Supervised Exercise Immediately After Bariatric Surgery: the Study Protocol of the EFIBAR Randomized Controlled Trial
Enrique G. ArteroManuel Ferrez-MárquezMaría José Torrente‐SánchezElena Martínez‐RosalesAlejandro Carretero‐RuizAlba Hernández‐MartínezL. López-SánchezAlba Esteban‐SimónAndrea Romero del ReyManuel Alcaraz‐IbáñezManuel A. Rodríguez‐PérezEmílio Villa-GonzálezYaira Barranco‐RuizSonia Martínez-ForteCarlos Joel González CastilloCarlos Gómez NavarroJesús Aceituno CuberoRaúl Reyes ParrillaJ. Abelairas GómezPedro FemiaAna M. Fernández‐AlonsoAlberto Soriano‐Maldonado
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Abstract:
Previous studies have investigated weight loss caused by exercise following bariatric surgery. However, in most cases, the training program is poorly reported; the exercise type, volume, and intensity are briefly mentioned; and the sample size, selection criteria, and follow-up time vary greatly across studies.The EFIBAR study aims to investigate over 1 year the effects of a 16-week supervised exercise program, initiated immediately after bariatric surgery, on weight loss (primary outcome), body composition, cardiometabolic risk, physical fitness, and quality of life in patients with severe/extreme obesity.The EFIBAR study is a parallel-group, superiority, randomized controlled trial (RCT), comprising 80 surgery patients. Half of the participants, randomly selected, perform a 16-week supervised exercise program, including both strength and aerobic training, starting immediately after the surgery (7-14 days). For each participant, all primary and secondary outcomes are measured at three different time points: (i) before the surgery, (ii) after the intervention (≈4 months), and (iii) 1 year after the surgery.The EFIBAR study will provide new insights into the multidimensional benefits of exercise in adults with severe/extreme obesity following bariatric surgery.EFIBAR randomized controlled trial was prospectively registered at Clinicaltrials.gov (NCT03497546) on April 13, 2018.Keywords:
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Abstract: The Journal of Nutrition and Weight loss (JNWL) was inaugurated in 2016 and has continued publishing successfully with Volume 5 in 2020. Since the journal was established, JNWL has published in excess of 14 topical broadly such as diet pills, liquid diet, Yoga for weight loss, green tea weight loss, Vitamins for weight loss, Weight management, Ideal body weight, Obesity, Weight Reduction, Weight loss surgery, Overweight and Obesity, Ornish diet, Rapid weight loss, Body mass index (BMI), Body Mass composition, Non-surgical weight loss, Weight loss supplements, Weight loss diet, Weight Loss Medical Devices, Very low Calorie diet and Weight loss management program, Monitoring and treatment protocols. This journal was also accepting articles about animal nutrition.
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Abstract Objective Individuals seeking weight loss treatment have diverse pretreatment weight trajectories, and once enrolled, individuals' response to weight loss treatments also varies greatly and may be influenced by the presence of binge‐eating disorder (BED). Reported average weight losses may obscure these considerable differences. This study examined whether BED status and different weight‐related change variables are associated with successful weight loss treatment outcomes in a controlled treatment study. Method Participants ( N = 89) with overweight/obesity, with and without BED, participated in a 3‐month weight loss trial in primary care with 3‐ and 12‐month follow‐ups. We tested the prognostic significance of four weight‐related change variables (the last supper, early weight loss, pretreatment weight trajectory, weight suppression) on outcomes (weight loss‐overall, weight loss‐“subsequent,” weight loss during second half of treatment). Results Early weight loss was positively associated with weight loss‐overall at post‐treatment, and at 3‐month and 12‐month follow‐up. Early weight loss was positively associated with weight loss‐subsequent at post‐treatment only. No other weight‐related variables were significantly associated with weight loss. Models including BED status and treatment condition were not significant. Discussion Participants with early weight loss were more likely to continue losing weight, regardless of BED status or treatment condition. The results highlight the importance of early dedication to weight loss treatment to increase the likelihood of positive outcomes.
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Abstract The changing pattern of obesity‐related disease has created a need for a greater range of weight management options for the increasing number of people for whom weight loss and maintenance cannot be addressed by conventional dietary methods. Formula diet weight loss programmes [very low‐calorie diets ( VLCD s) (400–800 kcal/day) and low‐calorie diets ( LCD s) (800–1200 kcal/day)] can deliver weight loss at rates of 1–2 kg/week. This rate of weight loss can result in 10–20 kg weight loss in 8–12 weeks. Many health benefits associated with weight reduction seem to require between 10 and 20 kg weight loss. Formula diet programmes can result in weight loss, reduction of liver volume and reduction of visceral fat before bariatric surgery; weight loss before knee joint replacement surgery has also been shown. The benefit of pre‐operative weight loss is still under investigation and such practices before bariatric surgery are variable in surgical units across the UK . Weight loss with formula diet in obesity‐associated conditions where inflammation is an important component, such as osteoarthritis and psoriasis, has been demonstrated. Maintenance of about 10% of initial bodyweight loss, with symptom improvement in elderly obese people with knee osteoarthritis, has been shown over a period of 4 years. In obese people with psoriasis, weight loss with skin improvement has been maintained for 1 year. Clinical trials are currently underway to examine the merits of an initial weight loss with formula diet in pre‐diabetes, in early type 2 diabetes and in insulin‐treated type 2 diabetes. Rapid initial weight loss can result in rapid symptom improvement, such as reduced joint pain in osteoarthritis, improved sleep quality in obstructive sleep apnoea, reduced shortness of breath on exertion, reduced peripheral oedema and rapid improvement in metabolic control in diabetes, all changes that are highly motivating and conducive towards compliance. There is also some evidence for improved vitamin D status and maintained bone health in elderly obese people with osteoarthritis but more research is needed. Rapid initial weight loss was feared to be followed by rapid weight regain. However, provided initial weight loss is delivered in parallel with an intense education programme about nutrition, cooking, shopping and lifestyle for long‐term maintenance; and where long‐term support is provided, subsequent weight maintenance after VLCDs and LCDs has been shown to be possible. A recent literature review identified high‐protein diets, obesity drugs and partial use of formula meal replacements as methods which can result in statistically significantly greater weight maintenance after initial weight loss with VLCDs or LCDs . Anxiety about serious adverse side effects seems to be unfounded although users need to be aware of both minor and more serious, though very infrequent, adverse events, such as gallstones and gallbladder disease.
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