Integrating yoga and nutrition: a complementary therapy for addressing obesity in clinical practice

Aggressive nutritional strategy in morbid obesity in clinical practice: Safety, feasibility, and effects on metabolic and haemodynamic risk factors

The California Endowment's Healthy Eating, Active Communities program was designed to reduce disparities in the incidence of obesity by improving food and physical-activity environments for low-income children. It was recognized at the outset that to succeed, the program needed support from community advocates. Health care providers can be effective advocates to mobilize community members and influence policy makers. This study was conducted to describe how health care providers address obesity prevention in clinical practice and to assess health care providers' level of readiness to advocate for policies to prevent childhood obesity. The study included two data-collection methods, (1) a self-administered survey of health care providers (physicians, dietitians, nurses, nurse practitioners, medical assistants, and community health workers) and (2) stakeholder interviews with health care facility administrators, health department staff, and health insurance organization representatives. Two-hundred and forty-eight health care providers participated in the provider survey and the health care stakeholder interviews were conducted with 56 respondents. The majority (65%) of health care providers usually or always discussed the importance of physical-activity, reducing soda consumption, and breastfeeding (as appropriate) during clinical pediatric visits. More than 90% of the providers perceived home or neighborhood environments and parental resistance as barriers to their efforts to prevent childhood obesity in clinical practice. More than 75% of providers reported not having engaged in any policy/advocacy activities related to obesity-prevention. Most (88%) of the stakeholders surveyed thought that health care professionals should advocate for policies to reduce obesity, especially around insurance coverage for obesity-prevention. Providers perceived that changing the food and physical-activity environments in neighborhoods and schools was likely to be the most effective way to support their clinical obesity-prevention efforts. Health care providers need time, training, resources, and institutional support to improve their ability to communicate obesity-prevention messages in both clinical practice and as community policy advocates.

Tirzepatide use in patients with heart failure with preserved ejection fraction and obesity in clinical practice

ObjectivesThe aim of the current study is to generate waist circumference to height ratio cut-off values for obesity categories from a model of the relationship between body mass index and waist circumference to height ratio. We compare the waist circumference to height ratio discovered in this way with cut-off values currently prevalent in practice that were originally derived using pragmatic criteria.MethodPersonalized data including age, gender, height, weight, waist circumference and presence of diabetes, hypertension and cardiovascular disease for 847 participants over eight years were assembled from participants attending a rural Australian health review clinic (DiabHealth). Obesity was classified based on the conventional body mass index measure (weight/height2) and compared to the waist circumference to height ratio. Correlations between the measures were evaluated on the screening data, and independently on data from the National Health and Nutrition Examination Survey that included age categories.ResultsThis article recommends waist circumference to height ratio cut-off values based on an Australian rural sample and verified using the National Health and Nutrition Examination Survey database that facilitates the classification of obesity in clinical practice. Gender independent cut-off values are provided for waist circumference to height ratio that identify healthy (waist circumference to height ratio ≥0.45), overweight (0.53) and the three obese (0.60, 0.68, 0.75) categories verified on the National Health and Nutrition Examination Survey dataset. A strong linearity between the waist circumference to height ratio and the body mass index measure is demonstrated.ConclusionThe recommended waist circumference to height ratio cut-off values provided a useful index for assessing stages of obesity and risk of chronic disease for improved healthcare in clinical practice.

Visceral obesity assessment is not easy, and although computed tomography (CT) is an accurate tool, this technique is expensive and sometimes not suitable in clinical practice. We developed a new two-dimensional elliptical anthropometric equation to classify visceral obesity and evaluated the validity and the reliability of the new equation compared with CT. We collected anthropometric and CT data from overweight/obese subjects (n = 61, BMI = 32.4 +/- 3.7 kg/m2). A validation group of 32 subjects was also selected. An equation for the assessment of visceral obesity was developed using multiple regression analysis. Once validated, the equation was compared with previous models. Tests for accuracy included mean differences, analysis of diagnostic, R2, Snedecor's F-test, and Bland-Altman plot. Multiple regression analysis revealed that the sagittal and coronal diameters and the triceps skinfold were significant contributors to the model. The final equation was: visceral area (VA)/subcutaneous area (SA)predicted = 0.868 + 0.064 x sagittal diameter - 0.036 x coronal diameter - 0.022 x triceps skinfold. Patients with visceral-subcutaneous area ratio (VA/SA) > 0.42 were classified as having visceral obesity. The predictive equation was valid, showing a significant association with VA/SA assessed by CT (VA/SA(CT); r = 0.68; p < 0.0001). Paired Student's t test showed no significant differences with VA/SACT (p = 0.541). The reliability was high [F(24/60) = 2.12; p = 0.01]. The new two-dimensional and elliptical predictive equation is valid to assess visceral obesity and is more precise than previous models.

The role of sibutramine as an effective adjunct to diet and exercise in weight management programmes has been proven in clinical trials. Although the reality of managing obesity in clinical practice is very different from that of a controlled clinical trial, there is good evidence that sibutramine is an easy-to-use and highly effective additional therapy when used in everyday practice to manage obesity and its complications. It is possible to predict which patients will respond well to sibutramine treatment, and to modify programmes and support to ensure the best outcome for patients, whatever their clinical circumstances.

In order to evaluate the effectiveness of a cognitive behavioural group therapy programme for the treatment of obesity in clinical practice, 122 patients from 14 general practices (n = 70) were randomised into either a treatment or a control arm with a ratio of 3 to 2. The group treatment programme was also assessed in a clinical centre (n = 52; University Hospital Basel). Before therapy, a clinical interview and a mental disorder examination were carried out on all patients. The instructors of the programme (practitioners; clinic physicians) were trained during two afternoon meetings to supervise the group sessions. The treatment programme consisted of 16 group sessions of 90 min each, and contained psycho-educational elements concerning a balanced diet, instruction for the integration of more activity in everyday life (lifestyle activity), problemsolving strategies, and the cognitive restructuring of dysfunctional cognition regarding the own body. All the patients who were treated in the various settings demonstrated a benefit from therapy. Compared to the control groups which received usual medical care, they were able to reduce their starting weight by around 5% (p <0.001 for the group treated by practitioners) at the end of treatment and stabilise it until follow up after one year. In regard to psychological factors the treatment groups showed an increased sense of control over eating behaviour, and feelings of distractibility and hunger were reduced after treatment and at follow up (p <0.05). All treatment groups showed statistically relevant increases in feelings of attractiveness regarding their body and shape (p <0.05). These results support the effectiveness of the integrated cognitive behavioural treatment programme in clinical practice over a duration of 12 months.

The incidence of diabetes, atherosclerosis and sudden cardiac death is high among obese individuals, with significant metabolic and cardiovascular adverse effects being observed when obesity is centered in the abdominal region. The objective of this study was to determine which of the anthropometric indicators of abdominal obesity commonly used show the highest predictive power to discriminate a high coronary risk (HCR) and to propose cut-off values for their use in clinical practice and in population studies on Brazilian adults. The studies publi-shed by the research group on non-transmissible chronic diseases of the Public Health Institute (PHI), Federal University of Bahia (UFBA), that compare different anthropometric indicators as predictors of HCR were analyzed. The evidence provided by the studies analyzed suggests the use of the conicity index for the evaluation of abdominal obesity in clinical practice, with cut-off values of 1.25 for men and of 1.18 and 1.22 for women ≤ 49 years and &gt; 50 years, respectively. The waist-height ratio should be used in population studies, with the recommendation that waist should not exceed half the height of a particular subject.

In order to evaluate the effectiveness of a cognitive behavioural group therapy programme for the treatment of obesity in clinical practice, 122 patients from 14 general practices (n = 70) were randomised into either a treatment or a control arm with a ratio of 3 to 2. The group treatment programme was also assessed in a clinical centre (n = 52; University Hospital Basel). Before therapy, a clinical interview and a mental disorder examination were carried out on all patients. The instructors of the programme (practitioners; clinic physicians) were trained during two afternoon meetings to supervise the group sessions. The treatment programme consisted of 16 group sessions of 90 min each, and contained psycho-educational elements concerning a balanced diet, instruction for the integration of more activity in everyday life (lifestyle activity), problemsolving strategies, and the cognitive restructuring of dysfunctional cognition regarding the own body. All the patients who were treated in the various settings demonstrated a benefit from therapy. Compared to the control groups which received usual medical care, they were able to reduce their starting weight by around 5% (p <0.001 for the group treated by practitioners) at the end of treatment and stabilise it until follow up after one year. In regard to psychological factors the treatment groups showed an increased sense of control over eating behaviour, and feelings of distractibility and hunger were reduced after treatment and at follow up (p <0.05). All treatment groups showed statistically relevant increases in feelings of attractiveness regarding their body and shape (p <0.05). These results support the effectiveness of the integrated cognitive behavioural treatment programme in clinical practice over a duration of 12 months.

Limited data are available on long-term weight loss achieved with semaglutide or liraglutide for type 2 diabetes (T2D) or obesity in clinical practice. To document weight loss achieved with injectable forms of semaglutide or liraglutide and identify factors associated with weight reduction of 10% or greater at 1 year. This retrospective cohort study used electronic health records from a large, integrated health system in Ohio and Florida. Participants included adults with a body mass index (calculated as the weight in kilograms divided by the height in meters squared) of at least 30.0 who initiated treatment with semaglutide or liraglutide between July 1, 2015, and June 30, 2022. Follow-up was completed July 28, 2023. Injectable forms of semaglutide or liraglutide approved for T2D or obesity. Percentage weight change and categorical weight reduction of 10% or greater at 1 year. A total of 3389 patients (mean [SD] age, 50.4 [12.2] years; 1835 [54.7%] female) were identified. Of these, 1341 patients received semaglutide for T2D; 1444, liraglutide for T2D; 227, liraglutide for obesity; and 377, semaglutide for obesity. Mean (SD) percentage weight change at 1 year was -5.1% (7.8%) with semaglutide vs -2.2% (6.4%) with liraglutide (P < .001); -3.2% (6.8%) for T2D as a treatment indication vs -5.9% (9.0%) for obesity (P < .001); and -5.5% (7.5%) with persistent medication coverage (ie, a cumulative gap of less than 90 days) at 1 year vs -2.8% (7.0%) with 90 to 275 medication coverage days and -1.8% (6.7%) with fewer than 90 medication coverage days (P < .001). In the multivariable model, semaglutide vs liraglutide (adjusted odds ratio [AOR], 2.19 [95% CI, 1.77-2.72]), obesity as a treatment indication vs T2D (AOR, 2.46 [95% CI, 1.83-3.30]), persistent medication coverage vs 90 medication coverage days (AOR, 3.36 [95% CI, 2.52-4.54]) or 90 to 275 medication coverage days within the first year (AOR, 1.50 [95% CI, 1.10-2.06]), high dosage of the medication vs low (AOR, 1.58 [95% CI, 1.11-2.25]), and female sex (AOR, 1.57 [95% CI, 1.27-1.94]) were associated with achieving a 10% or greater weight reduction at year 1. In this retrospective cohort study of 3389 patients with obesity, weight reduction at 1 year was associated with the medication's active agent, its dosage, treatment indication, persistent medication coverage, and patient sex. Future research should focus on identifying the reasons for discontinuation of medication use and interventions aimed at improving long-term persistent coverage.

Integrating Yoga and Nutrition: A Complementary Therapies for Addressing Obesity in Clinical Practice

Strategies to Treat Obesity in Patients With CKD

Though the pathophysiology of clinical obesity is undoubtedly multifaceted, several lines of clinical evidence implicate an important functional role for glucagon-like peptide 1 (GLP-1) signalling. Clinical studies assessing GLP-1 responses in normal weight and obese subjects suggest that weight gain may induce functional deficits in GLP-1 signalling that facilitates maintenance of the obesity phenotype. In addition, genetic studies implicate a possible role for altered GLP-1 signalling as a risk factor towards the development of obesity. As reductions in functional GLP-1 signalling seem to play a role in clinical obesity, the pharmacological replenishment seems a promising target for the medical management of obesity in clinical practice. GLP-1 analogue liraglutide at a high dose (3 mg/d) has shown promising results in achieving and maintaining greater weight loss in obese individuals compared to placebo control, and currently licensed anti-obesity medications. Generally well tolerated, provided that longer-term data in clinical practice supports the currently available evidence of superior short- and long-term weight loss efficacy, GLP-1 analogues provide promise towards achieving the successful, sustainable medical management of obesity that remains as yet, an unmet clinical need.

BackgroundWhile obesity is common in the United States, monogenic obesity is rare, accounting for approximately 5% of individuals with obesity. New targeted therapies for genetic forms of obesity are available but there is limited guidance on who requires testing. The aims of this study were to evaluate the prevalence of potentially clinically significant variants among individuals in Pediatric Endocrinology or Medical Weight Center clinics at a single center and to identify clinical characteristics that may make genetic obesity more likely.MethodsChildren and adults who had a genetic test for obesity, Uncovering Rare Obesity Gene panel, ordered during routine clinic visits from December 2019 to March 2021 were identified.ResultsOf the 139 patients with testing ordered, 117 had available results and clinical data. Over 40% (52/117, 44%) had at least one positive result (variant) with a variant that is considered pathogenic, likely pathogenic, or a variant of uncertain significance. No association was detected between age, sex, race, and body mass index (BMI) or BMI z‐score with a variant. Twenty‐six individuals (22%) had one or more variants in genes associated with Bardet Biedl Syndrome, and 8 (6.8%) of them had pathogenic variants, higher than expected.ConclusionOverall, clinical suspicion for genetic obesity is important in determining who requires genetic testing but no clinical factors were found to predict results. While obesity is multifactorial, novel medications for genetic forms of obesity indicate the need for evidence‐based guidelines for who requires genetic testing for obesity.

Purpose of ReviewThis review aims to elucidate the limitations of diagnosing metabolic syndrome in adolescents as well as challenges and opportunities in the identification and reduction of cardiometabolic risk in this population.Recent FindingsThere are multiple criticisms of how we define and approach obesity in clinical practice and scientific research, and weight stigma further complicates the process of making and communicating weight-related diagnoses. While the goal of diagnosing and managing metabolic syndrome in adolescents would be to identify individuals at elevated future cardiometabolic risk and intervene to reduce the modifiable component of this risk, there is evidence that identifying cardiometabolic risk factor clustering may be more useful in adolescents than establishing a cutoff-based diagnosis of metabolic syndrome. It has also become clear that many heritable factors and social and structural determinants of health contribute more to weight and body mass index than do individual behavioral choices about nutrition and physical activity. Promoting cardiometabolic health equity requires that we intervene on the obesogenic environment and mitigate the compounding effects of weight stigma and systemic racism.SummaryThe existing options to diagnose and manage future cardiometabolic risk in children and adolescents are flawed and limited. While striving to improve population health through policy and societal interventions, there are opportunities to intervene at all levels of the socioecological model in order to decrease future morbidity and mortality from the chronic cardiometabolic diseases associated with central adiposity in both children and adults. More research is needed to identify the most effective interventions.