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Sample records for obese patients correlation

  1. [Applying method of correlative adaptometry for evaluating of treatment efficiency of obese patients].

    PubMed

    Vasil'ev, A V; Mal'tsev, G Iu; Khrushcheva, Iu V; Razzhevaĭkin, V N; Shpitonkov, M I

    2007-01-01

    By the method of correlative adaptometry was perfomed a treatment of many physiological and biochemical data from patients with different degree of obese and in during dietotherapy treatment. It was shown that weight of correlative graphs of more informative parameters was originally high and parallel with the heave of disease and was decreases during a dietotherapy. It was concluded, that correlative adaptometry is the promising method of evaluation nutrition status and quality of dietotherapy. PMID:17561653

  2. Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder.

    PubMed

    Masheb, Robin M; White, Marney A; Grilo, Carlos M

    2016-05-01

    Sex differences and correlates of pain were examined in a sample of patients with comorbid binge eating disorder (BED) and obesity. One hundred fifty-two treatment-seeking patients with BED completed the Brief Pain Inventory. Analysis of covariance was utilized to compare women and men on pain, and correlational analysis, overall and by sex, was performed to examine relationships among pain, eating behaviour and metabolic risk factors. Women reported significantly greater pain severity and pain interference than men. Among women, eating behaviour and metabolic markers were not associated with pain. Among men, however, binge frequency was significantly associated with pain, as was high-density lipoprotein cholesterol and fasting glucose. In sum, while women in this sample had more pain than men, the presence of pain in men was associated with increased behavioural and metabolic risk factors. Findings have clinical implications for the assessment of comorbid pain and obesity-related health risks among individuals with BED. PMID:26841114

  3. Sex Differences and Correlates of Pain in Patients with Comorbid Obesity and Binge Eating Disorder

    PubMed Central

    Masheb, Robin M.; White, Marney A.; Grilo, Carlos M.

    2016-01-01

    Sex differences and correlates of pain were examined in a sample of patients with comorbid binge eating disorder (BED) and obesity. One hundred fifty-two treatment-seeking patients with BED completed the Brief Pain Inventory. Analysis of covariance was utilized to compare women and men on pain, and correlational analysis, overall and by sex, was performed to examine relationships among pain, eating behaviour and metabolic risk factors. Women reported significantly greater pain severity and pain interference than men. Among women, eating behaviour and metabolic markers were not associated with pain. Among men, however, binge frequency was significantly associated with pain, as was high-density lipoprotein cholesterol and fasting glucose. In sum, while women in this sample had more pain than men, the presence of pain in men was associated with increased behavioural and metabolic risk factors. Findings have clinical implications for the assessment of comorbid pain and obesity-related health risks among individuals with BED. PMID:26841114

  4. Dieting Frequency in Obese Patients With Binge Eating Disorder: Behavioral and Metabolic Correlates

    PubMed Central

    Roehrig, Megan; Masheb, Robin M.; White, Marney A.; Grilo, Carlos M.

    2013-01-01

    This study examined the clinical significance of self-reported frequency of time spent dieting in obese patients with binge eating disorder (BED). A total of 207 treatment-seeking obese BED patients (57 men and 150 women) were dichotomized by dieting frequency and gender and compared on a number of historical, psychological, and metabolic variables. Frequent dieters reported significantly earlier age of onset for binge eating, dieting, and obesity, more episodes of weight cycling, greater weight suppression, and greater eating disorder pathology than infrequent dieters; no differences, however, emerged on current binge eating frequency or psychological distress. Among women but not among men, frequent dieters had consistently lower chances of abnormalities in total cholesterol, high-density lipoprotein (HDL) cholesterol, and the total/HDL cholesterol ratio while infrequent dieters had greater chances of abnormalities on these variables. Dietary restraint was inversely correlated with abnormalities in triglycerides, HDL cholesterol, and the total/HDL cholesterol ratio but was unrelated to low-density lipoprotein (LDL) cholesterol. In summary, frequent dieters of both genders had greater lifetime and current eating and weight concerns, and in women, decreased chance of metabolic abnormalities than infrequent dieters. Our findings suggest that frequent dieting attempts, particularly in women, are associated with greater eating disorder pathology but may have a beneficial effect on metabolic functioning and cardiovascular disease risk independent of actual weight status. These findings may have implications for clinical advice provided to obese BED patients. PMID:19165172

  5. Lifetime Obesity in Patients with Eating Disorders: Increasing Prevalence, Clinical and Personality Correlates

    PubMed Central

    Villarejo, Cynthia; Fernández-Aranda, Fernando; Jiménez-Murcia, Susana; Peñas-Lledó, Eva; Granero, Roser; Penelo, Eva; Tinahones, Francisco J; Sancho, Carolina; Vilarrasa, Nuria; Montserrat-Gil de Bernabé, Mónica; Casanueva, Felipe F; Fernández-Real, Jose Manuel; Frühbeck, Gema; De la Torre, Rafael; Treasure, Janet; Botella, Cristina; Menchón, José Manuel

    2012-01-01

    Objectives : The aims of our study were to examine the lifetime prevalence of obesity rate in eating disorders (ED) subtypes and to examine whether there have been temporal changes among the last 10 years and to explore clinical differences between ED with and without lifetime obesity. Methods : Participants were 1383 ED female patients (DSM-IV criteria) consecutively admitted, between 2001 and 2010, to Bellvitge University Hospital. They were assessed by means of the Eating Disorders Inventory-2, the Symptom Checklist-90—Revised, the Bulimic Investigatory Test Edinburgh and the Temperament and Character Inventory—Revised. Results : The prevalence of lifetime obesity in ED cases was 28.8% (ranging from 5% in anorexia nervosa to 87% in binge-eating disorders). Over the last 10 years, there has been a threefold increase in lifetime obesity in ED patients (p < .001). People with an ED and obesity had higher levels of childhood and family obesity (p < .001), a later age of onset and longer ED duration; and had higher levels of eating, general and personality symptomatology. Conclusions : Over the last 10 years, the prevalence of obesity associated with disorders characterized by the presence of binge episodes, namely bulimic disorders, is increasing, and this is linked with greater clinical severity and a poorer prognosis. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. PMID:22383308

  6. Correlations between surrogate measures of insulin resistance and cardiovascular risk factors in obese and overweight patients.

    PubMed

    Lerman, Israel; Villa, Antonio R; Ríos Torres, Juan Manuel; Tamez, Laura Elena; Gómez Pérez, Francisco; del Villar Velasco, Sonia Luna; Rull Rodrigo, Juan Antonio

    2003-01-01

    There are different equations to estimate insulin sensitivity by using OGTT with a reasonable approximation to whole body sensitivity obtained with the glucose clamp. Further work is needed to address their role in clinical practice as markers of the metabolic syndrome and predictors for cardiovascular disease. In the present study, we determined plasma glucose and insulin values during an OGTT test in 144 overweight and obese individuals. We assessed insulin resistance by the use of different equations and established their relationship with cardiovascular risk factors associated to the insulin resistance syndrome. Distributed the patients by quintiles of body mass index (BMI), the different surrogate measures clearly demonstrated that the more obese individuals were the most insulin resistant, a similar but not significant trend was observed related to the other cardiovascular risk factors. Efforts to use both fasting and post-load glucose and insulin concentrations to create indexes for routine use in clinical practice do not seem to be particularly useful in overweight or obese patients, as most of these patients will be insulin-resistant and insulin resistance is closely linked but not equal to the metabolic syndrome. PMID:12614971

  7. Endoscopy in the obese patient.

    PubMed

    Schreiner, Mitchal A; Fennerty, M Brian

    2010-03-01

    Obese patients present many unique challenges to the endoscopist. Special consideration should be given to these patients, and endoscopists need to be aware of the additional challenges that may be present while performing endoscopic procedures on obese patients. This article reviews the special risks that obese patients face while undergoing endoscopy, endoscopic management of patients postbariatric surgery, and future role of endoscopy in the management of obese patients. PMID:20202582

  8. Plasma bile acids show a positive correlation with body mass index and are negatively associated with cognitive restraint of eating in obese patients

    PubMed Central

    Prinz, Philip; Hofmann, Tobias; Ahnis, Anne; Elbelt, Ulf; Goebel-Stengel, Miriam; Klapp, Burghard F.; Rose, Matthias; Stengel, Andreas

    2015-01-01

    Bile acids may be involved in the regulation of food intake and energy metabolism. The aim of the study was to investigate the association of plasma bile acids with body mass index (BMI) and the possible involvement of circulating bile acids in the modulation of physical activity and eating behavior. Blood was obtained in a group of hospitalized patients with normal weight (BMI 18.5–25 kg/m2), underweight (anorexia nervosa, BMI < 17.5 kg/m2) and overweight (obesity with BMI 30–40, 40–50 and >50 kg/m2, n = 14–15/group) and plasma bile acid concentrations assessed. Physical activity and plasma bile acids were measured in a group of patients with anorexia nervosa (BMI 14.6 ± 0.3 kg/m2, n = 43). Lastly, in a population of obese patients (BMI 48.5 ± 0.9 kg/m2, n = 85), psychometric parameters related to disordered eating and plasma bile acids were assessed. Plasma bile acids showed a positive correlation with BMI (r = 0.26, p = 0.03) in the population of patients with broad range of BMI (9–85 kg/m2, n = 74). No associations were observed between plasma bile acids and different parameters of physical activity in anorexic patients (p > 0.05). Plasma bile acids were negatively correlated with cognitive restraint of eating (r = −0.30, p = 0.008), while no associations were observed with other psychometric eating behavior-related parameters (p > 0.05) in obese patients. In conclusion, these data may point toward a role of bile acids in the regulation of body weight. Since plasma bile acids are negatively correlated with the cognitive restraint of eating in obese patients, this may represent a compensatory adaptation to prevent further overeating. PMID:26089773

  9. Progressive Care of Obese Patients.

    PubMed

    Dambaugh, Lori A; Ecklund, Margaret M

    2016-08-01

    Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36[4]:58-63). PMID:27481802

  10. Psychological correlates of childhood obesity.

    PubMed

    Puder, J J; Munsch, S

    2010-12-01

    To enhance the prevention and intervention efforts of childhood obesity, there is a strong need for the early detection of psychological factors contributing to its development and maintenance. Rather than a stable condition, childhood obesity represents a dynamic process, in which behavior, cognition and emotional regulation interact mutually with each other. Family structure and context, that is, parental and familial attitudes, activity, nutritional patterns as well as familial stress, have an important role with respect to the onset and maintenance of overweight and obesity. Behavioral and emotional problems are found in many, though not all, obese children, with a higher prevalence in clinical, treatment-seeking samples. The interrelatedness between obesity and psychological problems seems to be twofold, in that clinically meaningful psychological distress might foster weight gain and obesity may lead to psychosocial problems. The most frequently implicated psychosocial factors are externalizing (impulsivity and attention-deficit hyperactivity disorder) and internalizing (depression and anxiety) behavioral problems and uncontrolled eating behavior. These findings strengthen the need to further explore the interrelatedness between psychological problems and childhood obesity. PMID:21151145

  11. Leukocyte Activation in Obese Patients

    PubMed Central

    Minervino, Daniele; Gumiero, Daniela; Nicolazzi, Maria Anna; Carnicelli, Annamaria; Fuorlo, Mariella; Guidone, Caterina; Di Gennaro, Leonardo; Fattorossi, Andrea; Mingrone, Geltrude; Landolfi, Raffaele

    2015-01-01

    Abstract The rising prevalence of obesity is a major global health problem. In severe obesity, bariatric surgery (BS) allows to obtain a significant weight loss and comorbidities improvement, among them one of the factors is the thrombotic risk. In this observational study, we measured indices of leukocyte activation in severely obese patients as markers of increased thrombotic risk in relation with serum markers of inflammation before and after BS. Frequency of polymorphonuclear neutrophil-platelet (PLT) and monocyte (MONO)-PLT aggregates as well as of tissue factor (TF) expressing MONOs was measured in the peripheral blood of 58 consecutive obese patients and 30 healthy controls. In 31 of the 58 obese patients, data obtained at the enrollment were compared with those obtained at 3, 6, and 12 months after BS. Compared with healthy controls, obese patients showed a higher frequency of polymorphonuclear leukocyte (PMNL)-PLT aggregates (7.47 ± 2.45 [6.82–8.11]% vs 5.85 ± 1.89 [5.14–6.55]%, P = 0.001), MONO-PLT aggregates (12.31 ± 7.33 [10.38–14.24]% vs 8.14 ± 2.22 [7.31–8.97]%, P < 0.001), and TF expressing MONOs (4.01 ± 2.11 [3.45–4.56]% vs 2.64 ± 1.65 [2.02–3.25]%, P = 0.002). PMNL-PLT and MONO-PLT aggregate frequency was positively correlated with TF expressing MONOs (R2 = 0.260, P = 0.049 and R2 = 0.318, P = 0.015, respectively). BS was performed in 31 patients and induced a significant reduction of the body mass index, and waist and hip circumferences. These effects were associated with a significant decrease of PMNL-PLT aggregates at 12 months (7.58 ± 2.27 [6.75–8.42]% vs 4.47 ± 1.11 [3.93–5.01]%, P < 0.001), and a reduction of TF expressing MONOs at 6 (3.82 ± 2.04 [3.07–4.57]% vs 1.60 ± 1.69 [0.30–2.90]%, P = 0.008) and 12 months (3.82 ± 2.04 [3.07–4.57]% vs 1.71 ± 0.54 [1.45–1.97]%, P = 0.001) after BS. These data suggest that leukocyte

  12. Antimicrobial Dose in Obese Patient

    PubMed Central

    Kassab, Sawsan; Syed Sulaiman, Syed Azhar; Abdul Aziz, Noorizan

    2007-01-01

    Introduction Obesity is a chronic disease that has become one of major public health issue in Malaysia because of its association with other disease states including cardiovascular disease and diabetes. Despite continuous efforts to educate the public about the health risks associated with obesity, prevalence of the disease continues to increase. Dosing of many medications are based on weight, limited data are available on how antimicrobial agents should be dosed in obesity. The aim of this case presentation is to discuss dose of antibiotic in obese patient. Case report: Patient: GMN, Malay, Female, 45 year old, 150kg, transferred from medical ward to ICU with problems of fever, orthopnea, sepsis secondary to nosocomial pneumonia. She was admitted to hospital a week ago for SOB on exertion, cyanosis, mildly dyspneic, somasthenia, bilateral ankle swelling. There was no fever, cough, chest pain, clubbing, flapping tremor. Her grand father has pre-morbid history of obesity, HPT, DM and asthma. She was non alcoholic, smoker, and not on diet control. The diagnosis Pickwickian syndrome was made. Patient was treated with IV Dopamine 11mcg/kg/min, IV Morphine 4mg/h. IV GTN 15mcg/min, IV Ca gluconate 10g/24h for 3/7, IV Zantac 50mg tds, IV Augmentin 1.2g tds, IV Lasix 40mg od, IV Plasil 10mg tds, S.c heparin 5000IU bd. patient become stable and moved to medical ward to continue her treatment. Discussion: The altered physiologic function seen in obese patients is a concern in patients receiving antimicrobial agents because therapeutic outcomes depend on achieving a minimum inhibitory concentration (MIC). The therapeutic effect of any drug can be altered when any of the 4 pharmacokinetic processes (absorption, distribution, metabolism, or elimination) are altered. Decreased blood flow rates and increased renal clearance in obese patients can affect drug distribution and elimination. Changes in serum protein levels can change the metabolism and distribution of drugs that are

  13. Obesity and Insulin Resistance: An Abridged Molecular Correlation

    PubMed Central

    Mukherjee, Biswajit; Hossain, Chowdhury M; Mondal, Laboni; Paul, Paramita; Ghosh, Miltu K

    2013-01-01

    A relationship between obesity and type 2 diabetes is now generally well accepted. This relationship represents several major health hazards including morbid obesity and cardiovascular complications worldwide. Diabetes mellitus is a complex metabolic disorder characterized by impaired insulin release and insulin resistance. Lipids play an important physiological role in skeletal muscle, heart, liver and pancreas. Deregulation of fatty acid metabolism is the main culprit for developing insulin resistance and type 2 diabetes. A predominant predisposing factor to developing obesity, insulin resistance and type 2 diabetes is the permanent elevation of free fatty acids in plasma followed by impaired utilization of lipids by muscle. Diabetes-induced inflammation and oxidative stress have also vital role for development of insulin resistance in diabetic patients. The present review is intended to describe the correlation between lipids, obesity and insulin resistance based on current literature, in order to elucidate involved molecular mechanisms in depth. PMID:25278764

  14. Potential for Higher Treatment Failure in Obese Patients: Correlation of Elevated Body Mass Index and Increased Daily Prostate Deviations From the Radiation Beam Isocenters in an Analysis of 1,465 Computed Tomographic Images

    SciTech Connect

    Wong, James R. Gao Zhanrong; Merrick, Scott; Wilson, Paula; Uematsu, Minoru; Woo, Kevin; Cheng, C.-W.

    2009-09-01

    Purpose: Recent clinical outcome studies on prostate cancer have reported the influence of patient's obesity on the biochemical failure rates after various treatment modalities. In this study, we investigated the effect of patient's physical characteristics on prostate shift in external beam radiotherapy (EBRT) and hypothesized that there maybe a correlation between patient physique and tumor shift. Methods and Materials: A retrospective analysis was performed using data for 117 patients who received image-guided radiation therapy (IGRT) for prostate cancer between January 2005 and April 2007. A total of 1,465 CT scans were analyzed. The standard deviations (SDs) of prostate shifts for all patients, along with patient weight, body mass index (BMI), and subcutaneous adipose-tissue thickness (SAT), were determined. Spearman rank correlation analysis was performed. Results: Of the 117 patients, 26.5% were considered normal weight, 48.7% were overweight, 17.9% were mildly obese, and 6.9% were moderately to severely obese. Notably 1.3%, 1.5%, 2.0%, and 21.2% of the respective shifts were greater than 10 mm in the left-right (LR) direction for the four patient groups, whereas in the anterior-posterior direction the shifts are 18.2%, 12.6%, 6.7%, and 21.0%, respectively. Strong correlations were observed between SAT, BMI, patient weight, and SDs of daily shifts in the LR direction (p < 0.01). Conclusions: The strong correlation between obesity and shift indicates that without image-guided radiation therapy, the target volume (prostate with or without seminal vesicles) may not receive the intended dose for patients who are moderate to severely obese. This may explain the higher recurrence rate with conventional external beam radiation therapy.

  15. Kidney transplantation in obese patients

    PubMed Central

    Tran, Minh-Ha; Foster, Clarence E; Kalantar-Zadeh, Kamyar; Ichii, Hirohito

    2016-01-01

    The World Health Organization estimated that in 2014, over 600 million people met criteria for obesity. In 2011, over 30% of individuals undergoing kidney transplant had a body mass index (BMI) 35 kg/m2 or greater. A number of recent studies have confirmed the relationship between overweight/obesity and important comorbidities in kidney transplant patients. As with non-transplant surgeries, the rate of wound and soft tissue complications are increased following transplant as is the incidence of delayed graft function. These two issues appear to contribute to longer length of stay compared to normal BMI. New onset diabetes after transplant and cardiac outcomes also appear to be increased in the obese population. The impact of obesity on patient survival after kidney transplantation remains controversial, but appears to mirror the impact of extremes of BMI in non-transplant populations. Early experience with (open and laparoscopic) Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy support excellent weight loss (in the range of 50%-60% excess weight lost at 1 year), but experts have recommended the need for further studies. Long term nutrient deficiencies remain a concern but in general, these procedures do not appear to adversely impact absorption of immunosuppressive medications. In this study, we review the literature to arrive at a better understanding of the risks related to renal transplantation among individuals with obesity. PMID:27011911

  16. Promoting positive outcomes in obese patients.

    PubMed

    Troia, Cecilia

    2002-01-01

    Obese patients are seen in every practice setting. Obesity is a chronic disease that may lead to physical and emotional problems, which may have an impact on the social and psychological functioning of the patient. With appropriate preoperative, intraoperative, and postoperative precautions; monitoring; and restructuring the environment to promote care and safety, the incidence of poor surgical outcomes can be minimized. This paper will address the significance of obesity, related diseases, and proper care of the obese patient. PMID:12035338

  17. Perioperative management of obese patients.

    PubMed

    Pelosi, Paolo; Gregoretti, Cesare

    2010-06-01

    Obesity is a metabolic disease that is on the increase all over the world. Up to 35% of the population in North America and 15-20% in Europe can be considered obese. Since these patients are characterised by several systemic physiopathological alterations, the perioperative management may present some problems, mainly related to their respiratory system. Body mass is an important determinant of respiratory function before and during anaesthesia not only in morbidly but also in moderately obese patients. These can manifest as (a) reduced lung volume with increased atelectasis; (b)derangements in respiratory system, lung and chest wall compliance and increased resistance; and (c) moderate to severe hypoxaemia. These physiological alterations are more marked in obese patients with hypercapnic syndrome or obstructive sleep apnoea syndrome. The suggested perioperative ventilation management includes (a) awake and/or facilitated endotracheal intubation by using a video-laryngoscope; (b) tidal volume of 6-10 ml kg(-1) ideal body weight, increasing respiratory rate to maintain physiological PaCO2, while avoiding intrinsic positive end-expiratory pressure (PEEPi); and (c) a recruitment manoeuvre (35-55 cmH2O for 6 s) followed by the application of an end-expiratory pressure (PEEP) of 10 cmH2O. The recruitment manoeuvre should always be performed only when a volemic and haemodynamic stabilisation is reached after induction of anaesthesia. In the postoperative period, beach chair position, aggressive physiotherapy, noninvasive respiratory support and short-term recovery in intermediate critical care units with care of fluid management and pain may be useful to reduce pulmonary complications. PMID:20608558

  18. [Obesity, alexithymia, psychopathology and binge eating: a comparative study of 40 obese patients and 32 controls].

    PubMed

    De Chouly De Lenclave, M B; Florequin, C; Bailly, D

    2001-01-01

    found significantly more frequent in those with binge-eating disorder (81.8% vs 10.3%, respectively; p < 0.0001), although the mean BDI score was significantly higher in patients with binge-eating disorder (18.5 +/- 11.7 vs 9.8 +/- 5.9, respectively; p < 0.02). Group by group comparisons suggested that two factors may play a role in the correlation found between obesity and alexithymia. First, the mean TAS score was found significantly higher in subjects with low educational level (p < 0.05), obese patients exhibiting significantly lower educational level when compared to controls (p < 0.002). Then, a significant positive correlation was found between TAS scores and BDI scores (Spearman's test: p < 0.01), obese patients showing significantly higher BDI scores than controls (p < 0.0001). In order to confirm these results, a logistic regression procedure was performed in the total sample (obese patients + controls). Three factors were found significantly increasing the risk to get a TAS score > or = 74: low educational level (odds ratio: 3.56), past and/or current major depression (odds ratio: 2.77), and BDI score > or = 8 (odds ratio: 2.18). Obesity in itself had no significant effect on TAS scores. Our results confirm that alexithymia is a psychological feature frequently observed in obese patients. In our study, the correlation found between obesity and alexithymia appears to be irrespective of binge-eating disorder, and seems to be mediated by the educational level and the frequency of associated depression. However, further investigations need to be done in order to specify the relationships between obesity, alexithymia, low educational level, and depression. PMID:11686056

  19. Pain management in critically ill obese patients.

    PubMed

    Astle, Sonia M

    2009-09-01

    Achieving pain control in critically ill patients is a challenging problem for the health care team, which becomes more challenging in morbidly obese patients. Obese patients may experience drug malabsorption and distribution, which may lead to either subtherapeutic or toxic drug levels. To manage pain effectively for the critically ill obese patient, nurses must have an understanding of how obesity alters a patient's physiologic response to injury and illness. In addition, nurses must be knowledgeable about physiologic pain mechanisms, types and manifestations of pain, differing patterns of drug absorption and distribution, pharmacokinetic properties of analgesic medications, and pain management strategies. This article explores factors affecting pharmacokinetics in obese patients, trends in pain management, and treatment strategies for the obese patient. PMID:19840712

  20. Critical care of obese patients during and after spine surgery.

    PubMed

    Elgafy, Hossein; Hamilton, Ryan; Peters, Nicholas; Paull, Daniel; Hassan, Ali

    2016-02-01

    Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes. PMID:26855897

  1. Critical care of obese patients during and after spine surgery

    PubMed Central

    Elgafy, Hossein; Hamilton, Ryan; Peters, Nicholas; Paull, Daniel; Hassan, Ali

    2016-01-01

    Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes. PMID:26855897

  2. Obesity and Readmission in Elderly Surgical Patients

    PubMed Central

    Reinke, Caroline E.; Kelz, Rachel R.; Zubizarreta, Jose R.; Mi, Lanyu; Saynisch, Philip; Kyle, Fabienne A.; Even-Shoshan, Orit; Fleisher, Lee A.; Silber, Jeffrey H.

    2013-01-01

    Introduction Reducing readmissions has become a focus in efforts by Medicare to improve healthcare quality and reduce costs. This study aimed to determine whether causes for readmission differed between obese and non-obese patients, possibly allowing for targeted interventions. Methods A matched case-control study of Medicare patients admitted between 2002–2006 who were readmitted following hip or knee surgery, colectomy, or thoracotomy was performed. Patients were matched exactly for procedure, while also balancing on hospital, age and sex. Conditional logistic regression was used to study the odds of readmission for very obese cases (BMI > 35kg/m2) versus normal weight patients (BMI of 20–30kg/m2) after further controlling for race, transfer-in and emergency status, and comorbidities. Results Among 15,914 patient admissions we identified 1,380 readmitted patients and 2,760 controls. Risk of readmission was increased for obese vs. non-obese patients, before and after controlling for comorbidities (OR=1.35, P=0.003; OR=1.25, P=0.04). Reasons for readmission varied by procedure but were not different by BMI category. Conclusions Obese patients have an increased risk of readmission, yet reasons for readmission in obese patients appear similar to the non-obese, suggesting that improved post-discharge management for the obese cannot focus on a few specific causes of readmission, but must provide a broad range of interventions. PMID:22938896

  3. Stress echocardiography in patients with morbid obesity.

    PubMed

    Shah, Benoy N; Senior, Roxy

    2016-06-01

    The incidence of significant obesity is rising across the globe. These patients often have a clustering of cardiovascular risk factors and are frequently referred for noninvasive cardiac imaging tests. Stress echocardiography (SE) is widely used for assessment of patients with known or suspected coronary artery disease (CAD), but its clinical utility in morbidly obese patients (in whom image quality may suffer due to body habitus) has been largely unknown. The recently published Stress Ultrasonography in Morbid Obesity (SUMO) study has shown that SE, when performed appropriately with ultrasound contrast agents (whether performed with physiological or pharmacological stress), has excellent feasibility and appropriately risk stratifies morbidly obese patients, including identification of patients who require revascularization. This article reviews the evidence supporting the use of echocardiographic techniques in morbidly obese patients for assessment of known or suspected CAD and briefly discusses other noninvasive modalities, including magnetic resonance and nuclear techniques, comparing and contrasting these techniques against SE. PMID:27249552

  4. Stress echocardiography in patients with morbid obesity

    PubMed Central

    Senior, Roxy

    2016-01-01

    The incidence of significant obesity is rising across the globe. These patients often have a clustering of cardiovascular risk factors and are frequently referred for noninvasive cardiac imaging tests. Stress echocardiography (SE) is widely used for assessment of patients with known or suspected coronary artery disease (CAD), but its clinical utility in morbidly obese patients (in whom image quality may suffer due to body habitus) has been largely unknown. The recently published Stress Ultrasonography in Morbid Obesity (SUMO) study has shown that SE, when performed appropriately with ultrasound contrast agents (whether performed with physiological or pharmacological stress), has excellent feasibility and appropriately risk stratifies morbidly obese patients, including identification of patients who require revascularization. This article reviews the evidence supporting the use of echocardiographic techniques in morbidly obese patients for assessment of known or suspected CAD and briefly discusses other noninvasive modalities, including magnetic resonance and nuclear techniques, comparing and contrasting these techniques against SE. PMID:27249552

  5. Sleep study in patients with overweight and obesity.

    PubMed

    Namysłowski, G; Scierski, W; Mrówka-Kata, K; Kawecka, I; Kawecki, D; Czecior, E

    2005-12-01

    Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by repetitive collapse of the pharyngeal airway during sleep, which leads to oxygen desaturation, sleep fragmentation and daytime somnolence. Obesity is one of the most important risk factor for the development of OSAS. The exact mechanisms responsible for the relationship between obesity and OSAS are still unclear. The fat deposits in the pharynx region as well as the reduction in the lung volume have been considered as factors that might be responsible for the increase of the upper airway collapsibility. The aim of our study was to evaluate the correlation between the Body Mass Index (BMI) and sleep study parameters in overweight and obese patients suffering from breathing disturbances during sleep. We studied a group of 106 consecutive obese or overweight patients with a primary complaint of snoring or other breathing disturbances during sleep. In all cases, BMI and sleep studies (PolyMESAM) were examined. We evaluated relationship between the BMI and sleep study parameters such as Respiratory Disturbance Index (RDI), Apnea Index (AI), Desaturation Index (DI) and Average of Lowest Saturation (LSAT). The results showed the lack of significant statistical correlations between BMI and all the sleep parameters studied in the overweight patients and the statistical positive correlation between the BMI and RDI in the obese cases. We conclude that BMI determination may be considered as a simple, yet important predictor, of the OSAS in the group of obese patients. PMID:16340039

  6. Scale-free correlations in the geographical spreading of obesity

    NASA Astrophysics Data System (ADS)

    Gallos, Lazaros; Barttfeld, Pablo; Havlin, Shlomo; Sigman, Mariano; Makse, Hernan

    2012-02-01

    Obesity levels have been universally increasing. A crucial problem is to determine the influence of global and local drivers behind the obesity epidemic, to properly guide effective policies. Despite the numerous factors that affect the obesity evolution, we show a remarkable regularity expressed in a predictable pattern of spatial long-range correlations in the geographical spreading of obesity. We study the spatial clustering of obesity and a number of related health and economic indicators, and we use statistical physics methods to characterize the growth of the resulting clusters. The resulting scaling exponents allow us to broadly classify these indicators into two separate universality classes, weakly or strongly correlated. Weak correlations are found in generic human activity such as population distribution and the growth of the whole economy. Strong correlations are recovered, among others, for obesity, diabetes, and the food industry sectors associated with food consumption. Obesity turns out to be a global problem where local details are of little importance. The long-range correlations suggest influence that extends to large scales, hinting that the physical model of obesity clustering can be mapped to a long-range correlated percolation process.

  7. [Isotope nephrography in patients with obesity].

    PubMed

    Vlakhov, N; Benova, A; Penkova, D

    1989-04-01

    131I-hippuran nephrography conducted in 80 patients aged 26-53 with I and II degree obesity has revealed changes in the excretory phase (36.9 per cent of the patients with I degree obesity) and secretory and excretory and some vascular and metabolic abnormalities were registered in 79.4 per cent of those with II degree obesity. Weight gain had an adverse effect on the condition of such patients. Isotope nephrography enables one to study risk factors (arterial hypertension, atherosclerosis, diabetes mellitus). PMID:2755067

  8. Sarcopenia, obesity and sarcopenic obesity: effects on liver function and volume in patients scheduled for major liver resection

    PubMed Central

    Lodewick, Toine M; Roeth, Anjali AJ; Olde Damink, Steven WM; Alizai, Patrick H; van Dam, Ronald M; Gassler, Nikolaus; Schneider, Mark; Dello, Simon AWG; Schmeding, Maximilian; Dejong, Cornelis HC; Neumann, Ulf P

    2015-01-01

    Background Sarcopenia, obesity and sarcopenic obesity have been linked to impaired outcome after liver surgery. Preoperative liver function of sarcopenic, obese and sarcopenic-obese patients might be reduced, possibly leading to more post-operative morbidity. The aim of this study was to explore whether liver function and volume were influenced by body composition in patients undergoing liver resection. Methods In 2011 and 2012, all consecutive patients undergoing the methacetin breath liver function test were included. Liver volumetry and muscle mass analysis were performed using preoperative CT scans and Osirix® software. Muscle mass and body-fat% were calculated. Predefined cut-off values for sarcopenia and the top two body-fat% quintiles were used to identify sarcopenia and obesity, respectively. Histologic assessment of the resected liver gave insight in background liver disease. Results A total number of 80 patients were included. Liver function and volume were comparable in sarcopenic(-obese) and non-sarcopenic(-obese) patients. Obese patients showed significantly reduced liver function [295 (95–508) vs. 358 (96–684) µg/kg/h, P = 0.018] and a trend towards larger liver size [1694 (1116–2685) vs. 1533 (869–2852) mL, P = 0.079] compared with non-obese patients. Weight (r = −0.40), body surface area (r = −0.32), estimated body-fat% (r = −0.43) and body mass index (r = −0.47) showed a weak but significant negative (all P < 0.05) correlation with liver function. Moreover, body-fat% was identified as an independent factor negatively affecting the liver function. Conclusion Sarcopenia and sarcopenic obesity did not seem to influence liver size and function negatively. However, obese patients had larger, although less functional, livers, indicating dissociation of liver function and volume in these patients. PMID:26136191

  9. Obesity in preschoolers: behavioral correlates and directions for treatment.

    PubMed

    Kuhl, Elizabeth S; Clifford, Lisa M; Stark, Lori J

    2012-01-01

    Nearly 14% of American preschoolers (ages 2-5) are obese (BMI ≥ 95th percentile for age and gender), yet this group has received little attention in the obesity intervention literature. This review examines what is known about behavioral correlates of obesity in preschoolers and the developmental context for lifestyle modification in this age group. Information was used to critically evaluate existing weight management prevention and intervention programs for preschoolers and formulate suggestions for future intervention research development. A systematic search of the medical and psychological/behavioral literatures was conducted with no date restrictions, using PubMed, PsycInfo, and MEDLINE electronic databases and bibliographies of relevant manuscripts. Evidence suggests several modifiable behaviors, such as sugar sweetened beverage intake, television use, and inadequate sleep, may differentiate obese and healthy weight preschoolers. Developmental barriers, such as food neophobia, food preferences, and tantrums challenge caregiver efforts to modify preschoolers' diet and activity and parental feeding approaches, and family routines appear related to the negative eating and activity patterns observed in obese preschoolers. Prevention programs yield modest success in slowing weight gain, but their effect on already obese preschoolers is unclear. Multi-component, family-based, behavioral interventions show initial promise in positive weight management for already obese preschoolers. Given that obesity intervention research for preschoolers is in its infancy, and the multitude of modifiable behavioral correlates for obesity in this age group, we discuss the use of an innovative and efficient research paradigm (Multiphase Optimization Strategy; MOST) to develop an optimized intervention that includes only treatment components that are found to empirically reduce obesity in preschoolers. PMID:21760634

  10. Obesity paradox in patients on maintenance dialysis.

    PubMed

    Kalantar-Zadeh, Kamyar; Kopple, Joel D

    2006-01-01

    Overweight (body mass index [BMI]=25-30 kg/m2) and obesity (BMI>30 kg/m2) have become mass phenomena with a pronounced upward trend in prevalence in most countries throughout the world and are associated with increased cardiovascular risk and poor survival. In patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis an 'obesity paradox' has been consistently reported, i.e., a high BMI is incrementally associated with better survival. While this 'reverse epidemiology' of obesity is relatively consistent in maintenance hemodialysis patients, studies in peritoneal dialysis patients have yielded mixed results. A similar obesity paradox has been described in patients with chronic heart failure as well as in 20 million members of other distinct medically 'at risk' populations in the USA. Possible causes of the reverse epidemiology of obesity include: (1) time-discrepancies between the competing risks for the adverse events that are associated with overnutrition and undernutrition; (2) sequestration of uremic toxins in adipose tissue; (3) selection of a gene pool favorable to longer survival in dialysis patients during the course of CKD progression, which eliminates over 95% of the CKD population before they commence maintenance dialysis therapy; (4) a more stable hemodynamic status; (5) alterations in circulating cytokines; (6) unique neurohormonal constellations; (7) endotoxin-lipoprotein interactions; and (8) reverse causation. Examining the causes and consequences of the obesity paradox in dialysis patients can improve our understanding of similar paradoxes observed both for other conventional risk factors in chronic dialysis patients, such as blood pressure and serum cholesterol, and in other populations, such as patients with heart failure, cancer or AIDS or geriatric populations. PMID:16929133

  11. Survival advantages of obesity in dialysis patients.

    PubMed

    Kalantar-Zadeh, Kamyar; Abbott, Kevin C; Salahudeen, Abdulla K; Kilpatrick, Ryan D; Horwich, Tamara B

    2005-03-01

    In the general population, a high body mass index (BMI; in kg/m(2)) is associated with increased cardiovascular disease and all-cause mortality. However, the effect of overweight (BMI: 25-30) or obesity (BMI: >30) in patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis (MHD) is paradoxically in the opposite direction; ie, a high BMI is associated with improved survival. Although this "reverse epidemiology" of obesity or dialysis-risk-paradox is relatively consistent in MHD patients, studies in CKD patients undergoing peritoneal dialysis have yielded mixed results. Growing confusion has developed among physicians, some of whom are no longer confident about whether to treat obesity in CKD patients. A similar reverse epidemiology of obesity has been described in geriatric populations and in patients with chronic heart failure (CHF). Possible causes of the reverse epidemiology of obesity include a more stable hemodynamic status, alterations in circulating cytokines, unique neurohormonal constellations, endotoxin-lipoprotein interaction, reverse causation, survival bias, time discrepancies among competitive risk factors, and malnutrition-inflammation complex syndrome. Reverse epidemiology may have significant clinical implications in the management of dialysis, CHF, and geriatric patients, ie, populations with extraordinarily high mortality. Exploring the causes and consequences of the reverse epidemiology of obesity in dialysis patients can enhance our insights into similar paradoxes observed for other conventional risk factors, such as blood pressure and serum cholesterol and homocysteine concentrations, and in other populations such as those with CHF, advanced age, cancer, or AIDS. Weight-gaining interventional studies in dialysis patients are urgently needed to ascertain whether they can improve survival and quality of life. PMID:15755821

  12. Transvaginal appendectomy in morbidly obese patient.

    PubMed

    Yagci, Mehmet Ali; Kayaalp, Cuneyt; Ates, Mustafa

    2014-01-01

    Introduction. Laparoscopic appendectomy has significant benefits in obese patients. However, morbid obesity can be accepted as an exclusion criterion for natural orifice transluminal endoscopic surgery (NOTES). Here, we present a transvaginal appendectomy in a 66-year-old morbidly obese (BMI 36 kg/m(2), ASA III) patient. Case and Technique. Acute appendicitis was suspected based on history, physical examination, laboratory tests, and ultrasound findings. During laparoscopic surgery, a 5 mm trocar was inserted through the umbilicus and a 5 mm telescope was placed. A 12 mm trocar and a 5 mm grasper were inserted separately through the posterior fornix of the vagina under laparoscopic guidance. The appendix was divided with an endoscopic stapler through the transvaginal 12 mm trocar and removed from the same trocar. The operating time was 75 minutes with minimal blood loss (<10 mL). The patient was discharged 16 hours after surgery uneventfully and she did not require any analgesic administration. Conclusion. To the best of our knowledge, this is the first clinical case that focuses on the transvaginal appendectomy at morbid obesity. We can say that morbid obesity does not constitute an obstacle for treatment of acute appendicitis by transvaginal endoscopic surgery. PMID:25506028

  13. Skipping Breakfast is Correlated with Obesity

    PubMed Central

    Watanabe, Yoko; Saito, Isao; Henmi, Ikuyo; Yoshimura, Kana; Maruyama, Kotatsu; Yamauchi, Kanako; Matsuo, Tatsuhiro; Kato, Tadahiro; Tanigawa, Takeshi; Kishida, Taro; Asada, Yasuhiko

    2014-01-01

    Objective: Despite the fact that the total energy intake of Japanese people has decreased, the percentage of obese people has increased. This suggests that the timing of meals is related to obesity. The purpose of the study was to investigate the relationship between the timing of meals and obesity, based on analyses of physical measurements, serum biochemical markers, nutrient intake, and lifestyle factors in the context of Chrononutrition. Participants and Methods: We analyzed data derived from 766 residents of Toon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medical examinations between 2011 and 2013. These medical examinations included. (1) physical measurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers (total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors such as family structure and daily habits (22 issues), exercise and eating habits (28 issues), alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups (FFQg); and (5) a questionnaire concerning the times at which meals and snacks are consumed. Results: The values for body mass index (BMI) and waist circumference were higher for participants who ate dinner less than three hours before bedtime (<3-h group) than those who ate more than three hours before bedtime (>3-h group). The Chi-square test showed that there was a significant difference in eating habits, e.g., eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after 9 p.m., between the <3-h group and the >3-h group. Multiple linear regression analysis showed that skipping breakfast significantly influenced both waist circumference (β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed only influenced BMI (β = 0.581). Conclusion: Skipping breakfast had a greater influence on both waist circumference and BMI than eating dinner <3-h before going to bed. PMID:25648986

  14. Perioperative lung protective ventilation in obese patients.

    PubMed

    Fernandez-Bustamante, Ana; Hashimoto, Soshi; Serpa Neto, Ary; Moine, Pierre; Vidal Melo, Marcos F; Repine, John E

    2015-01-01

    The perioperative use and relevance of protective ventilation in surgical patients is being increasingly recognized. Obesity poses particular challenges to adequate mechanical ventilation in addition to surgical constraints, primarily by restricted lung mechanics due to excessive adiposity, frequent respiratory comorbidities (i.e. sleep apnea, asthma), and concerns of postoperative respiratory depression and other pulmonary complications. The number of surgical patients with obesity is increasing, and facing these challenges is common in the operating rooms and critical care units worldwide. In this review we summarize the existing literature which supports the following recommendations for the perioperative ventilation in obese patients: (1) the use of protective ventilation with low tidal volumes (approximately 8 mL/kg, calculated based on predicted -not actual- body weight) to avoid volutrauma; (2) a focus on lung recruitment by utilizing PEEP (8-15 cmH2O) in addition to recruitment maneuvers during the intraoperative period, as well as incentivized deep breathing and noninvasive ventilation early in the postoperative period, to avoid atelectasis, hypoxemia and atelectrauma; and (3) a judicious oxygen use (ideally less than 0.8) to avoid hypoxemia but also possible reabsorption atelectasis. Obesity poses an additional challenge for achieving adequate protective ventilation during one-lung ventilation, but different lung isolation techniques have been adequately performed in obese patients by experienced providers. Postoperative efforts should be directed to avoid hypoventilation, atelectasis and hypoxemia. Further studies are needed to better define optimum protective ventilation strategies and analyze their impact on the perioperative outcomes of surgical patients with obesity. PMID:25907273

  15. Metabolic Characteristics in Obese Patients Complicated by Mild Thyroid Hormone Deficiency.

    PubMed

    Wang, X; Liu, H; Chen, J; Huang, Y; Li, L; Rampersad, S; Qu, S

    2016-05-01

    The prevalence of subclinical hypothyroidism (SH) is increasing, especially in obese people. The purpose of this study was to evaluate the difference in metabolic profiles between obese patients with mild increased thyrotropin (TSH) or with normal TSH. A total of 219 obese patients were recruited in this cross-sectional study. They were divided into 2 groups: obese patients with normal TSH (0.35-2.5 mU/l) and age-, and body mass index (BMI)-matched obese patients with higher-normal TSH (2.5-5.5 mU/l). We have named it compensatory hypothyroidism or mild thyroid hormone deficiency. Anthropometric data, glucose-lipid metabolism, markers of inflammation, body composition, and thyroid function parameters were measured. Results showed that: 1) The levels of fasting plasma glucose (FPG), high density lipoprotein cholesterol (HDL-C), and 25-hydroxyvitamin D levels were significantly lower in obese patients complicated by mild increased TSH than in obese patients with normal TSH (p<0.05). The fasting insulin (FINS) and C reactive protein (CRP) levels were significantly higher in obese patients complicated by mild increased TSH when compared to the obese patients with normal TSH (p<0.01). Jostel's TSH index (TSHI) and standard TSH index (sTSHI) were significantly higher in obesity with mild increased TSH when compared to obesity with normal TSH (both p<0.001). Thyroid's secretory capacity (GT) was significantly lower in obesity with mild increased TSH when compared to obesity with normal TSH (p<0.001). 2) In the obese patients complicated by mild increased TSH group, serum TSH was significantly positively correlated with ALT, AST and CP (p<0.05). In the obese patients with normal TSH group, serum TSH was significantly positively correlated with UA (p<0.05). In all subjects, serum TSH was significantly positively correlated with ALT, AST, FINS, CP, CRP, and UA (p<0.05), but negatively with DBP, FPG, and HDL-C (p<0.05). 3) There was significant difference of the

  16. FGF21 Is Associated with Acanthosis Nigricans in Obese Patients

    PubMed Central

    Huang, Yueye; Yang, Jie; Li, Yan; Chen, Jiaqi; Song, Kexiu; Wang, Xingchun; Bu, Le; Cheng, Xiaoyun; Wang, Jiying; Qu, Shen

    2016-01-01

    Objective. We aimed to investigate the relationship between FGF21 and obesity-related acanthosis nigricans (AN). Methods. 40 obese patients without AN (OB group), 40 obese patients with AN (AN group), and 40 healthy volunteers (control group, CON) were included in this study. Weight, BMI, lipid profile, FFA, UA, and CRP were measured in all participants. Oral glucose tolerance tests (OGTT) were performed and serum glucose and plasma insulin were measured. Serum FGF21 was measured by ELISA. Results. Compared with OB group, AN group had higher levels of fasting insulin and homeostasis model of assessment for insulin resistance (HOMA-IR) (P < 0.05), but lower serum levels of blood glucose. The difference of FGF21 among three groups was significant and AN group showed the highest serum level of FGF21 (P < 0.05). Serum FGF21 was most positively correlated with fasting insulin and HOMA-IR. Multiple logistic analysis showed that FGF21 was the independent risk factor for AN (OR 4.550; 95% CI 1.054–19.635; P = 0.042). Conclusion. AN patients had more serious hyperinsulinemia but better serum levels of blood glucose than OB. Increased FGF21 is associated with AN in obese patients and may be considered as compensatory response to the decreased insulin sensitivity. PMID:27190511

  17. Correlates and Suspected Causes of Obesity in Children

    ERIC Educational Resources Information Center

    Crothers, Laura M.; Kehle, Thomas J.; Bray, Melissa A.; Theodore, Lea A.

    2009-01-01

    The correlates and suspected causes of the intractable condition obesity are complex and involve environmental and heritable, psychological and physical variables. Overall, the factors associated with and possible causes of it are not clearly understood. Although there exists some ambiguity in the research regarding the degree of happiness in…

  18. Obesity, Diabetes and Survival in Maintenance Hemodialysis Patients

    PubMed Central

    Deger, Serpil M.; Ellis, Charles D.; Bian, Ahuia; Shintani, Ayumi; Ikizler, T. Alp; Hung, Adriana M.

    2016-01-01

    Increased body mass index (BMI) confers a survival advantage in maintenance hemodialysis (MHD) patients. Diabetic (DM) patients undergoing MHD have worse survival. There are limited studies examining the effect of obesity on the risk of death among MHD patients with diabetes. Ninety-eight MHD patients were studied for median follow-up time of 78 months. Patients were classified according to the presence of obesity (BMI ≥ 30 kg/m2) or DM. Primary outcome was all-cause mortality. Cox regression was used to evaluate the effect of obesity on time to death. Effect modification and mediation analysis were also performed. Mean age was 49 ± 13 years, 66% were male, 48% were obese and 34% were diabetic. Mortality rates (per 100 person years) were: 3.4 for non-diabetic obese, 8.6 for non-diabetic non-obese, 14.3 for diabetic non-obese and 18.1 for diabetic obese patients. Log-rank comparing diabetic obese versus non diabetic obese was significant (p=0.007). Diabetes was associated with an increased risk of mortality after adjustment for potential mediators. Effect modification of obesity in the mortality risk was different between patients with and without diabetes. With adjustment for adipokines, a greater effect modification by diabetes was observed whereas adjustment for inflammatory marker did not influence the effect modification. Diabetic obese MHD patients have increased mortality risk compared to non-diabetic obese. Obesity does not offer survival benefits in Diabetic obese MHD patients and potentially may have detrimental effects. Larger studies evaluating the effect of adipokines and obesity in outcomes in the diabetic MHD population need to be undertaken. PMID:24467439

  19. Gastrointestinal Conditions in the Obese Patient.

    PubMed

    Taylor, Sharonda Alston; Himes, Ryan; Hastings, Elisabeth; Garland, Beth

    2016-01-01

    Obesity in adolescents presents many challenges for the patient, family, and physician. The myriad problems involving the GI tract will be managed more effectively when the treating physician has an understanding of the presentations, pathophysiology, appropriate laboratory evaluation, and approaches to treatment for these complications. In addition to being familiar with the pharmacotherapeutic options available, having an approach to behavioral change, such as MI, can be an extremely useful tool. PMID:27363235

  20. Patient selection for obesity surgery.

    PubMed

    Grace, D M

    1987-09-01

    Patients selected for gastroplasty should be at least 45 kg above ideal weight, between the ages of 18 and 50, and operated on in a center with good results, where team assessment and long-term follow-up is emphasized. Referral by a family doctor who provides local care and support is important. Medical complications need not be present because the idea is to prevent them, but problems such as sleep apnea, adult onset diabetes mellitus, hypertension, osteoarthritis, and infertility, which may be corrected by weight loss, increase the indication for gastroplasty. Patients should have social support and be intelligent enough to understand the postoperative diet and the need for regular follow-up. Those with a history of psychiatric admission require careful preoperative assessment by psychiatrist or psychologist and close follow-up and support. Patients should have made a good supervised attempt at dieting, have had stable weight for 3 to 5 years preoperatively, and have stopped smoking at least 6 weeks prior to operation. Tests to assess personality factors, eating habits, and motivation are developing, but more precise methods of selecting patients for gastroplasty and predicting successful and uncomplicated weight loss are still needed. PMID:3325422

  1. Associations between lower extremity muscle mass and metabolic parameters related to obesity in Japanese obese patients with type 2 diabetes.

    PubMed

    Hamasaki, Hidetaka; Kawashima, Yu; Adachi, Hiroki; Moriyama, Sumie; Katsuyama, Hisayuki; Sako, Akahito; Yanai, Hidekatsu

    2015-01-01

    Background. Age-related loss of muscle mass (sarcopenia) increases the incidence of obesity in the elderly by reducing physical activity. This sarcopenic obesity may become self-perpetuating, increasing the risks for metabolic syndrome, disability, and mortality. We investigated the associations of two sarcopenic indices, the ratio of lower extremity muscle mass to body weight (L/W ratio) and the ratio of lower extremity muscle mass to upper extremity muscle mass (L/U ratio), with metabolic parameters related to obesity in patients with type 2 diabetes and obesity. Methods. Of 148 inpatients with type 2 diabetes treated between October 2013 and April 2014, we recruited 26 with obesity but no physical disability. Daily physical activity was measured by a triaxial accelerometer during a period of hospitalization, and which was also evaluated by our previously reported non-exercise activity thermogenesis questionnaire. We measured body composition by bioelectrical impedance and investigated the correlations of L/W and L/U ratios with body weight, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), visceral fat area, subcutaneous fat area, serum lipid profile, and daily physical activity. Results. The L/W ratio was significantly and negatively correlated with BMI, WC, WHR, body fat mass, body fat percentage, subcutaneous fat area, and serum free fatty acid concentration, was positively correlated with daily physical activity: the locomotive non-exercise activity thermogenesis score, but was not correlated with visceral fat area. The L/U ratio was significantly and positively correlated with serum high-density lipoprotein cholesterol. Conclusions. High L/W and L/U ratios, indicative of relatively preserved lower extremity muscle mass, were predictive of improved metabolic parameters related to obesity. Preserved muscle fitness in obesity, especially of the lower extremities, may prevent sarcopenic obesity and lower associated risks for metabolic

  2. Correlation between Body Composition and Walking Capacity in Severe Obesity

    PubMed Central

    2015-01-01

    Background Obesity is associated with mobility reduction due to mechanical factors and excessive body fat. The six-minute walk test (6MWT) has been used to assess functional capacity in severe obesity. Objective To determine the association of BMI, total and segmental body composition with distance walked (6MWD) during the six-minute walk test (6MWT) according to gender and obesity grade. Setting University of São Paulo Medical School, Brazil; Public Practice. Methods Functional capacity was assessed by 6MWD and body composition (%) by bioelectrical impedance analysis in 90 patients. Results The mean 6MWD was 514.9 ± 50.3 m for both genders. The male group (M: 545.2 ± 46.9 m) showed a 6MWD higher (p = 0.002) than the female group (F: 505.6 ± 47.9 m). The morbid obese group (MO: 524.7 ± 44.0 m) also showed a 6MWD higher (p = 0.014) than the super obese group (SO: 494.2 ± 57.0 m). There was a positive relationship between 6MWD and fat free mass (FFM), FFM of upper limps (FFM_UL), trunk (FFM_TR) and lower limbs (FFM_LL). Female group presented a positive relationship between 6MWD and FFM, FFM_UL and FFM_LL and male group presented a positive relationship between 6MWD and FFM_TR. In morbid obese group there was a positive relationship between 6MWD with FFM, FFM_UL, FFM_TR and FFM_LL. The super obese group presented a positive relationship between 6MWD with FFM, FFM_TR and FFM_LL. Conclusions Total and segmental FFM is associated with a better walking capacity than BMI. PMID:26098769

  3. Overweight and Obesity in Portuguese Children: Prevalence and Correlates

    PubMed Central

    Gomes, Thayse Natacha; Katzmarzyk, Peter T.; dos Santos, Fernanda K.; Souza, Michele; Pereira, Sara; Maia, José A. R.

    2014-01-01

    There are widespread differences in overweight/obesity prevalence in children, and understanding the reasons for this is very important. The present study aims: (I) to conduct a meta-analysis on overweight/obesity prevalence in Portuguese children; (II) to identify differences in biological and behavioural characteristics between normal-weight and overweight/obese children; and (III) to investigate the importance of individual- and school-level correlates of variation in children’s BMI using multilevel modelling. A search was done for all published papers including Portuguese children during the last decade; further, 686 Portuguese children (9–11 years old) were sampled and their BMI, family income, maturity offset, nutritional habits, physical activity, sedentariness, sleep time, and school environment information were collected. Results showed a stabilization of overweight/obesity during the last decade, 30.6% (95%CI: 0.287–0.34) for boys, 28.4% (95%CI: 0.23–0.35) for girls, and 30.3% (95%CI: 0.27–0.34) for boys and girls together. Differences between weight groups were only found in individual-level biological traits. The multilevel analysis did not identify significant contributions of school-level variables to children’s BMI variation. In conclusion, no increase was found in the prevalence of overweight/obesity among Portuguese children since 2000. Normal-weight and overweight/obese children only differ in individual-level characteristics, and school context variables were not related to variation in BMI. PMID:25372884

  4. Psychological and physiological correlates of childhood obesity in Taiwan

    PubMed Central

    Chung, Kuo-Hsuan; Chiou, Hung-Yi; Chen, Yi-Hua

    2015-01-01

    Evidence of associations between psychopathology and obesity in childhood remains inconsistent, and most studies have been conducted in Western countries. This study investigated psychological and physiological correlates of obesity in a community sample of children in Taiwan. In total, 302 children (157 overweight/obese and 145 healthy-weight children) were selected from first- and fourth-grade schoolchildren in eight elementary schools in 2009. These children participated in a comprehensive health examination, including a physical examination, blood sample analysis, and questionnaire administration. We found that regarding physiological characteristics, compared with the healthy-weight children, the overweight/obese children had significantly higher values for body fat estimated using the bioelectrical impedance method (p < 0.001), systolic blood pressure (p < 0.001), and diastolic blood pressure (p = 0.001); lower values for high-density lipoprotein (p < 0.001); and worse values for glutamic-pyruvic transaminase (p < 0.001), triglycerides (p < 0.001), and fasting blood glucose (p = 0.049). In logistic models adjusted for parental and child traits and physiological characteristics, children’s overweight/obesity was significantly associated with lower self-concept (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.93–0.99) and less disruptive behavior (OR = 0.96, 95% CI = 0.92–0.99). Less disruptive behavior and the lack of a higher prevalence of anxiety and depression in childhood obesity appear to be a unique pattern in Taiwan that warrants further investigation. PMID:26612264

  5. Haemodynamic monitoring of morbidly obese intensive care unit patients.

    PubMed

    Lagrand, W K; van Slobbe-Bijlsma, E R; Schultz, M J

    2013-06-01

    Because of technical and practical difficulties in relation to increased body size, haemodynamic monitoring of morbidly obese critically ill patients (i.e. body mass index ≥40 kg÷m2) may be challenging. Obese and non-obese patients are not so different with respect to haemodynamic monitoring and goals. The critical care physician, however, should be aware of the basic principles of the monitoring tools used. The theoretical assumptions and calculations of these tools could be invalid because of the high body weight and fat distribution. Although the method of assessing haemodynamic data may be more complex in morbidly obese patients, its interpretation should not be different from that in non-obese patients. Indeed, when indexed for body surface area or (predicted) lean body mass, reliable haemodynamic data are comparable etween obese and non-obese individuals. PMID:23799309

  6. Hip Arthroplasty in Obese Patients: Rising Prevalence–Standard Procedures?

    PubMed Central

    Skutek, Michael; Wirries, Nils; von Lewinski, Gabriela

    2016-01-01

    We examined our experience and, in particular, complications associated with total hip arthroplasty in obese and morbidly obese patients. We prospectively gathered 50 patients in a matched control series including 25 obese and morbidly obese patients. All patients were operated using the direct lateral approach and standard postoperative protocols. Operating room time, complications, dislocations, blood loss, cup position and clinical parameters using the Harris Hip Score and the Western Ontario and McMaster Universities Arthritis Index results were compared. Although there were some significant differences in clinical outcomes, standard procedures yielded good overall results and an acceptable rate of complications. Details approaching this patient entity are being discussed. PMID:27433302

  7. Hip Arthroplasty in Obese Patients: Rising Prevalence-Standard Procedures?

    PubMed

    Skutek, Michael; Wirries, Nils; von Lewinski, Gabriela

    2016-06-27

    We examined our experience and, in particular, complications associated with total hip arthroplasty in obese and morbidly obese patients. We prospectively gathered 50 patients in a matched control series including 25 obese and morbidly obese patients. All patients were operated using the direct lateral approach and standard postoperative protocols. Operating room time, complications, dislocations, blood loss, cup position and clinical parameters using the Harris Hip Score and the Western Ontario and McMaster Universities Arthritis Index results were compared. Although there were some significant differences in clinical outcomes, standard procedures yielded good overall results and an acceptable rate of complications. Details approaching this patient entity are being discussed. PMID:27433302

  8. PAI-1 and TNF-α profiles of adipose tissue in obese cardiovascular disease patients

    PubMed Central

    Bilgic Gazioglu, Sema; Akan, Gokce; Atalar, Fatma; Erten, Gaye

    2015-01-01

    Obesity as a leading preventable cause of death worldwide is closely linked to cardiovascular disease (CVD). Plasma plasminogen activator inhibitor (PAI)-1, a potent inhibitor of plasminogen activation and fibrinolysis, is increased in many clinical situations associated with high incidence of CVD. In the obesity-linked elevation of PAI-1, evidence points to TNF-α as an important regulator of PAI-1 expression in adipose tissue. Background: This study aims to evaluate mediastinal PAI-1 and TNF-α mRNA levels in adipose tissues (AT) and compare serum levels in obesity with and without coronary artery disease (CAD). Patients and methods: Obese patients with (n=37) and without CAD (n=20) were included in the study. Results: The serum levels of PAI-1 and TNF-α were significantly higher in obese patients with CAD compared to obese patients without CAD. PAI-1 mRNA expression was significantly increased in mediastinal adipose tissue (MAT) of obese patients with CAD compared to those without CAD, TNF-α mRNA expressions were found to be higher in EAT (epicardial AT), MAT and SAT (subcutaneous AT) of obese patients with CAD. Conclusions: The study demonstrated a close direct relationship between TNF-α and PAI-1. PAI-1 mRNA expression strongly correlated positively with serum TNF-α in MAT, and TNF-α expressions with PAI-1 serum levels. PMID:26884864

  9. Israeli dietitians' professional stigma attached to obese patients.

    PubMed

    Stone, Osnat; Werner, Perla

    2012-06-01

    The aim of this study was to explore and define the different dimensions of professional stigma attached to obese patients by dietitians. Four focus groups were conducted with 23 Israeli dietitians. Findings showed that while treating obese patients, dietitians underwent a stigmatization process involving cognitive, emotional, and behavioral phases. Obese patients with an internal locus of control, who took responsibility for their failure to diet, triggered positive feelings (e.g., pity and empathy), whereas obese patients with an external locus of control, who blamed others for their failure, triggered negative feelings (e.g., anger and frustration). Participants' emotional rejection of obese patients was manifested in three behavioral dimensions: instrumental avoidance (e.g., shorter sessions); professional avoidance (e.g., less energy and effort); and interpersonal avoidance (negative tone and evasive verbal and body language). Continuing education for dietitians is recommended to assist them in dealing with their negative feelings and behaviors toward resistant obese patients. PMID:22218267

  10. Sarcopenia and Sarcopenic Obesity in Patients with Muscular Dystrophy

    PubMed Central

    Merlini, Luciano; Vagheggini, Alessandro; Cocchi, Daniela

    2014-01-01

    Aging sarcopenia and muscular dystrophy (MD) are two conditions characterized by lower skeletal muscle quantity, lower muscle strength, and lower physical performance. Aging is associated with a peculiar alteration in body composition called “sarcopenic obesity” characterized by a decrease in lean body mass and increase in fat mass. To evaluate the presence of sarcopenia and obesity in a cohort of adult patients with MD, we have used the measurement techniques considered golden standard for sarcopenia that is for muscle mass dual-energy X-ray absorptiometry (DXA), for muscle strength hand-held dynamometry (HHD), and for physical performance gait speed. The study involved 14 adult patients with different types of MD. We were able to demonstrate that all patients were sarcopenic obese. We showed, in fact, that all were sarcopenic based on appendicular lean, fat and bone free, mass index (ALMI). In addition, all resulted obese according to the percentage of body fat determined by DXA in contrast to their body mass index ranging from underweight to obese. Skeletal muscle mass determined by DXA was markedly reduced in all patients and correlated with residual muscle strength determined by HHD, and physical performances determined by gait speed and respiratory function. Finally, we showed that ALMI was the best linear explicator of muscle strength and physical function. Altogether, our study suggests the relevance of a proper evaluation of body composition in MD and we propose to use, both in research and practice, the measurement techniques that has already been demonstrated effective in aging sarcopenia. PMID:25339901

  11. Behavioral Treatment of the Patient with Obesity.

    PubMed

    Alamuddin, Naji; Wadden, Thomas A

    2016-09-01

    Advisory panels encourage persons with obesity to lose 5% to 10% of body weight, which can be achieved with dietary change, increased physical activity, and behavioral therapy. Patients participate in weekly individual or group treatment sessions delivered in-person or by telephone. Large-scale trials have demonstrated the effectiveness of this approach, with resulting improvement in cardiovascular disease risk factors. Weight regain is common. Several strategies improve weight loss maintenance, including monthly or more frequent follow-up with an interventionist. Digitally-delivered approaches are promising because they have the potential to reach more individuals. PMID:27519131

  12. Limitations of Aneuploidy and Anomaly Detection in the Obese Patient.

    PubMed

    Zozzaro-Smith, Paula; Gray, Lisa M; Bacak, Stephen J; Thornburg, Loralei L

    2014-01-01

    Obesity is a worldwide epidemic and can have a profound effect on pregnancy risks. Obese patients tend to be older and are at increased risk for structural fetal anomalies and aneuploidy, making screening options critically important for these women. Failure rates for first-trimester nuchal translucency (NT) screening increase with obesity, while the ability to detect soft-markers declines, limiting ultrasound-based screening options. Obesity also decreases the chances of completing the anatomy survey and increases the residual risk of undetected anomalies. Additionally, non-invasive prenatal testing (NIPT) is less likely to provide an informative result in obese patients. Understanding the limitations and diagnostic accuracy of aneuploidy and anomaly screening in obese patients can help guide clinicians in counseling patients on the screening options. PMID:26237478

  13. Method of Detection of Well-Differentiated Thyroid Cancers in Obese and Non-Obese Patients

    PubMed Central

    2016-01-01

    Background The incidence of well-differentiated thyroid cancer (WDTC) is increasing rapidly. Many authors feel that this increase is due to over-diagnosis and that one of the contributing factors is the increasing use of various imaging studies. The rate of obesity has also been increasing in the United States. It has been suggested that patients with an increased body mass index (BMI kg/m2) have a higher incidence of WDTC than patients with normal BMI. One might hypothesize that thyroid nodules are more difficult to palpate in obese patients and that as more cancers are detected by imaging the apparent rate of increase in WDTC in obese patients would appear to be greater than in non-obese patients. This study was undertaken to evaluate this hypothesis by determining if there is any difference in the way thyroid cancers are initially detected in obese and non-obese patients. Methods The medical records of all 519 patients with a postoperative diagnosis of WDTC who underwent thyroidectomy at NYU Langone Medical Center from January 1, 2007 through August 31, 2010 by the three members of NYU Endocrine Surgery Associates were reviewed. Patients were divided into Non-obese (BMI<30 kg/m2) and Obese (BMI≥30 kg/m2) groups. Patients were also divided by the initial method of detection of their tumor into Palpation, Imaging, and Incidental groups. Results The final study group contained 270 patients, 181(67%) of whom were in the Non-obese Group and 89(33%) were in the Obese Group. In the Non-obese group, 81(45%) of tumors were found by palpation, 72(40%) were found by imaging, and 28(16%) were found incidentally. In the Obese group, 40(45%) were found by palpation, 38(43%) were found by imaging, and 11(12%) were found incidentally. These differences were not statistically significant (p-value 0.769). Conclusion We show that BMI does not play a role in the method of initial detection in patients with WDTC. This suggests that the prevalence of WDTC detected by imaging is not

  14. Therapeutic immunoglobulin should be dosed by clinical outcome rather than by body weight in obese patients.

    PubMed

    Hodkinson, J P; Lucas, M; Lee, M; Harrison, M; Lunn, M P; Chapel, H

    2015-07-01

    There are currently no data to support the suggestion that the dose of therapeutic immunoglobulin (Ig) should be capped in obese patients for pharmacokinetic (PK), safety and economic reasons. We compared IgG trough levels, increment and efficiency in matched pairs of obese and lean patients receiving either replacement or immunomodulatory immunoglobulin therapy. Thirty-one obese patients were matched with a clinically equivalent lean patient across a range of indications, including primary antibody deficiency or autoimmune peripheral neuropathy. Comprehensive matching was carried out using ongoing research databases at two centres in which the dose of Ig was based on clinical outcome, whether infection prevention or documented clinical neurological stability. The IgG trough or steady state levels, IgG increments and Ig efficiencies at times of clinical stability were compared between the obese and lean cohorts and within the matched pairs. This study shows that, at a population level, obese patients achieved a higher trough and increment (but not efficiency) for a given weight-adjusted dose compared with the lean patients. However at an individual patient level there were significant exceptions to this correlation, and upon sub-group analysis no significant difference was found between obese and lean patients receiving replacement therapy. Across all dose regimens a high body mass index (BMI) cannot be used to predict reliably the patients in whom dose restriction is clinically appropriate. PMID:25731216

  15. Are sarcopenia, obesity and sarcopenic obesity predictive of outcome in patients with colorectal liver metastases?

    PubMed Central

    Lodewick, Toine M; van Nijnatten, Thiemo J A; van Dam, Ronald M; van Mierlo, Kim; Dello, Simon A W G; Neumann, Ulf P; Olde Damink, Steven W M; Dejong, Cornelis H C

    2015-01-01

    Background The impact of body composition on outcomes after surgery for colorectal liver metastases (CRLM) remains unclear. The aim of the present study was to determine the influence of sarcopenia, obesity and sarcopenic obesity on morbidity, disease-free (DFS) and overall survival (OS). Method Between 2005 and 2012, all patients undergoing a partial liver resection for CRLM in the Maastricht University Medical Centre, and who underwent computed tomography (CT) imaging within 3 months before liver surgery, were included. Body composition was primarily based on pre-operative CT measurements. Sarcopenia was based on total muscle area at the level of the third lumbar vertebra and predefined body mass index (BMI)- and gender-specific cut-off values for sarcopenia were used. Body fat percentages were calculated and the top 40% for men and women were considered obese. Results Of the 171 included patients undergoing liver surgery for CRLM, 80 (46.8%) patients were sarcopenic, 69 (40.4%) obese and 49 (28.7%) sarcopenic obese. The presence of sarcopenia, obesity or sarcopenic obesity did not affect the complication rates. However, readmission rates were significantly increased in patients with (sarcopenic) obesity (P < 0.05). Surprisingly, obesity seemed to prolong OS (P = 0.021) and was identified as an independent predictor [hazard ratio (HR):0.58 and P = 0.046] for better OS. Sarcopenia and sarcopenic obesity did not affect DFS or OS. Conclusion Sarcopenia, obesity and sarcopenic obesity did not worsen DFS, OS and complication rates after a partial liver resection for CRLM. PMID:25512239

  16. Complications Following Colon Rectal Surgery in the Obese Patient

    PubMed Central

    Geiger, Timothy M.; Muldoon, Roberta

    2011-01-01

    It is well recognized that obesity contributes to multiple co-morbidities, and it would seem intuitive that obese patients experience an increase in post-operative complications after colorectal surgery. Overall, the data examining postoperative morbidity and mortality in the obese colorectal patient is inconsistent. Studies have shown a trend for obese patients have a higher post-operative risk of pulmonary embolism, atelectasis, cardiac complications, and thromboembolic disease. However, even with multiple large trials concluding this, there are also many studies showing no difference. The literature has shown that using laparoscopic techniques is safe and feasible, but there is a higher rate of conversion to open, and longer operative times. In addition, obese patients might have a higher leak rate for distal anastomosis as compared with normal weight patients. These patients also have a higher post-operative rate of stomal complications and fascial dehiscense. In reviewing the literature, at best, the complication rate in obese patients is the same as non-obese patients after colorectal surgery, but there are significant trends that suggest a negative effect of obesity after colorectal surgery. PMID:23204943

  17. Behavioral management of the obese patient

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Despite countless diets, exercise regimens, drugs, and behavior modification strategies, the prevalence of obesity continues its relentless increase in both developed and developing nations. Although many necessary components to treat obesity have been identified, behavior modification remains the b...

  18. Do obese patients have worse outcomes after direct lateral interbody fusion compared to non-obese patients?

    PubMed

    Adogwa, Owoicho; Farber, S Harrison; Fatemi, Parastou; Desai, Rupen; Elsamadicy, Aladine; Cheng, Joseph; Bagley, Carlos; Gottfried, Oren; Isaacs, Robert E

    2016-03-01

    Obese patients undergoing lumbar spinal fusion surgery are a challenge to the operating surgeon. Direct lateral interbody fusion (DLIF) has been performed for degenerative disease of the lumbar spine with good outcomes; nevertheless, how obese patients fare compared to non-obese patients after DLIF remains unknown. The primary aim of this study is to compare rates of postoperative complications and long-term outcomes between obese and non-obese patients undergoing DLIF. Sixty-three patients (obese: 29, non-obese: 34) undergoing index DLIF for degenerative disease of the spine between 2010 and 2012 at our institution were retrospectively enrolled. We analyzed data on demographics, postoperative complications, back and leg pain, and functional disability over 2 years. Patients completed the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) back and leg pain numerical rating scores before surgery, then at 12 and 24 months after surgery. Outcomes and complication rates were compared between the cohorts. The cohorts were similar at baseline. Postoperative complications rates were similar between obese and non-obese patients. There was no statistically significant difference in the incidence of durotomy (p=0.91), anterior thigh numbness (p=0.60), cerebrospinal fluid leak (p=0.91), postoperative infection (p=0.37), or bleeding requiring transfusion (p=0.16). No patient experienced a nerve injury or psoas hematoma. Both cohorts had similar 2 year improvement in VAS for back pain, leg pain, and ODI. Our study demonstrates that obese and non-obese patients undergoing DLIF have similar complication profiles; hence, a patient's weight should not be a contraindication to DLIF. PMID:26549673

  19. Altered lower extremity fracture characteristics in obese pediatric trauma patients

    PubMed Central

    MacLennan, Paul A.; Backstrom, Ian; Creek, Aaron; Sawyer, Jeffrey

    2014-01-01

    Objective To determine whether there are differences in fracture patterns and femur fracture treatment choices in obese vs. non-obese pediatric trauma patients. Design Prognostic study, retrospective chart review. Setting Two level I pediatric trauma centers. Patients The trauma registries of two pediatric hospitals were queried for patients with lower extremity long bone fractures resulting from blunt trauma. 2858 alerts were examined and 397 patients had lower extremity fractures. 331 patients with a total of 394 femur or tibia fractures met inclusion criteria, and 70 patients (21%) were obese. Main Outcome Measurements Weight for age >95th percentile was defined as obese. Radiographs were reviewed and fractures were classified according the OTA/AO pediatric fracture classification system. Fracture patterns (OTA subsegment), severity, and choice of intervention for femur fractures were primary outcomes. Results Overall, obese patients were twice as likely (RR=2.20, 95% CI 1.25–3.89) to have fractures involving the physis. Physeal fracture risk was greater for femur fractures (RR=3.25, 95% CI 1.35–7.78) than tibia fractures (RR=1.58, 95% CI 0.76–3.26). Severity did not differ between groups. Obese patients with femur fractures were more likely to be treated with locked nails. Conclusion Obese pediatric trauma patients are more likely to sustain fractures involving the physis than non-obese patients. This could be related to intrinsic changes to the physis related to obesity, or altered biomechanical forces. This is consistent with the observed relationships between obesity and other conditions affecting the physis including Blount’s and slipped capital femoral epiphysis. PMID:24740109

  20. Correlative studies on the effects of obesity, diabetes and hypertension on gene expression in omental adipose tissue of obese women

    PubMed Central

    Fain, J N

    2011-01-01

    Objective: A major consequence of obesity is the enormous expansion of and enhanced inflammatory response seen in visceral adipose tissue. I hypothesized that the expression of inflammatory markers in visceral omental fat would correlate with the extent of visceral adiposity as measured by waist circumference or body mass index and that diabetes and hypertension, defined as subjects taking anti-hypertensive drugs, would be associated with changes in mRNA expression in visceral fat. Design and methods: The expression of 106 mRNAs by RT-PCR was examined in observational studies using extracts of omental fat of obese women undergoing bariatric surgery as well as the circulating levels of some adipokines. We also compared the mRNA levels of 65 proteins in omental fat removed during gastric bypass surgery of women with and without hypertension and those with type 2 diabetes. Results: Out of 106 mRNAs the expression of 10 mRNAs in omental fat of women not taking anti-hypertensive drugs correlated with waist circumference while 7 different mRNAs had significant correlations with circulating glucose. The correlations of waist circumference with mRNA expression were abolished, except for interleukin (IL)-1 receptor antagonist (IL-1RA), in women taking anti-hypertensive drugs. The correlations of blood glucose with omental fat mRNA expression were abolished, except for that of Akt1 and Akt2, in women taking anti-hypertensive drugs. However, the expression of 4 different mRNAs in omental fat was affected by circulating glucose in subjects taking anti-hypertensive drugs. The circulating levels of IL-1 RA, but not fatty acid binding protein 4, adipsin and phospholipase A2, correlated with both waist circumference and mRNA expression in omental fat. Conclusion: In female bariatric surgery patients, the mRNA expression of some proteins in omental fat was affected by the degree of obesity, whereas hypertension and diabetes affected a separate set of mRNAs. PMID:23154658

  1. Beyond BMI: Conceptual Issues Related to Overweight and Obese Patients.

    PubMed

    Müller, Manfred James; Braun, Wiebke; Enderle, Janna; Bosy-Westphal, Anja

    2016-01-01

    BMI is widely used as a measure of weight status and disease risks; it defines overweight and obesity based on statistical criteria. BMI is a score; neither is it biologically sound nor does it reflect a suitable phenotype worthwhile to study. Because of its limited value, BMI cannot provide profound insight into obesity biology and its co-morbidity. Alternative assessments of weight status include detailed phenotyping by body composition analysis (BCA). However, predicting disease risks, fat mass, and fat-free mass as assessed by validated techniques (i.e., densitometry, dual energy X ray absorptiometry, and bioelectrical impedance analysis) does not exceed the value of BMI. Going beyond BMI and descriptive BCA, the concept of functional body composition (FBC) integrates body components into regulatory systems. FBC refers to the masses of body components, organs, and tissues as well as to their inter-relationships within the context of endocrine, metabolic and immune functions. FBC can be used to define specific phenotypes of obesity, e.g. the sarcopenic-obese patient. Well-characterized obesity phenotypes are a precondition for targeted research (e.g., on the genomics of obesity) and patient-centered care (e.g., adequate treatment of individual obese phenotypes such as the sarcopenic-obese patient). FBC contributes to a future definition of overweight and obesity based on physiological criteria rather than on body weight alone. PMID:27286962

  2. Diagnostic Predictors of Obesity-Hypoventilation Syndrome in Patients Suspected of Having Sleep Disordered Breathing

    PubMed Central

    Macavei, Vladimir M.; Spurling, Kristofer J.; Loft, Janine; Makker, Himender K.

    2013-01-01

    Introduction: Obesity-hypoventilation syndrome (OHS) is associated with significant morbidity and mortality and requires measurement of arterial pCO2 for diagnosis. Objective: To determine diagnostic predictors of OHS among obese patients with suspected obstructive sleep apnea/hypopnea syndrome (OSAHS). Methods: Retrospective analysis of data on 525 sleep clinic patients (mean age 51.4 ± 12.7 years; 65.7% males; mean BMI 34.5 ± 8.1). All patients had sleep studies, and arterialized capillary blood gases (CBG) were measured in obese subjects (BMI > 30 kg/m2). Results: Of 525 patients, 65.5% were obese, 37.2% were morbidly obese (BMI > 40 kg/m2); 52.3% had confirmed OSAHS. Hypercapnia (pCO2 > 6 kPa or 45 mm Hg) was present in 20.6% obese and 22.1% OSAHS patients. Analysis of OHS predictors showed significant correlations between pCO2 and BMI, FEV1, FVC, AHI, mean and minimum nocturnal SpO2, sleep time with SpO2 < 90%, pO2, and calculated HCO3 from the CBG. PO2 and HCO3 were independent predictors of OHS, explaining 27.7% of pCO2 variance (p < 0.0001). A calculated HCO3 cutoff > 27 mmol/L had 85.7% sensitivity and 89.5% specificity for diagnosis of OHS, with 68.1% positive and 95.9% negative predictive value. Conclusion: We confirmed a high prevalence of OHS in obese OSAHS patients (22.1%) and high calculated HCO3 level (> 27 mmol/L) to be a sensitive and specific predictor for the diagnosis of OHS. Citation: Macavei VM; Spurling KJ; Loft J; Makker HK. Diagnostic predictors of obesity-hypoventilation syndrome in patients suspected of having sleep disordered breathing. J Clin Sleep Med 2013;9(9):879-884. PMID:23997700

  3. Managing anesthesia for cesarean section in obese patients: current perspectives.

    PubMed

    Lamon, Agnes M; Habib, Ashraf S

    2016-01-01

    Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464

  4. Managing anesthesia for cesarean section in obese patients: current perspectives

    PubMed Central

    Lamon, Agnes M; Habib, Ashraf S

    2016-01-01

    Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464

  5. Transfer of obese patients in European air ambulances.

    PubMed

    Prottengeier, Johannes; Meyer, Michael; Münster, Tino

    2014-10-01

    The prevalence of obesity is rising worldwide. To investigate how fixed-wing air ambulances handle bariatric transfers, we conducted a survey addressing logistical and medical issues. A questionnaire was sent to 24 air ambulance companies in Europe. Seventy-nine percent of European companies returned the questionnaire, 95% of the companies consider the transfer of heavyweight patients challenging, and 21% have experienced critical incidents related to the patient's obesity. Forty-seven percent have standard operating procedures in place for bariatric transports. Only 26% will dispatch extra personnel for such flights. Dedicated tools for transferring, bedding, and securing patients are available very inconsistently. Medical provisions such as airway management, monitoring, and vascular access for the obese reach high standards. While medical resources for obesity-related problems reach a high standard, poor logistical preparations could lead to harm for patient and medical escort alike. PMID:24296875

  6. Human obese gene: molecular screening in Japanese and Asian Indian NIDDM patients associated with obesity.

    PubMed

    Niki, T; Mori, H; Tamori, Y; Kishimoto-Hashirmoto, M; Ueno, H; Araki, S; Masugi, J; Sawant, N; Majithia, H R; Rais, N

    1996-05-01

    The mouse obese (ob) gene has recently been isolated through the positional cloning technique and has been proved to result in the obese and NIDDM phenotype in mice when mutated (Nature 372:425-432, 1994). More recently, it has been demonstrated, by experiments with recombinant ob protein, that ob gene product can cause mice, including ob/ob mice, diet-induced obesity mice, and normal mice, to lower their food intake and body weight (Science 269:540-549, 1995). To investigate the genetic and/or environmental influences underlying the development of NIDDM associated with obesity, we isolated and partially sequenced the human obese (OB) gene. The human OB gene isolated in this study encoded 167 amino acids and its open reading frame was revealed to be divided into two parts with an intermediate intron of approximately 2.4 kb. Using the single-strand conformation polymorphism (SSCP) technique, we screened Japanese and Asian Indian subjects for mutations in the protein coding regions of the OB gene. A total of 75 NIDDM patients with obesity (54 Japanese and 21 Asian Indians), 40 NIDDM patients without obesity (34 Japanese and 6 Asian Indians), and 34 Japanese patients with simple obesity showed no abnormal SSCP patterns in either component of the coding sequences. These results suggested that mutations in the coding regions of the OB gene are not likely to be commonly identifiable and that there would likely be a kind of obesity-associated NIDDM not caused by mutations of the OB gene. PMID:8621021

  7. Morbidities of Lung Cancer Surgery in Obese Patients

    PubMed Central

    Dhakal, Binod; Eastwood, Daniel; Sukumaran, Sunitha; Hassler, George; Tisol, William; Gasparri, Mario; Choong, Nicholas; Santana-Davila, Rafael

    2016-01-01

    Background Obesity is a risk factor for increased peri-operative morbidity and mortality in surgical patients. There have been limited studies to correlate the morbidity of lung cancer resection with obesity. Methods We performed a retrospective study of patients who underwent surgical resection for lung cancer at the Medical College of Wisconsin from 2006 to 2010. Data on patient demographics, weight, pathology findings and hospital course were abstracted after appropriate IRB approval. Peri-operative morbidity was defined as atrial fibrillation, heart failure, respiratory failure, pulmonary embolism or any medical complications arising within 30 days after surgery. Fisher’s exact test was used to test the association between BMI and peri-operative morbidities. Results Between 2006 and 2010,320 lung resections were performed for lung cancer. Median age was 67(IQR 59–75) years and 185(57.8%) were females.121 (37.8%) patients had a BMI<25 and 199(62.18%) patients had a BMI≥25. The 30-day mortality rate was 1.8 % (n=6) in the whole group; only 2 of these patients had a BMI ≥ 25. Peri-operative morbidity occurred in 28(23.14%) of normal BMI patients and in 47(23.61%) of BMI ≥ 25 patients (p=0.54). Specific morbidities encountered by patients with normal vs. BMI ≥ 25 were: atrial fibrillation 11(9.09%) vs. 24(12.06%) (p=0.46), Pulmonary embolism 1(0.83%) vs. 3(1.51%) (p=1.0), congestive heart failure 2(1.65%) vs. 2(1.01%) (p=0.63), renal failure 4(3.3%) vs.2 (1.0%)(p=0.29), respiratory failure 12(9.92%) vs. 17(8.54%) (p=0.69) and acute respiratory distress syndrome 2(1.65%) vs. 1(0.50%) (p=0.55). Median hospital stay was 5 days in the lower BMI group and 4 days in the BMI ≥25 groups (p=0.52). Conclusions Overweight and normal weight patients do not differ significantly in rates of perioperative morbidities, 30-day mortality and length of stay. Our study indicates that potential curative surgical resections can be offered to even significantly overweight

  8. Transforaminal full-endoscopic lumbar discectomy in obese patients

    PubMed Central

    Bae, Jun Seok

    2016-01-01

    Background Obese patients are at risk of complications such as slower wound healing and increased infection rates after spinal surgery. Transforaminal full-endoscopic lumbar discectomy (ELD) has advantages over conventional microdiscectomy because it decreases perioperative complications and increases favorable clinical outcomes. No clinical studies have reported ELD in obese patients. The purpose of this study is to evaluate the clinical outcomes of transforaminal ELD in obese patients Methods Obesity is defined as a body mass index (BMI) of more than 30 kg/m2. Our study included 21 obese patients and 27 normal BMI patients treated by posterolateral transforaminal ELD for radiating pain caused by a single-level lumbar disc herniation with more than 2 years of follow-up. Clinical chart reviews and telephone surveys were conducted. Clinical and functional outcomes using VAS and ODI, perioperative complications, and reherniation were evaluated. Results Overall clinical and functional outcomes were improved during postoperative follow-up evaluation. There were no immediate perioperative complications, such as infection or durotomy in both groups. In obese group, three patients had late reherniations. Of these, 2 patients had tolerable pain and showed good recovery with conservative treatment; 1 patient who had undergone ELD for recurrent disc herniation underwent open microdiscectomy. In control group, two patients had early reherniation and underwent open microdiscectomy and one patient with late reherniation showed good recovery with conservative treatment. Conclusion In select cases, ELD is an effective, safe, and minimally invasive technique for obese patients. It decreases perioperative morbidity and allows for both early mobilization and early return to work. Level of Evidence: level 3b. PMID:27441176

  9. Type 2 Diabetes Treatment in the Patient with Obesity.

    PubMed

    Malin, Steven K; Kashyap, Sangeeta R

    2016-09-01

    Lifestyle modification is the cornerstone treatment of type 2 diabetes in the obese patient, and is highly effective at promoting glucose regulation. However, many individuals struggle over time to maintain optimal glycemic control and/or body weight with lifestyle modification. Therefore, additional therapeutic approaches are needed. Pharmacologic interventions have shown promising results for obesity-related diabetes complications. Not surprisingly though lifestyle modification and pharmacology may become ineffective for treating diabetes over time. Bariatric surgery is considered by some, but not all, to be the most effective and durable treatment for combating obesity. In fact many patients with type 2 diabetes have normalized glucose concentrations within days postoperation. Taken together, treatment of obesity in the patient with type 2 diabetes requires a multi-faceted approach. PMID:27519130

  10. Prevalence and correlates of being overweight or obese in college.

    PubMed

    Odlaug, Brian L; Lust, Katherine; Wimmelmann, Cathrine L; Chamberlain, Samuel R; Mortensen, Erik L; Derbyshire, Katherine; Christenson, Gary; Grant, Jon E

    2015-05-30

    Recent statistics indicate that over one-third of college students are currently overweight or obese, however, the impact of weight in this population from academic and psychiatric perspectives is not fully understood. This study sought to examine the prevalence of overweight and obesity in college students and its association with stress, mental health disorders and academic achievement. A total of 1765 students completed the College Student Computer User Survey (CSCUS) online at a large Midwestern United States University. Responders were classified by weight as normal, overweight or obese based on body mass index. Data were stratified by sex, with cross-tabulation and t-tests, one-way analysis of variance, and logistic regression for analysis. A total of 492 (27.9%) students were overweight (20.2%; range 25.01-29.98) or obese (7.7%; range 30.04-71.26). Overweight and obesity were associated with significantly lower overall academic achievement, more depressive symptoms, and using diet pills for weight loss. Obese males had significantly higher rates of lifetime trichotillomania while overweight and obese females reported higher rates of panic disorder. Higher educational institutions should be aware of the significant burden associated with overweight and obesity in students, and of the differing demographic and clinical associations between overweight or obesity in men and women. PMID:25770354

  11. Obese patients have similar short-term outcomes to non-obese in laparoscopic colorectal surgery

    PubMed Central

    Chand, Manish; De’Ath, Henry D; Siddiqui, Muhammed; Mehta, Chetanya; Rasheed, Shahnawaz; Bromilow, James; Qureshi, Tahseen

    2015-01-01

    AIM: To determine whether obese patients undergoing laparoscopic surgery within an enhanced recovery program had worse short-term outcomes. METHODS: A prospective study of consecutive patients undergoing laparoscopic colorectal resection was carried out between 2008 and 2011 in a single institution. Patients were divided in groups based on body mass index (BMI). Short-term outcomes including operative data, length of stay, complications and readmission rates were recorded and compared between the groups. Continuous data were analysed using t-test or one-way Analysis of Variance. χ2 test was used to compare categorical data. RESULTS: Two hundred and fifty four patients were included over the study period. The majority of individuals (41.7%) recruited were of a healthy weight (BMI < 25), whilst 50 patients were classified as obese (19.6%). Patients were matched in terms of the presence of co-morbidities and previous abdominal surgery. Obese patients were found to have a statistically significant difference in The American Society of Anesthesiologists grade. Length of surgery and intra-operative blood loss were no different according to BMI. CONCLUSION: Obesity (BMI > 25) does not lead to worse short-term outcomes in laparoscopic colorectal surgery and therefore such patients should not be precluded from laparoscopic surgery. PMID:26527560

  12. Gender differences in patients with obesity hypoventilation syndrome.

    PubMed

    BaHammam, Ahmed S; Pandi-Perumal, Seithikurippu R; Piper, Amanda; Bahammam, Salman A; Almeneessier, Aljohara S; Olaish, Awad H; Javaheri, Shahrokh

    2016-08-01

    The role of gender and menopause in obstructive sleep apnoea is well known; however, no study has reported the impact of gender on the clinical presentation and the nocturnal respiratory events in patients with obesity hypoventilation syndrome. Therefore, this study prospectively evaluated differences in the clinical characteristics of women and men with obesity hypoventilation syndrome in a large cohort of patients with obstructive sleep apnoea. During the study period, a total of 1973 patients were referred to the sleep clinic with clinical suspicion of obstructive sleep apnoea. All patients underwent overnight polysomnography, during which time spirometry, arterial blood samples and thyroid tests were routinely obtained. Among 1973 consecutive patients, 1693 (617 women) were diagnosed with obstructive sleep apnoea, among whom 144 suffered from obesity hypoventilation syndrome (96 women). The prevalence of obesity hypoventilation syndrome among women and men was 15.6% and 4.5%, respectively (P < 0.001). Women with obesity hypoventilation syndrome were significantly older than men with obesity hypoventilation syndrome (61.5 ± 11.9 years versus 49.1 ± 12.5 years, P < 0.001). Although there were no significant differences between genders regarding symptoms, body mass index, spirometric data or daytime PaCO2 , women with obesity hypoventilation syndrome suffered significantly more from hypertension, diabetes and hypothyroidism. The prevalence of obesity hypoventilation syndrome was higher in post-menopausal (21%) compared with pre-menopausal (5.3%) women (P < 0001). HCO3 and duration of SpO2 <90% were the only independent predictors of obesity hypoventilation syndrome. In conclusion, this study reported that among subjects referred to the sleep disorders clinic for evaluation of obstructive sleep apnoea, obesity hypoventilation syndrome is more prevalent in women than men, and that women with obesity hypoventilation syndrome suffer from significantly

  13. Comparison of Clinical Presentation, Left Ventricular Morphology and Hemodynamics, and Exercise Tolerance in Obese versus Non-Obese Patients with Hypertrophic Cardiomyopathy

    PubMed Central

    Canepa, Marco; Sorensen, Lars L.; Pozios, Iraklis; Dimaano, Veronica L.; Hong-Chang, Luo; Pinheiro, Aurelio C.; Strait, James B.; Brunelli, Claudio; Abraham, M. Roselle; Ferrucci, Luigi; Abraham, Theodore P.

    2014-01-01

    Obesity is independently associated with left ventricular (LV) hypertrophy and thus may be an important modifier of the hypertrophic cardiomyopathy (HC) phenotype. We examined if obesity modifies the clinical presentation, LV morphology, outflow hemodynamics and exercise tolerance in HC. In this cross-sectional study, 88 obese (body mass index, BMI≥30 kg/m2) and 154 non-obese (BMI<30 kg/m2) patients from the Johns Hopkins HC clinic were compared with respect to a variety of clinical and LV echocardiographic measurements. Obese patients (36.4%) were more likely to report exertional dyspnea (p=0.04) and chest pain (p=0.002), and had higher prevalence of hypertension (p=0.008). LV posterior wall thickness (p=0.01) but not the septal wall (p≥0.21) was significantly higher in obese patients, resulting in an increased LV mass index (p=0.003). No significant differences in LV systolic and diastolic function were observed, but obesity was associated with higher LV stroke volume (p=0.03), inducible LV outflow tract gradients (p=0.045) and chance of developing LV outflow tract obstruction during stress (p=0.035). In multivariate analysis, BMI was associated with increased posterior (but not septal) wall thickness (β=0.15, p=0.02) and LV mass index (β=0.18, p=0.005), particularly in those with hypertension. Obesity was also associated with reduced exercise time and functional capacity, and BMI independently correlated with reduced exercise tolerance. In conclusion, obesity is associated with larger LV mass, worse symptoms, lower exercise tolerance and labile obstructive hemodynamics in HC. The association with increased outflow tract gradients has particular importance as contribution of obesity to the pressure gradients may influence clinical decisions in labile obstructive HC. PMID:24079444

  14. Obesity Paradox in End-Stage Kidney Disease Patients

    PubMed Central

    Park, Jongha; Ahmadi, Seyed-Foad; Streja, Elani; Molnar, Miklos Z; Flegal, Katherine M.; Gillen, Daniel; Kovesdy, Csaba P.; Kalantar-Zadeh, Kamyar

    2016-01-01

    In the general population, obesity is associated with increased cardiovascular risk and decreased survival. In patients with end-stage renal disease (ESRD), however, an “obesity paradox” or “reverse epidemiology” (to include lipid and hypertension paradoxes) has been consistently reported, i.e. a higher body mass index (BMI) is paradoxically associated with better survival. This survival advantage of large body size is relatively consistent for hemodialysis patients across racial and regional differences, although published results are mixed for peritoneal dialysis patients.. Recent data indicate that both higher skeletal muscle mass and increased total body fat are protective, although there are mixed data on visceral (intra-abdominal) fat. The obesity paradox in ESRD is unlikely to be due to residual confounding alone and has biologic plausibility. Possible causes of the obesity paradox include protein-energy wasting and inflammation, time discrepancy among competitive risk factors (undernutrition versus overnutrition), hemodynamic stability, alteration of circulatory cytokines, sequestration of uremic toxin in adipose tissue, and endotoxin-lipoprotein interaction. The obesity paradox may have significant clinical implications in the management of ESRD patients especially if obese dialysis patients are forced to lose weight upon transplant wait-listing. Well-designed studies exploring the causes and consequences of the reverse epidemiology of cardiovascular risk factors, including the obesity paradox, among ESRD patients could provide more information on mechanisms. These could include controlled trials of nutritional and pharmacologic interventions to examine whether gain in lean body mass or even body fat can improve survival and quality of life in these patients. PMID:24438733

  15. Robotic transabdominal kidney transplantation in a morbidly obese patient.

    PubMed

    Giulianotti, P; Gorodner, V; Sbrana, F; Tzvetanov, I; Jeon, H; Bianco, F; Kinzer, K; Oberholzer, J; Benedetti, E

    2010-06-01

    Kidney transplantation in morbidly obese patients can be technically demanding. Furthermore, morbidly obese patients experience a high rate of wound infections and related complications, which mostly result from the longer length and extent of the incision. These complications can be avoided through minimally invasive surgery; however, conventional laparoscopic instruments are unsuitable for the safe performance of a kidney transplant in morbidly obese patients. Herein, we report the first minimally invasive, total robotic kidney transplant in a morbidly obese patient. A left, deceased donor kidney was transplanted into a 29-year-old woman with a body mass index (BMI) of 41 kg/m(2) who had been on hemodialysis for 5 years. The operation was performed intraabdominally using the DaVinci Robotic Surgical System with 4 trocars and a 7 cm midline incision. The operative time was 223 min, and the blood loss was less than 50 cc. The kidney had immediate graft function. No perioperative complications were observed, and the patient was discharged on postoperative day 5 with normal kidney function. Minimally invasive access and robotic technology facilitated the safe performance of a successful kidney transplant in a morbidly obese patient. PMID:20486912

  16. Risks associated with obese patient handling in emergency prehospital care.

    PubMed

    Réminiac, François; Jouan, Youenn; Cazals, Xavier; Bodin, Jean-François; Dequin, Pierre-François; Guillon, Antoine

    2014-01-01

    The number of ambulance crewmembers may affect the quality of cardiopulmonary resuscitation in particular situations. However, few studies have investigated how the number of emergency care providers affects the quality of CPR. Nonetheless, problems in the initial handling of patients due to small ambulance crew sizes may have significant consequences. These difficulties may be more frequent in an obese population than in a non-obese population. Hence such problems may be frequently encountered because obesity is epidemic in developed countries. In this report, we illustrate the fatal consequences of initial problems in patient handling due to a small ambulance crew size in an obese patient who suffered an out-of-hospital cardiac arrest. Following successful resuscitation, this patient presented humeral fractures that may have promoted a disorder of hemostasis. The patient eventually died. This case highlights the requirement for specific instructions for paramedics to manage obese patients in these emergency conditions. This case also highlights the need to take into account body mass index when deciding on appropriate pre-hospital care, especially regarding the number of ambulance crewmembers. PMID:24830962

  17. Avoiding Management Errors in Patients with Obesity Hypoventilation Syndrome.

    PubMed

    Manthous, Constantine A; Mokhlesi, Babak

    2016-01-01

    The prevalence of obesity hypoventilation syndrome and obstructive sleep apnea are increasing rapidly in the United States in parallel with the obesity epidemic. As the pathogenesis of this chronic illness is better understood, effective evidence-based therapies are being deployed to reduce morbidity and mortality. Nevertheless, patients with obesity hypoventilation still fall prey to at least four avoidable types of therapeutic errors, especially at the time of hospitalization for respiratory or cardiovascular decompensation: (1) patients with obesity hypoventilation syndrome may develop acute hypercapnia in response to administration of excessive supplemental oxygen; (2) excessive diuresis for peripheral edema using a loop diuretic such as furosemide exacerbates metabolic alkalosis, thereby worsening daytime hypoventilation and hypoxemia; (3) excessive or premature pharmacological treatment of psychiatric illnesses can exacerbate sleep-disordered breathing and worsen hypercapnia, thereby exacerbating psychiatric symptoms; and (4) clinicians often erroneously diagnose obstructive lung disease in patients with obesity hypoventilation, thereby exposing them to unnecessary and potentially harmful medications, including β-agonists and corticosteroids. Just as literary descriptions of pickwickian syndrome have given way to greater understanding of the pathophysiology of obesity hypoventilation, clinicians might exercise caution to consider these potential pitfalls and thus avoid inflicting unintended and avoidable complications. PMID:26512908

  18. Correlates of Obesity in Young Black and White Women: The CARDIA Study.

    ERIC Educational Resources Information Center

    Burke, Gregory L.; And Others

    1992-01-01

    Contrasts body size and potential correlates of obesity in 1,481 African-American and 1,307 white 18- through 30-year-old women in the Coronary Artery Risk Development in Young Adults Study (CARDIA). The increased prevalence of obesity in African-American women could not be explained by racial differences in age or education. (SLD)

  19. Respiratory management of the obese patient undergoing surgery.

    PubMed

    Hodgson, Luke E; Murphy, Patrick B; Hart, Nicholas

    2015-05-01

    As a reflection of the increasing global incidence of obesity, there has been a corresponding rise in the proportion of obese patients undergoing major surgery. This review reports the physiological effect of these changes in body composition on the respiratory system and discusses the clinical approach required to maximize safety and minimize the risk to the patient. The changes in respiratory system compliance and lung volumes, which can adversely affect pulmonary gas exchange, combined with upper airways obstruction and sleep-disordered breathing need to be considered carefully in the peri-operative period. Indeed, these challenges in the obese patient have led to a clear focus on the clinical management strategy and development of peri-operative pathways, including pre-operative risk assessment, patient positioning at induction and under anesthesia, modified approach to intraoperative ventilation and the peri-operative use of non-invasive ventilation (NIV) and continuous positive airways pressure. PMID:26101653

  20. Respiratory management of the obese patient undergoing surgery

    PubMed Central

    Hodgson, Luke E.; Murphy, Patrick B.

    2015-01-01

    As a reflection of the increasing global incidence of obesity, there has been a corresponding rise in the proportion of obese patients undergoing major surgery. This review reports the physiological effect of these changes in body composition on the respiratory system and discusses the clinical approach required to maximize safety and minimize the risk to the patient. The changes in respiratory system compliance and lung volumes, which can adversely affect pulmonary gas exchange, combined with upper airways obstruction and sleep-disordered breathing need to be considered carefully in the peri-operative period. Indeed, these challenges in the obese patient have led to a clear focus on the clinical management strategy and development of peri-operative pathways, including pre-operative risk assessment, patient positioning at induction and under anesthesia, modified approach to intraoperative ventilation and the peri-operative use of non-invasive ventilation (NIV) and continuous positive airways pressure. PMID:26101653

  1. Physical environmental correlates of childhood obesity: a systematic review.

    PubMed

    Dunton, G F; Kaplan, J; Wolch, J; Jerrett, M; Reynolds, K D

    2009-07-01

    Increasing rates of childhood obesity in the USA and other Western countries are a cause for serious public health concern. Neighborhood and community environments are thought to play a contributing role in the development of obesity among youth, but it is not well understood which types of physical environmental characteristics have the most potential to influence obesity outcomes. This paper reports the results of a systematic review of quantitative research examining built and biophysical environmental variables associated with obesity in children and adolescents through physical activity. Literature searches in PubMed, PsychInfo and Geobase were conducted. Fifteen quantitative studies met the inclusion criteria for this systematic review. The majority of studies were cross-sectional and published after 2005. Overall, few consistent findings emerged. For children, associations between physical environmental variables and obesity differed by gender, age, socioeconomic status, population density and whether reports were made by the parent or child. Access to equipment and facilities, neighborhood pattern (e.g. rural, exurban, suburban) and urban sprawl were associated with obesity outcomes in adolescents. For most environmental variables considered, strong empirical evidence is not yet available. Conceptual gaps, methodological limitations and future research directions are discussed. PMID:19389058

  2. Psychiatric symptoms and leptin in obese patients who were bariatric surgery candidates

    PubMed Central

    Changchien, Te-Chang; Tai, Chi-Ming; Huang, Chih-Kun; Chien, Chia-Chang; Yen, Yung-Chieh

    2015-01-01

    Objective There is a significant relationship between obesity and common mental symptoms (depression and anxiety symptoms). But the association between depression (or anxiety symptoms) and serum leptin is still unclear and controversial, despite the growing body of evidence supporting the existence of “leptin resistance” in obese persons. So we investigated whether common mental symptoms, obesity, and the interactive effect of these two factors have a relationship with leptin in obese patients who were candidates for bariatric surgery. Methods In all, 139 participants (mean age: 31.4 years, standard deviation: 9.3 years, 73.4% female) were enrolled at an obesity treatment center in southern Taiwan. Serum leptin levels and body mass index (BMI) were measured. The Chinese Health Questionnaire and Taiwanese Depression Questionnaire were administered. Results The mean BMI of our participants was 39.4 kg/m2 (±6.8), and the mean leptin level was 24.5 ng/mL (±9.4). In the multivariate regression models, Chinese Health Questionnaire-by-BMI and Taiwanese Depression Questionnaire-by-BMI interaction terms remained significant predictors of leptin level (β=0.16, P<0.0001; β=0.04, P<0.0001, respectively), after adjustment for age, sex, and history of hypertension, diabetes, and hyperlipidemia, despite the inverse correlation between Chinese Health Questionnaire (or Taiwanese Depression Questionnaire) and leptin. In addition, female patients had significantly higher leptin levels than male patients. Conclusion The present findings confirmed that the relationship between common mental symptoms and leptin is modulated by obesity in severely obese patients. Future studies should focus on further measures of leptin receptors or signaling on the basis of these interactive effects in psychiatry. PMID:26316761

  3. Obesity and type 2 diabetes: which patients are at risk?

    PubMed

    Garber, A J

    2012-05-01

    An estimated 72.5 million American adults are obese, and the growing US obesity epidemic is responsible for substantial increase in morbidity and mortality, as well as increased health care costs. Obesity results from a combination of personal and societal factors, but is often viewed as a character flaw rather than a medical condition. This leads to stigma and discrimination towards obese individuals and decreases the likelihood of effective intervention. Conditions related to obesity are increasingly common, such as metabolic syndrome, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), all of which indicate high risk for type 2 diabetes (T2DM). This paper reviews the progression from obesity to diabetes, identifying physiological changes that occur along this path as well as opportunities for patient identification and disease prevention. Patients with prediabetes (defined as having IFG, IGT or both) and/or metabolic syndrome require interventions designed to preserve insulin sensitivity and β-cell function, both of which start to deteriorate prior to T2DM diagnosis. Lifestyle modification, including both healthy eating choices and increased physical activity, is essential for weight management and diabetes prevention. Although sustained weight loss is often considered by patients and physicians as being impossible to achieve, effective interventions do exist. Specifically, the Diabetes Prevention Program (DPP) and programs modelled along its parameters have shown repeated successes, even with long-term maintenance. Recent setbacks in the development of medications for weight loss further stress the importance of lifestyle management. By viewing obesity as a metabolic disorder rather than a personal weakness, we can work with patients to address this increasingly prevalent condition and improve long-term health outcomes. PMID:22074144

  4. Paraesophageal Hernia Repair With Partial Longitudinal Gastrectomy in Obese Patients

    PubMed Central

    Rodriguez, John; El-Hayek, Kevin; Brethauer, Stacy; Schauer, Philip; Zelisko, Andrea; Chand, Bipan; O'Rourke, Colin; Kroh, Matthew

    2015-01-01

    Background and Objectives: Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes. Methods: We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief. Results: Mean preoperative body mass index was 38.1 ± 4.9 kg/m2. Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass. Conclusions: Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required

  5. Weight loss during chronic, cervical vagus nerve stimulation in depressed patients with obesity

    PubMed Central

    Pardo, JV; Sheikh, SA; Kuskowski, MA; Surerus-Johnson, C; Hagen, MC; Lee, JT; Rittberg, BR; Adson, DE

    2008-01-01

    Fourteen patients were treated over 2 years with cervical vagus nerve stimulation (VNS) for adjunctive therapy of severe, treatment-resistant depression. Here, we report the serendipitous observation that this treatment was associated with highly significant, gradual weight loss despite the patients’ report of not dieting or exercising. The weight loss was proportional to the initial BMI, that is, the more severe the obesity, the greater the weight loss. Weight loss did not correlate with changes in mood symptoms. The vagus nerve carries visceral information to and from the brain; modulation of its activity may alter eating behavior. Chronic cervical VNS may merit controlled study for the treatment of severe obesity. PMID:17563762

  6. High prevalence of esophageal dysmotility in asymptomatic obese patients

    PubMed Central

    Côté-Daigneault, Justin; Leclerc, Pierre; Joubert, Josette; Bouin, Mickael

    2014-01-01

    BACKGROUND: Obesity is an important health problem affecting >500 million people worldwide. Esophageal dysmotility is a gastrointestinal pathology associated with obesity; however, its prevalence and characteristics remain unclear. Esophageal dysmotilities have a high prevalence among obese patients regardless of gastrointestinal symptoms. OBJECTIVE: To identify the prevalence of esophageal dysmotility among obese patients. The secondary goals were to characterize these pathologies in obese patients and identify risk factors. METHOD: A prospective study from January 2009 to March 2010 at the University of Montreal Hospital Centre (Montreal, Quebec) was performed. Every patient scheduled for bariatric surgery underwent preoperatory esophageal manometry and was included in the study. Manometry was performed according to a standardized protocol with the following measures: superior esophageal sphincter – coordination and release during deglutition; esophageal body – presence, propagation, length, amplitude and type of esophageal waves of contraction; lower esophageal sphincter – localization, tone, release, intragastic pressure and intraesophageal pressure. All reference values were those used in the digestive motility laboratory. A gastrointestinal symptoms questionnaire was completed on the day manometry was performed. Chart reviews were performed to identify comorbidities and treatments that could influence the results. RESULTS: A total of 53 patients were included (mean [± SD] age 43±10 years; mean body mass index 46±7 kg/m2; 70% female). Esophageal manometry revealed dysmotility in 51% (n=27) of the patients. This dysmotility involved the esophageal body in 74% (n=20) of the patients and the inferior sphincter in 11% (n=3). Mixed dysmotility (body and inferior sphincter) was found in 15% (n=4) of cases. The esophageal body dysmotilities were hypomotility in 85% (n=23) of the patients, either from insignificant waves (74% [n=20]), nonpropagated waves (11

  7. An examination of weight bias among treatment-seeking obese patients with and without binge eating disorder

    PubMed Central

    Barnes, Rachel D.; Ivezaj, Valentina; Grilo, Carlos M.

    2013-01-01

    Objective The objective was to compare weight-bias attitudes among treatment-seeking obese patients with and without binge eating disorder (BED vs. NBO) and to explore racial and sex differences and correlates of weight-bias attitudes. Method Participants included 221 obese patients (169 female, 52 male) seeking treatment for weight and eating, recruited through primary care settings; of these, 168 patients met BED criteria. Patients completed semi-structured interviews and psychometrically established self-report measures of attitudes about obesity, eating pathology and depression. Results Main effects for group (BED vs. NBO) and race (White vs. African American) were significant. Patients with BED had significantly higher levels of negative attitudes towards obesity than NBO patients, while African American patients had significantly lower levels of weight bias than did White patients. Greater negative attitudes towards obesity were significantly correlated with higher levels of depression and eating pathology for all patients. Conclusions Endorsement of negative weight bias was related to binge eating status, race, disordered eating, and depression. Primary care providers should be aware of weight biases among their patients. PMID:24359678

  8. Panniculectomy and Cystectomy: An Approach to the Morbidly Obese Patient

    PubMed Central

    Turner, Robert M.; Gusenoff, Jeffrey A.; Correa, Andres F.; Jacobs, Bruce L.; Davies, Benjamin J.

    2016-01-01

    The obese patient undergoing radical cystectomy faces a unique set of challenges. We present the case of a 68-year-old gentleman who presented to our institution with Bacillus Calmette-Guerin refractory disease, a body mass index of 38.5, and a large pannus. The present paper describes our technique for performing radical cystectomy with ileal conduit urinary diversion and concomitant panniculectomy. We discuss the impact of obesity on patients undergoing radical cystectomy and how this may be mitigated by panniculectomy. PMID:27195168

  9. Liposuction-Assisted Medial Thigh Lift in Obese and Non Obese Patients

    PubMed Central

    Aboueldahab, Abdelmohsen Khalaf

    2013-01-01

    Introduction: The abdomen, thighs and buttocks are often the areas of greatest concern to patients following massive weight loss due to bariatric surgery. The typical appearance of the patient who has lost a massive amount of weight derives from a combination of factors, including gender-dependent body morphology and a change in body mass index, which lead to skin and soft-tissue excess and poor skin tone. Thigh laxity and redundancy represents a great challenge to both patients and surgeons. Not only because of the difficulty to satisfy the patients, but also due to the higher incidence of complications especially, with those obese patients who have not undergone bariatric surgery before. The problems with such patients are due to the heavy thighs that require both debulking and tight anchorage to prevent scar migration or labial distortion. Aim of the Work: The aim of the present study is to improve the aesthetic outcome and avoid the complications of medial thigh lifting with simultaneous liposuction in obese and non-obese. Patients and Methods: A total of 25 female patients presented during the period from January 2007 to July 2011 complaining of moderate to severe thigh laxity with or without lipodystrophy. In 20 patients medial transverse thigh lift was performed, to treat medial thigh friction and laxity particularly in the upper half. Whereas, in the other five patients were suffering from upper and lower medial thigh bulkiness, vertical thigh lift was performed. Results: All patients recovered well in 2 weeks and showed improvement of thigh contour. Scar downward displacement in one patient. No skin necrosis or seroma. No labial distortion or separation encountered. Conclusion: Simultaneous liposuction and thigh lift gave good results provided proper patients selection, appropriate technique to each patient, meticulous, cautious liposuction and handling of the tissues and most importantly is the deep tight anchorage sutures to guard against the effect of

  10. Obesity

    MedlinePlus

    Morbid obesity; Fat - obese ... is because the body stores unused calories as fat. Obesity can be caused by: Eating more food ... use your BMI to estimate how much body fat you have. Your waist measurement is another way ...

  11. Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents

    PubMed Central

    Liang, J.; Matheson, BE.; Kaye, WH.; Boutelle, KN.

    2015-01-01

    Childhood obesity rates have risen dramatically over the past few decades. Although obesity has been linked to poorer neurocognitive functioning in adults, much less is known about this relationship in children and adolescents. Therefore, we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth. We reviewed articles from 1976 to 2013 using PsycInfo, PubMed, Medline and Google Scholar. Search terms included cognitive function, neurocognitive function/performance, executive function, impulsivity, self-regulation, effortful control, cognitive control, inhibition, delayed gratification, memory, attention, language, motor, visuo-spatial, academic achievement, obesity, overweight, body mass index, waist-hip ratio, adiposity and body fat. Articles were excluded if participants had health problems known to affect cognitive functioning, the study used imaging as the only outcome measure, they were non-peer-reviewed dissertations, theses, review papers, commentaries, or they were non-English articles. Sixty-seven studies met inclusion criteria for this review. Overall, we found data that support a negative relationship between obesity and various aspects of neurocognitive functioning, such as executive functioning, attention, visuo-spatial performance, and motor skill. The existing literature is mixed on the effects among obesity, general cognitive functioning, language, learning, memory, and academic achievement. Executive dysfunction is associated with obesity-related behaviors, such as increased intake, disinhibited eating, and less physical activity. Physical activity is positively linked with motor skill. More longitudinal research is needed to determine the directionality of such relationships, to point towards crucial intervention time periods in the development of children, and to inform effective treatment programs. PMID:23913029

  12. Neurocognitive correlates of obesity and obesity-related behaviors in children and adolescents.

    PubMed

    Liang, J; Matheson, B E; Kaye, W H; Boutelle, K N

    2014-04-01

    Childhood obesity rates have risen dramatically over the past few decades. Although obesity has been linked to poorer neurocognitive functioning in adults, much less is known about this relationship in children and adolescents. Therefore, we conducted a systematic review to examine the relationship between obesity and obesity-related behaviors with neurocognitive functioning in youth. We reviewed articles from 1976 to 2013 using PsycInfo, PubMed, Medline and Google Scholar. Search terms included cognitive function, neurocognitive function/performance, executive function, impulsivity, self-regulation, effortful control, cognitive control, inhibition, delayed gratification, memory, attention, language, motor, visuo-spatial, academic achievement, obesity, overweight, body mass index, waist-hip ratio, adiposity and body fat. Articles were excluded if participants had health problems known to affect cognitive functioning, the study used imaging as the only outcome measure, they were non-peer-reviewed dissertations, theses, review papers, commentaries, or they were non-English articles. Sixty-seven studies met inclusion criteria for this review. Overall, we found data that support a negative relationship between obesity and various aspects of neurocognitive functioning, such as executive functioning, attention, visuo-spatial performance, and motor skill. The existing literature is mixed on the effects among obesity, general cognitive functioning, language, learning, memory, and academic achievement. Executive dysfunction is associated with obesity-related behaviors, such as increased intake, disinhibited eating, and less physical activity. Physical activity is positively linked with motor skill. More longitudinal research is needed to determine the directionality of such relationships, to point towards crucial intervention time periods in the development of children, and to inform effective treatment programs. PMID:23913029

  13. The cholestyramine-induced decrease of PYY postprandial response is negatively correlated with fat mass in obese women.

    PubMed

    Rigamonti, A E; Resnik, M; Compri, E; Agosti, F; De Col, A; Monteleone, P; Marazzi, N; Bonomo, S M; Müller, E E; Sartorio, A

    2011-07-01

    Obese patients have decreased fasting and postprandial levels of peptide YY (PYY), an anorexigenic peptide produced by the L cells of the gastrointestinal mucosa. Fatty nutrients are the most powerful stimulus for PYY release. Cholestyramine, an anion exchanger which adsorbs bile salts, reduces digestion of lipids. The aim of the present study was to investigate the effects of cholestyramine or placebo on PYY secretion in obese women administered a high-fat meal [n=8; age: 30.9±2.7 years; BMI: 47.3±3.3 kg/m2]. Postprandial PYY levels in obese women given placebo significantly increased in plasma at 30, 60, 90, and 120 min after meal ingestion. Cholestyramine administration significantly reduced postprandial PYY response at 15, 30, and 60 min. Percent fat mass (FM%) was negatively correlated with the percent increment of plasma PYY concentrations induced by meal administration at 30 min; conversely, there was a positive correlation between FM% and the percent decrement of plasma PYY concentrations induced by cholestyramine at the same time interval. These correlations failed to reach statistical significance when related to BMI. This study implies that in the obese state the altered PYY response to food consumption is a consequence of a dysfunction of L cells, which become less sensitive to the positive feedback effect of lipids. PMID:21769759

  14. Whole Exome Sequencing of Extreme Morbid Obesity Patients: Translational Implications for Obesity and Related Disorders

    PubMed Central

    Paz-Filho, Gilberto; Boguszewski, Margaret C.S.; Mastronardi, Claudio A.; Patel, Hardip R.; Johar, Angad S.; Chuah, Aaron; Huttley, Gavin A.; Boguszewski, Cesar L.; Wong, Ma-Li; Arcos-Burgos, Mauricio; Licinio, Julio

    2014-01-01

    Whole-exome sequencing (WES) is a new tool that allows the rapid, inexpensive and accurate exploration of Mendelian and complex diseases, such as obesity. To identify sequence variants associated with obesity, we performed WES of family trios of one male teenager and one female child with severe early-onset obesity. Additionally, the teenager patient had hypopituitarism and hyperprolactinaemia. A comprehensive bioinformatics analysis found de novo and compound heterozygote sequence variants with a damaging effect on genes previously associated with obesity in mice (LRP2) and humans (UCP2), among other intriguing mutations affecting ciliary function (DNAAF1). A gene ontology and pathway analysis of genes harbouring mutations resulted in the significant identification of overrepresented pathways related to ATP/ITP (adenosine/inosine triphosphate) metabolism and, in general, to the regulation of lipid metabolism. We discuss the clinical and physiological consequences of these mutations and the importance of these findings for either the clinical assessment or eventual treatment of morbid obesity. PMID:25158045

  15. Obesity-related insulin resistance: implications for the surgical patient.

    PubMed

    Tewari, N; Awad, S; Macdonald, I A; Lobo, D N

    2015-11-01

    In healthy surgical patients, preoperative fasting and major surgery induce development of insulin resistance (IR). IR can be present in up to 41% of obese patients without diabetes and this can rise in the postoperative period, leading to an increased risk of postoperative complications. Inflammation is implicated in the aetiology of IR. This review examines obesity-associated IR and its implications for the surgical patient. Searches of the Medline and Science Citation Index databases were performed using various key words in combinations with the Boolean operators AND, OR and NOT. Key journals, nutrition and metabolism textbooks and the reference lists of key articles were also hand searched. Adipose tissue has been identified as an active endocrine organ and the chemokines secreted as a result of macrophage infiltration have a role in the pathogenesis of IR. Visceral adipose tissue appears to be the most metabolically active, although results across studies are not consistent. Results from animal and human studies often provide conflicting results, which has rendered the pursuit of a common mechanistic pathway challenging. Obesity-associated IR appears, in part, to be related to inflammatory changes associated with increased adiposity. Postoperatively, the surgical patient is in a proinflammatory state, so this finding has important implications for the obese surgical patient. PMID:26028059

  16. Relationship between Obesity and Massive Transfusion Needs in Trauma Patients, and Validation of TASH Score in Obese Population: A Retrospective Study on 910 Trauma Patients

    PubMed Central

    De Jong, Audrey; Deras, Pauline; Martinez, Orianne; Latry, Pascal; Jaber, Samir; Capdevila, Xavier; Charbit, Jonathan

    2016-01-01

    Background Prediction of massive transfusion (MT) is challenging in management of trauma patients. However, MT and its prediction were poorly studied in obese patients. The main objective was to assess the relationship between obesity and MT needs in trauma patients. The secondary objectives were to validate the Trauma Associated Severe Hemorrhage (TASH) score in predicting MT in obese patients and to use a grey zone approach to optimize its ability to predict MT. Methods and Findings An observational retrospective study was conducted in a Level I Regional Trauma Center Trauma in obese and non-obese patients. MT was defined as ≥10U of packed red blood cells in the first 24h and obesity as a BMI≥30kg/m². Between January 2008 and December 2012, 119 obese and 791 non-obese trauma patients were included. The rate of MT was 10% (94/910) in the whole population. The MT rate tended to be higher in obese patients than in non-obese patients: 15% (18/119, 95%CI 9‒23%) versus 10% (76/791, 95%CI 8‒12%), OR, 1.68 [95%CI 0.97‒2.92], p = 0.07. After adjusting for Injury Severity Score (ISS), obesity was significantly associated with MT rate (OR, 1.79[95%CI 1.00‒3.21], p = 0.049). The TASH score was higher in the obese group than in the non-obese group: 7(4–11) versus 5(2–10)(p<0.001). The area under the ROC curves of the TASH score in predicting MT was very high and comparable between the obese and non-obese groups: 0.93 (95%CI, 0.89‒0.98) and 0.94 (95%CI, 0.92‒0.96), respectively (p = 0.80). The grey zone ranged respectively from 10 to 13 and from 9 to 12 in obese and non obese patients, and allowed separating patients at low, intermediate or high risk of MT using the TASH score. Conclusions Obesity was associated with a higher rate of MT in trauma patients. The predictive performance of the TASH score and the grey zones were robust and comparable between obese and non-obese patients. PMID:27010445

  17. Obesity and Outcomes in Patients with Metastatic Urothelial Carcinoma1

    PubMed Central

    Leiter, Amanda; Doucette, John; Krege, Susan; Lin, Chia-Chia; Hahn, Noah; Ecke, Thorsten; Sonpavde, Guru; Bamias, Aristotle; Oh, William K.; Galsky, Matthew D.

    2016-01-01

    Background: Obesity has been associated with worse outcomes in patients with clinically localized urothelial cancer. However, this impact has not been evaluated in metastatic disease. Objective: To assess the impact of obesity on outcomes of patients with metastatic urothelial cancer. Methods: Data from 537 patients were aggregated from eight phase II and phase III clinical trials investigating first-line cisplatin-based combination therapy in metastatic urothelial cancer. Chemotherapy regimen, adverse events, treatment response, and survival outcomes were compared across body mass index (BMI) and body surface area (BSA) categories. Results: BMI was classified according to WHO criteria (<18.5 underweight, 18.5–24.99 normal weight, 25–29.99 overweight, >30 obese). BSA was classified as either below or greater than or equal to (average for this cohort (1.87 m2 for males and 1.66 m2 for females). There was no significant difference in number of chemotherapy cycles, adverse events, and response rate or survival outcomes (overall and progression-free) across BMI and BSA categories. There was no significant difference in adverse events across BMI categories, but the incidences of embolic events and renal failure were higher in patients with an average or higher BSA than those with a lower than average BSA (6.6% vs. 3.1% for renal failure p = 0.06; 5.9% vs. 2.7% for renal failure, p = 0.07). There was no significant difference in response rate or survival outcomes (overall and progression-free) amongst BMI and BSA categories. Conclusions: Obese patients with metastatic urothelial cancer on cisplatin-based therapies have similar response rates, survival outcomes, and tolerability of cisplatin-based therapy to non-obese patients. PMID:27500201

  18. Psychiatrists' Perceptions and Practices in Treating Patients' Obesity

    ERIC Educational Resources Information Center

    Lichwala-Zyla, Christine; Price, James H.; Dake, Joseph A.; Jordan, Timothy; Price, Joy Ann

    2009-01-01

    Objective: This study identified psychiatrists' perceptions and practices regarding advising and treating obese patients. Methods: Questionnaires were mailed to a national random sample of 500 members of APA. A three-wave mailing was used to maximize the return rate. The questionnaire contained items on weight control based on the Stages of Change…

  19. Insulin resistance and endocrine-metabolic abnormalities in polycystic ovarian syndrome: Comparison between obese and non-obese PCOS patients

    PubMed Central

    Layegh, Parvin; Mousavi, Zohreh; Farrokh Tehrani, Donya; Parizadeh, Seyed Mohammad Reza; Khajedaluee, Mohammad

    2016-01-01

    Background: Insulin resistance has an important role in pathophysiology of polycystic ovarian syndrome (PCOS). Yet there are certain controversies regarding the presence of insulin resistance in non-obese patients. Objective: The aim was to compare the insulin resistance and various endocrine and metabolic abnormalities in obese and non-obese PCOS women. Materials and Methods: In this cross-sectional study which was performed from 2007-2010, 115 PCOS patients, aged 16-45 years were enrolled. Seventy patients were obese (BMI ≥25) and 45 patients were non-obese (BMI <25). Presence of insulin resistance and endocrine-metabolic abnormalities were compared between two groups. Collected data were analyzed with SPSS version 16.0 and p<0.05 was considered as statistically significant. Results: There was no significant difference in presence of insulin resistance (HOMA-IR >2.3) between two groups (p=0.357). Waist circumference (p<0.001), waist/hip ratio (p<0.001), systolic (p<0.001) and diastolic (p<0.001) blood pressures, fasting blood sugar (p=0.003) and insulin (p=0.011), HOMA-IR (p=0.004), total cholesterol (p=0.001) and triglyceride (p<0.001) were all significantly higher in obese PCOS patients. There was no significant difference in total testosterone (p=0.634) and androstenedione (p=0.736) between groups whereas Dehydroepiandrotendione sulfate (DHEAS) was significantly higher in non-obese PCOS women (p=0.018). There was no case of fatty liver and metabolic syndrome in non-obese patients, whereas they were seen in 31.3% and 39.4% of obese PCOS women, respectively. Conclusion: Our study showed that metabolic abnormalities are more prevalent in obese PCOS women, but adrenal axis activity that is reflected in higher levels of DHEAS was more commonly pronounced in our non-obese PCOS patients. PMID:27351028

  20. Caring for class III obese patients.

    PubMed

    Gardner, Lea Anne

    2013-11-01

    The Pennsylvania Patient Safety Reporting System is a confidential, statewide Internet reporting system to which all Pennsylvania hospitals, outpatient-surgery facilities, and birthing centers, as well as some abortion facilities, must file information on medical errors.Safety Monitor is a column from Pennsylvania's Patient Safety Authority, the authority that informs nurses on issues that can affect patient safety and presents strategies they can easily integrate into practice. For more information on the authority, visit www.patientsafetyauthority.org. For the original article discussed in this column or for other articles on patient safety, click on "Patient Safety Advisories" and then "Advisory Library" in the left-hand navigation menu. PMID:24149276

  1. Recognizing Disordered Eating in Primary Care Patients with Obesity

    PubMed Central

    Chacko, Sara A.; Chiodi, Sarah N.; Wee, Christina C.

    2015-01-01

    Objective In clinical practice, behavioral approaches to obesity treatment focus heavily on diet and exercise recommendations. However, these approaches may not be effective for patients with disordered eating behaviors. Little is known about the prevalence of disordered eating behaviors in primary care patients with obesity or whether they affect difficulty making dietary changes. Methods We conducted a telephone interview of 337 primary care patients aged 18–65 years with BMI≥35kg/m2 in Greater-Boston, 2009–2011 (58% response rate, 69% women). We administered the Three-Factor Eating Questionnaire R-18 (Scores 0–100) and the Impact of Weight on Quality of Life-Lite (IWQOL-lite) (Scores 0–100). We measured difficulty making dietary changes using four questions regarding perceived difficulty changing diet (Scores 0–10). Results 50% of patients reported high emotional eating (score>50) and 28% reported high uncontrolled eating (score>50). Women were more likely to report emotional [OR=4.14 (2.90, 5.92)] and uncontrolled eating [OR=2.11 (1.44, 3.08)] than men. African Americans were less likely than Caucasians to report emotional [OR=0.29 (95% CI: 0.19, 0.44)] and uncontrolled eating [OR=0.11 (0.07, 0.19)]. For every 10-point reduction in QOL score (IWQOL-lite), emotional and uncontrolled eating scores rose significantly by 7.82 and 5.48, respectively. Furthermore, participants who reported emotional and uncontrolled eating reported greater difficulty making dietary changes. Conclusions Disordered eating behaviors are prevalent among obese primary care patients and disproportionately affect women, Caucasians, and patients with poor QOL. These eating behaviors may impair patients' ability to make clinically recommended dietary changes. Clinicians should consider screening for disordered eating behaviors and tailoring obesity treatment accordingly. PMID:25572624

  2. Neural Correlates to Food-Related Behavior in Normal-Weight and Overweight/Obese Participants

    PubMed Central

    Ho, Alan; Kennedy, James; Dimitropoulos, Anastasia

    2012-01-01

    Two thirds of US adults are either obese or overweight and this rate is rising. Although the etiology of obesity is not yet fully understood, neuroimaging studies have demonstrated that the central nervous system has a principal role in regulating eating behavior. In this study, functional magnetic resonance imaging and survey data were evaluated for correlations between food-related problem behaviors and the neural regions underlying responses to visual food cues before and after eating in normal-weight individuals and overweight/obese individuals. In normal-weight individuals, activity in the left amygdala in response to high-calorie food vs. nonfood object cues was positively correlated with impaired satiety scores during fasting, suggesting that those with impaired satiety scores may have an abnormal anticipatory reward response. In overweight/obese individuals, activity in the dorsolateral prefrontal cortex (DLPFC) in response to low-calorie food cues was negatively correlated with impaired satiety during fasting, suggesting that individuals scoring lower in satiety impairment were more likely to activate the DLPFC inhibitory system. After eating, activity in both the putamen and the amygdala was positively correlated with impaired satiety scores among obese/overweight participants. While these individuals may volitionally suggest they are full, their functional response to food cues suggests food continues to be salient. These findings suggest brain regions involved in the evaluation of visual food cues may be mediated by satiety-related problems, dependent on calorie content, state of satiation, and body mass index. PMID:23028988

  3. The perioperative management of morbidly obese patients (a surgeon's perspective).

    PubMed

    Ramsey-Stewart, G

    1985-11-01

    One hundred and thirteen morbidly obese patients underwent bariatric surgery. Mean preoperative percentage above ideal weight was 98.3% (SD 30.0%). Mean percentage above ideal weight eighteen months after operation was 19.5% (SD 23.8%). Fifteen patients (13.3%) required pre-operative weight loss because of respiratory dysfunction and raised PaCO2. One patient developed asthma in the postoperative period. There were no other clinical postoperative respiratory complications. 40% of patients however did show radiological evidence of basal pulmonary atelectasis on the initial postoperative chest X-ray. All patients had pre-operative cardiological screening: there were no cardiac complications except one case of atrial fibrillation. One patient suffered a proven pulmonary embolus and recovered. Six patients (5.3%) required correction of a pre-operative potassium deficit. No episode of gastric acid aspiration syndrome occurred. 58% of patients presenting for obesity surgery had identifiable psychopathology. Despite strict pre-operative psychiatric screening, 15% of patients coming to operation required postoperative psychiatric management. PMID:4073456

  4. Obesity

    MedlinePlus

    Obesity means having too much body fat. It is different from being overweight, which means weighing too ... what's considered healthy for his or her height. Obesity occurs over time when you eat more calories ...

  5. Intraabdominal pressure after full abdominoplasty in obese multiparous patients.

    PubMed

    Al-Basti, Habib B; El-Khatib, Hamdy A; Taha, Ahmed; Sattar, Hisham Abdul; Bener, Abdulbari

    2004-06-01

    This study measured intraabdominal pressure in morbidly obese and multiparous patients who underwent abdominoplasty with musculoaponeurotic plication. The purpose of this study was to evaluate any potential adverse effect on pulmonary function by virtue of pulmonary function tests and measurement of peak airway pressure. The study included 43 multiparous, morbidly obese women (mean body mass index, 35.8 kg/m2) with a mean age (+/- SD) of 38.6 +/- 7 years. All had full abdominoplasty and repair of the musculoaponeurotic system during the period from June of 1999 to May of 2002. Forty-three morbidly obese multiparous patients were seen over a period of 24 months. Their intraabdominal pressure was estimated by measuring the intravesical pressure before and after repair of severe diastases (divarication) of the rectus abdominis muscles with severely flaccid myofascial component before using a hydrometer connected to a Foley catheter both before and after repair. All patients had pulmonary function checked before and 2 months after the repair. The study confirmed that there are minimal changes on the intraabdominal pressure parameters compared with measurement before and after full abdominoplasty with plication of the rectus muscles, with minimal to negligible changes in the intrathoracic pressure. These changes are clinically and statistically significant (p < 0.0001). The study also recommended the safety of full abdominoplasty and repair of the musculoaponeurotic system in multiparous and morbidly obese patients. Furthermore, no statistically significant difference was found in pulmonary function parameters before and after surgery in patients with a history of bronchial asthma. PMID:15253209

  6. Low-Velocity Knee Dislocations in Obese and Morbidly Obese Patients

    PubMed Central

    Vaidya, Rahul; Roth, Matthew; Nanavati, Dhiren; Prince, Matthew; Sethi, Anil

    2015-01-01

    Background: Knee dislocations from minor trauma have been reported sparsely in the literature. The consensus is that these injuries tend not to be associated with neurovascular compromise. Purpose: To present a series of atraumatic knee dislocations in obese and morbidly obese patients and to compare operative versus conservative treatment. Study Design: Case series; Level of evidence, 4. Methods: This study included 19 patients (21 knees) who presented with knee dislocation from a low-velocity or ultra low–velocity incident. Charts, radiographs, and magnetic resonance images (MRIs) were reviewed, and patients were reviewed based on their latest follow-up. We included patients in our database from 2001 to 2011 and compared knees of patients who had ligament repair or reconstruction (9 total knees) verses nonoperative treatment (12 total knees). Range of motion, activity levels, and knee laxity information were collected as outcome measures to compare operative and nonoperative results. Results: The mean age at presentation was 30.3 years (range, 15-74 years), with 5 men and 14 women. The average body mass index (BMI) was 41.4 kg/m2 (range, 30-64.4 kg/m2), with an average follow-up of 31 months (range, 12-72 months). Five patients (27%) had a popliteal artery injury, and 7 (44.4%) had a peroneal nerve injury at presentation. Four had a vascular repair, 1 had an amputation, and 3 of 7 patients had return of peroneal nerve. Ligament reconstruction was performed on 9 individuals. The average operating time for ligament reconstruction was 183% of that with injury-matched normal-weight patients. Eight operative patients who complied with therapy had an average range of motion of 91.4° (range, 60°-110°). The nonoperative patients had an average range of motion of 60.45° (range, 0°-120°). Two of these patients later required a total knee arthroplasty (3 total knee arthroplasties overall). Conclusion: Knee dislocations from minor falls occur in obese patients and

  7. Obesity Does Not Influence Outcomes in Hepatocellular Carcinoma Patients following Curative Hepatectomy

    PubMed Central

    Li, Le-Qun; Xiang, Bang-De

    2015-01-01

    Background Whether obesity affects surgical outcomes in patients with hepatocellular carcinoma (HCC) is controversial. Here we retrospectively evaluated the impact of obesity on outcomes in HCC patients after curative hepatectomy. Methods Patients with Child-Pugh A liver function who underwent curative hepatectomy between 2006 and 2010 were categorized as obese (BMI ≥25 kg/m2, n = 68) and non-obese (<25 kg/m2, n = 242). To reduce interference from baseline differences between the two groups, propensity score-matched analysis was performed in the ratio 1:2 using a caliper width of 0.1. Surgical outcomes were compared for 61 obese and 115 non-obese patients. Results Obese patients had higher levels of albumin and aspartate aminotransferase, and more solitary tumors compared to the non-obese patients (all P<0.05). In the propensity-matched cohort, baseline characteristics did not differ between the two groups (all P>0.05). Obese and non-obese patients had comparable 30-day mortality (1.6% vs. 2.6%, P = 1.000), 90-day mortality (3.3% vs. 4.3%, P = 1.000), and incidence of postoperative complications (19.7% vs. 18.3%, P = 0.819). Overall survival at 1, 3, and 5 years was similar for obese patients (83.6%, 63.6%, 41.6%) as for non-obese patients (80.9%, 65.9%, 49.1%; P = 0.358). Disease-free survival at 1, 3, and 5 years was also similar for obese patients (71.5%, 36.3%, 24.3%) as for non-obese ones (60.2%, 43.7%, 27.7%; P = 0.969). Conclusion Our propensity score-matched analysis strengthens the case that obesity does not adversely affect surgical outcomes of HCC patients undergoing curative hepatectomy. PMID:25965529

  8. Elevated IgG levels against specific bacterial antigens in obese patients with diabetes and in mice with diet-induced obesity and glucose intolerance.

    PubMed

    Mohammed, Nadeem; Tang, Lihua; Jahangiri, Anisa; de Villiers, Willem; Eckhardt, Erik

    2012-09-01

    High fat diets increase the risk for insulin resistance by promoting inflammation. The cause of inflammation is unclear, but germfree mouse studies have implicated commensal gut bacteria. We tested whether diet-induced obesity, diabetes, and inflammation are associated with anti-bacterial IgG. Blood from lean and obese healthy volunteers or obese patients with diabetes were analyzed by ELISA for IgG against extracts of potentially pathogenic and pro-biotic strains of Escherichia coli (LF-82 and Nissle), Bacteroides thetaiotaomicron, and Lactobacillus acidophilus, and for circulating tumor necrosis factor α (TNFα). C57Bl/6 mice were fed low- or high-fat diets (10% or 60% kcal from fat) for 10 weeks and tested for anti-bacterial IgG, bodyweight, fasting glucose, and inflammation. Obese diabetic patients had significantly more IgG against extracts of E. coli LF-82 compared with lean controls, whereas IgG against extracts of the other bacteria was unchanged. Circulating TNFα was elevated and correlated with IgG against the LF-82 extract. Mice fed high-fat diets had increased fasting glucose levels, elevated TNFα and neutrophils, and significantly more IgG against the LF-82 extracts. Diabetes in obesity is characterized by increased IgG against specific bacterial antigens. Specific commensal bacteria may mediate inflammatory effects of high-fat diets. PMID:22424821

  9. Levels of Neopterin and other Inflammatory Markers in Obese and Non-Obese Patients with Polycystic Ovary Syndrome

    PubMed Central

    Agacayak, Elif; Tunc, Senem Yaman; Sak, Sibel; Basaranoglu, Serdar; Yüksel, Hatice; Turgut, Abdulkadir; Gul, Talip

    2015-01-01

    Background We aimed to measure the levels of inflammatory markers and neopterin in obese and non-obese patients with PCOS by using 2 separate control groups with matching body mass index (BMI). Material/Methods A total of 60 women of reproductive age with (n=30) and without (n=30) PCOS were included in this study. Based on their BMI, patients with PCOS were divided into 2 groups as obese (n=15) and non-obese (n=15) PCOS groups. In addition, 2 BMI-matched control groups were formed. Neopterin, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (N/L ratio), and vitamin B12 were assessed by complete blood count. Results No significant difference was found between patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and CRP levels. However, N/L ratio levels were significantly higher (p 0.045) and vitamin B12 levels were significantly lower (p 0.033) in patients with PCOS compared to control subjects. No statistically significant difference was found between obese and non-obese patients with PCOS and control subjects in neopterin, IL-6, TNF-α, and N/L ratio levels. However, CRP levels were significantly higher in obese patients with PCOS compared to obese control subjects (p 0.007). Conclusions It can be concluded that inflammatory activity is increased in patients with PCOS, can lead to an increased risk for atherosclerosis, and this increase is not caused by obesity but rather by the polycystic ovary syndrome itself. However, studies with larger sample sizes are needed in this area. PMID:26292090

  10. Diabetes screening: a pending issue in hypertense/obese patients.

    PubMed

    Sepehri, Armina; Palazón-Bru, Antonio; Gil-Guillén, Vicente Francisco; Ramírez-Prado, Dolores; Navarro-Cremades, Felipe; Cortés, Ernesto; Rizo-Baeza, María Mercedes

    2015-01-01

    The literature about possible cardiovascular consequences of diagnostic inertia in diabetes is scarce. We examined the influence of undetected high fasting blood glucose (FBG) levels on the cardiovascular risk and poor control of cardiovascular risk factors in hypertensive or obese patients, with no previous diagnosis of diabetes mellitus (i.e., diagnostic inertia). A cross-sectional study during a preventive program in a Spanish region was performed in 2003-2004. The participants were aged ≥40 years and did not have diabetes but were hypertensive (n = 5, 347) or obese (n = 7, 833). The outcomes were high cardiovascular risk (SCORE ≥5%), poor control of the blood pressure (≥140/90 mmHg) and class II obesity. The relationship was examined between FBG and the main parameters, calculating the adjusted odd ratios with multivariate models. Higher values of FBG were associated with all the outcomes. A more proactive attitude towards the diagnosis of diabetes mellitus in the hypertensive and obese population should be adopted. PMID:25922799

  11. Diabetes screening: a pending issue in hypertense/obese patients

    PubMed Central

    Sepehri, Armina; Gil-Guillén, Vicente Francisco; Ramírez-Prado, Dolores; Navarro-Cremades, Felipe; Cortés, Ernesto; Rizo-Baeza, María Mercedes

    2015-01-01

    The literature about possible cardiovascular consequences of diagnostic inertia in diabetes is scarce. We examined the influence of undetected high fasting blood glucose (FBG) levels on the cardiovascular risk and poor control of cardiovascular risk factors in hypertensive or obese patients, with no previous diagnosis of diabetes mellitus (i.e., diagnostic inertia). A cross-sectional study during a preventive program in a Spanish region was performed in 2003–2004. The participants were aged ≥40 years and did not have diabetes but were hypertensive (n = 5, 347) or obese (n = 7, 833). The outcomes were high cardiovascular risk (SCORE ≥5%), poor control of the blood pressure (≥140/90 mmHg) and class II obesity. The relationship was examined between FBG and the main parameters, calculating the adjusted odd ratios with multivariate models. Higher values of FBG were associated with all the outcomes. A more proactive attitude towards the diagnosis of diabetes mellitus in the hypertensive and obese population should be adopted. PMID:25922799

  12. Increased BMR in overweight and obese patients with type 2 diabetes may result from an increased fat-free mass.

    PubMed

    Sun, Min-xian; Zhao, Shi; Mao, Hong; Wang, Zhong-jing; Zhang, Xu-yan; Yi, Lan

    2016-02-01

    The study aimed to determine the relationships between the basal metabolic rate (BMR) and body composition of overweight and obese Chinese adults with type 2 diabetes mellitus (DM). This cross-sectional clinical study enrolled 193 Chinese adults with type 2 DM who were overweight (24 kg/m(2)=BMI≤28 kg/m(2), n=99), or obese (BMI ≥28 kg/m(2), n=94). Ninety-seven adults with normal BMIs, including 50 DM patients and 47 healthy adults, were recruited as a control group. BMR was measured by indirect calorimetry; predicted BMR was calculated according to the Schofield equation; and the relationships between BMR, body composition, and biochemical results were determined by the Pearson correlation. The results showed that obese DM patients had significantly higher BMRs than both overweight patients (P<0.05) and patients with normal BMI did (P<0.05). The measured BMR was significantly lower than the predicted BMR (P<0.05) in all groups. Obese and overweight DM patients had significantly greater weight, waist circumference, hip circumference, BMI, body surface area, body fat percentage, fat mass, and fat-free mass than patients with normal BMI. Except for waist circumference, these body composition measurements were significantly increased in obese DM patients when compared with those in overweight DM patients (P<0.05). Fat-free mass was closely correlated with BMR in both DM patients (r=0.874, P<0.01) and in healthy controls (r=0.902, P<0.01). It was concluded that overweight and obese Chinese adults with type 2 DM had increased BMRs compared with normal-weight controls, which may result from the difference in fat-free mass. PMID:26838741

  13. SU-C-18C-04: Evaluation of Effective Dose During Ureteroscopy for Obese and Non-Obese Patients

    SciTech Connect

    Wang, C; Nguyen, G; Chung, Y; Yoshizumi, T; Cabrera, F; Lipkin, M; Shin, R

    2014-06-01

    Purpose: Ureteroscopy involves fluoroscopy which potentially results in considerable amount of radiation dose to the patient. Purpose of this study was two-fold: (a) to develop the effective dose computational model for obese and non-obese patients undergoing left and right ureteroscopy, and (b) to evaluate the utility of a commercial Monte Carlo software for dose assessment in ureteroscopy. Methods: Organ dose measurements were performed on an adult male anthropomorphic phantom, representing the non-obese patients, with 20 high-sensitivity MOSFET detectors and two 0.18cc ionization chambers placed in selected organs. Fat-equivalent paddings were placed around the abdominal region to simulate for obese patients. Effective dose (ED) was calculated using ICRP 103 tissue weighting factors and normalized to the effective dose rate in miliSivert per second (mSv/s). In addition, a commercial Monte Carlo (MC) dose estimation program was used to estimate ED for the non-obese model, with table attenuation correction applied to simulate clinical procedure. Results: For the equipment and protocols involved in this study, the MOSFETderived ED rates for the obese patient model (‘Left’: 0.0092±0.0004 mSv/s; ‘Right’: 0.0086±0.0004 mSv/s) was found to be more than twice as much as that to the non-obese patient model (‘Left’: 0.0041±0.0003 mSv/s; ‘Right’: 0.0036±0.0007 mSv/s). The MC-derived ED rates for the non-obese patient model (‘Left’: 0.0041 mSv/s; ‘Right’: 0.0036 mSv/s; with statistical uncertainty of 1%) showed a good agreement with the MOSFET method. Conclusion: The significant difference in ED rate between the obese and non-obese patient models shows the limitation of directly applying commercial softwares for obese patients and leading to considerable underestimation of ED. Although commercial softwares offer a convenient means of dose estimation, but the utility may be limited to standard-man geometry as the software does not account for

  14. Neuroendocrine Alterations in Obese Patients with Sleep Apnea Syndrome

    PubMed Central

    Lanfranco, Fabio; Motta, Giovanna; Minetto, Marco Alessandro; Baldi, Matteo; Balbo, Marcella; Ghigo, Ezio; Arvat, Emanuela; Maccario, Mauro

    2010-01-01

    Obstructive sleep apnea syndrome (OSAS) is a serious, prevalent condition that has significant morbidity and mortality when untreated. It is strongly associated with obesity and is characterized by changes in the serum levels or secretory patterns of several hormones. Obese patients with OSAS show a reduction of both spontaneous and stimulated growth hormone (GH) secretion coupled to reduced insulin-like growth factor-I (IGF-I) concentrations and impaired peripheral sensitivity to GH. Hypoxemia and chronic sleep fragmentation could affect the sleep-entrained prolactin (PRL) rhythm. A disrupted Hypothalamus-Pituitary-Adrenal (HPA) axis activity has been described in OSAS. Some derangement in Thyroid-Stimulating Hormone (TSH) secretion has been demonstrated by some authors, whereas a normal thyroid activity has been described by others. Changes of gonadal axis are common in patients with OSAS, who frequently show a hypogonadotropic hypogonadism. Altogether, hormonal abnormalities may be considered as adaptive changes which indicate how a local upper airway dysfunction induces systemic consequences. The understanding of the complex interactions between hormones and OSAS may allow a multi-disciplinary approach to obese patients with this disturbance and lead to an effective management that improves quality of life and prevents associated morbidity or death. PMID:20182553

  15. Obese and diabetic patients with end-stage renal disease: Peritoneal dialysis or hemodialysis?

    PubMed

    Ekart, Robert; Hojs, Radovan

    2016-07-01

    Obesity is a chronic disease that is increasingly prevalent around the world and is a well-recognized risk factor for type 2 diabetes and hypertension, leading causes of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge for the nephrologist with regard to the type of renal replacement therapy that should be suggested and offered to the patient. There is no evidence that either peritoneal dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature, we can find a discrepancy in the impact of obesity on mortality among hemodialysis vs. peritoneal dialysis patients. Several studies in hemodialysis patients suggest that a higher BMI confers a survival advantage - the so-called "reverse epidemiology". In contrast, the literature among obese peritoneal dialysis patients is inconsistent, with various studies reporting an increased risk of death, no difference, or a decreased risk of death. Many of these studies only spanned across a few years, and this is probably too short of a time frame for a realistic assessment of obesity's impact on mortality in ESRD patients. The decision for dialysis modality in an obese diabetic patient with ESRD should be individualized. According to the results of published studies, we cannot suggest PD or HD as a better solution for all obese diabetic patients. The obese patient should be educated about all their dialysis options, including home dialysis therapies. In this review, the available literature related to the dialysis modality in obese patients with diabetes and ESRD was reviewed. PMID:27067614

  16. Correlates of obesity in young black and white women: the CARDIA Study.

    PubMed Central

    Burke, G L; Savage, P J; Manolio, T A; Sprafka, J M; Wagenknecht, L E; Sidney, S; Perkins, L L; Liu, K; Jacobs, D R

    1992-01-01

    OBJECTIVES. Although differences in obesity between Blacks and Whites are well documented in adult women, less information is available on potential correlates of these differences, especially in young adults. METHODS. The association between behavioral and demographic factors and body size was assessed in 2801 Black and White women aged 18 to 30 years. RESULTS. Black women had significantly higher age-adjusted mean body mass index and subscapular skinfold thickness than did White women. Obesity had different associations with age and education across racial groups. A positive relationship between age and obesity was seen in Black women but not in White women, whereas a negative association between education and body size was noted only in White women. Potential contributing factors to the increased prevalence of obesity in Black women include a more sedentary lifestyle, higher energy intake, earlier menarche, and earlier age at first childbirth. CONCLUSIONS. The difference in obesity across race could not be explained completely by these factors, since within virtually all strata, Black women had higher body mass indexes. Further investigation is needed to develop interventional strategies to prevent or reduce excess levels of obesity in Black women. PMID:1456336

  17. Obesity prevalence and associated outcomes in cardiothoracic patients: a single-centre experience.

    PubMed

    Goh, R; Darvall, J; Wynne, R; Tatoulis, J

    2016-01-01

    The objective of this study was to investigate the prevalence of obesity and its relationship with adverse outcomes in ICU cardiothoracic patients. We performed a retrospective analysis of cardiothoracic patients admitted to The Royal Melbourne Hospital ICU between 2002 and 2014. Eight thousand and sixty-four patients who underwent coronary artery bypass, valve replacement/repair, or both, were divided into six categories of body mass index using World Health Organization criteria. Prevalence of obesity over time in the ICU was measured and compared to prevalence of obesity in the adult Australian population. The association between obesity and adverse postoperative outcomes was then analysed. Obesity is currently 1.2 times more prevalent in the Royal Melbourne Hospital ICU cardiothoracic patients than in the adult Australian population, with 33.5% of patients having a body mass index =30 kg/m(2). Over time, this was relatively constant, but an increasing proportion were morbidly obese. Obesity, but not morbid obesity, was associated with reduced 30-day mortality (odds ratio [OR] 0.41). Both obese and morbidly obese patients had reduced odds of return to theatre for bleeding (OR 0.49 and OR 0.19, respectively), but increased odds of new-onset renal failure (OR 1.62 and OR 3.17, respectively). Morbidly obese patients had double the odds of an ICU stay longer than 14 days (OR 2.05). In summary, a growing proportion of our obese ICU patients are morbidly obese, with a dramatically increased length of ICU stay. This has major implications for resource allocation in the ICU, and may inform modelling of future bed utilisation. Obesity, but not morbid obesity, conferred a mortality benefit. PMID:26673592

  18. Tolerance of intragastric balloon and patient's satisfaction in obesity treatment

    PubMed Central

    Garnysz, Karolina

    2015-01-01

    Introduction The dietary management of obesity is associated with a high failure rate. Methods which enable the long-term reduction of food intake have been developed. Patients treated with an intragastric balloon may experience some unwanted symptoms during therapy. The severity of these symptoms may result in poor tolerance of treatment, while patients who do not experience these symptoms may refuse to follow dietary modifications. In these cases, weight reduction at the end of treatment may be below expectations. Aim To assess the tolerance of intragastric balloon treatment in obese patients as well as their satisfaction with this treatment. Material and methods Fifty-seven gastric balloon procedures were performed in 51 females and 6 males aged 17 to 65 years (39.5 ±10.7 years). Baseline weight was 104 ±14.5 kg (78–140 kg), body mass index 37.2 ±4.1 kg/m2 (29.8–48.1 kg/m2), mean excess body weight 41.2 ±11.5 kg (20.4–63.1 kg). The balloon was filled with 669 ±25.8 ml of saline solution (550–700 ml). Upon balloon removal 6 months later, the patients completed a 12-question survey. Results We obtained 57 surveys. The most common symptoms included vomiting, heartburn, abdominal pain and others. Twenty-two patients reported > 2 symptoms. Two patients were symptom-free. The mean duration of symptoms was 24.8 days. Patients reported better control of hypertension, diabetes and resolution of obstructive sleep apnoea and joint symptoms. Only 14 patients did not observe any significant improvement in their bodily function. Fifty-four patients expressed satisfaction after treatment, 6 patients were dissatisfied with the weight loss, and 5 patients would not opt for balloon re-treatment. Conclusions The balloon treatment is a safe and well-tolerated therapy with a low complication rate. PMID:26649094

  19. Robotic Hysterectomy Strategies in the Morbidly Obese Patient

    PubMed Central

    2013-01-01

    Background and Objectives: The purpose of this study was to present strategies for performing computer-enhanced telesurgery in the morbidly obese patient. Methods: This was a prospective, institutional review board-approved, descriptive feasibility study (Canadian Task Force classification II-2) conducted at a university-affiliated hospital. Twelve class III morbidly obese women with a body mass index of 40 kg/m2 or greater were selected to undergo robotic-assisted total laparoscopic hysterectomy. Robotic-assisted total laparoscopic hysterectomy, classified as type IVE, with complete detachment of the cardinal-uterosacral ligament complex, unilateral or bilateral, with entry into the vagina was performed. Results: The median estimated blood loss was 146.3 mL (range, 15–550 mL), the mean length of stay in the hospital was 25.3 hours (range, 23–48 hours), and the complication rate was 0%. The rate of conversion to laparotomy was 8%. The median surgical time was 109.6 minutes (range, 99–145 minutes). Conclusion: Robotic-assisted total laparoscopic hysterectomy can be a safe and effective method of performing hysterectomies in select morbidly obese patients, allowing them the opportunity to undergo minimally invasive surgery without increased perioperative complications. PMID:24018079

  20. ELECTROCARDIOGRAPHIC ABNORMALITIES AMONG MEXICAN AMERICANS: CORRELATIONS WITH DIABETES, OBESITY, AND THE METABOLIC SYNDROME

    PubMed Central

    Queen, Saulette R.; Smulevitz, Beverly; Rentfro, Anne R.; Vatcheva, Kristina P.; Kim, Hyunggun; McPherson, David D.; Hanis, Craig L.; Fisher-Hoch, Susan P.; McCormick, Joseph B.; Laing, Susan T.

    2012-01-01

    SUMMARY BACKGROUND Resting ischemic electrocardiographic abnormalities have been associated with cardiovascular mortality. Simple markers of abnormal autonomic tone have also been associated with diabetes, obesity, and the metabolic syndrome in some populations. Data on these electrocardiographic abnormalities and correlations with coronary risk factors are lacking among Mexican Americans wherein these conditions are prevalent. OBJECTIVE This study aimed to evaluate the prevalent resting electrocardiographic abnormalities among community-dwelling Mexican Americans, and correlate these findings with coronary risk factors, particularly diabetes, obesity, and the metabolic syndrome. METHODS Study subjects (n=1280) were drawn from the Cameron County Hispanic Cohort comprised of community-dwelling Mexican Americans living in Brownsville, Texas at the United States-Mexico border. Ischemic electrocardiographic abnormalities were defined as presence of ST/T wave abnormalities suggestive of ischemia, abnormal Q waves, and left bundle branch block. Parameters that reflect autonomic tone, such as heart rate-corrected QT interval and resting heart rate, were also measured. RESULTS Ischemic electrocardiographic abnormalities were more prevalent among older persons and those with hypertension, diabetes, obesity, and the metabolic syndrome. Subjects in the highest quartiles of QTc interval and resting heart rate were also more likely to be diabetic, hypertensive, obese, or have the metabolic syndrome. CONCLUSIONS Among Mexican Americans, persons with diabetes, obesity, and the metabolic syndrome were more likely to have ischemic electrocardiographic abnormalities, longer QTc intervals, and higher resting heart rates. A resting electrocardiogram can play a complementary role in the comprehensive evaluation of cardiovascular risk in this minority population. PMID:23515880

  1. Sarcopenia and Sarcopenic Obesity in Patients Undergoing Orthopedic Surgery

    PubMed Central

    Ji, Hyung-Min; Han, Jun; Jin, Dong San; Suh, Hyunseok; Chung, Yoon-Sok

    2016-01-01

    Background The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). Methods A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared, total body weight, and height and fat mass (residuals). Obesity was defined as body mass index (BMI) > 25.0 kg/m2. Results The prevalence of sarcopenia in the OS group was 25.7%, 44.1%, and 26.6%, respectively, according to the 3 different criteria. The prevalence was significantly lower in the OPD group (6.0%, 33.1%, and 14.8%, respectively). The highest rates of sarcopenia with height-adjusted definition were seen in patients with a femoral neck fracture. In the multivariate analysis, factors associated with sarcopenia were male gender, older age, and lower BMI (odds ratio [OR]: 28.38, 1.03, and 1.83, respectively) when muscle mass was adjusted for height, whereas male gender, older age, and higher BMI were associated with sarcopenia (OR: 1.04, 2.57, and 1.83, respectively) when adjusted for weight. When residuals were used as a cutoff, decreased BMI and total hip bone mineral density (0.1 g/cm2) were independent risk factors associated with sarcopenia (OR: 1.09 and 1.05). The prevalence of sarcopenic obesity ranged from 1.8% to 21.2%. Conclusions Our study demonstrated a high prevalence of sarcopenia among OS patients. PMID:27247746

  2. [Somatotype of the patients with obesity and associated cardio-vascular patholodgy. Clinical and anthropological bonds].

    PubMed

    Bukavneva, N S; Pozdniakov, A L; Nikitiuk, D B

    2008-01-01

    In the article there are presented major anthropometric parameters of patients (male and female) with obesity, combined with cardiovascular pathology, before and after treatment. Constitutional predisposition to obesity is defined. Efficacy of dietary therapy is estimated and with obesity are defined on the basil of associated cardio-vascular pathology. PMID:18839806

  3. Concordance of Patient-Physician Obesity Diagnosis and Treatment Beliefs in Rural Practice Settings

    ERIC Educational Resources Information Center

    Ely, Andrea Charbonneau; Greiner, K. Allen; Born, Wendi; Hall, Sandra; Rhode, Paula C.; James, Aimee S.; Nollen, Nicole; Ahluwalia, Jasjit S.

    2006-01-01

    Context: Although clinical guidelines recommend routine screening and treatment for obesity in primary care, lack of agreement between physicians and patients about the need for obesity treatment in the primary care setting may be an unexplored factor contributing to the obesity epidemic. Purpose and Methods: To better understand this dynamic, we…

  4. Communication between the obese patient and bariatric surgeon.

    PubMed

    Ruiz de Angulo, David; Munitiz, Vicente; Ortiz, M Ángeles; Martínez de Haro, Luisa F; Frutos, M Dolores; Hernández, Antonio; Parrilla, Pascual

    2015-10-01

    Communication between the bariatric surgeon and the obese patient is very important as it influences the expectations of patients with regard to surgery, aim of the surgery and the understanding of the mechanisms of failure of surgery. Furthermore, the incidence of certain psychopathology in these patients makes it necessary for the surgeon to have the ability to communicate to the patient the need for motivation and the maintenance of healthy life habits. Although the topic is subjective, in this article we review several useful recommendations to optimize communication before and after surgery. Finally, we emphasize the need to create workshops to train the bariatric surgeon in these issues that we consider so important. PMID:25912163

  5. Physical Self-Concept, Trait Depression and Readiness for Physical Activity of Obese Patients

    ERIC Educational Resources Information Center

    Boros, Szilvia; Halmy, Laszlo

    2009-01-01

    Study aim: To assess the physical self-concept, trait depression and readiness for physical activity in relation to the degree of obesity. Material and methods: Obese (Grade I and II; n = 59) and morbidly obese (Grade III; n = 42) patients aged 30-66 years, as well as 83 non-obese college students aged 30 [plus or minus] 7.3 years were studied.…

  6. Circulating endothelin-1 levels in obese patients with the metabolic syndrome.

    PubMed

    Ferri, C; Bellini, C; Desideri, G; Baldoncini, R; Properzi, G; Santucci, A; De Mattia, G

    1997-01-01

    We evaluated venous plasma ET-1 concentrations in 18 never-treated obese men (body mass index 31.0 +/- 0.5 kg/m2; age 45.4 +/- 4.3 years) showing the whole features of the above syndrome and 12 control men (age 44.1 +/- 3.6 years). Circulating ET-1 levels were significantly higher in patients than in controls (p < 0.05), and were directly correlated with fasting insulin levels (r = 0.564, p = 0.015) and erythrocyte Na+/Li+ counter-transport activity (r = 0.504, p = 0.033). In conclusion, venous plasma ET-1 levels are elevated in obese men manifesting the whole features of the metabolic syndrome. Due to the biological properties of ET-1, our findings suggest the peptide as a further component of the cluster of cardiovascular risk factors which characterizes this syndrome. PMID:9288542

  7. Binge eating onset in obese patients with binge eating disorder.

    PubMed

    Marcus, M D; Moulton, M M; Greeno, C G

    1995-01-01

    In this study we examined whether obese women with binge eating disorder (BED) reporting earlier onset binge eating differed from those with later onset binge eating on salient clinical parameters. Subjects were 112 women who sought treatment for BED. Subjects with early (< or = age 18) and later onset (> age 18) did not differ in age, weight, body mass index, or severity of binge eating. Participants were interviewed using the Eating Disorder Examination (EDE) and the Structured Clinical Interview for DSM-III-R, and completed a weight and diet history questionnaire. Early-onset binge eaters were more likely than those with later-onset to binge-eat before dieting, to have early onset of obesity and dieting, to have longer binge-free periods, and more paternal obesity and binge eating. Early-onset binge eaters also reported more eating-disorders psychopathology, and they were more likely to report a lifetime history of bulimia nervosa and DSM-III-R mood disorder. These data suggest that there are marked differences among BED patients presenting for treatment. Further research is needed to determine whether these differences reflect a different etiology or have implications for treatment. PMID:8820527

  8. Feeding the critically ill obese patient: the role of hypocaloric nutrition support.

    PubMed

    Miller, Jerad P; Choban, Patricia Smith

    2006-12-01

    Obesity and its many metabolic and physiologic comorbidities are becoming more common. Thus, a strategy to approach the nutritional needs of obese critically ill patients is warranted. The adverse effect of obesity on the respiratory system is well established. The obesity may be an inciting event or merely an additional burden in the obese critically ill patient. A strategy of hypocaloric nutrition support avoids the many detrimental effects of overfeeding and has been considered for all critically ill patients. In the obese patient, the strategy addresses the additional problem of the excessive fat store and has the additional benefit of fat reduction while sparing lean body mass. In the patient with normal renal and hepatic function, hypocaloric nutrition support simplifies care and may improve outcome. PMID:17150433

  9. Abdominal Adiposity Correlates with Adenotonsillectomy Outcome in Obese Adolescents with Severe Obstructive Sleep Apnea

    PubMed Central

    Nino, Gustavo; Gutierrez, Maria J.; Ravindra, Anjani; Nino, Cesar L.; Rodriguez-Martinez, Carlos E.

    2012-01-01

    Background. Obese adolescents with Obstructive Sleep Apnea (OSA) have a unique pathophysiology that combines adenotonsillar hypertrophy and increased visceral fat distribution. We hypothesized that in this population waist circumference (WC), as a clinical marker of abdominal fat distribution, correlates with the likelihood of response to AT. Methods. We conducted a retrospective cohort study of obese adolescents (BMI ≥ 97th percentile) that underwent AT for therapy of severe OSA (n = 21). We contrasted WC and covariates in a group of subjects that had complete resolution of severe OSA after AT (n = 7) with those obtained in subjects with residual OSA after AT (n = 14). Multivariate linear and logistic models were built to control possible confounders. Results. WC correlated negatively with a positive AT response in young adolescents and the percentage of improvement in obstructive apnea-hypopnea index (OAHI) after AT (P ≤ 0.01). Extended multivariate analysis demonstrated that the link between WC and AT response was independent of demographic variables, OSA severity, clinical upper airway assessment, obesity severity (BMI), and neck circumference (NC). Conclusion. The results suggest that in obese adolescents, abdominal fat distribution determined by WC may be a useful clinical predictor for residual OSA after AT. PMID:23251797

  10. Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning?

    PubMed

    Elson, Leah C; Barr, Christopher J; Chandran, Shaun E; Hansen, Viktor Johannes; Malchau, Henrik; Kwon, Young-Min

    2013-09-01

    Acetabular cup positioning is a critical factor in determining adverse clinical outcomes in THA. This evaluation was performed to determine if morbid obesity (BMI ≥35kg/m(2)) is a contributing risk factor to cup malpositioning. Two groups of patients were obtained from a local arthroplasty registry and match-controlled for gender, age, and diagnosis (n=211 morbidly obese; n=211 normal). Intraoperative data and postoperative AP pelvis and cross-table lateral radiographs were obtained for each patient. The Martell Hip Analysis Suite was used to calculate cup positioning (successful positioning defined as 30°-45° of abduction, and 5°-25° of anteversion), as well as varus-valgus alignment of the femoral stem. There was a significant correlation between morbid obesity with respect to underanteversion; using multivariate analysis, there was a trend toward a combined underanteversion/overabduction of the acetabular cup. Of all variables considered, high BMI was the most significant risk factor leading to malpositioning. PMID:23910510

  11. Temporal obesity trends in patients undergoing transthoracic echocardiography 2002-2006.

    PubMed

    Rao, Seshu C; Kusnetzky, Lisa L; Lan, Xiao; Main, Michael L

    2009-03-01

    In a recent data brief, the National Center for Health Statistics reported that obesity prevalence has plateaued in recent years, with no increase in obesity from 2003 to 2006. We have subjectively observed a marked increase in clinically severe obesity over this same period in patients presenting to our echocardiographic laboratory. The aim of this study was to determine temporal trends in obesity prevalence in patients presenting for transthoracic echocardiographic studies. A retrospective database analysis was performed using the Cardiovascular Consultants (Kansas City, Missouri) database (ProSolv Cardiovascular, Indianapolis, Indiana). The height and weight of patients who underwent transthoracic echocardiography in 2002 (n = 10,804) and 2006 (n = 17,556) were obtained. Body mass index was calculated as weight/height squared. Patients were grouped into 1 of 6 body mass index categories (underweight, normal weight, overweight, obese, morbidly obese, or super obese). Continuous variables were compared using Student's t test, and categorical variables were compared using chi-square test. In the 2 years, approximately (1/3) of patients were normal weight and (1/3) of patients were overweight. Obesity prevalence increased significantly (by nearly 8%) over the study period, with 28.1% of patients in the obese category by 2006. Clinically severe obesity (morbidly obese and super obese) increased dramatically from 2002 to 2006 (16%, p <0.008, and 41.7%, p <0.001, increases, respectively). In conclusion, clinically severe obesity has markedly increased in our midwestern echocardiographic laboratory in the period from 2002 to 2006. PMID:19231334

  12. Biopsychosocial Correlates of Binge Eating Disorder in Caucasian and African American Women with Obesity in Primary Care Settings.

    PubMed

    Udo, Tomoko; White, Marney A; Lydecker, Janet L; Barnes, Rachel D; Genao, Inginia; Garcia, Rina; Masheb, Robin M; Grilo, Carlos M

    2016-05-01

    This study examined racial differences in eating-disorder psychopathology, eating/weight-related histories, and biopsychosocial correlates in women (n = 53 Caucasian and n = 56 African American) with comorbid binge eating disorder (BED) and obesity seeking treatment in primary care settings. Caucasians reported significantly earlier onset of binge eating, dieting, and overweight, and greater number of times dieting than African American. The rate of metabolic syndrome did not differ by race. Caucasians had significantly elevated triglycerides whereas African Americans showed poorer glycaemic control (higher glycated haemoglobin A1c [HbA1c]), and significantly higher diastolic blood pressure. There were no significant racial differences in features of eating disorders, depressive symptoms, or mental and physical health functioning. The clinical presentation of eating-disorder psychopathology and associated psychosocial functioning differed little by race among obese women with BED seeking treatment in primary care settings. Clinicians should assess for and institute appropriate interventions for comorbid BED and obesity in both African American and Caucasian patients. PMID:26640009

  13. Health Outcomes of Gastric Bypass Patients Compared to Nonsurgical, Nonintervened Severely Obese

    PubMed Central

    Adams, Ted D.; Pendleton, Robert C.; Strong, Michael B.; Kolotkin, Ronette L.; Walker, James M.; Litwin, Sheldon E.; Berjaoui, Wael K.; LaMonte, Michael J.; Cloward, Tom V.; Avelar, Erick; Owan, Theophilus E.; Nuttall, Robert T.; Gress, Richard E.; Crosby, Ross D.; Hopkins, Paul N.; Brinton, Eliot A.; Rosamond, Wayne D.; Wiebke, Gail A.; Yanowitz, Frank G.; Farney, Robert J.; Halverson, R. Chad; Simper, Steven C.; Smith, Sherman C.; Hunt, Steven C.

    2010-01-01

    Favorable health outcomes at 2 years postbariatric surgery have been reported. With exception of the Swedish Obesity Subjects (SOS) study, these studies have been surgical case series, comparison of surgery types, or surgery patients compared to subjects enrolled in planned nonsurgical intervention. This study measured gastric bypass effectiveness when compared to two separate severely obese groups not participating in designed weight-loss intervention. Three groups of severely obese subjects (N = 1,156, BMI ≥ 35 kg/m2) were studied: gastric bypass subjects (n = 420), subjects seeking gastric bypass but did not have surgery (n = 415), and population-based subjects not seeking surgery (n = 321). Participants were studied at baseline and 2 years. Quantitative outcome measures as well as prevalence, incidence, and resolution rates of categorical health outcome variables were determined. All quantitative variables (BMI, blood pressure, lipids, diabetes-related variables, resting metabolic rate (RMR), sleep apnea, and health-related quality of life) improved significantly in the gastric bypass group compared with each comparative group (all P < 0.0001, except for diastolic blood pressure and the short form (SF-36) health survey mental component score at P < 0.01). Diabetes, dyslipidemia, and hypertension resolved much more frequently in the gastric bypass group than in the comparative groups (all P < 0.001). In the surgical group, beneficial changes of almost all quantitative variables correlated significantly with the decrease in BMI. We conclude that Roux-en-Y gastric bypass surgery when compared to severely obese groups not enrolled in planned weight-loss intervention was highly effective for weight loss, improved health-related quality of life, and resolution of major obesity-associated complications measured at 2 years. PMID:19498344

  14. Obesity

    MedlinePlus

    ... may have less time to exercise. The term eating disorder means a group of medical conditions that have ... obese, follow an unhealthy diet, and have an eating disorder all at the same time. Sometimes, medical problems ...

  15. Pharmacotherapy for Obesity and Changes in Eating Behavior: a Patient and Physician's Perspective.

    PubMed

    Miguelgorry, Piper L; Hendricks, Ed J

    2016-07-01

    This article, co-authored by a patient with obesity, diabetes, and hypertension, and an obesity medicine specialist, discusses the patient's experience with the onset of diabetes complicating obesity and with her frustration living with these diagnoses until finding an obesity medicine specialist physician who helped her lose weight and reverse her diabetes. The patient continues to maintain a significant weight loss and is diabetes free for 5.5 years after treatment initiation. The physician discusses the application of combination treatment that can be effective in diabetes reversal in such cases. He also discusses salient clinical lessons exemplified by this case. PMID:27246171

  16. Impact of obesity in favorable-risk AML patients receiving intensive chemotherapy.

    PubMed

    Tavitian, Suzanne; Denis, Amélia; Vergez, François; Berard, Emilie; Sarry, Audrey; Huynh, Anne; Delabesse, Eric; Luquet, Isabelle; Huguet, Françoise; Récher, Christian; Bertoli, Sarah

    2016-02-01

    We assessed the influence of obesity on the characteristics and prognosis of acute myeloid leukemia (AML). Indeed, safety of intensive chemotherapy and outcome of obese AML patients in a real-life setting are poorly described, and chemotherapy dosing remains challenging. We included 619 consecutive genetically-defined cases of AML treated with intensive chemotherapy between 2004 and 2012. In this cohort, 93 patients (15%) were classified in the obese category according to WHO classification; 59% of them received capped doses of chemotherapy because of a body surface area above 2 m(2) . Obese patients were older and presented more often with cardiovascular comorbidities. Although obese patients had more frequently de novo AML, main characteristics of AML including white blood cell count, karyotype and mutations were well-balanced between obese and non-obese patients. After induction chemotherapy, early death and complete remission rates were similar. Overall (OS), event-free (EFS) and disease-free (DFS) survival were not significantly different compared to non-obese patients. However, in the European LeukemiaNet (ELN) favorable subgroup, obese patients had lower median OS, EFS and DFS than non-obese patients (18.4, 16.8 and 17.2 vs. 43.6, 31.8 and 29.7 months, respectively) and obesity showed a significant impact on OS (OR 2.54; P = 0.02) in multivariate models. Although we did not find any significant impact of obesity on outcome in the whole series, this study suggests that special efforts for chemotherapy dose optimization are needed in the ELN favorable subgroup since dose capping may be deleterious. PMID:26509505

  17. A "Family-Based" Approach to the Treatment of Obese Type II Diabetic Patients.

    ERIC Educational Resources Information Center

    Wing, Rena R.; And Others

    1991-01-01

    Assigned 49 obese diabetic patients with obese spouses (diabetic or nondiabetic) to an alone or together (with spouses) treatment condition of behavioral weight control program. Found no significant differences in weight losses of patients at posttreatment or one-year followup, but did find that women did better when treated with their spouses,…

  18. Obesity.

    PubMed

    Callaway, C W

    1987-01-01

    Obesity is not a single disease, but a variety of conditions resulting from different mechanisms and associated with various types and degrees of risks. To determine who should lose weight, how much weight should be lost, and how to undertake weight loss, the following types of information are needed: personal-demographic data, developmental patterns, family history, energy balance, body composition/fat distribution, psychological/behavioral measures, endocrine/metabolic measures, complications and associated conditions. Weight reduction should be undertaken by women with morbid obesity, with complications secondary to the obesity, with a strong family history of conditions associated with obesity, or with increased abdomen:hip ratios. In contrast, women who have excess weight localized in the hips and thighs and no personal or family history of associated conditions may not benefit from dietary restriction. Low calorie diets result in adaptive changes, "designed" to prolong survival in the face of famine. These include changes in water balance, metabolic rate, and appetite. Metabolic rate declines, allowing the individual to burn fewer and fewer calories. Each time a woman diets she tends to lose weight less rapidly than the time before. "Restrained eating" predisposes binge eating. Indeed, bulimia rarely occurs in the absence of prior caloric restrictions. Current medical definitions of obesity do not consider these nuances. Existing definitions "over-diagnose" obesity in women, in general, and in older women and nonwhite women, in particular. For example, by existing standards, more than 60 percent of black women more than 45 years of age are considered obese. In contrast, the health risks of similar degrees of obesity are substantially greater for men than for women. Part of the problems lies in the fact that many women have pear-shaped fat distribution,a pattern which is not associated with increased health risks.Current cultural definitions of obesity for

  19. The investigation of the some body parameters of obese and (obese+diabetes) patients with using bioelectrical impedance analysis techniques

    NASA Astrophysics Data System (ADS)

    Yerlikaya, Emrah; Karageçili, Hasan; Aydin, Ruken Zeynep

    2016-04-01

    Obesity is a key risk for the development of hyperglycemia, hypertension, hyperlipidemia, insulin resistance and is totally referred to as the metabolic disorders. Diabetes mellitus, a metabolic disorder, is related with hyperglycemia, altered metabolism of lipids, carbohydrates and proteins. The minimum defining characteristic feature to identify diabetes mellitus is chronic and substantiated elevation of circulating glucose concentration. In this study, it is aimed to determine the body composition analyze of obese and (obese+diabetes) patients.We studied the datas taken from three independent groups with the body composition analyzer instrument. The body composition analyzer calculates body parameters, such as body fat ratio, body fat mass, fat free mass, estimated muscle mass, and base metabolic rate on the basis of data obtained by Dual Energy X-ray Absorptiometry using Bioelectrical Impedance Analysis. All patients and healthy subjects applied to Siirt University Medico and their datas were taken. The Statistical Package for Social Sciences version 21 was used for descriptive data analysis. When we compared and analyzed three groups datas, we found statistically significant difference between obese, (obese+diabetes) and control groups values. Anova test and tukey test are used to analyze the difference between groups and to do multiple comparisons. T test is also used to analyze the difference between genders. We observed the statistically significant difference in age and mineral amount p<0.00 between (diabetes+obese) and obese groups. Besides, when these patient groups and control group were analyzed, there were significant difference between most parameters. In terms of education level among the illiterate and university graduates; fat mass kg, fat percentage, internal lubrication, body mass index, water percentage, protein mass percentage, mineral percentage p<0.05, significant statistically difference were observed. This difference especially may result

  20. The Impact of Obesity on Patient Reported Outcomes Following Stereotactic Body Radiation Therapy for Prostate Cancer

    PubMed Central

    Cyr, Robyn; Feng, Li Rebekah; Bae, Edward; Danner, Malika T; Ayoob, Marilyn; Yung, Thomas M; Lei, Siyuan; Collins, Brian T; Saligan, Leorey; Simeng, Suy; Kumar, Deepak; Collins, Sean P

    2016-01-01

    Objectives The relationship between obesity (Body Mass Index ­>30 kg/m2) and quality of life (QoL) following prostate cancer (PCa) radiation therapy (RT) is unknown. Excess abdominal fat may compromise the precise delivery of radiation, putting surrounding organs at risk for greater radiation exposure. Stereotactic body radiation therapy (SBRT) utilizes a real-time tracking system that provides updated prostate position information and allows for correction of the therapeutic beam during treatment with high accuracy. In this study, we evaluate the impact of obesity on patient reported outcomes following SBRT for prostate cancer. Materials and methods Between February 2008 and April 2012, 88 obese and 178 non-obese patients with PCa were treated with SBRT at Georgetown University Hospital, Washington, DC. Health-related quality of life (HRQol) was assessed via the expanded prostate cancer index composite (EPIC)-26 at baseline, 6, 12, 18, and 24 months after 5-fraction delivery of 35-36.25 Gy with the CyberKnife. Patients who received androgen deprivation therapy (ADT) were excluded from this analysis due to its known negative impact on HRQoL. Results Pretreatment characteristics of obese and non-obese patient groups were similar except that obese patients had lower total testosterone levels. Urinary and bowel function and bother scores between the two patient cohorts were comparable at baseline and subsequent follow-ups. Sexual function and bother were also similar at baseline between both groups. Bother was defined by displeasure patients may experience from functional decline. At 24 months post-SBRT, obese men experienced borderline clinically significant decrease in sexual function and greater sexual bother compared to non-obese patients. Fatigue was significantly higher in obese patients compared to non-obese patients at 18 months post-SBRT. Conclusions Prostate SBRT affects obese and non-obese patients similarly in total HRQoL scores and majority of its

  1. Effect of Obesity on Mortality and Morbidity After Coronary Artery Bypass Grafting Surgery in Iranian Patients

    PubMed Central

    Ardeshiri, Maryam; Faritous, Zahra; Ojaghi Haghighi, Zahra; Hosseini, Shirin; Baghaei, Ramin

    2014-01-01

    Background: Recent years have witnessed the emergence of obesity as a major public health concern. The drastic rise in obesity and its concomitant co-morbidities is a reflection of the recent changes in dietary habits in Iran and many other developing countries. A recent large population study in Tehran reported that 58% and 75% of middle-aged Iranian men and women, respectively, were either overweight or obese. Objectives: Considering the impact of obesity on mortality and morbidity after coronary artery bypass graft surgery (CABG), we sought to investigate the association between central obesity and the body mass index (BMI) and the post-CABG mortality and morbidity in Iranian patients. Patients and Methods: This prospective study was on 235 adult patients scheduled for isolated CABG in a university hospital. The patients were divided in two groups according to BMI ≥ 30 (obese; n = 60) and BMI < 30 (non-obese; n = 175). In-hospital and late (after 3 months) morbidity and mortality rates were compared between obese and non-obese patients. Results: A total of 235 patients (135 women) with a mean age of 59 ± 9.2 years (range = 29 to 79 years), mean BMI of 27.3 ± 4.2 (range = 17 to 40), and mean waist circumference of 101.2 ± 14.7 cm (range = 55 to 145 cm) were included. By the third postoperative month, wound infection had significantly increased in patients with BMI ≥ 30 (P = 0.022). In-hospital and late morbidity and mortality rates were comparable between the two groups (P > 0.05). Conclusions: In our patients obesity was a risk factor for wound infection but not atelectasis or the need for intra-aortic balloon pump or re-exploration. Obesity was not associated with increased in-hospital or 3 months mortality rates after CABG. PMID:24977121

  2. Prognostic evaluation in obese patients using a dedicated multipinhole cadmium-zinc telluride SPECT camera.

    PubMed

    De Lorenzo, Andrea; Peclat, Thais; Amaral, Ana Carolina; Lima, Ronaldo S L

    2016-02-01

    The purpose of this study is to evaluate the prognostic value of myocardial perfusion SPECT obtained in CZT cameras (CZT-SPECT) with multipinhole collimation in obese patients. CZT-SPECT may be technically challenging in the obese, and its prognostic value remains largely unknown. Patients underwent single-day, rest/stress (supine and prone) imaging. Images were visually inspected and graded as poor, fair or good/excellent. Summed stress and difference scores (SSS and SDS, respectively) were converted into percentages of total perfusion defect and of ischemic defect by division by the maximum possible score. Obesity was defined as a body mass index (BMI) ≥ 30 kg/m(2) and classified as class I (BMI 30-34.9 kg/m(2)), II (BMI 35-39.9 kg/m(2)), or III (BMI ≥ 40 kg/m(2)). Patients were followed-up by telephone interview for the occurrence of all-cause death, myocardial infarction or revascularization. A Cox proportional hazards analysis was used to assess the independent predictors of death. Among 1396 patients, 365 (26.1 %) were obese (mean BMI 33.9 ± 3.6; 17.5 % class I, 3.4 % class II, and 3.4 % class III). Image quality was good/excellent in 94.5 % of the obese patients. The annualized mortality rates were not significantly different among obese and non-obese patients, being <1 % with normal CZT-SPECT, and increased with the degree of scan abnormality in both obese and non-obese patients. Age, the use of pharmacologic stress and an abnormal CZT-SPECT, but not obesity, were independent predictors of death. In obese patients, single-day rest/stress CZT-SPECT with a multipinhole camera provides prognostic discrimination with high image quality. PMID:26424491

  3. The Impact of Hypoxemia on Nephropathy in Extremely Obese Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Leong, Wen Bun; Nolen, Melissa; Thomas, G. Neil; Adab, Paymanè; Banerjee, Dev; Taheri, Shahrad

    2014-01-01

    Study Objectives: Diabetes mellitus (DM) is associated with obstructive sleep apnea (OSA) and nephropathy. The hypoxemia associated with OSA may exacerbate renal deterioration in DM nephropathy. We examined the role of hypoxemia in the development of DM nephropathy in severely obese patients. Methods: This cross-sectional study examined anonymized data from 90 DM patients with extreme obesity attending a weight management service. All patients underwent a routine overnight sleep study. Respiratory parameters measured included apnea-hypopnea index (AHI), mean and minimum oxygen (O2) saturations, and time spent under 90% O2 saturation (%TST < 90%). Chronic kidney disease (CKD+) was defined as estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73 m2. Results: Twenty (22%) patients were CKD+. These patients were 7 years older (mean age ± SD 57 ± 11 years, p = 0.003) and had greater adiposity (mean body mass index [BMI] ± SD 50.6 ± 8.7 kg/m2, p = 0.012). No significant differences were found for median AHI and minimum O2 saturation. %TST < 90% was 4 times greater in CKD+ group (p = 0.046). Multivariate regression analysis showed that AHI (β = −0.17, 95% CI: −0.316 to −0.024) and %TST < 90% (β = −0.215, 95% CI: −0.406 to −0.023) were negatively correlated with eGFR after adjustment for age, gender, BMI, comorbidities, insulin treatment, and drugs affecting the renin-angiotensin system. No associations were found between mean and minimum O2 saturations, and eGFR. Conclusion: Apnea and hypopnea events as well as duration of nocturnal hypoxemia were inversely associated with renal function after adjusting for potential confounders. Given the significant burden of renal disease in diabetes, greater vigilance is required in identifying OSA in DM patients with extreme obesity. Citation: Leong WB, Nolen M, Thomas GN, Adab P, Banerjee D, Taheri S. The impact of hypoxemia on nephropathy in extremely obese patients with type 2 diabetes mellitus. J Clin

  4. 25OH-Vitamin D3 Levels in Obesity and Metabolic Syndrome-Unaltered in Young and not Correlated to Carotid IMT in All Ages.

    PubMed

    Mangge, Harald; Zelzer, Sieglinde; Meinitzer, Andreas; Stelzer, Ingeborg; Schnedl, Wolfgang J; Weghuber, Daniel; Fuchs, Dietmar; Postolache, Teodor T; Aigner, Elmar; Datz, Christian; Reininghaus, Eva Z

    2015-01-01

    Contradictory results exist for levels of vitamin D measured in patients with cardiovascular disease (CVD), obesity and metabolic syndrome (MetS). To clarify this, we investigated 527 participants of the STYJOBS/ EDECTA cohort (NCT00482924), with ages between 10 and 65 years. A cross-sectional analysis of anthropometry, carotid intima media thickness (IMT), and laboratory measurements for 25OH-Vitamin D3 (vitD), glucose metabolism, ultra-sensitive C-reactive protein (US-CRP), interleukin-6 (IL-6), lipids, liver-, renal-parameters, and kynurenine to tryptophan ratio were made for a selection of persons who were either obese or of normal weight. The homeostasis model assessment insulin resistance (HOMA) was also measured. As compared to the normal weight controls, significantly decreased blood levels of vitD were found in overweight/obese adults, which were not observed in the juveniles. Nevertheless, both overweight/obese juveniles and adults had significantly increased US-CRP, IL-6, HOMA, triglyceride, and LDL-cholesterol levels, and significantly decreased HDL-cholesterol levels. Juveniles with MetS displayed unchanged levels of vitD as compared to overweight/obese juveniles without MetS. Although IMT was significantly increased in both juvenile and adult overweight/obese subjects, vitD and IMT levels were not correlated. Assuming a minimum threshold of 20 ng/ml for the establishment of "low" or "normal" vitD levels, no significant alteration in IMT, metabolic, and inflammatory markers was observed in juveniles with a low vitD-status . In conclusion, although metabolic and inflammatory symptoms of obesity are displayed in juveniles, their vitD levels are unaffected. This, together with the complete lack of association with carotid IMT in both juveniles and adults, argues against a causative role of vitD in obesity-associated vascular pathology. PMID:25557634

  5. Mother-daughter correlation of central obesity and other noncommunicable disease risk factors: Tehran Lipid and Glucose Study.

    PubMed

    Heidari, Zahra; Hosseinpanah, Farhad; Barzin, Maryam; Safarkhani, Maryam; Azizi, Fereidoun

    2015-03-01

    This study aimed to investigate the mother-daughter correlation for central obesity and other noncommunicable disease risk factors. The authors used metabolic and anthropometric data from the Tehran Lipid and Glucose Study, enrolling 1041 mother-daughter pairs for the current study. Three age strata were defined: 3 to 9 years for childhood (146 mother-daughter pairs), 10 to 17 years for adolescence (395 mother-daughter pairs), and 18 to 25 years for early adulthood (500 mother-daughter pairs). Familial associations for central obesity and other noncommunicable disease risk factors were assessed. The prevalence of central obesity was 44.7% in mothers and 11.2% in daughters (6.2% in the 3-9, 19.2% in the 10-17, and 6.4% in the 18-25 years groups). Mothers with central obesity were more likely than nonobese mothers to have daughters with central obesity (10.5% and 1.7%, respectively; P = .0001). Central obesity indices among daughters were positively correlated with those of their mothers in all 3 age strata. Correlations for other noncommunicable disease risk factors were analyzed before and after adjusting the risk factor levels for mothers' and daughters' waist circumferences (WCs) within each group to determine whether risk factor correlations were, in part, a result of the central obesity correlations. After the non-communicable disease risk factor levels of participants were adjusted for their WCs, the mother-daughter correlations remained significant. The consistent association of central obesity between mothers and daughters may indicate the key role that could be played by the mother in the primary prevention of central obesity, particularly in high-risk families. PMID:22500034

  6. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity

    PubMed Central

    Phelan, SM; Burgess, DJ; Yeazel, MW; Hellerstedt, WL; Griffin, JM; van Ryn, M

    2015-01-01

    The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care. PMID:25752756

  7. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity.

    PubMed

    Phelan, S M; Burgess, D J; Yeazel, M W; Hellerstedt, W L; Griffin, J M; van Ryn, M

    2015-04-01

    The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care. PMID:25752756

  8. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients.

    PubMed

    Pelosi, P; Croci, M; Ravagnan, I; Cerisara, M; Vicardi, P; Lissoni, A; Gattinoni, L

    1997-03-01

    The effects of inspiratory flow and inflation volume on the mechanical properties of the respiratory system in eight sedated and paralyzed postoperative morbidly obese patients (aged 37.6 +/- 11.8 yr who had never smoked and had normal preoperative seated spirometry) were investigated by using the technique of rapid airway occlusion during constant-flow inflation. With the patients in the supine position, we measured the interrupter resistance (Rint,rs), which in humans probably reflects airway resistance, the "additional" resistance (delta Rrs) due to viscoelastic pressure dissipation and time-constant inequalities, and static respiratory elastance (Est,rs). Intra-abdominal pressure (IAP) was measured by using a bladder catheter, and functional residual capacity was measured by the heliumdilution technique. The results were compared with a previous study on 16 normal anesthetized paralyzed humans. Compared with normal persons, we found that in obese subjects: 1) functional residual capacity was markedly lower (0.645 +/- 0.208 liter) and IAP was higher (24 +/- 2.2 cmH2O); 2) alveolar-arterial oxygenation gradient was increased (178 +/- 59 mmHg); 3) the volume-pressure curve of the respiratory system was curvilinear with an "inflection" point; 4) Est,rs, Rint,rs, and delta Rrs were higher than normal (29.3 +/- 5.04 cmH2O/l, 5.9 +/- 2.4 cmH2O.l-1.s, and 6.4 +/- 1.6 cmH2O.l-1.s, respectively); 5) Rint,rs increased with increasing inspiratory flow, Est,rs did not change, and delta Rrs decreased progressively; and 6) with increasing inflation volume, Rint,rs and Est,rs decreased, whereas delta Rrs rose progressively. Overall, our data suggest that obese subjects during sedation and paralysis are characterized by hypoxemia and marked alterations of the mechanical properties of the respiratory system, largely explained by a reduction in lung volume due to the excessive unopposed IAP. PMID:9074968

  9. The results of a national survey regarding nutritional care of obese burn patients.

    PubMed

    Coen, Jennifer R; Carpenter, Annette M; Shupp, Jeffrey W; Matt, Sarah E; Shaw, Jesse D; Flanagan, Katherine E; Pavlovich, Anna R; Jeng, James C; Jordan, Marion H

    2011-01-01

    Little is known about the nutritional needs of obese burn patients. Given the impact of obesity on the morbidity and mortality of these patients, a uniform understanding of perceptions and practices is needed. To elucidate current practices of clinicians working with the obese burn population, the authors constructed a multidisciplinary survey designed to collect this information from practitioners in United States burn centers. An electronic approach was implemented to allow for ease of distribution and completion. A portable document format (pdf) letter was e-mailed to the members of the American Burn Association and then mailed separately to additional registered dietitians identified as working in burn centers. This letter contained a link to a 29-question survey on the SurveyMonkey.com server. Questions took the form of multiple choice and free text entry. Responses were received from physicians, mid-level practitioners, registered dietitians, and nurses. Seventy-five percent of respondents defined obesity as body mass index >30. The Harris-Benedict equation was identified as the most frequently used equation to calculate the caloric needs of burn patients (32%). Fifty-eight percent indicated that they alter their calculations for the obese patient by using adjusted body weight. Calculations for estimated protein needs varied among centers. The majority did not use hypocaloric formulas for obese patients (79%). Enteral nutrition was initiated within the first 24 hours for both obese and nonobese patients at most centers. Sixty-three percent suspend enteral nutrition during operative procedures for all patients. Oral feeding of obese patients was the most preferred route, with total parenteral nutrition being the least preferred. Longer length of stay, poor wound healing, poor graft take, and prolonged intubation were outcomes perceived to occur more in the obese burn population. In the absence of supporting research, clinicians are making adjustments to the

  10. Obesity

    MedlinePlus

    ... come from muscle, bone, fat, and/or body water. Both terms mean that a person's weight is greater than what's considered healthy for his or her height. Obesity occurs over time when you eat more calories than you use. The balance between calories-in and calories-out differs for ...

  11. Comparison of energy estimation equations with measured energy expenditure in obese adolescent patients with cancer.

    PubMed

    Ringwald-Smith, K; Williams, R; Mackert, P; Stricklin, L; Sargent, T; Bowman, L

    1999-07-01

    Obesity is increasing in the US adolescent population. As the number of obese adolescents increases, obesity is becoming a more frequent problem in the hospital setting, sometimes causing patients to have complicated and prolonged hospital stays. Calculation of the energy requirements of obese adolescent patients with chronic diseases such as cancer is complicated by increased energy requirements as a result of disease state and growth. This study examined the accuracy of the commonly used equations for calculating energy requirements. Estimated energy expenditure was compared with measured energy expenditure determined by indirect calorimetry. All energy estimation equations were inaccurate, which indicates the need for a specific equation for determination of energy needs in this special patient population. Until further research is done, indirect calorimetry is recommended for all obese adolescent patients with cancer who require nutrition support. PMID:10405683

  12. Evaluation of Biomarkers of NAFLD in a Cohort of Morbidly Obese Patients

    PubMed Central

    Kälsch, Julia; Bechmann, Lars P.; Kälsch, Hagen; Schlattjan, Martin; Erhard, Jochen; Gerken, Guido; Canbay, Ali

    2011-01-01

    Hepatocyte apoptosis is a key event in nonalcoholic fatty liver disease (NAFLD), and serum apoptotic markers are emerging as surrogate markers for NAFLD. We studied the role of caspase-cleaved cytokeratin18 in the diagnosis of fibrosis in a cohort of 127 morbidly obese patients and also performed a review of the literature biomarkers of NAFLD and fibrosis. Here, we found that cleaved caspase 18 correlated with liver steatosis and liver injury as assessed by serum transaminase levels. Furthermore, hepatocyte apoptosis as assessed by cleaved CK18 and TUNEL staining correlated with the extent of fibrosis as assessed by Sirius Red staining and serum hyaluronic acid. These results underscore the important role of hepatocyte apoptosis in the pathogenesis of fibrosis in NAFLD, which led to the utilization of surrogate markers for apoptosis in the noninvasive diagnosis of NAFLD. We furthermore reviewed current literature of biomarkers of NAFLD and fibrosis. PMID:21773018

  13. Evaluation of Biomarkers of NAFLD in a Cohort of Morbidly Obese Patients.

    PubMed

    Kälsch, Julia; Bechmann, Lars P; Kälsch, Hagen; Schlattjan, Martin; Erhard, Jochen; Gerken, Guido; Canbay, Ali

    2011-01-01

    Hepatocyte apoptosis is a key event in nonalcoholic fatty liver disease (NAFLD), and serum apoptotic markers are emerging as surrogate markers for NAFLD. We studied the role of caspase-cleaved cytokeratin18 in the diagnosis of fibrosis in a cohort of 127 morbidly obese patients and also performed a review of the literature biomarkers of NAFLD and fibrosis. Here, we found that cleaved caspase 18 correlated with liver steatosis and liver injury as assessed by serum transaminase levels. Furthermore, hepatocyte apoptosis as assessed by cleaved CK18 and TUNEL staining correlated with the extent of fibrosis as assessed by Sirius Red staining and serum hyaluronic acid. These results underscore the important role of hepatocyte apoptosis in the pathogenesis of fibrosis in NAFLD, which led to the utilization of surrogate markers for apoptosis in the noninvasive diagnosis of NAFLD. We furthermore reviewed current literature of biomarkers of NAFLD and fibrosis. PMID:21773018

  14. Effect of obesity on the pharmacokinetics of antimicrobials in critically ill patients: A structured review.

    PubMed

    Alobaid, Abdulaziz S; Hites, Maya; Lipman, Jeffrey; Taccone, Fabio Silvio; Roberts, Jason A

    2016-04-01

    The increased prevalence of obesity presents challenges for clinicians aiming to provide optimised antimicrobial dosing in the intensive care unit. Obesity is likely to exacerbate the alterations to antimicrobial pharmacokinetics when the chronic diseases associated with obesity exist with the acute pathophysiological changes associated with critical illness. The purpose of this paper is to review the potential pharmacokinetic (PK) changes of antimicrobials in obese critically ill patients and the implications for appropriate dosing. We found that hydrophilic antimicrobials (e.g. β-lactams, vancomycin, daptomycin) were more likely to manifest altered pharmacokinetics in critically ill patients who are obese. In particular for β-lactam antibiotics, obesity is associated with a larger volume of distribution (Vd). In obese critically ill patients, piperacillin is also associated with a lower drug clearance (CL). For doripenem, these PK changes have been associated with reduced achievement of pharmacodynamic (PD) targets when standard drug doses are used. For vancomycin, increases in Vd are associated with increasing total body weight (TBW), meaning that the loading dose should be based on TBW even in obese patients. For daptomycin, an increased Vd is not considered to be clinically relevant. For antifungals, little data exist in obese critically ill patients; during fluconazole therapy, an obese patient had a lower Vd and higher CL than non-obese comparators. Overall, most studies suggested that standard dosage regimens of most commonly used antimicrobials are sufficient to achieve PD targets. However, it is likely that larger doses would be required for pathogens with higher minimum inhibitory concentrations. PMID:26988339

  15. Hypothalamic Obesity in Craniopharyngioma Patients: Disturbed Energy Homeostasis Related to Extent of Hypothalamic Damage and Its Implication for Obesity Intervention

    PubMed Central

    Roth, Christian L.

    2015-01-01

    Hypothalamic obesity (HO) occurs in patients with tumors and lesions in the medial hypothalamic region. Hypothalamic dysfunction can lead to hyperinsulinemia and leptin resistance. This review is focused on HO caused by craniopharyngiomas (CP), which are the most common childhood brain tumors of nonglial origin. Despite excellent overall survival rates, CP patients have substantially reduced quality of life because of significant long-term sequelae, notably severe obesity in about 50% of patients, leading to a high rate of cardiovascular mortality. Recent studies reported that both hyperphagia and decreased energy expenditure can contribute to severe obesity in HO patients. Recognized risk factors for severe obesity include large hypothalamic tumors or lesions affecting several medial and posterior hypothalamic nuclei that impact satiety signaling pathways. Structural damage in these nuclei often lead to hyperphagia, rapid weight gain, central insulin and leptin resistance, decreased sympathetic activity, low energy expenditure, and increased energy storage in adipose tissue. To date, most efforts to treat HO have shown disappointing long-term success rates. However, treatments based on the distinct pathophysiology of disturbed energy homeostasis related to CP may offer options for successful interventions in the future. PMID:26371051

  16. PTEN loss is a context-dependent outcome determinant in obese and non-obese endometrioid endometrial cancer patients.

    PubMed

    Westin, Shannon N; Ju, Zhenlin; Broaddus, Russell R; Krakstad, Camilla; Li, Jane; Pal, Navdeep; Lu, Karen H; Coleman, Robert L; Hennessy, Bryan T; Klempner, Samuel J; Werner, Henrica M J; Salvesen, Helga B; Cantley, Lewis C; Mills, Gordon B; Myers, Andrea P

    2015-10-01

    Endometrial cancer incidence is increasing, due in part to a strong association with obesity. Mutations in the phosphatidylinositol 3-kinase (PI3K) pathway, the central relay pathway of insulin signals, occur in the majority of endometrioid adenocarcinomas, the most common form of endometrial cancer. We sought to determine the impact of PI3K pathway alterations on progression free survival in a cohort of endometrioid endometrial cancers. Prognostic utility of PIK3CA, PIK3R1, and PTEN mutations, as well as PTEN protein loss by immunohistochemistry, was explored in the context of patient body mass index. Reverse-phase protein arrays were utilized to assess protein expression based on PTEN status. Among 187 endometrioid endometrial cancers, there were no statistically significant associations between PFS and PIK3CA, PIK3R1, PTEN mutation or loss. When stratified by body mass index, PTEN loss was associated with improved progression free survival (P < 0.006) in obese (body mass index ≥ 30) patients. PTEN loss resulted in distinct protein changes: Canonical PI3K pathway activation was observed only in the non-obese population while decreased expression of β-CATENIN and phosphorylated FOXO3A was observed in obese patients. These data suggest the impact of PTEN loss on tumor biology and clinical outcomes must be interpreted in the context of body mass index, and provide a potential explanation for discrepant reports on the effect of PTEN status and obesity on prognosis in endometrial cancer. This reveals a clinically important interaction between metabolic state and tumor genetics that may unveil the biologic underpinning of obesity-related cancers and impact ongoing clinical trials with PI3K pathway inhibitors. PMID:26045339

  17. Acceptance and Efficacy of a Guided Internet Self-Help Treatment Program for Obese Patients with Binge Eating Disorder

    PubMed Central

    Isabelle, Carrard; Christelle, Crépin; Patrick, Rouget; Tony, Lam; der Linden Martial, Van; Alain, Golay

    2011-01-01

    Introduction: A significant percentage of obese patients suffer from binge eating disorder (BED), with negative consequences on psychological health, quality of life, weight loss treatment and maintenance. Cognitive behavioral therapy (CBT), delivered in traditional or self-help format, is effective in reducing BED symptoms. To improve dissemination, a self-help treatment program composed of eleven CBT based modules was implemented on the Internet and evaluated in a population of adult obese patients with BED. Method: Forty-two obese BED patients wait-listed for a multi-disciplinary obesity treatment took part in the study. Twenty-two patients completing the six-month online guided self-help treatment program were compared to a control group of twenty patients without intervention. Both groups were evaluated before and after six months of Internet self-help treatment or waiting list. A follow-up evaluation was carried out six months later. Results: Participants in the online self-help treatment program showed higher binge eating abstinence rates, lower EDE-Q shape and weight concerns, and improved TFEQ disinhibition of eating and hunger scores compared to the control group. They also scored better on psychological health and quality of life measures after intervention, and gains were maintained at follow-up. No effect was found regarding BMI. The number of modules completed was correlated with a better quality of life improvement at post evaluation. Participants rated the program as useful and easy to use. Conclusion: The Internet seems to be a valuable tool for disseminating CBT for BED obese patients. Acceptance of new technology was good in this population. Further research is needed with a larger sample to corroborate these results. PMID:21552482

  18. Preoperative Very Low-Calorie Diet Reduces Technical Difficulty During Laparoscopic Cholecystectomy in Obese Patients.

    PubMed

    Jones, Alexander D; Waterland, Peter W; Powell-Brett, Sarah; Super, Paul; Richardson, Martin; Bowley, Douglas

    2016-06-01

    This study investigates the effectiveness of preoperative very low-calorie diet (VLCD) in laparoscopic cholecystectomy. A prospective observational study of consecutive patients undergoing laparoscopic cholecystectomy was undertaken. At the preoperative visit, all patients were advised to adhere to VLCD for 2 weeks before surgery (<800 kcal/d). Patients were judged to have complied with the VLCD if weight loss >2 kg. Technical difficulty was assessed using questionnaires. A total of 38 patients met the inclusion criteria. Difficulty of visualization and dissection of Calot's triangle in obese patients was twice that of nonobese patients (P=0.01). In 62% of procedures involving obese VLCD noncompliant patients, the surgeon experienced ≥1 area of technical difficulty, compared with 0% of procedures on obese, compliant patients (P=0.018). Difficulty of dissection of the gallbladder bed was 3 times higher in obese, noncompliant patients, compared with obese, compliant patients (P=0.07). Adherence to a 2-week preoperative VLCD may reduce technical difficulty of laparoscopic cholecystectomy in obese patients. PMID:27258913

  19. Carotid Plaques Correlates in Patients With Familial Hypercholesterolemia.

    PubMed

    Waluś-Miarka, Małgorzata; Czarnecka, D; Wojciechowska, W; Kloch-Badełek, M; Kapusta, M; Sanak, M; Wójcik, M; Małecki, M T; Starzyk, J; Idzior-Waluś, B

    2016-05-01

    Patients with familial hypercholesterolemia (FH) are at increased risk of premature cardiovascular disease. We compared factors associated with the presence of carotid plaques and carotid intima-media thickness (cIMT), markers of subclinical atherosclerosis, in 241 patients with FH (98, 40.7% men; mean age 41 ± 18.4 years). Patients with FH having carotid plaques (36.5%) had mean age, apolipoprotein (apo) B, glucose, apoA1, systolic blood pressure (SBP) and diastolic BP, waist/hip ratio (WHR), and body mass index higher than patients without plaques. Logistic regression revealed that apoB (odds ratio [OR] per 1 unit change 1.03,P= .005), high-density lipoprotein cholesterol (HDL-C; OR per 1 standard deviation [SD] change 0.59,P= .015), and non-HDL-C (OR per 1SD change 1.53,P= .04) were significantly associated with the presence of plaques. The cIMT correlated with obesity parameters, BP, apoB, glucose, high-sensitivity C-reactive protein, creatinine, γ-glutamyl transpeptidase, and alanine transaminase (P< .001). Regression analysis revealed that cIMT was significantly associated with apoB, SBP, and WHR. These results confirm the role of apoB-containing lipoproteins and low HDL-C with the presence of carotid plaques and apoB, BP, and WHR with cIMT. PMID:26198473

  20. Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer

    PubMed Central

    Sumer, Fatih; Karagul, Servet

    2016-01-01

    Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer. PMID:27104027

  1. Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer.

    PubMed

    Sumer, Fatih; Kayaalp, Cuneyt; Karagul, Servet

    2016-03-01

    Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer. PMID:27104027

  2. Socio-demographic correlates of overweight and obesity among women of reproductive age in Nigeria.

    PubMed

    Okoh, Mathew

    2013-12-01

    The prevalence of excess adiposity is increasing in less developed countries. This study explored the associations of sociodemographic factors with increased BMI among Nigeria women aged 20-49 years using secondary data collected for the 2008 NDHS. Anthropometric and socio-demographic variables of interest were extracted from the data and analyzed with SPSS version 15.0. Chi(2) was used to compare categorical variables and multi-nominal logistic regression was used to examine for correlates. The prevalence of overweight (BMI 25 to 29.9kg/m(2)) and obesity (BMI 30kg/m(2) and above) in this population were 18.1% and 7.1% respectively. The prevalence of overweight/obesity was highest among Igbo women. Multivariable logistic regression revealed increased frequency of watching television, belonging to a particular ethnic group, having a tertiary education and increased parity as risk factors for increased BMI. This study confirms a high prevalence of overweight and obesity among Nigerian women and identifies high risk groups for excessive weight gain. PMID:24558783

  3. Serum Autotaxin/ENPP2 Correlates with Insulin Resistance in Older Humans with Obesity

    PubMed Central

    Reeves, Valerie L.; Trybula, Joy S.; Wills, Rachel C.; Goodpaster, Bret H.; Dubé, John J.; Kienesberger, Petra C.; Kershaw, Erin E.

    2015-01-01

    Objective Autotaxin (ATX) is an adipocyte-derived lysophospholipase D that generates the lipid signaling molecule lysophosphatidic acid (LPA). The ATX/LPA pathway in adipose tissue has recently been implicated in obesity and insulin resistance in animal models, but the role of circulating ATX in humans remains unclear. The aim of the present study was to determine the relationship between serum ATX and insulin resistance. Methods In this retrospective study, older (60–75 years), non-diabetic human participants with overweight or obesity (BMI 25–37 kg/m2), were characterized for metabolic phenotype including measures of energy, glucose, and lipid homeostasis. The relationship between serum ATX and metabolic parameters was then determined using correlative and predictive statistics. Results Serum ATX was higher in females than in males. After controlling for sex, serum ATX correlated with multiple measures of adiposity and glucose homeostasis/insulin action. Serum ATX and BMI also independently predicted glucose infusion rate during a hyperinsulinemic euglycemic clamp and homeostatic model assessment of insulin resistance after controlling for sex and medication use. Conclusion Serum ATX correlates with and predicts measures of glucose homeostasis and insulin sensitivity in older humans, suggesting that it may be a potential pathogenic factor and/or diagnostic/therapeutic target for insulin resistance in this population. PMID:26727116

  4. Hepatic Expression Patterns of Inflammatory and Immune Response Genes Associated with Obesity and NASH in Morbidly Obese Patients

    PubMed Central

    Bertola, Adeline; Bonnafous, Stéphanie; Anty, Rodolphe; Patouraux, Stéphanie; Saint-Paul, Marie-Christine; Iannelli, Antonio; Gugenheim, Jean; Barr, Jonathan; Mato, José M.; Le Marchand-Brustel, Yannick; Tran, Albert; Gual, Philippe

    2010-01-01

    Background Obesity modulates inflammation and activation of immune pathways which can lead to liver complications. We aimed at identifying expression patterns of inflammatory and immune response genes specifically associated with obesity and NASH in the liver of morbidly obese patients. Methodology/Principal Findings Expression of 222 genes was evaluated by quantitative RT-PCR in the liver of morbidly obese patients with histologically normal liver (n = 6), or with severe steatosis without (n = 6) or with NASH (n = 6), and in lean controls (n = 5). Hepatic expression of 58 out of 222 inflammatory and immune response genes was upregulated in NASH patients. The most notable changes occurred in genes encoding chemokines and chemokine receptors involved in leukocyte recruitment, CD and cytokines involved in the T cell activation towards a Th1 phenotype, and immune semaphorins. This regulation seems to be specific for the liver since visceral adipose tissue expression and serum levels of MCP1, IP10, TNFα and IL6 were not modified. Importantly, 47 other genes were already upregulated in histologically normal liver (e.g. CRP, Toll-like receptor (TLR) pathway). Interestingly, serum palmitate, known to activate the TLR pathway, was increased with steatosis. Conclusion/Significance The liver of obese patients without histological abnormalities already displayed a low-grade inflammation and could be more responsive to activators of the TLR pathway. NASH was then characterized by a specific gene signature. These findings help to identify new potential actors of the pathogenesis of NAFLD. PMID:21042596

  5. Patients Having Bariatric Surgery: Surgical Options in Morbidly Obese Patients with Barrett's Esophagus.

    PubMed

    Braghetto, I; Csendes, A

    2016-07-01

    This article summarizes the currently knowledge and results observed in patients with obesity and Barrett's esophagus which were presented and discussed during the IFSO 2014 held in Montreal. In this meeting, the surgical options for the management after bariatric surgery were discussed. For this purpose, a complete revision of the available literature was done including Pubmed, Medline, Scielo database, own experience, and experts opinion. A total of 49 publications were reviewed and included in the present paper. The majority of authors agree that gastric bypass is the procedure of choice. Sleeve gastrectomy is not an absolute contraindication. Up to now, gastric bypass appears to be the best procedure for treatment of obese patients with Barrett's esophagus. Future investigations should give the definitive consensus. PMID:27167837

  6. Multimorbidity and weight loss in obese primary care patients: longitudinal study based on electronic healthcare records

    PubMed Central

    Calderón-Larrañaga, Amaia; Hernández-Olivan, Paola; González-Rubio, Francisca; Gimeno-Feliu, Luis A; Poblador-Plou, Beatriz; Prados-Torres, Alexandra

    2015-01-01

    Objective To analyse the association between cardiovascular and mental comorbidities of obesity and weight loss registered in the electronic primary healthcare records. Design and setting Longitudinal study of a cohort of adult patients assigned to any of the public primary care centres in Aragon, Spain, during 2010 and 2011. Participants Adult obese patients for whom data on their weight were available for 2010 (n=62 901), and for both 2010 and 2011 (n=42 428). Outcomes Weight loss (yes/no) was calculated based on the weight difference between the first value registered in 2010 and the last value registered in 2011. Multivariate logistic regression models were adjusted for individuals’ age, sex, total number of chronic comorbidities, type of obesity and length of time between both weight measurements. Results According to the recorded clinical information, 9 of 10 obese patients showed at least one chronic comorbidity. After adjusting for covariates, weight loss seemed to be more likely among obese patients with a diagnosis of diabetes and/or dementia and less likely among those with hypertension, anxiety and/or substance use problems (p<0.05). The probability of weight loss was also significantly higher in male patients with more severe obesity and older age. Conclusions An increased probability of weight loss over 1 year was observed in older obese male patients, especially among those already manifesting high levels of obesity and severe comorbidities such as diabetes and/or dementia. Yet patients with certain psychological problems showed lower rates of weight reduction. Future research should clarify if these differences persist beyond potential selective weight documentation in primary care, to better understand the trends in weight reduction among obese patients and the underlying role of general practitioners regarding such trends. PMID:25783419

  7. Prevalence of Obesity and Its Influence on Achievement of Cardiometabolic Therapeutic Goals in Chinese Type 2 Diabetes Patients: An Analysis of the Nationwide, Cross-Sectional 3B Study

    PubMed Central

    Zhou, Xianghai; Ji, Linong; Ran, Xingwu; Su, Benli; Ji, Qiuhe; Pan, Changyu; Weng, Jianping; Ma, Changsheng; Hao, Chuanming; Zhang, Danyi; Hu, Dayi

    2016-01-01

    Background There are few data on the prevalence of obesity and its influence on achieving blood glucose, blood pressure, and blood lipid (3B) goals in Chinese type 2 diabetes outpatients. Methods Patient demographic data, anthropometric measurements, medications, and blood glucose and lipid profiles of 24,512 type 2 diabetes patients from a large, geographically diverse study (CCMR-3B) were analyzed. Using cut-points for body mass index (BMI) and waist circumference (WC) recommended by the Working Group on Obesity in China, overweight and obesity were defined as BMIs of 24–27.9kg/m2 and ≥28.0kg/m2. Central obesity was defined as a waist circumference ≥80cm in women and ≥85cm in men. The 3B therapeutic goals were HbA1c<7.0%, BP<140/90mmHg and LDL-C<2.6mmol/L. Results Overall, 43.0% of type 2 diabetes patients were overweight and 16.7% were obese; 13.3% of overweight and and10.1% of obese patients achieved all the 3B target goals. Overweight or obese patients were less likely to achieve 3B goals than those with normal BMIs. More than a half the overweight or obese patients (69.6%) were centrally obese. Patients with abdominal obesity were less likely to achieve cardiometabolic targets than those without abdominal obesity. In multivariate logistic regression analysis, female, higher BMI and waist circumference, smoking, drinking, sedentary lifestyle, and longer diabetes duration were significantly correlated with failure to achieve 3B control goals. Conclusions Obesity is highly prevalent and associated with poor 3B control in Chinese type 2 diabetes patients. In clinical practice, more attention and resources should focus on weight loss for such patients. PMID:26726883

  8. Obese patients and radiography literature: what do we know about a big issue?

    PubMed Central

    Le, Nhat Tan Thanh; Robinson, John; Lewis, Sarah J

    2015-01-01

    Obesity is a global health issue with obese patients requiring specialised diagnosis, treatment and care through the health service. The practical and social difficulties associated with medical imaging of obese patients are an increasingly common problem and it is currently unknown how student and qualified radiographers perceive and respond to these challenges. By better understanding challenges presented in providing quality imaging and care of imaging obese patients, education for both qualified and student radiographers can be enhanced. Radiographers are heavily reliant on visual and tactile senses to locate the position of anatomical structures for diagnostic imaging and determine radiation exposure through a delicate consideration of dose, image quality and anatomical attenuation. However, obese patients require modifications to routine radiographic practice in terms of movement/assisted positioning, equipment capabilities to take increased weight or coverage. These patients may also be subject to compromised radiological diagnosis through poor visualisation of structures. In this paper, the professional and educational literature was narratively reviewed to assess gaps in the evidence base related to the skill and care knowledge for obese patients. Literature was sourced relating to discrete radiographic considerations such as the technical factors of imaging obese patients, exposure and the impact of obesity on imaging departments’ service provisions. The recent literature (post-2000 to coincide with the sharp increase in global obesity) on the perceptions of health professionals and student health practitioners has also been explored because there are no specific radiographer studies to report. By understanding the research in similar fields, we may identify what common attitudes qualified and student radiographer's hold and what challenges, technical and care related, can be prepared for. PMID:26229678

  9. Obese patients and radiography literature: what do we know about a big issue?

    PubMed

    Le, Nhat Tan Thanh; Robinson, John; Lewis, Sarah J

    2015-06-01

    Obesity is a global health issue with obese patients requiring specialised diagnosis, treatment and care through the health service. The practical and social difficulties associated with medical imaging of obese patients are an increasingly common problem and it is currently unknown how student and qualified radiographers perceive and respond to these challenges. By better understanding challenges presented in providing quality imaging and care of imaging obese patients, education for both qualified and student radiographers can be enhanced. Radiographers are heavily reliant on visual and tactile senses to locate the position of anatomical structures for diagnostic imaging and determine radiation exposure through a delicate consideration of dose, image quality and anatomical attenuation. However, obese patients require modifications to routine radiographic practice in terms of movement/assisted positioning, equipment capabilities to take increased weight or coverage. These patients may also be subject to compromised radiological diagnosis through poor visualisation of structures. In this paper, the professional and educational literature was narratively reviewed to assess gaps in the evidence base related to the skill and care knowledge for obese patients. Literature was sourced relating to discrete radiographic considerations such as the technical factors of imaging obese patients, exposure and the impact of obesity on imaging departments' service provisions. The recent literature (post-2000 to coincide with the sharp increase in global obesity) on the perceptions of health professionals and student health practitioners has also been explored because there are no specific radiographer studies to report. By understanding the research in similar fields, we may identify what common attitudes qualified and student radiographer's hold and what challenges, technical and care related, can be prepared for. PMID:26229678

  10. Obese patients and radiography literature: what do we know about a big issue?

    SciTech Connect

    Le, Nhat Tan Thanh; Robinson, John; Lewis, Sarah J

    2015-06-15

    Obesity is a global health issue with obese patients requiring specialised diagnosis, treatment and care through the health service. The practical and social difficulties associated with medical imaging of obese patients are an increasingly common problem and it is currently unknown how student and qualified radiographers perceive and respond to these challenges. By better understanding challenges presented in providing quality imaging and care of imaging obese patients, education for both qualified and student radiographers can be enhanced. Radiographers are heavily reliant on visual and tactile senses to locate the position of anatomical structures for diagnostic imaging and determine radiation exposure through a delicate consideration of dose, image quality and anatomical attenuation. However, obese patients require modifications to routine radiographic practice in terms of movement/assisted positioning, equipment capabilities to take increased weight or coverage. These patients may also be subject to compromised radiological diagnosis through poor visualisation of structures. In this paper, the professional and educational literature was narratively reviewed to assess gaps in the evidence base related to the skill and care knowledge for obese patients. Literature was sourced relating to discrete radiographic considerations such as the technical factors of imaging obese patients, exposure and the impact of obesity on imaging departments’ service provisions. The recent literature (post-2000 to coincide with the sharp increase in global obesity) on the perceptions of health professionals and student health practitioners has also been explored because there are no specific radiographer studies to report. By understanding the research in similar fields, we may identify what common attitudes qualified and student radiographer's hold and what challenges, technical and care related, can be prepared for.

  11. A review of important medical and surgical considerations for obese patients undergoing arthroscopic surgery.

    PubMed

    Prodromo, John; Rackley, Justin; Mulcahey, Mary K

    2016-09-01

    Obesity represents a unique challenge in orthopaedic surgery, the impact of which is seen through all phases of injury: in the development of disease, during the operative procedure, and throughout the rehabilitation period. Given the high prevalence of obesity in the United States and around the world, this patient population represents a substantial proportion of patients in need of orthopedic care. The effects of this disease constrain both medical and financial resources. For obese patients undergoing orthopedic procedures, adequate steps must be taken to minimize the risks that occur before, during, and after surgical intervention. This literature review discusses the impact of obesity on arthroscopic procedures, with a focus on procedures involving the shoulder, hip, and knee. The management of obese patients during the perioperative period should address the specific concerns relating to these patients. Obesity is a risk factor for numerous comorbidities, is associated with surgical complications, and is a predictor of poor functional outcomes following arthroscopy. Efforts to minimize the negative impact of obesity on arthroscopic procedures are crucial. PMID:27578242

  12. Challenging Obesity: Patient, Provider, and Expert Perspectives on the Roles of Available and Emerging Nonsurgical Therapies

    PubMed Central

    Apovian, Caroline M.; Garvey, W. Timothy; Ryan, Donna H.

    2015-01-01

    Objective Adult obesity is recognized as a chronic disease. According to principles of chronic disease management, healthcare professionals should work collaboratively with patients to determine appropriate therapeutic strategies that address overweight and obesity, specifically considering a patient’s disease status in addition to their individual needs, preferences, and attitudes regarding treatment. A central role and responsibility of healthcare professionals in this process is to inform and educate patients about their treatment options. Although current recommendations for the management of adult obesity provide general guidance regarding safe and proper implementation of lifestyle, pharmacological, and surgical interventions, healthcare professionals need awareness of specific evidence-based information that supports individualized clinical application of these therapies. More specifically, healthcare professionals should be up-to-date on approaches that promote successful lifestyle management and be knowledgeable about newer weight loss pharmacotherapies, so they can offer patients with obesity a wide range of options to personalize their treatment. Accordingly, this educational activity has been developed to provide participants with the latest information on treatment recommendations and therapeutic advances in lifestyle intervention and pharmacotherapy for adult obesity management. Design and Methods This supplement is based on the content presented at a live CME symposium held in conjunction with ObesityWeek 2014. Results This supplement provides an expert summary of current treatment recommendations and recent advances in nonsurgical therapies for the management of adult obesity. Patient and provider perspectives on obesity management are highlighted in embedded video clips available via QR codes, and new evidence will be applied using clinically relevant case studies. Conclusions This supplement provides a topical update of obesity management

  13. Impact of obesity on the efficacy of ustekinumab in Japanese patients with psoriasis: a retrospective cohort study of 111 patients.

    PubMed

    Yanaba, Koichi; Umezawa, Yoshinori; Ito, Toshihiro; Hayashi, Mitsuha; Kikuchi, Sota; Fukuchi, Osamu; Saeki, Hidehisa; Nakagawa, Hidemi

    2014-12-01

    Obesity is thought to be involved in the pathogenesis of psoriasis, although its impact on the therapeutic response to systemic treatments remains unclear. The aim of this study was to examine the association of body mass index (BMI) with the efficacy of ustekinumab in Japanese patients with psoriasis. Clinical data from a cohort of 111 Japanese patients treated with ustekinumab 45 mg between July 2011 and March 2014 were retrospectively evaluated. The measured outcome was improvement in the psoriasis area and severity index (PASI) score at week 16. Patients with BMI ≥ 25 and BMI < 25 had comparable rates of ≥50 and 75 % improvement in PASI (PASI-50 and PASI-75, respectively), whereas patients with BMI ≥ 25 had significantly lower PASI-90 and PASI-100 response rates. Patients with BMI ≥ 25 also showed significantly lower percent reduction in PASI than those with BMI < 25 at week 16 (85 vs. 74 %, P < 0.004). BMI was negatively correlated with percent reduction in PASI, whereas body weight was not. These results show that a higher BMI, but not body weight, is associated with lower effectiveness of ustekinumab for psoriasis. BMI ≥ 25 could therefore be a negative predictor of achieving PASI-90 and PASI-100 in patients with psoriasis when starting ustekinumab. PMID:25193345

  14. [Surgical correction of dislipodemia in patients with obesity].

    PubMed

    Fishman, M B; Mirchuk, K K; Chie, Ma; Muzhikov, S P

    2014-01-01

    The results of surgical treatment of 139 patients with metabolic syndrome, obesity and dislipodemia were analyzed. Modern bariatric operations (4 types) were performed by using laparoscopic method. There were regulated bandages of the stomach (RBS), lengthwise gastric resections (LGR), biliopancreatic and stomach bypass surgeries (BBS, SBS). Results of five-year follow-up indicated that restrictive operations on the stomach (RBS, LGR) aimed to correct overweight and dislipodemia had some limitations to application in a varying degree. The RBS operation should be appropriate to use for women of the young age group, when an initial body-weight index wasn't more than 43 kg/m2. The LGR operation was effective for men of the young age group and women in case of moderately expressed dislipodemia and in case when the initial body-weight index didn't exceed more than 45 kg/m2. Combined bariatric operations (BBS, SBS) were most likely effective on body weight and dislipodemia. PMID:25823310

  15. Resolution of proteinuria in a patient with focal segmental glomerulosclerosis following BiPAP initiation for obesity hypoventilation syndrome.

    PubMed

    Hall, Isaac E; Kashgarian, Michael; Moeckel, Gilbert W; Dahl, Neera K

    2012-01-01

    Associations between secondary focal segmental glomerulosclerosis and both obesity and obstructive sleep apnea have been previously described. Current theory suggests obesity induces glomerular hyperfiltration, leading to glomerulosclerosis. We describe a case of focal segmental glomerulosclerosis in the setting of severe obesity and obstructive sleep apnea with complete resolution of heavy proteinuria following treatment with bi-level positive airway pressure. The patient's proteinuria resolved completely with treatment of obstructive sleep apnea although the patient remained morbidly obese. PMID:22185970

  16. Patient Selection and Surgical Management of High-Risk Patients with Morbid Obesity.

    PubMed

    Daniel Guerron, A; Portenier, Dana D

    2016-08-01

    Bariatric surgery is the most effective way to improve comorbidities related to obesity. Since the introduction of minimally invasive laparoscopic surgery in the bariatric surgery techniques, the number of procedures has increased substantially; advances in techniques and the transition from open to minimally invasive procedures have decreased morbidity and mortality. Multidisciplinary teams in charge of the operative planning, surgical act, and postoperative recovery are determinant in the success of the management of high-risk bariatric patients; careful identification and preoperative management of these higher-risk patients is crucial in decreasing complications after weight loss surgery. PMID:27473799

  17. Handling difficult anastomosis. Tips and tricks in obese patients and narrow pelvis

    PubMed Central

    Samavedi, Srinivas; Abdul-Muhsin, Haidar; Pigilam, Suneel; Sivaraman, Ananth; Patel, Vipul R.

    2014-01-01

    Vesico-urethral anastomosis (VUA) is a technically challenging step in robotic-assisted laparoscopic prostatectomy (RALP) in obese individuals. We describe technical modifications to facilitate VUA encountered in obese individuals and in patients with a narrow pelvis. A Pubmed literature search was performed between 2000 and 2012 to review all articles related to RALP, obesity and VUA for evaluation of technique, complications and outcomes of VUA in obese individuals. In addition to the technical modifications described in the literature, we describe our own experience to encounter the technical challenges induced by obesity and narrow pelvis. In obese patients, technical modifications like use of air seal trocar technology, steep Trendlenburg positioning, bariatric trocars, alterations in trocar placement, barbed suture and use of modified posterior reconstruction facilitate VUA in robotic-assisted radical prostatectomy. The dexterity of the robot and the technical modifications help to perform the VUA in challenging patients with lesser difficulty. The experience of the surgeon is a critical factor in outcomes in these technically challenging patients, and obese individuals are best avoided during the initial phase of the learning curve. PMID:25378824

  18. The pathophysiology of hypertension in patients with obesity

    PubMed Central

    DeMarco, Vincent G.; Aroor, Annayya R.; Sowers, James R.

    2015-01-01

    The combination of obesity and hypertension is associated with high morbidity and mortality because it leads to cardiovascular and kidney disease. Potential mechanisms linking obesity to hypertension include dietary factors, metabolic, endothelial and vascular dysfunction, neuroendocrine imbalances, sodium retention, glomerular hyperfiltration, proteinuria, and maladaptive immune and inflammatory responses. Visceral adipose tissue also becomes resistant to insulin and leptin and is the site of altered secretion of molecules and hormones such as adiponectin, leptin, resistin, TNF and IL-6, which exacerbate obesity-associated cardiovascular disease. Accumulating evidence also suggests that the gut microbiome is important for modulating these mechanisms. Uric acid and altered incretin or dipeptidyl peptidase 4 activity further contribute to the development of hypertension in obesity. The pathophysiology of obesity-related hypertension is especially relevant to premenopausal women with obesity and type 2 diabetes mellitus who are at high risk of developing arterial stiffness and endothelial dysfunction. In this Review we discuss the relationship between obesity and hypertension with special emphasis on potential mechanisms and therapeutic targeting that might be used in a clinical setting. PMID:24732974

  19. The pathophysiology of hypertension in patients with obesity.

    PubMed

    DeMarco, Vincent G; Aroor, Annayya R; Sowers, James R

    2014-06-01

    The combination of obesity and hypertension is associated with high morbidity and mortality because it leads to cardiovascular and kidney disease. Potential mechanisms linking obesity to hypertension include dietary factors, metabolic, endothelial and vascular dysfunction, neuroendocrine imbalances, sodium retention, glomerular hyperfiltration, proteinuria, and maladaptive immune and inflammatory responses. Visceral adipose tissue also becomes resistant to insulin and leptin and is the site of altered secretion of molecules and hormones such as adiponectin, leptin, resistin, TNF and IL-6, which exacerbate obesity-associated cardiovascular disease. Accumulating evidence also suggests that the gut microbiome is important for modulating these mechanisms. Uric acid and altered incretin or dipeptidyl peptidase 4 activity further contribute to the development of hypertension in obesity. The pathophysiology of obesity-related hypertension is especially relevant to premenopausal women with obesity and type 2 diabetes mellitus who are at high risk of developing arterial stiffness and endothelial dysfunction. In this Review we discuss the relationship between obesity and hypertension with special emphasis on potential mechanisms and therapeutic targeting that might be used in a clinical setting. PMID:24732974

  20. Multidisciplinary Teams and Obesity: Role of the Modern Patient-Centered Medical Home.

    PubMed

    Bernstein, Kevin M; Manning, Debra A; Julian, Regina M

    2016-03-01

    With the growing obesity epidemic, it is difficult for individual primary care providers to devote the time and effort necessary to achieve meaningful weight loss for significant numbers of patients. A variety of health care professionals provide value and evidence-based care that is effective in treating obesity and other preventable diseases. Multidisciplinary collaboration between primary care physicians and other trained health professionals within patient-centered medical homes offers an effective approach to sustainable behavioral treatment options for individuals who are obese or overweight. PMID:26896199

  1. [Work capacity and the factors limiting it in patients with III- to IV-degree obesity].

    PubMed

    Solov'ev, M V; Savich, A B; Sedletskiĭ, Iu I; Mirchuk, K K

    1995-01-01

    There is a marked decrement in physical performance of those patients with III to IV grade obesity as compared to apparently healthy volunteers going into training. Deficient reserve capabilities of the system for utilization of oxygen and oxygen transport appear to be those factors determining and limiting physical fitness of obese individuals. Exercise testing involving recording of indices for gas exchange in real time appears to be a valuable method of diagnosis of particular features of oxygen supply in patients with III to IV grade obesity, providing a very helpful information. PMID:8630799

  2. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery

    PubMed Central

    Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim

    2013-01-01

    The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described. PMID:24553513

  3. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery.

    PubMed

    Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim

    2013-01-01

    The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described. PMID:24553513

  4. The obesity paradox is not observed in chronic heart failure patients with metabolic syndrome

    PubMed Central

    Narumi, Taro; Watanabe, Tetsu; Kadowaki, Shinpei; Otaki, Yoichiro; Honda, Yuki; Nishiyama, Satoshi; Takahashi, Hiroki; Arimoto, Takanori; Shishido, Tetsuro; Miyamoto, Takuya; Kubota, Isao

    2014-01-01

    Introduction: Although being overweight or obese is a risk factor for cardiovascular disease, obese subjects often live longer than their lean peers, and this is known as the obesity paradox. We investigated the impact of obesity on cardiac prognosis in chronic heart failure (CHF) patients, with or without metabolic syndrome. Design and Methods: We divided 374 consecutive CHF patients into two groups according to their mean body mass index (BMI) and prospectively followed them for 2 years. Results: There were 126 cardiac events, including 32 cardiac deaths and 94 re-hospitalizations. Kaplan-Meier analysis revealed a significantly lower cardiac event rate in the higher BMI group (log-rank test P < 0.001) in all patients and those patients without metabolic syndrome. There was no association between BMI and cardiac prognosis in patients with metabolic syndrome. Cox hazard analysis revealed that a higher BMI was associated with favorable cardiac outcomes in all patients and patients without metabolic syndrome, after adjusting for confounding factors. However, this finding did not extend to patients with metabolic syndrome. Conclusions: The advantages of obesity are not found in CHF patients with metabolic syndrome. PMID:26417279

  5. Characterizing the profile of obese patients who are metabolically healthy.

    PubMed

    Primeau, V; Coderre, L; Karelis, A D; Brochu, M; Lavoie, M-E; Messier, V; Sladek, R; Rabasa-Lhoret, R

    2011-07-01

    The presence of obesity-related metabolic disturbances varies widely among obese individuals. Accordingly, a unique subset of obese individuals has been described in the medical literature, which seems to be protected or more resistant to the development of metabolic abnormalities associated with obesity. These individuals, now known as 'metabolically healthy but obese' (MHO), despite having excessive body fatness, display a favorable metabolic profile characterized by high levels of insulin sensitivity, no hypertension as well as a favorable lipid, inflammation, hormonal, liver enzyme and immune profile. However, recent studies have indicated that this healthier metabolic profile may not translate into a lower risk for mortality. Mechanisms that could explain the favorable metabolic profile of MHO individuals are poorly understood. However, preliminary evidence suggests that differences in visceral fat accumulation, birth weight, adipose cell size and gene expression-encoding markers of adipose cell differentiation may favor the development of the MHO phenotype. Despite the uncertainty regarding the exact degree of protection related to the MHO status, identification of underlying factors and mechanisms associated with this phenotype will eventually be invaluable in helping us understand factors that predispose, delay or protect obese individuals from metabolic disturbances. Collectively, a greater understanding of the MHO individual has important implications for therapeutic decision making, the characterization of subjects in research protocols and medical education. PMID:20975726

  6. PATIENT-VENTILATION ASYNCHRONY CAUSING NEGATIVE PRESSURE PULMONARY EDEMA IN AN INTUBATED OBESE PATIENT.

    PubMed

    Siddik-Sayyid, Sahar M; AlFahel, Waseem; El-Khatib, Mohamad F

    2016-02-01

    Negative pressure pulmonary edema is a potentially life-threatening condition that may occur when a large negative intrathoracic pressure is generated against a 'physically' obstructed upper airway during emergence from anesthesia. We report a 35 year old male patient who is morbidly obese and undergoing laparoscopic gastric bypass who developed negative pressure pulmonary edema without any evidence of a 'physical' upper airway obstruction. In our patient, the negative pressure pulmonary edema occurred after complete reversal of neuromuscular blockade and during manual positive pressure ventilation with the endotracheal tube still in place and in the presence of an oral airway. Since the patient was still intubated and had an airway in place with no possibility for physical obstruction, we speculate that the occurrence of the negative pressure pulmonary edema was mainly due to a 'functional' obstruction secondary to the severe patient-ventilation asynchrony that ensued upon reversal of the neuromuscular blockade. PMID:27382824

  7. Obesity and Minority--Changing Meanings of Big Bodies among Young Pakistani Obesity Patients in Norway

    ERIC Educational Resources Information Center

    Wathne, Kjetil; Mburu, Christina Brux; Middelthon, Anne-Lise

    2015-01-01

    Globally, paediatric obesity causes widespread concern, and the role of ethnicity is an important focus. Investigating how culture can mediate health-related behaviour through ideas about bodies, food and physical activity, while addressing a notion that the Pakistani community in Norway is particularly conservative and slow to change, this…

  8. Impact of obesity on hospital complications and mortality in hospitalized patients with hyperglycemia and diabetes

    PubMed Central

    Alexopoulos, Anastasia-Stefania; Fayfman, Maya; Zhao, Liping; Weaver, Jeff; Buehler, Lauren; Smiley, Dawn; Pasquel, Francisco J; Vellanki, Priyathama; Haw, J Sonya; Umpierrez, Guillermo E

    2016-01-01

    Objective Obesity is associated with increased risk of diabetes, hypertension and cardiovascular mortality. Several studies have reported increased length of hospital stay and complications; however, there are also reports of obesity having a protective effect on health, a phenomenon coined the ‘obesity paradox’. We aimed to investigate the impact of overweight and obesity on complications and mortality in hospitalized patients with hyperglycemia and diabetes. Research design and methods This retrospective analysis was conducted on 29 623 patients admitted to two academic hospitals in Atlanta, Georgia, between January 2012 and December 2013. Patients were subdivided by body mass index into underweight (body mass index <18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (>30 kg/m2). Hyperglycemia was defined as a blood glucose >10 mmol/L during hospitalization. Hospital complications included a composite of pneumonia, acute myocardial infarction, respiratory failure, acute kidney injury, bacteremia and death. Results A total of 4.2% were underweight, 29.6% had normal weight, 30.2% were overweight, and 36% were obese. 27.2% of patients had diabetes and 72.8% did not have diabetes (of which 75% had hyperglycemia and 25% had normoglycemia during hospitalization). A J-shaped curve with higher rates of complications was observed in underweight patients in all glycemic groups; however, there was no significant difference in the rate of complications among normal weight, overweight, or obese patients, with and without diabetes or hyperglycemia. Conclusions Underweight is an independent predictor for hospital complications. In contrast, increasing body mass index was not associated with higher morbidity or mortality, regardless of glycemic status. There was no evidence of an obesity paradox among inpatients with diabetes and hyperglycemia. PMID:27486518

  9. Assessment of Weight Bias Among Pediatric Nurses and Clinical Support Staff Toward Obese Patients and Their Caregivers.

    PubMed

    Garcia, Janelle T; Amankwah, Ernest K; Hernandez, Raquel G

    2016-01-01

    The increasing burden of obesity is prevalent in the pediatric populations. Pediatric nurses are spending increasing amounts of time and effort caring for obese patients however no prior studies have explored how nurses perceive obese patients. The purpose of this study is to identify weight bias in pediatric nurses (RNs) and clinical support staff (CSS) working in a pediatric hospital setting. A convenience sample of RNs and CSS from an urban, pediatric hospital were surveyed using the Nurses' Attitudes toward Obesity and Obese Patients Scale (NATOOPS), which consists of 6 patient-care factors with an additional factor added to assess bias towards the patient's caregiver. Mean factor scores ≥50 indicated bias. Data were summarized using descriptive statistics and means were compared using independent t tests. Multivariate logistic regression models were used to determine the association between putative risk factors and weight bias. RNs and CSS (N=308) demonstrated weight bias toward obese patient characteristics (mean=61.9) and perceived controllability of obesity (mean=65.8). CSS felt negatively about their supportive roles in caring for obese patients (mean=52.5). Respondent weight status and professional title resulted in variability of biased attitudes. Race, employment status, number of obese patients cared for daily, and department were predictive of biased attitudes. Weight biased attitudes toward obese pediatric patients and their caregivers were found among RNs and CSS. Future qualitative research will assist in the understanding the factors that cause nurse weight bias. PMID:26948091

  10. Obesity coexists with malnutrition? Adequacy of food consumption by severely obese patients to dietary reference intake recommendations.

    PubMed

    Correia Horvath, Jaqueline Driemeyer; Dias de Castro, Mariana Laitano; Kops, Natália; Kruger Malinoski, Natasha; Friedman, Rogério

    2014-01-01

    To assess the adequacy of food intake in severely obese patients and describe their main nutritional deficiencies on the basis of Dietary Reference Intakes (DRIs). Patients on a waiting list for bariatric surgery were sequentially recruited from March 2010 to November 2011. All subjects underwent nutritional status assessment (anthropometry, dietary recall and semi-structured interview), socioeconomic evaluation (Brazilian Association of Research Companies criteria) and laboratory testing (glucose/hormone/lipid panel). A total of 77 patients were assessed, 50 of whom (76.6%) were female. Mean age was 44.48 ± 12.55 years. The most common comorbidities were hypertension (72.4%), binge eating disorder (47.4%), type 2 diabetes mellitus (32.9%), sleep apnea (30.3%) and dyslipidemia (18.4%). Macronutrient intake was largely adequate, in view of the high calorie intake. However, some micronutrient deficiencies were present. Only 19.5% of patients had an adequate intake of potassium, 26.0% of calcium, and 66.2% of iron. All subjects consumed more than the minimum recommended intake of sodium, with 98.7% reaching the upper limit. Bcomplex vitamin intake was satisfactory (adequate in >80% of subjects), but lipid-soluble vitamin (A, D, E) intake often fell short of the RDI. The diet of severely obese patients is unbalanced, with high calorie intake paralleled by insufficient micronutrient intake. When these patients are assessed and managed, qualitative dietary changes should be considered in addition to routine caloric restriction. PMID:24528344

  11. Lifestyle modification with diet and exercise in obese patients with heart failure - A pilot study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There is a paucity of data regarding intentional weight loss in obese heart failure patients. This study sought to ascertain the safety and effectiveness of a lifestyle modification program in patients with systolic heart failure and metabolic syndrome. Patients (n=20) with systolic heart failure (e...

  12. Does obesity hinder radiotherapy in endometrial cancer patients? The implementation of new techniques in adjuvant radiotherapy – focus on obese patients

    PubMed Central

    Moszyńska-Zielińska, Małgorzata; Chałubińska-Fendler, Justyna; Żytko, Leszek; Bigos, Ewelina; Fijuth, Jacek

    2014-01-01

    The increasing incidence of obesity in Poland and its relation to endometrioid endometrial cancer (EEC) is resulting in the increasing necessity of treating obese women. Treatment of an overweight patient with EEC may impede not only the surgical procedures but also radiotherapy, especially external beam radiotherapy (EBRT). The problems arise both during treatment planning and when delivering each fraction due to the difficulty of positioning such a patient – it implies the danger of underdosing targets and overdosing organs at risk. Willingness to use dynamic techniques in radiation oncology has increased for patients with EEC, even those who are obese. During EBRT careful daily verification is necessary for both safety and treatment accuracy. The most accurate method of verification is cone beam computed tomography (CBCT) with soft tissue assessment, although it is time consuming and often requires a radiation oncologist. In order to improve the quality of such treatment, the authors present the practical aspects of planning and treatment itself by means of dynamic techniques in EBRT. The authors indicate the advantages and disadvantages of different types of on-board imaging (OBI) verification images. Considering the scanty amount of literature in this field, it is necessary to conduct further research in order to highlight proper planning and treatment of obese endometrial cancer patients. The review of the literature shows that all centres that wish to use EBRT for gynaecological tumours should develop their own protocols on qualification, planning the treatment and methods of verifying the patients’ positioning. PMID:26327837

  13. Exome sequencing in Thai patients with familial obesity.

    PubMed

    Kaewsutthi, S; Santiprabhob, J; Phonrat, B; Tungtrongchitr, A; Lertrit, P; Tungtrongchitr, R

    2016-01-01

    Obesity is a major worldwide health issue, with increasing prevalence in adults and children from developed and developing countries. Obesity causes several chronic diseases, including cardiovascular and respiratory diseases, osteoarthritis, hypertension, stroke, type II diabetes, obstructive sleep apnea, and several types of cancer. Previous genome-wide association studies have identified several genes associated with obesity, including LEP, LEPR, POMC, PCSK1, FTO, MC3R, MC4R, GNPDA2, TMEM18, QPCTL/GIPR, BDNF, ETV5, MAP2K5/SKOR1, SEC16B, SIM1, and TNKS/MSRA. However, most of these variants are found in the intronic or intergenic regions, making it difficult to elucidate the underlying mechanisms. Therefore, in this study, we performed a whole exome sequencing of the protein-coding regions in the total genome (exome) of two obese and one normal subject belonging to the same Thai family to identify the genes responsible for obesity. We identified 709 functional variants that were differentially expressed between obese and normal subjects; of these, 65 were predicted to be deleterious to protein structure or function. The minor allele frequency of 14 of these genes (ALOX5AP, COL9A2, DEFB126, GDPD4, HCRTR1, MLL3, OPLAH, OR4C45, PRIM2, RXFP2, TIGD6, TRPM8, USP49, and ZNF596) was low, indicating causal variants that could be associated with complex traits or diseases. Genotyping revealed HCRTR1, COL9A2, and TRPM8 to be associated with the regulation of feeding behavior and energy expenditure. These genes constituted a network of pathways, including lipid metabolism, signaling transduction, immune, membrane transport, and gene regulation pathways, and seemed to play important roles in obesity. PMID:27421018

  14. Mucosal-associated invariant T cell alterations in obese and type 2 diabetic patients

    PubMed Central

    Magalhaes, Isabelle; Pingris, Karine; Poitou, Christine; Bessoles, Stéphanie; Venteclef, Nicolas; Kiaf, Badr; Beaudoin, Lucie; Da Silva, Jennifer; Allatif, Omran; Rossjohn, Jamie; Kjer-Nielsen, Lars; McCluskey, James; Ledoux, Séverine; Genser, Laurent; Torcivia, Adriana; Soudais, Claire; Lantz, Olivier; Boitard, Christian; Aron-Wisnewsky, Judith; Larger, Etienne; Clément, Karine; Lehuen, Agnès

    2015-01-01

    Obesity and type 2 diabetes (T2D) are associated with low-grade inflammation, activation of immune cells, and alterations of the gut microbiota. Mucosal-associated invariant T (MAIT) cells, which are innate-like T cells that recognize bacterial ligands, are present in blood and enriched in mucosal and inflamed tissues. Here, we analyzed MAIT cells in the blood and adipose tissues of patients with T2D and/or severe obesity. We determined that circulating MAIT cell frequency was dramatically decreased in both patient groups, and this population was even undetectable in some obese patients. Moreover, in both patient groups, circulating MAIT cells displayed an activated phenotype that was associated with elevated Th1 and Th17 cytokine production. In obese patients, MAIT cells were more abundant in adipose tissue than in the blood and exhibited a striking IL-17 profile. Bariatric surgery in obese patients not only improved their metabolic parameters but also increased circulating MAIT cell frequency at 3 months after surgery. Similarly, cytokine production by blood MAIT cells was strongly decreased after surgery. This study reveals profound MAIT cell abnormalities in patients harboring metabolic disorders, suggesting their potential role in these pathologies. PMID:25751065

  15. Plasma Periostin Levels Are Increased in Chinese Subjects with Obesity and Type 2 Diabetes and Are Positively Correlated with Glucose and Lipid Parameters

    PubMed Central

    Luo, Yuanyuan; Qu, Hua; Wang, Hang; Wei, Huili; Wu, Jing; Duan, Yang; Liu, Dan; Deng, Huacong

    2016-01-01

    The purpose of this study is to examine the relations among plasma periostin, glucose and lipid metabolism, insulin resistance and inflammation in Chinese patients with obesity (OB), and type 2 diabetes mellitus (T2DM). Plasma periostin levels in the T2DM group were significantly higher than the NGT group (P < 0.01). Patients with both OB and T2DM had the highest periostin levels. Correlation analysis showed that plasma periostin levels were positively correlated with weight, waist circumference (WC), body mass index (BMI), waist-hip ratio (WHR), fasting plasma glucose (FPG), 2 h postchallenge plasma glucose (2 h PG), glycated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TC), fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR), TNF-α, and IL-6 (P < 0.05 or 0.001) and negatively correlated with high-density lipoprotein cholesterol (HDL-C) (P < 0.001). Multiple linear regression analysis showed that TG, TNF-α, and HOMA-IR were independent related factors in influencing the levels of plasma periostin (P < 0.001). These results suggested that Chinese patients with obesity and T2DM had significantly higher plasma periostin levels. Plasma periostin levels were strongly associated with plasma TG, chronic inflammation, and insulin resistance. PMID:27313402

  16. Individual, Family, and Community Environmental Correlates of Obesity in Latino Elementary School Children*

    PubMed Central

    Elder, John P.; Arredondo, Elva M.; Campbell, Nadia; Baquero, Barbara; Duerksen, Susan; Ayala, Guadalupe; Crespo, Noc C.; Slymen, Donald; McKenzie, Thomas

    2015-01-01

    BACKGROUND The prevalence of overweight children has reached epidemic proportions, and affects Latinos youth more than other subgroups in the United States. Given the prevalence of obesity and its economic consequences, community health initiatives have shifted toward primary prevention at younger ages. METHODS Data representing all levels of the ecological systems theory were collected using diverse methods. Participants were children enrolled in K-2nd grade and their parents. RESULTS Overweight children were less active compared to normal weight children. The parents of overweight children provided less instrumental support to engage in activity and set fewer limits on their child’s activities. Similarly, parents of overweight children were less likely to control, but more likely to set limits on their child’s diet compared to parents of normal weight children. Parents who rated their health more positively and were less acculturated were more likely to have children who were overweight. School and community level variables were not significantly correlated with children’s weight. Adjusting for the aforementioned variables, parents’ weight status was positively associated with children’s weight. CONCLUSIONS Social and structural environments in which Hispanic children are reared may play an important role in determining their risk for obesity and related behaviors. Parents’ weight was among the strongest correlate of child weight; however, the extent to which this influence functions primarily through biological or social/structural influences is not entirely clear. The role of school and community factors on child’s health practices and body mass index needs to be further examined. PMID:20051087

  17. Obesity and psychological wellbeing in patients undergoing fertility treatment.

    PubMed

    Rodino, Iolanda S; Byrne, Susan; Sanders, Katherine A

    2016-01-01

    Obesity negatively affects reproductive functioning and psychological wellbeing. Distress experienced by infertile women with elevated body mass index (BMI) was investigated. Infertile women (n = 403) were stratified according to World Health Organization (2000) BMI categories (normal, overweight and obese) and infertility category (polycystic ovary syndrome [PCOS] or non-PCOS). Participants anonymously completed a Demographics Questionnaire, International Physical Activity Questionnaire, Depression, Anxiety and Stress Scale, Positive and Negative Affect Schedule, Rosenberg Self Esteem Scale, Fertility Problem Inventory, Clinical Perfectionism Questionnaire and the Eating Disorder Examination Questionnaire. Women in the obese BMI group were no more psychologically vulnerable to general mood (depression, anxiety and stress) or fertility-specific distress than normal or overweight BMI women. Independent of their PCOS status, obese women reported more frequent episodes of binge eating, shape concerns and low self-esteem symptoms associated with disordered eating. Women with PCOS had elevated shape concerns and anxiety independent of their BMI category compared with women who did not have PCOS. Obese infertile women presenting with the characteristics of binge eating, low self-esteem and body shape concerns may represent a vulnerable subgroup that could benefit from accessing targeted psychological interventions as do women with PCOS who have body shape concerns. PMID:26611501

  18. Surgical treatment of nonalcoholic fatty liver disease in severely obese patients

    PubMed Central

    Vander Naalt, Steven J; Gurria, Juan P; Holterman, AiXuan L

    2014-01-01

    Obesity is a multi-organ system disease with underlying metabolic abnormalities and chronic systemic inflammation. Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of obesity metabolic dysfunction and its associated cardiovascular- and liver-related morbidities and mortality. Our current understanding of NAFLD pathogenesis, disease characteristics, the role of insulin resistance, chronic inflammation, gut–liver and gut–brain crosstalk and the effectiveness of pharmacotherapy is still evolving. Bariatric surgery significantly improves metabolic and NAFLD histology in severely obese patients, although its positive effects on fibrosis are not universal. Bariatric surgery benefits NAFLD through its metabolic effect on insulin resistance, inflammation, and insulinotropic and anorexinogenic gastrointestinal hormones. Further studies are needed to understand the natural course of NAFLD in severely obese patients and the role of weight loss surgery as a primary treatment for NAFLD. PMID:25378958

  19. Clinical review: Ventilatory strategies for obstetric, brain-injured and obese patients

    PubMed Central

    Lapinsky, Stephen E; Posadas-Calleja, Juan Gabriel; McCullagh, Iain

    2009-01-01

    The ventilatory management of patients with acute respiratory failure is supported by good evidence, aiming to reduce lung injury by pressure limitation and reducing the duration of ventilatory support by regular assessment for discontinuation. Certain patient groups, however, due to their altered physiology or disease-specific complications, may require some variation in usual ventilatory management. The present manuscript reviews the ventilatory management in three special populations, namely the patient with brain injury, the pregnant patient and the morbidly obese patient. PMID:19291279

  20. Impact of obesity on the clinical outcome of rheumatologic patients in biotherapy.

    PubMed

    Iannone, Florenzo; Lopalco, Giuseppe; Rigante, Donato; Orlando, Ida; Cantarini, Luca; Lapadula, Giovanni

    2016-05-01

    There is raising interest in the scientific community about the impact of body mass on different rheumatologic diseases. A growing body of evidence suggests that the effect of obesity on joint structure goes beyond the simply overload but is based on a complex interwinding of cytokines, hormones, growth factors, and intracellular regulators that at different stages can modify the course of a rheumatologic disease and the clinical response to biotherapies. In these settings, psoriatic arthritis (PsA) and rheumatoid arthritis (RA) have been the more extensively studied. Intriguing is the finding that the interaction between obesity and diseases seems different for PsA or RA. Concerning PsA, epidemiologic studies have provided robust data about the association between obesity and prevalence of psoriasis or PsA. Yet obesity is associated with an increase in degree of disability and poor clinical outcome on treatment with anti-tumor necrosis factor (TNF) drugs. Nevertheless, there are clues suggesting that weight reduction above 5% from baseline increases the probability of achieving a good clinical response in PsA patients on anti-TNF drugs. On the contrary, the epidemiological association between obesity and RA seems to be restricted to some categories of patients with peculiar demographic and autoimmune status. Furthermore, obesity definitely impairs the clinical response of RA patients to anti-TNF treatment, and this might be an effect limited to TNF-blocking agents, as preliminary studies are not confirming these findings for abatacept or tocilizumab. However, the most puzzling aspect of the impact of obesity on RA is that obese patients tend to have a more clinical active disease, an impaired response to biotherapies, and a less radiographically evident joint damage over time. The latter is a very stimulating issue and the knowledge of the underlying mechanisms should be an auspicious challenge for the researchers, which will provide further insights on the

  1. Dietary, Lifestyle and Socio-Economic Correlates of Overweight, Obesity and Central Adiposity in Lebanese Children and Adolescents

    PubMed Central

    Nasreddine, Lara; Naja, Farah; Akl, Christelle; Chamieh, Marie Claire; Karam, Sabine; Sibai, Abla-Mehio; Hwalla, Nahla

    2014-01-01

    The Eastern Mediterranean region is characterized by one of the highest burdens of paediatric obesity worldwide. This study aims at examining dietary, lifestyle, and socio-economic correlates of overweight, obesity, and abdominal adiposity amongst children and adolescents in Lebanon, a country of the Eastern Mediterranean basin. A nationally representative cross-sectional survey was conducted on 6–19-year-old subjects (n = 868). Socio-demographic, lifestyle, dietary, and anthropometric data (weight, height, waist circumference) were collected. Overweight and obesity were defined based on BMI z-scores. Elevated waist circumference (WC) and elevated waist to height ratio (WHtR) were used as indices of abdominal obesity. Of the study sample, 34.8% were overweight, 13.2% were obese, 14.0% had elevated WC, and 21.3% had elevated WHtR. Multivariate logistic regression analyses showed that male gender, maternal employment, residence in the capital Beirut, sedentarity, and higher consumption of fast food and sugar sweetened beverages were associated with increased risk of obesity, overweight, and abdominal adiposity, while regular breakfast consumption, higher intakes of milk/dairies and added fats/oils were amongst the factors associated with decreased risk. The study’s findings call for culture-specific intervention strategies for the promotion of physical activity, healthy lifestyle, and dietary practices amongst Lebanese children and adolescents. PMID:24618510

  2. Robotic partial nephrectomy for renal tumours in obese patients: Perioperative outcomes in a multi-institutional analysis

    PubMed Central

    Abdullah, Newaj; Dalela, Deepansh; Barod, Ravi; Larson, Jeff; Johnson, Michael; Mass, Alon; Zargar, Homayoun; Allaf, Mohamad; Bhayani, Sam; Stifelman, Michael; Kaouk, Jihad; Rogers, Craig

    2015-01-01

    Introduction: We sought to evaluate the association of obesity with surgical outcomes of robotic partial nephrectomy (RPN) using a large, multicentre database. Methods: We identified 1836 patients who underwent RPN from five academic centres from 2006–2014. A total of 806 patients were obese (body mass index [BMI] ≥30 kg/m2). Patient characteristics and outcomes were compared between obese and non-obese patients. Multivariable analysis was used to assess the association of obesity on RPN outcomes. Results: A total of 806 (44%) patients were obese with median BMI of 33.8kg/m2. Compared to non-obese patients, obese patients had greater median tumour size (2.9 vs. 2.5cm, p<0.001), mean RENAL nephrometry score (7.3 vs. 7.1, p=0.04), median operating time (176 vs. 165 min, p=0.002), and median estimated blood loss (EBL, 150 vs. 100 ml, p=0.002), but no difference in complications. Obesity was not an independent predictor of operative time or EBL on regression analysis. Among obese patients, males had a greater EBL (150 vs. 100 ml, p<0.001), operative time (180 vs. 166 min, p<0.001) and warm ischemia time (WIT, 20 vs. 18, p=0.001), and male sex was an independent predictor of these outcomes on regression analysis. Conclusions: In this large, multicentre study on RPN, obesity was not associated with increased complications and was not an independent predictor of operating time or blood loss. However, in obese patients, male gender was an independent predictor of greater EBL, operative time, and WIT. Our results indicate that obesity alone should not preclude consideration for RPN. PMID:26788235

  3. Dietary patterns are associated with obesity in Japanese patients with schizophrenia

    PubMed Central

    2014-01-01

    Background Obesity among patients with schizophrenia is a growing concern because being overweight is widely regarded as a major risk factor for cardiovascular disease and premature death. Dietary patterns have been suggested as one modifiable factor that may play a role in development of obesity. The objective of this study was to examine the association between dietary patterns and obesity among patients with schizophrenia in Japan. Methods We recruited patients (n = 338) aged 44.0 ± 13.2 (mean ± SD) years with a DSM-IV diagnosis of schizophrenia who were admitted to four psychiatric hospitals using a cross-sectional design. Diet was assessed with a validated brief-type self-administered diet history questionnaire (BDHQ). Dietary patterns from 52 predefined food groups were extracted by principal component analysis. Results A total of 61 subjects (18.0%) were classified as obese. Three dietary patterns were identified: the healthy dietary pattern, the processed food dietary pattern, and the alcohol and accompanying dietary patterns. After adjusting for age and gender, patients within the high tertile of each healthy dietary pattern (OR = 0.29, 95% CI = 0.13 to 0.62) and processed food dietary pattern (OR = 0.44, 95% CI = 0.22 to 0.89) had a significantly lower risk for obesity compared with low tertile of dietary pattern. Conclusions Our findings suggest that dietary patterns, including higher intake of protein, fat, n-3 polyunsaturated fatty acids, n-6 polyunsaturated fatty acids, and vitamins, may be related to a decreased prevalence of obesity within patients with schizophrenia. Future longitudinal research exploring dietary patterns and obesity among patients with schizophrenia is warranted. PMID:24947974

  4. Overweight and Obesity: Prevalence and Correlates in a Large Clinical Sample of Children with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Zuckerman, Katharine E.; Hill, Alison P.; Guion, Kimberly; Voltolina, Lisa; Fombonne, Eric

    2014-01-01

    Autism Spectrum Disorders (ASDs) and childhood obesity (OBY) are rising public health concerns. This study aimed to evaluate the prevalence of overweight (OWT) and OBY in a sample of 376 Oregon children with ASD, and to assess correlates of OWT and OBY in this sample. We used descriptive statistics, bivariate, and focused multivariate analyses to…

  5. The Adolescent Adjustment Profile (AAP) in comparisons of patients with obesity, phenylketonuria or neurobehavioural disorders.

    PubMed

    Olsson, Gunilla Maria; Mårild, Staffan; Alm, Jan; Brodin, Ulf; Rydelius, Per-Anders; Marcus, Claude

    2008-01-01

    Psychosocial development in children with chronic disease is a key issue in paediatrics. This study investigated whether psychosocial adjustment could be reliably assessed with the 42-item Adolescent Adjustment Profile (AAP) instrument. The study mainly focused on adjustment-to-obesity measurement, although it compared three patient groups with chronic conditions. All phenylketonuria (PKU) patients in Sweden between ages 9 and 18 and their parents and teachers were invited to participate. Patients with neurobehavioural syndromes and obesity were age- and gender-matched with PKU patients. Healthy children constituted a reference group. Psychosocial adjustment was measured using the AAP, which is a multi-informant questionnaire that contains four domains. Information concerning parents' socio-economic and civil status was requested separately. Respondents to the three questionnaires judged the PKU patients to be normal in all four domains. Patients with neurobehavioural syndromes demonstrated less competence and the most problems compared with the other three groups. According to the self-rating, the parent rating and the teacher rating questionnaires, obese patients had internalizing problems. The parent rating and the teacher rating questionnaire scored obese patients as having a lower work capacity than the reference group. Compared with the reference group, not only families with obese children but also families with children with neurobehavioural syndromes had significantly higher divorce rates. Obese patients were also investigated with the Strength and Difficulties Questionnaire (SDQ), another instrument that enables comparison between two measures of adjustment. The AAP had good psychometric properties; it was judged a useful instrument in research on adolescents with chronic diseases. PMID:18389428

  6. Correlations of Fecal Metabonomic and Microbiomic Changes Induced by High-fat Diet in the Pre-Obesity State.

    PubMed

    Lin, Hong; An, Yanpeng; Hao, Fuhua; Wang, Yulan; Tang, Huiru

    2016-01-01

    Obesity resulting from interactions of genetic and environmental factors becomes a serious public health problem worldwide with alterations of the metabolic phenotypes in multiple biological matrices involving multiple metabolic pathways. To understand the contributions of gut microbiota to obesity development, we analyzed dynamic alterations in fecal metabonomic phenotype using NMR and fecal microorganism composition in rats using pyrosequencing technology during the high-fat diet (HFD) feeding for 81 days (pre-obesity state). Integrated analysis of these two phenotypic datasets was further conducted to establish correlations between the altered rat fecal metabonome and gut microbiome. We found that one-week HFD feeding already caused significant changes in rat fecal metabonome and such changes sustained throughout 81-days feeding with the host and gut microbiota co-metabolites clearly featured. We also found that HFD caused outstanding decreases in most fecal metabolites implying enhancement of gut absorptions. We further established comprehensive correlations between the HFD-induced changes in fecal metabonome and fecal microbial composition indicating contributions of gut microbiota in pathogenesis and progression of the HFD-induced obesity. These findings provided essential information about the functions of gut microbiota in pathogenesis of metabolic disorders which could be potentially important for developing obesity prevention and treatment therapies. PMID:26916743

  7. Correlations of Fecal Metabonomic and Microbiomic Changes Induced by High-fat Diet in the Pre-Obesity State

    NASA Astrophysics Data System (ADS)

    Lin, Hong; An, Yanpeng; Hao, Fuhua; Wang, Yulan; Tang, Huiru

    2016-02-01

    Obesity resulting from interactions of genetic and environmental factors becomes a serious public health problem worldwide with alterations of the metabolic phenotypes in multiple biological matrices involving multiple metabolic pathways. To understand the contributions of gut microbiota to obesity development, we analyzed dynamic alterations in fecal metabonomic phenotype using NMR and fecal microorganism composition in rats using pyrosequencing technology during the high-fat diet (HFD) feeding for 81 days (pre-obesity state). Integrated analysis of these two phenotypic datasets was further conducted to establish correlations between the altered rat fecal metabonome and gut microbiome. We found that one-week HFD feeding already caused significant changes in rat fecal metabonome and such changes sustained throughout 81-days feeding with the host and gut microbiota co-metabolites clearly featured. We also found that HFD caused outstanding decreases in most fecal metabolites implying enhancement of gut absorptions. We further established comprehensive correlations between the HFD-induced changes in fecal metabonome and fecal microbial composition indicating contributions of gut microbiota in pathogenesis and progression of the HFD-induced obesity. These findings provided essential information about the functions of gut microbiota in pathogenesis of metabolic disorders which could be potentially important for developing obesity prevention and treatment therapies.

  8. Correlations of Fecal Metabonomic and Microbiomic Changes Induced by High-fat Diet in the Pre-Obesity State

    PubMed Central

    Lin, Hong; An, Yanpeng; Hao, Fuhua; Wang, Yulan; Tang, Huiru

    2016-01-01

    Obesity resulting from interactions of genetic and environmental factors becomes a serious public health problem worldwide with alterations of the metabolic phenotypes in multiple biological matrices involving multiple metabolic pathways. To understand the contributions of gut microbiota to obesity development, we analyzed dynamic alterations in fecal metabonomic phenotype using NMR and fecal microorganism composition in rats using pyrosequencing technology during the high-fat diet (HFD) feeding for 81 days (pre-obesity state). Integrated analysis of these two phenotypic datasets was further conducted to establish correlations between the altered rat fecal metabonome and gut microbiome. We found that one-week HFD feeding already caused significant changes in rat fecal metabonome and such changes sustained throughout 81-days feeding with the host and gut microbiota co-metabolites clearly featured. We also found that HFD caused outstanding decreases in most fecal metabolites implying enhancement of gut absorptions. We further established comprehensive correlations between the HFD-induced changes in fecal metabonome and fecal microbial composition indicating contributions of gut microbiota in pathogenesis and progression of the HFD-induced obesity. These findings provided essential information about the functions of gut microbiota in pathogenesis of metabolic disorders which could be potentially important for developing obesity prevention and treatment therapies. PMID:26916743

  9. Intermuscular and perimuscular fat expansion in obesity correlates with skeletal muscle T cell and macrophage infiltration and insulin resistance

    PubMed Central

    Khan, Ilvira M.; Dai Perrard, Xiao-Yuan; Brunner, Gerd; Lui, Hua; Sparks, Lauren M.; Smith, Steven R.; Wang, Xukui; Shi, Zheng-Zheng; Lewis, Dorothy E.; Wu, Huaizhu; Ballantyne, Christie M.

    2015-01-01

    Background/Objectives Limited numbers of studies demonstrated obesity-induced macrophage infiltration in skeletal muscle (SM), but dynamics of immune cell accumulation and contribution of T cells to SM insulin resistance are understudied. Subjects/Methods T cells and macrophage markers were examined in SM of obese humans by RT-PCR. Mice were fed high-fat diet (HFD) for 2–24 weeks, and time course of macrophage and T cell accumulation was assessed by flow cytometry and quantitative RT-PCR. Extramyocellular adipose tissue (EMAT) was quantified by high-resolution micro-CT, and correlation to T cell number in SM was examined. CD11a−/− mice and C57BL/6 mice were treated with CD11a-neutralizing antibody to determine the role of CD11a in T cell accumulation in SM. To investigate the involvement JAK/STAT, the major pathway for T helper I (TH1) cytokine IFNγ? in SM and adipose tissue inflammation and insulin resistance, mice were treated with a JAK1/JAK2 inhibitor, baricitinib. Results Macrophage and T cells markers were upregulated in SM of obese compared with lean humans. SM of obese mice had higher expression of inflammatory cytokines, with macrophages increasing by 2 weeks on HFD and T cells increasing by 8 weeks. The immune cells were localized in EMAT. Micro-CT revealed that EMAT expansion in obese mice correlated with T cell infiltration and insulin resistance. Deficiency or neutralization of CD11a reduced T cell accumulation in SM of obese mice. T cells polarized into a proinflammatory TH1 phenotype, with increased STAT1 phosphorylation in SM of obese mice. In vivo inhibition of JAK/STAT pathway with baricitinib reduced T cell numbers and activation markers in SM and adipose tissue and improved insulin resistance in obese mice. Conclusions Obesity-induced expansion of EMAT in SM was associated with accumulation and proinflammatory polarization of T cells, which may regulate SM metabolic functions through paracrine mechanisms. Obesity-associated SM

  10. [Impact of abdominoplasty on quality of life in patients, suffering anterior abdominal wall deformity and obesity].

    PubMed

    Dronov, O I; Koval's'ka, I O; Roshchyna, L O; Fedoruk, V I; Burov, E Iu; Fedoruk, P V

    2011-12-01

    The modern tendencies of surgery development include not only the operative procedures improvement but guaranteeing also a maximally high level achievement in the patients quality of life in the early, as well as during remote, postoperative period. The quality of life analysis was done in 132 patients, operated on for the anterior abdominal wall defects, obesity and other surgical diseases, using special questionnaire SF-36. The patients have aged 23-65 years old, in all of them the excessive body mass or obesity of abdominal type was noted. PMID:22432186

  11. A Novel Rodent Model That Mimics the Metabolic Sequelae of Obese Craniopharyngioma Patients

    PubMed Central

    Roth, Christian L.; Blevins, James E.; Ralston, Melissa; Elfers, Clinton; Ogimoto, Kayoko; Kaiyala, Karl J.; Morton, Gregory J.

    2013-01-01

    Patients with craniopharyngioma (CP), a tumor located in the pituitary and/or hypothalamus, are susceptible to developing obesity and many metabolic complications. The study aim was to create a rodent model that mimics the complex neuroanatomical and metabolic disturbances commonly seen in obese CP patients. We compared the metabolic phenotype of animals with three distinct types of hypothalamic lesions: 1) destruction of the arcuate nucleus (ARC) induced by monosodium glutamate (MSG), 2) electrolytic lesion of the adjacent ventromedial nucleus (VMN) alone, 3) both the VMN and dorsomedial nucleus (DMN), or a 4) combined medial hypothalamic lesion (CMHL) affecting the VMN, DMN, and the ARC. Only the CMHL model exhibited all key features observed in patients with hypothalamic obesity induced by CP. These features included excessive weight gain due to increased adiposity, increased food intake, and pronounced hyperinsulinemia and hyperleptinemia. Similar to characteristics of patients with CP, CMHL animals exhibited reduced plasma levels of alpha-melanocyte stimulating hormone and reduced ambulatory activity compared with weight-matched controls. Therefore, the CMHL model best mimics the complex metabolic abnormalities observed in obese CP patients compared with lesions to other hypothalamic areas and provides a foundation for future pharmacological approaches to treat obesity in children with hypothalamic damage. PMID:21372758

  12. Predictors of Quality of Life in Portuguese Obese Patients: A Structural Equation Modeling Application

    PubMed Central

    Vilhena, Estela; Pais-Ribeiro, José; Silva, Isabel; Cardoso, Helena; Mendonça, Denisa

    2014-01-01

    Living with obesity is an experience that may affect multiple aspects of an individual's life. Obesity is considered a relevant public health problem in modern societies. To determine the comparative efficacy of different treatments and to assess their impact on patients' everyday life, it is important to identify factors that are relevant to the quality of life of obese patients. The present study aims to evaluate, in Portuguese obese patients, the simultaneous impact of several psychosocial factors on quality of life. This study also explores the mediating role of stigma in the relationship between positive/negative affect and quality of life. A sample of 215 obese patients selected from the main hospitals in Portugal completed self-report questionnaires to assess sociodemographic, clinical, psychosocial, and quality of life variables. Data were analysed using structural equation modeling. The model fitted the data reasonably well, CFI = 0.9, RMSEA = 0.06. More enthusiastic and more active patients had a better quality of life. Those who reflect lower perception of stigma had a better physical and mental health. Partial mediation effects of stigma between positive affect and mental health and between negative affect and physical health were found. The stigma is pervasive and causes consequences for psychological and physical health. PMID:24693421

  13. Liraglutide reduces the body weight and waist circumference in Chinese overweight and obese type 2 diabetic patients

    PubMed Central

    Feng, Ping; Yu, De-min; Chen, Li-ming; Chang, Bao-cheng; Ji, Qiu-di; Li, Shu-ying; Zhu, Mei; Ding, Sheng-hua; Zhang, Bao-zhen; Wang, Su-li; Li, Hong-tao; Lin, Jing-na; Wang, Mao-jun; Guo, Jian-chao; Liu, Jie; Liu, Zhong-dong; Wu, Shen-tao; Yang, Ju-hong

    2015-01-01

    Aim: To investigate the effects of liraglutide, a glucagon-like peptide-1 (GLP-1) receptor activator, on body weight and waist circumference in Chinese overweight and obese type 2 diabetic patients. Methods: A total of 328 Chinese overweight and obese type 2 diabetic patients were included in this multi-center, open-labeled and self-controlled clinical study. The patients were subcutaneously injected with liraglutide once daily for 24 weeks as add-on therapy to their previous hypoglycemic treatments. Statistical analyses were performed using SPSS software package version 11.5 for Windows. Results: Liraglutide treatment caused significant reduction of the mean body weight (from 86.61±14.09 to 79.10±13.55 kg) and waist circumference (from 101.81±13.96 to 94.29±14.17 cm), resulting in body weight lose of 5%–10% in 43.67% patients, and body weight loss above 10% in 34.06% patients, who had significant lower plasma creatinine levels. Baseline waist circumference, BMI and HOMA-IR were independently correlated with the body weight loss. Furthermore, liraglutide treatment significantly decreased HbA1c levels (from 8.66%±2.17% to 6.92%±0.95%) with HbA1c<7.0% in 35.37% patients, who had a significantly lower baseline level of HbA1c, but higher baseline levels of C peptide and glucagon. Moreover, liraglutide treatment resulted in greater body weight loss in patients with a long duration of diabetes, and better glycemic control in patients with a short duration of diabetes. Conclusion: Liraglutide significantly reduces body weight and waist circumference in Chinese overweight and obese type 2 diabetic patients. Patients with apparent visceral obesity, insulin resistance and a long duration of diabetes may have greater body weight loss; whereas patients with high insulin-secreting ability, hyperglucagonemia, and short-duration diabetes may obtain better glycemic control with liraglutide. PMID:25619391

  14. Unrealistic weight-loss goals among obese patients are associated with age and causal attributions.

    PubMed

    Wamsteker, Erika W; Geenen, Rinie; Zelissen, Pierre M J; van Furth, Eric F; Iestra, Jolein

    2009-11-01

    Unrealistic weight-loss goals may impede the success of weight-loss attempts. The aim of this study was to examine the frequency of unrealistic goals and their association with other patient characteristics at the start of a weight-loss program. For patients with a body mass index (calculated as kg/m(2)) of 30 to 35, 35 to 40, or 40 to 50, medically advised weight-loss goals were set at 10%, 15%, and 20% of current weight, respectively. Personal weight-loss goals exceeding the medically advised goal by >50% were considered unrealistic. Obesity-related beliefs were measured by the "Obesity Cognition Questionnaire" and the eating-behavior self-efficacy scale of the "Obesity Psychosocial State Questionnaire." From September 2003 until March 2006, 90 patients were enrolled in the study, 26 men and 64 women, with a mean age of 43 years (range=18 to 68 years) and body mass indexes ranging from 30 to 50. Unrealistic goals were observed in 49% of the patients and were more frequent in younger patients (P=0.03), in patients attributing their obesity to physical causes (r=0.35, P=0.001), and in patients not attributing their obesity to behavioral causes (r=-0.28, P=0.008). This study confirms that discrepancies in weight-loss goals between obese patients and professionals occur frequently. Because unrealistic goals can hamper long-term outcomes of weight-loss programs, better outcomes could possibly be achieved by addressing unrealistic weight-loss goals before treatment. PMID:19857632

  15. Smoking Is Associated with More Abdominal Fat in Morbidly Obese Patients

    PubMed Central

    Casagrande, Daniela; Wagner, Mario; Mottin, Cláudio

    2015-01-01

    Introduction While the association between cigarette smoking and abdominal fat has been well studied in normal and overweight patients, data regarding the influence of tobacco use in patients with morbid obesity remain scarce. The aim of this study is to evaluate body fat distribution in morbidly obese smokers. Methods We employed a cross-sectional study and grouped severely obese patients (body mass index [BMI] >40 kg/m2 or >35 kg/m2 with comorbidities) according to their smoking habits (smokers or non-smokers). We next compared the anthropometrical measurements and body composition data (measured by electric bioimpedance) of both groups. We analyzed the effect of smoking on body composition variables using univariate and multiple linear regression (MLR); differences are presented as regression coefficients (b) and their respective 95% confidence intervals. Results We included 536 morbidly obese individuals, 453 (84.5%) non-smokers and 83 (15.5%) smokers. Male smokers had a higher BMI (b=3.28 kg/m2, p=0.036), larger waist circumference (b=6.07 cm, p=0.041) and higher percentage of body fat (b=2.33%, p=0.050) than non-smokers. These differences remained significant even after controlling for confounding factors. For females, the only significant finding in MLR was a greater muscle mass among smokers (b=1.34kg, p=0.028). No associations were found between tobacco load measured in pack-years and anthropometric measures or body composition. Discussion Positive associations between smoking and BMI, and waist circumference and percentage of body fat, were found among male morbidly obese patients, but not among females. To the best of our knowledge, this study is the first investigation of these aspects in morbidly obese subjects. We speculate that our findings may indicate that the coexistence of morbid obesity and smoking helps to explain the more serious medical conditions, particularly cardiovascular diseases and neoplasms, seen in these patients. PMID:25978682

  16. Changes in Gut Microbiota in Rats Fed a High Fat Diet Correlate with Obesity-Associated Metabolic Parameters

    PubMed Central

    Maloney, Christopher A.; Raipuria, Mukesh; Huinao, Karina D.; Mitchell, Hazel M.; Morris, Margaret J.

    2015-01-01

    The gut microbiota is emerging as a new factor in the development of obesity. Many studies have described changes in microbiota composition in response to obesity and high fat diet (HFD) at the phylum level. In this study we used 16s RNA high throughput sequencing on faecal samples from rats chronically fed HFD or control chow (n = 10 per group, 16 weeks) to investigate changes in gut microbiota composition at the species level. 53.17% dissimilarity between groups was observed at the species level. Lactobacillus intestinalis dominated the microbiota in rats under the chow diet. However this species was considerably less abundant in rats fed HFD (P<0.0001), this being compensated by an increase in abundance of propionate/acetate producing species. To further understand the influence of these species on the development of the obese phenotype, we correlated their abundance with metabolic parameters associated with obesity. Of the taxa contributing the most to dissimilarity between groups, 10 presented significant correlations with at least one of the tested parameters, three of them correlated positively with all metabolic parameters: Phascolarctobacterium, Proteus mirabilis and Veillonellaceae, all propionate/acetate producers. Lactobacillus intestinalis was the only species whose abundance was negatively correlated with change in body weight and fat mass. This species decreased drastically in response to HFD, favouring propionate/acetate producing bacterial species whose abundance was strongly correlated with adiposity and deterioration of metabolic factors. Our observations suggest that these species may play a key role in the development of obesity in response to a HFD. PMID:25992554

  17. Gut microbial metabolites of polyunsaturated fatty acids correlate with specific fecal bacteria and serum markers of metabolic syndrome in obese women.

    PubMed

    Druart, Céline; Dewulf, Evelyne M; Cani, Patrice D; Neyrinck, Audrey M; Thissen, Jean-Paul; Delzenne, Nathalie M

    2014-04-01

    The aim of this human study was to assess the influence of prebiotic-induced gut microbiota modulation on PUFA-derived bacterial metabolites production. Therefore, we analyzed the circulating fatty acid profile including CLA/CLnA in obese women treated during 3 months with inulin-type fructan prebiotics. In these patients, we had already determined gut microbiota composition by phylogenetic microarray and qPCR analysis of 16S rDNA. Some PUFA-derived bacterial metabolites were detected in the serum of obese patients. Despite the prebiotic-induced modulation of gut microbiota, including changes in CLA/CLnA-producing bacteria, the treatment did not impact significantly on the circulating level of these metabolites. However, some PUFA-derived bacterial metabolites were positively correlated with specific fecal bacteria (Bifidobacterium spp., Eubacterium ventriosum and Lactobacillus spp.) and inversely correlated with serum cholesterol (total, LDL, HDL). These correlations suggest a potential beneficial effect of some of these metabolites but this remains to be confirmed by further investigation. PMID:24473752

  18. Obesity and other correlates of physical activity and sedentary behaviors among US high school students.

    PubMed

    Lowry, Richard; Lee, Sarah M; Fulton, Janet E; Demissie, Zewditu; Kann, Laura

    2013-01-01

    Understanding correlates of physical activity (PA) can help inform and improve programs that promote PA among youth. We analyzed data from the 2010 National Youth Physical Activity and Nutrition Study, a representative sample of US students in grades 9-12. Logistic regression was used to examine associations between PA correlates (obesity, physical education classes, sports team participation, attitude toward PA, adult support for PA, and environmental support for PA) and participation in daily PA (DPA), vigorous PA (VPA), muscle-strengthening activity (MSA), viewing television (TV), and using computers or video games (C/VG). A positive attitude toward PA and adult support for PA were both associated with increased PA and decreased sedentary behavior. However, among students who lived in neighborhoods that were not safe for PA, a positive attitude toward PA was not associated with increased DPA or decreased sedentary behavior and was less strongly associated with VPA and MSA. Efforts to increase PA among youth should promote a positive attitude toward PA among youth and encourage adult family members to support their efforts to be active. Policies that promote safe neighborhoods may work synergistically with a positive attitude toward PA to increase participation in PA and decrease sedentary behaviors. PMID:23606950

  19. Ipragliflozin Improves Hepatic Steatosis in Obese Mice and Liver Dysfunction in Type 2 Diabetic Patients Irrespective of Body Weight Reduction.

    PubMed

    Komiya, Chikara; Tsuchiya, Kyoichiro; Shiba, Kumiko; Miyachi, Yasutaka; Furuke, Shunsaku; Shimazu, Noriko; Yamaguchi, Shinobu; Kanno, Kazuo; Ogawa, Yoshihiro

    2016-01-01

    Type 2 diabetes mellitus (T2DM) is associated with a high incidence of non-alcoholic fatty liver disease (NAFLD) related to obesity and insulin resistance. Currently, medical interventions for NAFLD have focused on diet control and exercise to reduce body weight, and there is a requirement for effective pharmacological therapies. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are oral antidiabetic drugs that promote the urinary excretion of glucose by blocking its reabsorption in renal proximal tubules. SGLT2 inhibitors lower blood glucose independent of insulin action and are expected to reduce body weight because of urinary calorie loss. Here we show that an SGLT2 inhibitor ipragliflozin improves hepatic steatosis in high-fat diet-induced and leptin-deficient (ob/ob) obese mice irrespective of body weight reduction. In the obese mice, ipragliflozin-induced hyperphagia occurred to increase energy intake, attenuating body weight reduction with increased epididymal fat mass. There is an inverse correlation between weights of liver and epididymal fat in ipragliflozin-treated obese mice, suggesting that ipragliflozin treatment promotes normotopic fat accumulation in the epididymal fat and prevents ectopic fat accumulation in the liver. Despite increased adiposity, ipragliflozin ameliorates obesity-associated inflammation and insulin resistance in epididymal fat. Clinically, ipragliflozin improves liver dysfunction in patients with T2DM irrespective of body weight reduction. These findings provide new insight into the effects of SGLT2 inhibitors on energy homeostasis and fat accumulation and indicate their potential therapeutic efficacy in T2DM-associated hepatic steatosis. PMID:26977813

  20. Ipragliflozin Improves Hepatic Steatosis in Obese Mice and Liver Dysfunction in Type 2 Diabetic Patients Irrespective of Body Weight Reduction

    PubMed Central

    Komiya, Chikara; Tsuchiya, Kyoichiro; Shiba, Kumiko; Miyachi, Yasutaka; Furuke, Shunsaku; Shimazu, Noriko; Yamaguchi, Shinobu; Kanno, Kazuo; Ogawa, Yoshihiro

    2016-01-01

    Type 2 diabetes mellitus (T2DM) is associated with a high incidence of non-alcoholic fatty liver disease (NAFLD) related to obesity and insulin resistance. Currently, medical interventions for NAFLD have focused on diet control and exercise to reduce body weight, and there is a requirement for effective pharmacological therapies. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are oral antidiabetic drugs that promote the urinary excretion of glucose by blocking its reabsorption in renal proximal tubules. SGLT2 inhibitors lower blood glucose independent of insulin action and are expected to reduce body weight because of urinary calorie loss. Here we show that an SGLT2 inhibitor ipragliflozin improves hepatic steatosis in high-fat diet-induced and leptin-deficient (ob/ob) obese mice irrespective of body weight reduction. In the obese mice, ipragliflozin-induced hyperphagia occurred to increase energy intake, attenuating body weight reduction with increased epididymal fat mass. There is an inverse correlation between weights of liver and epididymal fat in ipragliflozin-treated obese mice, suggesting that ipragliflozin treatment promotes normotopic fat accumulation in the epididymal fat and prevents ectopic fat accumulation in the liver. Despite increased adiposity, ipragliflozin ameliorates obesity-associated inflammation and insulin resistance in epididymal fat. Clinically, ipragliflozin improves liver dysfunction in patients with T2DM irrespective of body weight reduction. These findings provide new insight into the effects of SGLT2 inhibitors on energy homeostasis and fat accumulation and indicate their potential therapeutic efficacy in T2DM-associated hepatic steatosis. PMID:26977813

  1. Are Complexity Metrics Reliable in Assessing HRV Control in Obese Patients During Sleep?

    PubMed Central

    Cabiddu, Ramona; Trimer, Renata; Borghi-Silva, Audrey; Migliorini, Matteo; Mendes, Renata G.; Oliveira Jr., Antonio D.; Costa, Fernando S. M.; Bianchi, Anna M.

    2015-01-01

    Obesity is associated with cardiovascular mortality. Linear methods, including time domain and frequency domain analysis, are normally applied on the heart rate variability (HRV) signal to investigate autonomic cardiovascular control, whose imbalance might promote cardiovascular disease in these patients. However, given the cardiac activity non-linearities, non-linear methods might provide better insight. HRV complexity was hereby analyzed during wakefulness and different sleep stages in healthy and obese subjects. Given the short duration of each sleep stage, complexity measures, normally extracted from long-period signals, needed be calculated on short-term signals. Sample entropy, Lempel-Ziv complexity and detrended fluctuation analysis were evaluated and results showed no significant differences among the values calculated over ten-minute signals and longer durations, confirming the reliability of such analysis when performed on short-term signals. Complexity parameters were extracted from ten-minute signal portions selected during wakefulness and different sleep stages on HRV signals obtained from eighteen obese patients and twenty controls. The obese group presented significantly reduced complexity during light and deep sleep, suggesting a deficiency in the control mechanisms integration during these sleep stages. To our knowledge, this study reports for the first time on how the HRV complexity changes in obesity during wakefulness and sleep. Further investigation is needed to quantify altered HRV impact on cardiovascular mortality in obesity. PMID:25893856

  2. Exploring Self-Efficacy in Australian General Practitioners Managing Patient Obesity: A Qualitative Survey Study

    PubMed Central

    Ashman, Freya; Sturgiss, Elizabeth; Haesler, Emily

    2016-01-01

    Background. Obesity is a leading cause of morbidity and mortality in the Australian community, and general practitioners (GPs) are commonly approached by patients for assistance in losing weight. Previous studies have shown that GPs have low self-efficacy and low outcome expectation when it comes to managing overweight and obese patients, which affects their willingness to initiate and continue with weight counselling. This qualitative survey study aimed to explore the factors influencing confidence and behaviour in obesity management in GPs. Method. Twelve GPs recruited to deliver a pilot of an obesity management program participated in semistructured interviews, and interpretive analysis underpinned by social cognitive theory was performed on the transcripts. Results. Analysis identified five main themes: (1) perceived knowledge and skills, (2) structure to management approach, (3) the GP-patient relationship, (4) acknowledged barriers to weight loss and lifestyle change, and (5) prior experience and outcome expectation. Conclusions. GPs are likely to welcome tools which provide a more structured approach to obesity management. Shifting away from weight and BMI as sole yardsticks for success or failure and emphasising positive lifestyle changes for their own sake may improve GP self-efficacy and allow for a more authentic GP-patient interaction. PMID:27274872

  3. Effective Ventilation Strategies for Obese Patients Undergoing Bariatric Surgery: A Literature Review.

    PubMed

    Hu, Xin Yan

    2016-02-01

    Obesity causes major alterations in pulmonary mechanics. Obese patients undergoing bariatric surgery present mechanical ventilation-related challenges that may lead to perioperative complications. Databases were systematically searched for clinical trials of ventilation maneuvers for obese patients and bariatric surgery. Thirteen randomized controlled trials were selected. The quality of the studies was evaluated with the Critical Appraisal Skills Programme tool, and a matrix was developed to present the essential components of the studies. Eight strategies of ventilation maneuvers were identified. Recruitment maneuvers followed by positive end-expiratory pressure (PEEP) consistently demonstrated effectiveness in obese patients undergoing bariatric surgery. Pressure-controlled ventilation and volume-controlled ventilation did not differ significantly in their efficacy. Noninvasive positive pressure ventilation (NIPPV) during induction was effective in preventing atelectasis and increasing the duration of safe apnea. Equal ratio ventilation can be a useful ventilation strategy. Recruitment maneuvers followed by PEEP are effective ventilation strategies for obese patients undergoing bariatric surgery. During induction, NIPPV provides further benefit. Future studies are needed to examine the postoperative effects of recruitment maneuvers with PEEP as well as the efficacy and safety of equal ratio ventilation. PMID:26939387

  4. Obesity and the orthopedic trauma patient: a review of the risks and challenges in medical and surgical management.

    PubMed

    Mulcahey, Mary K; Appleyard, Deborah V; Schiller, Jonathan R; Born, Christopher T

    2011-02-01

    The medical and surgical care of obese trauma patients presents a variety of unique and important challenges. Over the past 30 years, this population has increased dramatically in number, and the optimization of their care demands the attention of the medical community. The problems of caring for an obese trauma patient begin before the actual traumatic event occurs due to their substantially higher incidence of serious comorbidities, such as diabetes mellitus, hypertension, and cardiopulmonary issues. In the setting of trauma, important considerations for the obese patient include careful and expeditious preoperative medical optimization; appropriate deep vein thrombosis prophylaxis; planning for and preventing operative and postoperative challenges (eg, pulmonary and wound complications); and ensuring adequate hospital equipment and staffing resources in the acute and rehabilitative phases of care. This article outlines the scope of the obesity epidemic, reviews the medical consequences of obesity, and highlights surgical considerations specific to the care of orthopedic injuries in the obese trauma patient. PMID:21441770

  5. Weight loss interventions for morbidly obese patients with compensated cirrhosis: a Markov decision analysis model.

    PubMed

    Bromberger, Bianca; Porrett, Paige; Choudhury, Rashikh; Dumon, Kristoffel; Murayama, Kenric M

    2014-02-01

    Many transplant centers require that patients maintain a BMI below 40 kg/m(2) in order to be eligible for listing, rendering many morbidly obese patients with end-stage liver disease unable to access liver transplantation as a method of treatment. In order to determine the safest and most efficacious weight loss regimen in this challenging population, Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and diet and exercise were modeled to assess their impact on life expectancy in morbidly obese patients with cirrhosis. A Markov state transition model was developed to assess the survival benefit of undergoing RYGB, AGB, or 1 year of diet and exercise in morbidly obese patients with compensated cirrhosis. A base case analysis of no weight loss intervention in a 45-year-old patient with compensated cirrhosis and a BMI of 45 kg/m(2) revealed an average survival of 7.93 years. The average survival for the weight loss simulations was 9.14, 8.84, and 8.16 years for RYGB, AGB, and diet and exercise, respectively. In morbidly obese patients with compensated cirrhosis, RYGB allows patients to lose more weight more rapidly than is probable with either AGB or diet and exercise, thus having the greatest impact on survival. PMID:23918085

  6. Obese Patients With a Binge Eating Disorder Have an Unfavorable Metabolic and Inflammatory Profile.

    PubMed

    Succurro, Elena; Segura-Garcia, Cristina; Ruffo, Mariafrancesca; Caroleo, Mariarita; Rania, Marianna; Aloi, Matteo; De Fazio, Pasquale; Sesti, Giorgio; Arturi, Franco

    2015-12-01

    To evaluate whether obese patients with a binge eating disorder (BED) have an altered metabolic and inflammatory profile related to their eating behaviors compared with non-BED obese.A total of 115 White obese patients consecutively recruited underwent biochemical, anthropometrical evaluation, and a 75-g oral glucose tolerance test. Patients answered the Binge Eating Scale and were interviewed by a psychiatrist. The patients were subsequently divided into 2 groups according to diagnosis: non-BED obese (n = 85) and BED obese (n = 30). Structural equation modeling analysis was performed to elucidate the relation between eating behaviors and metabolic and inflammatory profile.BED obese exhibited significantly higher percentages of altered eating behaviors, body mass index (P < 0.001), waist circumference (P < 0.01), fat mass (P < 0.001), and a lower lean mass (P < 0.001) when compared with non-BED obese. Binge eating disorder obese also had a worse metabolic and inflammatory profile, exhibiting significantly lower high-density lipoprotein cholesterol levels (P < 0.05), and higher levels of glycated hemoglobin (P < 0.01), uric acid (P < 0.05), erythrocyte sedimentation rate (P < 0.001), high-sensitive C-reactive protein (P < 0.01), and white blood cell counts (P < 0.01). Higher fasting insulin (P < 0.01) and higher insulin resistance (P < 0.01), assessed by homeostasis model assessment index and visceral adiposity index (P < 0.001), were observed among BED obese. All differences remained significant after adjusting for body mass index. No significant differences in fasting plasma glucose or 2-hour postchallenge plasma glucose were found. Structural equation modeling analysis confirmed the relation between the altered eating behaviors of BED and the metabolic and inflammatory profile.Binge eating disorder obese exhibited an unfavorable metabolic and inflammatory profile, which is related to their characteristic

  7. Obesity and Risk of Biochemical Failure for Patients Receiving Salvage Radiotherapy After Prostatectomy

    SciTech Connect

    King, Christopher R. Spiotto, Michael T.; Kapp, Daniel S.

    2009-03-15

    Purpose: Obesity has been proposed as an independent risk factor for patients undergoing surgery or radiotherapy (RT) for prostate cancer. Using body mass index (BMI) as a measure of obesity, we tested its role as a risk factor for patients receiving salvage RT after prostatectomy. Methods and Materials: Rates of subsequent biochemical relapse were examined in 90 patients who underwent salvage RT between 1984 and 2004 for biochemical failure after radical prostatectomy. Median follow-up was 3.7 years. The BMI was tested as a continuous and categorical variable (stratified as <25, 25-<30, and {>=}30 kg/m{sup 2}). Univariate and multivariate proportional hazards regression analyses were performed for clinical, pathologic, and treatment factors associated with time to relapse after salvage RT. Results: There were 40 biochemical failures after salvage RT with a median time to failure of 1.2 years. The BMI was not associated with adverse clinical, pathologic, or treatment factors. On multivariate analysis, obesity was independently significant (hazard ratio [HR], 1.2; p = 0.01), along with RT dose (HR, 0.7; p = 0.003) and pre-RT prostate-specific antigen level (HR, 1.2; p = 0.0003). Conclusions: This study is weakly suggestive that obesity may be a risk factor for salvage RT patients. Whether this results from greater biologic aggressiveness or technical inadequacies cannot be answered by this study. Given the very high failure rate observed for severely obese patients, we propose that technical difficulties with RT are at play. This hypothesis is supported by the RT literature and could be prospectively investigated. Techniques that optimize targeting, especially in obese patients, perhaps seem warranted at this time.

  8. Effect of Obesity on the Population Pharmacokinetics of Meropenem in Critically Ill Patients.

    PubMed

    Alobaid, Abdulaziz S; Wallis, Steven C; Jarrett, Paul; Starr, Therese; Stuart, Janine; Lassig-Smith, Melissa; Ordóñez Mejia, Jenny Lisette; Roberts, Michael S; Lipman, Jeffrey; Roberts, Jason A

    2016-08-01

    Severe pathophysiological changes in critical illness can lead to dramatically altered antimicrobial pharmacokinetics (PK). The additional effect of obesity on PK potentially increases the challenge for effective dosing. The aim of this prospective study was to describe the population PK of meropenem for a cohort of critically ill patients, including obese and morbidly obese patients. Critically ill patients prescribed meropenem were recruited into the following three body mass index (BMI) groups: nonobese (18.5 to 29.9 kg/m(2)), obese (30.0 to 39.9 kg/m(2)), and morbidly obese (≥40 kg/m(2)). Serial plasma samples were taken, and meropenem concentrations were determined using a validated chromatographic method. Population PK analysis and Monte Carlo dosing simulations were undertaken with Pmetrics. Nineteen critically ill patients with different BMI categories were enrolled. The patients' mean ± standard deviation (SD) age, weight, and BMI were 49 ± 15.9 years, 95 ± 22.0 kg, and 33 ± 7.0 kg/m(2), respectively. A two-compartment model described the data adequately. The mean ± SD parameter estimates for the final covariate model were as follows: clearance (CL), 15.5 ± 6.0 liters/h; volume of distribution in the central compartment (V1), 11.7 ± 5.8 liters; intercompartmental clearance from the central compartment to the peripheral compartment, 25.6 ± 35.1 liters h(-1); and intercompartmental clearance from the peripheral compartment to the central compartment, 8.32 ± 12.24 liters h(-1) Higher creatinine clearance (CLCR) was associated with a lower probability of target attainment, with BMI having little effect. Although obesity was found to be associated with an increased V1, dose adjustment based on CLCR appears to be more important than patient BMI. PMID:27185798

  9. [Optimization of diet therapy in patients with gallstones complicated with obesity and impaired glucose tolerance].

    PubMed

    Kurbanov, S K

    2003-01-01

    It was investigated the influence of a diet with lower glycaemic index on clinico-metabolic parameters in obese patients with gallstones and impaired glucose tolerance. The results investigations indicated that the lowering of glycaemic index and the caloric reduction of diet have a beneficial effects on dynamic of parameters of functional status of liver and gallbladder. It was noted the increase of medical effect of diet in correction of obesity and impaired parameters of carbohydrate and lipid metabolism in this patients in process of dietotherapy. PMID:14619611

  10. Superstorm Sandy's forgotten patient: a lesson in emergency preparedness in severe obesity.

    PubMed

    Ramme, Austin J; Vira, Shaleen; McLaurin, Toni M

    2015-02-01

    Superstorm Sandy gained national attention in late 2012 after its impact on the Northeastern US. In New York City, thousands of residents lost power, and multiple hospitals were forced to evacuate. Bellevue Hospital Center (BHC), the nation's oldest public hospital, was forced to close for the first time in over 275 years. Two patients remained in BHC three days after the primary evacuation without water service and minimal power. Herein, we describe the challenges associated with evacuating a severely obese patient. Obesity management is challenging and at an institutional level must be addressed in emergency preparedness plans. PMID:25627622

  11. Cardiovascular Autonomic Dysfunction in Patients with Morbid Obesity

    PubMed Central

    de Sant Anna Junior, Maurício; Carneiro, João Regis Ivar; Carvalhal, Renata Ferreira; Torres, Diego de Faria Magalhães; da Cruz, Gustavo Gavina; Quaresma, José Carlos do Vale; Lugon, Jocemir Ronaldo; Guimarães, Fernando Silva

    2015-01-01

    Background Morbid obesity is directly related to deterioration in cardiorespiratory capacity, including changes in cardiovascular autonomic modulation. Objective This study aimed to assess the cardiovascular autonomic function in morbidly obese individuals. Methods Cross-sectional study, including two groups of participants: Group I, composed by 50 morbidly obese subjects, and Group II, composed by 30 nonobese subjects. The autonomic function was assessed by heart rate variability in the time domain (standard deviation of all normal RR intervals [SDNN]; standard deviation of the normal R-R intervals [SDNN]; square root of the mean squared differences of successive R-R intervals [RMSSD]; and the percentage of interval differences of successive R-R intervals greater than 50 milliseconds [pNN50] than the adjacent interval), and in the frequency domain (high frequency [HF]; low frequency [LF]: integration of power spectral density function in high frequency and low frequency ranges respectively). Between-group comparisons were performed by the Student’s t-test, with a level of significance of 5%. Results Obese subjects had lower values of SDNN (40.0 ± 18.0 ms vs. 70.0 ± 27.8 ms; p = 0.0004), RMSSD (23.7 ± 13.0 ms vs. 40.3 ± 22.4 ms; p = 0.0030), pNN50 (14.8 ± 10.4 % vs. 25.9 ± 7.2%; p = 0.0061) and HF (30.0 ± 17.5 Hz vs. 51.7 ± 25.5 Hz; p = 0.0023) than controls. Mean LF/HF ratio was higher in Group I (5.0 ± 2.8 vs. 1.0 ± 0.9; p = 0.0189), indicating changes in the sympathovagal balance. No statistical difference in LF was observed between Group I and Group II (50.1 ± 30.2 Hz vs. 40.9 ± 23.9 Hz; p = 0.9013). Conclusion morbidly obese individuals have increased sympathetic activity and reduced parasympathetic activity, featuring cardiovascular autonomic dysfunction. PMID:26536979

  12. Obesity and smoking in patients with schizophrenia and normal controls: a case-control study.

    PubMed

    Fountoulakis, Konstantinos N; Siamouli, Melina; Panagiotidis, Panagiotis; Magiria, Stamatia; Kantartzis, Sotiris; Papastergiou, Natalia; Shoretsanitis, George; Pantoula, Eleonora; Moutou, Katerina; Kouidi, Evangelia; Deres, Symeon

    2010-03-30

    Cardiovascular risk factors, especially obesity and smoking are highly prevalent in patients with schizophrenia. Central obesity and the metabolic syndrome are conditions mostly attributed to the use of antipsychotic medication and lifestyle habits, and they constitute a significant health concern. Our study sample included 105 patients suffering from schizophrenia aged 36.25+/-10.03 and 156 normal control subjects aged 36.03+/-11.33. All patients were in- or out-patients of a private hospital. Clinical diagnosis was made according to DSM-IV-TR criteria. Height, weight, waist circumference and number of cigarettes smoked daily were recorded. Duration of illness was calculated based on records concerning the age of first onset of psychotic symptoms. Body Surface Area (BSA) and Body Mass Index (BMI) were calculated as well as % body fat, with the use of LifeWise Body Fat Analyzers No 63-1525. The results of analysis of variance suggested a significant main effect regarding diagnosis and sex as well as for their interaction. There were significant differences between patients and controls regarding body weight, waist circumference, BMI, BSA and % body fat, with patients, especially females, being more obese than controls. The results of the present study corroborate the increased prevalence of obesity in schizophrenia. The interpretation of this finding remains unclear. PMID:20079934

  13. Leptin Levels Are Negatively Correlated with 2-Arachidonoylglycerol in the Cerebrospinal Fluid of Patients with Osteoarthritis

    PubMed Central

    Nicholson, James; Azim, Syed; Rebecchi, Mario J.; Galbavy, William; Feng, Tian; Reinsel, Ruth; Rizwan, Sabeen; Fowler, Christopher J.; Benveniste, Helene; Kaczocha, Martin

    2015-01-01

    Background There is compelling evidence in humans that peripheral endocannabinoid signaling is disrupted in obesity. However, little is known about the corresponding central signaling. Here, we have investigated the relationship between gender, leptin, body mass index (BMI) and levels of the endocannabinoids anandamide (AEA) and 2-arachidonoylglycerol (2-AG) in the serum and cerebrospinal fluid (CSF) of primarily overweight to obese patients with osteoarthritis. Methodology/Principal Findings Patients (20 females, 15 males, age range 44-78 years, BMI range 24-42) undergoing total knee arthroplasty for end-stage osteoarthritis were recruited for the study. Endocannabinoids were quantified by liquid chromatography – mass spectrometry. AEA and 2-AG levels in the serum and CSF did not correlate with either age or BMI. However, 2-AG levels in the CSF, but not serum, correlated negatively with CSF leptin levels (Spearman’s ρ -0.48, P=0.0076, n=30). No such correlations were observed for AEA and leptin. Conclusions/Significance In the patient sample investigated, there is a negative association between 2-AG and leptin levels in the CSF. This is consistent with pre-clinical studies in animals, demonstrating that leptin controls the levels of hypothalamic endocannabinoids that regulate feeding behavior. PMID:25835291

  14. Validation of a Portable Monitor for the Diagnosis of Obstructive Sleep Apnea in Morbidly Obese Patients

    PubMed Central

    Fredheim, Jan Magnus; Røislien, J.; Hjelmesæth, J.

    2014-01-01

    Study Objectives: We aimed to validate the diagnostic accuracy and night-to-night variability of a simple 3-channel (type IV monitor) portable sleep monitor, ApneaLink (AL), in a population of morbidly obese subjects. Design: Cross-sectional validation and diagnostic accuracy study. Setting: Public tertiary care obesity center in Norway. Participants: A total of 105 (67 females) treatment seeking morbidly obese subjects were included, mean (SD) age 44.3 (11.4) years and BMI 43.6 (5.6) kg/m2. Interventions: The patients underwent two successive nights of recordings; the first night with the AL only, and the following night with both the reference instrument Embletta (E), a type III portable somnograph, and the AL. Measurements and Results: Main outcomes were diagnostic accuracy of AL as assessed by sensitivity, specificity and area under ROC curves, and level of agreement between AL and E. AL had high diagnostic accuracy at all levels of OSA, and the Bland-Altman plots showed good agreement between AL and E. The sensitivity and specificity of the instrument were 93% and 71% at the AHI cutoff 5 events/h, and 94% and 94% at the AHI cutoff 15, respectively. The night-to-night variability was low. Conclusion: Our results indicate that a simple 3-channel portable sleep monitor (ApneaLink) has a high diagnostic accuracy in diagnosing OSA in morbidly obese treatment seeking patients. Accordingly, this and similar instruments might help non-specialists to diagnose OSA in morbidly obese patients, and, importantly, help non-specialists to refer patients who need specific treatment to specialist without unnecessary delay. Citation: Fredheim JM, Røislien J, Hjelmesæth J. Validation of a portable monitor for the diagnosis of obstructive sleep apnea in morbidly obese patients. J Clin Sleep Med 2014;10(7):751-757. PMID:25024652

  15. General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

    PubMed Central

    2011-01-01

    Background Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men) and 10 district nurses (7 women, 3 men) from 19 primary health care centres within a well-defined area of Sweden. Results Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and profession differences in this

  16. Disparities in Treatment Uptake and Outcomes of Patients with Obesity in the USA.

    PubMed

    Lewis, Kristina H; Edwards-Hampton, Shenelle A; Ard, Jamy D

    2016-06-01

    There are clear and persistent disparities in obesity prevalence within the USA. Some of these disparities fall along racial/ethnic lines; however, there are a number of other social and demographic constructs where obesity disparities are present. In addition to differing rates of obesity across groups, there is growing evidence that subgroups of patients both seek out and respond to obesity treatment differently. This review article explores the epidemiology of obesity disparities, as well as the existing evidence around how different groups may respond to behavioral, medical, and surgical therapies, and potential reasons for differential uptake and response, from culture, to access, to physiology. We find that the vast majority of evidence in this area has focused on the observation that African Americans tend to lose less weight in clinical trials compared to non-Hispanic whites and mainly pertains to behavioral interventions. Moving forward, there will be a need for studies that broaden the notion of health disparity beyond just comparing African Americans and non-Hispanic whites. Additionally, a more thorough examination of the potential for disparate outcomes after medical and surgical treatments of obesity is needed, coupled with the careful study of possible physiologic drivers of differential treatment response. PMID:27023070

  17. STUDY OF DIETARY PATTERNS AND THEIR CORRELATION WITH OBESITY IN THE MEXICAN-AMERICAN POPULATION

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Data from the National Health and Nutrition Examination Survey (NHANES) indicate that the trend toward increasing overweight and obesity among Mexican-Americans is continuing. This large population subgroup has a high prevalence of obesity and associated chronic conditions. Ethnic groups have been...

  18. A Systematic Review of Environmental Correlates of Obesity-Related Dietary Behaviors in Youth

    ERIC Educational Resources Information Center

    van der Horst, Klazine; Oenema, A.; Ferreira, I.; Wendel-Vos, W.; Giskes, K.; van Lenthe, F.; Brug, J.

    2007-01-01

    There is increasing interest in the role the environment plays in shaping the dietary behavior of youth, particularly in the context of obesity prevention. An overview of environmental factors associated with obesity-related dietary behaviors among youth is needed to inform the development of interventions. A systematic review of observational…

  19. Two patients with chromosome 22q11.2 deletion presenting with childhood obesity and hyperphagia.

    PubMed

    Bassett, J K; Chandler, K E; Douzgou, S

    2016-08-01

    Chromosome 22q11.2 deletion syndrome is a clinically heterogeneous condition of intellectual disability, parathyroid and thyroid hypoplasia, palatal abnormalities, cardiac malformations and psychiatric symptoms. Hyperphagia and childhood obesity is widely reported in Prader-Willi Syndrome (PWS) but there is only one previous report of this presentation in chromosome 22q11.2 deletion syndrome. We describe two further cases of chromosome 22q11.2 deletion syndrome in which hyperphagia and childhood obesity were the presenting features. This may be a manifestation of obsessive behaviour secondary to some of the psychiatric features commonly seen in chromosome 22q11.2 deletion syndrome. Serious complications may result from hyperphagia and childhood obesity therefore early recognition and intervention is crucial. Due to the similar clinical presentation of these two patients to patients with PWS, it is suggested that the hyperphagia seen here should be managed in a similar way to how it is managed in PWS. PMID:27184501

  20. Group behavioral activation for patients with severe obesity and binge eating disorder: a randomized controlled trial.

    PubMed

    Alfonsson, Sven; Parling, Thomas; Ghaderi, Ata

    2015-03-01

    The aim of the present study was to assess whether behavioral activation (BA) is an efficacious treatment for decreasing eating disorder symptoms in patients with obesity and binge eating disorder (BED). Ninety-six patients with severe obesity and BED were randomized to either 10 sessions of group BA or wait-list control. The study was conducted at an obesity clinic in a regular hospital setting. The treatment improved some aspects of disordered eating and had a positive effect on depressive symptoms but there was no significant difference between the groups regarding binge eating and most other symptoms. Improved mood but lack of effect on binge eating suggests that dysfunctional eating (including BED) is maintained by other mechanisms than low activation and negative mood. However, future studies need to investigate whether effects of BA on binge eating might emerge later than at post-assessment, as in interpersonal psychotherapy for bulimia nervosa. PMID:25268019

  1. Pharmacotherapy considerations in diabetes and obesity: setting patients up for success.

    PubMed

    Cornell, Susan; D'Souza, Jennifer

    2014-03-01

    The causal relationship between obesity and type 2 diabetes mellitus has been acknowledged over the past few decades and is frequently expressed by the term diabesity. It is predicted that the number of people with diabetes mellitus (DM) and prediabetes will continue to rise, with obesity placing people at increased risk for diabetic complications and comorbidities. Therefore, an individualized, patient-centered care approach is needed to optimally treat and manage the obese patient with DM. With 11 classes of medications available to lower blood glucose levels, 2 new agents for weight loss, and various surgical procedures, the clinician and the patient have numerous options from which to choose. In an effort to promote optimal disease management, clinicians should work with their obese patients to select appropriate pharmacotherapy combinations that will enable the patients to successfully manage DM. The current clinical recommendations and guidelines emphasize the need to consider the weight effects of the various DM agents as monotherapy and in combination. Additionally, with the approval of 2 new weight loss medications, the clinician must be aware of the place of the medications in therapy and their appropriate use in combination with DM pharmacotherapy. PMID:24685973

  2. Improvement in chronic low back pain in an obese patient with topiramate use.

    PubMed

    Gupta, Anita; Kulkarni, Archana; Ramanujam, Vendhan; Zheng, Lu; Treacy, Erin

    2015-06-01

    The objective of this study was to demonstrate efficacy, benefit, and potential use of topiramate in treating obese patients with chronic low back pain. This is a case report from an outpatient academic pain multidisciplinary clinical center. The patient was a 30-year-old morbidly obese (body mass index [BMI]: 61.4 kg/m(2)) female suffering from chronic low back pain. With a known association between obesity and chronic low back pain, and a possible role of topiramate in treating both simultaneously, the patient was started on a therapeutic trial of topiramate. Over a period of a 12-week topiramate therapy, the patient experienced clinically meaningful and significant weight loss as well as improvement in her chronic low back pain and functionality. With more substantial evidence, pain physicians may start considering using topiramate in the multimodal management of obesity-related chronic low back pain based on their thoughtful consideration of the drug's efficacy and side effects and the patient's comorbidities and preferences. PMID:26095484

  3. Homocysteine levels in morbidly obese patients: its association with waist circumference and insulin resistance.

    PubMed

    Vayá, Amparo; Rivera, Leonor; Hernández-Mijares, Antonio; de la Fuente, Miguel; Solá, Eva; Romagnoli, Marco; Alis, R; Laiz, Begoña

    2012-01-01

    The association between morbid obesity and hyperhomocysteinemia (HH) remains controversial and the nature of this relationship needs to be clarified as several metabolic, lipidic, inflammatory and anthropometric alterations that accompany morbid obesity may be involved. In 66 morbidly obese patients, 47 women and 19 men aged 41 ± 12 years and 66 normo-weight subjects, 43 women and 23 men, aged 45 ± 11 years, we determined homocysteine (Hcy) levels along with lipidic, anthropometric, inflammatory and insulin resistance markers. In addition, we investigated the effect of Metabolic Syndrome (MS) and its components on Hcy levels. Obese patients had statistically higher Hcy levels than controls: 12.76 ± 5.30 μM vs. 10.67 ± 2.50 μM; p = 0.006. Moreover, morbidly obese subjects showed higher waist circumference, glucose, insulin, HOMA, leptin, triglycerides, fibrinogen, C reactive protein (CRP) (p < 0.001, respectively), and lower vitamin B12 (p = 0.002), folic acid and HDL-cholesterol (p < 0.001, respectively). In the multivariate regression analysis, waist circumference, glucose, leptin and folic acid levels were independent predictors for Hcy values (p < 0.050). When obese patients were classified as having MS or not, no differences in Hcy levels were found between the two groups (p = 0.752). Yet when we analysed separately each MS component, only abdominal obesity was associated with Hcy levels (p = 0.031). Moreover when considering glucose >110 mg/dL (NCEP-ATPIII criteria) instead of glucose intolerance >100 mg/dl (updated ATPIII criteria), it also was associated with HH (p = 0.042). These results were confirmed in the logistic regression analysis where abdominal obesity and glucose >115 mg/dL constitute independent predictors for HH (OR = 3.2; CI: 1.23-13.2; p = 0.032, OR: 4.6; CI: 1.7-22.2; p = 0.016, respectively). The results of our study indicate that increased Hcy levels are related mostly with abdominal obesity and with insulin resistance. Thus, HH may

  4. Studies of Metabolic Phenotypic Correlates of 15 Obesity Associated Gene Variants

    PubMed Central

    Bille, Dorthe Sadowa; Borglykke, Anders; Almind, Katrine; Hansen, Lars; Sandbæk, Annelli; Lauritzen, Torsten; Witte, Daniel; Jørgensen, Torben; Pedersen, Oluf; Hansen, Torben

    2011-01-01

    Aims Genome-wide association studies have identified novel BMI/obesity associated susceptibility loci. The purpose of this study is to determine associations with overweight, obesity, morbid obesity and/or general adiposity in a Danish population. Moreover, we want to investigate if these loci associate with type 2 diabetes and to elucidate potential underlying metabolic mechanisms. Methods 15 gene variants in 14 loci including TMEM18 (rs7561317), SH2B1 (rs7498665), KCTD15 (rs29941), NEGR1 (rs2568958), ETV5 (rs7647305), BDNF (rs4923461, rs925946), SEC16B (rs10913469), FAIM2 (rs7138803), GNPDA2 (rs10938397), MTCH2 (rs10838738), BAT2 (rs2260000), NPC1 (rs1805081), MAF (rs1424233), and PTER (rs10508503) were genotyped in 18,014 middle-aged Danes. Results Five of the 15 gene variants associated with overweight, obesity and/or morbid obesity. Per allele ORs ranged from 1.15–1.20 for overweight, 1.10–1.25 for obesity, and 1.41–1.46 for morbid obesity. Five of the 15 variants moreover associated with increased measures of adiposity. BDNF rs4923461 displayed a borderline BMI-dependent protective effect on type 2 diabetes (0.87 (0.78–0.96, p = 0.008)), whereas SH2B1 rs7498665 associated with nominally BMI-independent increased risk of type 2 diabetes (1.16 (1.07–1.27, p = 7.8×10−4)). Conclusions Associations with overweight and/or obesity and measures of obesity were confirmed for seven out of the 15 gene variants. The obesity risk allele of BDNF rs4923461 protected against type 2 diabetes, which could suggest neuronal and peripheral distinctive ways of actions for the protein. SH2B1 rs7498665 associated with type 2 diabetes independently of BMI. PMID:21912638

  5. [NEW OPTIONS OF ENDOSCOPIC TREATMENT FOR KIDNEY AND URETER STONES IN OBESE PATIENTS].

    PubMed

    Martov, A G; Dutov, S V; Andronov, A S; Kil'chukov, Z I; Tahaev, R A

    2015-01-01

    Effective urolithiasis treatment, especially in overweight patients has a considerable medical and social implication. Extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotripsy (PCNL) in prone position of the patient are standard treatment options for kidney and ureter stones. These interventions are not always effective in patients with concomitant obesity and are associated with technical difficulties and an increased risk of complications. The study included 175 patients with obesity. The first group consisted of 96 (54.8%) patients treated with transurethral contact lithotripsy. The 2nd group consisted of 54 (30.9%) patients who underwent PCNL in the supine position. The third group comprised 25 (14.3%) patients with multiple stones of kidney and ureter, who underwent combined transurethral and percutaneous intervention in the supine position. The 1st and 3rd group had a higher prevalence of patients with II degree of obesity, in the 2nd group--with I degree of obesity. The mean duration of surgery in 1st group was 43.4 min, in the 2nd--70.3 min and in the third--84.6 min. Method of kidney drainage depended mainly on the presence, location and size of residual stone fragments. The average duration of the kidney drainage stent in patients of the 1st group was 39 days (ureteral catheter--1.3 days). In all patients of the 2nd and 3rd groups, at the final stage of the operation a nephrostomy tube was placed for an average of 2.7 days. The average postoperative hospital stay was 2.9 days in the 1st group, 4.1 days in the 2nd group and 4.5 days in the third group. In the 1st group, the stone-free status was achieved in 81 (84.4%) patients. Another 10 (10.4%) patients later needed ESWL for the complete disposal of the stones. In the 2nd group, the complete clearance of kidney stones was achieved in 49 (90.7%) patients. Another 3 (5.6%) patients required added ESWL to achieve the stone-free status. In the third group of patients stone free status

  6. Vasodilator Stress Perfusion CMR Imaging Is Feasible and Prognostic in Obese Patients

    PubMed Central

    Shah, Ravi V.; Heydari, Bobak; Coelho-Filho, Otavio; Abbasi, Siddique A.; Feng, Jiazhuo H.; Neilan, Tomas G.; Francis, Sanjeev; Blankstein, Ron; Steigner, Michael; Jerosch-Herold, Michael; Kwong, Raymond Y.

    2014-01-01

    Objectives This study sought to determine feasibility and prognostic performance of stress cardiac magnetic resonance (CMR) in obese patients (body mass index [BMI] ≥30 kg/m2). Background Current stress imaging methods remain limited in obese patients. Given the impact of the obesity epidemic on cardiovascular disease, alternative methods to effectively risk stratify obese patients are needed. Methods Consecutive patients with a BMI ≥30 kg/m2 referred for vasodilating stress CMR were followed for major adverse cardiovascular events (MACE), defined as cardiac death or nonfatal myocardial infarction. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic association of inducible ischemia or late gadolinium enhancement (LGE) by CMR beyond traditional clinical risk indexes. Results Of 285 obese patients, 272 (95%) completed the CMR protocol, and among these, 255 (94%) achieved diagnostic imaging quality. Mean BMI was 35.4 ± 4.8 kg/m2, with a maximum weight of 200 kg. Reasons for failure to complete CMR included claustrophobia (n = 4), intolerance to stress agent (n = 4), poor gating (n = 4), and declining participation (n = 1). Sedation was required in 19 patients (7%; 2 patients with intravenous sedation). Sixteen patients required scanning by a 70-cm-bore system (6%). Patients without inducible ischemia or LGE experienced a substantially lower annual rate of MACE (0.3% vs. 6.3% for those with ischemia and 6.7% for those with ischemia and LGE). Median follow-up of the cohort was 2.1 years. In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, inducible ischemia (hazard ratio 7.5; 95% confidence interval: 2.0 to 28.0; p = 0.002) remained independently associated with MACE. When patients with early coronary revascularization (within 90 days of CMR) were censored on the day of revascularization, both presence of inducible ischemia and ischemia extent per segment maintained a strong

  7. Filling the treatment gap in the weight management of overweight and obese patients

    PubMed Central

    Gesundheit, N

    2012-01-01

    Approximately two out of three adult Americans are overweight or obese. Despite widespread recognition of this disorder, there has been little progress in the past 20 years in finding effective noninvasive treatments for weight loss. The consequences of obesity are increasingly well recognized and include increases in blood pressure, plasma lipids, the onset of type 2 diabetes, sleep apnea, asthma, osteoarthritis and a variety of cancers. Obesity can increase the rate of pregnancy complications and fetal malformations in normoglycemic women. Current medical approaches to obesity, including intensive lifestyle interventions and drug therapies, have been successful in achieving modest weight loss of 4–7%, less than the 1998 NIH Guidelines target of 10%. Surgical approaches, including laparoscopic adjustable gastric banding, vertical banded gastroplasty and Roux-en-Y gastric bypass, are much more successful, achieving weight loss of 15–50%. A treatment gap therefore exists in the management of obese and overweight patients, because many patients desire and would receive great health benefits by achieving weight loss of 7–15%. This review will discuss the dilemma of the treatment gap and explore possible ways by which it may be filled in the future by the use of innovative approaches. PMID:25018869

  8. Obesity affects the chondrocyte responsiveness to leptin in patients with osteoarthritis

    PubMed Central

    2010-01-01

    Introduction Increasing evidence support the regulatory role of leptin in osteoarthritis (OA). As high circulating concentrations of leptin disrupt the physiological function of the adipokine in obese individuals, the current study has been undertaken to determine whether the elevated levels of leptin found in the joint from obese OA patients also induce changes in the chondrocyte response to leptin. Methods Chondrocytes isolated from OA patients with various body mass index (BMI) were treated with 20, 100 or 500 ng/ml of leptin. The expression of cartilage-specific components (aggrecan, type 2 collagen), as well as regulatory (IGF-1, TGFβ, MMP-13, TIMP 2) or inflammatory (COX-2, iNOS, IL-1) factors was investigated by real-time PCR to evaluate chondrocyte responsiveness to leptin. Furthermore, the effect of body mass index (BMI) on leptin signalling pathways was analyzed with an enzyme-linked immunosorbent assay for STATs activation. Results Leptin at 20 ng/ml was unable to modulate gene expression in chondrocytes, except for MMP-13 in obese OA patients. Higher leptin levels induced the expression of IGF-1, type 2 collagen, TIMP-2 and MMP-13. However, the activity of the adipokine was shown to be critically dependent on both the concentration and the BMI of the patients with a negative association between the activation of regulated genes and BMI for 100 ng/ml of adipokine, but a positive association between chondrocyte responsiveness and BMI for the highest leptin dose. In addition, the gene encoding MMP-13 was identified as a target of leptin for chondrocytes originated from obese patients while mRNA level of TIMP-2 was increased in leptin-treated chondrocytes collected from normal or overweight patients. The adipokine at 500 ng/ml triggered signal transduction through a STAT-dependent pathway while 100 ng/ml of leptin failed to activate STAT 3 but induced STAT 1α phosphorylation in chondrocytes obtained from obese patients. Conclusions The current study

  9. A simple method of alignment for pelvic irradiation in obese patients

    SciTech Connect

    Sweigart, Kenneth

    2002-12-31

    Administering radiation therapy to obese pelvic patients can pose a difficult challenge to even the veteran radiation therapist. Daily reproducibility can be achieved with the sacrifice of additional time and filming. We have developed a technique which has shown consistent reproducibility of the radiation treatments with a minimum of inconvenience to busy schedules.

  10. Are Self-Management Interventions Suitable for All? Comparing Obese Versus Nonobese Type 2 Diabetes Patients

    ERIC Educational Resources Information Center

    Kroese, Floor M.; Adriaanse, Marieke A.; De Ridder, Denise T. D.

    2013-01-01

    Objective: The aim of the current study was to compare obese and nonobese type 2 diabetes patients at baseline and after participating in an existing self-management intervention (i.e., "Beyond Good Intentions") on cognitive, self-care, and behavioral measures to examine whether both groups are equally prepared and able to adopt…