ABSTRACT
Introduction: Overweight and obesity in youth with serious emotional disturbance (SED) is exceedingly common. In 2015 the AHA called attention to mental illnesses in youth as important risk conditions for early CVD and the need for transformational change in management of overweight and obesity in this group. Our objective was to test a 12-month, innovative healthy weight intervention in youth with SED.Hypothesis: The active intervention is more effective than control in decreasing BMI Z-score compared at 12 m. Method(s): We conducted a two-arm randomized trial in 2 outpatient pediatric mental health settings in 112 youth, ages 8-18 yrs. The active intervention group was offered 12m of in-person and virtual individual weight management sessions led by health coaches who provided guidance on improving diet and increasing physical activity, and engaged parents. Result(s): At baseline, mean (SD) age was 13.0 (2.7) yrs with 46% ages 8-12 and 54% 13-18;55% were male, 46% Black, 39% had household income less than $50K/yr and 31% lived in a single-parent household. Primary diagnoses were ADHD (41%), major depression (23%), and anxiety (23%). Mean BMI Z-score (SD) was 2.0(0.4), BMI 30.4 (6.4) kg/m2.Mean(SD) psychotropic medications were 2.1(1.4).At 12m, 111 (99%) had a follow-up weight;42 were collected after the onset of the COVID pandemic). The intervention group compared to the control group had 0.15 decrease in BMI Z-Score (95% CI 0.26 to 0.04), p<0.007) between baseline and 12 m (Figure) and a 1.43 kg/m2 decrease in BMI (95% CI 2.43, 0.42, p<0.006). Estimated net effect on BMI Z-score for intervention vs. control was enhanced during the pandemic but not statistically different from net effects pre-pandemic (p=0.06). Conclusion(s): A weight control intervention designed for children with SED decreased BMI Z-score substantially over 12 months, including during the COVID-19 pandemic. These results provide empirical evidence in support of weight control programs in a population at high risk for early development of CVD risk factors.
ABSTRACT
Background: Since late 2019, infections with novel coronavirus SARS-CoV-2 have caused a global pandemic. By now, limited adequate pharmacological therapy exists for severe COVID-19 related acute respiratory distress syndrome (ARDS). Therefore, treatment with veno-venous extracorporeal membrane oxygenation (vv-ECMO) still is considered as an ultimate rescue option. However, especially in obese patients, implantation of vv-EMCO cannulas is challenging and results in these patients are often considered as inferior to normal weight control patients. Method(s): Between 2020 and 2022, a total of 82 patients were treated with vv-ECMO for severe COVID-19-related ARDS in our department. All patients were prospectively enrolled into an institutional database and retrospectively reviewed for the purpose of this study. Patients were divided concerning their body mass index (BMI) (BMI <= 30.0 kg/m2 : control, n = 41;BMI > 30.0 kg/m2 : obesity, n = 41). Result(s): Mean BMI of the control group was 27.0 +/- 2.1 kg/m2 compared with 33.5 +/- 5.3 kg/m2 in obesity group (p < 0.01). Minimum BMI of the whole cohort was 23.0 kg/m2 and maximum BMI 50.0 kg/m2. There were no relevant differences regarding age, gender and the incidence of concomitant diseases, except for diabetes (control: 17.1%, obesity: 41.5%, p = 0.03) and renal insufficiency (control: 22.0%, obesity: 4.9%, p = 0.05) between the two study groups. Peri-interventional incidence of severe device-related adverse events such as bleeding (control: 17.1%, obesity: 25.0%, p = 0.42), ischemic stroke (control: 9.8%, obesity: 10.0%, p > 0.99), intracranial bleeding (control: 22.0%, obesity: 27.5%, p = 0.61), and visceral ischemia (control: 4.9%, obesity: 12.2%, p = 0.43) did not differ with regard to the BMI. Weaning from vv-ECMO was achieved in 39.0% of the obese patients and in 34.0% of the controls (p = 0.82). In-hospital death was observed for 75.6% of the control patients compared with 61.0% for the obesity group (p = 0.24). Conclusion(s): vv-ECMO as ultimate rescue therapy for serve COVID-19-related ARDS is also feasible in obese patients. Although implantation of the cannulas may be more difficult in obese patients, the results regarding weaning rate and survival are encouraging and not inferior to non-obese patients. However, an increased rate of kidney injury in the control group during vv-ECMO support may represent a relevant confounder, which should be investigated in larger study cohorts.
ABSTRACT
Lockdown and social distancing due to COVID-19 affected the mental health and lifestyle of the population. However, there is insufficient evidence of alterations in eating behavior. Our study seeks to describe the relationship between eating behavior and eating habits among Chilean adults during the confinement period. A sample of 760 Chilean subjects was analyzed, who answered surveys using Google Forms, considering demographic characteristics, social distancing, dietary habits and EB. More than half of the participants consider that their dietary intake increased during confinement. Changes in dietary intake were analyzed according to food group, and a decrease in the consumption of fish, fruits and dairy products was observed, while legumes, processed foods and soft drinks showed an increase, which represents risk factors for the development of cardiovascular diseases. When analyzing eating behavior, a greater difficulty in stopping eating was observed when faced with external stimuli;increased intake associated with complex emotional situations, and when iso-lating the group that decreased their intake of unhealthy foods, a greater ability to limit their intake for weight control was reported. Our results are similar to other studies, and they reinforce that confinement is related to eating behavior, leading to changes in eating habits, which indicates that, at the public health level, post-pandemic nutritional strategies, should be focused on regulating eating behavior in order to guide habits towards healthy eating. Copyright © 2022, Sociedad Chilena de Nutricion Bromatologia y Toxilogica. All rights reserved.
ABSTRACT
Background: Adolescents with overweight (OW) and obesity (OB) report profound psychological stressors. Yet, traditional adolescent behavioral weight control interventions have not focally targeted stress reduction. Mindfulness skills may benefit adolescents with OW/OB and enhance treatment outcomes by providing strategies to manage stress. The goal of this study was to integrate mindfulness and behavioral weight control for adolescents with OW/OB by obtaining feedback from a Youth Advisory Board (YAB) and conducting an open trial of a novel Mindfulness-Based Weight Control (MBWC) intervention. A secondary goal was to describe intervention adaptation intervention in response to the COVID-19 pandemic. Methods: Feedback on the intervention was obtained during 6 group meetings of the YAB (N = 9;M = 15.22 yrs, SD = 1.20;66.6% male;zBMI M = 1.97, SD = .34). The open trial included 2 cohorts (N = 14;M = 15.14 yrs, SD = 1.56;71.4% female;zBMI M = 2.08, SD = .26) both of which received 8 sessions of the group MBWC intervention. Cohort 1 was conducted in-person. Due to COVID-19, cohort 2 was adapted for virtual, synchronous delivery. Results: The YAB provided feedback on developmental and cultural fit of MBWC for adolescents with OW/OB. For the open trial, a small effect (Hedge's g = .16) was found in zBMI decrease from pre-( M = 2.02, SD = .26) to post-( M = 1.97, SD = .30) treatment. However, the pre-post change in zBMI failed to reach significance, t = 1.68(10), p >.05. Post-treatment, participants in both groups rated on a 10-point scale (0 = strongly disagree to 10 = strongly agree) that they were 'satisfied with the HEARTS program' (M = 7.92, SD = 1.38) and would 'recommend the HEARTS program to a friend' (M = 8.50;SD = 1.78). Conclusions: Open trial findings provide preliminary support for this novel adolescent mindfulness-enhanced group behavioral weight control intervention, with adaptation for real-time online delivery. Specifically, results support the acceptability of this MBWC intervention, run both in-person and virtually with adaptation due to COVID-19. Further evaluation of the full 16-week MBWC intervention with a larger sample is needed to examine the impact on adolescent zBMI change.
ABSTRACT
Background: Amidst the COVID-19 pandemic, telemedicine was a strategy to expand patient care during quarantine. However, there is little data on how this transition may have impacted weight loss outcomes and practices among patients with overweight/obesity. Methods: This retrospective observational study of adults who established care at the Weill Cornell Comprehensive Weight Control Center during September-November 2019 and May-July 2020 explored weight loss outcomes and weight management practices over 6 months of follow-up. Results: Of 516 charts eligible for review, 245 (47.5%) were included for analysis after excluding patients who failed to return for a follow-up visit within 6 ± 3 months or who were missing relevant data. Of 245 patients, 69 had in-person visits only ('in-person'), 91 had video visits only ('video'), and 85 started in-person and later switched to video visits ('hybrid'). All cohorts were predominantly white and female. Median ages were 56, 49, and 49 years, and baseline median weights were 98.9, 96.8, and 93.0kg for in-person, video, and hybrid cohorts, respectively. The median percent weight losses were not significantly different among cohorts: 4.3% [-8.5, -1.5] in the in-person cohort, 5.8% [-9.7, -2.4] in the video cohort, and 5.7% [-8.7, -2.2] in the hybrid group. The percent of patients who achieved ≥5% weight loss were also similar: 46.4%, 59.3%, and 55.3%, respectively. The median number of visits were 4 [3,4] for the in-person cohort, 4 [3,6] for the hybrid cohort, and 5 [4,7] for the video visit cohort. Median number of anti-obesity medications (AOMs) prescribed was 1 [1,2] for the in-person cohort and 2 [1, 2] for both the hybrid and video cohorts. The most common AOMs were metformin (all cohorts) followed by semaglutide (in-person and video) or topiramate (hybrid). Conclusions: Video visits are an effective weight management strategy and require further exploration to compare to in-person care.
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Background: Individuals living in rural areas have higher obesity and obesity related co-morbidities than their urban counterparts. Understanding rural-urban differences associated with weight management may inform the development of effective weight management interventions for adults living in rural areas. Methods: The International Weight Control Registry (IWCR) is an online registry designed to assess factors contributing to successes and challenges with weight loss and weight loss maintenance across the world. We examined demographics, weight history and weight management strategies in a sample of urban and rural residents in the Midwestern U.S. (IA, IL, IN, KS, MI, MN, MO, ND, NE, OH, SD, WI). Participants were classified as rural or urban by the Rural-Urban Commuting Area Code. Analyses included Chi-square tests for proportions and independent t-test and Wilcoxon rank sum test for continuous variables. Results: The sample was 45% rural (n = 78 of a total N = 174) with a mean age of 50.3 years. Rural residents were more likely to be white, non-college graduates, and have lower family income compared with urban areas (p < 0.05). Rural and urban residents reported similar weight histories and strategies for weight management. Work-related physical activity was higher and weekday sitting time was lower in rural compared to urban residents (p < 0.01). These data could potentially be impacted by the relative number of residents working from home during COVID-19 (Urban: 59% vs. Rural: 37%, p < 0.05). Rural residents were more likely to report a lack of neighborhood walkability (p < 0.01) and healthy food availability (p < 0.05) compared with urban residents. Conclusions: These data suggest rural-urban differences in demographic characteristics, opportunity for leisure time physical activity, and the availability of heathy foods should be considered in the development of weight management interventions. The consistency of the observed findings will be evaluated at the regional, national and international levels as the size of the available sample in the IWCR increases.
ABSTRACT
Introduction: SARS-CoV-2 has affected the whole world as a global health pandemic in 2020. A nationwide home confinement was declared in our country by beginning of March. Cardiac rehabilitation programs (CRP) had to adapt to new health requirements and the impact of these changes is unknown. Purpose: To analyse the impact of COVID-19 pandemic in improvement of cardiopulmonary exercise test (CPET) with maximal oxygen consumption uptake (VO2max) and control of cardiovascular risk factors in patients with cardiovascular established disease (coronary heart disease, heart failure or cardiac surgery) included in the phase II of our centre CRP. Methods: 510 consecutive patients were evaluated. A maximal CPET was performed for each patient from the beginning and at the end of phase II of CRP. Enrolled patients were divided in two groups: from March 2019 to March 2020 (before Covid pandemic) and second one, from the beginning of the pandemic in March 2020 until February 2021. Results: 296 patients were studied in preCovid group and 214 patients were studied in Covid group. There were no statistically significant differences between these two groups in reference to cardiovascular risk factors and medical treatment (Figure 1). 82.7% of patients completed a hospital-based program in preCovid group vs 36% in Covid (p=0.001). Comparing the percentage of patients that accomplished the risk factors control targets between pre- and Covid group, statistically significant differences have been seen referring to systolic BP <140mmHg (85.1 vs 95.4%, p=0.001) and cLDL <70 mg/dl (67.2 vs 77.7%, p=0.003). However, in terms of glucose control (fasting blood glucose <110 mg/dl: 78.4 vs 82.2%, p=0.612;HbA1c <7%: 90.7 vs 92.7%, p=0.464) and weight control (BMI: 27.8±4.69 kg/m2 vs 27.3±4.07 kg/m2, p=0.299) this could not be established. There were no differences in psychological attention demand (27 vs 23.3%, p=0.695). Statistical differences between two groups were found in terms of VO2max at the beginning phase II CPET (22.7±7 vs 20±5 ml/min/kg, p=0.006) and ending phase II CPET (24±7 vs 21±6, p=0.001). Nevertheless, no differences were found in the final phase II CPET improvement between both groups (1.4±4.1 ml/kg/min vs 0.81±2.9 ml/kg/min;p=0.221) (Figure 2). Conclusions: SARS-CoV-2 changed our practice from an in-hospital based phase II CRP to a home-based phase II CRP. COVID-19 pandemic had no negative impact in the control of risk factors in our phase II patients. In our experience, despite preCovid phase II patients have a better functional capacity in terms of VO2max, the improvement in VO2max after phase II CRP persists in the SARS-CoV-2 era. This might show that an accurate structure of home-based program could also have great results. (Figure Presented).