Implementation of weekday time-restricted eating to improve metabolic health in breast cancer survivors with overweight/obesity.

OBJECTIVE: This study aimed to evaluate the implementation of telephone-based delivery of weekday-only time-restricted eating (TRE), its preliminary efficacy for metabolic outcomes, and concurrent lifestyle changes. METHODS: Twenty-two breast cancer survivors aged 60+ years with overweight/obesity completed an 8-week feasibility study of 12 to 8 p.m. weekday-only ad libitum TRE. The intervention was delivered by one registered dietitian call, twice-daily automated text messages asking about eating start and stop times, and three support phone calls. Magnetic resonance imaging, venipuncture, and 3 days of diet records and accelerometry were performed at baseline and after intervention. RESULTS: Participants had a mean age of 66 (SD 5) years with BMI of 31.8 (4.8) kg/m2 . Intervention implementation was successful, including excellent adherence (98%), participant acceptability, and a low symptom profile and cost ($63/participant). There were no significant changes in individual components of metabolic syndrome, lipid profile, or hemoglobin A1c , despite clinically relevant changes occurring within individual participants. Magnetic resonance imaging-derived hepatic steatosis and thigh myosteatosis did not change. Dietary intake changes included reduced energy (-22%) and protein (-0.2 g/kg). Physical activity and sleep did not change. CONCLUSIONS: Eight weeks of telephone-delivered weekday TRE is a feasible, acceptable, low-symptom, and low-cost intervention. Future studies may consider a longer intervention length for more consistent metabolic improvements and counseling to enhance protein intake.

Feeding intolerance during prolonged prone position in overweight and obese patients with severe COVID-19.

Introduction: Objective: the aim of this study was to compare the incidence rate of feeding intolerance (FI) during supine (SP) or prone positioning (PP) in critically ill COVID-19 patients. Methods: this was a retrospective cohort study of critically ill patients with overweight or obesity who received enteral nutrition (EN) in prone or supine positioning continuously during the first five days of mechanical ventilation. Nutritional risk, anthropometric measurements and body composition were assessed at the first 24 hours upon Intensive Care Unit (ICU) admission. Biochemical and clinical variables (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], Acute Kidney Injury [AKI] or comorbidities diagnosis) were collected. Pharmacotherapy (prokinetics, sedatives or neuromuscular blocking agents) and FI incidence (gastric residual volume [GRV] ≥ 200 ml or ≥ 500 ml, vomiting or diarrhea) were daily recorded. Constipation was defined as the absence of evacuation for five consecutive days. Results: eighty-two patients were included. Higher rate of prophylactic prokinetic prescription was observed in PP (42.8 vs 12.5 %, p = 0.002). GRV ≥ 200 in supine position was not different when compared to PP (p = 0.47). Vomiting episodes in supine compared to PP showed no difference between groups (15 % vs 24 %, p = 0.31). No differences in diarrhea events were detected (10 % vs 4.7 %, p = 0.36). Constipation was common in both groups (95 % vs 82 %, p = 0.06). Conclusion: FI during prone position was not different in comparison to supine position. Routinely use of prokinetics in continuous prone position may help to prevent FI incidence. Algorithm development is necessary for FI prevention and treatment so to avoid EN interruptions and adverse clinical outcomes.

Introducción: Objetivo: comparar la incidencia de intolerancia a la alimentación entre pacientes críticos en posición supino (PS) o prono (PP). Métodos: cohorte retrospectiva de pacientes bajo ventilación mecánica por distrés respiratorio por COVID-19 y sobrepeso y obesidad, quienes recibieron nutrición enteral (NE) en PP o PS. Se evaluaron riesgo nutricional, mediciones antropométricas y composición corporal en las primeras 24 horas de ingreso a la Unidad de Cuidados Intensivos (UCI). Se recolectaron variables bioquímicas y clínicas (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II], lesión renal aguda y otras comorbilidades). Se registró el esquema de farmacoterapia prescrita durante los primeros cinco días (procinéticos, sedantes y bloqueadores neuromusculares). Se evaluó la incidencia de intolerancia a la alimentación, definida como la presencia de residuo gástrico (RG) ≥ 200 o ≥ 500 ml, vómito, diarrea o estreñimiento. Resultados: fueron incluidos 82 pacientes. Se observó una mayor prescripción de procinéticos como terapia profiláctica en PP (42,8 vs. 12,5 %, p = 0,002). No se observaron diferencias en RG ≥ 200 ml (p = 0,47) ni vómito (p = 0,31) entre ambos grupos. No se observaron diferencias en episodios de diarrea (10 % en PS vs. 4,7 % en PP, p = 0,36). El estreñimiento fue común en ambos grupos de estudio (95 vs. 82 %, p = 0,06). Conclusiones: la PP no se relaciona con una mayor incidencia de intolerancias a la alimentación. El uso rutinario de procinéticos durante la PP continua puede ayudar a prevenir la incidencia de dichas intolerancias. Es necesario el desarrollo de algoritmos para la prevención y tratamiento de las intolerancias a la alimentación para evitar interrupciones en la NE y desenlaces no deseables.

Rugby Fans in Training New Zealand (RUFIT NZ): a randomized controlled trial to assess the effectiveness of a healthy lifestyle program for overweight men delivered through professional rugby clubs.

BACKGROUND: A healthy lifestyle program that appeals to, and supports, overweight and obese New Zealand (NZ) European, Maori (indigenous) and Pasifika men to achieve weight loss is urgently needed. A pilot program inspired by the successful Football Fans in Training program but delivered via professional rugby clubs in NZ (n = 96) was shown to be effective in weight loss, adherence to healthy lifestyle behaviors, and cardiorespiratory fitness in overweight and obese men. A full effectiveness trial is now needed. AIMS: To determine the effectiveness and cost effectiveness of Rugby Fans In Training-NZ (RUFIT-NZ) on weight loss, fitness, blood pressure, lifestyle change, and health related quality of life (HRQoL) at 12- and 52-weeks. METHODS: We conducted a pragmatic, two-arm, multi-center, randomized controlled trial in NZ with 378 (target 308) overweight and obese men aged 30-65 years, randomized to an intervention group or wait-list control group. The 12-week RUFIT-NZ program was a gender-sensitised, healthy lifestyle intervention delivered through professional rugby clubs. Each intervention session included: i) a 1-h workshop-based education component focused on nutrition, physical activity, sleep, sedentary behavior, and learning evidence-based behavior change strategies for sustaining a healthier lifestyle; and 2) a 1-h group-based, but individually tailored, exercise training session. The control group were offered RUFIT-NZ after 52-weeks. The primary outcome was change in body weight from baseline to 52-weeks. Secondary outcomes included change in body weight at 12-weeks, waist circumference, blood pressure, fitness (cardiorespiratory and musculoskeletal), lifestyle behaviors (leisure-time physical activity, sleep, smoking status, and alcohol and dietary quality), and health-related quality of life at 12- and 52-weeks. RESULTS: Our final analysis included 200 participants (intervention n = 103; control n = 97) who were able to complete the RUFIT-NZ intervention prior to COVID-19 restrictions. At 52-weeks, the adjusted mean group difference in weight change (primary outcome) was -2.77 kg (95% CI -4.92 to -0.61), which favored the intervention group. The intervention also resulted in favorable significant differences in weight change and fruit and vegetable consumption at 12-weeks; and waist circumference, fitness outcomes, physical activity levels, and health-related quality of life at both 12 and 52 weeks. No significant intervention effects were observed for blood pressure, or sleep. Incremental cost-effective ratios estimated were $259 per kg lost, or $40,269 per quality adjusted life year (QALY) gained. CONCLUSION: RUFIT-NZ resulted in sustained positive changes in weight, waist circumference, physical fitness, self-reported physical activity, selected dietary outcomes, and health-related quality of life in overweight/obese men. As such, the program should be recommended for sustained delivery beyond this trial, involving other rugby clubs across NZ. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry, ACTRN12619000069156. Registered 18 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376740 Universal Trial Number, U1111-1245-0645.

Interventions for weight reduction in obesity to improve survival in women with endometrial cancer.

BACKGROUND: This is an updated version of the original Cochrane Review published in Issue 2, 2018. Diagnoses of endometrial cancer are increasing secondary to the rising prevalence of obesity. Obesity plays an important role in promoting the development of endometrial cancer, by inducing a state of unopposed oestrogen excess, insulin resistance and inflammation. It also affects treatment, increasing the risk of surgical complications and the complexity of radiotherapy planning, and may additionally impact on subsequent survival. Weight-loss interventions have been associated with improvements in breast and colorectal cancer-specific survival, as well as a reduction in the risk of cardiovascular disease, which is a frequent cause of death in endometrial cancer survivors. OBJECTIVES: To evaluate the benefits and harm of weight-loss interventions, in addition to standard management, on overall survival and the frequency of adverse events in women with endometrial cancer who are overweight or obese compared with any other intervention, usual care, or placebo. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was from January 2018 to June 2022 (original review searched from inception to January 2018). SELECTION CRITERIA: We included randomised controlled trials (RCTs) of interventions to facilitate weight loss in women with endometrial cancer who are overweight or obese undergoing treatment for, or previously treated for, endometrial cancer compared with any other intervention, usual care, or placebo.  DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. overall survival and 2. frequency of adverse events. Our secondary outcomes were 3. recurrence-free survival, 4. cancer-specific survival, 5. weight loss, 6. cardiovascular and metabolic event frequency and 7. quality of Life. We used GRADE to assess certainty of evidence. We contacted study authors to obtain missing data, including details of any adverse events. MAIN RESULTS: We identified nine new RCTs and combined these with the three RCTs identified in the original review. Seven studies are ongoing.  The 12 RCTs randomised 610 women with endometrial cancer who were overweight or obese. All studies compared combined behavioural and lifestyle interventions designed to facilitate weight loss through dietary modification and increased physical activity with usual care. Included RCTs were of low or very low quality, due to high risk of bias by failing to blind participants, personnel and outcome assessors, and significant loss to follow-up (withdrawal rate up to 28% and missing data up to 65%, largely due to the effects of the COVID-19 pandemic). Importantly, the short duration of follow-up limits the directness of the evidence in evaluating the impact of these interventions on any of the survival and other longer-term outcomes.  Combined behaviour and lifestyle interventions were not associated with improved overall survival compared with usual care at 24 months (risk ratio (RR) mortality, 0.23, 95% confidence interval (CI) 0.01 to 4.55, P = 0.34; 1 RCT, 37 participants; very low-certainty evidence). There was no evidence that such interventions were associated with improvements in cancer-specific survival or cardiovascular event frequency as the studies reported no cancer-related deaths, myocardial infarctions or strokes, and there was only one episode of congestive heart failure at six months (RR 3.47, 95% CI 0.15 to 82.21; P = 0.44, 5 RCTs, 211 participants; low-certainty evidence). Only one RCT reported recurrence-free survival; however, there were no events. Combined behaviour and lifestyle interventions were not associated with significant weight loss at either six or 12 months compared with usual care (at six months: mean difference (MD) -1.39 kg, 95% CI -4.04 to 1.26; P = 0.30, I2 = 32%; 5 RCTs, 209 participants; low-certainty evidence). Combined behaviour and lifestyle interventions were not associated with increased quality of life, when measured using 12-item Short Form (SF-12) Physical Health questionnaire, SF-12 Mental Health questionnaire, Cancer-Related Body Image Scale, Patient Health Questionnaire 9-Item Version or Functional Assessment of Cancer Therapy - General (FACT-G) at 12 months when compared with usual care (FACT-G: MD 2.77, 95% CI -0.65 to 6.20; P = 0.11, I2 = 0%; 2 RCTs, 89 participants; very low-certainty evidence). The trials reported no serious adverse events related to weight loss interventions, for example hospitalisation or deaths. It is uncertain whether lifestyle and behavioural interventions were associated with a higher or lower risk of musculoskeletal symptoms (RR 19.03, 95% CI 1.17 to 310.52; P = 0.04; 8 RCTs, 315 participants; very low-certainty evidence; note: 7 studies reported musculoskeletal symptoms but recorded 0 events in both groups. Thus, the RR and CIs were calculated from 1 study rather than 8).  AUTHORS' CONCLUSIONS: The inclusion of new relevant studies has not changed the conclusions of this review. There is currently insufficient high-quality evidence to determine the effect of combined lifestyle and behavioural interventions on survival, quality of life or significant weight loss in women with a history of endometrial cancer who are overweight or obese compared to those receiving usual care. The limited evidence suggests that there is little or no serious or life-threatening adverse effects due to these interventions, and it is uncertain if musculoskeletal problems were increased, as only one out of eight studies reporting this outcome had any events. Our conclusion is based on low- and very low-certainty evidence from a small number of trials and few women. Therefore, we have very little confidence in the evidence: the true effect of weight-loss interventions in women with endometrial cancer and obesity is currently unknown. Further methodologically rigorous, adequately powered RCTs are required with follow-up of five to 10 years of duration. These should focus on the effects of varying dietary modification regimens, and pharmacological treatments associated with weight loss and bariatric surgery on survival, quality of life, weight loss and adverse events.

Essential elements of weight loss apps for a multi-ethnic population with high BMI: a qualitative study with practical recommendations.

Smartphone weight loss apps are constantly being developed but the essential elements needed by a multi-ethnic population with overweight and obesity remains unclear. Purpose: To explore the perceptions of an Asian multi-ethnic population with overweight and obesity on the essential elements of weight loss apps. Twenty two participants were purposively sampled from a specialist weight management clinic in Singapore from 13 April to 30 April 2021. Recorded interviews were conducted using face-to-face and videoconferencing modalities. Data saturation was reached at the 18th participant. Data analysis was performed using inductive content analysis with constant comparison between and within transcripts. Findings: Three themes and eight subthemes on the essential app components emerged-(a) comprehensive and flexible calorie counters; (b) holistic, gradual and individualized behavior change recommendations tailored for people with overweight and obesity, and (c) just-in-time reminders of future consequences. There was a need to incorporate flexible options for food logging; break down general recommendations into small steps towards sustainable changes; tailor app contents for people with overweight and obesity; and evoke one's considerations of future consequences. Future weight loss apps should be designed to meet the needs of those with overweight and obesity, the very population that needs assistance with weight loss. Future apps could consider leveraging the capacity of artificial intelligence to provide personalized weight management in terms of sustaining self-regulation behaviors, optimizing goal-setting and providing personalized and timely recommendations for weight loss.

Weight loss smartphone apps are ubiquitous but the essential elements needed and preferred by people with overweight and obesity remains unclear. Therefore, we conducted a qualitative study to explore the perceptions and needs of this population in a weight loss app to prolong app engagement and enhance weight loss success. 22 participants were interviewed through face-to-face or videoconferencing sessions during the peak of the COVID-19 pandemic. Interview transcripts were analyzed within and between participants to develop codes, subthemes and themes that represent the participants' perceptions and needs in weight loss apps. Participants expressed the need for (a) comprehensive and flexible calorie counters; (b) holistic, gradual, and individualized behavior change recommendations tailored for people with overweight and obesity; and (c) just-in-time reminders of future consequences. Our findings showed a need to incorporate flexible options for food logging; break down general recommendations into small steps towards sustainable changes; tailor app contents for people with overweight and obesity; and evoke one's considerations of future consequences. Future apps could consider leveraging the capacity of artificial intelligence to provide personalized weight management in terms of sustaining self-regulation behaviors, optimizing goal-setting and providing personalized and timely recommendations for weight loss.

Well-Being Therapy and Lifestyle Intervention in Type 2 Diabetes: A Pilot Randomized Controlled Trial.

OBJECTIVE: This pilot randomized controlled trial evaluates the preliminary efficacy of a 4-month well-being therapy (WBT) and lifestyle intervention among adults with type 2 diabetes and overweight/obesity. METHODS: Fifty-eight patients were recruited from two outpatient clinics and randomized to receive the WBT-lifestyle intervention or the lifestyle intervention alone. Data were collected at baseline (T0), immediate postintervention (T1), 6-month follow-up (T2), and 12-month follow-up (T3). Primary efficacy outcomes included changes in weight, psychological distress, and well-being, whereas secondary efficacy outcomes included changes in lifestyle and physiological parameters. RESULTS: Compared with the lifestyle-alone intervention, the WBT-lifestyle intervention showed greater improvements in depression (p = .009, d = -0.6), hostility (p = .018, d = -0.6), and personal growth (p = .026, d = 0.5) at T1, in self-reported physical activity at T2 (p = .013, d = 0.7) and T3 (p = .040, d = 0.5), and in triglycerides (p = .019, d = -1.12) at T3. There were no differences between treatment groups in weight and other physiological parameters. CONCLUSIONS: These findings suggest that WBT may be a valuable addition to lifestyle interventions for improving short-term psychological outcomes and promoting long-term healthy changes in physical activity, with a potential impact on physiological outcomes.Trial Registration:ClinicalTrials.gov identifier: NCT03609463.

Effectiveness and Components of Web-Based Interventions on Weight Changes in Adults Who Were Overweight and Obese: A Systematic Review with Meta-Analyses.

Overweight and obesity have reached epidemic proportions worldwide. The COVID-19 pandemic resulted in an increased need for remote implementation of weight-loss interventions; therefore, the effectiveness of web-based interventions needed to be assessed. This study aimed to examine the effectiveness of web-based interventions and their potency in facilitating weight changes in adults who were overweight or obese. We searched PubMed and Ichu-shi Web from the first year of inclusion in each database until the search date (30 September 2020). Among 1466 articles retrieved from the two databases and manual search, 97 were selected to undergo qualitative analysis and 51 articles were subjected to quantitative analysis. Qualitative analysis of 97 articles demonstrated that articles showing significant effectiveness mostly used the following components: social support, self-monitoring for behavior, self-monitoring for the outcome (weight), behavioral goal setting, information about health consequences, and outcome goal setting. Quantitative analysis of 51 articles showed a significant effectiveness of web-based intervention (standardized mean difference, -0.57; 95% confidence interval, -0.75 to -0.40). This study demonstrated the effectiveness of web-based interventions on weight change in adults with overweight and obesity. Subgroup meta-analyses identified personalized information provision and expert advice to be remarkably effective components.

Relationship Between Moderate-to-Vigorous Physical Activity and Glycemia Among Young Adults with Type 1 Diabetes and Overweight or Obesity: Results from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON) Study.

Aims: Using data from the ACT1ON study, we conducted secondary analyses to assess the relationship between minutes of moderate-to-vigorous physical activity (MVPA) and glycemia in adults with type 1 diabetes (T1D) and overweight or obesity. Materials and Methods: Participants (n = 66) with T1D provided measures of glycemia (hemoglobin A1c [HbA1c], percent of time below range <70 mg/dL, time-in-range [TIR 70-180 mg/dL], and time above range [TAR >180 mg/dL]) and self-reported physical activity (Global Physical Activity Questionnaire [GPAQ] and Previous Day Physical Activity Recalls [PDPAR]) at baseline, 3, 6, and 9 months postintervention. Wearable activity data were available for a subset of participants (n = 27). Associations were estimated using mixed effects regression models adjusted for design, demographic, clinical, and dietary covariates. Results: Among young adults 19-30 years of age with a baseline HbA1c of 7.9% ± 1.4% and body mass index of 30.3 (interquartile range 27.9, 33.8), greater habitual weekly MVPA minutes were associated with higher HbA1c through the GPAQ (P < 0.01) and wearable activity data (P = 0.01). We did not observe a significant association between habitual MVPA and any continuous glucose monitoring metrics. Using PDPAR data, however, we observed that greater daily MVPA minutes were associated with more TAR (P < 0.01) and reduced TIR (P < 0.01) on the day following reported physical activity. Conclusions: Among young adults with T1D and overweight or obesity, increased MVPA was associated with worsened glycemia. As physical activity is vital to cardiovascular health and weight management, additional research is needed to determine how to best support young adults with T1D and overweight or obesity in their efforts to increase physical activity. Clinical Trial Registration number: NCT03651622.

Virtual Reality Exercise Program Effects on Body Mass Index, Depression, Exercise Fun and Exercise Immersion in Overweight Middle-Aged Women: A Randomized Controlled Trial.

Background: This study explored the effects of a virtual reality exercise program on overweight middle-aged women. Methods: This randomized controlled trial included women 40−65 years of age with a body mass index (BMI) of 23 kg/m2 or more living in Daejeon City. The virtual reality environment was set up by attaching an IoT sensor to an indoor bicycle and linking it with a smartphone, enabling exercise in an immersive virtual reality through a head-mounted display. Results: In the virtual reality exercise group, the BMI was significantly decreased after the 8-week intervention compared with the baseline value (F = 59.491, p < 0.001). The depression scores were significantly different among the three groups, with the intervention effect being more significant in the virtual reality exercise group than in the indoor bicycle exercise and control groups (F = 3.462, p < 0.001). Furthermore, the levels of exercise fun (F = 12.373, p < 0.001) and exercise immersion (F = 14.629, p < 0.001) were significantly higher in the virtual reality exercise group than in the indoor bicycle exercise and control groups. Conclusions: The virtual reality exercise program positively affected the BMI and the levels of depression, exercise fun, and exercise immersion in overweight middle-aged women. It is an effective home exercise program for obesity management in this population.

Effect of Age and Gender on the Efficacy of a 12-Month Body Weight Reduction Program Conducted Online-A Prospective Cohort Study.

Overweight and obesity are a cause of many non-communicable diseases leading to an increased risk of death. There are many programs aimed at weight reduction, but few publications have evaluated their effectiveness according to the gender and age of the subjects. The purpose of this study is to evaluate the effects of age and gender on weight loss outcomes in subjects participating in a 12-month online weight loss program. 400 subjects, 190 men and 210 women, were included in the study. The online intervention consisted of a 15% energy deficit diet and training (RESPO method). Changes in body weight over 12 months were similar (p = 0.14) across age groups. Weight reductions by month were statistically significant (p = 0.0001) in both groups. We noted no differences in weight loss between men and women expressed in kilograms. However, women reduced their body weight to a greater extent, i.e., by 2.7 percentage points, than men. Gender is a factor that may influence the effectiveness of weight loss programs, while age demonstrates no such influence. Our study shows that significant weight reduction during weight loss therapy is achieved by both men and women, but women can expect better results.

Telemedicine management of type 2 diabetes mellitus in obese and overweight young and middle-aged patients during COVID-19 outbreak: A single-center, prospective, randomized control study.

OBJECTIVE: The coronavirus disease-2019 (COVID-19) pandemic severely affected the disease management of patients with chronic illnesses such as type 2 diabetes mellitus (T2DM). This study aimed to assess the effect of telemedicine management of diabetes in obese and overweight young and middle-aged patients with T2DM during the COVID-19 pandemic. METHODS: A single-center randomized control study was conducted in 120 obese or overweight (body mass index [BMI] ≥ 24 kg/m2) young and middle-aged patients (aged 18-55 years) with T2DM. Patients were randomly assigned to the intervention (telemedicine) or control (conventional outpatient clinic appointment) group. After baseline assessment, they were home isolated for 21 days, received diet and exercise guidance, underwent glucose monitoring, and followed up for 6 months. Glucose monitoring and Self-Rating Depression Scale (SDS) scores were evaluated at 22 days and at the end of 3 and 6 months. RESULTS: Ninety-nine patients completed the 6-month follow-up (intervention group: n = 52; control group: n = 47). On day 22, the fasting blood glucose (FBG) level of the intervention group was lower than that of the control group (p < 0.05), and the control group's SDS increased significantly compared with the baseline value (p < 0.05). At the end of 3 months, glycated hemoglobin (HbA1c) and FBG levels in the intervention group decreased significantly compared with those in the control group (p < 0.01). At the end of 6 months, the intervention group showed a significant decrease in postprandial blood glucose, triglyceride, and low-density lipoprotein cholesterol levels as well as waist-to-hip ratio compared with the control group (p < 0.05); moreover, the intervention group showed lower SDS scores than the baseline value (p < 0.05). Further, the intervention group showed a significant reduction in BMI compared with the control group at the end of 3 and 6 months (p < 0.01). CONCLUSION: Telemedicine is a beneficial strategy for achieving remotely supervised blood glucose regulation, weight loss, and depression relief in patients with T2DM. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04723550.

Is time-restricted eating a robust eating regimen during periods of disruptions in daily life? A qualitative study of perspectives of people with overweight during COVID-19.

BACKGROUND: Time-restricted eating (TRE) has been suggested as a feasible dietary strategy in individuals with overweight. Disruptions in daily life e.g., severe illness can affect engagement in lifestyle interventions to obtain healthier body weight. This study examined if and how the engagement with TRE among people with overweight was affected by the Danish COVID-19 lockdowns as an example of disruptions in daily life. METHODS: Fifteen participants with overweight enrolled in a TRE intervention, i.e. restricting all eating and drinking except water to the same daily ten-hour window, were interviewed about their experiences and engagement with TRE during COVID-19 lockdowns. Interviews were semi-structured and conducted by phone or face-to-face with safe social distancing. Data analysis was grounded in a reflexive thematic analysis approach. RESULTS: Daily life rhythms were disrupted by lockdowns by preventing participants from performing ordinary daily activities such as going to work, socialising, eating out or exercising. For some, this challenged their TRE engagement, while most were able to undertake the TRE eating window but reported increased snacking and consumption of take-away food within their eating window. For all, exercise habits became unhealthier. The negative impact on TRE engagement primarily occurred during daytime, as social distancing made it easier to engage with TRE during evenings. CONCLUSIONS: This study showed that even people highly motivated to obtain healthier lifestyles practices struggled to maintain engagement with healthy behaviours, whereas sticking to the TRE window was manageable during COVID-19. TRE as a weight loss strategy was challenged which calls for more attention to supporting people in daily life to obtain healthier practices, also in case of periods of other disruptions such as divorce, serious illness etc.

Usage of mobile health interventions among overweight/obese PCOS patients undergoing assisted reproductive technology treatment during the COVID-19 pandemic.

Objective: In the context of the coronavirus disease 2019 (COVID-19) pandemic, telemedicine is a promising tool for providing clinical care for patients. Since the first-line treatment for infertile women with polycystic ovarian syndrome (PCOS) is lifestyle modification, a mobile-based service that provides lifestyle modification education would be helpful in the treatment of PCOS patients. In this observational study, the effect of a mobile Health (mHealth) application for lifestyle modification on PCOS patients undergoing assisted reproductive technology (ART) treatment was evaluated.Methods: A total of 79 overweight/obese patients (40 in the paper group and 39 in the WeChat application group) with PCOS from the First Affiliated Hospital of University of Science and Technology of China were enrolled in the study. The changes in the outcomes of BMI and ART treatment were analyzed between the two groups.Results: After three months of intervention, the BMIs in the control and mHealth groups were 24.5 ± 3.3 and 23.7 ± 3.1, respectively. The percentage of patients who lost weight was higher in the WeChat group than in the control group (87.2% vs. 67.5%). Furthermore, PCOS patients in the WeChat group were found to have a higher live birth rate than those in the control group (p = 0.005).Conclusion: Lifestyle modifications for PCOS patients undergoing ART treatment using the WeChat application improved weight loss and oocyte quality. Infertile patients with PCOS were more likely to make lifestyle modifications based on the usage of mobile applications during the COVID-19 pandemic.

Effects of a 12-Week Web-Based Weight Loss Program for Adults With Overweight and Obesity on COVIDAge and Lifestyle-Related Cardiometabolic Risk Factors: A Randomized Controlled Trial.

The coronavirus disease 2019 (COVID-19) pandemic has induced unhealthy lifestyles, particularly an increase in overweight and obesity, which have been shown to be associated with an increased risk of unfavorable COVID-19 outcomes. Web-based health programs could be a helpful measure, especially in times of severe restrictions. Therefore, the present study aimed to investigate the effects of regular attendance in a 12-week web-based weight loss program on COVIDAge, a new construct for risk assessment of COVID-19, and lifestyle-related cardiometabolic risk factors. N = 92 subjects with overweight and obesity (50.0 ± 10.8 years, 76.1% females, 30.5 ± 2.1 kg/m2) of this randomized controlled trial, which were assigned to an interactive (ONLINE: intervention group) or non-interactive (CON: control group) web-based weight loss program, were included in the data analysis. COVIDAge and cardiometabolic risk factors, including anthropometric outcomes, blood pressure, flow-mediated dilatation, and blood parameters, were assessed before and after the 12-week intervention phase. There was a significant group difference in the change of COVIDAge (ONLINE: -4.2%, CON: -1.3%, p = 0.037). The ONLINE group also showed significantly greater reductions in anthropometric outcomes and systolic blood pressure than the CON group (p < 0.05). To the authors' knowledge, this was the first study investigating the effects of regular attendance in a web-based health program on lifestyle-related risk factors for COVID-19. The results demonstrated that adults with overweight and obesity can improve their COVIDAge and specific cardiometabolic risk factors by using this interactive web-based weight loss program regularly. However, this needs to be confirmed by future studies. This study is registered at the German Clinical Trials Register (DRKS00020249, https://www.drks.de).

[Benefits of telematic monitoring for weight loss in overweight and obese patients in times of confinement]. / Beneficios del seguimiento telemático en la pérdida de peso de pacientes con sobrepeso y obesidad en tiempos de confinamiento.

Introduction: Introduction: the pandemic originated by SARS-Cov-2 in 2019 led to eating habits and physical exercise changes due to home confinement measures. The follow-up of patients in treatment for weight loss through telematic consultation could be a useful tool to prevent treatment failure. Objective: to describe the evolution of anthropometric parameters of patients under follow-up for weight loss through telematic consultation. Methods: a two-stage prospective study (before and after confinement) with a telematic intervention in adult patients under regular follow-up for overweight and obesity. Demographic variables and body composition parameters were analyzed by bioimpendance. In addition, the differences in the presence of drug treatment with GLP-1 hormone (liraglutide or semaglutide) adjuvants were also analyzed. The variables were studied using Wilcoxon's test, Mann-Whitney U-test, and Spearman's correlation. Significance was considered for p ≤ 0.05. Results: a total of 97 patients were included, before confinement 42.3 % were overweight (BMI < 30 kg/m2), 36.1 % were obese grade I (BMI = 30-34.9 kg/m2), 16.4 % were obese grade II (BMI = 35-39.9 kg/m2), and 5.2 % had BMI > 40 kg/m2. In all, 30.9 % had prediabetes and 9.3 % had type-2 diabetes. Between both consultations, 81.4 % of patients lost 4.2 ± 3.4 % of their weight, with a significant mean decrease in fat mass of 3.16 ± 4.4 kg. The group on pharmacological treatment with GLP-1 hormone analogs presented a significantly higher average fat loss without significant loss of skeletal muscle mass. Conclusions: telematic monitoring seems to be a useful tool to prevent weight gain in patients with restricted mobility. A telematic intervention that contains dietary advice and exercise, as a reinforcement to hypocaloric diet, helps to achieve weight loss with a predominant fat component. The presence of drug treatment with GLP-1 hormone analogues appears to significantly help maintain skeletal muscle mass during weight loss.

Introducción: Introducción: la pandemia originada en 2019 por el SARS-CoV-2 supuso un cambio en los hábitos de alimentación y ejercicio físico por causa de las medidas de confinamiento domiciliario. El seguimiento de pacientes en tratamiento de pérdida de peso mediante una consulta telemática podría ser una herramienta útil para prevenir el fracaso terapéutico. Objetivo: describir la evolución de los parámetros antropométricos de pacientes en seguimiento para pérdida de peso mediante una consulta telemática. Métodos: estudio prospectivo en 2 tiempos (antes y después del confinamiento) de una intervención telemática sobre pacientes adultos en seguimiento habitual por sobrepeso y obesidad. Se analizaron las variables demográficas y los parámetros de composición corporal mediante bioimpendancia. Además se analizaron las diferencias en cuanto a presencia de tratamiento farmacológico adyuvante del tipo de los análogos de la hormona GLP1 (liraglutida o semaglutida). Las variables se estudiaron mediante la prueba de Wilcoxon, la U de Mann-Whitney y la correlación de Spearman. Se consideró la significación si p ≤ 0,05. Resultados: se incluyeron 97 pacientes. Antes del confinamiento, el 42,3 % presentaban sobrepeso (IMC < 30 kg/m2), el 36,1 % tenían obesidad de grado I (IMC = 30-34,9 kg/m2), el 16,4 % la tenían de grado II (IMC = 35-39,9 kg/m2) y el 5,2 % tenían un IMC > 40 kg/m2. El 30,9 % presentaban prediabetes y el 9,3 % tenían diabetes de tipo 2. Entre ambas visitas presenciales, el 81,4 % de los pacientes perdieron un 4,2 ± 3,4 % del peso, con una disminución media significativa de la masa grasa de 3,16 ± 4,4 kg. El grupo en tratamiento farmacológico con análogos de la hormona GLP-1 presentó una pérdida de masa grasa media significativamente superior sin pérdida de masa muscular esquelética significativa. Conclusiones: el seguimiento telemático parece una herramienta útil para prevenir la ganancia de peso en los pacientes con restricción de la movilidad. Una intervención telemática que contenga consejo dietético y ejercicio como refuerzo de la dieta hipocalórica ayuda a conseguir perder peso, predominando el componente graso. La presencia de un tratamiento farmacológico con análogos de la hormona GLP-1 parece ayudar significativamente al mantenimiento de la masa muscular esquelética durante la pérdida de peso.

Nonadherence to appropriate tidal volume and PEEP in children with pARDS at a single center.

BACKGROUND: Low tidal volume and adequate positive end-expiratory pressure (PEEP) are evidence-based approaches for pediatric acute respiratory distress syndrome (pARDS), however, data are limited regarding their use since pARDS guidelines were revised in 2015. OBJECTIVE: To identify prevalence of, and factors associated with, nonadherence to appropriate tidal volume and PEEP in children with pARDS. METHODS: Retrospective cohort study of children 1 month to <18 years with pARDS who received invasive mechanical ventilation from 2016 to 2018 in a single pediatric intensive care unit (PICU). RESULTS: At 24 h after meeting pARDS criteria, 48/86 (56%) patients received tidal volume ≤8 ml/kg of ideal body weight and 45/86 (52%) received appropriate PEEP, with 22/86 (26%) receiving both. Among patients ≥2 years of age, a lower proportion of patients with overweight/obesity (9/25, 36%) had appropriate tidal volume versus those in the normal or underweight category (16/22, 73%, p = 0.02). When FIO2 was ≥50%, PEEP was appropriate in 19/60 (32%) cases versus 26/26 (100%) with FIO2 < 50% (p < 0.0001). pARDS was documented in the progress note in 7/86 (8%) patients at 24 h. Severity of pARDS, documentation in the progress note, and other clinical factors were not significantly associated with use of appropriate tidal volume and PEEP, however pARDS was documented more commonly in patients with severe pARDS. CONCLUSIONS: In a single PICU in the United States, children with pARDS did not receive appropriate tidal volume for ideal body weight nor PEEP. Targets for improving tidal volume and PEEP adherence may include overweight patients and those receiving FIO2 ≥ 50%, respectively.

The Impact of a Web-Based Lifestyle Educational Program ('Living Better') Reintervention on Hypertensive Overweight or Obese Patients.

'Living Better', a self-administered web-based intervention, designed to facilitate lifestyle changes, has already shown positive short- and medium-term health benefits in patients with an obesity-hypertension phenotype. The objectives of this study were: (1) to examine the long-term (3-year) evolution of a group of hypertensive overweight or obese patients who had already followed the 'Living Better' program; (2) to analyze the effects of completing this program a second time (reintervention) during the COVID-19 pandemic. A quasi-experimental design was used. We recruited 29 individuals from the 105 who had participated in our first study. We assessed and compared their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), eating behavior, and physical activity (PA) level (reported as METs-min/week), at Time 0 (first intervention follow-up), Time 1 (before the reintervention), and Time 2 (post-reintervention). Our results showed significant improvements between Time 1 and Time 2 in SBP (-4.7 (-8.7 to -0.7); p = 0.017), DBP (-3.5 (-6.2 to -0.8); p = 0.009), BMI (-0.7 (-1.0 to -0.4); p < 0.001), emotional eating (-2.8 (-5.1 to -0.5); p = 0.012), external eating (-1.1 (-2.1 to -0.1); p = 0.039), and PA (Time 1: 2308 ± 2266; Time 2: 3203 ± 3314; p = 0.030, Z = -2.17). Statistical analysis showed no significant differences in SPB, DBP, BMI, and eating behavior between Time 0 and Time 1 (p > 0.24). Implementation of the 'Living Better' program maintained positive long-term (3-year) health benefits in patients with an obesity-hypertension phenotype. Moreover, a reintervention with this program during the COVID-19 pandemic produced significant improvements in blood pressure, BMI, eating behavior, and PA.

The Effect of Wearable and Smartphone Applications on Physical Activity, Quality of Life, and Cardiovascular Health Outcomes in Overweight/Obese Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Advances in the device and smartphone technology have resulted in a convenient option for providing physical activity strategies; this is especially important during the coronavirus disease 2019 pandemic. OBJECTIVE: The purpose of this meta-analysis is to evaluate the efficacy of wearable and smartphone-based interventions to promote physical activity and improve quality of life and cardiovascular health outcomes among overweight/obese adults. DATA SOURCES: We searched relevant databases up to 18 November 2021 for conducting a systematic review and meta-analysis of randomized controlled trials lasting 4 or more weeks that investigated the impacts of wearables and smartphone applications on physical activity, quality of life and health outcomes. RESULTS: Twenty-six studies including 2373 participants were included. There was a significant pooled standard mean differences (SMD) for the comparison between intervention versus control in steps per day (SMD: 0.54; p = 0.0003), moderate-to-vigorous physical activity (SMD: 0.47; p = 0.02), quality of life (SMD: 0.33; p = 0.0006), body weight (mean difference (MD), -1.61 kg; p = 0.009), and BMI (MD, -0.59 kg/m2; p = 0.04). There were no significant differences between the intervention and control groups for systolic and diastolic blood pressure and resting heart rate (all p > 0.05). CONCLUSION: Our findings suggest that wearable and smartphone-based interventions are effective strategies in promoting physical activity and can provide a direct contact line to health professionals.

The Side-Effects of the COVID-19 Pandemic: Increased BMI z-Score in Children with Overweight and Obesity in a Personalised Lifestyle Intervention One Year after the Start of the Pandemic in The Netherlands.

BACKGROUND: Early research showed weight gain in children during the COVID-19 pandemic. OBJECTIVE: To compare changes in BMI z-score of children with overweight and obesity in a personalised lifestyle intervention before and during the pandemic. METHODS: Changes in BMI z-score half a year (T6) and twelve months (T12) after the first lockdown were included for 71 children in the '2020 during COVID' group and compared to 48 children in the '2019 before COVID' group, using a marginal model for repeated measures (model 1). Model 2 corrected for lifestyle intervention characteristics, and model 3 corrected additionally for family characteristics. RESULTS: The mean difference in BMI z-score change was significantly different at T12 (+0.07 in 2020 versus -0.09 in 2019, p = 0.022). Model 3 showed significant differences in BMI z-score change at both T6 (+0.15, p = 0.024) and T12 (+0.18, p = 0.016). This model also defined 'having a mother with obesity' (+0.13, p = 0.019) and the frequency of no-show consultations (+0.41 per missed consultation per month, p = 0.025) as related factors. CONCLUSIONS: Lifestyle intervention in children with overweight and obesity is less successful in decreasing BMI z-score during the COVID-pandemic. Identified risk factors for less success could contribute to identifying children with higher risks for, and possibly prevent, BMI z-score increase.

Home-based exercise for adults with overweight or obesity: A rapid review.

The COVID-19 pandemic has impacted the ability of people globally to consistently engage in their typical physical activity and exercise behaviour, contributing to the rising number of people living with overweight and obesity. The imposed government lockdowns and quarantine periods saw an increase in social media influencers delivering their own home-based exercise programmes, but these are unlikely to be an evidence-based, efficacious, long-term solution to tackle sedentary behaviour and increase physical activity. This rapid review aims to conceptualise home-based exercise and physical activity programmes, by extracting relevant programme characteristics regarding the availability of evidence and effectiveness of home-based exercise programmes. Fifteen studies met the inclusion criteria, of which there were varied reports of significant positive effects of the exercise programme on weight management and related outcomes. The two most common measures were Body Mass Index and body mass, as of which almost all reported a trend of post intervention reduction. Some programmes reported qualitative data, identifying barriers to physical activity and preferred programme components, highlighting a need to consider factors outside of physiological measures. The findings provide guidance and direction for the development of future home-based physical activity and exercise programmes for adults living with overweight and obesity.