Multidisciplinary Obesity Management Research Articles

Transoral Outlet Reduction: Expert Tips, Tricks, and Troubleshooting.

Transoral outlet reduction (TORe) is an incisionless, endoscopic procedure to address weight recurrence after Roux-en-Y gastric bypass. Given the chronic, progressive nature of obesity and the minimally invasive, anatomy preserving technique of TORe, the procedure is expected to be met with high patient acceptance and widening clinical adoption. Nevertheless, the approach to TORe has been heterogeneous. As endoscopic bariatric therapies are increasingly incorporated into the multidisciplinary management of obesity, it is crucial to have a standardized, evidence-based framework for their implementation. In this review, based on the available literature and the authors' combined experience of over 1,000 TORe procedures, we present our approach to patient selection, procedural technique, troubleshooting, and patient aftercare unique to TORe.

Optimizing Childhood Obesity Management: The Role of Edmonton Obesity Staging System in Personalized Care Pathways.

Childhood obesity, affecting 29% of 7-9-year-olds across 33 European countries, is a significant public health challenge. Its persistence into adulthood poses grave health risks influenced by genetic, environmental, and socio-economic factors. Belgium introduced a new care pathway in December 2023, based on the Edmonton Obesity Staging System for Pediatrics (EOSS-P), addressing four health domains and staging obesity severity. This pathway operates across three levels: primary care physicians, Paediatric Multidisciplinary Obesity Management Centres (PMOCs), and Centers of Expertise for Paediatric Obesity Management (CEPOs). Each stage of EOSS-P demands tailored interventions. Early stages involve dietary interventions, physical activity promotion, and behavior modifications. As obesity severity progresses, treatments intensify, encompassing psychological support, anti-obesity medications, and, in some cases, bariatric surgery. Throughout these stages, the involvement of multidisciplinary teams is crucial, emphasizing family-based approaches and continuous monitoring. This article provides detailed guidelines for healthcare professionals, delineating interventions and recommendations tailored to each EOSS-P stage. It emphasizes a holistic approach that extends beyond BMI-based diagnosis, promoting personalized care and prompt escalations between care levels, thereby ensuring optimal management of childhood obesity. This comprehensive framework aims to address the complexities of childhood obesity, emphasizing the importance of timely and targeted interventions for better health outcomes.

The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study.

Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children's hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193.

Treatment of obesity. A review of selected guidelines

Treatment of obesity is one of the challenges of the 21st century. It is a risk factor for the development of other diseases such as hypertension, coronary heart disease and cancer. The diagnosis of obesity should be based on body mass measurements, taking into account height and sex. It is also recommended to measure waist and hip circumference. Lifestyle modifications, which include increased physical activity and reduced calorie intake, are the primary method of treating obesity. Unfortunately, changing habits is difficult and even unattainable for many patients. Due to the increasing prevalence of obesity in the society, this review of guidelines is addressed to general practitioners and all physicians who encounter obese patients in their practice. Each of the guidelines analysed emphasises prevention, early diagnosis, and treatment of obesity. Behavioural and dietary changes are central in obesity management. The guidelines also point to the role of effective doctor–patient communication, as well as the need for a multidisciplinary management of obesity by a team composed of a physician, dietitian, and often physiotherapist. Pharmacotherapy, which was introduced in recent years as a supportive treatment, is another pillar of obesity therapy. Therefore, we also reviewed guidelines regarding pharmacological treatment of obesity. We focused on summarising indications for anti-obesity medications, descriptions of individual medications, their dosing regimens, as well as therapeutic goals, pointing out differences between individual recommendations.

Echocardiographic assessment of cardiac function abnormalities and related risk factors in Thai overweight and obese children

ABSTRACT Background: Childhood obesity has become a global concern, with its prevalence steadily increasing over the past decade. This condition negatively impacts the cardiovascular system, increasing the risk of morbidity and mortality in adulthood. This study aimed to identify cardiac function abnormalities and related risk factors among overweight and obese Thai children. Materials and Methods: A cross-sectional observational study of 70 children with body mass index (BMI) &gt;1 standard deviation above the mean for Thai children was conducted at Naresuan University Hospital. Body fat percentage (%Fat) was measured, and standard transthoracic echocardiography was performed. Metabolic profiles were collected from medical records. Results: The thickness and diameter of the Left ventricle (LV) wall, including the LV posterior wall, LV internal diameter, and interventricular septum (IVS), were significantly increased in both systolic and diastolic phases in obese children. LV concentric hypertrophy and an abnormal E/E’ ratio were found in 27% and 34.3% of participants, respectively. Right ventricular systolic dysfunction indicated by abnormal tricuspid annular plane systolic excursion values was found in 55.7% of all participants. In addition, 27.1% of all obese children had pulmonary hypertension. Significant differences in BMI and %Fat were detected between children with abnormal and normal IVS diastolic (IVSd) (P = 0.016). Our univariate and multivariate correlation analyses revealed a significant positive association between abnormal IVSd and %Fat, with an odd ratio (OR) of 1.13 (95% confidence interval [CI]: 1.01–1.27; P = 0.047) and an adjusted OR of 1.17 (95% CI: 1.01–1.36; P = 0.04). Conclusions: Cardiac function abnormalities in childhood obesity exhibit a significant positive correlation with BMI and various cardiac dimensions, including ventricular wall thickness. One important related risk factor for increased IVS thickness is %Fat. Therefore, multidisciplinary management of obesity should be initiated as early as possible to prevent future cardiovascular morbidity and mortality.

Influence of obesity on reproductive health before andduring pregnancy

Most women with obesity are fertile, although obesity increases the risk of infertility. This review describes the influence of obesity on reproductive health before and during pregnancy and postpartum. It also discusses the multidisciplinary management of obesity during a woman’s reproductive period based on the scientific literature on the subject published from January 2015 to March 2022. Obesity is a risk factor for endometrial hyperplasia and cancer. Women with obesity have a lower response to ovarian stimulation. In ovulation induction treatments, there is less likelihood of ovulation using clomiphene citrate, higher doses of gonadotropins are required and a smaller number of follicles develop. Women with polycystic ovary syndrome (PCOS) have a higher likelihood of obesity (prevalence ranging from 14 to 75% depending on the population studied), longitudinal weight gain and abdominal obesity compared to women without PCOS. Obesity and PCOS are two conditions with complex pathophysiologies and it is not clear which one of them acts as a cause or as a consequence of the other. The pregnancies of women with obesity are at increased risk of different complications, including gestational diabetes, hypertensive disease of pregnancy (gestational hypertension or preeclampsia), foetal malformations, prematurity, both spontaneous and induced by other complications, Caesarean delivery, postpartum haemorrhage and thromboembolism. Primary care practice includes health promotion and prevention actions, and it is often the first point of contact between a woman and her partner and the healthcare service before they conceive. Primary care is therefore responsible for providing this new family with quality prenatal care with preventive activities prior to pregnancy. In relation to obesity, this situation provides the opportunity for effective communication with women and their families about weight goals at this stage of life, the importance of weight loss prior to pregnancy, maximum weight gain during pregnancy and postpartum weight loss to reduce the risk of adverse outcomes in current and future pregnancies.

Nutritional Management and Role of Multidisciplinary Follow-Up after Endoscopic Bariatric Treatment for Obesity.

The prevalence of obesity has risen exponentially, and patients living with obesity suffer from its debilitating consequences. The treatment options for obesity have expanded significantly and include lifestyle changes, pharmacotherapy, endoscopic bariatric therapies (EBTs), and bariatric surgery. Endoscopic bariatric therapies comprise volume-reducing procedures such as endoscopic gastroplasty and gastric space-occupying devices such as intragastric balloons. Because of its minimally invasive nature and ease of delivery, EBTs are increasingly being adopted as a treatment option for obesity in several centers. These procedures mainly achieve weight loss by inducing early satiety and reducing meal volume. While the technical aspects of EBTs have been well explained, the nutritional management surrounding EBTs and the effectiveness of multidisciplinary team for maximizing weight loss is less described. There is considerable variation in post-EBT care between studies and centers. In this paper, we review the existing literature and share our experience on nutrition and the role of multidisciplinary management of obesity following EBT.

Cooperation behaviour of primary care paediatricians: facilitators and barriers to multidisciplinary obesity management.

Multidisciplinary management of obesity by primary care paediatricians, providing a promising approach to tackle childhood obesity includes cooperation with other health care professionals. However, facilitators for and barriers to multidisciplinary cooperation in ambulatory care are not yet well understood and are investigated in the present study. A nationwide, cross-sectional survey of 83% of German primary care paediatricians was conducted, using a questionnaire based on qualitative expert interviews. Frequency of paediatricians' cooperation with external partners (i.e. nutrition counsellors; sports groups; interdisciplinary obesity centres; inpatient rehabilitation centres; and endocrinologists) was assessed. Individual and structural factors were associated with cooperation patterns. Missing values were addressed using multiple imputation. Out of the 6081 primary care paediatricians approached, 2024 (33.3%) responded. Almost half of the respondents (40.8%) stated that they disengaged in the field of obesity prevention due to perceived inefficacy. Lack of financial reimbursement for consultation was agreed on by most of the respondents (90.4%). Identified barriers to cooperation included: higher proportion of patients with migration background, lack of time and available services. A more comprehensive conception of the professional role regarding overweight prevention, higher age, female gender, higher proportion of overweight/obese patients and practice location in urban or socially strained areas surfaced as facilitators for cooperation. Low-perceived self-efficacy in obesity management and insufficient financial reimbursement for consultation are commonly stated among German paediatricians. For cooperation behaviour, however, other individual and structural factors seem to be relevant, which provide indications on how multidisciplinary childhood obesity management can be improved.

2091-P: Relationship between Prediabetes (Pre-DM) and the Frequency of Periodontal Disease (PD) in Patients with Severe Obesity—A Retrospective Cohort Study in an Academic Center in Paraguay

Objectives: To determine the relationship between the Pre-DM and the PD frequency in patients with significant obesity and also between the Pre-DM as part of the metabolic syndrome (MS) and the PD in these patients. Methods: Retrospective cohort study with patients with severe obesity from an unit of multidisciplinary management of obesity. They were distinguished in patients with Pre-DM or normoglycemia. The outcome was the presence and degree of PD with the Modified Periodontal Index of Russell (MPIR). Results: There were evaluated 62 patients, half of them with Pre-DM. The Pre-DM vs. normoglycemia cohorts had: weight (in kg) 133,3±37,2 vs. 114,7±20,7 (p 0,01) and BMI 49,1±12,9 vs. 43,1±6,3 (p 0,02). According to the MPIR no patient was healthy. In the Pre-DM and normoglycemia cohorts the frequency of gingivitis and periodontitis was equal: 22,5 and 77,4% respectively. The frequency of severe periodontitis (SP) was 51,6% in patients with Pre-DM and 29,03% with normoglycemia (RR 1,77 - p 0,06). The SP was more frequent with higher fasting glucose levels: 29,4, 38,7 and 57,14% for each tertile respectively, as well as with greater BMI: 28,9, 50 and 75% for each tertile. Among patients with Pre-DM and BMI ≥ 45,9 kg/m2, 75% had SP vs. 26,7% of those with lower BMI (RR 2,81 - p 0, 01). Amidst patients with vs. without MS: 44,2 vs. 31,6% had SP (RR 1,39 - p 0,3). The frequency of SP had a fairly linear rise with the increase in the number of elements of the MS: 20, 36, 37, 53 and 43% in the presence of 1 to 5 elements of MS respectively (p &amp;gt; 0,05). Conclusions: The PD was not more common in patients with Pre-DM. SP was more frequent in those patients with Pre-DM, with a greater and statistically significant difference in those with more severe degrees of obesity. These results show that in the context of severe obesity and MS, even mild hyperglycemia seems to be related to SP and the need to request an evaluation of oral health in this group of patients. Disclosure V.M. Jiménez de Pane: None. A. Benitez: None. M. Palacios: None. E. Bueno Colman: None. J.T. Jimenez: None.

Evolution and Outcomes of a Canadian Pediatric Bariatric Surgery Program

PurposeAn interdisciplinary obesity management program was established in 2007 at our quaternary hospital, including bariatric surgery for selected adolescent patients. We report the evolution of surgical management within the program and outcomes following bariatric surgery. MethodsThis was a retrospective review of adolescents who underwent bariatric surgery between 2007 and 2017. All cases were performed by a pediatric surgeon and an adult bariatric surgeon. Baseline demographics, BMI, co-morbidities, and post-operative outcomes were recorded. ResultsThirty-eight patients underwent bariatric surgery. Median age at entrance into the program was 16.5 (range, 12.1–17.4) years and at time of surgery was 17.4 (range, 13.6–18.8) years. Eight patients had laparoscopic adjustable gastric banding (LAGB) from 2007 to 10. Between 2011 and 2017, 18 had laparoscopic sleeve gastrectomy (LSG), and 12 had laparoscopic Roux-en-Y gastric bypass (RYGB). There were no intraoperative complications or conversions. Postoperative complications included wound infection, bleeding requiring transfusion and re-exploration, and internal hernia. Of patients who had LAGB, 2 required surgical revision, and 3 underwent subsequent removal. ConclusionsAdolescent bariatric surgery in the context of a multidisciplinary obesity management program is safe and effective. RYGB and sleeve gastrectomy are associated with superior weight loss in the immediate post-operative period and at most recent follow-up and lower reoperation rates than gastric banding. Level of EvidenceIII.

The readiness and motivation interview for families (RMI-Family) managing pediatric obesity: study protocol

BackgroundExperts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth.MethodsFrom 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13–17 years old; n = 250) and their parents (n = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children’s hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined.DiscussionAs a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families’ needs.

Gastrointestinal Complications of Obesity

Obesity usually is associated with morbidity related to diabetes mellitus and cardiovascular diseases. However, there are many gastrointestinal and hepatic diseases for which obesity is the direct cause (eg, nonalcoholic fatty liver disease) or is a significant risk factor, such as reflux esophagitis and gallstones. When obesity is a risk factor, it may interact with other mechanisms and result in earlier presentation or complicated diseases. There are increased odds ratios or relative risks of several gastrointestinal complications of obesity: gastroesophageal reflux disease, erosive esophagitis, Barrett's esophagus, esophageal adenocarcinoma, erosive gastritis, gastric cancer, diarrhea, colonic diverticular disease, polyps, cancer, liver disease including nonalcoholic fatty liver disease, cirrhosis, hepatocellular carcinoma, gallstones, acute pancreatitis, and pancreatic cancer. Gastroenterologists are uniquely poised to participate in the multidisciplinary management of obesity as physicians caring for people with obesity-related diseases, in addition to their expertise in nutrition and endoscopic interventions.

Obesity: A Review of Pathogenesis and Management Strategies in Adult

Obesity is a chronic metabolic disease characterized by an increase of body fat stores. It is a gateway to ill health, and has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. Obesity is a major risk factor for cancer, cardiovascular, metabolic, and respiratory disorders. This presents an ever increasing social and economic burden to individuals, families and the healthcare system. Preventing obesity is the optimal long-term population strategy. A comprehensive history, physical examination and laboratory assessment relevant to the patient’s obesity should be obtained. Appropriate goals of weight management emphasize realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims.Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognize obesity as a disease and help obese patients with appropriate prevention and treatment. This review addresses the current therapeutic options in the treatment of obesity, focusing on pathogenesis, lifestyle changes, medications, and surgery. It also presents a suggested algorithm for the clinician assessing and managing obese patients.Delta Med Col J. Jan 2017 5(1): 35-48

Pediatric bariatric surgery: the clinical pathway.

Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution. Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only. Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients. Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.

The impact of family functioning on short term efficacy of a 10 week multidisciplinary obesity management program –A pilot study

The impact of family functioning on short term efficacy of a 10 week multidisciplinary obesity management program –A pilot study

Obésité et reproduction : revue de la littérature

Obesity is a growing public health problem because of the morbimortality factors linked to it. In obstetrics and gynecology, consequences on fertility and contraception are notable: infertility, low assisted reproductive technologies (ART) results, miscarriages, congenital abnormalities, obstetrical and neonatal complications, low hormonal contraception efficacy. These effects are partially corrected by weight loss which can be achieved by behavioural, medical or surgical treatment. Gynaecologists should always participate in a multidisciplinary management of obesity before hormonal contraception or ART.

Obesity in children and young people: a crisis in public health.

Ten per cent of the world’s school-aged children are estimated to be carrying excess body fat (Fig. 1), with an increased risk for developing chronic disease. Of these overweight children, a quarter are obese, with a significant likelihood of some having multiple risk factors for type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood. The prevalence of overweight is dramatically higher in economically developed regions, but is rising significantly in most parts of the world. In many countries the problem of childhood obesity is worsening at a dramatic rate. Surveys during the 1990s show that in Brazil and the USA, an additional 0.5% of the entire child population became overweight each year. In Canada, Australia and parts of Europe the rates were higher, with an additional 1% of all children becoming overweight each year. The burden upon the health services cannot yet be estimated. Although childhood obesity brings a number of additional problems in its train – hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression – the greatest health problems will be seen in the next generation of adults as the present childhood obesity epidemic passes through to adulthood. Greatly increased rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesityrelated conditions will be found in young adult populations, and their need for medical treatment may last for their remaining life-times. The costs to the health services, the losses to society and the burdens carried by the individuals involved will be great. The present report has been written to focus attention on the issue and to urge policy-makers to consider taking action before it is too late. Specifically, the report: