Obesity Prevention in Early Life (OPEL) study: linking longitudinal data to capture obesity risk in the first 1000 days.

To develop robust prediction models for infant obesity risk, we need data spanning multiple levels of influence, including child clinical health outcomes (eg, height and weight), information about maternal pregnancy history, detailed sociodemographic information of parents and community-level factors. Few data sources contain all of this information. This manuscript describes the creation of the Obesity Prevention in Early Life (OPEL) database, a longitudinal, population-based database that links clinical data with birth certificates and geocoded area-level indicators for 19 437 children born in Marion County, Indiana between 2004 and 2019. This brief describes the methodology of linking administrative data, the establishment of the OPEL database, and the clinical and public health implications facilitated by these data. The OPEL database provides a strong basis for further longitudinal child health outcomes studies and supports the continued development of intergenerational linked clinical-public health databases.

Apple cider vinegar for weight management in Lebanese adolescents and young adults with overweight and obesity: a randomised, double-blind, placebo-controlled study.

Background and aims: Obesity and overweight have become significant health concerns worldwide, leading to an increased interest in finding natural remedies for weight reduction. One such remedy that has gained popularity is apple cider vinegar (ACV). Objective: To investigate the effects of ACV consumption on weight, blood glucose, triglyceride and cholesterol levels in a sample of the Lebanese population. Materials and methods: 120 overweight and obese individuals were recruited. Participants were randomly assigned to either an intervention group receiving 5, 10 or 15 mL of ACV or a control group receiving a placebo (group 4) over a 12-week period. Measurements of anthropometric parameters, fasting blood glucose, triglyceride and cholesterol levels were taken at weeks 0, 4, 8 and 12. Results: Our findings showed that daily consumption of the three doses of ACV for a duration of between 4 and 12 weeks is associated with significant reductions in anthropometric variables (weight, body mass index, waist/hip circumferences and body fat ratio), blood glucose, triglyceride and cholesterol levels. No significant risk factors were observed during the 12 weeks of ACV intake. Conclusion: Consumption of ACV in people with overweight and obesity led to an improvement in the anthropometric and metabolic parameters. ACV could be a promising antiobesity supplement that does not produce any side effects.

MyFitnessPal smartphone application: relative validity and intercoder reliability among dietitians in assessing energy and macronutrient intakes of selected Filipino adults with obesity.

This study aimed to explore the validity of energy and macronutrient intake estimates provided by a popular nutrition tracking smartphone application. 37 obese Filipino adults and 3 nutritionist-dietitians participated in this study. Participants used MyFitnessPal to log their food intake for 5 days. They also completed paper-based food record forms at the same time. Dietitians then referred to each of the participants' completed food record forms to log the participants' food intakes and generated estimates of energy and nutrient intake using the same app. The researcher also referred to the participants' completed food record forms and generated energy and nutrient intake data using the Food Composition Tables (FCT)-the Philippine reference standard for estimating calorie and nutrient intakes. T-tests showed no statistical difference in energy and macronutrient data generated between participants and dietitians using MyFitnessPal app but Bland-Altman plots showed very weak to moderate agreements. T-tests revealed statistically significant difference between using the MyFitnessPal app and FCT in estimating energy, protein and fat intakes and Bland-Altman plots showed very weak to moderate agreement between MyFitnessPal and FCT. MyFitnessPal was found to underestimate the values for energy, carbohydrates and fat and overestimate values for protein when compared with estimates using FCT. Analysis of variance showed good intercoder reliability among dietitians, with the exception of fat intake estimates. The Goldberg approach showed very low likelihood of misreporting energy intake among the participants in this study. In this study, MyFitnessPal showed poor validity among Filipinos with obesity but with good reliability when used by dietitians. It also showed poor validity relative to the FCT. Prior nutrition knowledge is a factor in ensuring the accuracy of energy and nutrient intake data generated using MyFitnessPal app. It is recommended that users consult with dietitians for guidance on how to use these apps in weight management interventions.

Food availability, perceived food environment and social norm perceptions of healthy and vegetarian food consumption at a public music festival in the Netherlands: a cross-sectional study.

Objective: To gain insight into the food availability, the perceived food environment, and social norm perceptions in favour of healthy and vegetarian food consumption at a festival. Design: Two cross-sectional substudies were conducted to audit food and beverages at the festival, and to measure visitors' perceptions of the festival food environment (accessibility, affordability, availability, diversity, quality) and their social norms perceptions via a mobile survey. Setting: Public music festival, the Netherlands. Sample: 75 food stands and 153 adult festival visitors. Results: 75 food stands offered 627 food and beverage items, of which 92.4% were not supportive of a healthy diet. Of all food items, 46.6% were vegetarian (including 20% fries). Participants especially perceived the festival food environment as unsupportive of healthy choices. They also had weak descriptive and injunctive social norm perceptions in favour of healthy and vegetarian food consumption. However, they had stronger descriptive (t(152)=-5.5; p<0.001) and injunctive norm perceptions (t(152)=-4.5; p<0.001) of vegetarian food consumption (mean descriptive social norm perception=2.42; SD=0.82; mean injunctive social norm perception=3.14; SD=0.78), than healthy food consumption (mean descriptive social norm perception=2.10; SD=0.76; mean injunctive social norm perception=2.93; SD=0.78). Participants had stronger injunctive than descriptive social norm perceptions of healthy (t(152)=-12.4; p<0.001) and vegetarian (t(152)=-11.3; p<0.001) food consumption. Participants' perceived food environment and their perception of social norms were positively correlated. Conclusion: The festival's food environment appears unsupportive of healthy and vegetarian food consumption. The limited availability of healthy and vegetarian food coincided with weak social norm perceptions encouraging their consumption, particularly descriptive norms that arise from observing others. The food environment may stand in the way of developing descriptive norms for the consumption of healthy and vegetarian food, as people can only see others consume food that is available. Implementation of public event policies could support healthier, more sustainable festivals.

Differing intensities of a midwife-led antenatal healthy lifestyle service on maternal and neonatal outcomes: A retrospective cohort study.

INTRODUCTION: Maternal obesity and excessive gestational weight gain are associated with adverse maternal and neonatal outcomes. There is uncertainty over the most effective antenatal healthy lifestyle service, with little research determining the impact of different lifestyle intervention intensities on pregnancy outcomes. METHOD: This retrospective cohort study compared pregnancy and birth outcomes in women with a body mass index of 40 or above who were offered a low intensity midwife-led antenatal healthy lifestyle service (one visit) with women who were offered an enhanced service (three visits). The primary outcome was gestational weight gain. RESULTS: There were no differences between the two healthy lifestyle service intensities (N = 682) in the primary outcome of mean gestational weight gain [adjusted mean difference (aMD) -1.1 kg (95 % CI -2.3 to 0.1)]. Women offered the enhanced service had lower odds of gaining weight in excess of Institute of Medicine recommendations [adjusted odds ratio (aOR) 0.63 (95 % CI 0.40-0.98)] with this reduction mainly evident in multiparous women. Multiparous women also gained less weight per week [aMD -0.06 kg/week (95 % CI -0.11 to -0.01)]. No overall beneficial effects were seen in maternal or neonatal outcomes measured such as birth weight [aMD 25 g (95 % CI -71 to 121)], vaginal birth [aOR 0.87 (95 % CI 0.64-1.19)] or gestational diabetes mellitus [aOR 1.42 (95 % CI 0.93-2.17)]. However, multiparous women receiving the enhanced service had reduced odds of small for gestational age [aOR 0.52 (95 % CI 0.31-0.87)]. This study was however underpowered to detect differences in some outcomes with low incidences. DISCUSSION: Uncertainty remains over the best management of women with severe obesity regarding effective interventions in terms of intensity. It is suggested that further research needs to consider the different classes of obesity separately and have a particular focus on the needs of nulliparous women given the lack of effectiveness of this service among these women.

A New Drug for Obesity: Tirzepatide.

Obesity is now recognised as an emerging public health problem across the globe. Its incidence has been growing in the last two decades. Furthermore, as per the obesity treatment guidelines, a comprehensive approach that incorporates behavioural treatment, medications, lifestyle modifications, and/or bariatric surgery is the best way to manage weight. A novel dual agonist of Glucose-dependent insulinotropic peptide (GIP) and Glucagon-like peptide -1 (GLP- 1) receptors, Tirzepatide, was recently approved for the management of obesity. Tirzepatide manages blood sugar levels and enhances weight loss more than GLP-1 receptor agonists.

Consensus study on UK weight management services' response to COVID-19: best practices in outpatient management, governance and digital solutions.

BACKGROUND: The COVID-19 pandemic put unprecedented pressure on weight management services. These services were required to adapt to continue to provide care for people living with obesity. This study sought to develop consensus recommendations on the best practice solutions adopted by weight management services in the United Kingdom during the COVID-19 pandemic. METHODS: This study utilised a semi-structured interview and a modified Delphi methodology to develop a consensus of best practice recommendations identified by specialist weight management services during the pandemic. RESULTS: Twenty-three healthcare professionals working in weight management service across the United Kingdom participated in the study. Analysis of interview transcripts identified four key thematic domains: outpatient, patient education and support, perioperative care and team working. Of the initial 43 unique recommendations, 30 reached consensus agreement. Outpatient recommendations focused on communication strategies, patient self-monitoring and remote patient tracking. Patient education and support recommendations addressed the development of online educational resources and support groups. Perioperative care recommendations emphasised case prioritisation, waiting list support and postoperative care. Team working recommendations targeted the use of digital collaboration tools and strategies for effective teamwork. CONCLUSION: Developing consensus recommendations on best practice is a critical step for weight management and outpatient services to achieve higher standards of care. These recommendations provide a springboard for departmental discussions, paving the way for improved experiences for individuals living with obesity as they progress along their weight management journey.

Long-term effects of a lifestyle modification program for men with obesity delivered in German football clubs.

This study examined the long-term effects of a lifestyle modification program delivered at German Bundesliga football clubs. Weekly 90-minute group sessions over 12 weeks combined health education and physical activity and were delivered by coaches affiliated with the football clubs. A total of 371 men (mean age 49.7 years [SD = 7.6]) attended 41 classes at 19 clubs in 2017 and 2018 and participated in the long-term follow-up. Primary outcome was weight-loss at follow-up with a mean observation period of 20.4 months after baseline. Measures were taken partly by research staff and partly by participants themselves. At baseline, the men had a mean weight of 111.3 kg (SD = 16.9). Three months after baseline (posttest), the men had lost a mean of 6.3 kg (95% CI: 5.7-6.9). From posttest to follow-up, growth curve model showed men lost an average of 0.8 kg (95% CI: 0.2-1.4). Weight regain from posttest to follow-up of at least 3% was observed in 75 participants (20.2%) and was associated with less improvement in vegetable consumption in an adjusted logistic regression model. The data suggest that participation in a male-only lifestyle modification program offered by German football clubs may lead to sustained weight loss, but lack of a randomized control group and drop-outs prevent generalization of the results.

Cognitive and behavioral weight management strategies during the menopausal transition: Insights from the Menopause and Weight Loss (ME-WEL) project.

OBJECTIVE: Most women experience weight gain during the menopausal transition, often attributed to behavioral factors. Nevertheless, some women successfully maintain a healthy weight during this phase. This study aims to identify the successful cognitive and behavioral weight management strategies employed by postmenopausal women who effectively maintained a healthy weight during the menopausal transition (from premenopause to postmenopause). METHOD: Semi-structured interviews were conducted with 31 Portuguese postmenopausal women, aged 45-65 years (mean and standard deviation 54.06 ± 5.51) who successfully maintained a healthy weight (body mass index: 18.5 kg/m2-24.9 kg/m2) during the menopausal transition. The interviews were conducted via telephone (n = 29) and Zoom (n = 2), based on the participant's preference, and ranged from 11 to 52 min (22.06 ± 9.95). Using MAXQDA software, deductive-dominant content analysis of the interviews was performed. The Interface of R for the Multidimensional Analyses of Texts and Questionnaire software was used for lexical analysis. RESULTS: The qualitative analysis of cognitive and behavioral strategies for successful weight management yielded 17 categories and 37 sub-categories. Effective cognitive and behavioral strategies (e.g., planning content, stimulus control, support: help from others) were identified, mostly aligning with the Oxford Food and Activity Behaviors Taxonomy. Five new categories emerged: dietary choices, intuitive eating, food literacy, psychological self-care, and effortful inhibition. CONCLUSION: Knowing effective cognitive and behavioral weight management strategies for menopausal women is relevant, especially considering their status as a high-risk group. This knowledge provides a valuable guide for designing weight management interventions, emphasizing the essential role of behavioral change.

Household chaos and childhood obesity-related health outcomes.

OBJECTIVE: Household chaos, defined as a lack of organization, structure, and predictability, has been linked to deleterious childhood health outcomes and may hinder attempts to initiate and maintain healthy lifestyle changes. This study examined the associations of household chaos and obesity-related health conditions in a sample of youth being treated for obesity. METHODS: Participants were 715 patients (61.8% girls; Mage = 12.3 years; 68.7% non-Hispanic Black; M% of 95th BMI %-ile = 146.9%) enrolled in a pediatric weight management clinic. Caregiver report of household chaos was measured using the Confusion, Hubbub and Order Scale (CHAOS). Physiological obesity-related comorbidities (e.g., insulin resistance, hypertension, dyslipidemia) were assessed by a medical clinician and abstracted from electronic medical records; health conditions were dichotomized as present or not present. Psychological functioning was measured with the Pediatric Symptom Checklist, a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention concerns. RESULTS: The Wilcoxon rank-sum test was used to test differences in household chaos scores for each obesity-related health condition. Caregivers of youth diagnosed with hypertension and obstructive sleep apnea reported significantly lower levels of household chaos, while caregivers who reported clinical levels of psychological dysfunction reported higher levels of chaos. CONCLUSIONS: Traditional management of childhood obesity requires changes across multiple health domains (e.g., dietary, exercise, sleep), and such change may be facilitated by structure and consistency. Present findings suggest that psychological resources within pediatric weight management settings should address individual patient-level factors associated with physiological and mental health as well as household functioning.

Which components of behavioral weight management programs are essential for weight loss in people living with obesity? A rapid review of systematic reviews.

The optimal treatment and organization of care for people with obesity is one of the greatest challenges facing today's health services. While surgery and pharmacotherapy offer effective treatment options for some people with obesity, behavioral interventions are important to support long-term behavioral change. However, little is known about the most effective components of behavioral interventions, and this is especially the case for people with complex or severe obesity (i.e. body mass index [BMI] > 35 kg/m2). Accordingly, the current rapid review aimed to identify which behavior change techniques (BCTs) are effective for weight loss in adults with (severe) obesity. A secondary aim was to review the effects of BCTs on dietary behaviors and physical activity, and psychological outcomes, recognizing that behavioral interventions commonly target these. A search of Scopus, Ovid Medline, and Web of Science resulted in 1227 results, with 22 reviews eligible for inclusion. The most commonly reported BCTs were self-monitoring and goal setting, but these had variable effects on weight in adults with obesity. Combining these BCTs with other self-regulatory techniques led to increased weight loss. Further, for adults with severe obesity, so-called 'nudge' techniques and self-regulatory techniques were associated with greater weight loss. Three reviews also found that while self-monitoring increased physical activity, behavioral commitments increased changes to dietary behaviors. BCTs were not associated with psychological well-being. The review confirms that behavioral interventions have an impact in weight management, including for individuals with more complex or severe obesity, but highlights the need for further investigation of their use within clinical settings.

Beyond race: social vulnerability and access to metabolic and bariatric surgery.

BACKGROUND: Metabolic and bariatric surgery (MBS) is under-accessed by non-White patients, who are disproportionately affected by obesity. We hypothesized that unique barriers experienced by socially vulnerable patients drive disparate MBS utilization. OBJECTIVES: To determine whether socially vulnerable patients experience greater attrition and face more insurance-mandated medical weight management (MWM) requirements. SETTING: Urban, academic center. METHODS: This retrospective cohort study included adults evaluated for MBS in 2018. Social vulnerability was determined using the 2018 Social Vulnerability Index. Outcomes included attrition, or failure to undergo surgery within 1year, and the number and duration of MWM requirements. Multivariable logistic regression and negative binomial regression tested these associations. RESULTS: In 2018, 339 patients were evaluated for MBS (83% female, 70% Black). The attrition rate was 57%. On adjusted analyses, patients in the highest social vulnerability quartile had double the odds of attrition compared to their least vulnerable counterparts (OR 2.33, 95% CI 1.11-4.92, P = .03). Highly vulnerable patients had double the number (IRR 2.29, 95% CI 1.42-3.72, P = .001) and nearly quadruple the duration (IRR 3.90, 95% CI 1.93-7.86, P < .001) of MWM requirements compared to those with low social vulnerability. Odds of attrition increased by 11% and 20% for each additional MWM visit (OR 1.11, 95% CI 1.02-1.20, P = .02) and month (OR 1.20, 95% CI 1.08-1.33, P = .001), respectively. CONCLUSIONS: Patients with high social vulnerability were less likely to undergo MBS and faced more insurance-mandated preoperative requirements, which independently predicted attrition. Insurance-mandated MWM is inequitable and may contribute to disparate care of patients with severe obesity.

Personal Experiences and Preferences for Weight-Management Services from Adults Living with Overweight and Obesity in the United Kingdom.

Evidence-based approaches for weight management in the United Kingdom are lacking. This study examined preferences for behavioural weight-management programmes amongst adults aged eighteen and over in Northern Ireland who had experience living with overweight (i.e., body mass index (BMI) ≥ 25 kg/m2). It involved the design and implementation of an online survey assessing previous experience with weight management and preferences for future weight-management programmes. A total of 94.7% of participants had previously engaged with weight-management services but many struggled to maintain weight loss. Older adults were more likely to be motivated to reduce their weight whilst younger adults were more likely be motivated to change their appearance. A focus on both wellbeing and weight-related outcomes was evident. Participants preferred programmes to be low-cost, delivered by a range of professionals by blended delivery, consisting of short (≤1 h) weekly sessions. These preferences highlighted important considerations for the components of future services to improve engagement and effectiveness.

An Australian Football Themed Health Behaviour Change Intervention for Men With Cardiovascular Disease is Feasible and Acceptable: Results From a Feasibility Randomised Trial.

BACKGROUND: Physical activity (PA) and weight management are critical for cardiovascular disease (CVD) secondary prevention. However, PA adherence during or after cardiac rehabilitation is low. Here, we assess the feasibility and acceptability of the Australian football-themed Aussie Fans in Training (Aussie-FIT) program and associated trial procedures when adapted for men with CVD. METHOD: A pragmatic randomised control trial, with waitlist control arm, and follow-up measures at 3 and 6 months. Men with a CVD diagnosis and body mass index ≥25 kg/m2 were recruited from community and clinical settings, and randomised, following baseline measures of health and health behaviours. The intervention arm attended 12 face-to-face football-themed education and PA sessions. Feasibility (recruitment, retention, attendance, and adherence to trial procedures) was assessed via mixed methods. RESULTS: A total of 74% (64/86) of participants expressing interest met the eligibility criteria. Of those, 49 men (mean age=61.4, standard deviation=9.5, mean body mass index=31.3, standard deviation=4.2) were randomised. Program attendance rates (87% attended ≥80% of sessions) and retention (92%) were high. Trial retention at the primary end point (3 months) was high (86%) and at the 6-month follow-ups reduced to 67%. Program and trial procedures were acceptable, except for the request to visit a pathologist for the blood draw. CONCLUSIONS: Using a football theme and setting may be a feasible way to engage men with CVD in health behaviour change. Given the existing pilot evidence for men at risk of CVD, and that recruitment rates were under the target, trialling a program for men with or at risk of CVD is recommended.

Edible hydrogel with dual network structure for weight management.

Obesity, a global health crisis, is fueled by shifts in behavior and environmental factors, notably increased consumption of energy-dense processed foods and inadequate dietary fiber. Traditional weight loss methods pose safety challenges. Sodium carboxymethylcellulose (CMC), a promising dietary fiber supplement, aids weight management. However, CMC-based hydrogels have mechanical weaknesses and poor gastrointestinal retention. A new dual-network structured hydrogel here was introduced to address these issues, maintaining volume and elasticity in the digestive system without adding calories, reducing caloric density, and enhancing food elasticity for prolonged satiety. The study assessed four distinct hydrogels, analyzing their mechanical characteristics under simulated gastrointestinal conditions and biomimetic digestion to identify promising options for clinical development. This dual-network hydrogel exhibits a mechanical strength up to 100 times that of the original gel, while its swelling rate throughout the digestion process is approximately twice that of the original gel. This offers a potential solution for obesity management, providing sustained satiety and addressing the mechanical deficiencies of current hydrogels within the digestive system.

ß-Glucan-based superabsorbent hydrogel acts as a gastrointestinal exoskeleton enhancing satiety and interfering fat hydrolysis.

Fat and its hydrolysis products, fatty acids, are indispensable nutritional components; however, prolonged excessive fat consumption, particularly in western diets, contributes to the onset of obesity and multiple metabolic disorders. In this study, we propose a daily-ingestible hydrogel (denoted as ßC-MA hydrogel) composed of natural ß-glucan and sodium carboxymethylcellulose crosslinked by malic acid at 120 °C. This hydrogel exhibits rapid swelling performance, up to 24-fold within 1 min and 176-fold after 1 h in deionized water. It also lengthens gastric retention and increases endogenous satiety signal levels, potentially controlling appetite and reducing food intake. Furthermore, ßC-MA hydrogels that enter the small intestine can effectively inhibit fat hydrolysis and decrease triglyceride synthesis and transport. Specifically, the hydrogels inhibit the release of free fatty acids (FFAs) by approximately 50 % during digestion, influence the translocation of triglycerides and FFAs across the intestinal epithelium, and reduce the serum triglyceride levels by 22.2 %. These findings suggest that ßC-MA hydrogels could serve as a noninvasive gastrointestinal device for weight control, with the advantage of reducing food intake and restoring lipid metabolism homeostasis.

A predictive model for medium-term weight loss response in people with type 2 diabetes engaging in behavioural weight management interventions.

AIMS: To develop and evaluate prediction models for medium-term weight loss response in behavioural weight management programmes. MATERIALS AND METHODS: We conducted three longitudinal analyses using the Action for HEalth in Diabetes (LookAHEAD) trial, Weight loss Referrals for Adults in Primary care (WRAP) trial, and routine data from the National Health Service Greater Glasgow and Clyde Weight Management Service (NHS-GGCWMS). We investigated predictors of medium-term weight loss (>5% body weight) over 3 years in NHS-GGCWMS and, separately, predictors of weight loss response in LookAHEAD over 4 years. We validated predictors in both studies using WRAP over 5 years. Predictors of interest included demographic and clinical variables, early weight change in-programme (first 4 weeks) and overall in-programme weight change. RESULTS: In LookAHEAD and WRAP the only baseline variables consistently associated with weight loss response were female sex and older age. Of 1152 participants in NHS-GGCWMS (mean age 57.8 years, 60% female, type 2 diabetes diagnosed for a median of 5.3 years), 139 lost weight over 3 years (12%). The strongest predictor of weight loss response was early weight change (odds ratio 2.22, 95% confidence interval 1.92-2.56) per 1% weight loss. Losing 0.5% weight in the first 4 weeks predicted medium-term weight loss (sensitivity 89.9%, specificity 49.5%, negative predictive value 97.3%). Overall in-programme weight change was also associated with weight loss response over 3 years in NHS-GGCWMS and over 5 years in WRAP. CONCLUSIONS: Not attaining a weight loss threshold of 0.5% early in weight management programmes may identify participants who would benefit from alternative interventions.

GLP-1 RA for cardiometabolic risk reduction in obesity - How do we best describe benefit and value?

How do we assess the overall benefit and value of GLP1-RAs? Current clinical trials often focus narrowly on individual atherosclerotic cardiovascular endpoints like MACE, potentially missing broader GLP-1 RA benefits across multiple comorbidities. Herein, we set out a framework for expanding outcome analyses in large trials that we believe will provide a more holistic understanding of GLP-1 RA benefits across the cardio-kidney-metabolic (CKM) spectrum, guiding patient care, guidelines, and insurance coverage decisions.