scholarly journals Precision medicine in adult and pediatric obesity: a clinical perspective

2019 ◽  
Vol 10 ◽  
pp. 204201881986302 ◽  
Author(s):  
Eric M. Bomberg ◽  
Justin R. Ryder ◽  
Richard C. Brundage ◽  
Robert J. Straka ◽  
Claudia K. Fox ◽  
...  
Keyword(s):  
Weight Loss ◽  
Precision Medicine ◽  
Pediatric Obesity ◽  
Lifestyle Modification ◽  
Clinical Perspective ◽  
Treatment Type ◽  
Treatment Plans ◽  
Obesity Interventions ◽  
Metabolic And Bariatric Surgery ◽  
Obesity Treatments

It remains largely unknown as to why some individuals experience substantial weight loss with obesity interventions, while others receiving these same interventions do not. Person-specific characteristics likely play a significant role in this heterogeneity in treatment response. The practice of precision medicine accounts for an individual’s genes, environment, and lifestyle when deciding upon treatment type and intensity in order to optimize benefit and minimize risk. In this review, we first discuss biopsychosocial determinants of obesity, as understanding the complexity of this disease is necessary for appreciating how difficult it is to develop individualized treatment plans. Next, we present literature on person-specific characteristics associated with, and predictive of, weight loss response to various obesity treatments including lifestyle modification, pharmacotherapy, metabolic and bariatric surgery, and medical devices. Finally, we discuss important gaps in our understanding of the causes of obesity in relation to the suboptimal treatment outcomes in certain patients, and offer solutions that may lead to the development of more effective and targeted obesity therapies.

scholarly journals Management of severe pediatric obesity

2021 ◽  
Vol 64 (6) ◽  
pp. 416-424
Author(s):  
Lindsey Yoojin Chung ◽  
Young-Jun Rhie
Keyword(s):  
Metabolic Syndrome ◽  
Pediatric Obesity ◽  
Eating Behaviors ◽  
Severe Obesity ◽  
Lifestyle Modification ◽  
Treatment Options ◽  
Public Health Problem ◽  
Alcoholic Fatty Liver ◽  
Treatment Of Obesity ◽  
Metabolic And Bariatric Surgery

Background: Pediatric obesity has increased over the decades, and in particular, severe pediatric obesity has become a serious public health problem. A concern has arisen that the COVID-19 pandemic may exacerbate the incidence of childhood obesity.Current Concepts: The consequences of severe pediatric obesity are more devastating than those of moderate obesity. Children with severe obesity are at a greater risk for hypertension, type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, atherosclerosis, and adult obesity. Correct assessment and diagnosis of a child with severe obesity is key to successful therapy. A thorough history and physical examination are important in identifying monogenic obesity or metabolic syndrome. Eating behaviors and psychosocial factors should be assessed to improve weight management outcomes. Treatment options for severe pediatric obesity include lifestyle modification, pharmacotherapy, and metabolic and bariatric surgery. Even though progress has been made with regard to the treatment of obesity, safe and effective treatment of severe pediatric obesity is challenging.Discussion and Conclusion: More efforts and innovations are needed to find a solution for the huge medical and emotional burden the children with severe obesity and their families are enduring.

Obesity Therapy: How and Why?

2020 ◽  
Vol 27 (2) ◽  
pp. 174-186 ◽  
Author(s):  
Sara Paccosi ◽  
Barbara Cresci ◽  
Laura Pala ◽  
Carlo Maria Rotella ◽  
Astrid Parenti
Keyword(s):  
Weight Loss ◽  
Lifestyle Modification ◽  
Herbal Medicines ◽  
The Internet ◽  
Obese Patients ◽  
Self Medication ◽  
Pharmacological Management ◽  
Regulatory Standards ◽  
Meta Analyses ◽  
Obesity Drugs

Background: Obesity represents the second preventable mortality cause worldwide, and is very often associated with type 2 Diabetes Mellitus (T2DM). The first line treatment is lifestyle modification to weight-loss, but for those who fail to achieve the goal or have difficulty in maintaining achieved results, pharmacological treatment is needed. Few drugs are available today, because of their side effects. Objective: We aim to review actual pharmacological management of obese patients, highlighting differences between Food and Drug Administration - and European Medicine Agency-approved molecules, and pointing out self-medications readily obtainable and widely distributed. Methods: Papers on obesity, weight loss, pharmacotherapy, self- medication and diet-aid products were selected using Medline. Research articles, systematic reviews, clinical trials and meta-analyses were screened. Results: Anti-obesity drugs with central mechanisms, such as phentermine and lorcaserin, are available in USA, but not in Europe. Phentermine/topiramate and naltrexone/bupropion combinations are now available, even though the former is still under investigation from EMA. Orlistat, with peripheral mechanisms, represents the only drug approved for weight reduction in adolescents. Liraglutide has been approved at higher dose for obesity. Anti-obesity drugs, readily obtainable from the internet, include crude-drug products and supplements for which there is often a lack of compliance to national regulatory standards. Conclusion: Mechanisms of weight loss drugs include the reduction of energy intake or the increase in energy expenditure and sense of satiety as well as the decrease of hunger or the reduction in calories absorption. Few drugs are approved, and differences exist between USA and Europe. Moreover, herbal medicines and supplements often sold on the internet and widely used by obese patients, present a risk of adverse effects.

Enrolling Caregivers in Obesity Interventions to Improve Obesity-Related Outcomes in Children

2021 ◽  
pp. 019394592110370
Author(s):  
Hannah Bessette ◽  
MinKyoung Song ◽  
Karen S. Lyons ◽  
Sydnee Stoyles ◽  
Christopher S. Lee ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Mass Index ◽  
Weight Loss ◽  
Linear Regression ◽  
Body Mass ◽  
Sedentary Time ◽  
Vigorous Physical Activity ◽  
Weight Loss Program ◽  
Weight Loss Programs ◽  
Obesity Interventions

In this study, we assessed the influences of change in moderate-to-vigorous physical activity (MVPA)/sedentary time (ST) of caregivers participating in a commercial weight-loss program on their children’s change in MVPA/ST. Data from 29 caregivers and their children were collected over 8 weeks. We used multivariable linear regression to assess associations of changes in caregiver’s percent of time spent in MVPA/ST and changes in their child’s percent of time spent in MVPA/ST. For caregivers that decreased body mass index (BMI) over 8 weeks, changes in caregivers’ MVPA was strongly associated with the change in children’s MVPA (β = 2.61 [95% CI: 0.45, 4.77]) compared to caregivers who maintained/increased BMI (β = 0.24 [–2.16, 2.64]). Changes in caregivers’ ST was strongly associated with changes in children’s ST (β = 2.42 [1.02, 3.81]) compared to caregivers who maintained/increased BMI (β = 0.35 [–0.45, 1.14]). Findings reinforce encouraging caregivers to enroll in weight-loss programs for the benefit of their children as well as for themselves.

scholarly journals Lifestyle modification for weight loss: effects on cardiorespiratory capacity in Patients with Class II and Class III Obesity

2021 ◽  
Author(s):  
Finn Wammer ◽  
Andrea Haberberger ◽  
Anita Dyb Linge ◽  
Tor Åge Myklebust ◽  
Sveinung Vemøy ◽  
...  
Keyword(s):  
Weight Loss ◽  
Lifestyle Modification ◽  
Class Ii ◽  
Class Iii ◽  
Class Iii Obesity

scholarly journals Beyond insurance: race-based disparities in the use of metabolic and bariatric surgery for the management of severe pediatric obesity

2020 ◽  
Vol 16 (3) ◽  
pp. 414-419 ◽  
Author(s):  
Numa P. Perez ◽  
Maggie L. Westfal ◽  
Sahael M. Stapleton ◽  
Fatima Cody Stanford ◽  
Cornelia L. Griggs ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Pediatric Obesity ◽  
Metabolic And Bariatric Surgery

Examining the Effect of Three Low-Intensity Pediatric Obesity Interventions

2014 ◽  
Vol 53 (14) ◽  
pp. 1367-1374 ◽  
Author(s):  
Shannon M. Looney ◽  
Hollie A. Raynor
Keyword(s):  
Primary Care ◽  
Pediatric Obesity ◽  
Controlled Trial ◽  
Primary Care Providers ◽  
Growth Monitoring ◽  
Care Providers ◽  
Behavioral Counseling ◽  
Low Intensity ◽  
Contact Hours ◽  
Obesity Treatments

Background. Primary care is an ideal setting to treat pediatric obesity. Effective, low-intensity (≤25 contact hours over 6 months) interventions that reduce standardized body mass index ( z-BMI) and can be delivered by primary care providers are needed. Objective. This pilot randomized controlled trial investigated the effect of 3 low-intensity (≤25 contact hours over 6 months) pediatric obesity treatments on z-BMI. Methods. Twenty-two families (children 8.0 ± 1.8 years, z-BMI of 2.34 ± 0.48) were randomized into 1 of 3, 6-month, low-intensity conditions: newsletter (N), newsletter and growth monitoring (N + GM), or newsletter and growth monitoring plus family-based behavioral counseling (N + GM + BC). Anthropometrics and child eating and leisure-time behaviors were measured. Results. Mixed-factor analyses of variance found a significant ( P < .05) main effect of time for z-BMI and servings per day of sugar sweetened beverages, with both decreasing over time. Conclusion. Low-intensity obesity treatments can reduce z-BMI and may be more feasible in primary care.

Abstract MP009: Changes in Aldosterone are Associated With Changes in Obesity-Related Factors in Normotensive Overweight/Obese Young Adults Undergoing Lifestyle Modification

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Jennifer Cooper ◽  
Linda Fried ◽  
Ping Tepper ◽  
Emma Barinas-Mitchell ◽  
Kim Sutton-Tyrrell
Keyword(s):  
Insulin Resistance ◽  
Blood Pressure ◽  
Weight Loss ◽  
Young Adults ◽  
Lifestyle Modification ◽  
Urinary Sodium ◽  
Dietary Sodium ◽  
Related Factor ◽  
Related Factors ◽  
Aldosterone Antagonists

Background: Elevated aldosterone promotes inflammation, insulin resistance, and hypertension. These effects are particularly important in obesity because adipocytes secrete factors that increase aldosterone production. Weight loss is thought to lower aldosterone levels, but little longitudinal data is available. We aimed to determine if, independent of changes in sodium intake, reductions in circulating aldosterone are associated with weight loss and improvements in inflammation, adipokines, insulin resistance, and blood pressure in normotensive overweight and obese young adults undergoing lifestyle modification. Methods: Participants were overweight/obese adults aged 20–45 years (20% male, 15% black) from the Slow Adverse Vascular Effects of excess weight trial, a study evaluating the relationships between weight loss, dietary sodium, and vascular health. Subjects were randomly assigned to a regular or reduced sodium diet, and all received a one-year nutrition and physical activity intervention. For this study, individuals providing valid baseline 24hr urine collections were included (n=281). Linear mixed models were used to evaluate associations between changes in aldosterone and changes in weight, blood pressure, and obesity-related factors. Results: Weight loss was significant at 6 months (∼7%), 12 months (∼6%), and 24 months (∼4%) (p<0.0001 for all). Within-subject decreases in aldosterone were associated with decreases in C-reactive protein, leptin, and homeostasis assessment of insulin resistance (HOMA-IR) and with increases in adiponectin (p<0.01 for all) in models including baseline age, sex, race, intervention arm, time since baseline, and baseline and concurrent changes in BMI, urinary sodium and potassium, and the obesity-related factor of interest. Decreases in aldosterone were associated with weight loss only in the subgroup (n=98) with metabolic syndrome (MetS) at baseline (MetS x percent weight loss p=0.02); a 10% weight reduction in this subgroup was associated with a 9% (95% CI 1–16) reduction in aldosterone. Though no association was detected between changes in aldosterone and mean arterial pressure (MAP), a significant association was found between reductions in MAP and 24hr urinary sodium in those with MetS (MetS x urinary sodium reduction p=0.02). Independent of weight loss, a 30% reduction in urinary sodium was associated with a 0.9 mm Hg (95% CI 0.2–1.6) decrease in MAP in those with MetS. Conclusions: Changes in aldosterone are associated with changes in obesity-related factors in overweight/obese normotensive young adults. In persons with MetS, weight loss and dietary sodium restriction are particularly useful to reduce aldosterone and MAP respectively. Given the adverse effects of excess aldosterone on cardiac and vascular remodeling, future studies should investigate the benefits of aldosterone antagonists in individuals with MetS.

scholarly journals LIBERTI: A SMART study in plastic surgery

2018 ◽  
Vol 15 (3) ◽  
pp. 286-293
Author(s):  
Jonathan C Hibbard ◽  
Jonathan S Friedstat ◽  
Sonia M Thomas ◽  
Renee E Edkins ◽  
C Scott Hultman ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Precision Medicine ◽  
Laser Treatment ◽  
Population Level ◽  
Patient Characteristics ◽  
Patient Response ◽  
Multiple Assignment ◽  
Laser Treatments ◽  
Treatment Plans ◽  
Treatment Rules

Background/aims: Laser treatment of burns scars is considered by some providers to be standard of care. However, there is little evidence-based research as to the true benefit. A number of factors hinder evaluation of the benefit of laser treatment. These include significant heterogeneity in patient response and possible delayed effects from the laser treatment. Moreover, laser treatments are often provided sequentially using different types of equipment and settings, so there are effectively a large number of overall treatment options that need to be compared. We propose a trial capable of coping with these issues and that also attempts to take advantage of the heterogeneous response in order to estimate optimal treatment plans personalized to each individual patient. It will be the first large-scale randomized trial to compare the effectiveness of laser treatments for burns scars and, to our knowledge, the very first example of the utility of a Sequential Multiple Assignment Randomized Trial in plastic surgery. Methods: We propose using a Sequential Multiple Assignment Randomized Trial design to investigate the effect of various permutations of laser treatment on hypertrophic burn scars. We will compare and test hypotheses regarding laser treatment effects at a general population level. Simultaneously, we hope to use the data generated to discover possible beneficial personalized treatment plans, tailored to individual patient characteristics. Results: We show that the proposed trial has good power to detect laser treatment effect at the overall population level, despite comparing a large number of treatment combinations. The trial will simultaneously provide high-quality data appropriate for estimating precision-medicine treatment rules. We detail population-level comparisons of interest and corresponding sample size calculations. We provide simulations to suggest the power of the trial to detect laser effect and also the possible benefits of personalization of laser treatment to individual characteristics. Conclusion: We propose, to our knowledge, the first use of a Sequential Multiple Assignment Randomized Trial in surgery. The trial is rigorously designed so that it is reasonably straightforward to implement and powered to answer general overall questions of interest. The trial is also designed to provide data that are suitable for the estimation of beneficial precision-medicine treatment rules that depend both on individual patient characteristics and on-going real-time patient response to treatment.

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