Treatment Option For Obesity Research Articles

Development of an Online Diabetes Prevention Lifestyle Intervention Coaching Protocol for Use in Primary Care Practice

The translation of an evidence-based lifestyle intervention to an online delivery format has the potential to provide an effective treatment option for obesity in primary care practice. Research is needed, however, to standardize e-counseling procedures to promote the training of health coaches and the dissemination to primary care settings. This article describes the development of an online lifestyle intervention coaching protocol adapted from the Diabetes Prevention Program lifestyle intervention curriculum. The delivery of patient counseling via the Internet may enable the dissemination of high-quality lifestyle advice to prevent diabetes in patients whose schedules or geographic constraints prohibit their participation in in-person counseling sessions.

Endoscopic Treatment of Obesity

The increasing incidence of obesity and overweight among children and adolescents will be reflected by the imminent increase in the number of obese patients who require more definitive methods of treatment. There is great interest in new, safe, simple, nonsurgical procedures for weight loss. To provide an overview of new endoscopic methods for the treatment of obesity. An English-language literature search on endoscopic interventions, endoscopically placed devices and patient safety was performed in the MEDLINE and Cochrane Library databases. The literature search yielded the following weight loss methods: space-occupying devices (widely used), gastric capacity reduction, modifying gastric motor function and malabsorptive procedures. A commercially available intragastric balloon was the most commonly used device for weight loss. In specific subgroups of patients, it improved quality of life, decreased comorbidities and served as a bridge to surgery. More evidence regarding the potential benefits and safety of other commercially available intragastric balloons is needed to clarify whether they are superior to the most commonly used one. Moreover, early experiences with transoral gastroplasty, the duodenal-jejunal bypass sleeve and an adjustable, totally implantable intragastric prosthesis, indicate that they may be viable options for obesity treatment. Other agents, such as botulinum toxin and a device known as the 'butterfly', are currently at the experimental stage. New endoscopic methods for weight loss may be valuable in the treatment of obesity; however, more clinical experience and technical improvements are necessary before implementing their widespread use.

Pharmacologic Treatment of Obesity

The pharmacological treatment of obesity still faces many barriers. Notably, these include the disregard of obesity as a disease and the very limited treatment options for obesity. In this context, this special issue is of special importance as it focuses on several topics, related to this challenge. After careful screening, review, and revision, we selected 26 articles which deal with a variety of aspects related to the pharmacological therapy of obesity. Topics covered include possible etiologies of the disease (e.g., A. Niijima's rat study and B. Bjorndal et al.'s research on adipogenesis), the role of diet as an anti-inflammatory mediator (studies of B. Sears and C. Ricordi and W. R. Hamilton et al.), some new aspects of the drugs being used today, particularly orlistat (A. Hollywood and J. Ogden, J. Martin et al., and N. J. Perera et al. studies), and outlining the treatment of special conditions such as in children and adolescents (L. Iughett et al.), polycystic ovary syndrome (H. Kahal et al.), and diabetes mellitus (V. Cheng and S. R. Kashyap). Additional reports include reviews on the pharmacological treatment of obesity in the present and future (M. Glandt and I. Raz and L. L. Ioannides-Demos et al.). To conclude, this edition of the journal describing advances in the pharmacological treatment of obesity will provide those in the field with new and useful insights on obesity pathogenesis and management. Alfredo Halpern Steven B. Heymsfield Luc Van Gaal

Treatment Options for Obesity

Treatment Options for Obesity

Metabolic Management following Bariatric Surgery

Bariatric surgery is an effective treatment option for obesity. Commonly utilized procedures are either restrictive, malabsorptive, or both. Substantial weight loss can be achieved. Postoperatively, patients experience nutritional, metabolic, and hormonal changes that have important clinical implications. The postoperative diet should be advanced carefully, according to protocol. Micronutrient deficiencies such as vitamin C, vitamin A, and zinc deficiencies are common, especially following malabsorptive procedures. Bone metabolism is greatly affected, in part due to vitamin D deficiency, decreased calcium absorption, and secondary hyperparathyroidism. Diabetes improves acutely in malabsorptive procedures and in sequence with weight loss in restrictive procedures. Polycystic ovarian syndrome improves in nearly all women with this condition who undergo bariatric surgery. Testosterone levels in men also improve after surgery. Consideration of these nutritional, metabolic, and hormonal changes allows for optimal medical management following bariatric surgery.

The Public Health Implications of the Cost-Effectiveness of Bariatric Surgery for Diabetes

Bariatric surgery is one of the major breakthroughs in diabetes care to have emerged since the discovery of insulin. In the 15 years since the first observational study, clinical trials and observational studies of bariatric surgery in diabetic patients have confirmed the beneficial effects of surgery (1). Since 2000, guidelines from the National Institutes of Health (NIH) have recommended bariatric surgery as an option for obesity treatment in adults with a BMI ≥35 kg/m2 and a serious comorbid condition (2). In 2009, the Centers for Medicare & Medicaid Services officially announced it would cover bariatric surgery for beneficiaries with morbid obesity and type 2 diabetes. While bariatric surgery can be beneficial, it is an expensive intervention costing at least $13,000 in the first year (3). In light of its high costs and potential benefits, understanding the cost-effectiveness of bariatric surgery for diabetes is critical for policy discussions regarding any ongoing or additional public health investment in bariatric surgery. The cost-effectiveness of bariatric surgery for diabetes has been evaluated in prior studies, but these studies have been limited by simplistic diabetes models (4–6) with parameter inputs derived from individual trials (5). Only one previous study of Roux-en-Y gastric bypass has accounted for the future complications of diabetes (7,8), and only one study has been conducted from the perspective of the U.S. (7). In this issue of Diabetes Care , Hoerger et al. (9) address many of these deficits in the existing literature and report on the most rigorously conducted cost-effectiveness analysis of bariatric surgery for diabetes to date. Using the Centers for Disease Control-Research Triangle Institute (CDC-RTI) Diabetes Cost-Effectiveness Model, the authors modeled the potential lifetime effects of bariatric surgery on diabetes by estimating rates of diabetes remission and relapse, as well as diabetes complications, …

The Treatment of Obesity and Its Co-occurrence with Substance Use Disorders.

Obesity and binge eating disorder are detrimental health conditions that are associated with lower qualities of life. Individuals with obesity often face societal discrimination and frequently experience related medical disorders such as diabetes, hypertension, and hyperlipidemia. Current research suggests neurobiological similarities between obesity, binge eating disorder, and substance dependence. In addition, behavioral similarities link the two conditions; obese and substance dependent individuals often report similar features such as loss of control towards food or substances, respectively, and cravings. Treatment options for obesity have begun to use this information to formulate pharmacological and therapeutic interventions that may provide greater results for weight loss and decreased binge frequency. Similarly, treatment approaches to substance addictions should consider aspects of weight management. Findings from research and treatment studies are presented with the aim of reviewing the current literature of obesity within the context of an addiction framework and providing information on empirically supported approaches to the treatment of co-occurring obesity and substance addiction.

An active extract of Lindera obtusiloba inhibits adipogenesis via sustained Wnt signaling and exerts anti-inflammatory effects in the 3T3-L1 preadipocytes

Obesity, the related metabolic syndrome and associated liver diseases represent an epidemic problem and demand for effective therapeutic strategies. In this regard, natural compounds derived from Oriental medicine such as green tea polyphenols influencing adipogenesis attract growing attention. In Korea, an aqueous extract from the Japanese spice bush Lindera obtusiloba is traditionally used for treatment of inflammation and prevention of liver damage. We here investigated effects of the L. obtusiloba extract on cell growth, apoptosis, Wnt signaling and differentiation of (im)mature adipocytes using 3T3-L1, an established cell line for studying adipogenesis. L. obtusiloba extract reduced the de‑novo DNA synthesis of 3T3-L1 preadipocytes in a concentration dependent manner with an IC 50 of ∼135 μg/ml paralleled by induction of caspase‑3/7 mediated apoptosis. Hormone-induced 3T3‑L1 differentiation in the presence of L. obtusiloba extract resulted in a reduced accumulation of intracellular lipid droplets by 70%, in down-regulated expression of the adipogenesis-associated proteins glucose transporter-4 and vascular endothelial growth factor, in reduced secretion of the proadipogenic matrix metalloproteinase-2, and in dampened phosphorylation of the Wnt pathway effector protein β-catenin with subsequent diminished expression of the peroxisome proliferator-activated receptor-γ. Treatment of mature adipocytes with L. obtusiloba extract also significantly reduced intracellular lipid droplets. In addition to this strong interference of L. obtusiloba extract with adipogenesis, L. obtusiloba extract exerted anti-inflammatory effects. L. obtusiloba extract significantly attenuated lipopolysaccharide- and tumor necrosis factor α-induced secretion of IL-6 by preadipocytes, thus influencing insulin resistance and inflammatory state characterizing obesity. In conclusion, extracts of L. obtusiloba should be evaluated as a potential complementary treatment option for obesity associated with the metabolic syndrome.

Manometric Changes of the Lower Esophageal Sphincter After Sleeve Gastrectomy in Obese Patients

Laparoscopic sleeve gastrectomy has been accepted as an option for surgical treatment of obesity. After surgery, some patients present reflux symptoms associated with endoscopic esophagitis, therefore PPI's treatment must be indicated. This study aims to evaluate the manometric characteristic of the lower esophageal sphincter (LES) before and after sleeve gastrectomy This prospective study includes 20 patients submitted to esophageal manometry in order to determine the resting pressure, and total and abdominal LES length before and after the sleeve gastrectomy. Statistical variations on the LESP were validated according to Student's "t" test. Seventeen female and three male patients were included, with a mean age of 37.6 +/- 12.6 years. All patients reduced their body weight, from an initial BMI of 38.3 kg/m(2) to 28.2 kg/m(2) 6 months after surgery. No postoperative complications were observed in these patients. Preoperative mean LESP was 14.2 +/- 5.8 mmHg. Postoperative manometry decreased in 17/20 (85%), with a mean value of 11.2 +/- 5.7 mmHg (p = 0.01). Seven of them presented LESP <12 mmHg and ten patients <6 mmHg after the operation. Furthermore, the abdominal length and total length of the high pressure zone at the esophagogastric junction were affected. A sleeve gastrectomy produces an important decrease in LES pressure, which can in turn cause the appearance of reflux symptoms and esophagitis after the operation due to a partial resection of the sling fibers during the gastrectomy.

The Gut Hormone Response Following Roux-en-Y Gastric Bypass: Cross-sectional and Prospective Study

Bariatric surgery is the most effective treatment option for obesity, and gut hormones are implicated in the reduction of appetite and weight after Roux-en-Y gastric bypass. Although there is increasing interest in the gut hormone changes after gastric bypass, the long-term changes have not been fully elucidated. Thirty-four participants were studied cross-sectionally at four different time points, pre-operatively (n = 17) and 12 (n = 6), 18 (n = 5) and 24 months (n = 6) after laparoscopic Roux-en-Y gastric bypass. Another group of patients (n = 6) were studied prospectively (18-24 months). All participants were given a standard 400 kcal meal after a 12-h fast, and plasma levels of peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) were correlated with changes in appetite over 3 h using visual analogue scores. The post-operative groups at 12, 18 and 24 months had a higher post-prandial PYY response compared to pre-operative (p < 0.05). This finding was confirmed in the prospective study at 18 and 24 months. There was a trend for increasing GLP-1 response at 18 and 24 months, but this did not reach statistical significance (p = 0.189) in the prospective study. Satiety was significantly reduced in the post-operative groups at 12, 18 and 24 months compared to pre-operative levels (p < 0.05). Roux-en-Y gastric bypass causes an enhanced gut hormone response and increased satiety following a meal. This response is sustained over a 24-month period and may partly explain why weight loss is maintained.

The phospholipase A2 inhibitor methyl indoxam suppresses diet‐induced obesity and glucose intolerance in mice

Previous results have shown that mice lacking in the group 1B phospholipase A(2) (Pla2g1b) are resistant to obesity and diabetes induced by feeding a diabetogenic high-fat/high-carbohydrate diet. This study examined the potential of using the Pla2g1b inhibitor methyl indoxam as therapy to suppress diet-induced obesity and diabetes. Male C57BL/6 mice were fed the diabetogenic diet with or without methyl indoxam supplementation. Body weight gain, fasting plasma glucose levels, glucose tolerance and postprandial lysophospholipid absorption were compared. Wild-type C57BL/6 mice fed the diabetogenic diet without Pla2g1b inhibitor showed 31 and 69% body weight gain after 4 and 10 weeks respectively. These animals also showed elevated plasma glucose levels and were glucose intolerant. In contrast, C57BL/6 mice fed the diabetogenic diet with 90 mg.kg(-1) of methyl indoxam gained only 5% body weight after 10 weeks. These animals were also euglycaemic and displayed normal glucose excursion rates in glucose tolerance test. Methyl indoxam suppression of diet-induced body weight gain and glucose intolerance was correlated with the inhibition of Pla2g1b-mediated postprandial lysophospholipid absorption. These results show that oral supplementation of a diabetogenic diet with the Pla2g1b inhibitor methyl indoxam effectively suppresses diet-induced obesity and diabetes in mice. This suggests that Pla2g1b inhibition may be a potentially effective oral therapeutic option for treatment of obesity and diabetes.

Intestinal electric stimulation accelerates whole gut transit and promotes fat excrement in conscious rats.

IntroductionIntestinal electric stimulation (IES) is proposed as a potential tool for the treatment of morbid obesity. Our previous study showed that IES with one pair of electrodes accelerated intestinal transit and decreased fat absorption in a segment of the jejunum in the anesthetized rats. The aims of this study were to assess the effects of IES on the whole gut transit and fat absorption in conscious rats, to examine the effects of multi-pairs IES, and to explore the cholinergic mechanism behind the effects of IES.MethodsThirty-eight male rats implanted with serosal electrodes were randomized into five groups: control without IES, 2 or 3 pairs IES with short pulses, atropine and atropine plus IES. The whole gut transit and fat remained and emptied from the gut were analyzed after continuous 2-hour IES.ResultsTwo and three pairs IES significantly accelerated phenol red (marker used for transit) excretion (ANOVA, P < 0.001). No significant difference was found between two and three pairs IES. Two pairs IES significantly increased the excretion of fat (P < 0.05). Atropine significantly blocked the accelerated transit induced by IES (ANOVA, P < 0.001). Correlation was found between the percentage of phenol red and fat retained in the whole gut (r = 0.497, P < 0.01).ConclusionsIES accelerates whole gut transit and promotes fat excrement in conscious rats, and these effects are mediated through the cholinergic nerves. These findings are in support of the concept that IES may be a promising treatment option for obesity.

Intestinal Electric Stimulation Accelerates Whole Gut Transit and Promotes Fat Excrement in Conscious Rats

Abstract*Introduction:* Intestinal electric stimulation (IES) is proposed as a potential tool for the treatment of morbid obesity. Our previous study showed that IES with one pair of electrodes accelerated intestinal transit and decreased fat absorption in a segment of the jejunum in the anesthetized rats. The aims of this study were to assess the effects of IES on the whole gut transit and fat absorption in conscious rats, to examine the effects of multi-channel IES, and to explore the cholinergic mechanism behind the effects of IES. *Methods:* Thirty-eight male rats implanted with serosal electrodes were randomized into five groups: control without IES, 2/3 channel IES with short pulses, atropine and atropine plus IES. The whole gut transit and fat remained and emptied from the gut were analyzed after continuous 2-hour IES. *Results:* Two and three channel IES significantly accelerated phenol red (marker used for transit) excretion (ANOVA, P &lt; 0.001). No significant difference was found between two and three channel IES. Two channel IES significantly increased the excretion of fat (P &lt; 0.05). Atropine significantly blocked the accelerated transit induced by IES (ANOVA, P &lt; 0.001). Correlation was found between the percentage of phenol red and fat retained in the whole gut (r = 0.497, P &lt; 0.01). *Conclusions:* IES accelerates whole gut transit and promotes fat excrement in conscious rats, and these effects are mediated through the cholinergic nerves. These findings are in support of the concept that IES may be a promising treatment option for obesity.

Weighing options for obesity treatment

Nursing: December 2008 - Volume 38 - Issue 12 - p 27 doi: 10.1097/01.NURSE.0000342027.31881.61

Gut Microbiota and Its Possible Relationship With Obesity

Obesity results from alterations in the body's regulation of energy intake, expenditure, and storage. Recent evidence, primarily from investigations in animal models, suggests that the gut microbiota affects nutrient acquisition and energy regulation. Its composition has also been shown to differ in lean vs obese animals and humans. In this article, we review the published evidence supporting the potential role of the gut microbiota in the development of obesity and explore the role that modifying the gut microbiota may play in its future treatment. Evidence suggests that the metabolic activities of the gut microbiota facilitate the extraction of calories from ingested dietary substances and help to store these calories in host adipose tissue for later use. Furthermore, the gut bacterial flora of obese mice and humans include fewer Bacteroidetes and correspondingly more Firmicutes than that of their lean counterparts, suggesting that differences in caloric extraction of ingested food substances may be due to the composition of the gut microbiota. Bacterial lipopolysaccharide derived from the intestinal microbiota may act as a triggering factor linking inflammation to high-fat diet-induced metabolic syndrome. Interactions among microorganisms in the gut appear to have an important role in host energy homeostasis, with hydrogen-oxidizing methanogens enhancing the metabolism of fermentative bacteria. Existing evidence warrants further investigation of the microbial ecology of the human gut and points to modification of the gut microbiota as one means to treat people who are over-weight or obese.

Physician Attitudes, Beliefs and Barriers towards the Management and Treatment of Adult Obesity: A Literature Review

The objective of this study was to review physician attitudes, beliefs, knowledge and barriers towards adult patients who are overweight and obese. Electronic searches were carried out on PubMed, Medline and Embase up to July 2007. The search terms were built around 'obesity', 'physicians', and 'attitudes'. Only peer-reviewed full papers in English were included. Each paper had to directly investigate the attitudes, beliefs or barriers towards overweight and/or obese adults by physicians only. Forty-three studies met the inclusion criteria. Studies meeting inclusion criteria were reviewed by two authors. Evidence was fairly consistent across studies indicating that, in general, physicians feel qualified and well-equipped to manage and treat overweight and obese patients, yet overall do not feel successful. Knowledge about obesity is poor, with a lack of understanding of minimum BMI for obesity and the use of waist circumferences as a measure of obesity evident. There also appears to be a lack of knowledge about the treatment options available when treating obesity and their effectiveness. Furthermore, negative attitudes towards overweight and obese individuals are present, with many physicians categorising overweight and obese individuals as lazy, and that a key barrier in successfully treating obesity being lack of patient compliance and motivation. The study indicates additional training is necessary to educate physicians in regard to treatment options for obesity and to address the persistent negative attitudes towards obese patients.

Auricular Acupressure for Weight Reduction in Obese Asian Young Adults: A Randomized Controlled Trial

Background: Treatment options for obesity include calorie reduction, increased activity, behavior modification, pharmacotherapy, and surgery. Alternative options such as ear acupuncture may be effective adjunct therapy. Objective: To test the efficacy of auricular acupressure for weight reduction in overweight and obese young adults. Design, Setting, and Participants: An 8-week randomized controlled trial of 55 young Asian adults (18–20 years) with a body mass index (BMI) of 23 or higher (the cutpoint for overweight in Asians set by the World Health Organization). Intervention: All participants met once weekly for 10 minutes. Ear acupressure treatment was administered weekly for 8 weeks (10 minutes per session): the control group had adhesive tape placed on the ear acupoints only while the experimental group had Japanese Magnetic Pearls placed on the ear acupoints using adhesive tape to hold them in place. Main Outcome Measure: Change in BMI from baseline to trial completion. Results: Control group BMI increased significantly from baseline by 0.05 (P ≤ .001) and the acupressure group BMI decreased significantly from baseline by 0.70 (P ≤ .001). Conclusion: Auricular acupressure using Japanese Magnetic Pearls could be used to decrease BMI in young adults.

Gut Hormones as Mediators of Appetite and Weight Loss After Roux-en-Y Gastric Bypass

To evaluate the physiologic importance of the satiety gut hormones. Controversy surrounds the physiologic role of gut hormones in the control of appetite. Bariatric surgery remains the most effective treatment option for obesity, and gut hormones are implicated in the reduction of appetite and weight after Roux-en-Y gastric bypass. We correlated peptide YY (PYY) and glucagon-like peptide 1 (GLP-1) changes within the first week after gastric bypass with changes in appetite. We also evaluated the gut hormone responses of patients with good or poor weight loss after gastric bypass. Finally, we inhibited the gut hormone responses in gastric bypass patients and then evaluated appetite and food intake. Postprandial PYY and GLP-1 profiles start rising as early as 2 days after gastric bypass (P < 0.05). Changes in appetite are evident within days after gastric bypass surgery (P < 0.05), and unlike other operations, the reduced appetite continues. However, in patients with poor weight loss after gastric bypass associated with increased appetite, the postprandial PYY and GLP-1 responses are attenuated compared with patients with good weight loss (P < 0.05). Inhibiting gut hormone responses, including PYY and GLP-1 after gastric bypass, results in return of appetite and increased food intake (P < 0.05). The attenuated appetite after gastric bypass is associated with elevated PYY and GLP-1 concentrations, and appetite returns when the release of gut hormones is inhibited. The results suggest a role for gut hormones in the mechanism of weight loss after gastric bypass and may have implications for the treatment of obesity.

Pharmacologic Treatment Options for Obesity: Current and Potential Medications

Pharmacotherapy has a role in obesity management when combined with diet, physical activity, and behavior modification. Currently available therapies are safe when used appropriately. New treatments with novel mechanisms of action are likely to be available in the future.

Vascular risks and management of obesity in children and adolescents.

Childhood obesity has reached epidemic proportions in many countries. Pediatric obesity is associated with the development of cardiovascular (CV) risk factors including type 2 diabetes, hypertension, dyslipidemia, and the metabolic syndrome. It is also associated with an increased risk of CV disease (CVD) in adulthood. Moreover, obesity and CVD risk factors in obese youth tend to track into adulthood, further increasing the risk of adult CVD. Consequently, the treatment and prevention of childhood overweight and obesity has become a public health priority. Proper nutrition and increased physical activity are the main focus of these efforts; however, few studies have shown positive results. Treatment options for obesity in youth also include pharmacotherapy and surgery. While pharmacotherapy appears promising, additional evidence is needed, especially with respect to the long-term impact, before it becomes a widespread treatment option in the pediatric population.