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1.
JMIR Mhealth Uhealth ; 10(3): e33940, 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-1770914

ABSTRACT

BACKGROUND: Low-carbohydrate ketogenic diets are a viable method to lose weight that have regained popularity in recent years. Technology in the form of mobile health (mHealth) apps allows for scalable and remote delivery of such dietary interventions and are increasingly being used by the general population without direct medical supervision. However, it is currently unknown which factors related to app use and user behavior are associated with successful weight loss. OBJECTIVE: First, to describe and characterize user behavior, we aim to examine characteristics and user behaviors over time of participants who were enrolled in a remotely delivered clinical weight loss trial that tested an mHealth ketogenic diet app paired with a breath acetone biofeedback device. Second, to identify variables of importance to weight loss at 12 weeks that may offer insight for future development of dietary mHealth interventions, we aim to explore which app- and adherence-related user behaviors characterized successful weight loss. METHODS: We analyzed app use and self-reported questionnaire data from 75 adults with overweight or obesity who participated in the intervention arm of a previous weight loss study. We examined data patterns over time through linear mixed models and performed correlation, linear regression, and causal mediation analyses to characterize diet-, weight-, and app-related user behavior associated with weight loss. RESULTS: In the context of a low-carbohydrate ketogenic diet intervention delivered remotely through an mHealth app paired with a breath acetone biofeedback device, self-reported dietary adherence seemed to be the most important factor to predict weight loss (ß=-.31; t54=-2.366; P=.02). Furthermore, self-reported adherence mediated the relationship between greater app engagement (from c=-0.008, 95% CI -0.014 to -0.0019 to c'=-0.0035, 95% CI -0.0094 to 0.0024) or higher breath acetone levels (from c=-1.34, 95% CI -2.28 to -0.40 to c'=-0.40, 95% CI -1.42 to 0.62) and greater weight loss, explaining a total of 27.8% and 28.8% of the variance in weight loss, respectively. User behavior (compliance with weight measurements and app engagement) and adherence-related aspects (breath acetone values and self-reported dietary adherence) over time differed between individuals who achieved a clinically significant weight loss of >5% and those who did not. CONCLUSIONS: Our in-depth examination of app- and adherence-related user behaviors offers insight into factors associated with successful weight loss in the context of mHealth interventions. In particular, our finding that self-reported dietary adherence was the most important metric predicting weight loss may aid in the development of future mHealth dietary interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT04165707; https://clinicaltrials.gov/ct2/show/NCT04165707. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/19053.


Subject(s)
Diet, Ketogenic , Mobile Applications , Telemedicine , Adult , Humans , Obesity/therapy , Overweight , Weight Loss
2.
Obesity (Silver Spring) ; 30(3): 573-574, 2022 03.
Article in English | MEDLINE | ID: covidwho-1729182
3.
PLoS One ; 17(3): e0263723, 2022.
Article in English | MEDLINE | ID: covidwho-1724842

ABSTRACT

The aim of this article is to assess the odds ratio of hospitalization and mortality due to COVID-19 in people with obesity using data from residents of Espírito Santo, Brazil. An observational, quantitative, cross-sectional study was carried out from the database available on the official channel of the State Health Secretariat of Espírito Santo. Crude odds ratio estimates (ORs) referring to the association between variables were calculated, as well as adjusted odds ratios (adjusted odds ratios-OR adj.) and their respective 95% confidence intervals (CI 95%). The results indicate that men, non-white, no education or with lower education level and age over 40 years old were more likely to be hospitalized and died of COVID-19. People with obesity are at risk of hospitalization and death due to COVID-19 54% and 113% higher than people who do not have obesity. People with obesity had a higher chance of hospitalization when they were over 40 years old, had breathing difficulty, and the comorbidities diabetes (2.18 higher) and kidney disease (4.10 higher). The odds ratio of death for people with obesity over 60 years old was 12.51 higher, and those who were hospitalized was 17.9 higher compared to those who were not hospitalized.


Subject(s)
COVID-19 , Hospitalization , Obesity , SARS-CoV-2 , Adolescent , Adult , Aged , Brazil/epidemiology , COVID-19/mortality , COVID-19/therapy , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Obesity/mortality , Obesity/therapy , Risk Factors
4.
Int J Environ Res Public Health ; 19(5)2022 Feb 27.
Article in English | MEDLINE | ID: covidwho-1715353

ABSTRACT

The use of extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure in the course of COVID-19 indicates its limited efficacy and high mortality rates. It seems that one of the conditions for the success of veno-venous ECMO (VV ECMO) in obese patients with COVID-19 is the correct qualification and rapid implementation of this method. We present two cases of obese patients with acute respiratory distress syndrome (ARDS) as a result of SARS-CoV-2 infection with the successful use of ECMO. Two 41-year-old obese patients (Case 1: BMI 31.5 kg/m2 and Case 2: 44.5 kg/m2), with pneumonia and severe respiratory failure in the course of COVID-19, underwent ECMO therapy. The Extracorporeal Life Support Organization (ELSO) guidelines were used to qualify the patients. Due to the persistence of PaO2/FiO2 rate <80 for 6 h, a decision was made to implement VV ECMO. Both patients were discharged from the intensive care unit (Case 1: on day 35; Case 2: on day 22). Rapid implementation of VV ECMO in middle-aged, obese patients with ARDS in the course of COVID-19 showed a positive outcome.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Obesity , Respiratory Insufficiency , COVID-19/complications , COVID-19/therapy , Humans , Middle Aged , Obesity/complications , Obesity/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy
5.
Obesity (Silver Spring) ; 30(3): 577-586, 2022 03.
Article in English | MEDLINE | ID: covidwho-1705203

ABSTRACT

It has been estimated that, by 2030, nearly 80% of adults in the United States will have pre-obesity or obesity. Despite the continued rise in obesity prevalence and the difficulty for many affected patients to lose weight and maintain lost weight, the use of guideline-supported treatments, including pharmacotherapy, intensive behavioral counseling, and bariatric surgery, remains low. There are many potential barriers to effective use of antiobesity treatments, including limited access to guideline-supported obesity care (often driven by practical challenges, geographic barriers, limited insurance coverage, and high cost of care) and a dearth of specialists and comprehensive treatment teams. Driven in part by the COVID-19 pandemic, the recent expansion of telemedicine offers unique opportunities to mitigate these factors. This review discusses the use of telemedicine to facilitate obesity treatment. Continued growth and utility of telemedicine for obesity care require further formative and experimental research to determine best practices, assess challenges for implementation, and evaluate long-term outcomes, as well as proactive policy changes to promote ongoing use of telemedicine beyond the COVID-19 pandemic.


Subject(s)
COVID-19 , Telemedicine , Adult , Humans , Obesity/epidemiology , Obesity/therapy , Pandemics , SARS-CoV-2 , United States/epidemiology
6.
JMIR Mhealth Uhealth ; 10(2): e28886, 2022 02 15.
Article in English | MEDLINE | ID: covidwho-1686307

ABSTRACT

BACKGROUND: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. OBJECTIVE: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. METHODS: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire-Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. RESULTS: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI -0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks-minutes per week vs 1386 metabolic equivalents of tasks-minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. CONCLUSIONS: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872.


Subject(s)
COVID-19 , Gestational Weight Gain , Midwifery , Counseling , Exercise , Female , Humans , Infant, Newborn , Obesity/therapy , Pandemics , Pregnancy , Pregnant Women , SARS-CoV-2
7.
Pol Arch Intern Med ; 132(3)2022 03 30.
Article in English | MEDLINE | ID: covidwho-1687651

ABSTRACT

Obesity is a chronic disease associated with increased metabolic and cardiovascular risk, excessive morbidity and mortality worldwide. The authors of the present consensus, clinicians representing medical specialties related to the treatment of obesity and its complications, reviewed a number of European and American guidelines, published mostly in 2019-2021, and summarized the principles of obesity management to provide a practical guidance considering the impact that increased adiposity poses to health. From a clinical perspective, the primary goal of obesity treatment is to prevent or slow down the progression of diseases associated with obesity, reduce metabolic and cardiovascular risk, and improve the quality of life by achieving adequate and stable weight reduction. However, obesity should be not only considered a disease requiring treatment in an individual patient, but also a civilization disease requiring preventive measures at the populational level. Despite the evident benefits, obesity management within the health care system-whether through pharmacotherapy or bariatric surgery-is only a symptomatic treatment, with all its limitations, and will not ultimately solve the problem of obesity. The important message is that available treatment options fail to correct the true drivers of the obesity pandemic. To this end, new solutions and efforts to prevent obesity in the populations are needed.


Subject(s)
COVID-19 , Quality of Life , Climate Change , Consensus , Humans , Obesity/complications , Obesity/therapy , United States
8.
PLoS One ; 17(2): e0263405, 2022.
Article in English | MEDLINE | ID: covidwho-1674013

ABSTRACT

OBJECTIVE: Yoga targets psychological processes which may be important for long-term weight loss (WL). This study is the first to examine the feasibility, acceptability, and preliminary efficacy of yoga within a weight management program following WL treatment. METHODS: 60 women with overweight or obesity (34.3±3.9 kg/m2, 48.1±10.1 years) were randomized to receive a 12-week yoga intervention (2x/week; YOGA) or a structurally equivalent control (cooking/nutrition classes; CON), following a 3-month behavioral WL program. Feasibility (attendance, adherence, retention) and acceptability (program satisfaction ratings) were assessed. Treatment groups were compared on weight change, mindfulness, distress tolerance, stress, affect, and self-compassion at 6 months. Initial WL (3-mo WL) was evaluated as a potential moderator. RESULTS: Attendance, retention, and program satisfaction ratings of yoga were high. Treatment groups did not differ on WL or psychological constructs (with exception of one mindfulness subscale) at 6 months. However, among those with high initial WL (≥5%), YOGA lost significantly more weight (-9.0kg vs. -6.7kg) at 6 months and resulted in greater distress tolerance, mindfulness, and self-compassion and lower negative affect, compared to CON. CONCLUSIONS: Study findings provide preliminary support for yoga as a potential strategy for improving long-term WL among those losing ≥5% in standard behavioral treatment.


Subject(s)
Body Weight , Obesity/therapy , Overweight/therapy , Weight Loss , Weight Reduction Programs , Yoga , Adolescent , Adult , Exercise , Female , Humans , Middle Aged , Mindfulness , Treatment Outcome , Young Adult
9.
Obesity (Silver Spring) ; 30(1): 85-95, 2022 01.
Article in English | MEDLINE | ID: covidwho-1653322

ABSTRACT

OBJECTIVE: This study aimed to determine the impact of dietary weight loss (WL) plus aerobic exercise (EX) and a "move more, more often" approach to activity promotion (SitLess; SL) on WL and maintenance. METHODS: Low-active older adults (age 65-86 years) with obesity were randomized to WL+EX, WL+SL, or WL+EX+SL. Participants received a social-cognitive group-mediated behavioral WL program for 6 months, followed by a 12-month maintenance period. EX participants received guided walking exercise with the goal of walking 150 min/wk. SL attempted to achieve a step goal by moving frequently during the day. The primary outcome was body weight at 18 months, with secondary outcomes including weight regain from 6 to 18 months and objectively assessed physical activity and sedentary behavior at each time point. RESULTS: All groups demonstrated significant WL over 6 months (p < 0.001), with no group differences. Groups that received SL improved total activity time (p ≤ 0.05), and those who received EX improved moderate-to-vigorous activity time (p = 0.003). Over the 12-month follow-up period, those who received WL+EX demonstrated greater weight regain (5.2 kg; 95% CI: 3.5-6.9) relative to WL+SL (2.4 kg; 95% CI: 0.8-4.0). CONCLUSIONS: Pairing dietary WL with a recommendation to accumulate physical activity contributed to similar WL and less weight regain compared with traditional aerobic exercise.


Subject(s)
Weight Loss , Weight Reduction Programs , Aged , Aged, 80 and over , Exercise , Humans , Obesity/complications , Obesity/therapy , Sedentary Behavior
10.
Int J Environ Res Public Health ; 19(2)2022 01 12.
Article in English | MEDLINE | ID: covidwho-1634699

ABSTRACT

Obesity is a complex public health issue with multiple contributing factors. The emphasis on joined care has led to the development and implementation of a number of integrated care interventions targeting obesity and mental health. The purpose of this study was to examine user experience in an integrated care programme for obesity and mental health in Luton, UK. Semi-structured interviews were conducted with a purposeful sample of service users (N = 14). Interview transcripts were analysed using thematic analysis. Analysis of the interviews identified six main themes for understanding service users' experiences of integrated care: (1) 'A user-centered system', (2) 'Supports behaviour change', (3) 'Valued social support', (4) 'Communication is key', (5) 'Flexible referral process', and (6) 'Positive impact on life'. These themes describe how the service is operated, evidence perceived value service users place on social support in behavior change intervention, and address which service areas work well and which require improvement. The findings of these interviews have offered a significant contribution to understanding what service users value the most in an integrated healthcare setting. Service users value ongoing support and being listened to by healthcare professionals, as well as the camaraderie and knowledge acquisition to support their own behaviour change and promote self-regulation following their participation in the programme.


Subject(s)
Delivery of Health Care, Integrated , Mental Health Services , Humans , Mental Health , Obesity/therapy , Qualitative Research
11.
BMC Womens Health ; 22(1): 13, 2022 01 15.
Article in English | MEDLINE | ID: covidwho-1629653

ABSTRACT

BACKGROUND: Regarding the high rate of obesity and overweight among women, develop a comprehensive and effective program it seems necessary to improve their nutritional behaviors and physical activity. This study aims to survey the effect of educational intervention based on the theory of planned behavior (TPB) on improving physical and nutritional activities of obese and overweight women. METHODS: This experimental study was performed on 400 obese and overweight women over the age of 20. The sampling method was A simple random sampling. The data collection was valid and reliable self-reports measure, questionnaires. This tools was including demographic information, questionnaire based on the constructs of the theory of planned behavior, physical activity performance questionnaire and nutritional performance questionnaire that individuals completed before and 6 months after the educational intervention. The training intervention for the experimental group consisted of 12 sessions of 50-55 min. Data analyzed by SPSS22 and by using chi-square test, independent t-test and paired t-test. RESULTS: Findings showed that before the educational intervention, was no significant difference between the experimental and control groups in terms of education, household monthly income, occupation, mean age, marital status, awareness, attitude, perceived behavioral control, subjective norms, physical activity and nutritional behavioral intentions, and physical activity and nutritional performance, weight and BMI. However, six months after the training intervention, there was a significant increase in each of the TPB contracts, weight and BMI in the experimental group, while no significant difference was observed in the control group. The meaningful level was considered 0.05. CONCLUSION: Our findings partially support of applying theory of planned behavior in reducing the weight, BMI and improved nutritional performance and physical activity of the study subjects. TPB could be an important strategy for effective future educational interventions.


Subject(s)
Nutritional Status , Overweight , Female , Health Behavior , Humans , Obesity/therapy , Overweight/therapy , Surveys and Questionnaires
12.
Obesity (Silver Spring) ; 30(4): 858-863, 2022 04.
Article in English | MEDLINE | ID: covidwho-1626268

ABSTRACT

OBJECTIVE: This study evaluated whether the transition of a face-to-face behavioral intervention to videoconferencing-based telehealth delivery during the COVID-19 pandemic resulted in significantly smaller weight losses than those typically observed in gold-standard, face-to-face programs. METHODS: Participants were 160 adults with obesity (mean [SD] age = 49.2 [11.9] years, BMI = 36.1 [4.2] kg/m2 ) enrolled in two cohorts of a 16-week comprehensive weight-management program. Cohort 1 began in person and transitioned to telehealth (Zoom) delivery during week 11 of the intervention because of COVID-19; Cohort 2 was conducted completely remotely. A noninferiority approach (using a clinically relevant noninferiority margin of 2.5%) was used to assess whether the weight losses observed were inferior to the 8% losses from baseline typically produced by gold-standard, face-to-face lifestyle interventions. RESULTS: From baseline to postintervention, participants lost an average of 7.4 [4.9] kg, representing a reduction of 7.2% [4.6%]. This magnitude of weight change was significantly greater than 5.5% (t[159] = 4.7, p < 0.001), and, thus, was within the proposed noninferiority margin. CONCLUSIONS: These findings demonstrate that the results of behavioral weight-management interventions are robust, whether delivered in person or remotely, and that individuals can achieve clinically meaningful benefits from behavioral treatment even during a global pandemic. Pragmatic "lessons learned," including modified trial recruitment techniques, are discussed.


Subject(s)
COVID-19 , Telemedicine , Adult , COVID-19/therapy , Humans , Middle Aged , Obesity/epidemiology , Obesity/therapy , Pandemics , Telemedicine/methods , Videoconferencing
13.
Am J Gastroenterol ; 117(1): 7-10, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1607253
15.
Lancet Diabetes Endocrinol ; 9(11): 786-798, 2021 11.
Article in English | MEDLINE | ID: covidwho-1586178

ABSTRACT

Up to 50% of the people who have died from COVID-19 had metabolic and vascular disorders. Notably, there are many direct links between COVID-19 and the metabolic and endocrine systems. Thus, not only are patients with metabolic dysfunction (eg, obesity, hypertension, non-alcoholic fatty liver disease, and diabetes) at an increased risk of developing severe COVID-19 but also infection with SARS-CoV-2 might lead to new-onset diabetes or aggravation of pre-existing metabolic disorders. In this Review, we provide an update on the mechanisms of how metabolic and endocrine disorders might predispose patients to develop severe COVID-19. Additionally, we update the practical recommendations and management of patients with COVID-19 and post-pandemic. Furthermore, we summarise new treatment options for patients with both COVID-19 and diabetes, and highlight current challenges in clinical management.


Subject(s)
COVID-19/epidemiology , COVID-19/metabolism , Disease Management , Metabolic Diseases/epidemiology , Metabolic Diseases/metabolism , Angiotensin-Converting Enzyme 2/metabolism , COVID-19/therapy , Diabetes Mellitus/epidemiology , Diabetes Mellitus/metabolism , Diabetes Mellitus/therapy , Humans , Hypertension/epidemiology , Hypertension/metabolism , Hypertension/therapy , Metabolic Diseases/therapy , Non-alcoholic Fatty Liver Disease/epidemiology , Non-alcoholic Fatty Liver Disease/metabolism , Non-alcoholic Fatty Liver Disease/therapy , Obesity/epidemiology , Obesity/metabolism , Obesity/therapy
16.
Obes Facts ; 14(6): 650-657, 2021.
Article in English | MEDLINE | ID: covidwho-1495755

ABSTRACT

INTRODUCTION: Lockdown due to the COVID-19 pandemic has caused gym closures and adjustments to ongoing weight loss programs were needed in order to keep the programs running. Little is known whether adjustments affected the success of weight reduction. Weight reduction of at least 5% is related to improved fertility and better pregnancy outcomes in obese women. This study compared success of the weight loss program in infertile polycystic ovary syndrome women with obesity who attended the program before and during lockdown due to COVID-19 pandemic. Furthermore, we checked whether there were any differences in spontaneous pregnancy rates between both groups at the end of the program. METHODS: Altogether, 27 women were prospectively included to the weight loss program. Twelve women attended the 8 - week program before COVID-19 pandemic. Fifteen women began the program before the lockdown and ended it during lockdown. Due to lockdown, the program was prolonged for 4 weeks and taken online. RESULTS: On average, prior to lockdown women achieved a BMI reduction of 6.8% whereas women that attended the program during the lockdown reduced their BMI for 3.7%. This difference was not statistically significant. No significant differences were seen in other measured anthropometric and endocrine parameters between both groups. Furthermore, there were no differences in spontaneous pregnancy rates between both groups. In women who reduced their BMI for 5% or more, spontaneous pregnancy rate was 29.4%. DISCUSSION/CONCLUSIONS: Although statistical significance has not been reached in the present study, we have shown that lockdown due to COVID-19 pandemic has led to almost half lower BMI reduction despite adaptations and longer duration of the weight loss program. On average, BMI in the group of women that attended the program during lockdown was 3.7% lower after the end of the weight loss program. This means they did not reach the wanted 5% reduction which is known to improve fertility. We have also shown that weight reduction is the correct approach for treating infertile women with obesity, as almost 30% of those who reduced their body weight by 5% or more conceived spontaneously.


Subject(s)
COVID-19 , Infertility, Female , Polycystic Ovary Syndrome , Weight Reduction Programs , Communicable Disease Control , Female , Humans , Infertility, Female/therapy , Obesity/complications , Obesity/epidemiology , Obesity/therapy , Pandemics , Polycystic Ovary Syndrome/complications , Polycystic Ovary Syndrome/epidemiology , Polycystic Ovary Syndrome/therapy , Pregnancy , SARS-CoV-2
18.
PLoS One ; 16(10): e0258914, 2021.
Article in English | MEDLINE | ID: covidwho-1480460

ABSTRACT

BACKGROUND: Risk factors of severe COVID-19 have mainly been investigated in the hospital setting. We investigated pre-defined risk factors for testing positive for SARS-CoV-2 infection and cardiovascular or pulmonary complications in the outpatient setting. METHODS: The present cohort study makes use of ambulatory claims data of statutory health insurance physicians in Bavaria, Germany, with polymerase chain reaction (PCR) test confirmed or excluded SARS-CoV-2 infection in first three quarters of 2020. Statistical modelling and machine learning were used for effect estimation and for hypothesis testing of risk factors, and for prognostic modelling of cardiovascular or pulmonary complications. RESULTS: A cohort of 99 811 participants with PCR test was identified. In a fully adjusted multivariable regression model, dementia (odds ratio (OR) = 1.36), type 2 diabetes (OR = 1.14) and obesity (OR = 1.08) were identified as significantly associated with a positive PCR test result. Significant risk factors for cardiovascular or pulmonary complications were coronary heart disease (CHD) (OR = 2.58), hypertension (OR = 1.65), tobacco consumption (OR = 1.56), chronic obstructive pulmonary disease (COPD) (OR = 1.53), previous pneumonia (OR = 1.53), chronic kidney disease (CKD) (OR = 1.25) and type 2 diabetes (OR = 1.23). Three simple decision rules derived from prognostic modelling based on age, hypertension, CKD, COPD and CHD were able to identify high risk patients with a sensitivity of 74.8% and a specificity of 80.0%. CONCLUSIONS: The decision rules achieved a high prognostic accuracy non-inferior to complex machine learning methods. They might help to identify patients at risk, who should receive special attention and intensified protection in ambulatory care.


Subject(s)
Ambulatory Care , COVID-19 , Coronary Disease , Hypertension , Renal Insufficiency, Chronic , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Coronary Disease/epidemiology , Coronary Disease/therapy , Dementia/epidemiology , Dementia/therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Female , Germany , Humans , Hypertension/epidemiology , Hypertension/therapy , Male , Middle Aged , Obesity/epidemiology , Obesity/therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/therapy , Risk Assessment , Risk Factors
19.
Nutrients ; 13(6)2021 Jun 11.
Article in English | MEDLINE | ID: covidwho-1448908

ABSTRACT

The role of post-therapeutic support after weight loss in obesity treatment is not fully understood. Therefore, weight maintenance after a successful weight loss intervention is not very common, especially in obese individuals. This randomized controlled study was conducted to explore the efficacy of following dietary and psychological support in a group of 36 obese individuals. Participants (22 women, 14 men aged 35.58 ± 9.85 years, BMI 35.04 ± 3.80 kg/m2) who completed a 12-month weight loss phase (balanced energy-restricted diet) were randomly allocated to receive 18-month support (SG) or no additional care (CG). The support phase included some elements of Ten Top Tips (TTT), cognitive behavioral therapy (CBT), motivational interviewing (MI) in combination with nutritional education and assessment of the level of physical activity. The primary outcome was the maintenance of anthropometric parameters at an 18-month follow-up. The secondary outcomes included evaluation of biochemical parameters and single nucleotide polymorphisms (SNPs) in genes connected with obesity. A comparison of SG vs. CG after a 30-month period of the study revealed significant differences in weight changes (-3.83 ± 6.09 vs. 2.48 ± 6.24 kg), Body Mass Index (-1.27 ± 2.02 vs. 0.72 ± 2.12 kg/m2), visceral adipose tissue (-0.58 ± 0.63 vs. 0.45 ± 0.74 L), and waist circumference (-4.83 ± 4.05 vs. 1.83 ± 5.97 cm). Analysis of SNPs (rs9939609 FTO, rs987237 TFAP2B, and rs894160 PLIN1) provided further insight into the potential modulating effect of certain genotypes on weight loss and maintenance and extended the knowledge of the potential benefits of personalized medicine. Post-therapeutical support in current clinical practice may increase the chances of long-term weight loss maintenance in obesity treatment even in patients with a genetic predisposition to excessive weight.


Subject(s)
Body Weight Maintenance , Counseling , Nutritionists , Obesity/therapy , Weight Loss , Weight Reduction Programs , Adult , Alpha-Ketoglutarate-Dependent Dioxygenase FTO/genetics , Body Composition , Cognitive Behavioral Therapy , Exercise , Female , Humans , Male , Motivational Interviewing , Perilipin-1/genetics , Polymorphism, Single Nucleotide , Transcription Factor AP-2/genetics
20.
Obesity (Silver Spring) ; 29(10): 1606-1614, 2021 10.
Article in English | MEDLINE | ID: covidwho-1442027

ABSTRACT

OBJECTIVE: The aim of this study was to determine whether a Mediterranean-style, ketogenic diet mobile health application (app) with breath acetone biofeedback is superior to a calorie-restricted, low-fat diet app in promoting weight loss. METHODS: Participants (n = 155) with overweight/obesity (mean [SD]: age 41 [11] years, BMI = 34 [5] kg/m2 , 71% female) were randomized to one of the interventions delivered entirely via app. Participants received a wireless scale and were instructed to take daily weight measurements. A third-party laboratory collected blood samples at baseline and 12 weeks. RESULTS: Weight loss at 12 weeks was greater in the ketogenic (-5.6 kg; 95% CI: -6.7 kg to -4.5 kg) compared with the low-fat group (-2.5 kg; 95% CI: -3.6 kg to -1.4 kg) (between-group difference: -3.1 kg; 95% CI: -4.6 kg to -1.5 kg; p < 0.001). Weight loss at 24 weeks indicated durability of the effect (between-group difference: -5.5 kg; 95% CI: -8.3 kg to -2.8 kg; p < 0.001). Secondary/exploratory outcomes of hemoglobin A1c and liver enzymes were improved to a greater extent in the ketogenic diet group (p < 0.01). CONCLUSIONS: Among adults with overweight/obesity, a ketogenic diet app with breath acetone biofeedback was superior to a calorie-restricted diet app at promoting weight loss in a real-world setting.


Subject(s)
Mobile Applications , Overweight , Adult , Female , Glycated Hemoglobin A , Humans , Male , Obesity/therapy , Overweight/therapy , Weight Loss
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