Obesity‐Related Beliefs, Concerns, and Stigmatizing Perceptions Among Adults Living With Obesity

Previous studies have explored people's perceptions of weight-related terminology; however, to date, limited data has explored the emotional response to weight-related terms used by healthcare professionals (HCPs). This study explored the preferences and emotional responses of terms used by HCPs to describe body weight and of parents to describe their children's weight. A total of 2911 adults completed an online cross-sectional survey, with 1693 living with overweight or obesity (mean age 49.2 years [SD 12.5], female (96%), median body mass index (BMI) 31.4kg/m2 [28.1, 36.5]). The survey explored preferences of 22 weight-related terms using a 5-point Likert scale and their emotional response to these terms (using 7-core emotions). Parents also indicated preferences and emotional responses to terms used to describe their children's weight. Respondents completed the modified weight bias internalization scale to examine how this may impacted preferences. 'Weight', "unhealthy weight" and "overweight" were the three preferred terms, while "super obese", "chubby", and "extra-large" were least preferred in people living with overweight and obesity. Parents preferred 'weight', "unhealthy weight" and "body mass index", and least preferred "fat", "extra-large" and "extremely obese" when describing their children's weight. All terms elicited a negative emotional response. The most commonly emotion was sadness for terms to describe adult's bodyweight, and anger for terms used to describe children's weight. All BMI categories reported disgust with terms incorporating "obese". Our results offer novel insight into the preferred terminology and emotional responses to terminology used by HCPs for both adults and parents to describe their children's weight.

e21037 Background: Non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer diagnoses. Previous literature has evaluated associations between physical factors and outcomes in NSCLC. Throughout these studies, important physical factors that affect overall survival (OS) in NSCLC patients are body mass index (BMI) and serum albumin (SA) levels. In terms of BMI, previous research has come across the “obesity paradox.” That is, presenting an obese BMI serves as a protective role in patient survival. Hypoalbuminemia, defined as SA levels < 3.5 g/dL, has been shown to have a significantly adverse effect on both early and late stage patients’ outcomes. Our study aims to analyze the role of BMI and SA in patients with advanced-stage NSCLC. Methods: This retrospective study includes 112 patients with stage III and stage IV NSCLC identified between January 1st, 2014 through December 31st, 2018. Categorical and continuous analyses (Pearson’s chi-square and Kruskal-Wallis test) were performed to analyze the associations between median OS, BMI, and SA. BMI subgroups are classified according to the Center for Disease Control guidelines. BMI and SA are calculated at time of diagnosis. OS is defined as the date of diagnosis until the date of death. Other notable confounders investigated include treatment modality, histology, and comorbidities. Results: Of the 112 patients, 57% of patients identified as male. The study population mean age was 73 years. The majority (88%) of patients identified as white. The median BMI was 26.1, with 26% of patients presenting as obese. The median SA level of the population was 3.8 g/dL, with 34% of patients presenting as hypoalbuminemic. Study population median OS was 0.734 years. Median OS for the obese BMI subgroup was 1.42 years, compared to 0.70, 0.71, and 0.42 years for overweight, normal, and underweight BMI, respectively. Kruskal-Wallis analyses confirm that patient BMI plays a significant difference in terms of OS, with a significant subgroup difference between patients with obese and underweight BMIs (p = 0.05). Regarding SA, both chi-square and Kruskal-Wallis tests confirm that at the time of diagnosis, patients with normal SA have a longer median OS compared to their hypoalbuminemic counterparts (median OS 1.29 years vs 0.32 years, respectively; OR = 6.72, 95% CI [2.48, 18.22], p < 0.001). Conclusions: Our study reveals that an obese BMI plays a significant protective role regarding OS when evaluating prognostic outcomes between obese and underweight patients. Further, as SA levels are a known biomarker for nutritional status, our study highlights the importance of nutritional and educational optimization among healthcare professionals and patients alike prior to the diagnosis of malignancy. Future large prospective cohort studies are needed to analyze the efficacy of nutritional optimization, and further justify the “obesity paradox” and its underlying framework.

Evidence and consensus-based clinical practice guidelines for management of overweight and obesity in midlife women: An AIIMS-DST initiative.

Higher BMI is associated with worse asthma control and quality of life but not asthma severity

BackgroundWomen who have an overweight or obese BMI are more likely to experience pregnancy complications. However, little is known on the cost of childbirth in this group and no studies have been undertaken in England to date. The aim of this paper is therefore to investigate whether women with overweight and obese pre-pregnancy body mass index (BMI) incur higher average hospital costs of childbirth.MethodsWe employed data from 7564 women in the first wave of data collection of the Millennium Cohort Study. Using interval regression, we investigated the association between hospital costs of childbirth and pre-pregnancy BMI, fitting four models, progressively adjusting for additional potential confounders and mediators. Model 1 was a univariate model; model 2 adjusted for maternal age, education, marital status, ethnicity, income, and region; model 3 additionally included number of previous children, number of babies delivered, whether birth was at term, and type of delivery; model 4 also included length of hospital stay.ResultsChildbirth costs incurred by women who were overweight, obese class I and obese class II and III were £22, £82 and £126 higher than those incurred by women whose BMI was in the normal range (p ≤ 0.05). Delivery method, pre-term delivery, and length of hospital stay accounted for the observed difference.ConclusionsWomen with elevated pre-pregnancy BMI make greater use of services resulting in higher hospital costs. Interventions promoting healthy BMI in pre-pregnancy among women of child-bearing age have the potential to reduce pregnancy complications and be cost-effective.

The Association of Increasing Body Mass Index and Kidney Stone Disease

BackgroundIreland’s Model of Care for the Management of Overweight and Obesity outlines a plan for treating adolescent and child obesity (CO). However, engagement with key stakeholders is required to support its implementation and improve health services.AimThis study aims to map the perceived barriers and facilitators related to CO management across healthcare settings, professional disciplines, and regions in the Republic of Ireland (ROI).Materials and methodsAn online cross-sectional survey of registered healthcare professionals (HPs), designed to adhere to the Consolidated Framework for Implementation Research (CFIR), was co-developed by a project team consisting of researchers, healthcare professionals, and patient advocates. The survey was pilot tested with project stakeholders and distributed online to professional groups and via a social media campaign, between September 2021 and May 2022, using “SurveyMonkey.” Data were summarised using descriptive statistics and thematic analyses. Themes were mapped to the CFIR framework to identify the type of implementation gaps that exist for treating obesity within the current health and social care system.ResultsA total of 184 HPs completed the survey including nurses (18%), physicians (14%), health and social care professionals (60%), and other HPs (8%). The majority were female (91%), among which 54% reported conducting growth monitoring with a third (32.6%) giving a diagnosis of paediatric/adolescent obesity as part of their clinical practice. Nearly half (49%) of the HPs reported having the resources needed for clinical assessment. However, 31.5% of the HPs reported having enough “time,” and almost 10% of the HPs reported having no/limited access to suitable anthropometric measurement tools. Most HPs did not conduct obesity-related clinical assessments beyond growth assessment, and 61% reported having no paediatric obesity training. CFIR mapping identified several facilitators and barriers including time for clinical encounters, suitable materials and equipment, adequate training, perceived professional competency and self-efficacy, human equality and child-centredness, relative priorities, local attitudes, referral protocols, and long waiting times.ConclusionsThe findings provide actionable information to guide the implementation of the Model of Care for the Management of Overweight and Obesity in Ireland. Survey findings will now inform a qualitative study to explore implementation barriers and facilitators and prioritise actions to improve child and adolescent obesity management.

Addressing Conflict of Interest and Bias in Research, Education and Clinical Practice.

Maternal sociodemographic and health behaviours associated with adiposity in infants as measured by air displacement plethysmography

Laparoscopic Nissen fundoplication controls reflux symptoms and improves disease-specific quality of life in patients with class I and II obesity

The aim was to provide updated evidence on the association of male body mass index (BMI) with outcomes of assisted reproduction technology (ART). PubMed, Embase, and Scopus databases were systematically searched. The review included observational studies in patients undergoing ART, that is, either in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and compared rate of clinical pregnancy and live birth based on different categories of male BMI. Quality of the pooled findings was assessed using the GRADE criteria. A total of 19 studies were included in the review. Among subjects undergoing IVF, there were no significant differences in the rates of clinical pregnancy among overweight (odds ratio [OR] 1.38, 95% confidence interval [CI]: 0.65, 2.96) and obese (OR 1.86, 95% CI: 0.75, 4.58) BMI, compared to normal male BMI. Similarly, there were no significant differences in the rates of live birth among overweight (OR 1.04, 95% CI: 0.97, 1.13) and obese BMI (OR 0.90, 95% CI: 0.69, 1.18) when compared to males with normal BMI. Further, among those undergoing ICSI, there were no significant differences in the odds of clinical pregnancy among overweight (OR 0.98, 95% CI: 0.73, 1.33) and obese (OR 0.89, 95% CI: 0.62, 1.29). The odds of live births among overweight (OR 0.97, 95% CI: 0.89, 1.05) and obese (OR 0.95, 95% CI: 0.84, 1.07) male BMI were statistically similar to males with normal BMI undergoing ICSI. The low to very low-quality findings suggest no significant association of overweight and obese BMI with clinical pregnancy and live birth rates among couples undergoing either IVF or ICSI.

Confronting the evolution and expansion of anti-vaccine activism in the USA in the COVID-19 era

Human skills for human[istic] anatomy: An emphasis on nontraditional discipline-independent skills.

2660 Background: Recent studies suggest that obesity is linked to improved progression-free and overall survivals in patients treated with Immune-Checkpoint Inhibitors (ICI). Studies have also shown that irAEs occurrence following ICI infusion is associated with improved survival. Current evidence on the relationship between obesity and the risk of irAEs has been inconclusive. We aimed to assess the impact of obesity on the risk of irAEs after ICI infusion using data from a large retrospective cohort. Methods: The study included newly diagnosed stage I-VI cancer patients treated with ICIs between 2012 and 2021 at the Ohio State University Comprehensive Cancer Center. Patients’ body mass index (BMI) data at or before ICI infusion were classified into normal <25.0 Kg/M2, 25 to < 30 Kg/M2 overweight and obese ≥ 30 Kg/M2. An incident irAE was defined as any gastrointestinal, pulmonary, dermatological, endocrine or hepatobiliary irAEs following ICI infusion. Cox proportional hazard models were fitted to test the associations between obesity and 1) any irAEs and 2) organ-specific irAEs. We evaluated the dose-response association between BMI and irAEs using a three-knot restricted cubic spline in the adjusted Cox proportional models. Results: A total of 4,761 patients were included in the study with a median age of 62 years, 59.2% males and 89% White non-Hispanics. An estimated 34.7%, 31.5% and 33.8% of patients had normal, overweight, and obese BMIs. The median time to incident irAEs was 4.3 months. An estimated 2,791 (58.6%) experienced an irAE, with 28.8% having gastrointestinal, 17.7% pulmonary, 23.7% dermatological, 21.8% endocrine, and 4.4% hepatobiliary irAEs. BMI was a significant predictor of increased risk of irAEs, adjusted hazard ratio (aHR) 1.08 (95%CI: 0.98 to 1.19) overweight vs. normal BMI and aHR 1.17 (95% CI: 1.06 to 1.28) obese vs. normal BMI. In the organ-specific irAEs models, obese vs. normal BMI patients had higher risks of gastrointestinal aHR 1.23 (95% CI: 1.07 to 1.41), dermatological aHR 1.25 (95% CI: 1.07 to 1.28), and hepatobiliary aHR 1.61 (95% CI: 1.11 to 2.36) irAEs. A dose-response was observed in the relationship between BMI and the risk of irAEs whereby patients with BMIs lower than 22 Kg/M2 (median normal BMI range 18.5-24.9 Kg/M2) had lower risks of irAEs [BMI 18.5 Kg/M2 vs. 22 Kg/M2, aHR 0.93 (95% CI, 0.88 to 0.97)] and those with BMIs higher than 22 Kg/M2 had higher risks of irAEs [BMI 30 Kg/M2 vs. 22 Kg/M2, aHR 1.19 (95%CI, 1.09 to 1.29)] and [BMI 40 Kg/M2 vs. 22 Kg/M2, aHR 1.22 (95% CI, 1.11 to 1.34)]. Conclusions: Among patients treated with ICIs, higher BMI was significantly associated with an increased risk of irAEs. Patients with obesity should be monitored for symptom management following ICIs infusion. Our findings help to explain the previously reported benefits of increased BMI and higher irAEs rates on improved survival.

Little progress has been made in determining the prognostic factors for children and adolescents with high-grade mature B-cell non-Hodgkin lymphoma (HG B-NHL). Based on the important role of body mass index (BMI) in cancer, this study explored the effect of BMI on the prognosis of patients with HG B-NHL. Patients aged <18 years with newly diagnosed HG B-NHL were enrolled. Patients were divided into normal, overweight, obese, and emaciated BMI groups according to the growth criteria for children and adolescents. In total, 435 patients were enrolled in this study. There were 329 (75.6%), 46 (10.6%), 13 (3.0%), and 47 (10.8%) patients stratified into the normal, overweight, obese, and emaciated BMI groups, respectively. The event-free survival and overall survival rates of the entire cohort were 89.3% and 92.4%, respectively. The 5-year event-free survival rate for the patients with obese BMI was worse than those with overweight BMI (76.2% vs. 95.6%, p=.04). The 5-year overall survival rate for the patients with emaciated BMI was worse than those with normal (84.5% vs. 93.1%, p=.04) or overweight BMI (84.5% vs. 97.7%, p=.03). Cox multivariate analysis showed that obese or emaciated BMI at diagnosis was associated with an increased risk of death (p=0.04; HR,2.26) and was identified as an independent adverse prognostic factor in pediatric HG B-NHL. Obese or emaciated BMI at diagnosis is associated with poor prognosis in pediatric HG B-NHL and can be used for risk stratification.