Management Of Obese Patients Research Articles

Nutritional assessment and medical dietary therapy for management of obesity in patients with non-dialysis chronic kidney disease: a practical guide for endocrinologist, nutritionists and nephrologists. A consensus statement from the Italian society of endocrinology (SIE), working group of the club nutrition-hormones and metabolism; the Italian society of nutraceuticals (SINut), club ketodiets and nutraceuticals "KetoNut-SINut"; and the Italian society of nephrology

Chronic kidney disease (CKD) is a serious health concern with an estimated prevalence of about 13.4% worldwide. It is cause and consequence of various comorbidities, including cardiovascular diseases. In parallel, common pathological conditions closely related to ageing and unhealthy dietary habits increase the risk of CKD development and progression, including type 2 diabetes and obesity. Among these, obesity is either independent risk factor for new onset kidney disease or accelerates the rate of decline of kidney function by multiple mechanisms. Therefore, the role of diets aimed at attaining weight loss in patients with obesity is clearly essential to prevent CKD as to slow disease progression. Various dietary approaches have been licensed for the medical dietary therapy in CKD, including low-protein diet and Mediterranean diet. Interestingly, emerging evidence also support the use of low-carbohydrate/ketogenic diet (LCD/KD) in these patients. More specifically, LCD/KDs may efficiently promote weight loss, improve metabolic parameters, and reduce inflammation and oxidative stress, resulting in a dietary strategy that act globally in managing collateral conditions that are directly and indirectly related to the kidney function. This consensus statement from the Italian Society of Endocrinology (SIE), working group of the Club Nutrition - Hormones and Metabolism; the Italian Society of Nutraceuticals (SINut), Club Ketodiets and Nutraceuticals "KetoNut-SINut"; and the Italian Society of Nephrology (SIN) is intended to be a guide for Endocrinologist, Nutritionists and Nephrologist who deal with the management of patients with obesity with non-dialysis CKD providing a practical guidance on assessing nutritional status and prescribing the optimal diet in order to best manage obesity to prevent CKD and its progression to dialysis.

Outcomes of bariatric surgery in obese patients with heart failure:a meta-analysis

Abstract Background Patients with heart failure possess an increased risk for adverse outcomes with noncardiac surgery (1). While bariatric surgery is frequently performed in patients with obesity, there remains a limited understanding of the impact of bariatric surgery in obese patients with heart failure. Purpose The purpose of this study was to compare outcomes of bariatric surgery versus nonsurgical management in obese patients with heart failure. Methods We searched PubMed, EMBASE, and the Cochrane Library, through February 2024, for studies evaluating outcomes in obese patients with heart failure who underwent bariatric surgery compared to nonsurgical management. Outcomes assessed were postoperative atrial fibrillation, all-cause mortality, and hospital readmission. We used a fixed-effect model to calculate hazard ratios (HR) with 95% confidence intervals (CI) in R studio for outcomes assessed. In outcomes where significant heterogeneity was found (P< 0.05 and I2 > 60%), a random effects model was used. Results A total of 3 studies were identified, consisting of 260,186 patients. Compared to nonsurgical management, bariatric surgery was associated with a significant reduction in postoperative atrial fibrillation (HR 0.72; 95% CI: 0.62-0.84), all-cause mortality (HR 0.50; 95%CI 0.35-0.72), and hospital readmission (HR 0.73; 95% CI 0.69-0.78) in obese patients with heart failure. Conclusion Our study suggests that bariatric surgery significantly reduces post-operative atrial fibrillation, mortality, and hospital readmission among obese patients with heart failure.Our findings demonstrate that bariatric surgery should be considered as a viable intervention in obese patients with heart failure. Further studies are warranted to confirm our findings.Forest Plots of Outcomes Assessed

Protocolo terapéutico y seguimiento del paciente con diabetes mellitus tipo 1 y obesidad

Treatment protocol and follow-up of patients with type 1 diabetes and obesity This protocol focuses on the management of obesity in patients with type 1 diabetes mellitus (DM1), a growing problem due to factors such as lifestyle, insulin treatment, and hypoglycemia. The approach includes four key pillars: nutrition therapy, drug therapy, physical activity, and management of insulin therapy. Nutrition therapy is the first line of treatment and is based on calorie reduction and a diet rich in fiber. In addition, there are pharmacological options for the management of overweight in patients with DM1, although they have specific challenges, such as euglycemic diabetic ketoacidosis. Physical activity and the adjustment of insulin therapy also play an essential role in weight and glycemic control. In severe cases, bariatric surgery is a viable option for patients with severe obesity.

GLP-1 receptor agonists for weight loss, benefits and risks: A systematic review of the literature

Introduction: Obesity is a chronic disease linked to numerous complications. Pharmacotherapy constitutes one of the therapeutic options by which people with obesity can achieve and maintain the desired weight.Objectives: to describe the mechanism of action of glucagon-1 receptor agonists (GLP-1RAs) and their effect on weight loss and long-term weight maintenance. Methods: an information search was conducted using biomedical databases to gather relevant evidence on the efficacy and safety of GLP-1RAs in weight management. Studies addressing both initial weight loss and long-term maintenance based on the use of GLP-1RAs were analyzed.Development: GLP-1RA therapy, initially developed to treat type 2 diabetes, has been shown to be effective in reducing body weight. Daily subcutaneous administration of liraglutide has been approved, and weekly subcutaneous administration of semaglutide is being investigated in phase III trials for the management of obesity. Conclusions: consideration of GLP-1 receptor agonists as a robust therapeutic option for the management of obesity in patients who have not responded adequately to other interventions is recommended. Their use should be personalized, carefully evaluating the benefit-risk ratio for each patient. It is crucial to continue research in this field to better understand the long-term effects of GLP-1 receptor agonists

Anti-Obesity Medications in Patients With Heart Failure: Current Evidence and Practical Guidance.

Obesity is a significant risk factor for heart failure (HF) development, particularly HF with preserved ejection fraction and as a result, many patients with HF also have obesity. There is growing clinical interest in optimizing strategies for the management of obesity in patients with HF across the spectrums of both ejection fraction and disease severity. The emergence of anti-obesity medications with cardiovascular outcomes benefits, principally glucagon-like peptide-1 receptor agonists, has made it possible to study the impact of anti-obesity medications for patients with baseline cardiovascular conditions, including HF. However, clinical trials data supporting the safety and efficacy of treating obesity in patients with HF is currently limited to patients with HF with preserved ejection fraction, but do confirm safety and weight loss efficacy in this patient population as well as improvements in HF functional status, biomarkers of inflammation and HF stability. Here, we review the current data available surrounding the management of obesity for patients with HF, including the limitations of this evidence and ongoing areas for investigation, summarize the next phase of emerging anti-obesity medications and provide practical clinical advice for the multidisciplinary management of patients with both HF and obesity.

569-P: A CME Webcast Series’ Impact on Clinicians’ Knowledge and Competence of Long-Term Obesity Management in Patients with Type 2 Diabetes Mellitus

569-P: A CME Webcast Series’ Impact on Clinicians’ Knowledge and Competence of Long-Term Obesity Management in Patients with Type 2 Diabetes Mellitus

1082-P: Online Clinician Education Results in Performance Changes in Clinical Practice Related to Obesity Management in Patients With and Without Type 2 Diabetes

1082-P: Online Clinician Education Results in Performance Changes in Clinical Practice Related to Obesity Management in Patients With and Without Type 2 Diabetes

ASSESSMENT AND MANAGEMENT OF PATIENTS WITH OBESITY AND HYPERTENSION IN EUROPEAN SOCIETY OF HYPERTENSION EXCELLENCE CENTRES. A SURVEY FROM THE ESH WORKING GROUP ON DIABETES AND META

Objective: Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs). Design and method: We conducted a cross-sectional, worldwide 30-item survey through e-mails. Results: In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5 min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors. Conclusions: Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.

Laparoscopic sleeve gastrectomy for premenstrual syndrome symptoms in patients with obesity.

Premenstrual syndrome (PMS) is a pathological condition characterized by a series of abnormal physical, psychological, and behavioral symptoms. We evaluated the effectiveness of laparoscopic sleeve gastrectomy (LSG) in the treatment of patients with obesity and PMS. In this case-control study, 131 patients with obesity (BMI ≥ 27.5kg/cm2) diagnosed with moderate-to-severe PMS from March 2018 to March 2022 were prospectively selected to undergo LSG or not at their own discretion. Participants self-reported their PMS severity using the Premenstrual Syndrome Screening Tool. Among them, 68 patients chose LSG surgery, and 63 control group patients were followed up without surgery. Data were recorded at baseline and at 3months post-treatment. We used a multivariate analysis to assess the improvement in PMS symptoms and associated factors. Of the 131 patients with obesity and PMS, the improvement rate of PMS in the LSG group was 57.35% (n = 39), while the improvement rate of PMS in the control group was 25.40% (n = 16). Furthermore, our study revealed that surgery is an independent factor affecting the improvement of patients with PMS. Additionally, there was a correlation between alcohol use, T2DM and obesity-related metabolic diseases, and BMI with PMS. The changes in BMI, testosterone, and estradiol(E2) levels may also contribute to the improvement of patients with obesity and PMS. LSG can improve the management of obesity in patients with PMS to some extent. Changes in BMI, testosterone, and E2 may be indicative of improvement in patients with obesity and PMS.

Assessment and Management of Patients with Obesity and Hypertension in European Society of Hypertension Excellence Centres. A survey from the ESH Working Group on Diabetes and Metabolic Risk Factors.

Background Healthcare providers are faced with an increasing number of patients with obesity and arterial hypertension. Preventing obesity-associated hypertension and appropriately managing patients with established disease are both important. Hence, the aim of our study was to evaluate the clinical care of patients with obesity and hypertension among ESH Excellence Centres (ECs). Methods We conducted a cross-sectional, international 30-item survey through e-mails. Results In total, 70 representatives of ECs participated (78% men) with 66% of them practicing medicine for more than 30 years and working in well-equipped clinics. Most were internists (41%) and cardiologists (37%) and 73% reported training on the management of obese patients with hypertension. A majority weigh their patients (77%) and evaluate patients for sleep disorders (93%). However, only 47% spend more than 5min to advise for lifestyle modification in general, 59% for weight loss, 56% for salt intake and 64% for exercise. Finally, a minority of participants ask patients if they like their body (6%) or about previous attempts to lose weight (28%), evaluate 24h urinary sodium excretion rate (22%) and provide written (15%) or personalized (10%) dietary advices. If the patient suffers also from type 2 diabetes mellitus, 66% switch treatment to GLP1 receptor agonists and 60% to SGLT2 inhibitors. Conclusion Most clinicians in ESH ECs are well educated regarding obesity-associated hypertension, and clinics are sufficiently equipped to manage these patients, as well. However, several deficits were reported regarding efforts to address and implement obesity specific aspects and interventions to improve care in patients with obesity and hypertension.

The Association Between Obesity and Spontaneous Temporal Bone CSF Leak Outcomes: A Systematic Review and Meta-Analysis.

We undertook a systematic review of the literature with meta-analysis to identify the role of obesity (BMI ≥30) in the patient characteristics presenting with spontaneous cerebrospinal fluid (sCSF) leaks of the lateral skull base and the outcomes of their repair. A Systematic Review of English Articles using MEDLINE, EMBASE, and Cochrane Library. The research algorithm included the following keywords: "spontaneous CSF leak," "lateral skull base," "temporal bone," "meningocele," "encephalocele," and "otorrhea." We also manually searched the references of included studies, to identify possible studies missed during our literature search. More than two-thirds of the patients were female (69.2%) and often were obese (mean BMI 36.5 kg/m2) with a mean age of 57. Most common presenting symptoms were otorrhea and hearing loss. Most authors did not report a routine use of a post-operative lumbar drain. Most patients had a single skull base defect and encephaloceles prolapsing through, across obese and non-obese groups. Median length of stay in hospital was 3.2 days, and the majority of patients did not have any recurrence during their follow-up (89.6%), which was not affected by obesity. Obesity does not affect length of hospital stay or recurrence rate following surgical repair of lateral skull base sCSF leaks. Surgical repair is a safe and viable approach in the management of obese patients with sCSF leaks in the temporal bone. NA Laryngoscope, 134:2012-2018, 2024.

Robotic-assisted versus conventional laparoscopic surgery in the management of obese patients with early endometrial cancer in the sentinel lymph node era: a randomized controlled study (RObese)

BackgroundNearly 65% of patients with endometrial cancer who undergo primary hysterectomy have concurrent obesity. Retrospective data show advantages in using robotic surgery in these patients compared with conventional laparoscopy, namely...

Glucagonlike Peptide-1 Receptor Agonists: The Good, the Bad, and the Ugly-Benefits for Glucose Control and Weight Loss with Side Effects of Delaying Gastric Emptying.

Glucagonlike peptide-1 (GLP-1) receptor agonists (RAs) are being increasingly used for glycemic control in patients with diabetes and for weight loss and weight management in obese subjects. There has been recent public awareness of the potential of GLP-1 RAs to delay gastric emptying and cause gastroparesis. By delaying gastric emptying, these agents can complicate the clinical evaluation of patients on these drugs by affecting diagnostic testing for gastroparesis. This article discusses GLP-1 RAs and their effects on gastric emptying, gastric food retention, and gastroparesis. This article highlights how physicians should be attuned to the gastric side effects of these popular therapeutic agents for blood glucose control in people with diabetes and for weight loss and weight management in obese patients.

Assessment of public awareness about Semaglutide (Ozempic) use, safety, and adverse drug reaction in Saudi Arabia

Background: Obesity is a growing epidemic in Saudi Arabia, and Semaglutide has emerged as a promising pharmacotherapeutic option for weight management in obese patients. This study aims to assess public knowledge about Ozempic (semaglutide) use, safety, and adverse drug reactions in Saudi Arabia. Methods: We conducted a cross-sectional survey to collect data among the adult population in Saudi Arabia. Statistical tests of significance, including the chi-squared test and Spearman\'s rho correlation test, were employed to examine differences between groups and assess correlations between variables. Results: Of the 739 participants, 50.7% were females, and most participants had a bachelor's degree level of education. Study respondents reported that they had heard of Ozempic, but only 244 (58%) knew its indication (Type 2 DM). The analysis showed that good knowledge was observed among the 31–40 and 18–30 age groups compared to other age groups (p = 0.020); no other sociodemographic variables showed a significant association with the knowledge level (p > 0.05).The questionnaire was distributed to a representative sample with a minimum of 385 participants among the Saudi population, with a 95% confidence level and a margin of error of 5%, through online platforms. Data were collected and analyzed using descriptive and inferential statistical methods. Conclusion: Semaglutide is a valuable medication for the treatment of type 2 diabetes and, under appropriate circumstances, for weight loss management. The study showed that the majority of the participants used it for weight loss management, and their awareness regarding its indications, contraindications, and adverse effects was not adequate.

Anesthetic Management in Obese Patients with Placenta Accreta Undergoing Cesarean Section: Case Report

Background: Placenta accreta is a condition of abnormal attachment of the placenta that could cause massive bleeding complications and increase mortality in patients. Proper anesthetic management and transfusion protocol are required for the patient. Case: A patient with placenta previa total with Placenta accreta Index score is 9 and obesity. The patient is planned to have a cesarean section followed by a total hysterectomy. For anesthetic management, general anesthesia was performed with the insertion of an endotracheal tube as an anticipatory for massive bleeding in this patient. Total bleeding during the operation was 2100 ml, and two bags of Packed Red Cells (PRC) were transfused during the operation. Postoperatively, the patient underwent treatment in the intensive care unit for one day to stabilize his general condition before being transferred to the regular ward. The patient was discharged after 2 days of treatment in the ward. Conclusion: that case can be drawn from this case is the importance of early detection of patients with a high risk of Placenta accreta, so that early treatment and comprehensive preparation can be carried out before termination is done.

Body Mass Index Effect on Minimally Invasive Ventral Hernia Repair: A Systematic Review and Meta-analysis.

Obesity is one of the most important risk factors for complications after ventral hernia repair (VHR), and minimally invasive (MIS) techniques are preferred in obese patients as they minimize wound complications. It is common practice to attempt weight loss to achieve a specific body mass index (BMI) goal; however, patients are often unable to reach it and fail to become surgical candidates. Therefore, we aim to perform a meta-analysis of studies comparing outcomes of obese and nonobese patients undergoing laparoscopic or robotic VHR. A literature search of PubMed, Scopus, and Cochrane Library databases was performed to identify studies comparing obese and nonobese patients undergoing MIS VHR. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I2 statistics. A total of 6483 studies were screened and 26 were thoroughly reviewed. Eleven studies and 3199 patients were included in the meta-analysis. BMI >40 kg/m 2 cutoff analysis included 5 studies and 1533 patients; no differences in hernia recurrence [odds ratios (OR): 1.64; 95% CI: 0.57-4.68; P = 0.36; I2 = 47%), seroma, hematoma, and surgical site infection (SSI) rates were noted. BMI >35 kg/m 2 cutoff analysis included 5 studies and 1403 patients; no differences in hernia recurrence (OR: 1.24; 95% CI: 0.71-2.16; P = 0.58; I2 = 0%), seroma, hematoma, and SSI rates were noted. BMI >30 kg/m 2 cutoff analysis included 4 studies and 385 patients; no differences in hernia recurrence (OR: 2.07; 95% CI: 0.5-8.54; P = 0.32; I2 = 0%), seroma, hematoma, and SSI rates were noted. Patients with high BMI undergoing MIS VHR have similar hernia recurrence, seroma, hematoma, and SSI rates compared with patients with lower BMI. Further prospective studies with long-term follow-up and patient-reported outcomes are required to establish optimal management in obese patients undergoing VHR.

Cognitive behavioral therapy for managing obesity in patients with chronic kidney disease: Study protocol for a randomized controlled trial

Obesity is one of the main risk factors for progression of chronic kidney disease (CKD). Weight loss interventions have limited efficacy in patients with pre-dialysis CKD. Our objective is to test the efficacy of a cognitive behavioral therapy program for obesity management in patients with CKD. We will conduct a randomized controlled intervention trial to evaluate the effects of cognitive behavioral therapy for obesity on weight loss, change in proteinuria, weight maintenance, quality of life, depression symptoms, and anxiety symptoms in patients with CKD. The duration of the intervention will be 16 weeks. The primary study outcomes will be body mass index (BMI) and proteinuria. CKD patients will be randomized into two groups: an intervention group with cognitive behavioral therapy, sessions with a dietitian and a kinesiologist, and a control group with sessions with a dietitian and a kinesiologist, without cognitive behavioral therapy. Study outcomes will be assessed at baseline, immediately after the 16-week intervention, 3 months after the end of the intervention, and 12 months after the end of the intervention. This study will be the first to evaluate the efficacy of cognitive behavioral therapy for obesity in patients with CKD. We expect that our results will contribute to new ways of non-pharmacological treatment of CKD. Clinical trial registrationClinicalTrials.Gov, NCT05927337.

FOREIGN BODY IN AN OBESE PATIENT: AIRWAY OF CHALLENGES AND OPPORTUNITIES

Airway management in obese patients is a challenging task in itself but when there is a foreign body present, it can pose a bigger threat. In this article we present a case report of successful management of a patient with morbid obesity presenting in emergency room with meat bone in oesophagus.

829 Bariatric Surgery Versus Medical Therapy for the Management of Obesity in Patients With Type 2 Diabetes

Abstract Aim The risks associated with Type 2 Diabetes (T2DM) and obesity are increasingly becoming relevant across the world. This review aims to compare the clinical outcomes of the Bariatric surgery versus medical therapy in management of obese patients with diabetes. Method A systematic, electronic search was performed according to PRISMA guidelines to identify relevant articles that compared outcomes of medical therapy versus the Bariatric surgery procedures for obesity in diabetic patients. Results Twelve studies were included, enrolling 4097 patients. A greater reduction in HbA1c (SMD -12.27, 95% CI[-16.99, -7.56]) and BMI (SMD -10.77, 95% CI[-12.59, -8.95]), was observed in the surgical group. Secondary outcomes, weight (SMD -2.14, 95% CI [-6.30, -1.21]), total cholesterol (SMD -5.78, 95% CI[-9.92, -1.65]), waist circumference (SMD = -5.24 [-9.20, -1.28]) and fasting glucose (SMD -3.75, 95% CI [-6.79, -1.19]) were statistically significant in favour of the Bariatric surgery approach. No significant differences were observed in the triglycerides (SMD -1.55 [-4.53, 1.42], p = 0.31) and diastolic blood pressure (SMD -0.12 [-1.14, 0.90], p = 0.82). Systolic blood pressure (SMD 1.26, 95% CI[0.42, 2.11]) was significantly in favour of medical therapy. Conclusions The Bariatric surgery approach is associated with a reduced HbA1c and BMI. However, the long-term benefits of the procedure need to be evaluated. This review calls for robust trials comparing the two techniques to further strengthen the evidence.

1073 Roux-en-Y Gastric Bypass or Sleeve Gastrectomy Versus Medical Therapy in the Management of Obesity in Patients with Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis

Abstract Aim Bariatric Surgery has proven to be effective in achieving diabetic control in morbidly obese patients. Advances in Roux-En-Y Gastric Bypass (RYGB) and Sleeve gastrectomy procedures have influenced this majorly. This review aims to analyse the clinical outcomes by comparing the two procedures and medical therapy, in morbidly obese patients with Type 2 Diabetes Mellitus (T2DM). Method A systematic literature review was conducted in accordance to the PRISMA guidelines to identify relevant articles that compared RYGB, sleeve gastrectomy and medical therapy for obesity in diabetic patients. Primary outcomes included BMI and HbA1c. Results Seven studies were identified enrolling 900 patients. Participants were predominantly female (61.31%) with a mean follow up of 2.71 years. A greater reduction in BMI and HbA1c was noted with both procedures compared to medical therapy. Sleeve gastrectomy was better in reducing BMI than RYGB (SMD = 19.23 [15.61 – 22.84], p<0.01). HbA1c (SMD = -2.37 [-2.72 – -2.02], p<0.01) and Triglycerides (SMD = -0.87 [-1.65 – -0.08], p = 0.03) were statistically significantly in favour of RYGB. No differences were noted between the two procedures in other outcomes including fasting glucose, weight and Blood pressure. Both procedures compared to medical therapy were considered to be superior statistically across all outcomes measured. Conclusions Overall, the study shows the superiority of Bariatric surgery to medical therapy in managing T2DM in obese patients. No significant differences were noted between the types of bariatric surgery, however, there exists a need to perform studies with longer follow up and compare the feasibility of these procedures.