Designing, Implementing, and Evaluating a Home-Based, Multidisciplinary, Family-Centered Pediatric Obesity Intervention: The ProxOb Program.

Although family-based interventions have been suggested as promising approaches for preventing and treating pediatric obesity, available studies failed to include the whole family in its own natural environment and routine. This paper aims to detail the development, implementation, and evaluation phases of the ProxOb home-based, family-centered program and present its feasibility and early results. ProxOb provides families with a 6-month multidisciplinary, home-based, and family-centered intervention followed by an 18-month maintenance phase. A global psychosocial, clinical, and behavior evaluation was conducted at baseline (T0) at the end of the 6-month intervention (T1) and after the 18-month maintenance phase (T2). A total of 130 families with at least one child with obesity completed the ProxOb program so far, and more than 90% of them also presented at least one parent with overweight or obesity. Being part of a single-parent family seemed to increase the chance of completing the intervention (63.0% vs. 33.3% in the drop-outers subgroup, p = 0.03). The BMI z-score for children with obesity (T0 = 4.38 ± 1.05; T1 = 4.06 ± 1.07; T2 = 4.29 ± 1.12) significantly decreased between T0 and T1, followed by weight regain at T2. ProxOb proposes a feasible and replicable real-life approach to address childhood obesity while involving the children's family.

Body Mass Trajectory Affects the Long-Term Occurrence of Metabolic Syndrome in Adult Patients with Severe Obesity.

Independently of absolute BMI values, the amount, onset date, and duration of early body weight gain may influence cardio-metabolic health later in adulthood. Values of cardiac and metabolic variables from a cohort study of morbidly obese patients were retrospectively analyzed to study the association between early weight history and metabolic syndrome (MetS) occurrence in adults. Of 950 patients with severe morbid obesity (age 44.3 ± 13.8 y, BMI 42.5 ± 7.0 kg/m2), 31.4% had started excess weight gain in childhood (CH), 19.9% in adolescence (ADO), and 48.7% in adulthood (AD). Despite different BMI values, MetS prevalence (57.8%) was not significantly different in the three groups (54.4% CH vs. 57.7% ADO vs. 59.8% AD, p = 0.59). The overweight onset period was not significantly associated with the development of MetS in adults (ADO: OR = 1.14 [0.69-1.92], p = 0.60; AD: OR = 0.99 [0.62-1.56], p = 0.95) despite a higher BMI in the early obesity onset group. Weight gain of more than 50% after age 18 years significantly increased the risk of MetS (OR = 1.75 [1.07-2.88], p = 0.026). In addition to crude BMI values, analysis of body mass trajectories is a relevant clinical tool in the assessment of metabolic risk, suggesting that the magnitude of weight gain may be more important for metabolic syndrome progression than the period of obesity onset.

Outcomes of the Endovascular Treatment for the Supra-Aortic Trunks Occlusive Disease: A 14-Year Monocentric Experience.

BACKGROUND: Endovascular treatment of proximal supra-aortic trunks (SAT) has become a safe and reliable alternative to conventional open surgery, with a lower morbimortality rate and good short- and middle-term patency rates. The aim of our study was to assess the long-term results of endovascular treatment of proximal lesions of the SAT (brachiocephalic trunk, common carotid artery, and subclavian artery) and identify predictive risk factors of restenosis. METHODS: From 1999 to 2013, 67 consecutive stenotic lesions of the proximal SAT were treated by angioplasty (13.4%) or stenting (86.6%) in 63 patients with a mean age of 65.5 years (40-87). Procedures were performed under general (69%), local (24%), or locoregional (7%) anesthesia, with percutaneous puncture (47.8%) or open access (52.2%). Patients were followed up for 3, 6, and 12 months, and then every year with clinical examination, Doppler ultrasound and if required an angio-CT scan. RESULTS: The technical success rate was 98.5%. There was no postoperative death or strokes. One myocardial infarction occurred at day 2. There were 2 access complications: a nonsurgical hematoma after brachial access and a brachial thrombosis postpuncture. The mean follow-up was 4.5 years (2-163 months). The primary- and assisted-patency rates were 90.1%, 86.4%, 77.9% and 93.3%, 91.4%, 82.9% at 1, 2, and 5 years, respectively. Eleven restenosis (16.4%) occurred at 28.5 months (3, 0-112, 0) of follow-up. Four of them required an endovascular repair and 3 required a surgical one. The restenosis rate was 17.5% in the stented group on average at 30.2 months of follow-up (range, 3.0-112.0) and 10% in the group of patients with angioplasty alone at 8 months of follow-up, without significant statistically difference (P = 0.9). No predictive risk factor of restenosis was statistically identified. CONCLUSIONS: The endovascular treatment of proximal stenosis of SAT is a safe, reliable, and efficient technique with a low morbidity and mortality. The long-term results are good, but restenosis can occur. Long-term follow-up should be performed to detect and treat restenosis.

Metabolic syndrome and social deprivation: results of a French observational multicentre survey.

BACKGROUND: Deprivation, a process that prevents people to assume their social responsibilities, is a main cause of inequalities in health. Metabolic syndrome has a growing prevalence in France. OBJECTIVES: To assess the association between deprivation and the metabolic syndrome and to identify the most relevant waist circumference cut-off point. METHODS: A cross-sectional multicentre study was carried out of data extracted from health examination centres of two French areas in 2008. The harmonized definition of the metabolic syndrome contained five criteria with two thresholds for waist circumference. Deprivation was calculated by the Evaluation of Deprivation and Inequalities in Health Examination Centres score (EPICES). Eligible patients were at least 16 years old. The methodology of time to event analysis was used on patients having two criteria to identify the most relevant waist circumference threshold, taking waist circumference as event and computing it as a continuous variable. The median corresponded to the waist circumference threshold for which half of the patients switched from two to three criteria and so metabolic syndrome. RESULTS: Of the 32374 persons included in the study, 39.4% were socially deprived. The prevalence of the metabolic syndrome varied from 16.3% to 22.2% in the overall sample depending on the published waist circumference thresholds chosen. Deprivation was an independent factor associated with the metabolic syndrome. The cut-off point for waist circumference was between 95 and 99 cm for men and 88 and 97 cm for women. CONCLUSION: Deprivation is associated with a higher prevalence of the metabolic syndrome. The most relevant threshold for waist circumference could be 94 cm for men and 88 cm for women.