High prevalence of neurodevelopmental problems in adolescents eligible for bariatric surgery for severe obesity
Anna BjörkJovanna DahlgrenEva GronowitzFanny Henriksson WesselyAnnika JansonMy EngströmLovisa SjögrenTorsten OlbersKajsa Järvholm
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To assess the prevalence of neurodevelopmental problems in adolescents with severe obesity and their associations with binge eating and depression.Data were collected at inclusion in a randomised study of bariatric surgery in 48 adolescents (73% girls; mean age 15.7 ± 1.0 years; mean body mass index 42.6 ± 5.2 kg/m2 ). Parents completed questionnaires assessing their adolescents' symptoms of attention-deficit/hyperactivity disorder and autism spectrum disorder and reported earlier diagnoses. Patients answered self-report questionnaires on binge eating and depressive symptoms.The parents of 26/48 adolescents (54%) reported scores above cut-off for symptoms of the targeted disorders in their adolescents, but only 15% reported a diagnosis, 32% of adolescents reported binge eating, and 20% reported symptoms of clinical depression. No significant associations were found between neurodevelopmental problems and binge eating or depressive symptoms. Only a third of the adolescents reported no problems in either area.Two thirds of adolescents seeking surgical weight loss presented with substantial mental health problems (reported by themselves or their parents). This illustrates the importance of a multi-professional approach and the need to screen for and treat mental health disorders in adolescents with obesity.Keywords:
Severe obesity
Abstract Obesity treatment studies report attrition rates front 20% to 45%. To reduce attrition, researchers have proposed matching patients to treatment based upon level of obesity. The current study attempted to validate the commonly held assumption that a mismatch between obesity level and treatment will promote attrition. The level of obesity and attrition rates of 39 adults who enrolled in a 12‐session behavior therapy program were examined. As obesity level increased, so did attrition. Sixty‐nine percent of subjects with mild obesity, 43% of subjects with moderate obesity and 0% of subjects with severe obesity completed treatment.
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서 론 최근 전 세계적으로 비만인구의 수와 비율은 매우 빠른 속도로 증가하고 있다.미국의 경우 이상체중(ideal body weight)을 20% 이상 초과하는 인구의 비율이 50%를 넘었으 며, 1) 우리나라에서도 서구화된 식습관, 운동부족 등의 원인으 로 비만인구의 비율이 25%에 이른다. 2)아시아-태평양 비만진 단기준에 의하면 체질량 지수(body mass index, BMI [kg/m 2 ]) 가 18.5 미만을 저체중으로 정의하고 있으며, 18.5-22.9를정 상, 23-24.9이면과체중, 25-29.9이면비만, 30 이상이면 고 도비만이라 정의하고 있다. 2) 비만과 연관된 병태생리학적 변화는 모든 주요 장기에서 일어나며, 대사, 호르몬 및 생리학적인 변화가 비만과 연관 되어 발생할
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Significant childhood adversity and chronic life stress are highly prevalent in patients with severe obesity. Such stress has been found to increase risk of adulthood obesity by up to 50%, and it can also substantially degrade the effectiveness of evidence-based treatments for this chronic disease condition. Despite general appreciation of these facts, though, stress is not frequently measured in obesity research or routinely assessed during treatment for obesity or obesity-related complications. To address this important issue, we describe several validated tools that can be used for assessing life stress and discuss how information obtained from these instruments can be integrated into obesity treatment and research. Given the documented relevance of stress for obesity, we argue that stress assessment and management should be included in clinical treatments for obesity and that stress should be routinely measured in studies examining the long-term effects of obesity and obesity treatment.
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Abstract The prevalence of obesity has increased in recent years and is now considered a global epidemic. Due to the serious health and economic impacts of weight gain, an understanding of the consequences and causes of obesity is necessary in order to develop effective weight management strategies and implement weight loss programs. The objective of this chapter is to review the epidemiology, implications, etiology, and treatment of adult obesity. Obesity prevalence and trends, the health and economic implications of obesity, environmental and genetic determinants of obesity, benefits of weight loss treatment and treatment goals, obesity assessment, lifestyle, behavioral, and medical obesity treatment, and weight loss maintenance will be discussed.
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There are presented data of the study of the prevalence rate of obesity in children and adolescents residing in the city of Ivanteevka of the Moscow region. Indices of the prevalence rate of obesity were calculated per 1000 in child population of the appropriate age. The obesity in children and adolescents in the structure of endocrine diseases was found to be ranked as second. During the period from 2000 to 2013 there was revealed a consistent upward trend in the frequency of obesity in children. There was shown a possibility for the existence of regional features of the prevalence of obesity in children. The low incidence rate of the detection of obesity in children of the Moscow region may be caused by underdiagnosis of this form ofpathology. On the basis of own data the authors showed that the true prevalence rate of the obesity in children is much higher than the official data according to medical help seeking by patients. However, only 26.6% of children and adolescents with obesity are observed and receive treatment at the pediatric endocrinologist. This demonstrates the needfor increment in the medical activity and responsibility of children and parents, enhancement of their motivation in keeping healthy lifestyle, as well as improvement of the efficiency of the prevention of obesity by medical staff of children's polyclinics.
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Although the medical consequences of obesity are, quite rightly, the central focus of both obesity researchers and clinicians, it has increasingly become clear that the problems associated with obesity are not restricted simply to its effect on health; obesity also has a substantial impact on a person's health-related quality of life (HRQOL). HRQOL is generally regarded as a multidimensional construct encompassing emotional, physical, and social domains that reflect an individual's subjective evaluation and reaction to a health condition (1). Studies using both generic and obesity-specific measures of HRQOL have established that obesity is associated with profound decreases in HRQOL and that the greatest impairment tends to be on physically oriented domains of functioning (2,3). It has also been observed that the degree of HRQOL impairment tends to correspond with the level of obesity; heavier people report the greatest HRQOL impairment. Because the majority of obesity-related HRQOL studies have been conducted with individuals seeking treatment for their weight, typically university-based obesity treatment, it remains unknown whether the HRQOL among obese individuals who do not seek treatment differs markedly from those who do seek treatment. It is also unknown whether HRQOL differs among individuals with obesity seeking different forms of obesity treatment (e.g., outpatient treatment or gastric bypass). In this issue of Obesity Research, Kolotkin et al. (4) address these important questions by measuring obesity-specific HRQOL using the Impact of Weight on Quality of Life-Lite questionnaire (IWQOL-Lite) in a large (n = 3353) geographically and demographically diverse sample of overweight and obese adults who either were or were not seeking obesity treatment. Moreover, among those seeking treatment, the authors were able to capture the HRQOL of individuals along the range of obesity-treatment options from the least intensive (clinical trial involving infrequent meetings) to most intensive (gastric bypass surgery). Thus, this design allowed the authors to evaluate the continuum of available obesity treatments, as well as evaluate and compare HRQOL as a function of whether or not treatment was sought. Results indicated that, after controlling for age and body mass index, obesity-specific HRQOL was significantly more impaired according to the self-esteem, sexual life, work scales, and the IWQOL-Lite total score among treatment seekers compared with overweight/obese adults not currently seeking obesity treatment. Moreover, within treatment seekers, the degree of HRQOL impairment varied by treatment intensity. That is, the greatest level of impairment was found among gastric bypass patients, whereas the least HRQOL impairment was found among clinical-trial participants. Supplementary analyses indicated that greater HRQOL impairment was reported by whites, as well as by individuals with higher body mass indices, and by women in the non-treatment and clinical-trial groups. Although, in my view, this is a definitive study with regard to estimating the HRQOL of individuals with obesity, the non-treatment-seeking group of overweight and obese adults was not randomly selected, raising the possibility that their responses may not have been representative of the population of non-treatment-seeking individuals with obesity. Despite this possibility, the study by Kolotkin et al. (4) adds significantly to our knowledge by suggesting that the degree of HRQOL impairment corresponds with the intensity of the obesity treatment sought. Although we cannot determine from this study the role HRQOL played in a person's decision regarding whether or not to seek treatment or what type of treatment to seek, it is not unreasonable to propose that perceptions of HRQOL are important determinants of not only whether obese i2ndividuals seek treatment, but also the type of treatment they choose. The findings of Kolotkin et al. (4) imply that it may be both possible and worthwhile to use HRQOL assessments in a proactive way to assist obese individuals in making decisions about how to best manage their weight. That is, discussing the results of a HRQOL assessment with obese patients can stimulate a conversation that focuses explicitly on the impact their body weight has had on the way they live their life. Because body weight is generally gained slowly, many obese patients are not aware of the influence their weight has had on important dimensions until specific attention is given. Examining the impact of weight on these dimensions will allow clinicians to personalize the potential benefits that can be conferred from obesity treatment, as well as to help in the exploration of treatment options. For example, one of my former patients had stopped playing golf because his body weight increased by >100 kg. During our discussion of the results of his HRQOL assessment, however, it became evident to him that he had also abandoned many activities that he had previously enjoyed (e.g., mowing his lawn and taking his grandchild on day trips). Thus, as a result of the HRQOL assessment we were able to identify significant areas of impairment that prompted him to focus more acutely on his weight-control efforts so that he could “reclaim” his former life. Thus, HRQOL assessments can help clinicians identify important domains of functioning, set goals, discuss treatment options, and tailor a given treatment approach to the particular desires and needs of the individual. Despite the evidence from the study by Kolotkin et al. (4) and others suggesting that 1) individuals with obesity report decreases in HRQOL, 2) HRQOL varies in predictable ways (i.e., as a function of whether or not treatment is sought and the type of treatment sought), and 3) weight loss improves HRQOL (3,5,6), it is important to note that there is no consensus on what constitutes HRQOL, its domains, or how it is best measured. As it stands now, most generic and disease-specific HRQOL measures (including the IWQOL-Lite) focus on how patients are functioning, including their ability to perform the usual roles in their lives. In essence, these instruments simply measure self-reported health status and are used essentially as proxies for direct assessments of functional performance. Although the conceptualization of HRQOL as self-reported functional capacity has gained ascendancy in recent years, some have argued (7) that unless investigators tap into individual patient values, they are measuring only perceived health status, not HRQOL. In other words, an HRQOL score as typically derived does not reflect the values and meanings an individual places on his or her ability to perform a given function. The incorporation of individual values and preferences into HRQOL assessments will likely require researchers to supplement traditional questionnaire-based methodologies with other approaches (e.g., cognitive interviewing) that gather information on both the personal meanings associated with a given level of functioning and on the cognitive processes involved when one makes HRQOL judgments (8). Expanding both our conceptualization and measurement of HRQOL may not only increase our understanding of how obesity affects quality of life, but may also provide us with new ways to intervene to improve the lives of our patients. Nonetheless, within the current approaches to measuring HRQOL, the results of the study by Kolotkin et al. (4) confirm that the effects of obesity go far beyond its influence on physiological health parameters; obesity hampers an individual's capacity to live a full and satisfying life across a variety of important domains.
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Objective To know the trend of obesity in students, to forecast the developing trend, and explore measures for intervention. [Methods] The health survey data from the year 1994 to 2004 of students aged 7-18 years were collected. Using the standard weight for height as the obesity diagnostic standard, the obesity rates were calculated and analyzed. [Results] The obesity rates of students aged 7-18 years old from the year 1994 to 2004 rose 79.48%. The average rate was 13.57% and the average increasing rate per year was 6.82%. Obesity was more prevalent in boys than in girls. The obesity rates of boys were 2.12 times of girls' on average. The older the students, the higher the obesity rates were. [Conclusion] The prevalence of obesity in urban students is so severe that effective, overall and scientific intervention methods should be taken to cope with.
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The prevalence of obesity, a disorder linked to numerous comorbidities and metabolic complications, has recently increased dramatically worldwide and is highly prevalent in men, even at a young age. Compared to female patients, men with obesity more frequently have delayed diagnosis, higher severity of obesity, increased mortality rate, and only a minority of obese male patients are successfully treated, including with bariatric surgery. The aim of this review was to present the current state of knowledge about the clinical and therapeutic implications of obesity diagnosed in males.
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Conventionally, physiological and psychological differences between children and adults have directed their clinical care pathways, including treatment strategies, physician specialties, and health care facilities. One exception that has occurred gradually over the past few decades relates to the prevention and treatment of obesity. Striking similarities in obesity among adults, children, and adolescents have emerged — specifically, the increasing prevalence of obesity, multiple obesity-related coexisting conditions (medical, social, and psychological), and evolving methods of treatment.1-3 In addition, most adolescents who are obese remain obese as adults,4 and adults with obesity who were obese as adolescents have worse medical outcomes than persons . . .
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(1) Background: During the coronavirus disease 2019 (COVID-19) pandemic, the prevalence of obesity or severe obesity has increased worldwide to the point that it has even been referred to as a new disease. However, the impacts of the pandemic on obesity or severe obesity remain unclear, thus requiring a thorough examination of the leading factors of obesity and severe obesity during this time. (2) Methods: The required dataset for this study was extracted from the eighth (2019-2020) Korea National Health and Nutrition Examination Survey (KNHNES). The survey's data for 2019 and 2020 were analyzed to confirm the leading factors of obesity and severe obesity before and after the outbreak of COVID-19. The samples were weighted, and the data were analyzed using multiple logistic regression. (3) Results: In 2020, the prevalence of obesity and severe obesity in the Korean adult population aged 19 and over, compared with the normal weight group, showed significant increases of 2.5% and 1.4%, respectively, compared with those rates in 2019 (p < 0.05). The main variables affecting the obesity prevalence in Korean adults aged 19 and over in 2020 were gender, age, sitting time per day, and walking time per day, and the factors affecting severe obesity were gender and age. Meanwhile, the daily energy intake variable had no impact on the prevalence of obesity and severe obesity. (4) Conclusions: These findings will serve as a basis to help the present management directions and treatment approaches for individuals with obesity or severe obesity in the post-COVID-19 era.
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