Dietary modification is central to obesity treatment. Weight loss diets are available that include various permutations of energy restriction, macronutrients, foods, and dietary intake patterns. ...Caloric restriction is the common pathway for weight reduction, but different diets may induce weight loss by varied additional mechanisms, including by facilitating dietary adherence. This narrative Review of meta-analyses and select clinical trials found that lower-calorie diets, compared with higher-calorie regimens, reliably induced larger short-term (<6 months) weight losses, with deterioration of this benefit over the long term (>12 months). Few significant long-term differences in weight loss were observed for diets of varying macronutrient composition, although some regimens were found to have short-term advantages (e.g., low carbohydrate versus low fat). Progress in improving dietary adherence, which is critical to both short- and long-term weight loss, could result from greater efforts to identify behavioral and metabolic phenotypes among dieters.
Objective
To examine whether baseline chronic stress, morning cortisol, and other appetite‐related hormones (leptin, ghrelin, and insulin) predict future weight gain and food cravings in a ...naturalistic, longitudinal, 6‐month follow‐up study.
Methods
A prospective community cohort of 339 adults (age 29.1 ± 9.0 years; BMI = 26.7 ± 5.4 kg/m2; 56.9% female; 70.2% white) completed assessments at baseline and 6‐month follow‐up. Fasting blood draws were used to assess cortisol and other appetite‐related hormone levels at baseline. At baseline and follow‐up, body weight was measured, and the Cumulative Adversity Interview and Food Craving Inventory were administered. Data were analyzed using linear mixed models adjusting for demographic and clinical covariates.
Results
Over the 6‐month period, 49.9% of the sample gained weight. Food cravings and chronic stress decreased over 6 months (Ps < 0.05). However, after adjusting for covariates, individuals with higher baseline total ghrelin had significantly higher food cravings at 6 months (P = 0.04). Furthermore, higher cortisol, insulin, and chronic stress were each predictive of greater future weight gain (Ps < 0.05).
Conclusions
These results suggest that ghrelin plays a role in increased food cravings and reward‐driven eating behaviors. Studies are needed that examine the utility of stress reduction methods for normalizing disrupted cortisol responses and preventing future weight gain.
Background:
Disordered eating is common but underrecognized in people with obesity and the relationship of food insecurity, mood, and binge-spectrum eating disorders has not been well addressed in ...samples with higher weight. Young adults are particularly vulnerable to developing disordered eating.
Aim:
The purpose of this study was to compare the prevalence of food insecurity, depressive symptoms, anxiety, and loneliness among young adults (aged 18–35 years) who screened positive for binge-spectrum eating disorders (i.e., binge eating disorder and bulimia nervosa), those with subthreshold forms of these disorders, and individuals who did not screen positive for these conditions.
Method:
This was a cross-sectional study of young adults with a self-reported body mass index ≥30 kg/m2 from the United States who were recruited online. Participants (N = 1,331; M ± SD age = 28.0 ± 3.4 years; body mass index BMI = 36.5 ± 6.2 kg/m2; 73.9% male; 56.3% White) completed surveys that evaluated disordered eating behaviors, food insecurity, mood, and lifestyle factors.
Results:
In the sample, 8.0% of participants screened positive for binge-spectrum eating disorder and 16.0% had probable subthreshold symptoms. Higher depressive symptoms (odds ratio OR = 1.11, 95% confidence interval CI = 1.03, 1.20, p = .01), perceived stress (OR = 1.13, 95% CI = 1.07, 1.19, p < .001), and food insecurity scores (OR = 1.12, 95% CI = 1.03, 1.21, p = .01) were associated with an increased likelihood of threshold binge-spectrum eating disorders.
Conclusion:
People with disordered eating should also be evaluated for mood disorders and food insecurity and vice versa. Further research is needed to evaluate interventions that address food insecurity and mood disorders, which may help to decrease disordered eating.
Objective
This review synthesized literature on the relationship between food insecurity and binge eating.
Methods
Relevant studies were identified by searching PubMed, CINAHL, PsycINFO, and gray ...literature from inception to October 2022. Eligible studies included primary research that assessed the relationship between food insecurity and binge eating. Data extraction was performed independently by two reviewers. Pooled odds ratios and 95% confidence intervals (CI) were obtained from random effect models with the R package meta. Analyses were stratified by binge eating versus binge‐eating disorder (BED), study type (cross‐sectional vs. longitudinal), and age (adults vs. adolescents).
Results
We included 24 articles that reported on 20 studies, and 13 articles were included in the meta‐analysis. Based on the random effects meta‐analysis, the odds of adults in the food insecure group having binge eating were 1.66 (95% CI = 1.42, 1.93) times the odds of adults in the food secure group having binge eating. The odds of adults in the food insecure group having BED were 2.70 (95% CI = 1.47, 4.96) times the odds of adults in the food secure group having BED. Insufficient data were available for a meta‐analysis on adolescents or longitudinal relationships.
Conclusions
These findings support that food insecurity is associated with binge eating in adults. There is a need for research to investigate the mechanisms underlying this relationship. Results highlight the importance of screening participants with food insecurity for disordered eating behaviors and vice versa. Future research is needed to examine whether interventions targeting food insecurity may help to mitigate disordered eating behaviors.
Public Significance
Food insecurity is a common but under‐recognized contributor to binge eating. In this article, we systematically reviewed research that has been published on the relationship between food insecurity and binge eating. We found support that food insecurity should be considered in the prevention and treatment of binge eating.
Resumen
Objetivo
Esta revisión sintetizó la literatura sobre la relación entre la inseguridad alimentaria y comer en atracones.
Métodos
Los estudios relevantes se identificaron mediante búsquedas en PubMed, CINAHL, PsycINFO y literatura gris desde su inicio hasta octubre de 2022. Los estudios elegibles incluyeron estudios primarios que evaluaron la relación entre la inseguridad alimentaria y los atracones. La extracción de datos fue realizada de forma independiente por 2 revisores. Los odds ratios agrupados y los intervalos de confianza (IC) del 95% se obtuvieron de modelos de efectos aleatorios con el paquete R meta. Los análisis se estratificaron por comer en atracones versus trastorno por atracón (TpA), tipo de estudio (transversal vs longitudinal) y edad (adultos vs adolescentes).
Resultados
Se incluyeron 24 artículos que informaron sobre 20 estudios y 13 artículos se incluyeron en el metaanálisis. Según el metaanálisis de efectos aleatorios, las probabilidades de que los adultos en el grupo de inseguridad alimentaria comieran en atracones fue de 1,66 (IC del 95% = 1,42, 1,93) veces las probabilidades de que los adultos en el grupo de seguridad alimentaria comieran en atracones. Las probabilidades de que los adultos en el grupo de inseguridad alimentaria tuvieran TpA fue 2.70 (IC del 95% = 1.47, 4.96) veces las probabilidades de que los adultos en el grupo de seguridad alimentaria tuvieran TpA. No hubo datos suficientes disponibles para un metaanálisis sobre adolescentes o relaciones longitudinales.
Conclusiones
Estos hallazgos apoyan que la inseguridad alimentaria está asociada con comer en atracones en adultos. Existe la necesidad de desarrollar investigación para investigar los mecanismos subyacentes a esta relación. Los resultados resaltan la importancia de evaluar a los participantes con inseguridad alimentaria para detectar conductas alimentarias disfuncionales y viceversa. Se necesitan estudios de investigación futuros para examinar si las intervenciones dirigidas a la inseguridad alimentaria pueden ayudar a mitigar los comportamientos alimentarios disfuncionales.
Semaglutide for the treatment of obesity Chao, Ariana M.; Tronieri, Jena S.; Amaro, Anastassia ...
Trends in cardiovascular medicine,
04/2023, Letnik:
33, Številka:
3
Journal Article
Recenzirano
Semaglutide is a glucagon-like peptide-1 receptor agonist that was recently approved by the US Food and Drug Administration for chronic weight management. This paper reviews data on the mechanism of ...action, weight-loss and cardiometabolic efficacy, and safety of semaglutide 2.4 mg/week for obesity. Semaglutide has demonstrated the largest weight loss of any obesity medication to date with reductions of approximately 15% of initial weight at 68 weeks, accompanied by improvements in cardiovascular risks factors and physical functioning. The approval of this medication provides patients with greater options for weight management.
Purpose of Review
Obesity is a heterogeneous condition, yet sex/gender is rarely considered in the prevention or clinical care of this disease. This review examined and evaluated recent literature ...regarding the influence of sex and gender on obesity prevalence, comorbidities, and treatment in adults.
Recent Findings
Obesity is more prevalent in women than men in most countries, but in some countries and population subgroups, this gap is more pronounced. Several obesity-related comorbidities, including type 2 diabetes and hypertension, demonstrate sex-specific pathways. Women, compared to men, are more likely to be diagnosed with obesity and seek and obtain all types of obesity treatment including behavioral, pharmacological, and bariatric surgery. Men tend to have greater absolute weight loss, but this difference is attenuated once accounting for baseline weight.
Summary
Obesity is a multifactorial condition with complex interactions among sex/gender, sociocultural, environmental, and physiological factors. More sex/gender research is needed to investigate mechanisms underlying sex/gender differences in prevalence, comorbidities, and treatment, identify ways to increase men’s interest and participation in obesity treatment, and examine differences in obesity prevalence and treatments for transgender and gender non-conforming individuals.
Over the last century, hundreds of evaluations have been conducted to examine weight-management interventions related to diet, physical activity, and behavior therapy. These investigations have ...contributed to a growing body of knowledge that has consistently advanced the field of obesity treatment, while also revealing some persistent challenges. This narrative review summarizes key findings from randomized controlled trials conducted in adults that have combined diet, physical activity, and behavior therapy, an approach variously referred to as behavioral treatment, comprehensive lifestyle modification, or intensive lifestyle intervention. The review shows that current behavioral approaches induce average reductions in baseline body weight of 5 to 10% at 6 to 12 months. Such losses have proven effective in reducing the risk of type 2 diabetes in persons with impaired glucose tolerance and in improving other obesity-related complications. These benefits have also been associated with reductions in healthcare costs. Despite these advances, behavioral treatment is challenged by the need for larger losses to achieve optimal improvements in health, by difficulties associated with maintaining weight loss, and by barriers limiting access to treatment. New anti-obesity medications, when combined with behavioral obesity treatment, hold promise of addressing the first two issues.
Objective Food insecurity is associated with reduced dietary quality and excess weight gain. However, interventions that are effective for obesity among individuals with food insecurity are unclear. ...The purpose of this systematic review was to synthesize studies in which authors examined interventions for obesity among adults with food insecurity. Methods PubMed, PsycINFO, CINAHL, and EMBASE were searched from inception to October 2022. Studies were included if their authors reported on nonpharmacological and nonsurgical interventions that focused on adults with food insecurity and overweight/obesity and reported weight loss. Results A total of 1360 titles were reviewed during the electronic search, and only 5 studies met inclusion criteria. There were 2 primary types of interventions that have been tested: first, behavioral weight loss counseling with or without tailoring for individuals with food insecurity and, second, subsidies for food. Findings of the benefits of one type of intervention over another are mixed. Conclusions This systematic review highlights that the current evidence for interventions that address food insecurity and obesity is mixed and limited in scope. There is a need for rigorous controlled trials to examine the effectiveness and cost-effectiveness of interventions for weight management among individuals with food insecurity and obesity while considering sustainability.
The effects of tirzepatide, a glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, on weight reduction after successful intensive lifestyle intervention are ...unknown. This double-blind, placebo-controlled trial randomized (1:1) adults with body mass index ≥30 or ≥27 kg/m
and at least one obesity-related complication (excluding diabetes), who achieved ≥5.0% weight reduction after a 12-week intensive lifestyle intervention, to tirzepatide maximum tolerated dose (10 or 15 mg) or placebo once weekly for 72 weeks (n = 579). The treatment regimen estimand assessed effects regardless of treatment adherence in the intention-to-treat population. The coprimary endpoint of additional mean per cent weight change from randomization to week 72 was met with changes of -18.4% (standard error (s.e.) 0.7) with tirzepatide and 2.5% (s.e. 1.0) with placebo (estimated treatment difference -20.8 percentage points (95% confidence interval (CI) -23.2%, -18.5%; P < 0.001). The coprimary endpoint of the percentage of participants achieving additional weight reduction ≥5% was met with 87.5% (s.e. 2.2) with tirzepatide and 16.5% (s.e. 3.0) with placebo achieving this threshold (odds ratio 34.6%; 95% CI 19.2%, 62.6%; P < 0.001). The most common adverse events with tirzepatide were gastrointestinal, with most being mild to moderate in severity. Tirzepatide provided substantial additional reduction in body weight in participants who had achieved ≥5.0% weight reduction with intensive lifestyle intervention. ClinicalTrials.gov registration: NCT04657016 .
Bariatric surgery has been shown to have long-term benefits for patients with type 2 diabetes, according to a study published in JAMA. The study pooled the results of four randomized clinical trials ...and found that bariatric surgery was more effective than medical therapy and lifestyle management in improving glycemic control. The study also showed that sleeve gastrectomy and Roux-en-Y gastric bypass were equally effective in reducing hemoglobin A1c levels, while adjustable gastric banding was less effective. The study suggests that bariatric surgery should be considered for individuals with a BMI of 27 to 45 who have inadequate glycemic control with medical and lifestyle interventions. The study also highlights the need for long-term evaluations comparing bariatric surgery with new anti-obesity medications. Despite the higher upfront costs of bariatric surgery, it is generally considered cost-effective compared to usual medical care. Clinicians are encouraged to consider the long-term benefits of bariatric surgery for patients with type 2 diabetes.
PDF
