European Association For The Study Of Obesity Research Articles

European Association for the Study of Obesity (EASO): a new framework for the diagnosis, staging and management of obesity in adults

Obesity is defined as chronic disease process. However, current guidelines for obesity are not aligned sufficiently with those adopted for other chronic diseases. The diagnosis of obesity is based solely on BMI values, not reflecting the role of adipose tissue distribution and function in the severity of the disease. Indications for using the different therapeutic approaches now available for obesity management remain mostly based on anthropometric measurements, rather than on a complete clinical evaluation. This contrast with other chronic diseases, for which therapeutic targets are set, and the choice of the treatment is based on the probability of reaching the target, with adequate and prompt treatment intensification if needed. To stimulate the development of clinical guidelines for obesity more aligned with those already in place for other chronic diseases, the European Association for the Study of Obesity (EASO) conducted a consensus process to propose a new framework for the diagnosis, staging and management of obesity in adults.

The Performance and Associated Risks of the Criteria for Sarcopenic Obesity Proposed by the European Association for the Study of Obesity in a Geriatric Population

Background: There is no gold standard definition of sarcopenic obesity (SO). Our objective is to evaluate the benefit of using the new definition proposed by the European Association for the Study of Obesity (EASO) in older people. Methods: Data from the Toledo Study of Healthy Aging, a study based on a cohort of community-dwelling older adults, were used. SO was defined according to the EASO and by a composite of the Foundation for the National Institute of Health (FNIH) for the diagnosis of sarcopenia and the WHO’s criteria for obesity (Body Mass Index, BMI ≥ 30 kg/m2; waist circumference, >88 cm for women and >102 cm for men). Frailty [Frailty Phenotype (FFP) and Frailty Trait Scale-5 (FTS5)] and disability (Katz Index) statuses were assessed at baseline and at the follow-up (median 2.99 years). Mortality at a 5-year follow-up was also assessed. The Logistic and Cox regression models were used to assess the associations. Results: Of the 1559 subjects (age 74.79 ± 5.76 years; 45.54% men), 30.15% (EASO/ESPEN) vs. 16.36% (FNIH) met the SO criteria (Kappa = 0.42). SO was associated with the prevalence of frailty by both the EASO’s [OR(95%CI): FFP: 1.70 (1.33–2.16); FTS-5 binary: 2.29 (1.60–3.27); β(95%CI): FTS-5 continuous 3.63 (3.00–4.27)] and FNIH+WHO’s criteria [OR (95%CI): 2.20 (1.61, 3.00)]. The FNIH + WHO’s criteria were cross-sectionally associated with disability [OR: 1.52 (1.07, 2.16); p-value 0.018], while the EASO’s criteria were not. The EASO’s criteria did not show any association at the follow-up, while the FNIH + WHO’s criteria were associated with incident frailty. Conclusions: The EASO’s new criteria for sarcopenic obesity demonstrate moderate agreement with the traditional definition and are cross-sectionally associated with adverse events, but they do not effectively predict the outcomes generally associated with sarcopenic obesity in older adults. Therefore, the performance of the EASO’s criteria in older people raises the need for refinement before recommending it for generalized use in this population.

Application of a new definition of sarcopenic obesity in middle-aged and older adults and association with cognitive function: Findings from the National Health and Nutrition Examination Survey 1999–2002

Background & aimsThe role of sarcopenic obesity (SO) in impaired cognitive function has been investigated in several observational studies, but results have been mixed. This study applied the proposed European Society for Clinical Nutrition and Metabolism (ESPEN)-European Association for the Study of Obesity (EASO) definition of SO to a representative population aged ≥50 years to identify the association between SO and cognitive function. MethodsData from the National Health and Nutrition Examination Survey 1999-2002 waves were used. At the screening phase, body mass index or waist circumference were used to evaluate obesity; sarcopenia was identified using the SARC-F questionnaire. At the diagnostic phase I and II, sarcopenia was assessed using knee extensor isometric strength and appendicular lean mass, and fat mass percent was used to assess obesity. Cognitive function in older participants (60-85 years) was assessed using the Digit Symbol Substitution Test. A self-reported memory question was used in middle-aged individuals (50-59 years). ResultsThe sample included 2,356 participants (men, 44.7%). The prevalence of SO was 32.3%, 21.2% and 15.0% at the screening, diagnosis phase I, and diagnosis phase II, respectively. Significant associations between SO and cognitive impairment were observed in individuals aged 60-85 at diagnosis phase I (OR: 2.3, 95%CI 1.4-3.8, P=0.007) and phase II (OR: 2.7, 95%CI 1.5-4.9, P=0.004). ConclusionThe new ESPEN-EASO definition of SO identified a high prevalence of SO cases. A significant association between SO and poor cognitive function in older individuals was observed.

Sarcopenia prevalence and risk factors in obese Tunisian adults.

Sarcopenia is a clinical condition defined as low skeletal muscle mass and function. It has been identified and described as a geriatric syndrome, but it may arise in individuals with obesity at any age. screen for sarcopenia in obese adults and identify the nutritional, clinical and biological risk factors associated with the development of sarcopenic obesity (SO+). Descriptive cross-sectional study, including 53 obese patients. Screening for sarcopenia has been established according to pathological thresholds proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Mean age was 44.34±13.51 years. Prevalence of Sarcopenia was 7.5% (SO+). The average intakes of calorie, lipids and saturated fatty acids were higher in SO+. A statistically significant relationship was found between low skeletal muscle mass (SMM/W) and the average intake of vitamin PP (p=0.014) and vitamin B9 (p=0.009). Mean BMI (45.86 kg/m² for SO+ versus 39.29 kg/m² for SO-; p=0.03) and mean visceral fat (16.55 l for SO+, versus 10.93 l for SO-; p=0.043) were significantly higher in SO+. A statistically significant relationship was found between insulin resistance and low (SMM/W), as attested by mean insulinemia (28.81 µIU/mL for low SMM/W, versus 14.48 µIU/mL for normal SMM/W; p=0.004) and HOMA index (7.94 for low SMM/W, versus 3.49 for normal SMM/W; p=0.002), which were higher in cases of low (SMM/W). We recommend promoting a balanced, low-energy-density diet to improve insulin sensibility and thus reduce the risk of sarcopenia. Regular physical activity is also strongly recommended.

Detecting sarcopenia in obesity: emerging new approaches.

Sarcopenic obesity is a likely common, but certainly underestimated obesity phenotype, with an important negative clinical impact. Its definition and diagnosis have however remained elusive until recently. Substantial progress has been recently made in sarcopenic obesity diagnostic tools, with the first international consensus proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Very encouraging results emerge from initial implementation of the ESPEN-EASO algorithm. In addition, even more recent progress in global consensus on sarcopenia conceptual definition is likely to further enhance consistency in sarcopenic obesity identification. The latter Global Leadership Initiative on Sarcopenia (GLIS) initiative also adopted a new definition of muscle specific strength. Its inclusion in sarcopenia diagnostic constructs opens the possibility of its potential evaluation in sarcopenic obesity, also considering the emerging positive impact of obesity treatment and fat loss on muscle functional parameters. New consensus tools for sarcopenic obesity diagnosis are likely to improve awareness, understanding, identification and treatment of this under-recognized obesity phenotype.

The diagnostic agreement of sarcopenic obesity with different definitions in Chinese community-dwelling middle-aged and older adults.

In 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched a consensus on the diagnostic methods for sarcopenic obesity (SO). The study aimed to identify the prevalence and diagnostic agreement of SO using different diagnostic methods in a cohort of subjects from West China aged at least 50 years old. A large multi-ethnic sample of 4,155 participants from the West China Health and Aging Trend (WCHAT) study was analyzed. SO was defined according to the newly published consensus of the ESPEN/EASO. Furthermore, SO was diagnosed as a combination of sarcopenia and obesity. The criteria established by the Asian Working Group for Sarcopenia 2019 (AWGS2019) were used to define sarcopenia. Obesity was defined by four widely used indicators: percent of body fat (PBF), visceral fat area (VFA), waist circumference (WC), and body mass index (BMI). Cohen's kappa was used to analyze the diagnostic agreement of the above five diagnostic methods. A total of 4,155 participants were part of the study, including 1,499 men (63.76 ± 8.23 years) and 2,656 women (61.61 ± 8.20 years). The prevalence of SO was 0.63-7.22% with different diagnostic methods. The diagnosis agreement of five diagnostic methods was poor-to-good (κ: 0.06-0.67). The consensus by the ESPEN/EASO had the poorest agreement with other methods (κ: 0.06-0.32). AWGS+VFA had the best agreement with AWGS+WC (κ = 0.67), and consensus by the ESPEN/EASO had the best agreement with AWGS+ PBF (κ = 0.32). The prevalence and diagnostic agreement of SO varies considerably between different diagnostic methods. AWGS+WC has the highest diagnostic rate in the diagnosis of SO, whereas AWGS+BMI has the lowest. AWGS+VFA has a relatively good diagnostic agreement with other diagnostic methods, while the consensus of the ESPEN/EASO has a poor diagnostic agreement. AWGS+PBF may be suitable for the alternative diagnosis of the 2022 ESPEN/EASO.

Sarcopenic Obesity and Outcomes for Patients With Cancer

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) have recently proposed a consensus definition and diagnostic criteria for sarcopenic obesity (SO). To implement the ESPEN-EASO diagnostic algorithm to investigate the prevalence of SO and its association with outcomes in patients with solid tumor cancers, with particular regard to associations among SO, overall survival (OS), and patient quality of life (QoL). This prospective cohort study included patients diagnosed with solid tumor starting in May 7, 2013, with the last follow-up on June 30, 2022. Patients with solid tumors were categorized into SO and non-SO groups according to ESPEN-EASO criteria. The primary outcome was OS and the secondary outcomes included patient QoL and risk of intensive care unit (ICU) admission. Data were analyzed from June to December 2023. A total of 6790 patients were included in the study (mean [SD] age, 59.64 [10.77] years; 3489 were female [51.4%]). The prevalence of SO was 4.36% (296 of 6790) in the whole cohort and 14.98% (296 of 1976) in the subgroup with obesity. SO prevalence increased with age. During a median (IQR) follow-up period of 6.83 (5.67-7.04) years, 2103 patients died. Cox regression analysis indicated that SO was independently associated with lower OS (hazard ratio [HR], 1.54; 95% CI, 1.23-1.92), which was observed in both men (HR, 1.51; 95% CI, 1.09-2.10) and women (HR, 1.53; 95% CI, 1.12-2.07). SO was also associated with poorer QoL and higher risk of ICU admission (odds ratio, 2.39; 95% CI, 1.06-5.29). Among the diagnostic components of SO, low hand grip strength (HGS) was the only SO component associated with poor OS (HR, 1.15; 95% CI, 1.04-1.28). This cohort study of SO found that SO was significantly associated with lower OS, poorer QoL, and higher risk of ICU admission. Weak HGS, 1 of the diagnostic conditions, was the only component of SO associated with OS. The ESPEN-EASO algorithm appears to be an applicable tool to identify cancer-associated SO, which represents a major clinical complication and factor associated with risk for poor outcomes in these patients.

Assessment of sarcopenic obesity as a predictor of pneumonia in patients with stable schizophrenia—A prospective study

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recently released the first international consensus on the diagnostic criteria for Sarcopenic obesity (SO). The present study aimed to explore the ability of SO to predict the risk of pneumonia in patients with stable schizophrenia. This was a prospective study involving hospitalized patients with schizophrenia aged ≥50 years from two mental health centers in western China. Baseline patient data were collected from September 1 to September 30, 2020. Follow-up data on pneumonia were collected from October 2020 to October 2022. The diagnosis of SO was based on the ESPEN/EASO criteria. Patients were assessed for handgrip strength (HGS), skeletal muscle mass/weight (SMM/W), and fat mass percentage (FM%). Logistic regression analysis was used to explore the effect of SO on the risk of pneumonia in patients with stable schizophrenia. A total of 320 patients with stable schizophrenia were included. Of these, 74 (23.13%) were diagnosed with SO, while 117 (36.56%) developed pneumonia. Compared with patients in the non-low HGS, non-low HGS+non-low SMM/W (or non-low HGS+low SMM/W or low HGS+non-low SMM/W) and non-SO groups, the proportions of patients with pneumonia in the low HGS (42.3% vs. 25.9%, p=0.004), low HGS+low SMM/W (45.3% vs. 33.3%, p=0.048), and SO (47.3% vs. 33.3%, p=0.029) groups, respectively, were higher. However, there was no difference in the proportion of patients with pneumonia in the low SMM/W group and the obese group compared with the non-low SMM/W and non-obese groups. Further logistic regression analysis after adjustment for potential influencing factors showed that compared with the non-low HGS group, patients in the low HGS group had a higher risk of pneumonia (OR=1.892, 95%CI: 1.096-3.264). SO defined according to the ESPEN/EASO criteria was not found to be significantly associated with the development of pneumonia in patients with stable schizophrenia. Further verification of these results is needed with larger sample sizes and the establishment of a cutoff value for this population.

The Impact of the Physical Activity Level on Sarcopenic Obesity in Community-Dwelling Older Adults

Previous studies have reported that low levels of physical activity result in sarcopenic obesity (SO). However, the effects of specific intensities of physical activity on SO and the optimal amount of physical activity for lowering the prevalence of SO have not been well studied. This study aimed to identify the effects of physical activity levels and intensity on SO and the optimal amount of physical activity related to a lower prevalence of SO. This cross-sectional study used data from the nationwide Korean Frailty and Aging Cohort Study (KFACS), which included 2071 older adults (1030 men, 1041 women). SO was defined according to the criteria of the European Society for Clinical Nutrition Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO). Multivariate logistic regression analysis was performed to investigate the association between the physical activity level and SO. The high activity group had a significantly lower prevalence of SO than the non-high activity (low and moderate activity) group. On the other hand, moderate-intensity physical activity was associated with a lower prevalence of SO. A total physical activity energy expenditure of > 3032 kcal/week (433 kcal/day) for men and 2730 kcal/week (390 kcal/day) for women was associated with a reduced prevalence of SO. The high physical activity and total physical energy expenditure described above may be beneficial for reducing the prevalence of SO.

Саркопения и саркопеническое ожирение

Sarcopenia is a progressive generalised skeletal muscle disorder that is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability and mortality. Sarcopenic obesity is a clinical and functional condition characterized by the coexistence of excess fat mass and sarcopenia. In 2018, the European Working Group on Sarcopenia in Older People presented updated data on sarcopenia (EWGSOP2). The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for sarcopenic obesity. This article contains the main provisions of the documents and a review of the literature on the mechanisms, diagnosis and clinical significance of sarcopenia and sarcopenic obesity.

Analysis of sarcopenic obesity prevalence and diagnostic agreement according to the 2022 ESPEN and EASO Consensus in hospitalized older adults with severe obesity.

Sarcopenic obesity (SO) is a clinical disorder characterized by increased adiposity and decreased muscle mass and function, commonly observed in older adults. However, most of the studies that investigated SO prevalence rates were not based on current standardized diagnostic methods. Thus, this study aims to estimate the prevalence rates of SO and their level of agreement using different instruments proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) Consensus, in a sample of hospitalized older adults with severe obesity. A cross-sectional study with 90 older adults (≥ 60 years) with severe obesity (body mass index ≥ 35 kg/m/²) seeking an in-hospital multidisciplinary body weight reduction program. Skeletal muscle function was assessed using the five-repetition Sit-Stand test (5-SSt) and Handgrip Strength (HGS). Body composition was evaluated by high percentages of fat mass (FM), low appendicular lean mass (ALM/W), and skeletal muscle mass (SMM/W), adjusted to body weight. The stage of SO was assessed on the presence of at least one comorbidity and specific cut-offs were adopted for each step. All analyses were performed according to gender and age range. The prevalence rates of SO in the total sample were 23.3%, 25.5%, 31.1%, and 40.0% considering altered values of 5-SSt+FM+ALM/W, HGS+FM+ALM/W, 5-SSt+FMSSM/W, and HGS+FM+SSM/W, respectively. Higher prevalence rates were observed among female and old elderly subgroups, regardless of the diagnostic combination. There were weak agreements between the muscle function tests (5-SSt versus HGS) using both muscle mass indexes in the total sample and all subgroups. Moderate agreements were observed between muscle mass indexes (SMM/W versus ALM/W) in the total sample, male and younger older adults (using 5-SSt), and strong agreements for men and younger older adults (using HGS). The discrepancies observed between the prevalence rates and their levels of agreement reinforce the need for new studies in similar populations aiming for better standardization of SO assessment.

Applicability of the Diagnostic Criteria for Sarcopenic Obesity Defined by ESPEN/EASO Criteria in Acutely Admitted Patients with Stroke: Prevalence and Association with Outcomes.

Few reports have described sarcopenic obesity in patients with stroke. This study aimed to investigate the prevalence of sarcopenic obesity, as defined by the European Society for Clinical Nutrition and Metabolism (ESPEN) and European Association for the Study of Obesity (EASO) consensus statement, in patients with acute stroke and to determine whether it was associated with improved physical function at discharge. This retrospective cohort study was conducted from May 2020 to November 2021 in patients with acute stroke. Sarcopenic obesity was determined using the ESPEN and EASO consensus statement. The main outcome was physical function based on the Functional Independence Measure motor score at discharge. Multiple regression analysis was conducted to evaluate the association between sarcopenic obesity and the Functional Independence Measure motor score. This study included 276 patients (182 men; mean age, 72.4 y). Sarcopenic obesity screened for obesity with body mass index >27.5 was found in 11 (4%) patients. Multiple regression analysis revealed that sarcopenic obesity screened for obesity with body mass index >27.5 was not significantly associated with the Functional Independence Measure motor score at discharge (β=0.038; 95% confidence interval: -0.046, 0.123; p=0.369). This study revealed a prevalence rate of 4% for sarcopenic obesity diagnosed by the ESPEN and EASO criteria and showed that sarcopenic obesity was not statistically associated with activities of daily living at acute discharge in patients with stroke.

Obesity and comorbidities in COVID-19: a longitudinal observational retrospective study of the main relationships of life risk

Introduction: Currently, around 30% of the world's population is overweight or obese. By 2030, it is estimated that more than 60% of the world's population will be overweight or obese. The COVID19 pandemic has resulted in the worsening of obesity comorbidities. The primary increase in the inflammatory response in obese patients functions as a predictor for the hyperinflammatory state observed in COVID-19. Therefore, this primary increase can be amplified by SARS-CoV-2 infection, increasing the production of cytokines such as TNF-α, IL-1, and IL-6. Objective: It was to carry out a retrospective longitudinal observational study to quantitatively analyze how cardiovascular comorbidities such as diabetes, hypertension, obesity, smoking, and compromised immunity contribute to the increased risk of life of participants affected by COVID-19. Methods: This study followed a longitudinal observational retrospective design (STROBE). A total of 45 public and official documents from Brazil (ANVISA), WHO (World Health Organization), Pan American Health Organization (PAHO), EASO (The European Association for the Study of Obesity - The European Commission/ National Information on COVID-19, Lancet Resource Centre) and scientific articles were subjected to eligibility analysis and, after that, 32 documents dated from 2019 to 2022 were selected. Results: In total, 3,993,857 participants were found from 32 documents. The highest incidence of deaths occurred in participants who were smokers, had compromised immunity, had diabetes, and were obese. The greatest risk of death was observed among participants who smoke (HR=2.5) and those with compromised immunity (HR=2.1). Despite this, other comorbidities such as diabetes, obesity, and hypertension also presented statistically significant results for the risk of life. It was observed that only the difference between the means of the comorbidities “obesity” and “diabetes” was not statistically significant, with p<0.05, that is, both comorbidities have similar impacts on the worsening and death of participants in the presence of COVID-19. Conclusion: Cardiovascular comorbidities such as diabetes, hypertension, obesity, smoking, and compromised immunity contributed to the increased risk of life in participants affected by COVID-19, especially in those of an older age. The endothelial dysfunction caused by SARS-CoV-2 explains why participants with comorbidities related to blood vessels such as cardiovascular disease, hypertension, diabetes, and obesity are more likely to develop severe COVID-19, even death

Sarcopenic obesity by the ESPEN/EASO criteria for predicting mortality in advanced non-small cell lung cancer

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recently released the first international consensus on the diagnostic criteria for sarcopenic obesity (SO), which recommended skeletal muscle mass adjusted for body weight (SMM/W) to determine low muscle mass. SMM adjusted for body mass index (SMM/BMI) appeared to be better associated with physical performance than SMM/W. Thus, we modified the ESPEN/EASO criteria by using SMM/BMI. We aimed (1) to evaluate the agreement of the ESPEN/EASO-defined SO (SOESPEN) and the modified ESPEN/EASO-defined SO (SOESPEN-M) with other commonly used SO definitions, and (2) to compare different SO definitions for predicting mortality in a prospective cohort with advanced non-small cell lung cancer (NSCLC). This prospective study included patients with advanced NSCLC. We defined SO according to five different diagnostic criteria: SOESPEN, SOESPEN-M, Asian Working Group for Sarcopenia (AWGS)-determined sarcopenia with BMI-determined obesity (SOAWGS), computed tomography-derived sarcopenia with BMI-determined obesity (SOCT), and fat mass to fat-free mass ratio >0.8 (SOFM). The outcome was all-cause mortality. Of the 639 participants (mean age 58.6 years, 229 women) we studied, 488 (76.4%) died during the median follow-up period of 25 months. SMM/BMI was significantly lower in the death group than in the survivor group (men: p=0.001, women: p<0.001), but SMM/W was not. Only 3 (0.47%) participants metall five SO diagnostic criteria. SOESPEN showed an excellent agreement with SOESPEN-M (Cohen's kappa=0.896), a moderate agreement with SOAWGS (Cohen's kappa=0.415), but poor agreements with SOCT and SOFM (Cohen's kappa=0.078 and 0.092, respectively). After full adjustment for potential confounders, SOESPEN (HR 1.54, 95% CI 1.26-1.89), SOESPEN-M (HR 1.56, 95% CI 1.26-1.92), and SOAWGS (HR 1.43, 95% CI 1.14-1.78) were significantly associated with mortality. However, SOCT (HR 1.17, 95% CI 0.87-1.58) and SOFM (HR 1.15, 95% CI 0.90-1.46) showed no significant association with mortality. SOESPEN showed an excellent agreement with SOESPEN-M, a moderate agreement with SOAWGS, but poor agreements with SOCT and SOFM. SOESPEN, SOESPEN-M, and SOAWGS were independent prognostic factors for mortality in our study population, but SOCT and SOFM were not. Although SMM/BMI was better associated with survival than SMM/W, SOESPEN-M did not show an advantage in predicting survival over SOESPEN.

Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity

Obesity was first recognised as a disease by WHO in 1948, then between 2013 and 2022 by several medical societies and countries. 1 WHO ConsultationAppropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363: 157-163 Summary Full Text Full Text PDF PubMed Scopus (8005) Google Scholar , 2 Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894: 1-253 Google Scholar , 3 Carruba MO Busetto L Bryant S et al. The European Association for the Study of Obesity (EASO) endorses the milan charter on urban obesity. Obes Facts. 2021; 14: 163-168 Crossref PubMed Scopus (3) Google Scholar , 4 American Society for Metabolic and Bariatric SurgeryConsensus statement on obesity as a disease. https://asmbs.org/resources/consensus-statement-on-obesity-as-a-diseaseDate: 2022 Date accessed: February 20, 2023 Google Scholar , 5 Bray GA Kim KK Wilding JPH World Obesity FObesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017; 18: 715-723 Crossref PubMed Scopus (577) Google Scholar , 6 Jastreboff AM Kotz CM Kahan S Kelly AS Heymsfield SB Obesity as a disease: the Obesity Society 2018 position statement. Obesity (Silver Spring). 2019; 27: 7-9 Crossref PubMed Scopus (152) Google Scholar , 7 Pollack A NY TimesA.M.A. recognizes obesity as a disease. https://www.nytimes.com/2013/06/19/business/ama-recognizes-obesity-as-a-disease.htmlDate: 2013 Date accessed: February 26, 2023 Google Scholar , 8 Mechanick JI Garber AJ Handelsman Y et al. American Association of Clinical Endocrinologists' position statement on obesity and obesity medicine. Endocr Pract. 2012; 18: 642-648 Summary Full Text Full Text PDF PubMed Scopus (92) Google Scholar However, the notion that obesity is a disease and not merely a risk factor for other illnesses remains highly controversial, both within and beyond medical circles. This debate constitutes far more than arcane semantics, and seriously affects the provision of therapeutic strategies to improve health among people living with obesity.

Sarcopenic obesity research perspectives outlined by the sarcopenic obesity global leadership initiative (SOGLI) – Proceedings from the SOGLI consortium meeting in Rome November 2022

The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched the Sarcopenic Obesity Global Leadership Initiative (SOGLI) to reach expert consensus on a definition and diagnostic criteria for Sarcopenic Obesity (SO). The present paper describes the proceeding of the Sarcopenic Obesity Global Leadership Initiative (SOGLI) meeting that was held on November 25th and 26th, 2022 in Rome, Italy. This consortium involved the participation of 50 researchers from different geographic regions and countries. The document outlines an agenda advocated by the SOGLI expert panel regarding the pathophysiology, screening, diagnosis, staging and treatment of SO that needs to be prioritized for future research in the field.

The Applicability of the ESPEN and EASO-Defined Diagnostic Criteria for Sarcopenic Obesity in Japanese Patients after Stroke: Prevalence and Association with Outcomes.

Sarcopenic obesity is of growing research and clinical interest; however, validated diagnostic criteria are lacking. We therefore aimed to examine the prevalence of sarcopenic obesity as diagnosed by the criteria recently proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO), and its association with outcomes among patients after stroke. This study was based on a cohort of 760 Japanese patients after stroke admitted to a post-acute rehabilitation hospital. Sarcopenic obesity was diagnosed at admission according to the ESPEN and EASO criteria using reference values specific to Asians. Outcomes included the motor domain of the functional independence measure (FIM-motor) and the food intake level scale (FILS) at discharge. Multivariate linear regression models were used to assess the associations between sarcopenic obesity and outcomes. Among 760 patients (median age, 73 years; 352 women and 408 men), sarcopenic obesity was diagnosed in 34 patients (4.5%; 5.4% of women and 4.1% of men). In multivariate analyses, sarcopenic obesity was independently and negatively associated with FIM-motor (β = −0.048, p = 0.031) and FILS at discharge (β = −0.095, p = 0.046) in women. In contrast, in men, sarcopenic obesity showed an independent negative association with FIM-motor at discharge (β = −0.117, p < 0.001) but no statistically significant association with FILS at discharge (β = −0.004, p = 0.323). In conclusion, the prevalence of sarcopenic obesity diagnosed by the ESPEN and EASO-defined criteria was as low as 4.5% among Japanese patients after stroke. Furthermore, sarcopenic obesity was negatively associated with improvements in activities of daily living and dysphagia.

Prevalence of sarcopenic obesity based on newly proposed diagnostic criteria and functional outcomes in older adults undergoing rehabilitation

In 2022, the European Society for Clinical Nutrition and Metabolism (ESPEN) and European Association for the Study of Obesity (EASO) working group proposed uniform diagnostic criteria for sarcopenic obesity. However, no study has adapted these criteria to an Asian population or examined sarcopenic obesity prevalence diagnosed using these criteria or its association with functional outcomes. This retrospective cohort study investigated sarcopenic obesity prevalence diagnosed based on the ESPEN and EASO criteria, and its association with functional outcomes in 1080 older Japanese patients (mean age 79.5 years, 43.5 % male) undergoing rehabilitation. Based on the mentioned criteria, sarcopenic obesity is defined as a BMI ≥ 25 kg/m2, increased percent body fat (PBF), reduced skeletal muscle mass (SMM), and low handgrip strength. Sarcopenic obesity prevalence was investigated using various ESPEN- and EASO-proposed definitions of increased PBF and reduced SMM. Functional outcomes were evaluated based on whether patients improved in the minimal clinically important difference (MCID) of the Functional Independence Measure (FIM). The prevalence was 4.3–5.3 %. Sarcopenic obesity was not independently related to FIM MCID achievement. Sarcopenic obesity prevalence—based on the ESPEN and EASO criteria—in older Japanese patients undergoing rehabilitation was low and was not associated with poor functional outcomes.

Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement

Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases), and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of an universally established SO Definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a Definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into Stage I in the absence of clinical complications, or Stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO Definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing datasets, to study the predictive value, treatment efficacy, and clinical impact of this SO definition.

Status of Weight Change, Lifestyle Behaviors, Depression, Anxiety, and Diabetes Mellitus in a Cohort with Obesity during the COVID-19 Lockdown: Turk-Com Study Group

Introduction: The coronavirus disease 2019 (COVID-19) pandemic led to a lockdown period. Confinement periods have been related to unhealthy lifestyle behaviors. Our study aimed to determine weight change, changes in eating and exercise habits, the presence of depression and anxiety, and diabetes mellitus (DM) status in a cohort of patients with obesity. Methods: The study was undertaken in nine centers of Collaborative Obesity Management (COM) of the European Association for the Study of Obesity (EASO) in Turkey. An e-survey about weight change, eating habits, physical activity status, DM status, depression, and anxiety was completed by patients. The International Physical Activity Questionnaire (IPAQ) score was used to determine physical activity in terms of metabolic equivalents (METs). A healthy nutrition coefficient was calculated from the different categories of food consumption. The Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) Questionnaire were used for determining depression and anxiety, respectively. Results: Four hundred twenty-two patients (age 45 ± 12.7 years, W/M = 350/72) were included. The healthy nutrition coefficient before the pandemic was 38.9 ± 6.2 and decreased to 38.1 ± 6.4 during the pandemic (p < 0.001). Two hundred twenty-nine (54.8%) patients gained weight, 54 (12.9%) were weight neutral, and 135 (32.3%) lost weight. Patients in the weight loss group had higher MET scores and higher healthy nutrition coefficients compared with the weight gain and weight-neutral groups (p < 0.001). The PHQ and GAD scores were not different between the groups. Percent weight loss was related to healthy nutrition coefficient (CI: 0.884 [0.821–0.951], p = 0.001) and MET categories (CI: 0.408 [0.222–0.748], p = 0.004). One hundred seventy patients had DM. Considering glycemic control, only 12 (8.4%) had fasting blood glucose <100 mg/dL and 36 (25.2%) had postprandial BG <160 mg/dL. When patients with and without DM were compared in terms of dietary compliance, MET category, weight loss status, PHQ-9 scores, and GAD-7 scores, only MET categories were different; 29 (11.7%) of patients in the nondiabetic group were in the highly active group compared with 5 (2.9%) in the diabetic group. Conclusion: The COVID-19 lockdown resulted in weight gain in about half of our patients, which was related to changes in physical activity and eating habits. Patients with DM who had moderate glycemic control were similar to the general population in terms of weight loss but were less active.