Although all types of diabetes result in hyperglycemia, the pathophysiology of each type of diabetes is different. These guidelines summarize available data specific to the comprehensive care of ...youth with type 2 diabetes. The objective is to enrich the recognition of type 2 diabetes in youth, its risk factors, its pathophysiology, its management, and the prevention of associated complications.
IMPORTANCE: Effective long-term treatments are needed to address the obesity epidemic. Numerous wearable technologies specific to physical activity and diet are available, but it is unclear if these ...are effective at improving weight loss. OBJECTIVE: To test the hypothesis that, compared with a standard behavioral weight loss intervention (standard intervention), a technology-enhanced weight loss intervention (enhanced intervention) would result in greater weight loss. DESIGN, SETTING, PARTICIPANTS: Randomized clinical trial conducted at the University of Pittsburgh and enrolling 471 adult participants between October 2010 and October 2012, with data collection completed by December 2014. INTERVENTIONS: Participants were placed on a low-calorie diet, prescribed increases in physical activity, and had group counseling sessions. At 6 months, the interventions added telephone counseling sessions, text message prompts, and access to study materials on a website. At 6 months, participants randomized to the standard intervention group initiated self-monitoring of diet and physical activity using a website, and those randomized to the enhanced intervention group were provided with a wearable device and accompanying web interface to monitor diet and physical activity. MAIN OUTCOMES AND MEASURES: The primary outcome of weight was measured over 24 months at 6-month intervals, and the primary hypothesis tested the change in weight between 2 groups at 24 months. Secondary outcomes included body composition, fitness, physical activity, and dietary intake. RESULTS: Among the 471 participants randomized (body mass index BMI, 25 to <40; age range, 18-35 years; 28.9% nonwhite, 77.2% women), 470 (233 in the standard intervention group, 237 in the enhanced intervention group) initiated the interventions as randomized, and 74.5% completed the study. For the enhanced intervention group, mean baseline weight was 96.3 kg (95% CI, 94.2-98.5) and 24-month weight 92.8 kg (95% CI, 90.6-95.0). For the standard intervention group, mean baseline weight was 95.2 kg (95% CI, 93.0-97.3) and 24-month weight was 89.3 kg (95% CI, 87.1-91.5). Weight change at 24 months differed significantly by intervention group (estimated mean weight loss, 3.5 kg 95% CI, 2.6-4.5} in the enhanced intervention group and 5.9 kg 95% CI, 5.0-6.8 in the standard intervention group; difference, 2.4 kg 95% CI, 1.0-3.7; P = .002). Both groups had significant improvements in body composition, fitness, physical activity, and diet, with no significant difference between groups. CONCLUSIONS AND RELEVANCE: Among young adults with a BMI between 25 and less than 40, the addition of a wearable technology device to a standard behavioral intervention resulted in less weight loss over 24 months. Devices that monitor and provide feedback on physical activity may not offer an advantage over standard behavioral weight loss approaches. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01131871
Current and previous psychopathology in bariatric surgery candidates is believed to be common. Accurate prevalence estimates, however, are difficult to obtain given that bariatric surgery candidates ...often wish to appear psychiatrically healthy when undergoing psychiatric evaluation for approval for surgery. Also, structured diagnostic assessments have been infrequently used.
The present report concerned 199 patients enrolled in the longitudinal assessment of bariatric surgery study, who also participated in the longitudinal assessment of bariatric surgery-3 psychopathology substudy. The setting was 3 university hospitals, 1 private not-for-profit research institute, and 1 community hospital. All the patients were interviewed independently of the usual preoperative psychosocial evaluation process. The patients were explicitly informed that the data would not be shared with the surgical team unless certain high-risk behaviors, such as suicidality, that could lead to adverse perioperative outcomes were reported.
Most of the patients were women (82.9%) and white (nonwhite 7.6%, Hispanic 5.0%). The median age was 46.0 years, and the median body mass index was 44.9 kg/m2. Of the 199 patients, 33.7% had ≥1 current Axis I disorder, and 68.8% had ≥1 lifetime Axis I disorder. Also, 38.7% had a lifetime history of a major depressive disorder, and 33.2% had a lifetime diagnosis of alcohol abuse or dependence. All these rates were much greater than the population-based prevalence rates obtained for this age group in the National Comorbidity Survey-Replication Study. Also, 13.1% had a lifetime diagnosis and 10.1% had a current diagnosis of a binge eating disorder.
The current and lifetime rates of psychopathology are high in bariatric surgery candidates, and the lifetime rates of affective disorder and alcohol use disorders are particularly prominent. Finally, binge eating disorder is present in approximately 1 in 10 bariatric surgery candidates.
Objective
This virtual issue of the International Journal of Eating Disorders (IJED) is presented in conjunction with The Obesity Society (TOS) to coincide with Obesity Week held in Nashville, TN ...November 11‐15, 2018.
Methods
We present selected articles published in IJED in 2017‐2018 that are relevant to scholars who focus on obesity, eating disorders (EDs), or both areas of inquiry.
Discussion
We hope to promote discussion and collaboration between the obesity and ED fields, and stimulate additional work, including submissions to IJED.
Objective:This study evaluated the benefits of olanzapine compared with placebo for adult outpatients with anorexia nervosa.Methods:This randomized double-blind placebo-controlled trial of adult ...outpatients with anorexia nervosa (N=152, 96% of whom were women; the sample’s mean body mass index BMI was 16.7) was conducted at five sites in North America. Participants were randomly assigned in a 1:1 ratio to receive olanzapine or placebo and were seen weekly for 16 weeks. The primary outcome measures were rate of change in body weight and rate of change in obsessionality, assessed with the Yale-Brown Obsessive Compulsive Scale (YBOCS).Results:Seventy-five participants were assigned to receive olanzapine and 77 to receive placebo. A statistically significant treatment-by-time interaction was observed, indicating that the increase in BMI over time was greater in the olanzapine group (0.259 SD=0.051 compared with 0.095 SD=0.053 per month). There was no significant difference between treatment groups in change in the YBOCS obsessions subscale score over time (−0.325 compared with −0.017 points per month) and there were no significant differences between groups in the frequency of abnormalities on blood tests assessing potential metabolic disturbances.Conclusions:This study documented a modest therapeutic effect of olanzapine compared with placebo on weight in adult outpatients with anorexia nervosa, but no significant benefit for psychological symptoms. Nevertheless, the finding on weight is notable, as achieving change in weight is notoriously challenging in this disorder.
Objective
This study examines the course of eating pathology and its associations with change in weight and health‐related quality of life following bariatric surgery.
Method
Participants (N = 184) ...completed the eating disorder examination‐bariatric surgery version (EDE‐BSV) and the medical outcomes study 36‐Item short form health survey (SF‐36) prior to and annually following Roux‐en‐Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) for up to 7 years.
Results
The prevalence of ≥ weekly loss of control (LOC) eating, picking/nibbling, and cravings declined post‐RYGB and remained lower through 7 years (LOC: 5.4% at Year‐7 vs. 16.2% pre‐RYGB, p = .03; picking/nibbling: 7.0% vs. 32.4%, p < .001; and cravings: 19.4% vs. 33.6%, p = .02). The prevalence of picking/nibbling was significantly lower 7 years following LAGB vs. pre‐LAGB (29.4% vs 45.8%, p = .049), while cravings (p = .13) and LOC eating (p = .95) were not. EDE‐BSV global score and ratings of hunger and enjoyment of eating were lower 7 years following both RYGB and LAGB versus pre‐surgery (p's for all <.05). LOC eating following RYGB was associated with less long‐term weight loss from surgery (p < .01) and greater weight regain from weight nadir (p < .001). Higher post‐surgery EDE‐BSV global score was associated with less weight loss/greater regain (both p < .001) and worsening/less improvement from surgery in the SF‐36 mental component summary scores (p < .01).
Discussion
Initial improvements in eating pathology following RYGB and LAGB were sustained across 7 years of follow‐up. Individuals with eating pathology post‐RYGB, reflected by LOC eating and/or higher EDE‐BSV global score, may be at risk for suboptimal long‐term outcomes.
We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity.
Participants were 192 children 8.0 to 12.0 years of age (mean +/- SD: 10.2 +/- 1.2 ...years). The average BMI percentile for age and gender was 99.18 (SD: 0.72). Families were assigned randomly to the intervention or usual care. Assessments were conducted at baseline, 6 months, 12 months, and 18 months. The primary outcome was percent overweight (percent over the median BMI for age and gender). Changes in blood pressure, body composition, waist circumference, and health-related quality of life also were evaluated. Finally, we examined factors associated with changes in child percent overweight, particularly session attendance.
Intervention was associated with significant decreases in child percent overweight, relative to usual care, at 6 months. Intent-to-treat analyses documented that intervention was associated with a 7.58% decrease in child percent overweight at 6 months, compared with a 0.66% decrease with usual care, but differences were not significant at 12 or 18 months. Small significant improvements in medical outcomes were observed at 6 and 12 months. Children who attended > or =75% of intervention sessions maintained decreases in percent overweight through 18 months. Lower baseline percent overweight, better attendance, higher income, and greater parent BMI reduction were associated with significantly greater reductions in child percent overweight at 6 months among intervention participants.
Intervention was associated with significant short-term reductions in obesity and improvements in medical parameters and conferred longer-term weight change benefits for children who attended > or =75% of sessions.
Objective:
The present study was designed to document psychiatric disorders among candidates for weight loss surgery and to examine the relationship of psychopathology to degree of obesity and ...functional health status.
Method:
The authors collected demographic and clinical information from 288 individuals seeking surgery. Assessments were administered independently of the preoperative screening and approval process. The study group was mostly female (83.3%) and white (88.2%). Mean body mass index (BMI) of the group was 52.2 kg m
2
(SD=9.7), and the mean age was 46.2 years (SD=9.4).
Results:
Approximately 66% of the participants had a lifetime history of at least one axis I disorder, and 38% met diagnostic criteria at the time of preoperative evaluation. In addition, 29% met criteria for one or more axis II disorders. Axis I psychopathology, but not axis II, was positively related to BMI, and both axis I and axis II psychopathology were associated with lower scores on the Medical Outcomes Study 36-item Short-Form Health Survey.
Conclusions:
Current and past DSM-IV psychiatric disorders are prevalent among bariatric surgery candidates and are associated with greater obesity and lower functional health status, highlighting the need to understand potential implications for surgery preparation and outcome. Future work also will focus on the course of psychiatric disorder during the post-surgery period and its relationship to weight loss and maintenance.
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