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Postgraduate Medical Journal Jun 2022Prior studies have identified paediatric attending physicians' screening and management patterns related to overweight/obesity, but less is known about resident...
STUDY PURPOSE
Prior studies have identified paediatric attending physicians' screening and management patterns related to overweight/obesity, but less is known about resident physicians' behaviour. The objective was to understand paediatric resident physicians' knowledge, attitude and practice patterns of overweight/obesity screening and management.
STUDY DESIGN
We performed a retrospective chart review of preventive visits conducted by residents between August and October 2019. Charts of patients 2-18 years with body mass index ≥85th percentile at the visit were reviewed (85th-<95th for age and sex defined as overweight, ≥95th defined as obese). A survey was distributed to residents assessing knowledge, attitudes and barriers towards obesity management.
RESULTS
Of 1250 visits reviewed, 405 (32%) patients met the criteria for overweight or obesity. 39% were identified correctly by the provider, 53% were not identified and 8% were identified incorrectly. 89% of patients had diet history, 31% had physical activity and 43% had family history documented. Patients with obesity received physical activity documentation/counselling, portion size counselling, at least one referral, laboratory tests and a diagnosis more often than overweight patients. 84% of residents completed the survey. Although the majority of residents felt 'somewhat' or 'very' well prepared to counsel families about overweight/obesity, the majority thought their counselling on overweight/obesity was 'not at all' or 'slightly' effective.
CONCLUSION
Despite residents feeling prepared and comfortable discussing overweight/obesity with patients, these diagnoses were often under-recognised or incorrectly made and appropriate counselling was lacking. Future work will focus on specific strategies to improve diagnosis, screening and management of overweight/obesity and include educational interventions and electronic medical record adaptations.
Topics: Body Mass Index; Child; Health Knowledge, Attitudes, Practice; Humans; Obesity; Overweight; Practice Patterns, Physicians'; Retrospective Studies
PubMed: 33541933
DOI: 10.1136/postgradmedj-2020-139318 -
Obstetrical & Gynecological Survey Jan 2023Obesity is one of the most common clinical entities complicating pregnancies and is associated with short- and long-term consequences for both the mother and the... (Review)
Review
IMPORTANCE
Obesity is one of the most common clinical entities complicating pregnancies and is associated with short- and long-term consequences for both the mother and the offspring.
OBJECTIVE
The aim of this study were to review and compare the most recently published influential guidelines on the management of maternal obesity in the preconceptional, antenatal, intrapartum, and postpartum period.
EVIDENCE ACQUISITION
A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynecologists of Canada, the Royal College of Obstetricians and Gynecologists, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists on obesity in pregnancy was carried out.
RESULTS
There is an overall agreement among the reviewed guidelines regarding the importance of prepregnancy weight loss with behavioral modification, optimization of gestational weight gain, and screening for comorbidities in improving pregnancy outcomes of obese women. Women with previous bariatric surgery should be screened for nutritional deficiencies and have a closer antenatal surveillance, according to all guidelines. In addition, folic acid supplementation is recommended for 1 to 3 months before conception and during the first trimester, but several discrepancies were identified with regard to other vitamins, iodine, calcium, and iron supplementation. All medical societies recommend early screening for gestational diabetes mellitus and early anesthetic assessment in obese women and suggest the use of aspirin for the prevention of preeclampsia when additional risk factors are present, although the optimal dosage is controversial. The International Federation of Gynecology and Obstetrics, Society of Obstetricians and Gynecologists of Canada, Royal College of Obstetricians and Gynecologists, and Royal Australian and New Zealand College of Obstetricians and Gynecologists point out that specific equipment and adequate resources must be readily available in all health care facilities managing obese pregnant women. Moreover, thromboprophylaxis and prophylactic antibiotics are indicated in case of cesarean delivery, and intrapartum fetal monitoring is justified during active labor in obese patients. However, there are no consistent protocols regarding the fetal surveillance, the monitoring of multiple gestations, the timing and mode of delivery, and the postpartum follow-up, although weight loss and breastfeeding are unanimously supported.
CONCLUSIONS
Obesity in pregnancy is a significant contributor to maternal and perinatal morbidity with a constantly rising global prevalence among reproductive-aged women. Thus, the development of uniform international protocols for the effective management of obese women is of paramount importance to safely guide clinical practice and subsequently improve pregnancy outcomes.
Topics: Pregnancy; Female; Humans; Adult; Obesity, Maternal; Anticoagulants; Australia; Venous Thromboembolism; Obesity
PubMed: 36607201
DOI: 10.1097/OGX.0000000000001091 -
Fertility and Sterility Sep 2022The associations between female obesity and adverse maternal and fetal outcomes are exhaustively documented with associations with ovulatory dysfunction, delayed time to... (Review)
Review
The associations between female obesity and adverse maternal and fetal outcomes are exhaustively documented with associations with ovulatory dysfunction, delayed time to pregnancy, increased pregnancy loss in all trimesters, increased rates of fetal anomalies, higher rates of gestational diabetes, increased rate of hypertensive disorders of pregnancy including pre-eclampsia, increased spontaneous and iatrogenic preterm delivery rates, conversely also higher rates of large for gestational age infants at term and increased risk of maternal and fetal birth trauma, increased rates of thromboembolic events. Although preconception weight loss is often recommended as the first step for women with obesity and infertility, there is no clear best method and the role of the treating infertility provider in managing the weight loss is often secondary, if at all. The risk benefit ratio of preconception weight loss is uncertain. Rebound weight gain often follows weight loss, especially after conception with recommended weight gain during pregnancy even among women with obesity. Even less is known about the effects of obesity and preconception weight loss in males.
Topics: Diabetes, Gestational; Female; Humans; Infant, Newborn; Infertility; Male; Obesity; Pregnancy; Weight Gain; Weight Loss
PubMed: 36116797
DOI: 10.1016/j.fertnstert.2022.07.026 -
Expert Review of Gastroenterology &... Oct 2021Obesity is a major public health concern with an increasing prevalence. Recent studies suggest an influence of gastrointestinal microbiota on obesity. Consequently,... (Review)
Review
INTRODUCTION
Obesity is a major public health concern with an increasing prevalence. Recent studies suggest an influence of gastrointestinal microbiota on obesity. Consequently, microbiota restoration therapies are being considered as potential management. We present data on microbiome markers and the future of microbiota therapeutics for obesity.
AREAS COVERED
We summarize the pathogenesis of obesity, relationship between gut microbiota and obesity, use of microbiota-based therapies. Data were gathered by a literature search of articles in PubMed from the date of inception till August 2020. Keywords used were 'gut microbiota,' 'gut microbiome,' 'microbiota,' 'microbiome,' 'obesity,' and 'obesity and fecal microbiota transplantation' as MeSH terms.
EXPERT OPINION
The direct relationship of gut microbiota in causing obesity needs exploration. Because of the scarcity of human studies, the utility of microbiota-based therapies as treatment remains uncertain and the use of microbiome restoration for obesity should be restricted to research settings. To evaluate the efficacy of microbiota restoration, studies using these therapies as an adjunct with diet and lifestyle should be conducted. Once relationships between bacterial strains and the human metabolic profile are determined, these strains could be cultured for transfer to obese patients. Such advancement could help in tailoring personalized therapies for obese persons.
Topics: Anti-Bacterial Agents; Combined Modality Therapy; Fecal Microbiota Transplantation; Gastrointestinal Microbiome; Humans; Obesity; Prebiotics; Probiotics
PubMed: 34329563
DOI: 10.1080/17474124.2021.1963232 -
Expert Review of Respiratory Medicine Sep 2020Obesity-associated asthma (OA) is frequently severe, with an increased rate of hospitalizations, numerous comorbidities and low response to corticosteroids. Despite... (Review)
Review
INTRODUCTION
Obesity-associated asthma (OA) is frequently severe, with an increased rate of hospitalizations, numerous comorbidities and low response to corticosteroids. Despite progress in applying for personalized medicine in asthma, no specific recommendations exist for the management of OA.
AREAS COVERED
The aim of this review is to summarize recent data about the relationship obesity-asthma, describe clinical characteristics, potential mechanisms involved and possible therapeutic interventions to improve OA outcomes. Extensive research in the PubMed was performed using the following terms: "asthma and obesity" and "obese asthma" in combination with "phenotypes", "airway inflammation", "biomarkers", "lung function", "weight loss", "lifestyle interventions", "therapies" Currently two phenotypes are described. Early-onset atopic asthma is conventional allergic asthma aggravated by the pro-inflammatory properties of adipose tissue in excess, while late-onset non-atopic asthma is due to airway dysfunction as a consequence of the chronic lung compression caused by the obese chest walls. Previous data showed that different therapeutic strategies used in weight loss have a positive impact on OA outcomes.
EXPERT OPINION
The presence of a multidisciplinary team (chest physician, nutritionist, exercise physiologist, physiotherapist, psychologist, bariatric surgeon) and the collaboration between different specialists are mandatory to optimize the management and to apply the personalized medicine in OA.
Topics: Asthma; Biomarkers; Female; Humans; Inflammation; Lung; Male; Obesity; Precision Medicine; Respiratory System; Weight Loss
PubMed: 32506978
DOI: 10.1080/17476348.2020.1780123 -
Cell Metabolism Feb 2023There is increasing interest in GDF15 analogs as therapeutic agents for obesity. In this issue of Cell Metabolism, Benichou et al. report the first clinical trial of...
There is increasing interest in GDF15 analogs as therapeutic agents for obesity. In this issue of Cell Metabolism, Benichou et al. report the first clinical trial of such a drug in obese humans.
Topics: Humans; Obesity; Growth Differentiation Factor 15
PubMed: 36754014
DOI: 10.1016/j.cmet.2023.01.002 -
The British Journal of Surgery Jan 2020Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in... (Review)
Review
BACKGROUND
Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients.
METHODS
A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta-analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non-obese populations were used.
RESULTS AND CONCLUSION
Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.
Topics: Airway Management; Humans; Obesity; Patient Positioning; Perioperative Care; Surgical Procedures, Operative
PubMed: 31903602
DOI: 10.1002/bjs.11447 -
Hospital Pediatrics Dec 2022Despite obesity's effect on pediatric patient health, the role of hospitalizations in recognizing and diagnosing pediatric obesity is poorly explored.
BACKGROUND AND OBJECTIVES
Despite obesity's effect on pediatric patient health, the role of hospitalizations in recognizing and diagnosing pediatric obesity is poorly explored.
METHODS
We performed a retrospective cohort study of pediatric inpatients aged 2 to 18 years utilizing CERNER Health Facts database to determine the: (1) prevalence of obesity in a large, multicenter inpatient database, (2) appropriate International Classification of Diseases, 10th Revision, obesity diagnosis proportion, and (3) variables associated with appropriate obesity diagnosis. Covariates included patient demographics and hospital descriptors, which were summarized using frequencies, and differences across groups were compared using χ Square testing.
RESULTS
Of the hospitalized children with obesity (19.5%), only 13.2% had an appropriate obesity diagnosis. Appropriate obesity diagnosis increased with higher obesity class and was least common in the South census region at only 8.5%.
CONCLUSIONS
Despite pediatric hospitalizations being a potential area for recognition and intervention of obesity, the majority of hospitalized children do not receive an appropriate obesity diagnosis.
Topics: Child; Humans; United States; Inpatients; Retrospective Studies; Hospitalization; Pediatric Obesity; Child, Hospitalized
PubMed: 36325803
DOI: 10.1542/hpeds.2022-006723 -
Pharmacological Research May 2023The better understanding of the molecular causes of rare genetic obesities and its associated phenotype involving the hypothalamus allows today to consider innovative... (Review)
Review
The better understanding of the molecular causes of rare genetic obesities and its associated phenotype involving the hypothalamus allows today to consider innovative therapeutics focused on hunger control. Several new pharmacological molecules benefit patients with monogenic or syndromic obesity. They are likely to be among the treatment options for these patients in the coming years, helping clinicians and patients prevent rapid weight progression and eventually limit bariatric surgery procedures, which is less effective in these patients. Their positioning in the management of such patients will be needed to be well defined to develop precision medicine in genetic forms of obesity.
Topics: Humans; Obesity; Bariatric Surgery
PubMed: 37037398
DOI: 10.1016/j.phrs.2023.106763 -
Reviews in Endocrine & Metabolic... Dec 2021Obesity, whose prevalence is pandemic and continuing to increase, is a major preventable and modifiable risk factor for diabetes and cardiovascular diseases, as well as... (Review)
Review
Obesity, whose prevalence is pandemic and continuing to increase, is a major preventable and modifiable risk factor for diabetes and cardiovascular diseases, as well as for cancer. Furthermore, epidemiological studies have shown that obesity is a negative independent prognostic factor for several oncological outcomes, including overall and cancer-specific survival, for several site-specific cancers as well as for all cancers combined. Yet, a recently growing body of evidence suggests that sometimes overweight and obesity may associate with better outcomes, and that immunotherapy may show improved response among obese patients compared with patients with a normal weight. The so-called 'obesity paradox' has been reported in several advanced cancer as well as in other diseases, albeit the mechanisms behind this unexpected relationship are still not clear. Aim of this review is to explore the expected as well as the paradoxical relationship between obesity and cancer prognosis, with a particular emphasis on the effects of cancer therapies in obese people.
Topics: Body Mass Index; Cardiovascular Diseases; Humans; Neoplasms; Obesity; Overweight; Prognosis; Risk Factors
PubMed: 33025385
DOI: 10.1007/s11154-020-09597-y