Impact Of Severe Obesity Research Articles

The Impact Of Severe Obesity (Class II/III) In The Middle-age On Cardiac Remodeling And Exercise Capacity

The Impact Of Severe Obesity (Class II/III) In The Middle-age On Cardiac Remodeling And Exercise Capacity

Impact of Severe Obesity on Major Perioperative Complications for Prolapse Surgery

(Abstracted from Urogynecology 2024;30:658–664) Discussions surrounding surgical approach and minimizing complications and perioperative risks are necessary for many surgeries. Obesity introduces additional variables and risks that need to be discussed in making decisions about pelvic reconstructive surgery, particularly because it is associated with comorbidities such as diabetes, cardiovascular disease, chronic kidney disease, and others.

Are patients with severe obesity aging faster? Impact of severe obesity on different aspects of biological age.

Obesity and aging are characterized by chronic low‑grade inflammation, which contributes to the onset of degenerative processes. Our objective was to comprehensively analyze the prevalence of premature aging in patients with obesity and identify metabolic factors influencing aging. In this prospective cohort study, telomere length, DNA damage, interleukin 6 (IL‑6) level, metabolic age, and cognitive functions were evaluated in patients with severe obesity (study group [SG], defined as body mass index [BMI] equal to or above 40 kg/m2 or equal to or above 35 kg/m2 with comorbidities; n = 100) and healthy volunteers (control group [CG], defined as BMI 18.5-24.9 kg/m2; n = 33). The SG was further divided into 2 subgroups, SG1 comprising patients with BMI equal to or above 50 kg/m2 and SG2 with BMI below 50 kg/m2. Our findings showed that individuals in the SG had shorter telomeres, higher levels of inflammation, and more advanced metabolic age than those in the CG. However, no significant differences in DNA damage or cognitive function abilities were observed between the groups. Notably, the SG1 displayed elevated IL‑6 levels as compared with the SG2. Furthermore, IL‑6 levels decreased significantly with increasing body fat, and the individuals with higher visceral fat levels had longer telomeres. Premature aging manifests in obesity through telomere length, inflammation levels, and metabolic age. Aging in obesity should be considered as a nonlinear process.

Myocardial ultrastructure of human heart failure with preserved ejection fraction.

Over half of patients with heart failure have a preserved ejection fraction (>50%, called HFpEF), a syndrome with substantial morbidity/mortality and few effective therapies1. Its dominant comorbidity is now obesity, which worsens disease and prognosis1-3. Myocardial data from patients with morbid obesity and HFpEF show depressed myocyte calcium-stimulated tension4 and disrupted gene expression of mitochondrial and lipid metabolic pathways5,6, abnormalities shared by human HF with a reduced EF but less so in HFpEF without severe obesity. The impact of severe obesity on human HFpEF myocardial ultrastructure remains unexplored. Here we assessed the myocardial ultrastructure in septal biopsies from patients with HFpEF using transmission electron microscopy. We observed sarcomere disruption and sarcolysis, mitochondrial swelling with cristae separation and dissolution and lipid droplet accumulation that was more prominent in the most obese patients with HFpEF and not dependent on comorbid diabetes. Myocardial proteomics revealed associated reduction in fatty acid uptake, processing and oxidation and mitochondrial respiration proteins, particularly in very obese patients with HFpEF.

Heparin Dosing During Percutaneous Coronary Intervention and Obesity.

Unfractionated heparin is the most common anticoagulant used during percutaneous coronary intervention. Practice guidelines recommend an initial weight-based heparin bolus dose between 70 and 100 U/kg to achieve target activated clotting time (ACT) of 250-300 seconds. The impact of severe obesity on weight-based heparin dosing is not well studied. We performed a retrospective analysis of 424 patients undergoing percutaneous coronary intervention who received heparin for anticoagulation. We collected detailed data on cumulative heparin administration and measured ACT values in this cohort. We performed separate analyses to identify clinical predictors that may affect dose-response curves. There was significant variability in dosing with mean dose of 103.9 ± 32-U/kg heparin administered to achieve target ACT ≥ 250 seconds. Women received higher initial heparin doses when adjusted for weight than men (97.6 ± 31 vs. 89 ± 28 U/kg, P = 0.004), and only 49% of patients achieved ACT ≥ 250 s with the initial recommended heparin bolus dose (70-100 U/kg). Lower heparin dose (U/kg) was required in obese patients to achieve target ACT. In multivariate linear regression analysis with ACT as dependent variable, after inclusion of weight-based dosing for heparin, body mass index was the only significant covariate. In conclusion, there is significant variability in the therapeutic effect of heparin, with a lower weight-adjusted heparin dose required in obese patients.

Impact of Severe Obesity on Major Perioperative Complications for Prolapse Surgery.

Obesity adds complexity to the decision of surgical approach for pelvic organ prolapse; data regarding perioperative complications are needed. The aim of the study was to evaluate associations of body mass index (BMI) and surgical approach (vaginal vs laparoscopic) on perioperative complications. Patients who underwent prolapse surgery were identified via the Current Procedural Terminology codes from the American College of Surgeons National Surgical Quality Improvement Program database 2007-2018. Thirty-day major complications were compared across BMI to identify an inflection point, to create a dichotomous BMI variable. Multivariable logistic regression was used to assess the association between BMI and complications. An interaction term was introduced to evaluate for effect modification by operative approach. A total of 26,940 patients were identified (25,933 BMI < 40, 1,007 BMI ≥ 40). The proportion of patients experiencing a major complication was higher in the BMI ≥ 40 group (2.0 vs 1.1%, P = 0.007). In multivariate analysis, the odds of a major complication was 1.8 times higher for women with a BMI ≥ 40 (95% confidence interval, 1.1-2.9, P = 0.04). There was a significant interaction between operative approach and BMI; therefore, further analyses were restricted to either vaginal or laparoscopic operative approaches. Among women who underwent vaginal prolapse repair, there was no difference in the odds of a major complication (adjusted odds ratio, 1.4; 0.8-2.4; P = 0.06). Among women who underwent laparoscopic repair, those with a BMI ≥ 40 were 6 times more likely to have a major complication (adjusted odds ratio, 6.0; 2.5-14.6; P < 0.001). Body mass index ≥ 40 was associated with an increased odds of a 30-day major complication. This association was greatest in women who underwent a laparoscopic prolapse repair.

Intersection of sepsis, atrial fibrillation, and severe obesity: a population-based analysis in the United States.

Atrial fibrillation (AF) is an indicator of poor prognosis in patients with sepsis and can increase the risk of stroke and mortality. Data on the impact of severe obesity on the outcomes of sepsis complicated by AF remains poorly understood. National Inpatient Sample (2018) and ICD-10 CM codes were used to identify the principal sepsis admissions with AF. We assessed comorbidities and outcomes of sepsis in people without obesity (BMI < 30) vs. non-severe obesity (BMI 30-35) and severe obesity (BMI > 35) cohorts. We also did a subgroup analysis to further stratify obesity based on metabolic health and analyzed the findings. The primary outcomes were the prevalence and adjusted odds of AF, AF-associated stroke, and all-cause mortality in sepsis by obesity status. Multivariable regression analyses were adjusted for patient- and hospital-level characteristics and comorbidities. Our main analysis showed that of the 1,345,595 sepsis admissions, the severe obesity cohort was the youngest (median age 59 vs. non-severe 64 and people without obesity 68 years). Patients with obesity, who were often female, were more likely to have hypertension, diabetes, congestive heart failure, chronic pulmonary disease, and chronic kidney disease. The crude prevalence of AF was highest in non-severe obesity (19.9%). The adjusted odds of AF in non-severe obesity (OR 1.21; 95% CI:1.16-1.27) and severe obesity patients with sepsis (OR 1.49; 95% CI:1.43-1.55) were significantly higher than in people without obesity (p < 0.001). Paradoxically, the rates of AF-associated stroke (1%, 1.5%, and 1.7%) and in-hospital mortality (3.3%, 4.9%, and 7.1%) were lowest in the severe obesity cohort vs. the non-severe and people without obesity cohorts, respectively. On multivariable regression analyses, the all-cause mortality revealed lower odds in sepsis-AF patients with severe obesity (OR 0.78; 95% CI:0.67-0.91) or non-severe obesity (OR 0.63; 95% CI:0.54-0.74) vs. people without obesity. There was no significant difference in stroke risk. A higher prevalence of cardiovascular comorbidities can be linked to a higher risk of AF in people with obesity and sepsis. Paradoxically, lower rates of stroke and all-cause mortality secondary to AF in people with obesity and sepsis warrant further investigation.

Are severe obese patients aging faster? The impact of severe obesity on different markers of biological age

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Impact of severe obesity in the management of patients with high-risk endometrial cancer: A FRANCOGYN study

ObjectiveTo assess the surgical management and survival of severely obese patients with high-risk endometrial cancer. Materials and methodsData from 269 patients with high-risk endometrial cancer who were treated between 2001 and 2018 were collected from a multicenter database (11 centers). We classified the patients according to their BMI and compared outcomes in two groups: a normal weight group of women with a BMI < 25 kg/m2, and a severe obesity group of women with a BMI ≥ 35 kg/m2. The groups were compared for epidemiologic, pathologic, management, relapse-free survival (RFS) and overall survival (OS) elements. ResultsPatients in the severe obesity group were younger (64 years vs. 68 years, p < 0.05) and had more comorbidities (hypertension, diabetes). They also had more locally advanced tumors and pelvic lymph node involvement (47% vs 24%, p < 0.05). The severely obese patients were less likely to undergo recommended surgical staging, with fewer lumbar aortic dissections than women of normal weight (23% vs 36%, p < 0.05) and fewer pelvic sentinel lymph node biopsies (26.5% vs 12.1%, p < 0.05). No difference in RFS or OS were observed between the two groups. ConclusionPatients with severe obesity and high-risk endometrial cancer have more locally advanced tumors, and are less likely to be managed according to surgical recommendations. However, RFS and OS do not seem to be affected.

The impact of severe obesity on home health care agency admission: An organizational perspective

ABSTRACT Home health care is a growing treatment option for older adults who wish to remain in their homes and communities. However, the growing number of older adults with severe obesity presents a challenge for home health professionals. This study utilizes survey data from 128 home health care agencies in Arkansas and Pennsylvania to explore home health care agencies’ decision-making in admitting patients with severe obesity. The responding agencies indicated that concerns about adequate staffing levels were the primary barriers to entry for severe obesity patients. Existing research on the intersection of obesity and home health care is sparse, and this study adds an organizational perspective to the scant literature on the topic. Additional research on this topic is advised to accommodate the expected growth in home health care utilization and rising obesity rates among older adults.

Impact of severe obesity on exercise performance in heart failure with preserved ejection fraction.

BackgroundObesity plays an important role in functional impairment in HFpEF. The mechanisms underlying decreased functional capacity in obese HFpEF are not clear. We assessed the cardiac and peripheral determinants of exercise performance in HFpEF patients with class 2 obesity in the upright position, representative of posture when performing functional activities.Methods and ResultsThirty‐two HFpEF patients were divided into two groups by presence of class 2 obesity (C2, BMI ≥ 35 kg/m2, n = 14) and non‐C2 (BMI < 35 kg/m2, n = 18). Participants performed a bout of submaximal exercise followed by incremental stages of treadmill exercise to determine peak aerobic power (peak VO2). Peak VO2 and Ve/VCO2 were measured using Douglas bags while cardiac output (Qc) and stroke volume (SV) were measured by acetylene rebreathing. The C2 group were younger than the non‐C2 group (67 ± 6 versus 73 ± 6 years; p = .009). Comorbid condition burden was similar between groups. Peak VO2 indexed to body mass was not significantly different between groups. Absolute peak VO2 was higher in the C2 group secondary to a larger peak Qc (14.3 versus 11.0 L/min; p = .012). SV reserve was also higher in the C2 group (72 versus 49%; p = .038).ConclusionHFpEF patients with severe obesity had similar cardiorespiratory fitness compared to patients with lower BMI with similar comorbidity burden. Absolute VO2 was actually higher in the severely obese driven by larger Qc and SV reserve arguing against significant effects from obesity per se on aerobic performance. The presence of a larger “cardiac engine” may offer potential for fat‐loss strategies to improve impairments in functional capacity in obese patients with HFpEF.

Impact of severe obesity on long-term success and complications of the retropubic midurethral sling.

With conflicting evidence in the literature, we hypothesised that the long-term subjective outcomes of the retropubic midurethral sling (MUS) are the same in the severely obese and non-obese populations. A retrospective matched cohort study was performed on women with a BMI ≥ 35 and < 30 who had a retropubic MUS placed between 2010 and 2015 using telephone questionnaires. The primary outcome was the success rate of surgery defined by the Urogenital Distress Inventory Short Form (UDI-6) stress subscale. Statistical analysis was performed to test for associations between primary and secondary outcomes across the two groups. Seventy-eight severely obese (SOG) and 74 non-obese (NOG) were recruited. At a median time from surgery of 3.8years the success rate was 47.4% in the SOG compared to 64.9% in the NOG (p= 0.03). There was a 22% reduction in the odds of success with every 5 unit increase in BMI (p= 0.03). There were higher rates of mixed urinary incontinence preoperatively (60.3% vs. 37.8%, p= 0.006) and persistent urinary urge incontinence postoperatively (48.7% vs. 32.4% p= 0.04) in the severely obese. Lower PGI-I scores were obtained in the severely obese group indicating less improvement in symptoms from surgery. There was no difference in complication rates between the groups. Long-term subjective outcomes from the retropubic MUS are lower in severely obese women than in non-obese women with no difference in complication rates. High satisfaction and recommendation rates were found in both groups.

A484 The Impact of Severe Obesity on Pituitary Gland Structure

A484 The Impact of Severe Obesity on Pituitary Gland Structure

Impact of severe obesity on cardiovascular risk factors in youth

Rising degree of obesity has been shown to predict increased metabolic risk in obese children and adolescents (1). Nonetheless, it is unclear if BMI categories can be successfully applied to populations of obese children and adolescents for a risk-adapted stratification of therapeutic approaches, and here especially for the indication of pharmacologic and bariatric interventions. Here, Zabarsky et al. demonstrate the limitations of a simple, BMI-based categorization of the degree of obesity in the pediatric age range. As has been shown before, clustering of cardiovascular risk factors rises significantly with increasing degree of obesity and also with increasing weight gain during follow-up. But importantly, the “dose-response” relationship between obesity and metabolic risk seems to plateau above the threshold for class III obesity (BMI 140-160% of the 95th percentile), which – according to the authors – roughly corresponds to an adult BMI >40 kg/m2 in their population. Therefore, the challenge of developing an accurate and easy-to-use clinical classification system for metabolic risk specifically in severely obese children and adolescents remains unsolved for now.

Impact of Severe Obesity on Cardiovascular Risk Factors in Youth

To compare cardiovascular risk factor clustering (CVRFC) in severely obese youth with those with lower degrees of obesity. We divided a childhood obesity clinic derived cohort into the degrees of obesity (class I, II, and III) and added a "class IV" category corresponding to >160% of the 95th centile of body mass index (BMI) for age and sex. In a cross-sectional analysis, we investigated the presence of CVRFC in 2244 participants; in 621 who were followed longitudinally, we investigated the determinants of endpoint CVRFC. Class IV obesity was associated with increased risk for CVRFC compared with overweight (OR = 17.26, P < .001) at a similar magnitude to class III obesity (OR = 17.26, P < .001). Male children were at greater risk for presence of CVRFC (OR = 1.57, P = .03) compared with female children. Adiponectin (OR = 0.90, P < .001) and leptin levels (OR = 0.98, P = .008) were protective, independent of degree of obesity. Baseline class IV obesity was associated with increased risk compared with overweight of having CVRFC at follow-up (OR = 5.76, P = .001), to a similar extent as class III obesity (OR = 5.36, P = .001). Changes in the degree of obesity were significant predictors of CVRFC on follow-up (OR = 1.04, P < .01 per percent BMI change). The metabolic risk associated with obesity in childhood is conferred prior to reaching class IV obesity. An individualized risk stratification approach in children with severe obesity should be based on presence of complications rather than simple BMI cutoffs. ClinicalTrials.gov NCT01967849.

The Impact of Severe Obesity on Healthcare Resource Utilisation in Spain.

Obesity is not only a health problem but also a source of increased monetary expenditures. The objectives of this study were to analyse the use of healthcare resources in the Spanish adult population with class II obesity and above (BMI ≥35kg/m2) and to compare it with other BMI groups. We used the Spanish National Health Survey, a longitudinal population-based survey (n=18,682), to analyse healthcare resource utilisation by BMI groups. Adjusted and unadjusted logistic regression models were used to calculate odds ratios (OR) for healthcare use among class II and over obese subjects versus normal BMI. Persons with BMI ≥35 are more likely to attend general practitioner (GP)'s consultations (17%), to visit the emergency department (26%), to consume medications (36%), to be hospitalised (49%), to require nursing consultations (61%) and to require psychology consultations (83%). The proportion of obese people receiving home visits is 2.6 times higher than among normal BMI. After controlling for sex and age groups, people with severe obesity (BMI ≥35kg/m2) were more prone to requiring home care visits (OR 2.3; CI [1.3; 4.2]), GP visits (OR 2.1; CI [1.5; 3.0]), psychologist visits (OR 1.96; CI [1.3; 2.99]), emergency service visits (OR 1.5; CI [1.2; 1.8]), nurse visits (OR 1.46; CI [1.2; 1.9]) and hospitalisations (OR 1.43; CI [1.1; 1.9]) and after also adjusting for relevant comorbidities like hypertension, diabetes and cardiovascular diseases: GP visits (OR 1.85; CI [1.3; 2.7]), psychologist visits (OR 1.8; CI [1.2; 2.7]), specialised care visits (OR 0.92; CI [0.7; 1.2]) and physiotherapist visits (OR 0.7; CI [0.5; 1.0]). Severe obesity significantly increases healthcare resource utilisation in Spain. The results shed light on the real magnitude of the burden of obesity in Spain.

Impact of severe obesity and weight loss on systolic left ventricular function and morphology: Assessment by two-dimensional speckle-tracking echocardiography

Impact of severe obesity and weight loss on systolic left ventricular function and morphology: Assessment by two-dimensional speckle-tracking echocardiography

Impact of Severe Obesity and Weight Loss on Systolic Left Ventricular Function and Morphology: Assessment by 2-Dimensional Speckle-Tracking Echocardiography.

Obesity is associated with an increased risk of heart failure. Little is known about the impact of dietary changes on the cardiac sequelae in obese patients. Twenty-one obese subjects underwent a 12-week low calorie fasting phase of a formula diet. Transthoracic two-dimensional speckle-tracking echocardiography was performed to obtain systolic left ventricular strain before and after weight loss. Body mass index decreased significantly from 38.6 ± 6.2 to 31.5 ± 5.3 kg/m2, and the total percentage fat loss was 19%. Weight reduction was associated with a reduction in blood pressure and heart rate. Left ventricular longitudinal global peak systolic strain was in the lower normal range (−18.7 ± 3.2%) before weight loss and was unchanged (−18.8 ± 2.4%) after 12 weeks on diet with substantial weight loss. Also, no significant change in global radial strain after weight loss was noted (41.1 ± 22.0 versus 43.9 ± 23.3, p = 0.09). Left atrial and ventricular dimensions were in normal range before fasting and remained unchanged after weight loss. In our study obesity was associated with normal systolic left ventricular function. A 12-week low calorie diet with successful weight loss can reduce blood pressure and heart rate. Systolic left ventricular function and morphology were not affected by rapid weight reduction.

Poor mental health in severely obese patients is not explained by the presence of comorbidities.

The prevalence of obesity, especially severe obesity where body mass index (BMI) exceeds 40 kg m(-2) and where the physical risks are greatest, is increasing. However, little is known about the impact of severe obesity on psychological well-being and self-rated health (SRH). We aimed to investigate this relationship in patients attending an Irish weight management clinic. SRH was measured with a single-item inventory (excellent = 1, poor = 5). Well-being was measured with the validated World Health Organization-Five Well-being Index (WHO-5), in which scores <13 indicate poor well-being. Previous studies of the Irish population have reported mean SRH = 2.56 (males) and 2.53 (females) and mean well-being = 16.96. One hundred eighty-two (46.8%) completed questionnaires were returned. The sample was representative of the clinic population with a mean age of 47.1, mean baseline BMI of 51.9 kg m(-2) and 64.3% females. Mean SRH was 3.73 in males and 3.30 in females; mean well-being was 10.27 in males and 10.52 in females. In the final multivariable models, number of medications, depression and obstructive sleep apnoea, WHO-5 and current BMI were significant predictors of SRH, and secondary level education, social support and mindfulness scores were significant predictors of psychological well-being. Number of medications was not significant. The results suggest that the poor psychological well-being seen is not explained by the presence of comorbidities and that social support and mindfulness may be important targets for improving psychological well-being. Improving psychological well-being in addition to weight loss and effective management of comorbidities may be important for improving SRH.

The Impact of Severe Obesity on Post-Acute Rehabilitation Efficiency, Length of Stay, and Hospital Costs

Background and Objective. The purpose of this retrospective observational study was to examine the influence of severe obesity on length of stay (LOS), rehabilitation efficiency, and hospital costs post-acute rehabilitation in a population-based, tertiary care, publicly-funded regional rehabilitation center. Participants. 42 severely obese subjects (mean age 53 y; mean BMI 50.9 kg/m2) and 42 nonobese controls (mean age 59 y; mean BMI 23.0 kg/m2) matched by sex and admitting diagnosis. Main Outcome Measures. Total LOS, rehab LOS, waiting for transfer LOS, Fuctional Independence Measure (FIM) efficiency, and hospital costs. Results. Compared to controls, severely obese subjects experienced longer total LOS (98.4 vs. 37.4 days; P = 0.03), rehabilitation LOS (55.8 vs. 37.4 days; P = 0.04), and waiting for transfer LOS (42.6 vs. 0 days; P = 0.006); increased hospital costs ($115,822 vs. $43,969; P = 0.03); and similar FIM efficiency (0.58 vs. 0.67; P = 0.27). Severe obesity was an independent predictor of total LOS (beta-coefficient 0.51; P = 0.03), rehab LOS (0.46; P = 0.02) but not FIM efficiency (−0.63; P = 0.06). Conclusion. Severe obesity adversely affects rehabilitation LOS and expenditures. Targeted interventions in severely obese individuals to optimize post-acute rehabilitation care delivery are needed.