Preffered Methods of Treating Obesity in Late Adulthood and Senior Age

Objective: To identify preferred solutions – therapy - for over- weight and obesity in older adults and seniors Participants: Atotal of 110 respondents were contacted, out of which 14 refused to cooperate or filled in the questionnaire incor- rectly. The return of questionnaires was 96, i.e. 100%. The group of respondents consisted of individuals of both sexes, aged 50 and over, living in anatural social environment or in one of the se- lected institutions. Due to the fact that - in our opinion - arela- tively large amount of attention is paid to the senior age group while the group of people in the age range of 50-64 is forgotten, we have not chosen the senior age respondents exclusively. Methods: The data obtained by the processing of the question- naires were analytically evaluated. For statistical processing apro- gram StatisticaCz version 9 was chosen, adescriptive analysis of the data was performed, followed by analysis by comparing av- erages and particular tests of statistical significance (Chi-square test, Kruskal Wallis, KendalovoTau). Results: An adjustment of the diet as apart of the solution of the overweight and obesity therapy would be chosen by the most re- spondents, 75 (46.5%) of them. 44 (27.0%) respondents would choose sport or other physical activity. 11 (6.7%) respondents would deal with overweight and obesity pharmacologically - with the help of medications, and only 25 (15.3%) respondents would choose surgery as away of dealing with overweight and obesity. On the contrary, only 8 (4.9%) respondents were not interested in dealing with the weight gain. 24 (25.0%) respondents would choose the surgical way of solving obesity. Ananswer“possibly yes”was chosen by13 (13.5%) respondents. 21 (21.9%) individu- als inclined to the “rather not” variant. 33 (34.4%) respondents chose the “certainly not”answer. An answer“I don't know” was chosen by 5 (5.2%) respondents. Conclusion:Obesity is aglobal social problem which is not to be solved just in healthcare and it is certainly not an issue of an individual.

Energy exchange: how we can personalize obesity therapy

Obesity is a consequence of chronic energy imbalance when energy intake constantly exceeds expenditure, which leads to excess white adipose tissue accumulation. Effective treatment of obesity requires accurate measure of calories intake and expenditure, as well as related behavior to understand how energy homeostasis is regulated and evaluate the effectiveness of the measures taken. The greatest interest is to study features of energy metabolism in various forms of obesity. It is necessary to create an evidence-based, personalized approach to diet therapy and to increase the effectiveness of weight loss measures. Modern studies have shown that the use of indirect calorimetry in obesity treatment programs leads to greater weight loss compared to traditional diet therapy planning based on calculated formulas.

Obesity: there are more questions than answers

See “Is brown adipose tissue a new target for obesity therapy?” Drapkina O. M., Kim O. T. in Review articles, pp. 134-138.

Is brown adipose tissue a new target for obesity therapy?

The rapid increase in the prevalence of obesity and related diseases has prompted researchers to seek novel effective therapeutic targets. Recently, brown adipose tissue has been in the spotlight as a potential target for treatment of metabolic diseases due to its ability to increase energy expenditure and regulate glucose and lipid homeostasis. The review presents the latest data on approaches aimed at activating and expanding brown adipose tissue in order to combat obesity.

Trefoil Factor Family Member 2: From a High-Fat-Induced Gene to a Potential Obesity Therapy Target

Obesity has its epidemiological patterns continuously increasing. With controlling both diet and exercise being the main approaches to manage the energy metabolism balance, a high-fat (HF) diet is of particular importance. Indeed, lipids have a low satiety potential but a high caloric density. Thus, focusing on pharmacologically targetable pathways remains an approach with promising therapeutic potential. Within this context, trefoil factor family member 2 (Tff2) has been characterized as specifically induced by HF diet rather than low-fat diet. TFF2 has also been linked to diverse neurological mechanisms and metabolic patterns suggesting its role in energy balance. The hypothesis is that TFF2 would be a HF diet-induced signal that regulates metabolism with a focus on lipids. Within this review, we put the spotlight on key findings highlighting this line of thought. Importantly, the hypothetical mechanisms pointed highlight TFF2 as an important contributor to obesity development via increasing lipids intestinal absorption and anabolism. Therefore, an outlook for future experimental activities and evaluation of the therapeutic potential of TFF2 inhibition is given. Indeed, its knockdown or downregulation would contribute to an antiobesity phenotype. We believe this work represents an addition to our understanding of the lipidic molecular implications in obesity, which will contribute to develop therapies aiming to manage the lipidic metabolic pathways including the absorption, storage and metabolism via targeting TFF2-related pathways. We briefly discuss important relevant concepts for both basic and clinical researchers.

Physical Activity and Social Network Use of Adolescents in Overweight and Obesity Treatment

Tackling obesity among adolescents requires the optimization of existing obesity treatment strategies. For this purpose, social and personal circumstances, individual needs and behavior of therapy participants need to be analyzed to tailor aims, content and methods of therapy interventions to the target groups. A total of 432 obesity therapy participants between 11 and 17 years completed a written survey in a national multi-center study conducted in 2015. The data collection on behavior, in terms of physical activity, media use and sociodemographic variables, was based on questionnaires from the KiGGS, HBSC and JIM studies. The results show that participants were found to be physically active together with friends (75.5%), alone (41.4%) and in sports clubs (34.9%). Girls (OR 1.55) were less likely to participate in sports clubs. Social networks, especially YouTube, WhatsApp, Instagram and Facebook, were widely used. However, differences emerged among sociodemographic groups (e.g., boys vs. girls) regarding the use of social network features. A third of participants reported that smartphone apps regularly encouraged them to exercise. The findings imply that obesity therapy approaches need to be adapted and more differentiated according to the specific needs of the target groups.

New Horizons: Is Obesity a Disorder of Neurotransmission?

Obesity is a disease of the nervous system. While some will view this statement as provocative, others will take it as obvious. Whatever our side is, the pharmacology tells us that targeting the nervous system works for promoting weight loss. It works, but at what cost? Is the nervous system a safe target for sustainable treatment of obesity? What have we learned – and unlearned – about the central control of energy balance in the last few years? In this Mini-Review, we provide a thought-provoking exploration of obesity as a disorder of neurotransmission. We discuss the state of knowledge on the brain pathways regulating energy homeostasis that are commonly targeted in anti-obesity therapy and explore how medications affecting neurotransmission such as atypical antipsychotics, antidepressants and antihistamines relate to body weight. Our goal is to provide the endocrine community with a conceptual framework that will help expending our understanding of the pathophysiology of obesity, a disease of the nervous system.

Vitamin A Status Improvement in Obesity: Findings and Perspectives Using Encapsulation Techniques

The association between obesity and vitamin A has been studied. Some studies point to the anti-obesity activity related to this vitamin, carotenoids with provitamin A activity, and carotenoid conversion products. This performance has been evaluated in respect of adipogenesis, metabolic activity, oxidation processes, secretory function, and oxidative stress modulation, showing a new property attributed to vitamin A in preventing and treating obesity. However, vitamin A and its precursors are highly sensitive and easily degraded when subjected to heat, the presence of light, and oxygen, in addition to losses related to the processes of digestion and absorption. In this context, encapsulation presents itself as an alternative capable of increasing vitamin A’s stability in the face of unfavorable conditions in the environment, which can reduce its functionality. Considering that vitamin A’s status shows a strong correlation with obesity and is an innovative theme, this article addresses the associations between vitamin A’s consumption and its precursors, encapsulated or not, and its physiological effects on obesity. The present narrative review points out those recent studies that demonstrate that vitamin A and its encapsulated precursors have the most preserved functionality, which guarantees better effects on obesity therapy.

OP0197 EVALUATION OF THE RELATIONSHIP OF LEPTIN WITH THE METABOLIC PHENOTYPE OF KNEE OSTEOARTHRITIS IN THE CONTEXT OF OBESITY THERAPY

Background:Obesity and components of the metabolic syndrome (MS) play a key role in the pathogenesis of the metabolic phenotype of osteoarthritis (OA). Obesity is a process meta inflammation due to the synthesis of proinflammatory mediators (adipokines and adipocytokines). The severity of OA depends on the presence of obesity, adipokine activity, comorbidity, and the presence of MS. The problem of treatment of metabolic OA and obesity is very relevant, in connection with the obesity pandemic.Objectives:To evaluate the relationship of leptin with the clinical manifestations of OA and various components of MS in the context of obesity therapy.Methods:The study included 50 female patients aged 45-65 y.o. with Kellgren-Lawrence stage II-III knee OA and obesity (body mass index (BMI)>30kg/m2). The average age of the patients was 56.5 ± 5.86 years, the average duration of the disease was 7.43 ± 3.93 years. 62% of patients were diagnosed MS. Patients were randomly divided into 2 groups for the treatment of obesity. Patients from group 1 (n=25) took orlistat 120mg 3 times a day in combination with a hypocaloric diet and exercise for 6 months. Patients from group 2 (n=25) were on a hypocaloric diet in combination with exercise for 6 months. The groups were comparable in clinical parameters. The clinical course of OA was determined by the WOMAC and VAS. Anthropometric data (height, weight) were determined. All patients underwent a laboratory examination at 2 points (initially and after 6 months): a biochemical blood test, leptin was determined by PCR in peripheral blood.Results:8% of patients had 1 MS component, 34% - 2 MS components, 34% - 3 MS components, 22% - 4 MS components, and 2% - 5 MS components at the beginning of the study. High leptin levels (p=0.001) were determined in patients with more than 3 MS components. The correlation analysis showed direct correlations of high leptin levels with the severity of knee WOMAC pain (r=0.36, p=0.02) and VAS pain (r=0.51, p=0.01). A positive correlation was determined between high leptin levels and body weight (r=0.56, p<0.01) and waist circumference (r=0.38, p<0.01). Patients from group 1 had a significant decrease of body weight by 10.07% (p<0.05), the indicators of the WOMAC index improved: pain decreased by 52.5% (p<0.05), stiffness by 47.98% (p<0.05), joint functional failure by 51.55% (p<0.05) after 6 months of drug therapy for obesity. Patients of group 2 had a not significant decrease of body weight by 0.84% (p>0.05), and they were worse indicators of clinical manifestations of OA according to WOMAC compared to group 1 (p<0.05). 24% of patients from group 1 showed a decrease in the number of MS components. 12% of patients from group 2 had a decrease in the number of MS components and 12% patients increase in MS components. Patients from 1 group with a significant decrease in body weight, there was a decrease in the level of leptin (p = 0.05) (graphic 1), in contrast to patients without weight loss on the background of non-drug therapy (p = 0.64). We found direct correlations between a decrease in leptin levels and a decrease in the WOMAC index (pain, stiffness, joint functional failure, total WOMAC) (r=0.5, p=0.01; r=0.4, p=0.04; r=0.4, p=0.03; r=0.5, p=0.01, respectively). Patients with a decrease in the number of MS components had a significantly lower leptin levels (p=0.01).Graphic 1.Dynamic of leptin.Conclusion:Leptin is a predictor of a worse course of the metabolic phenotype of OA associated with MS and obesity. High levels of leptin were observed with more MS components, and were associated with the severity of knee pain and body weight. We observed a decrease in the level of leptin, a decrease in the number of MS components, and an improvement in the clinical manifestations of OA against the background of a significant decrease in body weight. Thus, the treatment of obesity in patients with the metabolic phenotype of OA and other interventions aimed at reducing the level of leptin may contribute to reducing the progression of knee OA.Disclosure of Interests:None declared