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3One might expect that a perception of obesity being a risk factor and disease, contributes to effective obesity prevention and management strategies. However, obesity rates continue to increase worldwide. The question arises whether obesity is truly perceived as a risk factor and a disease. This paper aims at describing perception of obesity as risk factor and disease among individuals seeking care, individuals not seeking care, the society, and different professionals having a role in the field of obesity. The paper is a reflection of the lecture on the topic that was given at the EASO’s New Investigators United’s Summer School 2016 in Portugal and the discussion with the new investigators and other senior speakers. Individual obese patients seeking help are very much aware of obesity being a risk factor and disease, but perceptions regarding obesity seem to be flawed among those who do not seek help for obesity. Also, misperceptions regarding obesity play a role at different levels, including society, different political levels, the fields of health care and social work, prevention organizations, and the food and marketing industry. The food and marketing industry has an enormous role in changing perceptions by the society and policy makers. Obesity rates will continue to increase as long as individuals, the society, and professionals at different levels have false interpretations of the severity of obesity. Severe action is needed against those who are playing a role in maintaining false perceptions of obesity as a risk factor and disease.
DOCUMENT
Introduction:
The association between obesity and outcome in critical illness is unclear. Since the amount of visceral adipose tissue(VAT) rather than BMI mediates the health effects of obesity we aimed to investigate the association between visceral obesity, BMI and 90-day mortality in critically ill patients.
Method:
In 555 critically ill patients (68% male), the VAT Index(VATI) was measured using Computed Tomography scans on the level of vertebra L3. The association between visceral obesity, BMI and 90-day mortality was investigated using univariable and multivariable analyses, correcting for age, sex, APACHE II score, sarcopenia and muscle quality.
Results:
Visceral obesity was present in 48.1% of the patients and its prevalence was similar in males and females. Mortality was similar amongst patients with and without visceral obesity (27.7% vs 24.0%, p = 0.31). The corrected odds ratio of 90-day mortality for visceral obesity was 0.667 (95%CI 0.424–1.049, p = 0.080). Using normal BMI as reference, the corrected odds ratio for overweight was 0.721 (95%CI 0.447–1.164 p = 0.181) and for obesity 0.462 (95%CI 0.208–1.027, p = 0.058).
Conclusion:
No significant association of visceral obesity and BMI with 90-day mortality was observed in critically ill patients, although obesity and visceral obesity tended to be associated with improved 90-day mortality.
DOCUMENT
Salivary biomarkers hold promise as non-invasive indicators of obesity-related metabolic dysfunction, particularly in MUO. However, their clinical diagnostic utility remains uncertain due to heterogeneity in study designs, a lack of biomarker validation, and limited longitudinal studies. Further research is needed to establish their bona fide diagnostic potential.
MULTIFILE
Purpose: To investigate the prevalence of multidimensional frailty in older people with hypertension and to examine a possible relationship of general obesity and abdominal obesity to frailty in older people with hypertension. Patients and Methods: A sample of 995 community-dwelling older people with hypertension, aged 65 years and older and living in Zhengzhou (China), completed the Tilburg Frailty Indicator (TFI), a validated self-report questionnaire for assessing multidimensional frailty. In addition, socio-demographic and lifestyle characteristics were assessed by self-report, and obesity was determined by measuring waist circumference and calculating the body mass index. Results: The prevalence of multidimensional frailty in this older population with hypertension was 46.5%. Using multiple linear regression analysis, body mass index was significantly associated with physical frailty (p = 0.001), and waist circumference was significantly positively associated with multidimensional frailty and all three frailty domains. Older age was positively associated with multidimensional frailty, physical frailty, and psychological frailty, while gender (woman) was positively associated with multidimensional, psychological, and social frailty. Furthermore, comorbid diseases and being without a partner were positively associated with multidimensional, physical, psychological, and social frailty. Of the lifestyle characteristics, drinking alcohol was positively associated with frailty domains. Conclusion: Multidimensional frailty was highly prevalent among Chinese community-dwelling older people with hypertension. Abdominal obesity could be a concern in physical frailty, psychological frailty, and social frailty, while general obesity was concerning in relation to physical frailty.
DOCUMENT
Background: Lipoedema is a chronic disorder of adipose tissue typically involving an abnormal build-up of fat cells in the legs, thighs and buttocks. Occurring almost exclusively in women, it often co-exists with obesity. Due to an absence of clear objective diagnostic criteria, lipoedema is frequently misdiagnosed as obesity, lymphoedema or a combination of both. The purpose of this observational study was to compare muscle strength and exercise capacity in patients with lipoedema and obesity, and to use the findings to help distinguish between lipoedema and obesity. Design: This cross-sectional, comparative pilot study performed in the Dutch Expertise Centre of Lymphovascular Medicine, Drachten, a secondary-care facility, included 44 women aged 18 years or older with lipoedema and obesity. Twenty-two women with lipoedema (diagnosed according the criteria of Wold et al, 1951) and 22 women with body mass index ≥30kg/m2 (obesity) were include in the study. No interventions were undertaken as part of the study. Results: Muscle strength of the quadriceps was measured with the MicroFET™, and functional exercise capacity was measured with the 6-minute walk test. The group with lipoedema had, for both legs, significantly lower muscle strength (left: 259.9 Newtons [N]; right: 269.7 N; p < 0.001) than the group with obesity. The group with lipoedema had a non-significant, but clinically relevant lower exercise-endurance capacity (494.1±116.0 metres) than the group with obesity (523.9±62.9 metres; p=0.296). Conclusions: Patients with lipoedema exhibit muscle weakness in the quadriceps. This finding provides a potential new criterion for differentiating lipoedema from obesity. We recommend adding measuring of muscle strength and physical endurance to create an extra diagnostic parameter when assessing for lipoedema.
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Obesity, especially morbid obesity, is a major health problem with considerable impact on physical, mental and social quality of life. Assessment of quality of life is considered crucial to understand and evaluate the consequences of obesity. Obesity has major consequences for quality of life, e.g., as a result of co-morbidities of obesity and weight stigmatization.Bariatric surgery has been proven to lead to significant weight loss and improvement of quality of life. Besides obesity, also personal and psychosocial variables influence quality of life and affect the outcome of surgery. Moreover, obesity, even after substantial weight loss by gastric bypass surgery, is a chronic disease requiring life long consideration, in order to sustain long standing quality of life improvement.
DOCUMENT
BACKGROUND: Visceral obesity is associated with the metabolic syndrome. The metabolic risk differs per ethnicity, but reference values for visceral obesity for body composition analyses using Computed Tomography (CT) scans in the Caucasian population are lacking. Therefore, the aim of this study was to define gender specific reference values for visceral obesity in a Caucasian cohort based upon the association between the amount of visceral adipose tissue (VAT) and markers of increased metabolic risk.
METHODS: Visceral Adipose Tissue Area Index (VATI cm 2/m 2) at the level of vertebra L3 was analyzed using CT scans of 416 healthy living kidney donor candidates. The use of antihypertensive drugs and/or statins was used as an indicator for increased metabolic risk. Gender specific cut-off values for VATI with a sensitivity ≥80% were calculated using receiver operating characteristic (ROC) curves.
RESULTS: In both men and women who used antihypertensive drugs, statins or both, VATI was higher than in those who did not use these drugs (p ≤ 0.013). In males and females respectively, a value of VATI of ≥38.7 cm 2/m 2 and ≥24.9 cm 2/m 2 was associated with increased metabolic risk with a sensitivity of 80%. ROC analysis showed that VATI was a better predictor of increased metabolic risk than BMI (area under ROC curve (AUC) = 0.702 vs AUC = 0.556 in males and AUC = 0.757 vs AUC = 0.630 in females).
CONCLUSION: Gender and ethnicity specific cut-off values for visceral obesity are important in body composition research, although further validation is needed. This study also showed that quantification of VATI is a better predictor for metabolic risk than BMI.
DOCUMENT
Background&aims
Obesity and sarcopenia are major health concerns, particularly among older populations. Dietary protein may help preserve muscle mass and function, but high-protein diets, especially from animal sources, may also increase adipose mass. We investigated associations of total, animal, and plant protein intake with body composition trajectories, sarcopenia, and sarcopenic obesity.
Methods
We included 4576 participants (mean age 65.1 years, 56 % women) from the population-based Rotterdam Study. Dietary protein was measured using food-frequency questionnaires at baseline (2004–2009). Body composition was measured every 4–5 years using dual X-ray-absorptiometry. Handgrip strength (HGS) was assessed starting 2006 using a hydraulic dynamometer. Sarcopenia was determined based on low appendicular skeletal muscle and HGS; and sarcopenic obesity risk based on measures of lean mass, HGS and body fat. Analyses used linear mixed models and generalized estimate equation models.
Results
Higher total protein intake was associated with increased BMI over time (mean difference [95 %-confidence interval (CI)]: 0.86 kg/m2 [0.01,1.71] per 5E% increase), and increased fat-mass index (1.33 [0.67,1.99]), body-fat-percentage (4.54[2.76,6.31]), and both gynoid and android fat percentage. Higher protein intake was also associated with a higher sarcopenic obesity risk (−0.85[-1.5,-0.2]), but with a lower sarcopenia risk (odds ratio: 0.62 [0.43,0.90]). These associations were mainly driven by animal protein.
Conclusion
Higher protein intake, particularly from animal food sources, is protective against sarcopenia but also linked to a higher obesity risk. A balanced protein intake advice for older persons should be formulated based on individual needs and health status to prevent sarcopenia, obesity, and sarcopenic obesity.
MULTIFILE
Obesity, especially morbid obesity, is a major health problem with considerable impact on physical, mental and social quality of life. Assessment of quality of life is considered crucial to understand and evaluate the consequences of obesity. However, the heterogeneity of the quality of life concept makes it difficult to compare and value studies on quality of life. Both generic -applying to any disease- and obesity specific quality of life instruments can be used as assessment instruments in obesity. Generic instruments have the advantage that they can be used to compare the quality of life consequences of divergent diseases, whereas the major advantage of obesity specific instruments is that these are more sensitive to changes in obesity. Obesity has major consequences for quality of life, as a result of co-morbidities of obesity, weight stigmatization, and other less frequently ventilated problems. Bariatric surgery has been proven to lead to significant weight loss and improvement of quality of life. Instruments differ in the suitability to assess quality of life after surgery and weight loss, and they differ in the domains of quality of life that are tapped by the instruments. Besides obesity, also personal and psychosocial variables influence quality of life and affect the outcome of surgery. Obesity, even after substantial weight loss by gastric bypass surgery, is a chronic disease requiring life long consideration, in order to attain long standing quality of life improvement.
DOCUMENT
Background: Dietetic treatment of adults with obesity can result in effective weight loss with health improvements. However, it remains unclear which components of dietetic consultation are key for successful treatment of individual patients. Therefore, the aim of this study is to explore dietitians' perceptions of key components relevant for successful dietetic treatment of adults with obesity in primary health care in the Netherlands. Methods: In this phenomenological study, semistructured interviews were conducted with 18 dietitians who have experience in treating adults with obesity in primary care. Validation of interview data was performed through two focus group discussions with 14 dietitians. Thematic analysis was used to analyse the data. Results: Four main themes were identified: (i) building a good relationship; (ii) identifying patient needs; (iii) supporting behaviour change and (iv) providing advice. Dietitians highlighted the relevance of building a good relationship with their patients and emphasised adopting a counselling role alongside their role of educator. They also recommended the use of educational materials, counselling techniques and behaviour change strategies (e.g. goal setting, self-monitoring, addressing barriers) to address specific patient needs, such as health literacy, self-efficacy and motivation. Conclusions: This study demonstrates that dietitians perceive the ability to build a trusted relationship, in which patient needs are properly explored and addressed, as the key to successful dietetic treatment of adults with obesity. Our findings emphasise the importance of the dietitian's approach in this process and show that patient factors influence the choice of appropriate treatment approaches.
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