Magnitude Of Weight Loss Research Articles

A diabetologist's perspective of non-alcoholic steatohepatitis (NASH): Knowledge gaps and future directions.

There is a close link between steatohepatitis (NASH) and Type 2 diabetes (T2DM). Recently, the American Diabetes Association (ADA) recommended screening for NASH and advanced fibrosis in patients with diabetes and hepatic steatosis or elevated plasma alanine aminotransferase (ALT). This is because as many as ~30% to 40% may have NASH and ~10% to 15% advanced fibrosis. The role of hyperglycemia and the natural history of NASH in diabetes remain poorly understood, as well as which diagnostic algorithm or interventions are most cost-effective. There is significant clinical inertia and most patients today are still not receiving adequate lifestyle intervention or pharmacological treatment with diabetes agents known to be effective against NASH. Lifestyle intervention improves steatohepatitis in proportion to the magnitude of weight loss, but this trend is not as consistent for regression of fibrosis. This limited success supports the need for concomitant pharmacological therapy. Pioglitazone has been shown to consistently induce resolution of NASH in both patients with or without diabetes in a total of 498 participants in five randomized controlled trials (RCTs), but with modest effects on liver fibrosis. Proof-of-concept studies suggest a potential role for GLP-1RAs and SGLT2 inhibitors. Combination therapy is on the horizon. Treating diabetes and NASH with a combination of pioglitazone, GLP-1RAs or SGLT2i, could be a cost-effective strategy to treat both diseases while reducing their high cardiovascular risk. Future combination therapies will likely combine existing diabetes agents with novel NASH-spechfic drugs under development. This review highlights current knowledge gaps and proposes future directions for the treatment of NASH in diabetes.

Weight control practices, beliefs, self-efficacy, and eating behaviors in college weight class athletes.

BACKGROUND/OBJECTIVESThis study aimed to examine differences in weight control practices, beliefs, self-efficacy, and eating behaviors of weight class athletes according to weight control level.SUBJECTS/METHODSSubjects were weight class athletes from colleges in Gyeong-gi Province. Subjects (n = 182) responded to a questionnaire assessing study variables by self-report, and data on 151 athletes were used for statistical analysis. Subjects were categorized into High vs. Normal Weight Loss (HWL, NWL) groups depending on weight control level. Data were analyzed using t-test, ANCOVA, χ2-test, and multiple logistic regressions.RESULTSSeventy-three percent of subjects were in the HWL group. The two groups showed significant differences in weight control practices such as frequency (P < 0.01), duration and magnitude of weight loss, methods, and satisfaction with weight control (P < 0.001). Multiple logistic regression showed that self-efficacy (OR: 0.846, 95% CI: 0.730, 0.980), eating behaviors during training period (OR: 1.285, 95% CI: 1.112, 1.485), and eating behaviors during the weight control period (OR: 0.731, 95% CI: 0.620, 0.863) were associated with weight control level. Compared to NWL athletes, HWL athletes agreed more strongly on the disadvantages of rapid weight loss (P < 0.05 – P < 0.01), perceived less confidence in controlling overeating after matches (P < 0.001), and making weight within their weight class (P < 0.05). HWL athletes showed more inappropriate eating behaviors than NWL athletes, especially during the weight control period (P < 0.05 – P < 0.001).CONCLUSIONSSelf-efficacy was lower and eating behaviors during pre-competition period were more inadequate in HWL athletes. Education programs should include strategies to help athletes apply appropriate methods for weight control, increase self-efficacy, and adopt desirable eating behaviors.

Adherence to Mediterranean Diet or Physical Activity After Bariatric Surgery and Its Effects on Weight Loss, Quality of Life, and Food Tolerance.

To assess whether a healthy dietary pattern or physical activity after bariatric surgery mediates the effects of surgery on weight loss, the quality of life, or food tolerance. A prospective observational study conducted in the context of a randomized controlled trial. We assessed the extent to which increasing or decreasing adherence to the Mediterranean diet (MedDiet)-assessed by MEDAS (Mediterranean Diet Adherence Screener)-and of increasing or decreasing physical activity (PA)-assessed with the Short Questionnaire of International PA (IPAQ-Short Q)-after bariatric surgery affected changes in weight, body mass index (BMI), quality of life (Moorehead-Arlet Questionnaire), and food tolerance (Suter test). Assessments were recorded at baseline and quarterly up to 12 months of surgery. Seventy-eight morbidly obese participants undergoing bariatric surgery were assessed up to 1 year after surgery. Those individuals who increased adherence to MedDiet showed a significantly higher mean of total weight loss percentage than those who decreased or maintained their adherence during follow-up: 37.6% (35.5-39.8) versus 34.1% (31.8-36.5) (p = 0.036). No significant differences were observed in changes in weight or BMI comparing individuals who increased their PA versus those who maintained or decreased PA, nor in quality of life or food tolerance between those individuals who increased versus those who decreased adherence to MedDiet or PA during the follow-up. After bariatric surgery, morbidly obese subjects present greater weight loss if they adhere to the MedDiet. PA after surgery is not associated with the magnitude of weight loss nor the quality of life and tolerance to diet.

Neglecting regression to the mean continues to lead to unwarranted conclusions: Letter regarding "The magnitude of weight loss induced by metformin is independently associated with BMI at baseline in newly diagnosed type 2 diabetes: Post-hoc analysis from data of a phase IV open-labeled trial".

As the prevalence of type 2 diabetes mellitus and obesity increases worldwide, scientifically rigorous research is needed in this field to determine effective interventions for the prevention and treatment of these chronic diseases. In a recent study published in this journal, Zhou et al. conclude that metformin, a drug used for treatment of type 2 diabetes mellitus, can be used effectively for weight loss, and that this effect is even more pronounced in individuals who weigh more at baseline. Unfortunately, we believe these results to be due to the regression to the mean (RTM) phenomenon, which weakens the causal inference proposed in this study. The conclusions of Zhou et al. that metformin is an effective strategy for weight loss in individuals with type 2 diabetes mellitus are not substantiated due to the lack of a control group and failure to consider other factors that may have confounded these results.

Body contouring in adolescents after bariatric surgery.

Bariatric surgery leads to sustained weight loss and resolution of obesity-associated co-morbidities in severely obese adolescents. However, one consequence of massive weight loss is excess skin and soft tissue. Many details regarding the timing, outcomes, and barriers associated with body contouring surgery (BCS) in youth who have undergone bariatric surgery are unknown. Describe the incidence and effect of BCS following bariatric surgery among adolescents. University Hospitals. Teen-Longitudinal Assessment of Bariatric Surgery is a prospective multi-institutional study of 242 adolescents who underwent bariatric surgery from 2007 to 2012. Utilization of BCS was analyzed in this population with comparison of anthropometrics and excess skin-related symptoms between those who did and those who did not undergo BCS. Among the 198 study participants with BCS data available, 25 (12.6%) underwent 41 body contouring procedures after bariatric surgery. The most common BCS was panniculectomy (n = 23). Presence of pannus-related symptoms at baseline and the magnitude of weight loss within the first year after bariatric surgery were independently associated with subsequent panniculectomy (P=.04 and P = .03, respectively). All adolescents who underwent panniculectomy experienced resolution of pannus-related symptoms. At 5 years after bariatric surgery, 74% of those who did not undergo panniculectomy reported an interest in the procedure, and 58% indicated that cost/insurance coverage was the barrier to obtaining BCS. Few adolescents who underwent bariatric surgery later underwent BCS procedures. Panniculectomy effectively treated pannus-related symptoms. Disparities in access to surgical care for adolescents who desire BCS warrants further investigation.

Association Between Weight Loss and Glycemic Outcomes: A Post Hoc Analysis of a Remote Patient Monitoring Program for Diabetes Management.

Background: Evidence-based guidelines for the management of type 2 diabetes (T2D) consist of blood glucose monitoring, medication adherence, and lifestyle modifications that may particularly benefit from reminders, consultation, education, and behavioral reinforcements through remote patient monitoring (RPM). Objectives: To identify predictors of weight loss and to examine the association between weight loss and hemoglobin A1C (HbA1C) outcomes for T2D patients who were enrolled in an RPM program for diabetes management. Materials and Methods: The study applied logistic and ordinary least-squares regression models to examine the relationship between baseline characteristics and the likelihood of weight loss during the RPM, and how the magnitude of weight loss was related to changes in HbA1C outcomes for 1,103 T2D patients who went through 3 months of RPM from 2014 to 2017. Results: Older patients were 3% more likely to have weight loss (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.02-1.05), whereas patients with higher baseline HbA1C had 9% reduced odds (OR, 0.91; 95% CI, 0.85-0.97) of experiencing weight loss. For every pound of weight lost, there was a 0.02-point (95% CI, 0.01-0.03) reduction on the HbA1C measured at the end of the RPM. Moreover, compared with those who had weight loss of ≤3%, participants who had lost 5-7%, or >7% of their baseline weight had a 0.37- and 0.58-point reduction in HbA1C, respectively. Conclusions: This study revealed a notable relationship between weight loss and positive HbA1C outcomes for T2D patients in an RPM-facilitated diabetes management program, which pointed to the potential of integrating evidence-based lifestyle modification programs into future telemedicine programs to improve diabetes management outcomes.

Lessons Learned from the POUNDS Lost Study: Genetic, Metabolic, and Behavioral Factors Affecting Changes in Body Weight, Body Composition, and Cardiometabolic Risk.

This paper reviews the genetic and non-genetic factors that provided predictions of, or were associated with, weight loss and other metabolic changes in the POUNDS Lost clinical trial of weight loss. This trial randomized 811 individuals who were overweight or obese to one of four diets that contained either 15% or 25% protein and 20% or 40% fat in a 2× 2 factorial design. A standard behavioral weight loss program was available for all participants who were followed for 2years with an 80% completion rate. Nineteen genes and five genetic risk scores were used along with demographic, behavioral, endocrine, and metabolic measurements. Genetic variations in most of the genes were associated with weight loss, but this association often varied with the dietary assignment. A number of demographic and behavioral factors, including attendance at behavioral sessions and food cravings were predictive of weight changes. A high baseline level of free triiodothyronine or free thyroxine predicted the magnitude of weight loss. Several perfluoroakyl compounds predicted more rapid weight regain. Genetic evidence from POUNDS Lost provides guidance toward selection of a personalized weight loss diet and improvement in metabolic profile. There is still room for additional research into the predictors of weight loss.

742-P: Magnitude of A1C Improvement in Relation to Weight Loss after Intensive Lifestyle Intervention in Real-World Diabetes Practice: Thirteen Years of Observation

The effect of intensive lifestyle intervention (ILI) on A1C in real-world clinical practice is inconsistent and is frequently underestimated. It is also presumed that the magnitude of A1C improvement is solely dependent on the amount of weight loss. In this study we report the magnitude of A1C change in a large cohort of patients with diabetes who underwent ILI over 13 years in relation to their baseline A1C and the amount of weight loss. We evaluated 590 diabetic patients (age 52.5±11 years, 58.6% females, A1C 7.7±1.4%, weight 105.54±18.6 Kg, BMI 36.7±5.1 Kg/m2, diabetes duration 10.9±9.8 years, 83.7% with type 2 diabetes), who enrolled in the Weight Achievement and Intensive Treatment (Why WAIT) program, a 12-week multidisciplinary ILI designed for real-world clinical practice between September 2005 and May 2018. We stratified patients based on baseline A1C into three groups: group A with A1C 9% (16.95% of participants), group B with A1C from 8 to &amp;lt;9% (19.15% of participants), and group C with A1C &amp;lt;8% (63.9% of participants). After 12 weeks of intervention, body weight decreased by 8.5±4.6 Kg in group A, 8.0±4.6 Kg in group B, and 7.6±5.8 Kg in group C (p=0.22 between groups). A1C decreased by 2.5±1.3% in group A, 1.2±0.8% in group B and 0.5±0.6% in group C (p&amp;lt;0.001 between groups). Pairwise comparisons of A1C changes between groups showed that: group A had 1.3% greater A1C reduction than group B (p=0.0001) and 2% greater A1C reduction than group C (p=0.0001), while group B had 0.7% greater A1C reduction than group C (p=0.0001). Conclusion: ILI may decrease A1C by up to 2.5% in patients with diabetes. In patients with a similar magnitude of weight loss, A1C reduction was more prominent in those with higher baseline A1C levels. This may be valuable for clinicians to set realistic expectations of A1C reduction for their patients in response to ILI, which is usually the primary step in diabetes management. Disclosure A.H. Eldib: None. S. Tomah: Stock/Shareholder; Self; Amarin Corporation. A. Mottalib: None. S. Ashrafzadeh: None. O. Hamdy: Advisory Panel; Self; AstraZeneca, Sanofi-Aventis. Consultant; Self; Abbott, Merck &amp; Co., Inc. Research Support; Self; National Dairy Council. Stock/Shareholder; Self; Healthimation, LLC.

Effect of weight loss on bone metabolism in postmenopausal obese women with osteoarthritis

BackgroundThe choice of hypocaloric diets in obesity can affect bone health. AimsThe aim of this study is to assess the effect of a hypocaloric diet in postmenopausal obese women and to determine the influence of weight reduction on bone metabolism. MethodsThis was a non-randomised, single-treatment study in 96 postmenopausal women with a body mass index (BMI) greater than 35kg/m2 and osteoarthritis. The patients received a formula diet with two intake levels of a normocaloric hyperproteic formula (1035kcal (25% protein)). Anthropometry and biochemistry with CrossLaps, osteocalcin, parathyroid hormone (PTH) and 25-OH vitamin D were measured. Consumption of protein, calcium and vitamin D were determined at the beginning of and 3 and 6 months into the study. The response to treatment was compared (high-responder (HR): weight loss greater than 15%, and low-responder (LR): weight loss less than 15%). ResultsThe mean age was 64.2 (7.5) years. After 6 months of treatment, a weight loss of 10.2% (8.2–13.8) was observed. There was a significant increase in vitamin D (HR: 21.8% (36.2) vs. LR: 22.7% (36.9), p=0.93) and CrossLaps (HR: 26.8% (19.5–35.2)) vs. LR: 13.3% (−6.1 to 27.9), p=0.01). The loss of more than 15% of initial body weight was an independent risk factor for an increase in CrossLaps (OR: 4.22 (1.1–16.8), p=0.04). ConclusionsIn postmenopausal obese women, weight loss was associated with an increase in the biochemical parameters of bone resorption. The increase in resorption parameters was related to the magnitude of weight loss.

Weight loss variability with SGLT2 inhibitors and GLP‐1 receptor agonists in type 2 diabetes mellitus and obesity: Mechanistic possibilities

We are facing a global epidemic of obesity and type 2 diabetes. Weight loss, in the context of obesity and type 2 diabetes, may improve glycaemic control and weight-related comorbidities, and in some cases, induce diabetes remission. Although lifestyle-based weight loss strategies may be initially successful, most are not effective long-term. There is an increasing need to consider pharmacological approaches to assist weight loss in diabetes-obesity. Older glucose-lowering agents may cause weight gain, whereas the newer drug classes, sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide receptor agonists (GLP-1 RAs), concomitantly target weight loss and glycaemic control. Clinical trial data suggest that both SGLT2i and GLP1 RAs cause a mean weight loss of approximately 2 to 3kg but real-world evidence and clinical experience suggests a significant heterogeneity in the magnitude of the weight loss (GLP-1 RAs) or the magnitude of the actual weight loss is significantly less than anticipated (SGLT2i). Why do some individuals lose more weight than others in response to these pharmacological treatments? This review will first explore mechanisms by which body weight is regulated through control of energy balance and its dysregulation in obesity, and then consider how these mechanisms may be modulated therapeutically with SGLT2i and GLP1 RAs.

Effect of lorcaserin in different age groups: a post hoc analysis of patients from the BLOOM, BLOSSOM and BLOOM-DM studies.

SummaryIntroductionThe elderly population is projected to be the fastest growing group of individuals with obesity group in the United States. As such, there is merit in examining factors that contribute to healthy aging and weight management. The effects of newer weight loss medications approved after 2013 have been studied but are not often assessed specifically in older persons.MethodsThis post hoc analysis evaluated the magnitude of weight loss in adults across age quartiles with lorcaserin, a serotonin (5‐HT) 2C receptor agonist indicated as an adjunct to a reduced‐caloric diet and increased physical activity for chronic weight management. Data from three lorcaserin pivotal phase 3 studies were used in this analysis. Data for patients with overweight/obesity without type 2 diabetes (T2D; BLOOM/BLOSSOM; body mass index [BMI] 27.0–29.9 kg/m2 and ≥1 comorbidity or BMI 30.0–45.0 kg/m2) and patients with overweight/obesity with T2D (BLOOM‐DM; BMI 27.0–45.0 kg/m2) were used. Patients were randomized to receive lorcaserin 10 mg twice daily or placebo in addition to diet and exercise for 52 weeks. Age quartiles between the studies differed as the T2D population was on average, 9 years older.ResultsThis analysis shows that lorcaserin was associated with improved weight loss relative to placebo regardless of age. Importantly, these results were consistent for patients with and without T2D. Interestingly, the magnitude of weight loss for lorcaserin appeared to increase with increasing age. In patients without T2D, odds of achieving ≥5% and ≥10% reduction in body weight at 52 weeks were significantly higher for patients >36 years. Lorcaserin was well tolerated in all patients across all quartiles including the oldest quartile.ConclusionsIn summary, this post hoc analysis demonstrates that lorcaserin treatment in patients with and without T2D was safe and effective at reducing weight across all age groups analysed. Weight loss appeared to be greater for older patients; additional analyses are warranted to confirm these findings and to better understand the factors for improved weight loss.

Effect of bariatric surgery on plasma GDF15 in humans.

Bariatric surgery results in marked body weight loss and improves type 2 diabetes in most patients with obesity. The growth differentiation factor 15 (GDF15) has recently emerged as a novel satiety factor. To begin to understand whether GDF15 is involved in mediating the effects of bariatric surgery on body weight and glycemia in humans, we measured plasma GDF15 in patients with obesity ( n = 25) and in patients with obesity and diabetes ( n = 22) before and after Roux-en-Y gastric bypass (RYGB) surgery. GDF15 was increased 1 wk after RYGB compared with before surgery (689 ± 45 vs. 487 ± 28 pg/ml, P < 0.001) and GDF15 remained elevated at 3 mo (554 ± 37 pg/ml, P < 0.05), at 1 yr (566 ± 37 pg/ml, P < 0.05), and at 2.5-4 yr (630 ± 50 pg/ml, P < 0.001) after RYGB surgery. Both age and insulin sensitivity correlated with GDF15 before the surgery ( r = 0.46, P < 0.0001 and r = 0.34, P < 0.001, respectively). These correlations disappeared at 2.5-4 yr following the surgery. Conversely, weight loss magnitude correlated with GDF15, measured 2.5-4 yr postsurgery ( r = 0.21, P < 0.0055). In summary, circulating GDF15 increases and correlates with body weight loss following RYGB surgery.

Effect of canagliflozin treatment on hepatic triglyceride content and glucose metabolism in patients with type 2 diabetes.

To evaluate the impact of the sodium glucose co-transporter 2 inhibitor canagliflozin on intrahepatic triglyceride (IHTG) accumulation and its relationship to changes in body weight and glucose metabolism. In this double-blind, parallel-group, placebo-controlled, 24-week trial subjects with inadequately controlled type 2 diabetes mellitus (T2DM; HbA1c = 7.7% ± 0.7%) from two centres were randomly assigned (1:1) to canagliflozin 300 mg or placebo. We measured IHTG by proton-magnetic resonance spectroscopy (primary outcome), hepatic/muscle/adipose tissue insulin sensitivity during a 2-step euglycaemic insulin clamp, and beta-cell function during a mixed meal tolerance test. Analyses were per protocol. Between 8 September 2014-13 June 2016, 56 patients were enrolled. Canagliflozin reduced HbA1c (placebo-subtracted change: -0.71% [-1.08; -0.33]) and body weight (-3.4% [-5.4; -1.4]; both P ≤ 0.001). A numerically larger absolute decrease in IHTG occurred with canagliflozin (-4.6% [-6.4; -2.7]) versus placebo (-2.4% [-4.2; -0.6]; P = 0.09). In patients with non-alcoholic fatty liver disease (n = 37), the decrease in IHTG was -6.9% (-9.5; -4.2) versus -3.8% (-6.3; -1.3; P = 0.05), and strongly correlated with the magnitude of weight loss (r = 0.69, P < 0.001). Body weight loss ≥5% with a ≥30% relative reduction in IHTG occurred more often with canagliflozin (38% vs. 7%, P = 0.009). Hepatic insulin sensitivity improved with canagliflozin (P < 0.01), but not muscle or adipose tissue insulin sensitivity. Beta-cell glucose sensitivity, insulin clearance, and disposition index improved more with canagliflozin (P < 0.05). Canagliflozin improves hepatic insulin sensitivity and insulin secretion and clearance in patients with T2DM. IHTG decreases in proportion to the magnitude of body weight loss, which tended to be greater and occur more often with canagliflozin.

Genetic Predictors of Behavioral Weight Loss: Current Status and Future Directions.

In this issue of Obesity, Hollensted and colleagues (1) report on their analysis of whether genetic loci previously implicated in childhood obesity predict the magnitude of weight loss with lifestyle intervention among 754 children and adolescents with overweight. Genetic risk scores combining 15 single-nucleotide polymorphisms (SNPs) from the most recent genome-wide association studies (GWAS) did not significantly predict change in BMI standard deviation score during the intervention. One of the 15 SNPs, LMX1B rs3829849, did predict weight loss independently. This study represents an important advance in understanding whether known genetic predictors of childhood BMI may inhibit children from losing weight with lifestyle methods. It is the largest study to date, tested a comprehensive list of the most recent genetic variants associated with childhood BMI, employed an evidence-based weight-loss intervention, and achieved a median weight loss of 0.20 BMI standard deviation score or roughly 10% weight loss. It should be noted that weight loss was reported at varying time points (follow-up: 6-24 months; median: 1.25 years). In addition, children who did not complete a minimum of 6 months of the program were excluded. These factors could have created variability in measurement of BMI and/or bias from excluding those who were not successful, potentially limiting the detection of genetic effects. Nonetheless, these results contribute to a growing literature indicating that SNPs related to BMI in GWAS largely do not appear to predict the magnitude of weight loss in behavioral interventions. Prominent examples include a lack of association of the FTO region with weight loss in a meta-analysis including 9,563 participants (2). In a joint analysis of the Action for Health in Diabetes (Look AHEAD) trial and the Diabetes Prevention Program (DPP), only one of a comprehensive list of 91 SNPs predicted magnitude of weight loss in the lifestyle interventions (3). MC4R mutations causing monogenic obesity also did not predict magnitude of weight loss with lifestyle intervention in children (4). That said, the progress in identifying genetic variation predictive of weight loss should be recognized. In the meta-analysis of Look AHEAD and DPP, the obesity-related allele of MTIF3 rs1885988 predicted greater weight loss. One copy of the obesity risk allele conferred an additional loss of 1.48 kg, and two copies predicted a 2.96-kg weight loss (3). Moreover, using a gene-centric assay, ABCB11 and RANK were shown to relate to magnitude of weight loss in Look AHEAD (5). In the Hollensted et al. paper, LMX1B rs3829849 also significantly predicted weight loss. Although not yet of sufficient magnitude to guide clinical recommendations, such findings provide a platform for replication and extension with increasing sample sizes and may ultimately be employed as part of a weight-loss genetic risk score. It is noteworthy that the search for genetic predictors of weight loss has been limited almost exclusively to SNPs related to BMI in GWAS. No genome-wide analysis of weight loss has been conducted, but it could lead to the discovery of novel genetic loci related to weight loss, as was observed for bariatric surgery (6). Such new discoveries could ultimately contribute to a genetic risk score sufficiently predictive of weight loss for clinical application. JMM reports personal fees from Weight Watchers, outside the submitted work.

Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials.

Multiple environmental factors have been implicated in obesity, and multiple interventions, besides drugs and surgery, have been assessed in obese patients. Results are scattered across many studies and meta-analyses, and they often mix obese and overweight individuals. PubMed and Cochrane Database of Systematic Reviews were searched through 21 January 2017 for meta-analyses of cohort studies assessing environmental risk factors for obesity, and randomized controlled trials investigating nonpharmacological and nonsurgical therapeutic interventions for obesity. We excluded data on overweight participants. Evidence from observational studies was graded according to criteria that included the statistical significance of the random-effects summary estimate and of the largest study in a meta-analysis, the number of obesity cases, heterogeneity between studies, 95% prediction intervals, small-study effects and excess significance. The evidence of intervention studies for obesity was assessed with the GRADE framework. Fifty-four articles met eligibility criteria, including 26 meta-analyses of environmental risk factors (166 studies) and 46 meta-analyses of nondrug, nonsurgical interventions (206 trials). In adults, the only risk factor with convincing evidence was depression, and childhood obesity, adolescent obesity, childhood abuse and short sleep duration had highly suggestive evidence. Infancy weight gain during the first year of life, depression and low maternal education had convincing evidence for association with paediatric obesity. All interventions had low or very-low-quality evidence with one exception of moderate-quality evidence for one comparison (no differences in efficacy between brief lifestyle primary care interventions and other interventions for paediatric obesity). Summary effect sizes were mostly small across compared interventions (maximum 5.1kg in adults and 1.78kg in children) and even these estimates may be inflated. Depression, obesity in earlier age groups, short sleep duration, childhood abuse and low maternal education have the strongest support among proposed risk factors for obesity. Furthermore, there is no high-quality evidence to recommend treating obesity with a specific nonpharmacological and nonsurgical intervention among many available, and whatever benefits in terms of magnitude of weight loss appear small.

Influence of modifiers on coked foam structure and properties formed with thermal decomposition of wood

Wood is a material that forms a surface layer of coke when burning. Properties of the coke layer significantly impact the fire resistance of structures due to the change of the structure working section reduction rate. This paper discusses the research of how the wood surface layer modifiers influence the structure and properties of the coke layer formed with thermal decomposition of wood. As modifiers have been used phosphorus flame-retardants. To evaluate how the modifiers influence the coke layer formation process, the source and modified samples of pine have been analyzed before and after thermal decomposition using the element analysis, electron microscopy, and adsorption. Thermal analysis has been accomplished using the thermogravimetry (TG), differential thermogravimetry (DTG), and differential scanning calorimetry. To evaluate the fire protection efficiency of the modified wood, fire tests have been accomplished. Such tests were tests to determine the magnitude of weight loss during combustion, flame spread index and the coefficient of smoke-ability. Based on the acquired data, it was identified that when the modifiers are used, and these modifiers enter into efficient superficial chemical reaction with wood under mild conditions, the thermal decomposition occurred under mild conditions - the first stage of thermal decomposition transits to the lower temperatures zone. This reduces the thermal effect of thermal decomposition reaction. There is a decrease in weight loss during thermal decomposition. This results in formation of the strong and structured, thermally stable surface, which is less adsorption ability, specific surface area and porosity reduction. This explains high rate of fire protection and low smoke-generating capacities.

Metabotypes of response to bariatric surgery independent of the magnitude of weight loss.

ObjectiveBariatric surgery is considered the most efficient treatment for morbid obesity and its related diseases. However, its role as a metabolic modifier is not well understood. We aimed to determine biosignatures of response to bariatric surgery and elucidate short-term metabolic adaptations.MethodsWe used a LC- and FIA-ESI-MS/MS approach to quantify acylcarnitines, (lyso)phosphatidylcholines, sphingomyelins, amino acids, biogenic amines and hexoses in serum samples of subjects with morbid obesity (n = 39) before and 1, 3 and 6 months after bariatric surgery. K-means cluster analysis allowed to distinguish metabotypes of response to bariatric surgery.ResultsFor the first time, global metabolic changes following bariatric surgery independent of the baseline health status of the subjects have been revealed. We identify two metabolic phenotypes (metabotypes) at the interval 6 months-baseline after surgery, which presented differences in the levels of compounds of urea metabolism, gluconeogenic precursors and (lyso)phospholipid particles. Clinically, metabotypes were different in terms of the degree of improvement in insulin resistance, cholesterol, low-density lipoproteins and uric acid independent of the magnitude of weight loss.ConclusionsThis study opens new perspectives and new hypotheses on the metabolic benefits of bariatric surgery and understanding of the biology of obesity and its associated diseases.

What is the effect of diet and/or exercise interventions on behavioural compensation in non-exercise physical activity and related energy expenditure of free-living adults? A systematic review.

Non-exercise physical activity (NEPA) and/or non-exercise activity thermogenesis (NEAT) reductions may occur from diet and/or exercise-induced negative energy balance interventions, resulting in less-than-expected weight loss. This systematic review describes the effects of prescribed diet and/or physical activity (PA)/exercise on NEPA and/or NEAT in adults. Studies were identified from PubMed, web-of-knowledge, Embase, SPORTDiscus, ERIC and PsycINFO searches up to 1 March 2017. Eligibility criteria included randomised controlled trials (RCT), randomised trials (RT) and non-randomised trials (NRT); objective measures of PA and energy expenditure; data on NEPA, NEAT and spontaneous PA; ≥10 healthy male/female aged>18 years; and ≥7 d length. The trial is registered at PROSPERO-2017-CRD42017052635. In all, thirty-six articles (RCT-10, RT-9, NRT-17) with a total of seventy intervention arms (diet, exercise, combined diet/exercise), with a total of 1561 participants, were included. Compensation was observed in twenty-six out of seventy intervention arms (fifteen studies out of thirty-six reporting declines in NEAT (eight), NEPA (four) or both (three)) representing 63, 27 and 23 % of diet-only, combined diet/exercise, and exercise-only intervention arms, respectively. Weight loss observed in participants who decreased NEAT was double the weight loss found in those who did not compensate, suggesting that the energy imbalance degree may lead to energy conservation. Although these findings do not support the hypothesis that prescribed diet and/or exercise results in decreased NEAT and NEPA in healthy adults, the underpowered trial design and the lack of state-of-the-art methods may limit these conclusions. Future studies should explore the impact of weight-loss magnitude, energetic restriction degree, exercise dose and participant characteristics on NEAT and/or NEPA.

Weight Loss, Physical Activity, And Conception In Obese Infertile Women

PURPOSE: To compare weight loss and physical activity in obese infertile women who did or did not become pregnant following completion of a weight loss program. METHODS: Obese infertile women, referred by a reproductive endocrinologist, completed the University of Kansas Weight Management Program (KWMP). This program included reduced energy intake (portion controlled entrees, low calorie shakes), increased moderate-to- vigorous physical activity (MVPA) targeting 300 min•wk. and lifestyle strategies were provided. Participants were asked to monitor weekly MVPA (self-report) and pedometer step counts. Height and weight were assessed by trained staff in the clinic. The cumulative average of MVPA and steps over the last 3-wks. of participation were used in the analysis. Pregnancy outcomes were obtained from a review of medical records. The Kruskal-Wallis nonparametric test was used to compare differences in percent weight loss, physical activity (MVPA min•wk.-1, steps•wk.-1 ), and time in the KWMP between women who did, or did not become pregnant. RESULTS: Obese infertile women (n = 14, BMI=40.0 + 5.9 kg•m2, age = 33.4+ 4.5 yrs.) completed an average of 17 wks. of the KWMP. Eight of 14 women (57%) became pregnant. Weight loss was greater in women who became (-15.4 ± 7.7 %) compared with those who did not become pregnant (-10.9 ± 11.3 %); however, the differences were not statistically significant (p= 0.17). Physical activity assessed by pedometer was significantly higher in women who became pregnant (64,774 ± 13,798 steps•wk.-1 ) compare with those who did not (51,207 ± 5,060 steps•wk.-1, p =0.02). Self-reported MVPA was not significantly higher in women who became pregnant (212 ± 89 min•wk.-1) compared with those who did not (175 ± 106 min•wk.-1 , p = 0.37. Women who became pregnant participated in the KWMP 11 wks. longer than those who did not (p = 0.016). CONCLUSION: Length of treatment and reported step counts were associated with increased pregnancy rates. Additional investigation with larger samples is warranted to evaluate the magnitude of weight loss and the potential independent contributions of weight loss and physical activity to improve conception.

Are Personality Characteristics as Measured by the Temperament and Character Inventory (TCI) Associated with Obesity Treatment Outcomes? A Systematic Review.

Some personality traits seem to be associated with obesity, but there is little information available regarding their association with obesity treatment outcomes. The aim of this systematic review was therefore to assess the associations between personality traits-evaluated by means of the Temperament and Character Inventory (TCI)-and outcomes of obesity treatment, including attrition, weight loss, and weight loss maintenance. The PubMed database was searched, and studies were screened as per the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, and data were collated using a narrative approach. Of the 886 articles retrieved, 9 studies assessing personality traits by means of the TCI in participants with obesity met the inclusion criteria and were reviewed. This approach revealed three main findings: (i) only one study found that attrition rate-during a 6-month behavioral weight loss program-is predicted by low reward dependence scores at baseline; (ii) two studies found that lower novelty-seeking and higher self-directedness scores at baseline positively predict short-term weight-loss magnitude; and (iii) four studies found that higher persistence and lower novelty-seeking scores at baseline predicted weight maintenance at 12 and 24months. Novelty-seeking and self-directedness traits appear to be predictors of short-term weight loss (≤ 6months), and persistence and novelty-seeking traits may be related to long-term weight loss maintenance (≥ 12months), although great uncertainty still exists regarding predictors of attrition.