36-Month Evaluation of a Weight Management Programme in Chinese Overweight and Obese Adults

Background: Few comprehensive lifestyle intervention programmes have been investigated on overweight and obese adults in China. This study was to evaluate the effect of a 36-month weight management programme on weight loss and its maintenance among overweight and obese patients in Ningbo, China.Methods: Adults with BMI ≥24kg/m2 enrolled in this programme, including nutritional, physical activity, psychological and endocrinological counselling sessions, from July 2015 to January 2020. Adults participated in face-to-face counselling sessions and group-based education. Then, participants joined 21-day intensive programme using Bohe health APP and WeChat group to get personal advice of nutrition and lifestyle. In the end, participants were requested to join 33-month follow-ups including face-to-face counselling and personal advice on WeChat group. The main outcome was to evaluate the changes in weight at each followup from baseline weight.Results: In total, 692 adults participated in this entire weight management programme. During follow-ups, 579, 475, 299, 219, and 135 adults participated at 3, 6, 12, 24, and 36 months, respectively. All participants had a significant initial weight loss at 3 months, then maintained the weight loss during 33-month follow-ups. At 36 months, 11.0%, 6.4%, and 3.5% of all participants achieved 5%, 10%, and 15% weight loss from the baseline weight, respectively. Adjusted weight at 36 months was significantly reduced from the baseline weight in both sex (−7.2 kg).Conclusion: This weight management programme is suggested to benefit to reduce initial body weight and maintain long-term weight loss among overweight and obese adults.

Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis

ObjectiveTo determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme.DesignSystematic review and meta-analysis.Data sourcesTrial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Randomised trials of behavioural weight loss programmes in adults with overweight or obesity, reporting outcomes at ≥12 months, including at the end of the programme and after the end of the programme.Review methodsStudies were screened by two independent reviewers with discrepancies resolved by discussion. 5% of the studies identified in the searches met the inclusion criteria. One reviewer extracted the data and a second reviewer checked the data. Risk of bias was assessed with Cochrane’s risk of bias tool (version 1). The rate of change in weight was calculated (kg/month; converted to kg/year for interpretability) after the end of the programme in the intervention versus control groups by a mixed model with a random intercept. Associations between the rate of change in weight and prespecified variables were tested.ResultsData were analysed from 249 trials (n=59 081) with a mean length of follow-up of two years (longest 30 years). 56% of studies (n=140) had an unclear risk of bias, 21% (n=52) a low risk, and 23% (n=57) a high risk of bias. Regain in weight was faster in the intervention versus the no intervention control groups (0.12-0.32 kg/year) but the difference between groups was maintained for at least five years. Each kilogram of weight lost at the end of the programme was associated with faster regain in weight at a rate of 0.13-0.19 kg/year. Financial incentives for weight loss were associated with faster regain in weight at a rate of 1-1.5 kg/year. Compared with programmes with no meal replacements, interventions involving partial meal replacements were associated with faster regain in weight but not after adjustment for weight loss during the programme. Access to the programme outside of the study was associated with slower regain in weight. Programmes where the intensity of the interaction reduced gradually were also associated with slower regain in weight in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in regain in weight.ConclusionFaster regain in weight after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with reduced weight for at least five years after the end of the programme, after which data were limited. Continued availability of the programme to participants outside of the study predicted a slower regain in weight, and provision of financial incentives predicted faster regain in weight; no other clear associations were found.Study registrationPROSPERO CRD42018105744.

The risk of consequent nephropathy following initial weight loss in diabetic patients treated with sodium glucose cotransporter 2 inhibitors

Background There is a controversy over the association between obesity and the risk of renal events in patients with type 2 diabetes mellitus (T2DM). Furthermore, whether body weight (BW) loss following sodium glucose cotransporter 2 inhibitor (SGLT2i) treatment associated with risk of adverse renal events is unknown. Methods We used medical data from a multi-center healthcare provider in Taiwan, enrolling 8992 T2DM patients with a baseline/following-up BW data available after around 12 weeks of SGLT2i treatment, from June 1, 2016 to December 31, 2018. Patients were followed up until the occurrence of composite renal outcome (estimated glomerular filtration rate decline > 40% or end-stage kidney disease) or the end of study period, whichever occurred first. Results Participants were divided into six baseline BMI categories: < 18.5 (n = 55); 18.5–22.9 (n = 985); 23.0–24.9 (n = 1389); 25.0–29.9 (n = 3941); 30.0–34.9 (n = 1973); and ≥ 35.0 kg/m2 (n = 649). There were 38.9%, 23.5%, 24.7%, 8.4%, 2.7%, and 1.8% of patients experienced no-BW loss, initial BW loss of 0.0–2.4%, 2.5–4.9%, 5.0–7.4%, 7.5–9.9%, and ≥ 10.0%, associated with SGLT2i treatment, respectively. Compared with patients with normal BMI (BMI: 18.5–22.9 kg/m2), underweight (BMI: < 18.5 kg/m2) was associated with a higher risk of composite renal outcome (adjusted hazard ratio (aHR) [95% confidence intervals (CI)]: 2.17; [1.16–4.04]), whereas pre-obese (BMI: 25.0–29.9 kg/m2) associated with the lowest risk of composite renal outcome (0.52; [0.40–0.68]) after multivariate adjustment. Compared with those without BW loss after SGLT2i treatment, BW loss of 0.0–2.4% (0.55; [0.43–0.70]) and 2.5–4.9% (0.78; [0.63–0.98]) were associated with a lower risk, whereas BW loss ≥ 10.0% associated with a higher risk of composite renal outcome (1.61; [1.06–2.46]) after multivariate adjustment. Conclusion A modest BW loss of 0–5% associated with SGLT2i treatment was associated with a favorable renal outcome. Caution should be taken for whom are underweight at baseline or have a pronounced BW loss ≥ 10.0% associated with SGLT2i treatment, which was associated with a worse renal outcome.

Improvements in Long-Term Appetite-Regulating Hormones in Response to a Combined Lifestyle Intervention for Obesity

Altered levels of hormonal appetite regulators have been observed in obesity (BMI ≥ 30.0 kg/m2), most prominently increases of insulin and leptin (indicating resistance) as well as decreases of adiponectin - all of which are long-term energy regulators and adiposity signals. Disrupted signaling of these hormones may have detrimental effects on metabolism, but may also promote weight gain. Weight loss is often accompanied by normalizations of long-term adiposity signals, but findings concerning short-term appetite regulators after weight loss vary across interventions (e.g. very low calorie diets vs. exercise). Moreover, it is debated whether such weight-loss-induced hormonal changes may reflect a disposition for weight regain. Here, we investigated changes of long- and short-term appetite signals in response to an intensive 75-week combined lifestyle intervention (CLI) comprising a normocaloric healthy diet, physical activity and psychotherapy to promote improved long-term weight management. For 39 patients, data on fasting serum levels of appetite-regulating hormones (leptin, insulin, adiponectin, GIP, PP, PYY, CCK, FGF21) were available. Hormone levels were correlated to BMI at baseline (T0) and compared across three time points: T0, T1 (after 10 weeks; initial weight loss) and T2 (after 75 weeks; weight loss maintenance). T0-T1 hormone changes were correlated to BMI changes between T1 and T2 to investigate whether hormonal alterations during initial weight loss are associated with weight regain. At T0, hormone levels were not associated with BMI. BMI decreased significantly from T0 (40.13 kg/m2 ± 5.7) to T1 (38.2 ± 5.4, p &lt; .001) which was maintained at T2 (38.2 kg/m2 ± 5.9, p &lt; .001). There were no significant changes in GIP, PP, PYY, CCK and FGF21. Leptin decreased from T0 (44.9 ng/nl ± 15.3) to T1 (33 ng/nl ± 14.8, p &lt; .001) and T2 (38.6 ng/nl ± 16.0, p &lt; .01), just like insulin which was significantly decreased at T1 (123 pmol/l ± 65, p &lt; .05) and T2 (128 pmol/l ± 64, p &lt; .05) compared to T0 (160 pmol/l ± 80). Adiponectin did not change between T0 (3.36 ug/ml ± 2.1) and T1 (3.2 ug/ml ± 2.1), but was increased at T2 (3.7 ug/ml ± 2.9, p &lt; .01) compared to T1. T0-T2 BMI decrease correlated positively with T0-T2 decreases in leptin (r = .667, p &lt; .001), insulin (rho = .535, p &lt; .001) and increases of adiponectin (r = .412, p &lt; .01), but no other hormone. T0-T1 hormone changes did not predict T1-T2 BMI changes. Thus, a 75-week CLI was associated with beneficial changes in the long-term energy regulators adiponectin, leptin and insulin, but no changes in short-term appetite-regulating hormones were observed despite significant weight loss. Initial changes in appetite-regulating hormones were not associated with subsequent weight regain. Overall, our data suggest that a CLI does not lead to adverse changes in appetite regulation, but rather long-term improvements such as e.g. increased leptin and insulin sensitivity.

Endoscopic Management of Weight Regain in the Bariatric Patient

Despite initial weight loss following bariatric surgery, weight recidivism is common. While weight regain is multifactorial and includes behavioral, psychosocial, and medical causes, changes in anatomy also play a role. Dilation of the gastrojejunal anastomosis following Roux-en-Y gastric bypass and enlargement of the gastric sleeve following sleeve gastrectomy are both important considerations. Historically, surgical revision has been performed to address weight regain; however, morbidity and mortality are not insignificant. Over the past decade, a variety of endoscopic approaches have been described for weight recidivism, several of which have proven to be safe, effective, and durable. This article will review each of these techniques in detail.

Low-dose lung radiotherapy for COVID-19 lung disease: a preclinical efficacy study in a bleomycin model of pneumonitis

PurposeLow-dose whole lung radiotherapy (LDLR) has been proposed as a treatment for patients with acute respiratory distress syndrome associated with SARS-CoV-2 infection and clinical trials are underway. There is an urgent need for preclinical evidence to justify this approach and inform dose, scheduling and mechanisms of action.Materials and methodsFemale C57BL/6 mice were treated with intranasal bleomycin sulphate (7.5 or 11.25 units/kg, day 0), then exposed to whole lung radiation therapy (0.5, 1.0, 1.5 Gy or sham, day 3). Bodyweight was measured daily and lung tissue harvested for histology and flow cytometry on day 10. Computed tomography (CT) lung imaging was performed pre-radiation (day 3) and pre-endpoint (day 10).ResultsBleomycin caused pneumonitis of variable severity which correlated with weight loss. LDLR at 1.0 Gy was associated with a significant increase in the proportion of mice recovering to 98% of initial bodyweight and a proportion of these mice exhibited less severe histopathological lung changes. Mice experiencing moderate initial weight loss were more likely to respond to LDLR than those experiencing severe initial weight loss. Additionally, LDLR (1.0 Gy) significantly reduced bleomycin-induced increases in interstitial macrophages, CD103+ dendritic cells and neutrophil-DC hybrids. Overall,bleomycin-treated mice exhibited significantly higher percentages of non-aerated lung in left than right lungs and LDLR (1.0 Gy) prevented further reductions in aerated lung volume in right but not left lungs. LDLR at 0.5 and 1.5 Gy did not modulate bodyweight or flow cytometric readouts of bleomycin-induced pneumonitis.ConclusionsOur data support the concept that LDLR can ameliorate acute inflammatory lung injury, identify 1.0 Gy as the most effective dose and provide preliminary evidence that it is more effective in the context of moderate than severe pneumonitis. Mechanistically, LDLR at 1.0 Gy significantly suppressed bleomycin-induced accumulation of pulmonary interstitial macrophages, CD103+ dendritic cells and neutrophil-DC hybrids.

Pediatric Cushing’s syndrome: greater risk of being overweight or obese after long-term remission and its predictive factors

Objective Due to the rarity of Cushing’s syndrome (CS) in children and adolescents, data are scarce about BMI during active disease and following remission. Therefore, our aim was to analyze BMI after long-term remission and determine predictive factors for promptly identifying patients at risk of being overweight or obese after remission for CS. Design Retrospective cohort study. Patients 73 patients: 58 (79.4%) had Cushing disease, 40 males (58%), median age of 12 years (IQR: 9–15). The mean follow-up time was 22.4 ± 18.2 months (range: 4–98). Methods Main outcome measures: BMI, lipid profile, blood pressure, HOMA-IR. Results At diagnosis, only eight (11%) patients had a normal weight. Although the BMI z-score at the last follow-up improved (2.0 ± 0.7 to 1.0 ± 1.2, P < 0.001), 44% remained overweight or obese after 2 years of remission according to the Kaplan-Meier curves. The BMI z-scores at the last follow-up correlated only with HOMA-IR levels (r: 0.49, P = 0.027). We found two independent factors related to reaching a normal weight: BMI z-score at diagnosis (HR: 0.156, 95% CI: 0.038–0.644; P = 0.01) and BMI z-score change at 6 ± 2 months (HR: 2.980, 95% CI:1.473–6.028; P = 0.002), which had high accuracy when a cut-off of 0.5 was used for ROC analysis (AUC = 0.828 (0.67–0.97); P < 0.001). Conclusions Children and adolescents with CS have a high risk of being overweight or obese after successful treatment for their disease. At risk patients can be identified quickly based on their baseline BMI and initial weight loss after surgery. Efforts should focus on adopting healthy diet and lifestyle in the immediate postoperative period.

Radiotagging a long-distance migratory characid fish: reproduction after surgery, tag losses, and effects in weight

Although biotelemetry studies bring useful information, tagging is a highly invasive procedure. For this reason, we assess if intracoelomic tagging alters survivorship, weight gain and/or reproductive capacity of a neotropical migratory fish. In August 2016, 60 fish were equally and randomly distributed among 3 treatments: Control (anesthesia), sham surgery (anesthesia and surgery), and true surgery (anesthesia, surgery and tagging). Surveys for weight and tag expulsion were performed periodically from surgery through spawning (November/2016), with a final survey occurring in May/2017. Mortality was higher in true surgery (25% died) and for males. Twenty percent expelled tags, and initial weight loss followed by gain were verified for all treatments. Females of all treatments spawned, and fecundity and fertility were not different. Then, future studies should consider the losses due to death and tag expulsion when defining the sample number. We also encourage further investigations about differences in mortality between sex and weight variation, as well as any other factor that leads to increase in mortality. This is the first study that investigated tagging effects in reproduction of neotropical fishes, and since the methods and tags used are not species-specific, we infer that similar effects could occur in other species.