoing (2); however, its conceptual validity and clinical value rest on the assumption that it is a stable physiological state, rather than a transient phase of obesity-associated metabolic deterioration. Therefore, a fundamental question is whether healthy obese adults maintain this metabolically healthy profile over the long term or naturally transition into unhealthy obesity over time. Few studies have examined this; in those that have, durations of follow-up have been modest, with none exceeding 10 years (3,4). Accordingly, we aimed to describe the natural course of healthy obesity over 2 decades in a large population-based study.

Microglia Dictate the Impact of Saturated Fat Consumption on Hypothalamic Inflammation and Neuronal Function

Article

Full-text available

Dec 2014

Diets rich in saturated fat produce inflammation, gliosis, and neuronal stress in the mediobasal hypothalamus (MBH). Here, we show that microglia mediate this process and its functional impact. Although microglia and astrocytes accumulate in the MBH of mice fed a diet rich in saturated fatty acids (SFAs), only the microglia undergo inflammatory activation, along with a buildup of hypothalamic SFAs. Enteric gavage specifically with SFAs reproduces microglial activation and neuronal stress in the MBH, and SFA treatment activates murine microglia, but not astrocytes, in culture. Moreover, depleting microglia abrogates SFA-induced inflammation in hypothalamic slices. Remarkably, depleting microglia from the MBH of mice abolishes inflammation and neuronal stress induced by excess SFA consumption, and in this context, microglial depletion enhances leptin signaling and reduces food intake. We thus show that microglia sense SFAs and orchestrate an inflammatory process in the MBH that alters neuronal function when SFA consumption is high.

Dopamine and glucose, obesity, and reward deficiency syndrome

Article

Full-text available

Sep 2014

Obesity as a result of overeating as well as a number of well described eating disorders has been accurately considered to be a world-wide epidemic. Recently a number of theories backed by a plethora of scientifically sound neurochemical and genetic studies provide strong evidence that food addiction is similar to psychoactive drug addiction. Our laboratory has published on the concept known as Reward Deficiency Syndrome (RDS) which is a genetic and epigenetic phenomena leading to impairment of the brain reward circuitry resulting in a hypo-dopaminergic function. RDS involves the interactions of powerful neurotransmitters and results in abnormal craving behavior. A number of important facts which could help translate to potential therapeutic targets espoused in this focused review include: (1) consumption of alcohol in large quantities or carbohydrates binging stimulates the brain’s production of and utilization of dopamine; (2) in the meso-limbic system the enkephalinergic neurons are in close proximity, to glucose receptors; (3) highly concentrated glucose activates the calcium channel to stimulate dopamine release from P12 cells; (4) a significant correlation between blood glucose and cerebrospinal fluid concentrations of homovanillic acid the dopamine metabolite; (5) 2-deoxyglucose (2DG), the glucose analog, in pharmacological doses is associated with enhanced dopamine turnover and causes acute glucoprivation. Evidence from animal studies and fMRI in humans support the hypothesis that multiple, but similar brain circuits are disrupted in obesity and drug dependence and for the most part, implicate the involvement of DA-modulated reward circuits in pathologic eating behaviors. Based on a consensus of neuroscience research treatment of both glucose and drug like cocaine, opiates should incorporate dopamine agonist therapy in contrast to current theories and practices that utilizes dopamine antagonistic therapy. Considering that up until now clinical utilization of powerful dopamine D2 agonists have failed due to chronic down regulation of D2 receptors newer targets based on novel less powerful D2 agonists that up-regulate D2 receptors seems prudent. We encourage new strategies targeted at improving DA function in the treatment and prevention of obesity a subtype of reward deficiency.

Poor ability to resist tempting calorie rich food is linked to altered balance between neural systems involved in urge and self-control

Article

Full-text available

Sep 2014
Nutr J

Background The loss of self-control or inability to resist tempting/rewarding foods, and the development of less healthful eating habits may be explained by three key neural systems: (1) a hyper-functioning striatum system driven by external rewarding cues; (2) a hypo-functioning decision-making and impulse control system; and (3) an altered insula system involved in the translation of homeostatic and interoceptive signals into self-awareness and what may be subjectively experienced as a feeling. Methods The present study examined the activity within two of these neural systems when subjects were exposed to images of high-calorie versus low-calorie foods using functional magnetic resonance imaging (fMRI), and related this activity to dietary intake, assessed by 24-hour recall. Thirty youth (mean BMI = 23.1 kg/m2, range = 19.1 - 33.7; age =19.7 years, range = 14 - 22) were scanned using fMRI while performing food-specific go/nogo tasks. Results Behaviorally, participants more readily pressed a response button when go trials consisted of high-calorie food cues (HGo task) and less readily pressed the response button when go trials consisted of low-calorie food cues (LGo task). This habitual response to high-calorie food cues was greater for individuals with higher BMI and individuals who reportedly consume more high-calorie foods. Response inhibition to the high-calorie food cues was most difficult for individuals with a higher BMI and individuals who reportedly consume more high-calorie foods. fMRI results confirmed our hypotheses that (1) the "habitual" system (right striatum) was more activated in response to high-calorie food cues during the go trials than low-calorie food go trials, and its activity correlated with participants’ BMI, as well as their consumption of high-calorie foods; (2) the prefrontal system was more active in nogo trials than go trials, and this activity was inversely correlated with BMI and high-calorie food consumption. Conclusions Using a cross-sectional design, our findings help increase understanding of the neural basis of one’s loss of ability to self-control when faced with tempting food cues. Though the design does not permit inferences regarding whether the inhibitory control deficits and hyper-responsivity of reward regions are individual vulnerability factors for overeating, or the results of habitual overeating.

Predicting Development of the Metabolically Healthy Obese Phenotype

Article

Full-text available

Jul 2014
INT J OBESITY

Objective: The metabolically healthy (MHO) and unhealthy obese (MUHO) differ in terms of cardiovascular risk. However, little is known about predicting the development of these phenotypes and the future stability of the MHO phenotype. Therefore, we examined these two issues in the San Antonio Heart Study. Design: Longitudinal, population-based study of cardiometabolic risk factors among Mexican Americans and non-Hispanic whites in San Antonio. Subjects: The study sample included 2368 participants with neither MUHO nor diabetes at baseline. Median follow-up was 7.8 years. MHO was defined as obesity with ⩽1 metabolic abnormality; MUHO, as obesity with ⩾2 abnormalities. Results: At baseline, 1595 and 498 individuals were non-obese with ⩽1 and ⩾2 metabolic abnormalities, respectively, and 275 were MHO. Among non-obese individuals, independent predictors of incident MHO (odds ratio (OR) for 1 s.d. change (95% confidence interval)) included body mass index (8.12 (5.66-11.7)), triglycerides (0.52 (0.39-0.68)) and high-density lipoprotein cholesterol (HDL-C) (1.41 (1.11-1.81)), whereas independent predictors of incident MUHO included body mass index (5.97 (4.58-7.77)) and triglycerides (1.26 (1.05-1.51)). Among participants with ⩽1 metabolic abnormality, obesity was associated with greater odds of developing multiple metabolic abnormalities (OR 2.26 (1.74-2.95)). Conclusions: Triglycerides and HDL-C may be useful for predicting progression to MHO. MHO may not be a stable condition, because it confers an increased risk of developing multiple metabolic abnormalities.

Obesity: A chronic relapsing progressive disease process. A position statement of the World Obesity Federation

Article

May 2017
OBES REV

This paper considers the argument for obesity as a chronic relapsing disease process. Obesity is viewed from an epidemiological model, with an agent affecting the host and producing disease. Food is the primary agent, particularly foods that are high in energy density such as fat, or in sugar-sweetened beverages. An abundance of food, low physical activity and several other environmental factors interact with the genetic susceptibility of the host to produce positive energy balance. The majority of this excess energy is stored as fat in enlarged, and often more numerous fat cells, but some lipid may infiltrate other organs such as the liver (ectopic fat). The enlarged fat cells and ectopic fat produce and secrete a variety of metabolic, hormonal and inflammatory products that produce damage in organs such as the arteries, heart, liver, muscle and pancreas. The magnitude of the obesity and its adverse effects in individuals may relate to the virulence or toxicity of the environment and its interaction with the host. Thus, obesity fits the epidemiological model of a disease process except that the toxic or pathological agent is food rather than a microbe. Reversing obesity will prevent most of its detrimental effects.

Early life cognitive abilities and body weight. Cross-sectional study of the association of inhibitory control, cognitive flexibility, and sustained attention with BMI percentiles in primary school children

Article

Jan 2014

Obesity

Article

Jan 2017

The prevalence of obesity-related hypertension is high worldwide and has become a major health issue. The mechanisms by which obesity relates to hypertensive disease are still under intense research scrutiny, and include altered hemodynamics, impaired sodium homeostasis, renal dysfunction, autonomic nervous system imbalance, endocrine alterations, oxidative stress and inflammation, and vascular injury. Most of these contributing factors interact with each other at multiple levels. Thus, as a multifactorial and complex disease, obesity-related hypertension should be recognized as a distinctive form of hypertension, and specific considerations should apply in planning therapeutic approaches to treat obese individuals with high blood pressure.

Metabolic phenotypes of obesity: Frequency, correlates, and change over time in a cohort of postmenopausal women

Article

Oct 2016

Objective: The possibility that a subset of persons who are obese may be metabolically healthy-referred to as the 'metabolically healthy obese' (MHO) phenotype-has attracted attention recently. However, few studies have followed individuals with MHO or other obesity phenotypes over time to assess change in their metabolic profiles. The aim of the present study was to examine transitions over a 6-year period among different states defined simultaneously by body mass index (BMI) and the presence/absence of the metabolic syndrome (MetS). Methods: We used repeated measurements available for a subcohort of participants enrolled in the Women's Health Initiative (N=3512) and followed for an average of 6 years to examine the frequency of different metabolic obesity phenotypes at baseline, the 6-year transition probabilities to other states and predictors of the risk of different transitions. Six phenotypes were defined by cross-tabulating BMI (18.5-<25.0, 25.0-<30.0, ⩾30.0 kg m-2) by MetS (yes, no). A continuous-time Markov model was used to estimate 6-year transition probabilities from one state to another. Results: Over the 6 years of follow-up, one-third of women with the healthy obese phenotype transitioned to the metabolically unhealthy obese (MUO) phenotype. Overall, there was a marked tendency toward increased metabolic deterioration with increasing BMI and toward metabolic improvement with lower BMI. Among MHO women, the 6-year probability of becoming MUO was 34%, whereas among unhealthy normal-weight women, the probability of 'regressing' to the metabolically healthy normal-weight phenotype was 52%. Conclusions: The present study demonstrated substantial change in metabolic obesity phenotypes over a 6-year period. There was a marked tendency toward metabolic deterioration with greater BMI and toward metabolic improvement with lower BMI.

Modulation of Gonadotropin-Releasing Hormone Pulse Generator Sensitivity to Progesterone Inhibition in Hyperandrogenic Adolescent Girls—Implications for Regulation of Pubertal Maturation

Article

Jun 2009

Lorcaserin administration decreases activation of brain centers in response to food cues and these emotion- and salience-related changes correlate with weight loss effects: a four week long randomized, placebo-controlled, double-blinded clinical trial

Article

Jul 2016
DIABETES

Lorcaserin is a serotonin 5-hydroxytryptamine 2c receptor agonist effective in treating obesity. Studies in rodents have shown that lorcaserin acts in the brain to exert its weight-reducing effects, but this has not yet been studied in humans. We performed a randomized, placebocontrolled, double-blind trial with 48 obese participants and used functional MRI to study the effects of lorcaserin on the brain. Subjects taking lorcaserin had decreased brain activations in the attention-related parietal and visual cortices in response to highly palatable food cues at 1 week in the fasting state and in the parietal cortex in response to any food cues at 4 weeks in the fed state. Decreases in emotion- and salience-related limbic activity, including the insula and amygdala, were attenuated at 4 weeks. Decreases in caloric intake, weight, and BMI correlated with activations in the amygdala, parietal, and visual cortices at baseline. These data suggest that lorcaserin exerts its weight-reducing effects by decreasing attention-related brain activations to food cues (parietal and visual cortices) and emotional and limbic activity (insula, amygdala). Results indicating that baseline activation of the amygdala relates to increased efficacy suggest that lorcaserin would be of particular benefit to emotional eaters.

Erratum: NIH Working Group Report - Using Genomic Information to Guide Weight Management: From Universal to Precision Treatment (Obesity (2016) 24 (14-22) DOI: 10.1002/oby.21381)

Article

Mar 2016
OBESITY

Nature and Nurture in Early Feeding Behavior

Article

Apr 2016

Obesity has reached epidemic proportions and research into its prevention is increasingly focusing on the earliest stages of life. Avidity of appetite has been linked to a higher risk of obesity, but studies in infancy were scarce. The Gemini twin cohort was established to investigate genetic and environmental determinants of weight trajectories in early childhood with a focus on appetite and the home environment. Gemini families have been supplying questionnaire data at regular intervals, starting when the twins were 8 months old. Analyses of data on infant appetite and weight have provided a number of important findings. Firstly, a prospective study found that appetite in infancy drives weight gain more strongly than weight drives appetite, although the two processes do coexist. A further study using a subsample of twins discordant for appetite ruled out the possibility of familial confounding, suggesting a causal role for appetite in weight. Heritability estimates for appetitive traits were moderate to high (53-84%). Finally, multivariate analyses indicated that roughly one third of the genes related to weight are also related to appetite and vice versa. Environmental factors affecting appetite in infancy are understudied, but some potential strategies for minimizing over- or underconsumption by at-risk individuals are suggested.

Short-term administration of the GLP-1 analog liraglutide decreases circulating leptin and increases GIP levels and these changes are associated with alterations in CNS responses to food cues: A randomized, placebo-controlled, crossover study

Article

Mar 2016
METABOLISM

Central Nervous System Regulation of Eating: Insights from Human Brain Imaging

Article

Feb 2016

Appetite and body weight regulation are controlled by the central nervous system (CNS) in a rather complicated manner. The human brain plays a central role in integrating internal and external inputs to modulate energy homeostasis. Although homeostatic control by the hypothalamus is currently considered to be primarily responsible for controlling appetite, most of the available evidence derives from experiments in rodents, and the role of this system in regulating appetite in states of hunger/starvation and in the pathogenesis of overeating/obesity remains to be fully elucidated in humans. Further, cognitive and affective processes have been implicated in the dysregulation of eating behavior in humans, and their exact relative contributions as well as the respective underlying mechanisms remain unclear. We briefly review each of these systems here and present the current state of research in an attempt to update clinicians and clinical researchers alike on the status and future directions of obesity research.

Obesity is associated with hypothalamic injury in rodents and humans (The Journal of Clinical Investigation (2012) 122, 1, (153-162) DOI: 10.1172/JCI59660)

Article

Feb 2012

Molecular mechanisms of insulin resistance

Article

Jan 1989

S. Taylor

Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality

Article

Nov 2015
ANN INTERN MED

Background: The relationship between central obesity and survival in community-dwelling adults with normal body mass index (BMI) is not well-known. Objective: To examine total and cardiovascular mortality risks associated with central obesity and normal BMI. Design: Stratified multistage probability design. Setting: NHANES III (Third National Health and Nutrition Examination Survey). Participants: 15,184 adults (52.3% women) aged 18 to 90 years. Measurements: Multivariable Cox proportional hazards models were used to evaluate the relationship of obesity patterns defined by BMI and waist-to-hip ratio (WHR) and total and cardiovascular mortality risk after adjustment for confounding factors. Results: Persons with normal-weight central obesity had the worst long-term survival. For example, a man with a normal BMI (22 kg/m2) and central obesity had greater total mortality risk than one with similar BMI but no central obesity (hazard ratio [HR], 1.87 [95% CI, 1.53 to 2.29]), and this man had twice the mortality risk of participants who were overweight or obese according to BMI only (HR, 2.24 [CI, 1.52 to 3.32] and 2.42 [CI, 1.30 to 4.53], respectively). Women with normal-weight central obesity also had a higher mortality risk than those with similar BMI but no central obesity (HR, 1.48 [CI, 1.35 to 1.62]) and those who were obese according to BMI only (HR, 1.32 [CI, 1.15 to 1.51]). Expected survival estimates were consistently lower for those with central obesity when age and BMI were controlled for. Limitations: Body fat distribution was assessed based on anthropometric indicators alone. Information on comorbidities was collected by self-report. Conclusion: Normal-weight central obesity defined by WHR is associated with higher mortality than BMI-defined obesity, particularly in the absence of central fat distribution. Primary funding source: National Institutes of Health, American Heart Association, European Regional Development Fund, and Czech Ministry of Health.

New insights in leptin resistance mechanisms in mice

Article

Sep 2015
FRONT NEUROENDOCRIN

Leptin resistance is one of the main challenges of obesity. To date, two levels of resistance have been identified, first a decreased rate of leptin uptake into the brain and secondly a diminished central response to leptin. New findings have identified the mechanisms of leptin transport and demonstrated that it can be rescued in obesity, but it did not overcome the problem of central resistance. Alteration in the actions of leptin following diet-induced obesity (DIO) appears to be a multifactorial condition. Several phosphatases are inhibiting leptin signaling pathways in a pathological way. Besides, hypothalamic inflammation alters the neuronal circuits that control metabolism. Recent studies describing both mechanisms (inhibition of leptin signaling and inflammation), have provided key insights to potential new targets for treatment. However, recent data showing that DIO mice may conserve a cellular and physiological response to endogenous leptin, highlights the need to redefine the concept of "leptin resistance".

Leptin applications in 2015: What have we learned about leptin and obesity?

Article

Oct 2015
Curr Opin Endocrinol Diabetes Obes

To summarize previous and current advancements for leptin therapeutics, we described how leptin may be useful in leptin deficient states such as lipodystrophy, for which leptin was recently approved, and how it may be useful in the future for typical obesity. The discovery of leptin in 1994 built the foundation for understanding the pathophysiology and treatment of obesity. Leptin therapy reverses morbid obesity related to congenital leptin deficiency and appears to possibly treat lipodystrophy, a finding which has led to the approval of leptin for the treatment of lipodystrophy in the USA and Japan. Typical obesity, on the other hand, is characterized by hyperleptinemia and leptin tolerance. Thus, leptin administration has proven ineffective for inducing weight loss on its own but could possibly be useful in combination with other therapies or for weight loss maintenance. Leptin is not able to treat typical obesity; however, it is effective for reversing leptin deficiency-induced obesity and is possibly useful in lipodystrophy. New mechanisms and pathways involved in leptin resistance are continuously discovered, whereas the development of new techniques and drug combinations which may improve leptin's efficacy and safety regenerate the hope for its use as an effective treatment for typical obesity.

A novel thermal cycling test method for thermal barrier coatings under CMAS coupled condition

Article

Jan 2014

A thermal cycling test method of thermal barrier coatings (TBCs) under high temperature gradient, gas heating and CMAS(CaO-MgO-Al2O3-SiO2) deposition condition were proposed. The reasons for the early failure of the plasma-sprayed coating with CMAS deposits at 1200℃ were discussed. The results show that, thermal cycling life of TBCs without CMAS deposition is 573 cycles, and thermal cycling life of TBCs with CMAS deposition reduces to 70 cycles. CMAS infiltrates into the surface layer of ceramic coating, forms a dense layer, and transverse cracks increase. The failure of TBCs occurs mainly by peeling of the ceramic layer under CMAS coupled condition. ©, 2014, Beijing Institute of Aeronautical Materials (BIAM). All right reserved.

Leptin resistance in obesity: An epigenetic landscape

Article

May 2015

Leptin is an adipocyte-secreted hormone that inhibits food intake and stimulates energy expenditure through interactions with neuronal pathways in the brain, particularly pathways involving the hypothalamus. Intact functioning of the leptin route is required for body weight and energy homeostasis. Given its function, the discovery of leptin increased expectations for the treatment of obesity. However, most obese individuals and subjects with a predisposition to regain weight after losing it have leptin concentrations than lean individuals, but despite the anorexigenic function of this hormone, appetite is not effectively suppressed in these individuals. This phenomenon has been deemed leptin resistance and could be the result of impairments at a number of levels in the leptin signalling pathway, including reduced access of the hormone to its receptor due to changes in receptor expression or changes in post-receptor signal transduction. Epigenetic regulation of the leptin signalling circuit could be a potential mechanism of leptin function disturbance. This review discusses the molecular mechanisms, particularly the epigenetic regulation mechanisms, involved in leptin resistance associated with obesity and the therapeutic potential of these molecular mechanisms in the battle against the obesity pandemic. Copyright © 2015. Published by Elsevier Inc.

Being overweight or obese is associated with inhibition control in children from six to ten-years-of-age

Article

Feb 2015
Acta Paediatr Suppl

This study investigated the relationship between being overweight or obese and executive function in six to ten-year-olds. The participants were 515 children (250 boys) from schools in Reus, Spain. The initial sample was measured and weighed and assessed with the Children's Color Trail Test. Children classified as overweight, including obese, and their age and gender-matched controls (n=221), were assessed in a second phase with the Five Digit Test (FDT) and the Symbol Digit Modalities Test. Logistic regression models were applied to analyse the effect of executive functions on being overweight, including obese. We found that 28.9% of the children were overweight and 7.2% were obese. The FDT showed that inhibition (odds risk of 1.04, range 1.00-1.08, p=0.04) and flexibility (odds risk of 1.04, range 1.00-1.07, p=0.02) were significantly associated with overweight, including obesity, regardless of sociodemographic and psychopathological variables. These results suggest that children who were overweight or obese had a reduced ability to mobilise the cognitive effort required to inhibit involuntary responses and to switch between different mental operations. A developmental trajectory would provide important insights into the relationship between executive functioning pattern and the risk of being overweight or obese. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Dyslipidemia in Visceral Obesity

Article

Jul 2004

Visceral obesity is frequently associated with high plasma triglycerides and low plasma high density lipoprotein-cholesterol (HDL-C), and with high plasma concentrations of apolipoprotein B (apoB)-containing lipoproteins. Atherogenic dyslipidemia in these patients may be caused by a combination of overproduction of very low density lipoprotein (VLDL) apoB-100, decreased catabolism of apoB-containing particles, and increased catabolism of HDL-apoA-I particles. These abnormalities may be consequent on a global metabolic effect of insulin resistance. Weight reduction, increased physical activity, and moderate alcohol intake are first-line therapies to improve lipid abnormalities in visceral obesity. These lifestyle changes can effectively reduce plasma triglycerides and low density lipoprotein-cholesterol (LDL-C), and raise HDL-C. Kinetic studies show that in visceral obesity, weight loss reduces VLDL-apoB secretion and reciprocally upregulates LDL-apoB catabolism, probably owing to reduced visceral fat mass, enhanced insulin sensitivity and decreased hepatic lipogenesis. Adjunctive pharmacologic treatments, such as HMG-CoA reductase inhibitors, fibric acid derivatives, niacin (nicotinic acid), or fish oils, may often be required to further correct the dyslipidemia. Therapeutic improvements in lipid and lipoprotein profiles in visceral obesity can be achieved by several mechanisms of action, including decreased secretion and increased catabolism of apoB, as well as increased secretion and decreased catabolism of apoA-I. Clinical trials have provided evidence supporting the use of HMG-CoA reductase inhibitors and fibric acid derivatives to treat dyslipidemia in patients with visceral obesity, insulin resistance and type 2 diabetes mellitus. Since drug monotherapy may not adequately optimize dyslipoproteinemia, dual pharmacotherapy may be required, such as HMG-CoA reductase inhibitor/fibric acid derivative, HMG-CoA reductase inhibitor/niacin and HMG-CoA reductase inhibitor/fish oils combinations. Newer therapies, such as cholesterol absorption inhibitors, cholesteryl ester transfer protein antagonists and insulin sensitizers, could also be employed alone or in combination with other agents to optimize treatment. The basis for a multiple approach to correcting dyslipoproteinemia in visceral obesity and the metabolic syndrome relies on understanding the mechanisms of action of the individual therapeutic components.

Leptin resistance and diet-induced obesity: Central and peripheral actions of leptin

Article

Jan 2015

Gender differences in the association between stop-signal reaction times, body mass indices and/or spontaneous food intake in pre-school children: An early model of compromised inhibitory control and obesity

Article

Dec 2014
INT J OBESITY

Background Poor inhibitory control is associated with overeating and/or obesity in school-age children, adolescents and adults. The current study examined whether an objective and reliable marker of response inhibition, the Stop-Signal Reaction Time (SSRT), is associated with BMI z-scores and/or food intake during a snack test in pre-school children.Methods The current sample consisted of 193 pre-school children taking part in a longitudinal study of early brain development (Maternal Adversity, Vulnerability and Neurodevelopment-the MAVAN project). Linear mixed-effect models were used to examine whether the SSRT measured at age 48 months associated with BMI z-scores and/or dietary intake during a laboratory-based snack test.ResultsAfter controlling for significant co-variates including maternal BMI, there was a significant gender by SSRT interaction effect in predicting 48-month BMI z-scores. Post-hoc analysis revealed an association between longer SSRTs (poor response inhibition) and higher BMIs in girls but not boys. Across both girls and boys, longer SSRTs were associated with greater intake of carbohydrates and sugars during the snack test. The association between SSRT scores and BMI z-scores in girls was not statistically mediated by carbohydrate or sugar intake.Conclusions At 48 months of age, slower response inhibition on the Stop-Signal Task associates with higher BMI-z scores in girls, and with higher intake of carbohydrates and sugars during a snack test across both genders. Ongoing follow-up of these children will help clarify the implications of these associations for longer term macronutrient intake, eating-related pathology and/or pathological weight gain over time.International Journal of Obesity accepted article preview online, 16 December 2014. doi:10.1038/ijo.2014.207.

Leptin: A hormone linking activation of neuroendocrine axes with neuropathology

Article

Jan 2015

Reward processing in obesity, substance addiction and non-substance addiction

Article

Oct 2014
OBES REV

Similarities and differences between obesity and addiction are a prominent topic of ongoing research. We conducted an activation likelihood estimation meta-analysis on 87 studies in order to map the functional magnetic resonance imaging (fMRI) response to reward in participants with obesity, substance addiction and non-substance (or behavioural) addiction, and to identify commonalities and differences between them. Our study confirms the existence of alterations during reward processing in obesity, non-substance addiction and substance addiction. Specifically, participants with obesity or with addictions differed from controls in several brain regions including prefrontal areas, subcortical structures and sensory areas. Additionally, participants with obesity and substance addictions exhibited similar blood-oxygen-level-dependent fMRI hyperactivity in the amygdala and striatum when processing either general rewarding stimuli or the problematic stimuli (food and drug-related stimuli, respectively). We propose that these similarities may be associated with an enhanced focus on reward – especially with regard to food or drug-related stimuli – in obesity and substance addiction. Ultimately, this enhancement of reward processes may facilitate the presence of compulsive-like behaviour in some individuals or under some specific circumstances. We hope that increasing knowledge about the neurobehavioural correlates of obesity and addictions will lead to practical strategies that target the high prevalence of these central public health challenges.

Attentional bias to food-related visual cues: Is there a role in obesity?

Article

Sep 2014

The incentive sensitisation model of obesity suggests that modification of the dopaminergic associated reward systems in the brain may result in increased awareness of food-related visual cues present in the current food environment. Having a heightened awareness of these visual food cues may impact on food choices and eating behaviours with those being most aware of or demonstrating greater attention to food-related stimuli potentially being at greater risk of overeating and subsequent weight gain. To date, research related to attentional responses to visual food cues has been both limited and conflicting. Such inconsistent findings may in part be explained by the use of different methodological approaches to measure attentional bias and the impact of other factors such as hunger levels, energy density of visual food cues and individual eating style traits that may influence visual attention to food-related cues outside of weight status alone. This review examines the various methodologies employed to measure attentional bias with a particular focus on the role that attentional processing of food-related visual cues may have in obesity. Based on the findings of this review, it appears that it may be too early to clarify the role visual attention to food-related cues may have in obesity. Results however highlight the importance of considering the most appropriate methodology to use when measuring attentional bias and the characteristics of the study populations targeted while interpreting results to date and in designing future studies.

Stress- and PTSD-associated obesity and metabolic dysfunction: A growing problem requiring further research and novel treatments

Article

Aug 2014
METABOLISM

Posttraumatic stress disorder (PTSD) is a growing public health concern. More recently, evidence has indicated that PTSD leads to obesity and associated metabolic dysfunction. Possible mechanisms of this link are through dysfunction of the hypothalamic-pituitary-adrenal axis and related moderation of appetite hormones and neural activity, leading to changes in consumptive behaviors. Although research has been examining associations between PTSD and obesity, diabetes, cardiovascular disease, and metabolic syndrome, future research should delineate potential mechanisms for these associations and develop targeted treatments to reduce these metabolic outcomes.

Genetic architecture of type 2 diabetes

Article

Sep 2014
BIOCHEM BIOPH RES CO

Genome-wide association studies (GWAS) have identified over 70 loci associated with type 2 diabetes (T2D). Most genetic variants associated with T2D are common variants with modest effects on T2D and are shared with major ancestry groups. To what extent the genetic component of T2D can be explained by common variants relies upon the shape of the genetic architecture of T2D. Fine mapping utilizing populations with different patterns of linkage disequilibrium and functional annotation derived from experiments in relevant tissues are mandatory to track down causal variants responsible for the pathogenesis of T2D.

Leptin and the brain: Influences on brain development, cognitive functioning and psychiatric disorders

Article

Jul 2014
METABOLISM

Obesity as a Disease

Abstract

No full-text available

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