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Clinics in Endocrinology and Metabolism Nov 1984Energy expenditure of obese subjects living in a respiration chamber is higher than that of lean controls; this is due to a greater basal metabolic rate in the obese.... (Review)
Review
Energy expenditure of obese subjects living in a respiration chamber is higher than that of lean controls; this is due to a greater basal metabolic rate in the obese. Groups of obese subjects with a family history of obesity and/or a childhood onset of obesity have a reduced thermogenic response after glucose or meal ingestion. However, this defect in diet-induced thermogenesis is not a uniform finding, since only a third of an unselected group of obese women exhibit a reduced response. Moreover, obese subjects with reduced thermogenesis have a higher overall energy expenditure than lean people, even in situations in which a thermogenic response is produced. After inducing loss of weight with a hypocaloric diet, the thermogenic defect does not disappear. Since basal metabolic rate decreases with weight loss, the postprandial energy expenditure of some 'post-obese' subjects can be lower than that of lean controls. It is concluded that a thermogenic defect can contribute to the development of obesity in some predisposed subjects. The mechanisms of the thermogenic defect in the obese are presently unknown; insulin resistance and/or a blunted response of the sympathetic nervous system have been reported, but this topic remains controversial. After weight loss, energy expenditure decreases by about 84 kJ/24 h (20 kcal/24 h) per kg of weight loss in all patients. The need to reset energy intake to a lower level than the previous maintenance food consumption represents a major difficulty in the treatment of obesity; failure to adjust energy intake to the new requirements contributes to the frequent relapse of body weight gain in the obese after completion of a period on a hypocaloric diet.
Topics: Adult; Body Temperature Regulation; Body Weight; Eating; Energy Metabolism; Female; Humans; Male; Middle Aged; Obesity
PubMed: 6391755
DOI: 10.1016/s0300-595x(84)80038-9 -
Endocrine Mar 2021This article aims to provide guidance on prevention and treatment of COVID-19 in patients with genetic obesity. Key principals of the management of patients with genetic... (Review)
Review
Clinical management of patients with genetic obesity during COVID-19 pandemic: position paper of the ESE Growth & Genetic Obesity COVID-19 Study Group and Rare Endo-ERN main thematic group on Growth and Obesity.
This article aims to provide guidance on prevention and treatment of COVID-19 in patients with genetic obesity. Key principals of the management of patients with genetic obesity during COVID-19 pandemic for patients that have contracted COVID-19 are to be aware of: possible adrenal insufficiency (e.g., POMC deficiency, PWS); a more severe course in patients with concomitant immunodeficiency (e.g., LEP and LEPR deficiency), although defective leptin signalling could also be protective against the pro-inflammatory phenotype of COVID-19; disease severity being masked by insufficient awareness of symptoms in syndromic obesity patients with intellectual deficit (in particular PWS); to adjust medication dose to increased body size, preferably use dosing in m2; the high risk of malnutrition in patients with Sars-Cov2 infection, even in case of obesity. Key principals of the obesity management during the pandemic are to strive for optimal obesity management and a healthy lifestyle within the possibilities of the regulations to prevent weight (re)gain and to address anxiety within consultations, since prevalence of anxiety for COVID-19 is underestimated.
Topics: Anxiety; COVID-19; Disease Management; Healthy Lifestyle; Humans; Obesity; Pandemics
PubMed: 33512658
DOI: 10.1007/s12020-021-02619-y -
Endokrynologia Polska 2023The health of post-menopausal women has become of paramount concern due to the aging of the world's population. Concurrently, the prevalence of obesity among...
The health of post-menopausal women has become of paramount concern due to the aging of the world's population. Concurrently, the prevalence of obesity among postmenopausal women is expected to increase, presenting a significant public health challenge. Although weight gain during menopause is a well-observed phenomenon, its underlying causes and mechanisms remain incompletely understood. This manuscript reviews the literature to explore potential hormonal factors and pathomechanisms contributing to obesity during perimenopause, aiming to identify pathogenic factors that can guide treatment selection. Menopause-induced hormonal changes, including hypoestrogenaemia, hypergonadotropinaemia, relative hyperandrogenaemia, growth hormone deficiency, leptin resistance, and chronic stress affecting the hypothalamic-pituitary-adrenal axis, have been implicated in the onset of obesity in perimenopausal women. These hormonal fluctuations, alongside lowered daily energy expenditure, lead to metabolic alterations that elevate the risk of developing metabolic disorders and cardiovascular diseases. Weight gain in perimenopausal women is associated with higher total and abdominal adipose tissue and lower lean body mass. Addressing this issue requires individualized behavioural management, supported by effective pharmacological therapy, and, when warranted, complemented by bariatric surgery. Modern obesity treatment therapies have demonstrated safety and efficacy in clinical trials, offering the potential to reduce excess body fat, improve metabolic profiles, lower cardiovascular risk, and enhance the quality and longevity of women's lives. In addition to standard obesity therapies, the article examines different treatment strategies based on obesity's pathogenic factors, which may offer promising options for treating obesity with or without complications in perimenopausal women. One such potential approach is menopausal hormone therapy (MHT), which hypothetically targets visceral obesity by reducing visceral adipose tissue accumulation, preserving metabolically active lean body mass, and improving lipid profiles. However, despite these reported benefits, gynaecological and endocrinological societies currently do not recommend the use of MHT for obesity prevention or treatment, necessitating further research for validation. Emerging evidence suggests that visceral obesity could result from hypoestrogenaemia during perimenopause, potentially justifying the use of MHT as a causal treatment. This highlights the importance of advancing research efforts to unravel the intricate hormonal and metabolic changes that occur during perimenopause and their role in obesity development.
Topics: Female; Humans; Perimenopause; Obesity, Abdominal; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Obesity; Menopause; Weight Gain
PubMed: 37994584
DOI: 10.5603/ep.96679 -
The Proceedings of the Nutrition Society Feb 1999The purpose of the present paper is to outline the current situation in the management of obesity in adults, and to make some suggestions as to how health professionals... (Review)
Review
The purpose of the present paper is to outline the current situation in the management of obesity in adults, and to make some suggestions as to how health professionals involved in obesity treatment can best address this growing problem. Dietitians and nutritionists have long been involved in the treatment of obesity, and have a vital role to play in the battle to reverse the increasing prevalence of this major public health problem. However, the current management of obesity is far from ideal. There is evidence to suggest that in general health care, even when there are clearly effective clinical interventions, health professionals may not practise in the best way. Furthermore, some professionals may also hold negative attitudes towards the obese. These are the subject of a systematic review on improving health professionals' practice and organization of care in obesity treatment, the preliminary findings of which will be discussed in the present paper (Harvey et al. 1998a,b). A new approach to obesity is required, encompassing effective treatment and prevention strategies. A greater understanding of the problems faced by the obese individual in attempting to lose weight is also needed, with a range of treatment approaches on offer to acknowledge the heterogeneity of obesity. Those health professionals involved in obesity treatment must consider the impact of dietary advice given in a consultation against the impact of environmental cues that assail the patient as soon as they leave the room. Tackling the obesity epidemic requires action at the individual and population level if we are to see any reduction in prevalence.
Topics: Adult; Attitude of Health Personnel; Dietetics; Exercise; Humans; Obesity
PubMed: 10343340
DOI: 10.1079/pns19990008 -
Contributions To Nephrology 2006The prevalence of obesity among U.S. adults has doubled within the past two decades, and if trends continue, over one-third of U.S. adults may be obese by the year 2008.... (Review)
Review
BACKGROUND/AIMS
The prevalence of obesity among U.S. adults has doubled within the past two decades, and if trends continue, over one-third of U.S. adults may be obese by the year 2008. Concurrent with the rising prevalence of obesity is an epidemic of chronic kidney disease (CKD) with an estimated 18 million U.S. adults currently affected. This review discusses the strong and consistent association between CKD risk and increasing body mass index noted in several observational studies. Potential mechanisms for obesity's role in the development and progression of CKD and secondary focal segmental glomerulosclerosis are also discussed.
METHODS
Literature review.
RESULTS
Although obesity is an important risk factor for diabetes and hypertension, the two most common etiologies of kidney failure, obesity itself may increase CKD risk by increasing the metabolic demands on the kidney, which leads to higher glomerular capillary pressures and glomerular hypertrophy. The hyperinsulinemia frequently linked with obesity may also accelerate structural damage by interacting with angiotensin II and increasing collagen production and deposition. The histologic changes in the kidney noted in some obese, especially morbidly obese, adults frequently mimic those changes associated with secondary focal segmental glomerulosclerosis, which may occur in disease states such as severely reduced nephron mass and hemodynamic stress. Given the presence of genetic susceptibility and/or reduced nephron mass, obesity may potentiate the development and progression of secondary focal segmental glomerulosclerosis.
CONCLUSIONS
Obesity is an important risk factor for CKD. Treatment plans for obese adults with CKD should include weight loss and exercise because these interventions may simultaneously reduce the metabolic demands on the kidney, lower systemic and glomerular pressures, and improve insulin sensitivity. However, more studies are needed to further optimize the treatment and prevention of CKD associated with obesity.
Topics: Humans; Kidney Failure, Chronic; Obesity; Prevalence; Risk Factors; United States
PubMed: 16929130
DOI: 10.1159/000095315 -
Progress in Food & Nutrition Science 1989Obesity is a widespread condition, with different etiologies, that is usually treated only symptomatically i.e. through lowered energy intake. The existence of a latent... (Review)
Review
Obesity is a widespread condition, with different etiologies, that is usually treated only symptomatically i.e. through lowered energy intake. The existence of a latent situation of pre-obesity is postulated. The preobese is defined as a lean individual susceptible to easily develop obesity with unlimited food availability. The physiologic and metabolic pathways responsible of the appearance of obesity are revisited, as well as the current theories on body weight regulatory mechanisms. From this information, a classification of obesities is proposed: 1) Hypothalamic, 2) Bulimic, 3) Digestive, 4) Hyperinsulinemic, 5) Hypothermogenic, 6) Hypothyroid, and 7) Set point. These conditions should not be treated therapeutically in the same way, as the causes of development of the illness are not equal. The need to determine the individualized causes of obesity prior to any treatment is stressed.
Topics: Adipose Tissue; Eating; Energy Metabolism; Humans; Obesity; Weight Gain
PubMed: 2678268
DOI: No ID Found -
Lancet (London, England) Jul 1982
Topics: Animals; Humans; Measles virus; Mice; Mice, Obese; Obesity; Rats; Virus Diseases
PubMed: 6123814
DOI: No ID Found -
PloS One 2022Obesity is frequently debated as a factor associated with increased postoperative complications. Specifically, upper airway surgeries for obstructive sleep apnea (OSA),...
OBJECTIVE
Obesity is frequently debated as a factor associated with increased postoperative complications. Specifically, upper airway surgeries for obstructive sleep apnea (OSA), a common comorbidity among obese patients, may be complicated by obesity's impact on intraoperative ventilation. The aim of this retrospective study was to analyze the association of various degrees of obesity with postoperative outcomes in patients undergoing surgery for OSA.
METHODS
The American College of Surgeons National Surgical Quality Improvement database between 2015 and 2019 was used to create a sample of patients diagnosed with OSA who underwent uvulopalatopharyngoplasty, tracheotomy, and surgeries at the base of tongue, maxilla, palate, or nose/turbinate. Inverse probability-weighted logistic regression and unadjusted multivariable logistic regression were used to compare outcomes of non-obese and obesity class 1, class 2, and class 3 groups (World Health Organization classification). Primary outcome was a composite of 30-day readmissions, reoperations, and/or postoperative complications, and a secondary outcome was all-cause same-day hospital admission.
RESULTS
There were 1929 airway surgeries identified. The inverse probability-weighted regression comparing class 1, class 2, and class 3 obesity groups to non-obese patients showed no association between obesity and composite outcome and no association between obesity and hospital admission (all p-values > 0.05).
CONCLUSION
These results do not provide evidence that obesity is associated with poorer outcomes or hospital admission surrounding upper airway surgery for OSA. While these data points towards the safety of upper airway surgery in obese patients with OSA, larger prospective studies will aid in elucidating the impact of obesity.
Topics: Humans; Obesity; Postoperative Complications; Prospective Studies; Retrospective Studies; Sleep Apnea, Obstructive
PubMed: 35951502
DOI: 10.1371/journal.pone.0272331 -
Circulation Sep 1993The workshop provided the opportunity to discuss issues and develop and integrate ideas. The following recommendations for public policies, education programs, and... (Review)
Review
The workshop provided the opportunity to discuss issues and develop and integrate ideas. The following recommendations for public policies, education programs, and high-priority research initiatives were developed: Recommendations for Public Policies: Focus on prevention by requiring school programs to emphasize appropriate diet, physical activity, and general health guidance to promote cardiovascular health and prevent disease through federal funding. Provide better access to exercise (city planning, work-site interventions). Influence food availability and accessibility. Influence reimbursement policies for effective early intervention and prevention strategies for obesity. Reevaluate policies for use of drugs in the treatment of obesity. Recommendations for Education Programs: Sponsor scientific workshop to: Define the most appropriate weight standards for prevention and treatment. Identify who should lose weight and why, when, and how. Promote the fact that obesity is an important health risk factor, even at moderate levels, and that excess visceral fat is particularly hazardous. Target health care professionals, consumers, and the media for education about: Nature of obesity as a heterogeneous syndrome. Recommendations for diet, exercise, behavioral interventions, drugs, and surgery. Recognition of special needs of populations of different ethnicity, gender, age, etc. State-of-the-art treatment and treatment programs. High-Priority Research Initiatives: Build better bridges between basic research and treatment/prevention practices. Acknowledge that obesity is a heterogeneous syndrome that may best be characterized as different obesities. Research on defining subtypes. Implications for etiology and treatment. Better characterization of genotypes and phenotypes. Study the effects of weight loss, weight gain,and weight cycling on medical and psychosocial outcomes and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Animals; Body Weight; Cardiovascular Diseases; Diet, Reducing; Female; Humans; Life Style; Male; Obesity; Risk Factors
PubMed: 8353906
DOI: 10.1161/01.cir.88.3.1391 -
Revue Medicale Suisse May 2007Since the 1980s, an epidemic of obesity is occurring worldwide among adults and children. The body mass index (BMI) is useful to determine whether a child is overweight... (Review)
Review
Since the 1980s, an epidemic of obesity is occurring worldwide among adults and children. The body mass index (BMI) is useful to determine whether a child is overweight or obese because BMI relates strongly to body fat mass. However, contrary to adults, BMI changes with sex and age in children. Sex- and age-specific norms for BMI of the International obesity task force (IOTF) are now widely used. Approximately 15-20% of schoolchildren in Switzerland are currently overweight (or obese) and 2-5% are obese. Obesity is a major public health challenge. It is associated with numerous short and long term health hazards (in particular cardiovascular and metabolic disorders, e.g. diabetes) and it tracks form childhood throughout adulthood. This emphasizes the need for programs and polices aimed at preventing paediatric obesity.
Topics: Body Mass Index; Child; Humans; Obesity; Prevalence
PubMed: 17585631
DOI: No ID Found