Obesity In The United States Research Articles

Associations between binge drinking and obesity-related anthropometric measures: Results from the national health and nutrition examination survey

Limited population-level data are available on the links between binge drinking and different measures (traditional and novel) of obesity in America. This study evaluated the associations between binge drinking and obesity anthropometric measures in adult Americans. This was a cross-sectional, observational study of 4098 adults from the 2013–2016 National Health and Nutrition Examination Survey. Body mass index, waist circumference (WC), and trunk-to-leg-volume ratio were assessed, along with binge drinking. Logistic regression was used to examine associations between binge drinking and obesity measures, by gender and age sub-groups. Men engaged in more binge drinking than women. For men and women aged 20–39 yr, those who binge drank 1–12 times yearly had approximately 25–40% lower odds of obesity than abstainers when using WC and trunk-to-leg-volume ratio, though the association was only significant for WC. Middle-aged men (40–59 yr) reporting >12 yearly binges had higher odds (2.30, 95% CI: 1.19–4.46) of elevated trunk-to-leg-volume ratio than abstainers. Associations between monthly binging and obesity measures were non-significant. Associations between obesity and binge drinking depend on age, gender, and the method of quantifying obesity. Research and public health efforts related to binge drinking and obesity should consider the complexity of these associations. • Among American men and women aged 20–39 years, those who binge drank 1–12 times yearly had approximately 40% lower odds of obesity (based on waist circumference) than abstainers. • Middle-aged men (40–59 years old) reporting >12 yearly binges had more than double the odds of elevated trunk-to-leg-volume ratio than abstainers. • The associations between binge drinking and obesity are conflicting and depend on age, gender, and method of quantifying obesity.

ODP009 Obesity-related Conditions in Adults with Overweight and Obesity in the United States: A Cluster Analysis

Abstract Background Obesity is a heterogeneous chronic condition that has varying metabolic, structural, inflammatory, degenerative, neoplastic and psychological health effects. We aimed to identify common patterns of obesity-related conditions in a nationally representative sample. Methods Respondents age ≥18y with body mass index (BMI) >25 kg/m2 in NHANES 2017-2018 were clustered based on key obesity-related conditions including type 2 diabetes (T2D), dyslipidemia, hypertension (HTN), cardiovascular disease (CVD), chronic kidney disease (CKD), osteoarthritis, physical limitation (PL), cancer, depression, and anxiety. Hierarchical adaptive means clustering was employed with NHANES survey weights. An optimal number of clusters was chosen with the "elbow method." Patient characteristics were compared across clusters. Clusters were characterized by conditions with a ≥ 50% prevalence in descending order. Results Six clusters were identified among 3,084 respondents. Cluster 1 (15.8% of the respondents; mean age: 34.9y; female: 53.5%; mean BMI: 30.8) had no obesity-related conditions. Cluster 2 (27.7%; 47.3; 42.7%; 32.5) was dominated by HTN. Cluster 3 (9.9%; 58. 0; 44.1%; 33. 0) was dominated by CKD and HTN. Cluster 4 (13.2%; 55.1; 68. 0%; 33.7) was dominated by depression, HTN, PL and dyslipidemia. Cluster 5 (23.7%; 59.4; 50.7%; 32.6) was dominated by HTN, PL, CVD and dyslipidemia. Cluster 6 (10.1%; 67.8; 45. 0%; 34.3) was dominated by HTN, dyslipidemia, T2D, PL, and CVD. Clusters 4 and 6 incurred the highest healthcare use. Conclusions Adults with overweight and obesity in the US have distinct patterns of obesity-related conditions, the burden of which generally increased with obesity severity and age. Presentation: No date and time listed

Effect of BMI on Outcomes after Surgery for Apical Pelvic Organ Prolapse

<h3>Study Objective</h3> Evaluate the impact of obesity on outcomes after apical pelvic organ prolapse surgery. <h3>Design</h3> Retrospective cohort study using cases identified in the ACS-NSQIP database from 2014-2018. <h3>Setting</h3> Surgical cases from 722 hospitals nationally. <h3>Patients or Participants</h3> 26,898 females age 18-89 who underwent apical prolapse repair were identified by CPT codes. BMI categories are defined as: underweight (BMI <18.5, N=147), normal weight (BMI 18.5-24.9, N=7,374), overweight (BMI 25.0-29.9, N=10,268), class 1 obesity (BMI 30.0-34.9, N=5,810), class 2 obesity (BMI 35.0-39.9, N=2,240), and class 3 obesity (BMI ≥ 40.0, N=1,059). <h3>Interventions</h3> Participants underwent vaginal colpopexy (N=15,466), laparoscopic or robotic sacral colpopexy (N= 9,678), or abdominal sacrocolpopexy (N=1,754). <h3>Measurements and Main Results</h3> The average age of the cohort was 60 years, with 76.3% identifying as white race, 24.2% ASA class 3 or 4, 44.5% with a major medical comorbidity, and 9.0% smoking within one year. A total of 1,463 patients (5.4%) experienced a minor complication, 611 (2.3%) a major complication, and 1,993 (7.4%) any complication. Complication rates differed significantly by BMI class (minor p=0.005, major p<.001, any p<.001). Class 3 obesity had higher rates of any complication and minor complication compared to all classes except underweight and more major complication compared to normal, overweight and class 1 obesity. After adjusting for age, race, ASA class, smoking, and repair type, significant associations persisted between BMI and complications. <h3>Conclusion</h3> Based on national data from over 26,000 apical prolapse procedures, obesity is associated with post-operative complications. As obesity and average BMI in the US continue to increase, controlled studies are needed to confirm these findings. These results should be considered in preoperative planning and patient counseling.

Extreme obesity in the ICU

Morbid obesity remains an extremely serious disorder resulting in significant impairment of health all over the World. This is particularly true especially now in the setting of lockdowns and people not exercising due to the recent COVID-19 pandemic. In general, overweight and obese adults are at in increased risk of morbidity and mortality from many acute and chronic medical conditions, including hypertension, dyslipidemia, coronary heart disease, diabetes mellitus, gallbladder disease, respiratory disease, some types of cancer, gout and arthritis. Although body weight that exceeds ideal standards as determined by age, sex and height may be accounted for by a greater muscle mass or bone mass, the majority of individuals who weigh more than 20% over their calculated ideal body weight (IBW) have excessive adipose mass. What is even more alarming is the fact that the incidence of obesity in the USA has increased progressively since 1960, when the first survey was conducted. More recent data has demonstrated that the prevalence of obesity is three times higher in the USA than France, and one-and-a-half times that of England. As obesity is such a pervasive disorder in our society, and because obesity is an important risk factor for many diseases, it is not surprising that many obese patients are treated in the intensive care unit (ICU).

Effects of statins on outcomes in Hispanic patients with COVID-19

The Hispanic population is regarded among those who are at greater risk of adverse prognoses due to higher rates of diabetes and obesity in the USA during the COVID-19 pandemic....

Regional differences in intercohort and intracohort trends in obesity in the USA: evidence from the National Health Interview Survey, 1982–2018

ObjectivesObesity in the USA is more prevalent in younger cohorts than older cohorts and also more prevalent in the South and the Midwest than other regions. However, little research has...

Clarifying methodological misunderstandings regarding estimates of excess mortality associated with elevated body weight.

The rise of obesity in the US has been well-documented,1,2 and a large body of scientific evidence has linked elevated body mass index (BMI) with increased risk of many diseases3,4 and all-cause mortality.5 We recently published updated estimates of excess mortality associated with elevated body weight in the US, finding that in 2016, excess weight was responsible for nearly 500,000 deaths and a loss of life expectancy of nearly 2.4 years, with large disparities by state and demographic group.6

Abstract 1321: Effects of sulindac on inflammatory and cellular responses in mammary tumors from obese mice

Abstract Background: Breast cancer is the second leading cause of cancer-related death in US women. Obesity (BMI &amp;gt; 30 kg/m2) promotes breast cancer incidence, progression, and mortality in women of all ages. The prevalence of obesity in the US has increased dramatically over recent decades and continues to rise. Although obesity is associated with increased adipose tissue inflammation and metabolic dysfunction the exact mechanisms regulating obesity-exacerbated tumor growth are relatively unknown. Nonsteroidal anti-inflammatory drugs (NSAIDs), like sulindac, inhibit cyclooxygenase-1 and cyclooxygenase-2 and modulate the secretion of pro-inflammatory cytokines. The purpose of this study was to investigate the mechanisms underlying the anticancer effects of sulindac in our E0771 mouse model of obesity and mammary tumor growth. Methods: C57BL/6J mice were fed either a high-fat diet (n=16) or a low-fat control diet (n=12) for 15 weeks. Half of the control (n=6) and DIO (n=8) mice were then treated with 140 ppm sulindac in their respective diets for 4 weeks prior to orthotopic injection of 20,000 E0771 cells. Tumors were harvested and weighed, and serum was collected 4 weeks following injection. Bulk transcriptional profile analysis was performed on E0771 tumors from untreated control and DIO mice relative to sulindac-treated control and DIO mice using Affymetrix microarrays followed by gene set enrichment analysis (GSEA) to identify significantly enriched gene sets. Serum cytokine levels were measured in all mice using the Bio-Plex Pro mouse chemokine panel 33-plex; multiple linear regression was conducted to determine cytokines associated with mammary tumor size, independent of diet or treatment group assignment. Results: DIO mice had increased tumor weight relative to control mice, while sulindac decreased tumor weight in DIO but not control mice. GSEA analysis revealed only one gene set upregulated in the DIO tumors relative to control or DIO sulindac tumors. Immune-related gene sets were commonly enriched in tumors from control and DIO sulindac relative to DIO mice, suggesting that sulindac restored immune signaling in tumors from DIO mice. Leading edge analysis of the significantly enriched gene sets showed that: 1) the reversal of DIO-mediated immunosuppression by sulindac occurred via principally overlapping genes; and 2) cytokine and immune genes predominate the transcriptional effects of sulindac treatment in DIO mice. Sulindac also modified circulating serum cytokine levels, but multiple linear regression showed that cytokine levels were not independently predictive of tumor weight in our study. Conclusions: The study suggests that sulindac can reverse transcriptional changes in mammary tumors from obese mice and restore immunosurveillance. Sulindac, or potentially other NSAIDs, may protect against obesity–driven mammary tumor growth via remodeling of antitumor immune function. Citation Format: Morgan E. Cody, Shannon B. McDonell, Qing Shi, Elaine M. Glenny, Michael F. Coleman, Stephen D. Hursting. Effects of sulindac on inflammatory and cellular responses in mammary tumors from obese mice [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1321.

Berry Anthocyanins in Rodent and Human Obesity and Diabetes: A Review of the Evidence

Obesity in America is a public health crisis that will continue to impact the country at an individual, social, and economic level unless we address the disease with dietary modifications to reduce or prevent its development. Nutritional interventions designed for obesity treatment are constantly evolving. Berries, which are a rich source of polyphenols, have been suggested as a potential bioactive component, as they have been reported to have anti-obesity effects. Therefore, this review will provide an overview of epidemiological studies to introduce the idea of berries for health promotion. Studies conducted in both rodents and humans are summarized. This review includes an overview of the physiological responses associated with berry consumption, including the effects on the composition of the gut microbiota in humans and rodents, which demonstrate how berry consumption may provide a protective effect against obesity and its related comorbidities. However, these findings have yet to be translated into feasible, long-term nutrition intervention in humans. Future research into different berries and their components will identify effective, accessible functional food options that can augment nutritional interventions.

Acute Compartment Syndrome in the Setting of Weight Loss Supplements and Exercise-Induced Rhabdomyolysis.

The growing prevalence of obesity in the USA has resulted in increased consumption of weight loss products that promote fat metabolism. Dietary supplements used for weight loss contain a wide variety of ingredients but the amount of scientific information available on these ingredients varies considerably. Such supplements have documented and undocumented adverse effects. Although the FDA frequently issues health advisories, the health consequences of consuming supplements are often overlooked by the general public. A common supplement used for weight loss is Hydroxycut. The ingredients used in the different forms of Hydroxycut products vary but generally include caffeine and green tea extract, which are responsible for a wide range of adverse effects. We present the case of 41-year-old man with a medical history of polysubstance abuse who developed acute compartment syndrome in the setting of rhabdomyolysis from prolonged immobilisation and the use of Hydroxycut. This case demonstrates the possible adverse effects of consuming weight loss herbal supplements like Hydroxycut. Healthcare professionals and consumers are encouraged to report serious adverse events or product quality problems with the use of these supplements to the FDA’s MedWatch adverse event reporting program.LEARNING POINTSThe weight loss supplement Hydroxycut is sold in various formulations whose side effect profiles are not fully known; the latest formulation has a very high concentration of caffeine which increases the risk of rhabdomyolysis.Although uncommon, exercise-induced rhabdomyolysis can cause compartment syndrome, especially in the setting of concurrent use of weight loss supplements.High clinical suspicion, prompt diagnosis and early treatment are key to preventing complications from compartment syndrome.

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

The Global Spread of Severe Obesity in Toddlers, Children, and Adolescents: A Systematic Review and Meta-Analysis

Introduction: Severe obesity among children and adolescents has emerged as a public health concern in multiple places around the world. Methods: We searched the Medline database for articles on severe obesity rates in children published between January 1960 and January 2020. For studies with available prevalence rates for an early and a more recent time period, the relative increase in prevalence was imputed. Results: In total, 874 publications were identified, of which 38 contained relevant epidemiological data. Rates of severe obesity varied significantly according to age, gender, geographic area, and the definition of severe obesity. The highest rates of class II and III obesity in the USA according to the Centers of Disease Control cut-off were 9.5% and 4.5%, respectively. Seventeen studies reported prevalence rates in at least two time periods. Data for 9,190,718 individuals showed a 1.71 (95% CI, 1.53–1.90) greater odds for severe obesity in 2006–2017 (N = 5,029,584) versus 1967–2007 (N = 4,161,134). In an analysis limited to studies from 1980s with a minimum follow-up of 20 years, a 9.16 (95% CI, 7.76–10.80) greater odds for severe obesity in recent versus earlier time was found. An analysis limited to studies from 2000, with a follow-up of 5–15 years, a 1.09 (95% CI, 0.99–1.20) greater odds was noted when comparing (2011–2017; N = 4,991,831) versus (2000–2011; N = 4,134,340). Conclusion: Severe pediatric obesity is escalating with a marked increase from the 1980s and a slower rate from 2000.

Play vs exergaming: A conceptual analysis as to why exergaming is not play

The fields of kinesiology and public health promotion have significantly invested in the potential for on-line, digitally mediated exergaming to promote higher levels of physical activity and so to reduce disconcertingly high levels of obesity in the USA. The proponents of exergaming attempt to tie exercise to play in order to make exercise fun and sustainable over time. Drawing on Huizinga’s Homo Ludens, the purpose of this concept-based paper was to conceptually analyze the motivational resources provided by true play in contrast to the engineered instrumental design of exergaming. The analysis furthermore explains the disappointing results of studies to date on the effects of exergaming. According to Huizinga, play is undertaken for its own sake, for the lived experience of joy, tension, creativity, and release. In contrast, exergaming emphasizes measurable objectives to lose weight and reduce morbidity and mortality rates. This pressure to meet biological needs appears not to be enjoyable like in true play, and, ironically, exergaming is more likely to harm rather than improve users’ health. Physical activity experts need to emphasize the true elements of playful movement for the felt experiences it can afford, including artistic expression, dance, and recreational games at schools, neighborhoods, and local parks.

Timing of Meals and Exercise Affects Hormonal Control of Glucoregulation, Insulin Resistance, Substrate Metabolism, and Gastrointestinal Hormones, but Has Little Effect on Appetite in Postmenopausal Women.

The current prevalence of obesity in the US is strongly associated with excessive food intake and insufficient physical activity. This study examined whether changing the timing of exercise before or after two daily meals could alter human appetite for food. Fifty-four healthy postmenopausal women were matched by body weight and assigned to two groups: (1) two bouts of 2-h moderate-intensity exercise ending one hour before each weight-maintenance meal (XM, n = 23), (2) two-hour moderate-intensity exercise starting 1 h after each weight-maintenance meal (MX, n = 23), and one sedentary control (SED) arm (n = 8). Measurements included appetite ratings, circulating glucose, free fatty acids (FFAs), a ketone body D-ß-hydroxybutyrate (BHB), glucoregulatory hormones insulin and glucagon, and gastrointestinal hormones associated with food digestion and absorption and implicated in appetite sensations. XM group increased concentrations of FFAs and BHB during exercise and increased insulin and homeostatic assessment of insulin resistance (HOMA-IR) during postprandial periods. MX group reduced postprandial insulin and HOMA-IR by about 50% without a major change in plasma glucose. There was brief suppression of hunger and an increase in satiation in both exercise groups near the end of the first postprandial period. The time course of hunger was unrelated to the perturbations in fuel metabolism, depletion of liver glycogen, and not correlated with concentration changes in hunger-stimulating hormone ghrelin during XM exercise before meals. Similarly, there was no correlation between the time course of fullness during exercise after meals with the postprandial secretion of gastrointestinal hormones including cholecystokinin (CCK) that has been linked to satiation. Hunger and satiation appear to depend on oral intake and gastrointestinal processing of nutrients and are not affected by metabolic and hormonal consequences of the timing of exercise with respect to meals. Moderate-intensity exercise performed shortly after meals induces a rapid and highly effective lowering of insulin resistance.

Abstract 8868: Impact of Obesity on Sinus Nodal Dysfunction - A Retrospective National Database Study

Introduction: Sick sinus syndrome (SSS) or sinus node dysfunction (SND) is degenerative disease of the sinus node. Previous research lacks objective data on the relationship between obesity and SND, with respect to inpatient mortality. This study aimed to discern a difference in mortality by using the National Inpatient Sample (NIS) database to identify patients with the principal discharge diagnosis of SSS with and without a secondary diagnosis of obesity. Methods: Hospitalizations of patients 18 years and older, who had a principal diagnosis of SSS with and without a secondary diagnosis of obesity in the US between January 1, 2016 and December 31, 2017 were obtained from the Nationwide Inpatient Sample (NIS) database for a cohort study. Patient and hospital characteristics are outlined in Table 1. Obese patients were classified according to a BMI&gt;30. Inpatient mortality between non-obese and obese groups was assessed as the primary outcome. Secondary outcomes included total hospital charges (THC), hospital length of stay (LOS), rate of pacemaker insertion, rate of acute renal failure (AKI), and rate of cardiogenic shock. Results: Patients with SSS and obesity, in comparison to those without obesity, had similar odds of inpatient mortality (aOR: 1.09, 95% CI 0.66-1.80), p=0.727) when adjusted for co-morbidities. Patients with obesity had higher length of stays (LOS) (4.5 vs 4 days, 0.2 CI: 0.1 - 0.4, p=0.002), higher odds of pacemaker insertion (aOR: 1.14, 95% CI:1.02-1.26, p=0.018), and higher rates of cardioversion/defibrillation (aOR: 1.36, 95% CI: 1.08 - 1.71, p=0.008). Summary of outcomes is outlined in Table 2. Conclusions: In conclusion, there was no difference between obese and non-obese patients with SND in regard to inpatient mortality, but obese patients may have higher lengths of stay and increased odds of pacemaker insertion and cardioversion or defibrillation during their hospital stay.

Abstract 13877: Financial Hardship From Medical Bills Among Non-Elderly Adults With Obesity in the US

Introduction: Obesity is a growing public health challenge in the US and carries a heavy economic toll. Previous work has detailed the overall health expenditures in this population, but we lack a current understanding on how these expenditures translate into financial hardship. We aimed to assess the financial hardship from medical bills, as well as other cost-related healthcare shortcomings experienced by those with obesity. Methods: We used the National Health Interview Survey (2013-18), a US nationally representative sample, to assess financial hardship from medical bills - difficulty paying or unable to pay at all (and consequences, including high financial distress, foregone/delayed care due to cost, and cost-related medication nonadherence) in non-elderly adults (18-65 years [i.e., those without universal coverage]) across different BMI strata. BMI was categorized as normal (18.5-24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), obesity classes 1 (30-34.9 kg/m 2 ), 2 (35-39.9 kg/m 2 ), and 3 (≥ 40 kg/m 2 ). Results: Among 139,521 surveyed individuals, 12,129 (weighted 8.5%) had class 3 obesity, representing 16 million non-elderly adults annually. A total of 38.0% of non-elderly adults with class 3 obesity reported having financial hardship from medical bills, compared with 24.7% among those with normal weight. Compared with adults with normal weight, those with class 3 obesity had higher odds of financial hardship from medical bills (OR 1.53, 95% CI 1.44-1.64), and among those with any financial hardship, higher odds of its consequences, including high financial distress (OR 1.13, 95% CI 1.01-1.25) and cost-related medication nonadherence (OR 1.16, 95% CI 1.02, 1.32). Conclusion: Non-elderly adults with class 3 obesity had 50% higher odds of financial hardship from medical bills, compared with those with normal weight, along with higher odds for its consequences, like financial distress and cost-related medication nonadherence.

Effectiveness and economic impact of a diabetes education program among adults with type 2 diabetes in South Texas

BackgroundThe long-term growth and sustained high prevalence of obesity in the US is likely to increase the burden of Type 2 diabetes. Hispanic individuals are particularly burdened by a larger share of diabetes than non-Hispanic White individuals. Given the existing health disparities facing this population, we aimed to examine the effectiveness and potential cost savings of the Diabetes Education Program (DEP) offered as part of Healthy South Texas, a state-legislated initiative to reduce health disparities in 27 counties in South Texas with a high proportion of Hispanic adults.MethodsDEP is an 8-h interactive workshop taught in English and Spanish. After the workshop, participants receive quarterly biometric screenings and continuing education with a health educator for one year. Data were analyzed from 3859 DEP participants with Type 2 diabetes living in South Texas at five time points (baseline, 3-months, 6-months, 9-months, 12-months). The primary outcome variable of interest for study analyses was A1c. A series of independent sample t-tests and linear mixed-model regression analyses were used to identify changes over time. Two methods were then applied to estimate healthcare costs savings associated with A1c reductions among participants.ResultsThe majority of participants were ages 45–64 years (58%), female (60%), Hispanic (66%), and had a high school education or less (75%). At baseline, the average hemoglobin A1c was 8.57%. The most substantial reductions in hemoglobin A1c were identified from baseline to 3-month follow-up (P < 0.001); however, the reduction in A1c remained significant from baseline to 12-month follow-up (P < 0.001). The healthcare cost savings associated with improved A1c for the program was estimated to be between $5.3 to $5.6 million over a two to three year period.ConclusionFindings support the effectiveness of DEP with ongoing follow-up for sustained diabetes risk management. While such interventions foster clinical-community collaboration and can improve patient adherence to recommended lifestyle behaviors, opportunities exist to complement DEP with other resources and services to enhance program benefits. Policy makers and other key stakeholders can assess the lessons learned in this effort to tailor and expand similar initiatives to potentially at-risk populations.Trial registrationThis community-based intervention is not considered a trial by ICMJE definitions, and has not be registered as such.

Sermons to Address Obesity in Partnership With African American and Latino Churches

Sermons to Address Obesity in Partnership With African American and Latino Churches

Panniculectomy Outcomes by Body Mass Index: an Analysis of 12,732 Cases.

PurposeWith an increasing rate of obesity in the USA, bariatric surgery has become widespread, resulting in a greater number of patients seeking panniculectomy. The authors aim to determine the complication profile of panniculectomies by body mass index (BMI).MethodsThe 2012–2018 National Surgical Quality Improvement Program database was queried for all panniculectomy cases. Patients were assigned to a category by their calculated BMI. Rates of complications were compared across BMI ranges. Demographics, comorbidities, and perioperative factors were compared between those with and without complications. Multivariable analyses were performed to analyze the associations between BMI ranges and post-surgical complications.ResultsTwelve thousand seven hundred thirty-two cases were analyzed, of which 1759 (13.8%) had at least one postoperative complication. As BMI increased, patients were more likely to experience postoperative complications (p<0.001). Patients experiencing complications were more likely to be male, older, of a higher BMI group, have a higher American Society of Anesthesiologists Personal Status classification, be an inpatient, have various comorbidities, or be undergoing a concurrent procedure. On multivariable analysis, patients who were overweight (OR=1.24, p=0.039), with class 1 (OR=1.72, p<0.001), class 2 (OR=2.10, p<0.001), or class 3 (OR=3.01, p<0.001) obesity were more likely to have a postoperative complication. Wound complications were particularly prevalent in patients who were overweight (OR=1.77, p=0.001) or with class 1 (OR=2.59, p<0.001), class 2 (OR=4.05, p<0.001), or class 3 (p=5.84, p<0.001) obesity compared to non-overweight patients.ConclusionA higher BMI is associated with more postoperative complications, particularly wound healing complications, following panniculectomy in a dose-dependent manner.Graphical abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s11695-021-05468-w.

Maximum intravenous alteplase dose for obese stroke patients is not associated with greater likelihood of worse outcomes

BackgroundIV alteplase is a primary treatment for acute ischemic stroke (AIS) at a weight-based dose (WBD) of 0.9 mg/kg and maximum dose (MD) of 90 mg. There are conflicting data regarding outcomes for those weighing ≥100 kg. There is also a paucity of data in Hispanics. The prevalence of adult obesity in the US has progressively increased; hence, the percentage of patients receiving the maximum dose also is expected to rise. We examined differences between patients treated with WBD vs. MD. MethodsA retrospective review of our center's Get With The Guidelines-Stroke database was performed for IV alteplase cases between October 2013–February 2017. Selection criteria included age ≥18 years, IV alteplase administration, and a recorded measured weight. Patients were dichotomized into WBD group weighing <100 kg and MD group weighing ≥100 kg. Categorical variables were analyzed using Chi square tests and continuous variables were analyzed using independent samples t-tests. Multivariable logistic regression analysis was performed to determine whether MD in combination with other variables was associated with poor outcomes. ResultsThere were 328 patients included in the study, 38 (11.6%) received MD. Proportions of younger, male, and non-Hispanic were higher in the MD group. There were no statistically significant differences for initial NIHSS, discharge modified Rankin Scale (mRS), 90-day mRS, symptomatic intracerebral hemorrhage (sICH), or systemic hemorrhage between groups. ConclusionOne in ten patients thrombolysed for the treatment of AIS received MD. In a predominantly Hispanic population, those who received MD and WBD had similar rates of sICH, discharge disposition, and functional outcome (mRS) at discharge and at 90 days. Limitations include small sample size and attrition for the 90-day mRS.