Presence Of Obesity-related Comorbidities Research Articles

Bariatric Surgery: The Current Perspective

Obesity and overweight are defined as abnormal or excessive fat accumulation that may impair health.1 The WHO definition of overweight is a BMI > 25 and for obesity is > 30kg/m2. The National Institute of Health defines morbid obesity as a BMI of 40kg/m2 or more or a BMI of 35kg/m2 or more in the presence of obesity related comorbidities.2 Obesity has emerged as a global health crisis, affecting millions of individuals and significantly increasing the risk of chronic diseases such as diabetes, cardiovascular disorders, and certain types of cancer. As traditional methods of weight loss often prove ineffective for severely obese individuals, bariatric surgery has gained prominence as a life-altering solution. This editorial explores the transformative impact of bariatric surgery on patients' lives, shedding light on its effectiveness, safety, and long-term benefits.

Increased Amino Acid Turnover and Net Protein Breakdown but Preserved Muscle and Cognitive Function in Obese Middle-Age Adults

ObjectivesSkeletal muscle weakness has been observed in obese patients despite preserved or even greater lean body mass. Additionally, the presence of obesity-related comorbidities is a recognized risk factor for cognitive dysfunction and mood disturbances. Metabolism of several amino acids (AAs) including the Branched-chain Amino Acids (BCAAs) is altered in obesity but whether these disturbances are associated with muscle and cognitive dysfunction remain underexplored.Methods159 subjects were divided, using the BMI cut-off of 30 kg/m2, into two groups: 79 non-obese (32 males/47 females, age 48.5 [43.3, 53.7], BMI 25.2 [24.6, 25.7] kg/m2) and 80 obese (31 males/49 females, age 54.3 [51.0, 57.6], BMI 38.3 [36.9, 39.6] kg/m2). Postabsorptive whole-body production (WBP) rates of several AAs were measured by IV pulse of stable isotopes including BCAAs, Phenylalanine (Phe), Tyrosine (Tyr), Glutamate (Glu), and Tryptophan (Trp). Plasma amino acid enrichments and concentrations were analyzed by LC-MS/MS. Large Neutral Amino Acids (LNAA) was calculated as the sum of BCAAs, Phe, and Tyr. Body composition (DXA), hand and leg peak strength and endurance (isokinetic dynamometer), cognitive function (Stroop, TMT), and mood (POMS, HADS) were assessed. Statistics performed by ANCOVA with age, gender, and lean body mass as covariates. Significance at P < 0.05. Results expressed as means [95% CI].ResultsObese subjects had higher concentrations of plasma Leu (12%, P = 0.0097), Ile (7%, P = 0.0310), Tyr (23%, P < 0.0001), and Glu (40%, P = 0.0001). The obese group was also characterized by elevated WBP of BCAAs (8%, P = 0.0343), Phe (12%, P = 0.0003), Tyr (18%, P = 0.0005) and increased whole-body net protein breakdown (Phe to Tyr conversion, 11%, P = 0.0212). Both groups had similar muscle and cognitive functions but obese individuals had greater scores for self-reported depressive symptoms (P = 0.0273), anger (P = 0.0234), fatigue (P = 0.0098), and tension (P = 0.0158). No changes in Trp metabolism were found but obese subjects had elevated LNAA (7%, P = 0.0170) resulting in increased systemic Trp availability to the brain (P = 0.0014).ConclusionsObese subjects have preserved muscle and cognitive function despite greater whole-body net protein breakdown and increased turnover of several AAs involved in muscle metabolism and serotonin synthesis.Funding SourcesNone.

Changing the narrative around obesity in the UK: a survey of people with obesity and healthcare professionals from the ACTION-IO study

ObjectivesTo investigate the perceptions, attitudes, behaviours and potential barriers to effective obesity care in the UK using data collected from people with obesity (PwO) and healthcare professionals (HCPs) in the...

Presence of Obesity Related Comorbidities Associated with Lower Attrition Rate in Pediatric Weight Management Program

Background: Multidisciplinary pediatric weight management clinics have reported varying effectiveness in childhood obesity and they faced a common issue of high attrition rate. The effectiveness of pediatric weight management clinic and predictors of attrition has not been described in a multiracial Singapore population. Objectives: The aim of the study is to determine whether a dedicated multidisciplinary pediatric weight management program in a single center tertiary institution effectively reduces Body Mass Index (BMI) Z-Scores and cardiovascular risk factors in children with obesity aged 2-16 years old pre post intervention and to examine the factors that predict attrition from the program. Methods: This is a single center retrospective study, where medical records of patients enrolled in KK Women’s and Children’s Hospital paediatric weight mangement clinic over a 14 months period was reviewed. The program is a multicomponent family based clinic that utilizes medical management, dietary and physical activity counseling and intervention. Inclusion criteria for enrollment in the program was more than 2 years of age with BMI of more than 90th percentile. Attenders were defined as attending more than ≥ 2 clinic visit. Analyses were performed to identify factors associated with changes in BMI Z-Score and cardiovascular risk factors and attrition from the program. Results: A total of 121 patients were enrolled in the pediatric weight management program and 68% had obesity related comorbidities with dyslipidemia being the most common followed by hypertension. There were 51 attenders and presence of obesity related comorbidities predicted lower attrition rate (p=0.05). The attenders had a significant reduction in mean BMI Z-Score of 0.082 (95% CI,-0.13 to -0.033) (p=0.001) with significant improvements in high-density lipoprotein level and total cholesterol to high- density lipoprotein level (p<0.05). Conclusions: A multidisciplinary pediatric weight management program can improve the overweight status and the cardiovascular risk factors. Attrition factors should be studied to minimize defaulting rates.

Patients with obesity-related comorbidities have higher disability compared with those without obesity-related comorbidities: results from a cross-sectional study.

The aim of the present study was to describe disability in adult obese patients with obesity-related comorbidities, and to compare it with that of patients without obesity-related comorbidities. Two groups of obese patients were administered a set of 166 International Classification of Functioning, Disability and Health (ICF) categories; on the basis of this set, count-based indexes were developed for each ICF component and difference between patients with and without comorbidities were assessed with independent-sample t-test and Cohen's d as a measure of effect size. ICF categories in which at least 20% of patients reported a problem were considered relevant for describing functioning of obese patients; for each of them, the risk of having obesity-related comorbidities was calculated using odds ratio and 95% confidence interval. A total of 106 inpatients were enrolled in the study: 68 ICF categories reached the 20% threshold, and 31 of them were relevant only among patients with comorbidities. The presence of obesity-related comorbidities was associated with an increased risk of bodily impairments and limitations in performing daily activities. Compared with patients without obesity-related comorbidities, those with comorbidities showed higher disability. Comorbidities contribute to obesity-related disability, and our results support the importance of early rehabilitation interventions to reduce disability.

Use of Antihypertensive Medications and Diagnostic Tests Among Privately Insured Adolescents and Young Adults With Primary Versus Secondary Hypertension

To compare the use of antihypertensive medications and diagnostic tests among adolescents and young adults with primary versus secondary hypertension. We conducted retrospective cohort analysis of claims data for adolescents and young adults (12-21 years of age) with ≥3 years of insurance coverage (≥11 months/year) in a large private managed care plan during 2003-2009 with diagnosis of primary hypertension or secondary hypertension. We examined their use of antihypertensive medications and identified demographic characteristics and the presence of obesity-related comorbidities. For the subset receiving antihypertensive medications, we examined their diagnostic test use (echocardiograms, renal ultrasounds, and electrocardiograms). The study sample included 1,232 adolescents and young adults; 84% had primary hypertension and 16% had secondary hypertension. The overall prevalence rate of hypertension was 2.6%. One quarter (28%) with primary hypertension had one or more antihypertensive medications, whereas 65% with secondary hypertension had one or more antihypertensive medications. Leading prescribers of antihypertensives for subjects with primary hypertension were primary care physicians (80%), whereas antihypertensive medications were equally prescribed by primary care physicians (43%) and sub-specialists (37%) for subjects with secondary hypertension. The predominant hypertension diagnosis among adolescents and young adults is primary hypertension. Antihypertensive medication use was higher among those with secondary hypertension compared with those with primary hypertension. Further study is needed to determine treatment effectiveness and patient outcomes associated with differential treatment patterns used for adolescents and young adults with primary versus secondary hypertension.

The prevalence of overweight and obesity in a breast clinic population: Consideration for weight loss as a therapeutic intervention

BackgroundObesity is an important risk factor for breast cancer and weight loss may be associated with a decreased risk for breast cancer and its recurrence. We evaluated the prevalence of overweight, obesity, and obesity-related co-morbidities in a breast health clinic population to determine the potential need for weight loss intervention. MethodsA retrospective review was conducted of sequential patients seen at a breast health clinic from July 1 to December 31, 2011. Body mass index (BMI), reason for visit (breast cancer diagnosis, high risk for breast cancer, or benign condition), and presence of obesity-related co-morbidities were recorded. ResultsThe 302 patients who met inclusion criteria had a median age of 52 years (10–91) and median BMI of 26 kg/m2 (15.4–56.5). Overall, 36.8% of patients had a BMI between 18.5–24.9 kg/m2; 32.1%, 25–29.9 kg/m2; 14.2%, 30–34.9 kg/m2; 8.3%, 35–39.9 kg/m2; and 4.3%,≥40 kg/m2. Overweight or obesity (BMI≥25 kg/m2) occurred in 64.2% of breast cancer, 65.0% of high-risk, and 57.1% of benign patients (P value not significant). Criteria for bariatric surgery (BMI 35–39.9 kg/m2 with≥1 obesity-related co-morbidity or BMI≥40 kg/m2) were met in 8.2% of breast cancer, 16.7% of high-risk, and 11.5% of benign patients (P value not significant). ConclusionsRegardless of diagnosis, a significant proportion of patients visiting the breast health clinic meet criteria for weight loss intervention, including bariatric surgery. Weight management represents an underutilized therapeutic modality that could potentially decrease the risk of breast cancer and its recurrence, and improve overall prognosis.

Cross-Sectional Assessment of the Roles of Comorbidities in Resting and Activity-Related Dyspnea in Severely Obese Women

Objectives. Obesity has been associated with a lesser degree of asthma control that may be biased by other comorbidities. The objectives of this cross-sectional study were to describe resting and activity-related dyspnea complaints according to the presence of obesity-related comorbidities (asymptomatic airway hyperresponsiveness (AHR), asthma, gastroesophageal reflux disease (GERD) and sleep-disordered breathing (SDB)). We hypothesized that obese women can exhibit both resting and activity-related dyspnea, independently of the presence of asthma. Methods. Severely obese (body mass index (BMI) > 35 kg m−2) women prospectively underwent description of resting and activity-related dyspnea (verbal descriptors and Medical Research Council (MRC) scale), pulmonary function testing (spirometry, absolute lung volumes, and methacholine challenge test), oesogastro-duodenal fibroscopy, and overnight polygraphy. Thirty healthy lean women without airway hyperresponsiveness were enrolled. Results. Resting dyspnea complaints were significantly more prevalent in obesity (prevalence 41%) than in healthy lean women (prevalence 3%). Chest tightness and the need for deep inspirations were independently associated with both asthma and GERD while wheezing and cough were related to asthma only in obese women. Activity-related dyspnea was very prevalent (MRC score > 1, 75%), associated with obesity, with the exception of wheezing on exertion due to asthma. Asymptomatic AHR and SDB did not affect dyspneic complaints. Conclusions. In severely obese women referred for bariatric surgery, resting dyspnea complaints are observed in association with asthma or GERD, while activity-related dyspnea was mainly related to obesity only. Consequently, asthma does not explain all respiratory complaints of obese women.

Antihypertensive Prescribing Patterns for Adolescents With Primary Hypertension

Hypertension is an increasingly common problem in adolescents yet current medical management of primary hypertension in adolescents has not been well-described. We identified adolescents with primary hypertension by International Classification of Diseases, Ninth Revision codes and looked at prescription patterns chronologically for antihypertensive drug class prescribed and the specialty of prescribing physician. We also examined patient demographics and presence of obesity-related comorbidities. During 2003-2008, there were 4296 adolescents with primary hypertension (HTN); 66% were boys; 73% were aged 11 to 14 years; 53% were black, 41% white, and 4% Hispanic; and 48% had obesity-related comorbidity. Twenty-three percent (977) received antihypertensive prescription. White subjects (odds ratio [OR]: 1.61; confidence interval [CI]: 1.39-1.88), older adolescents (≥15 years, OR: 2.11; CI: 1.79-2.48), and those with comorbidity (OR: 1.57; CI: 1.36-1.82) were more likely to receive antihypertensive prescriptions controlling for gender and years of Medicaid eligibility in logistic regression. Angiotensin converting enzyme inhibitors were the most frequently prescribed monotherapy. Nearly two-thirds of adolescents received prescriptions from adult primary care physicians (PCPs) only. More than one-quarter of adolescents who received a prescription received combination therapy, which was most often prescribed by adult PCPs. Adult PCPs were the leading prescribers of antihypertensives for adolescents with primary HTN. Race differences exist in physicians' prescribing of antihypertensives to adolescents with primary HTN. The choice of antihypertensives by physicians of different specialties warrants additional study to understand the underlying rationale for treatment decisions and to determine treatment effectiveness.

A Nomogram for Predicting Surgical Complications in Bariatric Surgery Patients

To minimize morbidity and mortality associated with surgery risks in the obese patient, algorithms offer planning operative strategy. Because these algorithms often classify patients based on inadequate category granularity, outcomes may not be predicted accurately. We reviewed patient factors and patient outcomes for those who had undergone bariatric surgical procedures to determine relationships and developed a nomogram to calculate individualized patient risk. From the American College of Surgeons National Security Quality Improvement Program database, we identified 32,426 bariatric surgery patients meeting NIH criteria and treated between 2005 and 2008. We defined a composite binary outcome of 30-day postoperative morbidity and mortality. A predictive model based on preoperative variables was developed using multivariable logistic regression; a multiple imputation procedure allowed inclusions of observations with missing data. Model performance was assessed using the C-statistic. A calibration plot graphically assessed the agreement between predicted and observed probabilities in regard to 30-day morbidity/mortality. The nomogram model was constructed for maximal predictive accuracy. The estimated C-statistic [95% confidence interval] for the predictive nomogram was 0.629 [0.614, 0.645], indicative of slight to moderate discriminative ability beyond that of chance alone, and the greatest impacts on the estimated probability of morbidity/mortality were determined to be age, body mass index, serum albumin, and functional status. By accurately predicting 30-day morbidity and mortality, this nomogram may prove useful in patient preoperative counseling on postoperative complication risk. Our results additionally indicate that neither age nor presence of obesity-related comorbidities should exclude patients from bariatric surgery consideration.

Pathophysiological and perioperative features of morbidly obese parturients

The prevalence of obesity is increasing among pregnant women. The association between obesity and pregnancy can result in further limitation of parturient physiological reserve. Indeed, maternal obesity is associated with an increased risk of delivery and postpartum complications, and poses a number of additional challenges for both general and neuroaxial anesthesia. The higher complication rate and the presence of obesity-related co-morbidities concur in placing this population at high risk for anesthesia-related maternal morbidity and mortality. Bariatric surgery scheduled before gestation to allow effective weight reduction, reduces the overall perinatal outcome to levels comparable to the general population. This review provides an insight into the magnitude and pathophysiological features of obese parturients, maternal and neonatal associated risks, along with peculiar anesthesiological management strategies.