Hunger, satiation, postprandial satiety, and hedonic eating constitute key food intake parameters. We aim to study whether these symptoms are associated with gastrointestinal symptoms (GIS) in ...patients with obesity.
This is a cross-sectional study of patients with obesity. Patients completed the following validated biomarkers and questionnaires: hunger was measured via visual analog scale (100 mm) following a standard meal, satiation was measured via ad libitum meal (calories to fullness; kcal), postprandial satiety was measured via gastric emptying scintigraphy (T1/2; mins), and hedonic eating was measured via the Hospital Anxiety and Depression Scale questionnaire. Participants completed the abridged Bowel Disease Questionnaire to evaluate their GIS. We calculated the odds ratios (ORs) adjusted for sex, weight, and age between food intake parameters <25th or >75th percentile observed in a prior cohort of 450 participants with obesity and GIS.
A total of 274 participants (41 ± 10 SD years, 75% females, body mass index 39 ± 8 kg/m2) were included in the analysis. Increased hunger was associated with a lower prevalence of lumpy stools (OR = 0.18, P = .02). Satiation was associated with abdominal pain/discomfort (relieved by defecation OR = 2.4, P = .02 or associated with change in stool consistency OR = 2.92, P < .01), loose/watery stools (OR = 2.09, P = .02), and bloating (OR = 2.49, P < .01). Abnormal postprandial satiety was associated with bloating (OR = 2.26, P < .01) and loose/watery stools (OR = 1.84, P = .04). Hedonic eating was associated with abdominal pain/discomfort with stool frequency change (OR = 2.4, P = .02), >3 bowel movements per day (OR = 1.93, P = .048), bloating (OR = 2.49, P = .01), abdominal pain after meals >1 per month (OR = 4.24, P < .01), and nausea >1 per week (OR = 4.51, P < .01).
Alterations in hunger, satiation, postprandial satiety, and hedonic eating are associated with GIS in patients with obesity.
Precision Medicine and Obesity Sacoto, Daniel; Hurtado, Maria Daniela; Acosta, Andres
Handbook of experimental pharmacology,
2022, Volume:
274
Journal Article
Peer reviewed
Open access
Obesity is a chronic, relapsing, and multifactorial disease, with a rising prevalence and an associated high economic burden. Achieving successful and sustained weight loss outcomes with current ...interventions is challenging. This is due, at least in part, to the disease's heterogenous pathophysiology that is yet to be completely understood. Technological advances and greater capabilities for the extraction and storage of information have facilitated the application of precision medicine. Several precision medicine initiatives have been proposed to improve obesity outcomes. Most of these initiatives are based on -omics technologies. Although the data generated from these technologies have led to developing hypotheses that may explain the underpinnings of obesity, their applicability to the clinical practice is yet to be determined. There are other initiatives that have identified quantitative or qualitative physiologic traits that can be targeted and that could have a more immediate clinical impact. This review aims to provide a perspective of current initiatives for precision medicine for obesity.
Importance
No retrospective cohort study has assessed the effectiveness of semaglutide at doses used in randomized clinical trials to treat obesity (ie, 1.7 and 2.4 mg).
Objective
To study weight ...loss outcomes associated with semaglutide treatment at doses used in randomized clinical trials for patients with overweight or obesity.
Design, Setting, and Participants
This cohort study, conducted at a referral center for weight management, retrospectively collected data on the use of semaglutide for adults with overweight or obesity between January 1, 2021, and March 15, 2022, with a follow-up of up to 6 months. A total of 408 patients with a body mass index (BMI) of 27 or more were prescribed weekly semaglutide subcutaneous injections for 3 months or more. Patients with a history of bariatric procedures, taking other antiobesity medications, and with an active malignant neoplasm were excluded.
Exposures
Weekly 1.7-mg or 2.4-mg semaglutide subcutaneous injections for 3 to 6 months.
Main Outcomes and Measures
The primary end point was the percentage of weight loss. Secondary end points were the proportion of patients achieving weight loss of 5% or more, 10% or more, 15% or more, and 20% or more after 3 and 6 months and the percentage of weight loss for patients with or without type 2 diabetes after 3 and 6 months.
Results
The study included 175 patients (132 women 75.4%; mean SD age, 49.3 12.5 years; mean SD BMI, 41.3 9.1) in the analysis at 3 months and 102 patients at 6 months. The mean (SD) weight loss after 3 months was 6.7 (4.4) kg, equivalent to a mean (SD) weight loss of 5.9% (3.7%) (
P
< .001), and the mean (SD) weight loss after 6 months was 12.3 (6.6) kg, equivalent to a mean (SD) weight loss of 10.9% (5.8%) (
P
< .001 from baseline). Of the 102 patients who were followed up at 6 months, 89 (87.3%) achieved weight loss of 5% or more, 56 (54.9%) achieved weight loss of 10% or more, 24 (23.5%) achieved weight loss of 15% or more, and 8 (7.8%) achieved weight loss of 20% or more. Patients with type 2 diabetes had a lower mean (SD) percentage weight loss at 3 and 6 months compared with those without type 2 diabetes: 3.9% (3.1%) vs 6.3% (3.7%) at 3 months (
P
= .001) and 7.2% (6.3%) vs 11.8% (5.3%) at 6 months (
P
= .005).
Conclusions and Relevance
The results of this cohort study suggest that weekly 1.7-mg and 2.4-mg doses of semaglutide were associated with weight loss similar to that seen in randomized clinical trials. Studies with longer periods of follow-up are needed to evaluate prolonged weight loss outcomes.
Background: Obesity is a chronic and multifactorial disease, with a significant medical and economic burden. Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, was recently approved for ...weight loss. Multiple randomized clinical studies showed sustained, clinically significant weight loss. However, little is known about real-world outcomes in patients with overweight and obesity with and without type 2 diabetes (T2DM). Methods: In this study, we performed a retrospective data collection on the use of semaglutide in adults with overweight or obesity. We included patients with a body mass index >27 kg/m2 who used weekly semaglutide subcutaneous injections (up to 2.4 mg) for >3 months. We excluded patients with a history of bariatric procedure, taking other anti-obesity medications, and with an active malignancy. The primary end point was the total body weight loss percentage (TBWL%), and secondary end points were the proportion of patients achieving >5% and >10% TBWL after 6 months, and TBWL% of patients with and without T2DM after 3 and 6 months. Continuous end points were analyzed using matched paired t test. Data are presented as mean ± standard deviation. Results: A total of 137 patients were included in the analysis (77% female, mean age 50±12.6 years, body-mass index 41.4±9.7 kg/m2). Their weight loss after 3 months was 6.8± 4.3 kg, equivalent to 6± 3.9% of TBWL (p < 0.001, n = 137) and after 6 months was 10.5± 6.6 kg, equivalent to 9.5± 6% of TBWL (p < 0.001, n = 51). Only 39% (20/51 patients) reached the maximum dose of 2.4 mg weekly. 41/51 (80%) of the patients who were followed for >6 months achieved >5% TBWL while 23/51 (45%) achieved >10% TBWL. Patients with T2DM had a lower TBWL% at 3 and 6 months compared to those without T2DM: 4.2±3.1% vs 6.3± 3.8% (p=0.004) and 6.0±7.5% vs 10.6±5.1% (p=0.07), respectively. Conclusions: Semaglutide resulted in weight loss in routine clinical care similar to that seen in randomized controlled trials.
Background: Obesity originates from an imbalance between energy intake and expenditure. Changes in each of the energy intake components (satiation, postprandial satiety, emotional eating) and energy ...expenditure have been linked to obesity and are referred to as obesity phenotypes (PMID: 33759389). We aim to study if these obesity phenotypes have an additive effect on body mass index (BMI) and body weight. Methods: This is a cross-sectional study of adult patients with obesity (body-mass index BMI > 30) who completed the validated tests to measure the obesity phenotypes. Higher calories to fullness during an ad libitum meal were defined as abnormal satiation, accelerated time to half gastric emptying with scintigraphy was defined as abnormal postprandial satiety, emotional eating was defined as a higher anxiety score on the Hospital Anxiety and Depression Scale, and lower-than predicted resting energy expenditure (REE) was defined by percentage of measured REE by indirect calorimetry from predicted REE by Harris Benedict equation. The primary analysis was done on the number of phenotypes (<1 and >2) and BMI using a t-test, and weight using an ANCOVA model with height as covariate. Results: Our cohort included 464 patients (mean SD age 42.0 10.9 years, 78% females, weight 111.4 23.6, BMI 39.0 7.2 kg/m2). There were 327 patients who had <1 phenotype, and 137 patients with >2 phenotype with no baseline demographical differences (i.e., age and sex). There is a significant effect of number of phenotypes on body weight, F(3, 463 = 75.8, p<0.001). Having >2 phenotypes was associated with higher body weight (115.9 kg vs 109.5 kg; p =0.03) and BMI (40.1 kg/m2 vs 38.5 kg/m2; p =0.048) compared to <1 phenotypes. Conclusions: Obesity phenotypes have a cumulative effect on the body weight and BMI. Patients who have multiple obesity phenotypes may require a more aggressive approach to enhance weight loss.
Background: The main regulators of body weight are food intake and energy expenditure. Hunger and satiation are important factors of food intake regulation, whereas resting metabolic rate (RMR) is ...the main determinant of energy expenditure. The pathophysiology of obesity is associated with changes in food intake and energy expenditure; however, their evolution throughout the lifespan of adult with obesity has not been studied simultaneously. Methods: This is a cross-sectional study of patients with obesity aged 19 to 70 years grouped by decades. We assessed hunger using 100-mm visual analog scales (VAS) 4 hours after a 320kcal breakfast, satiation using calories to fullness (CTF) in an ad libitum meal, and RMR by indirect calorimetry. We studied the effect age on these three parameters using an ANCOVA model that included age category by decades, sex, and body mass index (BMI) as covariates corrected by Dunnett's Test. We chose patients aged 19 to 29 years as control group. Results: We included 470 patients (mean SD age 42.111 years, 78% females, BMI 39.17.2). Patients were distributed in the following age groups: 19-29 years (n=70; BMI 37.6 6.4); 30-39 years (n=140; BMI 39.57.4); 40-49 years (n=132; BMI 39.78.0); 50-59 years (n=94; BMI 38.76.3); 60-69 years (n=34; BMI 37.8 6.6). Hunger was significantly different among groups (p=0.003) with a decrease on hunger levels of 13.6 mm (SE 5.3; p=0.03) in older patients (60 to 69 years) vs. controls. CTF differed significantly across groups (p<0.001) with older patients eating 163.7 kcal less (standard error SE 60.2; p=0.02) vs. controls. RMR was significantly different among groups (p<0.001) with 241.9 kcal per day (SE 55.7; p<.001) less in older patients vs. controls. Conclusion: We noticed a downward trend in food intake and energy expenditure, especially among older adults. These shifts offer information on human obesity and aging and should be considered when developing treatments for people of all ages.
PDF
