Obesity Reviews

Olatunbosun, S. T.; Kaufman, J. S.; Bella, A. F.

doi: 10.1111/j.1467-789X.2010.00801.xpmid: 20880100

Obesity is increasingly a major health problem in parts of the developing world. It has reached epidemic proportions among Africans living in the Western Hemisphere; similar potential may exist in urban Africa. We explored this possibility in an urban setting in Nigeria, Africa's most populous nation. A screening survey was carried out among randomly selected 998 civil servants, 581 men and 417 women, in Ibadan, a major Nigerian city. Biographical data were collected using standardized questionnaires, and measurements of anthropometric indices, blood pressures and plasma glucose concentration. Obesity and overweight were defined by body mass index based on international criteria. Prevalence of obesity was 8.82% (confidence interval [CI] = 7.13%, 10.75%), overweight 17.45% (CI = 15.12%, 19.95%), and overweight plus obesity = 26.18% (CI = 23.47%, 29.03%). Prevalence of obesity among the women was 17.27% (CI = 13.76%, 21.24%) and for men 2.75% (CI = 1.58%, 4.43%). Among the women 42% were obese or overweight compared with 15% of the male population. Obesity and overweight were associated with higher socioeconomic status. Prevalence of obesity and overweight in the study population is comparable to rates seen in many industrialized countries, and rapidly emerging urbanized populations in Africa.

Bond, M.; Wyatt, K.; Lloyd, J.; Taylor, R.

doi: 10.1111/j.1467-789X.2010.00713.xpmid: 20149120

Overweight and obesity in pre‐school children are an increasing problem, with poor diet and exercise habits laying the foundation for serious health risks in later life. Yet most research into childhood obesity has focused on school‐age children. Two previous systematic reviews of pre‐school children have included uncontrolled designs and self‐report outcomes potentially biasing the results in favour of the interventions. We have conducted a systematic review of the effectiveness and cost‐effectiveness of weight management schemes for the under fives restricting the inclusion criteria to controlled trials with objective measures. We found four effectiveness randomized controlled trials of prevention. No treatment or cost‐effectiveness studies were found. Only one study in a Latino community showed a statistically significant advantage from the intervention in a slower rate of increase in body mass index. However, trends in decrease in body mass index and weight loss favoured the intervention groups in other studies. From the studies characteristics we hypothesize that important features to include in future interventions may be; cultural sensitivity, sustained moderate to vigorous exercise, active engagement of the parents in the programme and as role models of healthy living and active engagement of the children in nutrition education. Further randomized controlled trials are needed in this population.

Tian, H. L; Tian, J. H; Yang, K. H; Yi, K.; Li, L.

doi: 10.1111/j.1467-789X.2010.00757.xpmid: 20546145

The aim of this meta‐analysis was to assess the effects of laparoscopic vs. open gastric bypass for morbid obesity. A systematic review of the literature was undertaken to assess randomized controlled trials on laparoscopic and open gastric bypass for morbid obesity. Six randomized controlled trials involving a total of 422 patients were included. There were 214 patients in the laparoscopic group and 208 patients in the open group separately. Compared with open surgery, laparoscopic surgery for morbid obesity could significantly shorten hospital stays (WMD = −1.11 d, 95% confidence interval [CI][−1.65, −0.56]). However, laparoscopic surgery for morbid obesity showed higher re‐operation (RR = 4.82, 95% CI [1.29, 17.98]) and longer surgical time (WMD = 28.00 min, 95% CI [7.84, 48.16]). There were no statistical differences in complication (RR = 0.84, 95% CI [0.64, 1.10]) and weight loss (WMD = 1.00 kg m−2, 95% CI [−0.79, 2.79]). The effects of laparoscopic and open gastric bypass for morbid obesity were basically the same except that laparoscopic had a shorter hospital stay and open surgery had a rate of fewer re‐operations and shorter surgical time. Further high‐quality, long follow‐up period randomized controlled trials should be carried out to provide more reliable evidence.

Stengel, A.; Goebel, M.; Taché, Y.

doi: 10.1111/j.1467-789X.2010.00770.xpmid: 20546141

The protein nucleobindin 2 (NUCB2) or NEFA (DNA binding/EF‐hand/acidic amino acid rich region) was identified over a decade ago and implicated in intracellular processes. New developments came with the report that post‐translational processing of hypothalamic NUCB2 may result in nesfatin‐1, nesfatin‐2 and nesfatin‐3 and convergent studies showing that nesfatin‐1 and full length NUCB2 injected in the brain potently inhibit the dark phase food intake in rodents including leptin receptor deficient Zucker rats. Nesfatin‐1 also reduces body weight gain, suggesting a role as a new anorexigenic factor and modulator of energy balance. In light of the obesity epidemic and its associated diseases, underlying new mechanisms regulating food intake may be promising targets in the drug treatment of obese patients particularly as the vast majority of them display reduced leptin sensitivity or leptin resistance while nesfatin‐1's mechanism of action is leptin independent. Although much progress on the localization of NUCB2/nesfatin‐1 in the brain and periphery as well as on the understanding of nesfatin‐1's anorexic effect have been achieved during the past three years, several important mechanisms have yet to be unraveled such as the identification of the nesfatin‐1 receptor and the regulation of NUCB2 processing and nesfatin‐1 release.

Diamant, M.; Blaak, E. E.; de Vos, W. M.

doi: 10.1111/j.1467-789X.2010.00797.xpmid: 20804522

The current obesity and type 2 diabetes pandemics have causes beyond changes in eating and exercise habits against a susceptible genetic background. Gut bacteria seem to additionally contribute to the differences in body weight, fat distribution, insulin sensitivity and glucose‐ and lipid‐metabolism. Data, mostly derived from preclinical studies, suggest that gut microbiota play an important role in conditions such as obesity, diabetes, metabolic syndrome and non‐alcoholic fatty liver disease. Regulation of energy uptake from the gut, by digesting otherwise indigestible common polysaccharides in our diet, production or activation of signalling molecules involved in host metabolism, modification of gut permeability, the release of gut hormones and inflammation, are among the mechanisms by which gut microbiota may influence the host cardiometabolic phenotype. Recent evidence suggests that quantitative and qualitative differences in gut microbiota exist between lean and obese, and between diabetic and non‐diabetic individuals. Modification of the gut microbiota composition and/or its biochemical capacity by specific dietary or pharmacological interventions may favourably affect host metabolism. Large‐scale intervention trials, investigating the potential benefit of prebiotics and probiotics in improving cardiometabolic health in high‐risk populations, are eagerly awaited.

Vance, V.; Mourtzakis, M.; McCargar, L.; Hanning, R.

doi: 10.1111/j.1467-789X.2010.00805.xpmid: 20880127

Weight gain is a common and persistent problem for many breast cancer survivors and is associated with adverse health consequences. A comprehensive review of the English language literature was conducted to investigate the frequency, magnitude and pattern of weight gain among breast cancer survivors, to identify factors that are associated with these changes and to review the clinical significance of weight gain on disease free survival and overall health. While there appears to be a general trend toward a reduction in the magnitude of weight gain in recent years, as many as 50–96% of women experience weight gain during treatment and many, including some women who remain weight stable during treatment, report progressive weight gain in the months and years after diagnosis. Weight gain is more common in women receiving adjuvant chemotherapy, especially for women receiving longer duration treatments and seems to be especially pronounced in premenopausal women. With or without weight gain, unfavourable changes in body composition including fat gain and loss of lean tissue are prevalent. This unique pattern of weight gain and change in body composition is distressing for most women, poses significant risk for the development of co‐morbid conditions and may impact on long term disease‐free survival.

Monasta, L.; Lobstein, T.; Cole, T. J.; Vignerová, J.; Cattaneo, A.

doi: 10.1111/j.1467-789X.2010.00748.xpmid: 20492539

Two international datasets are used to define overweight and obesity in pre‐school children: the International Obesity Task Force (IOTF) reference and the WHO standard. This study compares the performance of the two datasets in defining overweight and obesity in 24–60 months old children. This was done by plotting the IOTF cut‐offs against WHO curves and by comparing the prevalence of overweight and obesity, as defined by the IOTF reference and by the WHO standard, using 2001 data from the Czech Republic. The IOTF cut‐off for overweight in 24–60 months old children goes from 1.7 to 1.1 z‐scores on the WHO chart, and for obesity it shifts with age from 2.7 to 2.2 z‐scores. As a consequence, at 5 years of age the prevalence of overweight in Czech girls is 3.4% using the WHO and 15.3% using the IOTF definition. These discrepancies are due to the choice of cut‐offs and to the different criteria used to select the sample for the IOTF reference and the WHO standard. Research is urgently needed to identify, for the WHO standard, BMI cut‐offs associated with an increased risk of overweight and obesity, and associated health outcomes later in life.

Cole, T. J.; Viner, R. M.

doi: 10.1111/j.1467-789X.2010.00842.xpmid: 21418505

Reilly, J. J.; Kelly, J.; Wilson, D. C.

doi: 10.1111/j.1467-789X.2011.00868.xpmid: N/A

Plater, Suzanne; Egger, Garry

doi: 10.1111/j.1467-789X.2010.00854.xpmid: N/A