Prevalence Of Severe Obesity Research Articles

Hygienic characteristics of changes in the nutritional status of adult population in the Omsk region during the implementation of Demography national project

Aim. To evaluate changes in nutritional status parameters among the adult population of the Omsk region during.Materials and Methods. The comparison of nutritional status parameters was conducted as a part of an experimental epidemiological study using a "before-after" design. The intervention consisted of activities carried out in the region from 2019 to 2023 under the federal project "Strengthening Public Health." In 2018, a representative sample (n = 241) was formed, stratified by age, gender, and residential area; in 2023, a similar sample (n = 506) was used. Nutritional status was assessed using somatometric, clinical, and laboratory methods.Results. We have documented a significant reduction in the prevalence of severe obesity (grades II-III, from 7.1 ± 1.1% to 2.4 ± 0.9%), and a trend towards a decrease in prevalence of underweight (from 5.4 ± 1.4% to 3.0 ± 0.8%; p = 0.078). In 2023, the proportion of individuals with overweight was 36.0 ± 2.1%, and 16.4 ± 2.4% of the adult population suffered from obesity. The prevalence of micronutrient deficiencies decreased significantly (p < 0.001). In 2023, deficiencies in vitamin D (61.8 ± 1.7%), folates (50.0 ± 3.2%), vitamins B1 (26.6 ± 2.8%), B6 (36.7 ± 3.1%), and E (28.5 ± 2.9%), magnesium (32.0 ± 2.0%), zinc (27.2 ± 2.8%), copper (36.0 ± 3.1%), iron (25.0 ± 1.7%), and selenium (31.2 ± 3.9%) were the most common. Compared to 2018, the prevalence of deficiencies in vitamins D, E, B1, B6, and folates significantly decreased (p < 0.05), while the provision of essential elements remained unchanged.Conclusion. The prevalence of various nutritional disorders among the adult population of the Omsk region reduced, as the implementation of the federal project «Strengthening Public Health» under the national project "Demography" improved the provision of vitamins.

Factors beyond Body Mass Index Associated with Cardiometabolic Risk among Children with Severe Obesity.

Background: The increasing prevalence of severe obesity among children and adolescents poses a significant challenge for pediatricians and general practitioners. This study aimed to investigate the relationships between biochemical results, anthropometry, blood pressure measurements, and bioimpedance analysis (BIA)-derived parameters to identify potential cardiometabolic complications associated with severe obesity. Methods: This study included 347 children (162 boys, 185 girls) aged 0-19 years, meeting the criteria for severe obesity based on BMI thresholds for different age groups. The patients were recruited in four pediatric endocrinology centers in Poland (Zabrze, Cracow, Rzeszow, Szczecin). Each participant underwent anthropometric measurements, pubertal stage assessment, blood pressure measurement, biochemical and hormonal tests, and BIA. Results: BMI showed significant associations with fat mass percentage (FM%) and waist-to-height ratio (WHtR) but not waist-to-hip ratio (WHR). The relationship between BMI and FM% was stronger in girls and prepubertal children. The metabolic syndrome (MetS) Z-score showed a strong positive correlation with BMI in the pubertal children. A negative correlation between HDL and triglycerides was observed only in the boys. The prepubertal children exhibited more significant correlations, despite a smaller sample size and shorter duration of obesity. Conclusions: Considering multiple parameters beyond BMI alone provides a better understanding of cardiometabolic risks associated with severe obesity in children. MetS Z-score was not a reliable indicator of increased cardiometabolic risk in younger children. Early-onset severe obesity was associated with a higher risk of metabolic complications. Early intervention is crucial to mitigate metabolic complications in this population.

Improving Obesity Outcomes in an Academic Clinic: A Quality Improvement Study

Introduction: Obesity is a chronic disease that affects more than 40% of the population in the United States. The prevalence of severe obesity doubled in the past two decades. Primary care providers are usually the first to screen patients for obesity. According to a 2018 study. Only 55% of adults with obesity were reported to have received the diagnosis of obesity and less than a third of the patients followed up for an obesity-specific visit. The management of obesity is multifactorial with lifestyle modifications and pharmacological and psychological therapies. In our academic clinic, there was a gap in comprehensive satisfactory obesity counseling, which addresses lifestyle modifications and adjunctive pharmacological therapies. Addressing this gap with an obesity-specific visit helps clinicians to discuss available options to manage obesity. Improvement in body weight is linked with improved control of hypertension, diabetes, and heart disease leading to improved health outcomes. Aim: To improve obesity counseling rates and usage of standardized obesity templates in an academic clinic by 25% in 3 months. Method: We used the IHI model of improvement using the plan-do-study-act framework to test changes on a small scale and guide the quality improvement study. To better address our aim, we divided our QI project into 2 cycles. For PDSA-1, a thorough chart search for the last 3 months was done to calculate a baseline obesity counseling rate. A root-cause analysis was completed with multi-disciplinary input from faculty, clinic staff, and residents, and several existing barriers that preclude satisfactory obesity counseling were identified. Proposed interventions corresponding to each root cause were plotted on an impact effort matrix. Interventions with the least effort and the most impact were selected as proposed solutions. These included creating a short education session on obesity management and creating an obesity counseling template. Post-intervention, the obesity counseling rates and use of the template were recorded on a run chart. For PDSA-2, we introduced an obesity assessment and plan (A/P) template, with the goal to incorporate all aspects of obesity management, i.e., lifestyle modification, diet, exercise, and screening for disease related co-morbidities. Results: Satisfactory obesity counseling prior to intervention was 32%. The first PDSA cycle post-intervention showed an improvement in the obesity counseling rates to 56%. About 20% of the clinic notes for the counseled patients used the proposed template. About 8% of the counseled patients agreed to a separate obesity-specific visit. The second PDSA cycle showed 20.1% usage of the standardized A/P plan template. In the group that the template was used, there was 63.6% reduction in BMI; compared to 39.4% BMI reduction in group without template usage. (OR= 2.34, p=0.034. Next steps: We noted an overall improvement in the obesity counseling rates after our interventions. However, we noticed that the A/P template usage did not meet our goal of 25% usage. We will conduct multidisciplinary team meetings to understand measures that can be undertaken to improve usage of A/P template. Patients will also be encouraged to have an obesity-specific visit.

Increasing disparities in obesity and severe obesity prevalence among public elementary and middle school students in New York City, school years 2011-12 through 2019-20.

Recent national trends in the United States indicate a significant increase in childhood obesity, a major public health concern with documented physical and mental comorbidities and sociodemographic disparities. We aimed to estimate the prevalence of obesity and severe obesity among youth in New York City (NYC) before the COVID-19 pandemic and examine time trends overall and by key characteristics. We included all valid height and weight measurements of kindergarten through 8th grade public school students aged 5 to 15 from school years 2011-12 through 2019-20 (N = 1,370,890 unique students; 5,254,058 observations). Obesity and severe obesity were determined using age- and sex-specific body mass index percentiles based on the Centers for Disease Control and Prevention growth charts. Analyses were performed using multivariate logistic regression models with repeated cross-sectional observations weighted to represent the student population for each year and clustered by student and school. Among youth attending public elementary and middle schools in NYC, we estimate that 20.9% and 6.4% had obesity and severe obesity, respectively, in 2019-20. While consistent declines in prevalence were observed overall from 2011-12 to 2019-20 (2.8% relative decrease in obesity and 0.2% in severe obesity, p<0.001), increasing trends were observed among Black, Hispanic, and foreign-born students, suggesting widening disparities. Extending previous work reporting prevalence estimates in this population, nearly all groups experienced significant increases in obesity and severe obesity from 2016-17 to 2019-20 (relative change = 3.5% and 6.7%, respectively, overall; p<0.001). Yet, some of the largest increases in obesity were observed among those already bearing the greatest burden, such as Black and Hispanic students and youth living in poverty. These findings highlight the need for greater implementation of equity-centered obesity prevention efforts. Future research should consider the influence of the COVID-19 pandemic and changes in clinical guidance on childhood obesity and severe obesity in NYC.

Association of Housing Instability with Obesity Status Among Insured Adults

IntroductionObesity affects four in ten US adults. One of the most prevalent health-related social risk factors in the US is housing instability, which is also associated with cardiovascular health outcomes, including obesity. The objective of this research brief is to examine the association between housing instability with obesity status among a representative sample of insured adults across seven integrated health systems. MethodsKaiser Permanente National Social Needs Survey used a multistage stratified sampling framework to administer a cross-sectional survey across seven integrated health systems (administered Jan.-Sept. 2020). Survey data were linked with electronic health records (EHR). Housing instability was categorized into levels of risk: 1) ‘No Risk’; 2) ‘Moderate Risk’; and 3) ‘Severe Risk’. Based on established BMI thresholds, obesity and severe obesity served as the primary outcome variables. In 2023, weighted multivariable logistic regression accounted for the complex sampling design and response probability and controlled for covariates. ResultsThe analytic cohort comprised 6,397 adults. Unadjusted weighted prevalence of obesity and severe obesity was 31.1% and 5.3%, respectively; and 15.5% reported housing instability. Adjusted regression models showed that the odds of severe obesity was nearly double among adults exposed to severe housing instability (Adjusted OR=1.93; 95% CI 1.14-3.26). Other BMI categories were not associated with housing instability. ConclusionsAmong a representative cohort of insured adults, this study suggested increasing levels of housing instability are associated with increasing levels of obesity. Future research should further explore the temporal, longitudinal, and independent association of housing instability with obesity.

The Association of Metabolic Risk Factors with Advanced Adenomas in Hispanic Patients.

Obesity and metabolic syndrome (MetS) have been implicated as rising risk factors for the development of colorectal cancers. A rapid increase in the prevalence of obesity and severe obesity among Hispanic patients in the United States may present substantially increased risk for advanced colorectal neoplasia in this population. Currently, there is very little research in this area. We sought to identify metabolic risk factors for advanced adenomas (AA) in Hispanic Americans. We retrospectively reviewed data from the Los Angeles General (LAG) Medical Center of asymptomatic Hispanic patients above 45 years of age who underwent their first colonoscopies following a positive screening FBT. Patient demographics, metabolic characteristics, as well as colon polyp size and histology were recorded. Polyps were classified as adenomas or AA (including both high-risk adenomas and high-risk serrated polyps). Relative risk for AA was assessed by multivariate logistical regression analyses. Of the 672 patients in our study, 41.4% were male, 67% had adenomas, and 16% had AA. The mean BMI was 31.2kg/m2. The mean HDL-C was 49.5mg/dL (1.28 mmol/L) and the mean triglyceride level was 151mg/dL. 44.6% had diabetes and 64.1% had hypertension. When comparing patients with AA to patients with no adenoma, male sex, BMI > 34.9kg/m2, and elevated fasting triglyceride levels were associated with an increased risk of AA. FIB-4 ≥1.45 was also associated with an increased risk of AA in males. There was no significant difference in the risk of AA with diabetes, hypertension, FIB-4 score, LDL-C level, and HDL-C level. Hispanic patients with a positive FBT were observed to have a high incidence of AA. Class II obesity (BMI ≥ 35kg/m2), elevated triglyceride levels were identified as risk factors among males in our study. Early interventions to address these modifiable risk factors in at-risk populations, such as multi-disciplinary weight management programs for the treatment of obesity and related co-morbidities, could potentially lead to risk reduction and CRC prevention.

Early Home Visits and Health Outcomes in Low-Income Mothers and Offspring

Individuals with low income may have heightened rates of obesity and hypertension. To determine whether prenatal and infancy home visitation by nurses reduces maternal and offspring obesity and hypertension. This randomized clinical trial of prenatal and infancy nurse home visitation in a public health care system in Memphis, Tennessee, enrolled 742 women with no previous live births and at least 2 sociodemographic risk factors (unmarried, <12 years of education, unemployed) from June 1, 1990, through August 31, 1991. At registration during pregnancy, 727 mothers (98%) were unmarried, and 631 (85%) lived below the federal poverty level. At offspring ages 12 and 18 years, maternal and offspring obesity and hypertension were assessed by staff masked to treatment. The data analysis was performed from July 1, 2021, to October 31, 2023. Women assigned to the control group received free transportation for prenatal care and child developmental screening and referral at child ages 6, 12, and 24 months. Women assigned to nurse visitation received transportation and screening plus prenatal and infant and toddler nurse home visits. Obesity and hypertension among mothers and their offspring at child ages 12 and 18 years, although not hypothesized in the original trial design, were analyzed using post-double selection lasso method. Of the 742 participants randomized (mean [SD] age, 18.1 [3.2] years), interviews were completed with 594 mothers and 578 offspring at child age 12 years and 618 mothers and 629 offspring at child age 18 years. Obesity was assessed for 576 offspring at age 12 years and 605 at age 18 years and for 563 and 598 mothers at child ages 12 and 18 years, respectively. Blood pressure was assessed for 568 offspring aged 12 years and 596 aged 18 years and 507 and 592 mothers at child ages 12 and 18 years, respectively. There were no overall treatment-control differences in offspring obesity or hypertension at ages 12 and 18 years combined, although nurse-visited female offspring, compared with controls, had a lower prevalence of obesity (adjusted relative risk [ARR], 0.449; 95% CI, 0.234-0.858; P = .003) and severe obesity (ARR, 0.185; 95% CI, 0.046-0.748; P < .001). There were reductions at ages 12 and 18 years combined for stage 1 and stage 2 hypertension for nurse-visited vs control group mothers, with differences limited to mothers of females (stage 1: ARR, 0.613 [95% CI, 0.440-0.855; P = .001]; stage 2: ARR, 0.217 [95% CI, 0.081-0.582; P < .001]). For both obesity and hypertension outcomes, there was no intervention effect among male offspring or the mothers of males. Self-reported maternal health aligned with program effects on hypertension. In this clinical trial follow-up at offspring ages 12 and 18, nurse-visited female offspring had lower rates of obesity and mothers of females had lower rates of hypertension than control-group counterparts. These findings suggest that risks for chronic disease among mothers of females and their female offspring who live in extreme poverty may be prevented with prenatal and infant and toddler home visitations by nurses. ClinicalTrials.gov Identifier: NCT00708695.

Childhood Obesity and Early Body Mass Index Gains Associated with COVID-19 in a Large Rural Health System

ObjectiveTo evaluate body mass index (BMI) change among a population of children with a high proportion residing in rural areas across two pandemic time periods. MethodsElectronic health records were evaluated in a rural health system. Inclusion criteria: 2–17 years at initial BMI; >2 BMIs during pre-pandemic (January 1, 2018–February 29, 2020); >1 BMI in early pandemic (June 1, 2020–December 31, 2020); and >1 BMI in later pandemic (January 1, 2021–December 31, 2021). Mixed effects linear regression models were used to estimate average monthly rate of change in BMI slope (∆BMI) from pre-pandemic to pandemic and test for effect modification of sex, race/ethnicity, age, BMI, public insurance, and rural address. ResultsAmong the 40,627 participants, 50.2% were female, 84.6% were non-Hispanic white, 34.9% used public insurance, and 42.5% resided in rural areas. The pre-pandemic proportion of children with overweight, obesity, and severe obesity was 15.6%, 12.8%, and 6.3%, respectively. The ∆BMI nearly doubled during the early pandemic period compared with the pre-pandemic period (0.102 vs 0.055 kg/m2), however, ∆BMI in the later pandemic was lower (0.040 vs 0.055 kg/m2). ∆BMI remained higher in the later pandemic for all race categories compared to Non-Hispanic white. Children with public insurance had higher ∆BMI compared to those with private insurance that remained higher in the later pandemic (0.051 vs 0.035 kg/m2). There was no significant difference between ∆BMI for rural and urban children during pandemic periods. ConclusionsDespite the decreased ∆BMI among children in the later pandemic, prevalence of obesity and severe obesity remain high. Efforts must continue to be made to limit excess weight gain during childhood and to assess the impact of forces like structural and social factors in both etiology and prevention.

Trends in Severe Obesity Among Children Aged 2 to 4 Years in WIC: 2010 to 2020.

To examine the prevalence and trends in severe obesity among 16.6 million children aged 2 to 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from 2010 to 2020. Severe obesity was defined as a sex-specific BMI for age ≥120% of the 95th percentile on the Centers for Disease Control and Prevention growth charts or BMI ≥35 kg/m2. Joinpoint regression was used to identify when changes occurred in the overall trend. Logistic regression was used to compute the adjusted prevalence differences between years controlling for sex, age, and race and ethnicity. The prevalence of severe obesity significantly decreased from 2.1% in 2010 to 1.8% in 2016 and then increased to 2.0% in 2020. From 2010 to 2016, the prevalence decreased significantly among all sociodemographic subgroups except for American Indian/Alaska Native (AI/AN) children. The largest decreases were among 4-year-olds, Asian/Pacific Islander and Hispanic children, and children from higher-income households. However, from 2016 to 2020, the prevalence increased significantly overall and among sociodemographic subgroups, except for AI/AN and non-Hispanic white children. The largest increases occurred in 4-year-olds and Hispanic children. Among 56 WIC agencies, the prevalence significantly declined in 17 agencies, and 1 agency (Mississippi) showed a significant increase from 2010 to 2016. In contrast, 21 agencies had significant increases, and only Alaska had a significant decrease from 2016 to 2020. Although severe obesity prevalence in toddlers declined from 2010 to 2016, recent trends are upward. Early identification and access to evidence-based family healthy weight programs for at-risk children can support families and child health.

Obésité et risque cardiovasculaire : le rôle de la chirurgie bariatrique dans la modulation du microbiote intestinal: Obesity and cardiovascular risk: the role of bariatric surgery in modulating intestinal microbiota

In recent years, increasing attention has been given to the gut microbiota because of its role in metabolic diseases, cardiovascular health, gastrointestinal disorders, and cancers. In individuals suffering from obesity, a reduction in the richness, diversity, and composition of the intestinal microbiota has often been observed, and this has been associated with metabolic traits and low-grade systemic inflammation.Bariatric surgery has emerged as a valuable approach for reducing cardiometabolic risk. Recently, the number of bariatric surgeries has increased in parallel with the growing prevalence of severe obesity. Metabolic surgery, such as Roux-en-Y gastric bypass or Sleeve Gastrectomy, has shown promising results in terms of long-term weight loss, improved metabolic status, and even remission of comorbidities. However, it is important to note that these positive results cannot be attributed solely to food intake restriction or malabsorption. Emerging evidence suggests that bariatric surgery leads to significant changes in the intestinal microbiome, which may contribute to the beneficial effects observed on obesity-related complications. These changes could play a crucial role in reducing cardiovascular disease.Therefore, the main objective of this review is to better understand the links between the composition of the gut microbiota after bariatric surgery and improved cardiovascular health. By exploring this complex relationship, research teams aim to shed light on the underlying mechanisms and pave the way for novel therapeutic strategies to improve cardiovascular health in patients who have undergone bariatric surgery.© 2023 Société francophone nutrition clinique et métabolisme (SFNCM).Published by Elsevier Masson SAS. All rights reserved.

Incidence of cancer for patients after bariatric surgery: evidence from 33 cohort studies

BackgroundWith the rising prevalence of severe obesity, bariatric surgery has emerged as a crucial treatment option. As the number of surgeries performed worldwide increases, there has been growing interest in the impact of bariatric surgery on cancer incidence. While several studies have examined this relationship, the topic remains controversial. ObjectivesWe conducted this systematic review of cohort studies with meta-analysis to evaluate the effect of bariatric surgery versus nonsurgical treatment on overall cancer incidence. However, the effects may vary when focusing on specific cancer types, surgical procedures, or gender, so we conducted additional subgroup analyses. SettingA meta-analysis. University hospital. MethodsThe Cochrane, Embase, PubMed, and Web of Science databases were searched for studies from 1 January 2000 to 1 December 2022. Meta-analysis was conducted to evaluate the pooled effect and further implemented subgroup analysis stratified by cancer type, operation type, and sex. ResultsAll cohort studies were included in this meta-analysis from 18,216 studies. The overall cancer incidence demonstrated a significant decrease in the group with bariatric surgery (odds ratios [OR] = .56, P = .000, 95% CI .46 to .68). In subgroup analysis, similar decrease effect was found in 9 cancers. Furthermore, the incidence of cancer decreased significantly in male (OR = .66, P = .001, 95% CI .51 to .85) and female patients (OR = .63, P = .000, 95% CI .57 to .69) and patients undergoing gastric bypass (OR = .46, P = .000, 95% CI .33 to .63) or sleeve gastrectomy (OR = .44, P = .001, 95% CI .27 to .70). ConclusionsIn the overall analysis, bariatric surgery could reduce the incidence of cancer significantly. Further large-scale well-matched studies are needed to verify the protective effect of bariatric surgery on cancer incidence.

Temporal trends in severe obesity for patients with ST-elevation myocardial infarctions in patient cohorts stratified by age and gender

Abstract Background The prevalence of obesity and severe obesity has increased in the general population of modern societies during the last decades with growing implications on health systems. Aim of the present study was to analyse prevalence rates of severe obesity (body mass index (BMI)≥40 kg/m²) in patients with ST-elevation myocardial infarctions (STEMI) between 2006 and 2022 and its association to age, other cardiovascular risk factors and in-hospital- and long-term-outcome rates. Methods All patients admitted with STEMI between 2006 and March 2022 to a large German PCI center entered analysis. Patients were assigned to the study group with severe obesity (BMI≥40 kg/m²), a control group with obesity grade 2 (BMI 35-39.9 kg/m²) and a second control group (BMI &amp;lt;35 kg/m²). Results From a total of 11740 patient included, 269 patients (2.3%) presented with severe obesity with a mean weight of 128.9±18 kg, while 589 patients (5.0%) had obesity grade 2. Patients with severe obesity were on average 6.4 years younger compared to patients with a BMI&amp;lt;35 kg/m²: 57.7±11.5 yrs. vs. 64.1±13.1, p&amp;lt;0.01. Rates of severe obesity were higher in women in most age strata, especially in patients&amp;lt;45 yrs. of age: women 9.3%, men 3.0%, p&amp;lt;0.01. Over time, the proportion of severe obesity increased from 1.9% in 2006-2013 to 2.9% in 2014-2022, p&amp;lt;0.01. This increase was more pronounced in women 2.5 % to 3.9% (p=0.02) compared to men: 1.7% to 2.5% (p&amp;lt;0.01) and most prominent in the young (&amp;lt;45 yrs.): 2.3% to 6.2%, p&amp;lt;0.01. The increase over time could be confirmed in multivariate model for younger men and women, while it failed to reach statistical significance in patients ≥ 55 years of age (table). While there was no association between severe obesity and hyperlipidemia (LDL-cholesterol 120.9±44 mg/dl vs. 121.5±57 mg/dl in controls, p=0.91), it was associated with higher rates of diabetes mellitus (45.5% vs. 18.8%, p&amp;lt;0.01). Patients with severe obesity showed similar rates of multivessel disease (61.6% vs. 63.5%, p=0.51) and successful primary percutaneous coronary interventions (TIMI 2/3 post PCI: 96.2% vs. 95.1%, p=0.44). In a multivariate analysis of outcome severe obesity was associated with similar in-hospital-mortality-rates (OR 0.98, 95% CI 0.6-1.6, p=0.94), however in long term follow-up a trend for a higher 1-year-mortality (OR 1.49, 95% CI 0.98-2.2, p=0.065) and a significantly higher 5-year-mortality (OR 1.82, 95% CI 1.17-1.82, p&amp;lt;0.01) could be observed. Conclusions These results from a large registry study reveal that during the last 16 years rates of severe obesity increased by more than 50% in STEMI-patients. The increase was most prominent in the young and in women, were rates more than doubled. At the same time, severe obesity was associated with a young age during the index event and a worse long-term-outcome.Changes in obesity 2014-22 vs. 2006-13

Undue Burden the Medical School Application Process Places on Low-Income Latinos

Undue Burden the Medical School Application Process Places on Low-Income Latinos

Pediatric Obesity Prevalence inthe U.S. Military Health System, Fiscal Years 2012-2018.

Obesity prevalence in Military Health System (MHS) children has been reported through fiscal year (FY) 2012 as consistently lower than in the general population. Our study reports military pediatric overweight, obesity, and severe obesity prevalence through FY2018. We compared FY2018 prevalence to a sample of the general population using National Health and National Health and Nutrition Examination Survey (NHANES) 2017-2018 data. The MHS Data Repository was queried for all children aged 2-17 years seen at any military treatment facility between FY2012 and FY2018. We calculated overweight and obesity (classes 1, 2, and 3) prevalence for each FY and performed subgroup analysis for sex, age, and sponsor rank. We also compared FY2018 to NHANES 2017-2018 data. This study was approved by the Walter Reed National Military Medical Center Institutional Review Board. The prevalence of overweight and obesity was stable from FY2012 (14.4% and 11.3%, respectively) to FY2018 (14.1% and 10.7%). Rates of classes 2 and 3 obesity combined were also stable at around 2.5% of all children. In FY2018, obesity prevalence was greater in assigned males, increased with age, and was highest in 16-17-year-olds (odds ratio: 2.75) and children with an enlisted military sponsor (odds ratio: 1.78). Compared to NHANES, MHS children had lower rates of obesity (10.7% versus 19.3%) with a smaller proportion of severe obesity (24% versus 32%). The prevalence of pediatric overweight and obesity in the MHS was stable over time. Disparities were observed between age and sponsor rank groups. When compared to the general population, overall obesity prevalence was lower in younger military children. Further research is needed to explore disparities and to identify optimal strategies to mitigate the increase in obesity prevalence with age.

SAT295 Metabolic And Endocrine Risks In Association With The Use Of Intraarticular Glucocorticoid Injections: A Retrospective Study

Abstract Disclosure: E. Rabiei-Flori: None. Y. Yin: None. F. Hasan: None. Introduction: The use of intraarticular glucocorticoid injections (IGCI) to alleviate chronic pain from degenerative joint disease (DJD) is very common and the frequency of their use is probably underestimated. In our clinical experience the harmful metabolic effects of the frequent IGCI use are concerning, yet are not well studied. It is well-known that chronic exposure to systemic glucocorticoids is the most common cause of Cushing’s syndrome; i.e., iatrogenic Cushing’s (IC). There are, however, limited data assessing the link between IGCI use and IC. Methods: In this retrospective study we compare the outcomes in two large populations, both of which had received intraarticular injections to alleviate DJD pain. The first population received IGCI, while the second (comparison) population received a non-steroid, hyaluronic acid injection (IAHA). We hypothesize that, compared to the use of IAHA, the use of IGCI is associated with worse metabolic and endocrine outcomes, such as higher frequencies of diabetes, insulin requirement, obesity, hypertension, osteoporosis, and vertebral compression fractures. We included patients aged 18-90 years who received ≥1 IAHA dose versus ≥ 5 IGCI to a major joint (hip, knee, or shoulder) between 1/1/2017-9/30/2021. Results: During the study period 34,600 subjects received at least one of the two treatments (30,273 received IGCI vs 4327 who received IAHA; ratio of IGCI to IAHA population ≈ 7). Among the IGCI population 2421 (8%) received ≥ 5 IGCI injections. Comparisons are provided for this subset vs. IAHA. At baseline, mean age in the IGCI vs IAHA groups were 66.3 (±11.5) and 63.8 (±11.8) years, respectively. The use of IGCI was 2 folds higher and the use of IAHA was 1.5 folds higher in females than males. Most patients were White (88.6% and 90% in the IGCI and IAHA groups, respectively). There was no difference in BMI between the groups at baseline (both 32.7 ± 7). Compared to the IAHA population, those who received ≥ 5 IGCI had significantly higher frequency of incident diabetes (42.1% vs. 35.3%, p 0.0006), requiring insulin therapy for diabetes (14.8% vs 12.6%, p=0.02), hypertension (55.4% vs. 43.6%, p &amp;lt;0.001), osteopenia (7.9% vs 5.7%, p=0.001), osteoporosis (8.8% vs 4.9%, p&amp;lt;0.0001), vertebral compression fracture (2.1% vs. 1.3%, p=0.04), depression (14.3% vs. 9.5%, p&amp;lt;0.001), cataract (3.6% vs. 2 %, p=0.0008), emergency room visit (48.8% vs 43.2%, p &amp;lt; 0.0001), ER visit for hypertension (3.4% vs 2.3%, p=0.02) and hospitalization for any reason (32.6% vs 27%, p&amp;lt;0.0001). Furthermore, the IGCI population had significantly lower lumbar spine BMD on DXA scan (0.98 vs 1.04 g/cm3, p=0.02). In contrast, the prevalence of obesity or severe obesity was not different between the two populations. Conclusion: compared to IAHA, the use of IGCI is associated with increased frequency of endocrine and metabolic risks that are observed in iatrogenic Cushing’s syndrome. Presentation: Saturday, June 17, 2023

SAT682 Improving Obesity Counseling Rates In An Academic Internal Medicine Clinic: A Quality Improvement Study

Abstract Disclosure: A. Mathew: None. J. Asif: None. D. Samrah: None. K. Rai: None. J. Ramakrishna: None. H. Ilyas: None. V. Tegeltija: None. Introduction: Obesity is a chronic disease that affects more than 40% of the population in the United States. The prevalence of severe obesity doubled in the past two decades. PCP are usually the first to screen patients for obesity. Only 55% of adults with obesity were reported to have received the diagnosis of obesity and less than a third of the patients followed up for an obesity-specific visit. The management of obesity is multifactorial with lifestyle modifications, pharmacological and psychological therapies. In our academic clinic, there was a gap in satisfactory obesity counseling, which addresses lifestyle modifications and adjunctive pharmacological therapies. Addressing this gap with an obesity-specific visit helps clinicians to discuss available options to manage obesity. Improvement in body weight is linked with improved control of hypertension, diabetes, and heart disease leading to improved health outcomes. Aim: To improve obesity counseling rates in an academic clinic by 25% in 3 months. Method: We used the IHI model of improvement using the plan-do-study-act framework to test changes on a small scale and guide the quality improvement study. After the IRB exemption was granted, a thorough chart search for the last 3 months was done to calculate a baseline obesity counseling rate. A root-cause analysis was completed with multi-disciplinary input from faculty, clinic staff, and residents, and several existing barriers that preclude satisfactory obesity counseling were identified. Proposed interventions corresponding to each root cause were plotted on an impact effort matrix. Interventions with the least effort and the most impact were selected as proposed solutions. These included creating a short education session on obesity management and creating an obesity counseling template. Post-intervention, the obesity counseling rates and use of the template were recorded on a run chart. Results: Satisfactory obesity counseling prior to intervention was 32%. The first PDSA cycle post-intervention showed an improvement in the obesity counseling rates to 56%. About 20% of the clinic notes for the counseled patients used the proposed template. About 8% of the counseled patients agreed to a separate obesity-specific visit. Next steps: We noted an overall improvement in the obesity counseling rates after our interventions. However, we noticed there were instances of vague or unclear documentation for obesity counseling. Our next intervention will be to provide an infographic handout as a visual reminder for residents, which highlights key components of obesity counseling. This includes identifying obesity-associated health conditions, limitations to lifestyle modifications, social determinants of health, and indicated or contraindicated pharmacological options. We will also monitor the number of patients agreeing to an obesity-specific visit after the second PDSA cycle. Presentation: Saturday, June 17, 2023

Bariatric Surgery and Malpractice: an Extensive Review of Demographics, Complications, Litigation, and Proactive Mitigation Strategies.

The rising prevalence of severe obesity has led to a parallel increase in bariatric surgeries, raising a complex array of medicolegal issues. This review aims to analyze and synthesize literature on bariatric surgery malpractice, focusing on patient demographics, surgical complications, litigation costs, and the nature of malpractice cases. A systematic search was conducted across multiple databases for relevant studies published up to May 2023. Our review endeavors to provide insights into these medicolegal challenges and their implications and foster an informed dialogue on strategies for their effective management. By doing so, we hope to enhance ethical and legally sound bariatric practices, safeguarding both patient welfare and surgical practitioners from legal repercussions.

Health care cost of severe obesity and obesity-related comorbidities: A retrospective cohort study from Alberta, Canada.

Estimates of health care costs associated with severe obesity, and those attributable to specific health conditions among adults living with severe obesity are needed. Administrative data was used to identify adults who previously received a procedure, and had (investigational cohort) or did not have (control cohort) a body mass index ≥35kg/m2. Two-part models were used to estimate the incremental health care cost of severe obesity and related health conditions during a 1-year observation period. Adjusting for potential confounders, the total health care cost ratio was higher in the investigational (n=220,190) versus control (n=1,955,548) cohort (1.32 [95% CI: 1.32, 1.33]) with a predicted incremental cost of $2221 (95% CI $2184, $22,265) per person-year; costs were less when obesity-related health conditions were controlled for (1.13 [95% CI: 1.13, 1.14]; $1097 [95% CI: $1084, $1110] per person-year). Among those living with severe obesity, incremental costs associated with specific health conditions ranged from $737 (95% CI: $747, $728) lower (dyslipidemia) to $12,996 (95% CI: $12,512, $13,634) higher (peripheral vascular disease) per person-year. Adults living with severe obesity had greater costs than those without, largely driven by obesity-related health conditions. For the Alberta adult population with a severe obesity prevalence of 11%, severe obesity may account for an estimated additional $453-918 million in health care costs per year. Findings of this study provide rationale for resources and strategies to prevent and manage obesity and its complications.

State-Specific Prevalence of Severe Obesity Among Adults in the US Using Bias Correction of Self-Reported Body Mass Index.

Adults with severe obesity are at increased risk for poor metabolic health and may need more intensive clinical and community supports. The prevalence of severe obesity is underestimated from self-reported weight and height data. We examined severe obesity prevalence among US adults by sociodemographic characteristics and by state after adjusting for self-report bias. Using a validated bias-correction method, we adjusted self-reported body mass index (BMI) data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) by using measured data from the National Health and Nutrition Examination Survey. We compared bias-corrected prevalence of severe obesity (BMI ≥40) with self-reported estimates by sociodemographic characteristics and state. Self-reported BRFSS data significantly underestimated the prevalence of severe obesity compared with bias-corrected estimates. In 2020, 8.8% of adults had severe obesity based on the bias-corrected estimates, whereas 5.3% of adults had severe obesity based on self-reported data. Women had a significantly higher prevalence of bias-corrected severe obesity (11.1%) than men (6.5%). State-level prevalence of bias-corrected severe obesity ranged from 5.5% (Massachusetts) to 13.2% (West Virginia). Based on bias-corrected estimates, 16 states had a prevalence of severe obesity greater than 10%, a level not seen in the self-reported estimates. Self-reported BRFSS data underestimated the overall prevalence of severe obesity by 40% (5.3% vs 8.8%). Accurate state-level estimates of severe obesity can help public health and health care decision makers prioritize and plan to implement effective prevention and treatment strategies for people who are at high risk for poor metabolic health.

The Burden of Obesity in Type 1 Diabetic Subjects: A Sex-specific Analysis From the AMD Annals Initiative.

Obesity is a growing emergency in type 1 diabetes (T1D). Sex differences in obesity prevalence and its clinical consequences in adult T1D subjects have been poorly investigated. The aim of this study was to investigate the prevalence of obesity and severe obesity, clinical correlates, and potential sex differences in a large cohort of T1D subjects participating to the AMD (Associazione Medici Diabetologi) Annals Initiative in Italy. The prevalence of obesity [body mass index(BMI) ≥30 kg/m2] and severe obesity (BMI ≥ 35 kg/m2) according to sex and age, as well as obesity-associated clinical variables, long-term diabetes complications, pharmacological treatment, process indicators and outcomes, and overall quality of care (Q-score) were evaluated in 37 436 T1D subjects (45.3% women) attending 282 Italian diabetes clinics during 2019. Overall, the prevalence of obesity was similar in the 2 sexes (13.0% in men and 13.9% in women; mean age 50 years), and it increased with age, affecting 1 out of 6 subjects ages >65 years. Only severe obesity (BMI >35 kg/m2) was more prevalent among women, who showed a 45% higher risk of severe obesity, compared with men at multivariate analysis. Cardiovascular disease risk factors (lipid profile, glucose, and blood pressure control), and the overall quality of diabetes care were worse in obese subjects, with no major sex-related differences. Also, micro- and macrovascular complications were more frequent among obese than nonobese T1D men and women. Obesity is a frequent finding in T1D adult subjects, and it is associated with a higher burden of cardiovascular disease risk factors, micro- and macrovascular complications, and a lower quality of care, with no major sex differences. T1D women are at higher risk of severe obesity.