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Wagner MG, Rhee Y, Honrath K, Blodgett Salafia EH, Terbizan D. Nutrition education effective in increasing fruit and vegetable consumption among overweight and obese adults. Appetite. 2016 May 1;100:94-101. doi: 10.1016/j.appet.2016.02.002. Epub 2016 Feb 2. PMID: 26850310.

A change in dietary behavior is necessary to achieve weight loss in overweight and obese individuals. An increase in the consumption of fruits and vegetables is recommended due to the low caloric content and increase in dietary fiber and greatly impacts energy balance and aid in weight loss. This specific research study consisted of 54 male and female participants with a body mass index (BMI) of 25 kg/m^2 or have a history of bariatric surgery. The participants were split into three groups—the control group, the education group, and the fruit and vegetable group. This study determined the effectiveness of a community-based fruit and vegetable education program and provision of fruits and vegetables on change in consumption among overweight and obese individuals. A few goals of this study included exposure to different varieties of fruits and vegetables as well as provide education about the benefits of consumption. Results indicated that at pre-test none of the participants were consuming the recommended 5 or more servings of fruits and vegetables per day. In the present study, besides the control group, there was a significant increase in the frequency of fruit and vegetable consumption. There was an increase at the post-test and 26.4% of all participants reported to consume fruits and vegetables 5 or more time per week. Compared to the zero before, any improvements in fruit and vegetable consumption can help to improve patterns of obesity in individuals. In this study, the nutrition education intervention emphasis was to encourage participants to replace energy-dense nutrient poor foods with more fruits and vegetables emphasizing anti-oxidants, and many other vitamins and minerals. The findings of this study implicate that nutrition education is helpful in improving the consumption frequency of fruits and vegetables therefore helping to reduce the risk of overweight and obesity in adults in a short term. This is a short term study so there would need to be more long term studies to know the true effectiveness.

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Chen, H., Ye, Y., & Guo, J. (2020). Impact of weight stigma on preadolescents’ and adolescents’ disordered eating behaviors: Testing two mediation models. Social Behavior & Personality: An International Journal, 48(10), 1–15. https://doi-org.ezproxy.uky.edu/10.2224/sbp.9392

This is an important study because it examined the relationships among the four constructs of disordered eating behaviors, weight stigma, weight bias internalization, and core self-evaluation in one sample.

One of the three study’s hypotheses was that weight stigma will be positively correlated with disordered eating behaviors and weight bias internalization, whereas core self-evaluation will be negatively correlated with weight bias internalization, disordered eating behaviors, and weight stigma among preadolescents and adolescents.

One of the main study key findings was that weight stigma was associated with higher weight bias internalization, which was associated with lower core self-evaluation, and lower core self-evaluation was associated with higher disordered eating behaviors.

The clinical application of this study is that for treating disordered eating behaviors in preadolescents and adolescents, core self-evaluation and reducing weight bias internalization should be considered. Healthcare providers and caregivers should avoid weight stigma and weight bias when dealing with preadolescents and adolescents with disordered eating behaviors to minimize the related complications.

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Gómez-Ambrosi J, Silva C, Galofré JC, et al. Body adiposity and type 2 diabetes: increased risk with a high body fat percentage even having a normal BMI. Obesity (Silver Spring). 2011;19(7):1439-1444. doi:10.1038/oby.2011.36

This study is important because it reveals a possibility of practitioners overlooking skinny patients’ obesity due to overconfidence in BMI as a tool.  648 male and 1186 female patients were participated for evaluation of plasma glucose concentrations in blood sample obtained after an overnight fast.  It found that 32% of “lean” and 82% of “overweight” patients categorized by BMI were actually in a “obesity” level based on body fat % and had risks of pre- and type 2 diabetes.

This study’s key finding is the relationships between low BMI, high body fat % and obesity.  People in “normal” category of BMI could be vulnerable because of high adiposity, visceral fat which leads to inflammation and oxidative stress.  The study doesn’t mention about nutrition, but it gives us a new insight that nutritional interventions against obesity is not only to reduce weight, but also to lower sugar level in blood.

The clinical implication of this study is that body fat % is a superior measurement than BMI for obesity comorbidities like coronary heart disease and cardiovascular mortality.  Thus, practitioners should be aware of risks in undiagnosed low BMI patients.

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Swift JA, Tischler V, Markham S, et al. Are anti-stigma films a useful strategy for reducing weight bias among trainee healthcare professionals? Results of a pilot randomized control trial. Obes Facts. 2013;6(1):91-102. doi:10.1159/000348714

This study is important because it looked at health professionals in training and evaluated how obesity bias might be averted or lessened before careers begin.

One key finding was that obesity bias was present among medical and dietary students. The study was small but was able to determine that including brief, informative videos  about the  causes of obesity may improve trainees attitudes toward obesity and are worth further investigation in larger studies. I know that learning how obesity happens physiologically has gone a long way in changing my attitude toward obesity and people who suffer from the disease.

If full-scale randomized control trials prove this small study's work, we could see a huge decrease in fat shaming by health professionals by introducing curriculum early in training. What about if we taught this even earlier in life. Could we help the next generation by educating all students in health classes starting in late grade school?

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George A Bray, Samara Joy Nielsen, Barry M Popkin, Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity, The American Journal of Clinical Nutrition, Volume 79, Issue 4, April 2004, Pages 537–543, https://doi.org/10.1093/ajcn/79.4.537

Obesity is now at an epidemic level around the world and this study aims to link obesity to dietary consequence. High fructose corn syrup has been engineered as a sweetener found in many sodas and sugary fruit drinks as the source of the sweetened flavor. This study investigated the sharp rise in obesity in the United States and the relation to the increased consumption of high fructose corn syrup and obesity. The researchers suggested that obesity epidemic is growing at a rate that supersedes genetic factors being the only influence. This study is important because it indicated that environmental factors are influencing the drastic increase in obesity that is leading to epidemic levels. This study looked directly at high fructose corn syrup (HFCS) and found that there was in fact a link between obesity and high levels of high fructose corn syrup in diets analyzed from 1967 to 2000. A key finding of this study is that the increase use of HFCS in the United States directly mirrors the rapid increase in obesity in the participants. A nutritional concern with this study is that HFCS is found as the sweetening component of many fruity drinks and snacks as well as sodas (which the researchers indicated was at a rise in consumption as well). There are several clinical implications as a result of this study one of the most important being shifting to foods and beverages that contain other types of sweeteners. A suggestion to patients would be to limit processed foods, soft drinks and processed fruit drinks, and try to shift to various whole foods for snack like fresh fruits and veggies. If your sweet tooth remains look to home cooked sweets as opposed to processed store-bought sweets.

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Qi, Q., Chu, A. Y., Kang, J. H., Jensen, M. K., Curhan, G. C., Pasquale, L. R., Ridker, P. M., Hunter, D. J., Willett, W. C., Rimm, E. B., Chasman, D. I., Hu, F. B., & Qi, L. (2012). Sugar-sweetened beverages and genetic risk of obesity. The New England journal of medicine, 367(15), 1387–1396. https://doi.org/10.1056/NEJMoa1203039

This study is important because it looks at the relation sugar-sweetened beverages play on genetic predisposition for obesity. In this particular study, they analyzed three separate cohort groups of men and women health professionals. They also recorded their baseline statistics of all three cohorts and any changes in BMI after consuming different amounts of sugary beverages.

One key finding in this study is that greater consumption of sugar-sweetened beverages was associated with a greater genetic predisposition to elevated BMI and obesity risk among both men and women. All three of the cohort groups showed this positive association between sugary beverages and genetic predisposition to BMI and obesity risk. The study also looked at artificially sweetened beverages. There was slightly a smaller BMI increase in the people who were consuming artificially sweetened beverages compared to the people consuming sugar-sweetened beverages.

This study is important clinically because it shows that what we drink has an impact on our BMI and risk for obesity. When planning diets for patients it is also important to discuss recommended beverages. I think that if we keep this study in mind then it can help with the prevention or management of obesity.

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Sofi F, Dinu M, Pagliai G, Cesari F, Gori AM, Sereni A, Becatti M, Fiorillo C, Marcucci R, Casini A. Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet). Circulation. 2018 Mar 13;137(11):1103-1113. doi: 10.1161/CIRCULATIONAHA.117.030088. Epub 2018 Feb 26. PMID: 29483085.

Importance: The Mediterranean diet is generally recommended for all adults as one of the most healthful ways to eat. This study compares a low calorie vegetarian diet to a low calorie MD, looking at weight changes, inflammatory markers and lipid profiles (surrogates for cardiovascular disease risk). The study period was for 6 months, and it was a cross over design, so participants were randomized to complete 3 months of either diet, and then crossed over to 3 months of the other. Drop out rates were similar in both, as well as adherence to recommended macronutrients and caloric intake, indicating neither was significantly more difficult to comply with.

Key finding: Both the MD and VD lead to reduction in BMI and fat mass, while a VD led to a reduction in LDL and uric acid, while the MD led to a reduction in triglyceride level. The MD did lead to a decrease in IL17, an inflammatory marker, but otherwise, there were no changes in other inflammatory markers or oxidative stress markers with either of the diets.

Clinical implications: Having more healthful dietary options to present patients with is always a good thing – allowing them to find a diet that better fits their lifestyle is more efficacious than fitting one diet to everyone’s lifestyle. Aside from weight loss, there’s also promising metabolic syndrome and cardiovascular disease risk modifiers with both diets. One finding I thought was particularly interesting was the lowering of uric acid levels with the vegetarian diet. Difficult to control gout is something I run across fairly often, so having a specific dietary recommendation to make, rather than just avoid red/organ meats will be useful.

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Citation: Linkov F, Burke LE, Komaroff M, Edwards RP, Lokshin A, Styn MA, Tseytlin E, Freese KE, Bovbjerg DH. An exploratory investigation of links between changes in adipokines and quality of life in individuals undergoing weight loss interventions: possible implications for cancer research. Gynecol Oncol. 2014 Apr;133(1):67-72. doi: 10.1016/j.ygyno.2014.01.019. Epub 2014 Jan 22. PMID: 24462731; PMCID: PMC4340612.

This study is important because it shows that leptin can be used as a biomarker to help physicians gauge quality of life (QOL) in individuals undertaking weight loss measures. The main significance in my opinion is the application of this knowledge to encourage preventative strategies for obesity-related cancers.

One key finding from this study is that decreasing leptin levels were associated with increasing quality of life in individuals who are intentionally trying to lose weight through behavior modification. Leptin is known to play a role in regulating mood and emotion. This finding is related to nutrition because leptin is an adipokine whose secretion is increased as an individual becomes obese. A problem that is not addressed within the study is the idea of leptin resistance. Decreasing the amount of circulating does not always help correct the defects in leptin signaling. Investigating how to reactivate leptin sensitivity could be a way to help control body weight and energy expenditure.

The clinical implications for this study are quite clear. A focus needs to be placed on behavioral modification of weight. Weight loss is good in patients that are obese, however, it should be emphasized that an improved quality of life is what should be obtained. As individuals start controlling levels of leptin, then they are more likely to be motivated to make further positive behavior modifications. These modifications in theory can help prevent obesity-related cancers in these patients.

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Karri Silventoinen, Hanna Konttinen,
Obesity and eating behavior from the perspective of twin and genetic research,
Neuroscience & Biobehavioral Reviews,
Volume 109,
2020,
Pages 150-165,
ISSN 0149-7634,
https://doi.org/10.1016/j.neubiorev.2019.12.012.
(https://www.sciencedirect.com/science/article/pii/S0149763419305561)

This study is important as it looks at the eating behavior and obesity with twin research. By doing so, it is able to show that obesity is polygenic and heritable. It opens to the idea that obesity is dramatically increasing. The study hypothesized that obesity has a genetic background, and both family and society seem to impact this. Genetic influence was found to influence various nutrient intake. It was also shown to impact appetite and different behavioral intake on eating traits. I feel like I see this in real life, just from observing those around me. U.S. insurance started showing in the early 20th century that obesity and mortality were shown to have an association. The key finding that BMI is heritable is a huge conclusion. This also relates to nutritional sciences as it shows the connection with what your parents/family/guardians eat, the offspring typically eats the same. It is a very interesting connection that some may not think of. Clinical implications could include keeping this knowledge in the back of your mind when helping patients. Understanding the need to be open minded and offer help without targeting the person as the reason for their weight gain, when genetics may be a large factor.

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Citation:  Phelan S, Halfman T, Pinto AM, Foster GD. Behavioral and Psychological Strategies of Long-Term Weight Loss Maintainers in a Widely Available Weight Management Program. Obesity (Silver Spring). 2020 Feb;28(2):421-428. doi: 10.1002/oby.22685. PMID: 31970912; PMCID: PMC7003766.

Overview:

This was an observational study that looked at the behaviors and strategies of Long Term Weight Loss Maintainers (WLMs) in a commercial weight management program, in his case WW International (Weight Watchers), versus a control group of weight stable individuals with obesity.  The researchers state that while other national registries have tracked many strategies in clinical research settings, there are many strategies that have not been evaluated in an observational setting.  This study used validated questionnaires to identify and measure these weight loss strategies.

Why is this study important:

According to the researchers, this study is important because of the limited success in long-term weight maintenance.  The study objective was to evaluate successful strategies of individuals who are a part of a large commercial weight loss program so that those strategies can be incorporated into other weight loss programs.

While I feel that it is true that there is limited success to long-term weight maintenance, and therefore validating strategies is important, I also feel what is most interesting are the psychological coping mechanisms that individuals have or acquired to be successful in their weight maintenance efforts.

Key study findings related to nutritional sciences:

The study affirmed several well known weight maintenance strategies based on the National Weight Control Registry, such as consuming a low-calorie diet, self-monitoring and physical activity.  The results also demonstrated that WLMs focussed specifically on keeping low calorie foods accessible, set and tracked daily calorie goals, and practiced food measurement.  Successful psychological strategies included “thinking about past successes” and remaining positive if weight is regained.  WLMs also showed greater habit strength and less perceived maintenance effort when compared to weight stable individuals with obesity.  Interestingly, there was no difference in reporting of self-kindness, mindfulness and acceptance strategies.

Clinical Implications:

The clinical implications of this study include the validation of many lifestyle strategies that help with weight control, that can be applied to any weight loss program, not only a commercially available program such as WW.  As we have been discussing this week, nutrition intervention and education involves a high percentage of a practitioner's time focused on teaching psychological and behavior strategies and tools to patients, versus the education of selecting healthy nutritional choices.  For this reason, I found this study to be relevant.

The caveat that I would like to add however, is that acknowledgements and disclosures of this study revealed that the research was supported by a grant from WW International, Inc. and that 3 of the 4 researchers had potential conflicts of interest.  Important to note when evaluating and using the research.  While WW’s database of weight loss participants  for this type of research is robust and and quite valuable, it would be interesting to see additional observational studies of this nature that are not funded by the program of interest.

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Peña-Romero, A. C., Navas-Carrillo, D., Marín, F., & Orenes-Piñero, E. (2018). The future of nutrition: nutrigenomics and nutrigenetics in obesity and cardiovascular diseases. Critical reviews in food science and nutrition, 58(17), 3030-3041.

Importance: This study looks at obesity and cardiovascular disease through the lens of nutrigenomics and nutrigenetics. While macronutrients and micronutrients were popular within research for many years, this paper points out its inability to be broadly applied to patients due to a difference in how bodies respond to nutrients due to genetics and environment/epigenetics. This paper postulates that the field of nutrition in regards to obesity and CVD is headed toward genetic panels and a genetic-based personalized approach to nutritional recommendations.

Key Finding: This paper looked at 4 genes (APO-A, MC4R, INSIG2, and FTO), which have all been implicated in obesity. Each gene alters digestion and how nutrients are absorbed/used. Each gene requires a different nutritional recommendation. Knowing the exact genetic breakdown of a patient could personalize nutrition in a way that works for their body.

Clinical Implications: This paper shows where the whole of medicine (including nutrition) is headed: personalized genetic medicine. While this paper admits that a genetic panel for each client and genetic-based recommendations are not currently possible, they will soon be the gold standard in obesity treatment.

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Citation:Koochakpour G, Esfandiar Z, Hosseini-Esfahani F, Mirmiran P, Daneshpour MS, Sedaghati-Khayat B, Azizi F. Evaluating the interaction of common FTO genetic variants, added sugar, and trans-fatty acid intakes in altering obesity phenotypes. Nutr Metab Cardiovasc Dis. 2019 May;29(5):474-480. doi: 10.1016/j.numecd.2019.01.005. Epub 2019 Feb 1. PMID: 30954417.
Obesity is a current pandemic for several years. We are too easy to get the high calories of food and beverages, especially fatty acids and sugars, resulting in an increasingly obese population. This study shows whether the obesity-associated gene (FTO) interacts with extra sugar and trans-fatty acids. The researchers observe adult participants of the Tehran Lipid and Glucose Study. It helps patients or obese people to establish their diet strategies.

The critical finding is trans-fatty acids associating with FTO in BMI (body mass index) and WC (waist circumference). The researchers did single nucleotide polymorphisms (SNPs) to select the FTO gene and three SNPs related to trans-fatty acids. Although the study only discovered that trans-fatty acid intake influences minor alleles, it will conduct different approaches to understand the mechanism. Moreover, we know how to choose food, and it contributes to the gene functions. It also provides us information about trans-fatty acids and added sugar intakes.

In the clinic, it may examine the patients’ obesity-associated genes. It would target the significant genes to cure the patients in the medicine. Besides, we can provide personalized dietary guidelines.

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Nix, Robert L, Francis, Lori A, Feinberg, Mark E, Gill, Sukhdeep, Jones, Damon E, Hostetler, Michelle L, & Stifter, Cynthia A. (2021). Improving Toddlers' Healthy Eating Habits and Self-regulation: A Randomized Controlled Trial. Pediatrics (Evanston), 147(1), E20193326.

Why is this study important? This study shows the link between learned behaviors and nutritional choices later in life, which can determine if a child has a pre-disposition to obesity from a young age. While factors that can influence obesity are often genetic, research has shown that learned behavior plays a large role in lifetime nutrition and development of obesity.

Identify one key finding of this study and describe how it relates to nutritional sciences. One key finding was that toddlers not only were more likely to eat healthy, balanced meals, they also became better at self-regulation and delay of gratification when involving food, even with highly desired treats. Parents also were better at responsive feeding which circled back to the children learning healthy eating cues and responding to their own hunger rather than “cleaning their plate.”

What are the clinical implications of this study? This study shows that with some simple interventions with children when they are small, and with proper parental education, the nutritional outcome of a child can be improved. It would be interesting to see these children followed for 10-20 years and see if they retain some of their healthy eating habits for longer than the control group, and if they parental education was applied to subsequent children or if old habits returned. As the parent of a toddler, it is a constant struggle to know how much they should eat/when they should eat/what they should eat. Here is a balance to be had between foods that are quick and easy and that the child will eat, and foods that may be healthier but the child has no interest in. Educating adult patients will have a trickle-down effect if effective and will hopefully lead to healthier children. I hope that studies like this highlight the importance of education of parents, especially new parents, in forming healthy nutritional habits at a young age.

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Pradeep Yarra   Citation: European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol. 2019;70(1):172-193. doi:10.1016/j.jhep.2018.06.024                                        Question 1:   Why is this study important? In Cirrhosis patients, this article gives an elaborate review of guidelines for nutrition assessment and recommendations in chronic liver disease. In CLD patients, eating an adequate number of calories and protein is much more important than avoiding specific types of food, so it is important that patients can have a diet of their choice.                                  Identify one key finding of this study and describe how it relates to nutritional sciences.               There are a lot of recommendations, but here are which I found most important for bedside or outpatient practice:                       1)	split food intake into 3 main meals (breakfast, lunch and dinner) and 3 snacks (mid-morning, mid-afternoon, late evening). The late-evening snack is the most important, as it covers the long interval between dinner and breakfast. 2)	Optimal daily energy intake should not be lower than the recommended 35 kcal/kg. actual BW/d (in non-obese individuals). A tailored, moderately hypocaloric (-500–800 kcal/d) diet, including adequate protein intake (>1.5 g proteins/kg. Ideal BW/d) can be adopted to achieve weight loss without compromising protein stores in obese cirrhotic patients.       3)	Optimal daily protein intake should not be lower than the recommended 1.2–1.5 g/kg. actual BW/d. What are the clinical implications of this study?                 Clinical implication of this study will be in my daily practice. I will start with encouraging patients to have evening snack as a part of their diet. I will then educate about the nutritional needs and goals for the patients. Salt intake restriction and implement a nutritional and lifestyle program to achieve progressive weight loss (>5–10%) in obese cirrhotic patients (BMI >30)  

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Pradeep Yarra   Citation: European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol. 2019;70(1):172-193. doi:10.1016/j.jhep.2018.06.024                                        Question 1:   Why is this study important? In Cirrhosis patients, this article gives an elaborate review of guidelines for nutrition assessment and recommendations in chronic liver disease. In CLD patients, eating an adequate number of calories and protein is much more important than avoiding specific types of food, so it is important that patients can have a diet of their choice.                                  Identify one key finding of this study and describe how it relates to nutritional sciences.               There are a lot of recommendations, but here are which I found most important for bedside or outpatient practice:                       1)	split food intake into 3 main meals (breakfast, lunch and dinner) and 3 snacks (mid-morning, mid-afternoon, late evening). The late-evening snack is the most important, as it covers the long interval between dinner and breakfast. 2)	Optimal daily energy intake should not be lower than the recommended 35 kcal/kg. actual BW/d (in non-obese individuals). A tailored, moderately hypocaloric (-500–800 kcal/d) diet, including adequate protein intake (>1.5 g proteins/kg. Ideal BW/d) can be adopted to achieve weight loss without compromising protein stores in obese cirrhotic patients.       3)	Optimal daily protein intake should not be lower than the recommended 1.2–1.5 g/kg. actual BW/d. What are the clinical implications of this study?                 Clinical implication of this study will be in my daily practice. I will start with encouraging patients to have evening snack as a part of their diet. I will then educate about the nutritional needs and goals for the patients. Salt intake restriction and implement a nutritional and lifestyle program to achieve progressive weight loss (>5–10%) in obese cirrhotic patients (BMI >30)  

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Citation:

Cohen R, Newton-John T, Slater A. The case for body positivity on social media: Perspectives on current advances and future directions. Journal of Health Psychology. March 2020. doi:10.1177/1359105320912450

Key study question: Review of the potential benefits and disadvantages of ‘body positivity’ on social media in light of theory and the available research. Body positivity aims to change the definition of beauty in society by promoting acceptance and appreciation of all body shapes and sizes.

Key clinical findings:

There has been shown to be limited effectiveness and even perpetuation of eating disorders and obesity by the media portrayal of one body type as “healthy” and “beautiful”. In contrast to this, positive body image messages may provide a beneficial adjunct to prevention and intervention efforts.

Take away point: In 2021, social media provides an easy and phenomenal access to not just adults coping with weight problems, but it could also help direct and nurture adolescent minds towards a broader mindset.

Having said that, body positivity is about avoiding discriminating individuals on the basis of their weight while acknowledging the problems that come with obesity and work together towards common goals of health.

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Citation: Mattar A, Carlston D, Sariol G, Yu T, Almustafa A, Melton GB, Ahmed A. The prevalence of obesity documentation in Primary Care Electronic Medical Records. Are we acknowledging the problem? Appl Clin Inform. 2017 Jan 25;8(1):67-79. doi: 10.4338/ACI-2016-07-RA-0115. PMID: 28119990; PMCID: PMC5373753.

Importance: This retrospective  review brings to  light a  lack of acknowledgement and  documentation of  obesity in the primary care setting. This is important  because we must first recognize and diagnose the problem before it can be effectively treated.

Key Findings:  Reviewers looked at 10540 adult patient charts from a large private practice family medicine clinic and found that out of 3868 that met definition of obesity based on BMI, only 5.6% had this  documented on the problem list.  Documentation was found to be  more likely if patients  were female and morbidly obese.  Of those with  obesity noted as a diagnosis, only 30% received dietary counseling and  40% received exercise counseling.  Average time of counseling was very brief, <2minutes, although documentation of time spent was thought likely to not be entirely accounted for in each EMR.
Clinical Implications: This information is clinically significant  because of the cascade of not only health complications associated with obesity but also economic cost.  Obesity results in higher health care utilization and increased cost.  Obesity is  generally not being accurately recognized as a primary medical problem, resulting in lack of  counseling and referrals earlier in the disease process.  There are multiple factors that warrant attention, including  lack of structured approach to the problem  in addition to  insufficient resources  in the primary care setting, to include but not limited to  time, patient education resources, reimbursement for  nutrition counseling and lack of  clinical expertise and training.

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Citation: Brocks DR, Ben-Eltriki M, Gabr RQ, Padwal RS. The effects of gastric bypass surgery on drug absorption and pharmacokinetics. Expert Opin Drug Metab Toxicol. 2012 Dec;8(12):1505-19. doi: 10.1517/17425255.2012.722757. Epub 2012 Sep 24. PMID: 22998066.

This review article is important for two main reasons. One, the authors found only 15 studies that discuss pharmacokinetics after gastric bypass. Two, close to 220,000 people in the US/Canada received gastric bypass surgery. Since the number of patients receiving gastric bypass has increased each year since 2012, this is important knowledge.

There is little known about this topic and no consensus guidelines for dosing drugs to gastric bypass patients. However, the article discusses a few potential factors to consider when patients undergo Roux-en-Y gastric bypass (RYGB). Since RYGB bypasses a large part of the small intestine (SI), poorly soluble or extended-release drug formulations can be affected by the altered SI transit time. Out of studied drugs, bioavailability decreased for several drugs but was unchanged with others. Their biggest conclusion was that the effect RYGB has on drug absorption is very drug dependent.

The clinical implications of this paper are that prescribers of medication should carefully note the characteristics of the drugs they prescribe to patients post-RYGB because there are instances in which bioavailability is decreased. Prescribers that often see post-RYGB patients should stay up to date on which drugs have been studied in this context since the effects seem to be drug specific.

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Citation:
Ambroszkiewicz, J., Chełchowska, M., Rowicka, G., Klemarczyk, W., Strucińska, M., & Gajewska, J. (2018, September 06). Anti-Inflammatory and Pro-Inflammatory Adipokine profiles in children on vegetarian and omnivorous diets. February 2021. https://www.mdpi.com/2072-6643/10/9/1241/htm

Importance:
This study is important because it attempted to correlate different  adipokine and pro-inflammatory vs. anti-inflammatory cytokines levels in kids age 5-10 who were either consuming a vegan based diet vs. a omnivorous diet. The dependent variable was measured by immunoenzymatic assays and measured the concentrations of leptin, soluble leptin receptor (sOB-R), adiponectin, resistin, visfatin, vaspin, and omentin. The resultant levels determined the pro-inflammatory:anti-inflammatory profile for each of the children.  Given the two different diets, these values would allow us to relate the adipokine levels in the two populations simply based on diet.

Results/ Key Finding:
There was not a significant enough result for this the difference in adipokine levels in the two populations. But, anti-inflammatory and pro-inflammatory balance in the vegan population showed evidence of heavily favoring anti-inflammatory over pro-inflammatory cytokine secretion potentially due to the overall diet quality. These findings could lead us to relate more diets and life-style interventions to adipocyte secretions that are seen in chronic inflammation and chronic diseased states. I think it is so important that we encourage a diverse diet quality, but everyone has the ability to make their own decisions. As clinicians and dietitians, it is key for us to understand those who wish to restrict their diet in a certain way. Especially in studies such as this, I think it is particularly clinically relevant to study sustained diets in pre-pubescent populations, who later carry these diets into later adult life. For example, imagine an older person who had maybe only eaten single red meat for their entire life. What if we give them the same medicines and interventions we give to everyone else and they react differently? What are the implications of this? I like the direction of this study and the population more than anything.

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Citation: Katterman, S.N., Kleinman, B.M., Hood, M. M., Nackers, L.M. & Corsica, J.A. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systematic review.  (2014) Eating Behaviors, 15 (2).  https://doi.org/10.1016/j.eatbeh.2014.01.005.

Importance: Mindfulness-based approaches have become a popular practice in western medicine with broad application regarding behavior change and the prevention and management of chronic disease and mental illness. Mindfulness or rather mindful eating interventions are being increasingly incorporated by practitioners working with patients struggling with disordered eating and weight loss.  Mindful eating interventions are not limited to only the previously mentioned patients but are also being used to assist patients with changing eating behaviors necessary to manage chronic diseases such as diabetes and cardiovascular disease.  This study is important because it reviews the effectiveness of mindfulness as an intervention for weight loss related behavior change.

Key Finding: Mindfulness interventions alone, without supplemental behavioral weight management strategies may not produce significant or consistent weight loss results.

Clinical Implications: Although the results of this study did not indicate that mindfulness intervention alone was effective for short-term weight loss (none of the studies examined weight loss outcomes longer than 4 months) the researchers indicate that there is potential positive effects on long-term weight change and that further research is needed.  The authors did indicate that mindfulness intervention is effective at reducing binge eating behaviors and may also reduce emotional eating.

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Citation:

Skinner, R,  Gonet, V,  Currie, S,  Hoddinott, P,  Dombrowski, SU.  A systematic review with meta‐analyses of text message‐delivered behaviour change interventions for weight loss and weight loss maintenance. Obesity Reviews.  2020; 21:e12999. https://doi-org.ezproxy.uky.edu/10.1111/obr.12999

Importance:

Finding helpful way to promote behavior change in weight loss patients.

Key findings:

This systematic review looked at studies that used text messaging to promote behavior change. They found that text messaging is a low cost way to help elicit behavior change and promote weight loss.  This is important because its a low cost effective way to help promote weight loss in patients.

Clinical Implications:

This would be a good idea for healthcare groups to adapt into a weight loss program. For example, if University of Kentucky doctors could offer a weight loss program to patients where they would get text messages from dietitians. The possibly of involving this type of intervention into a weight loss program would be beneficial and cost effective.

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Citation: Bruci A, Tuccinardi D, Tozzi R, Balena A, Santucci S, Frontani R, Mariani S, Basciani S, Spera G, Gnessi L, Lubrano C, Watanabe M. Very Low-Calorie Ketogenic Diet: A Safe and Effective Tool for Weight Loss in Patients with Obesity and Mild Kidney Failure. Nutrients. 2020; 12(2):333. https://doi.org/10.3390/nu12020333

Very low-calorie ketogenic diet (VLCKD) are effective and increasingly used tool for weight loss. This diet is traditionally considered high protein, thus, there are concern for potential harm to kidney function. VLCKD are characterized by a very low carb content (<20g daily), 1-1.5g protein/kg ideal body weight, 15-30g fat/daily, and 500-800 caloric intake daily and often delivered through meal replacements modeling a Mediterranean diet.This study is a prospective observational real-life study (of 3-month duration) that evaluated the efficacy and safety of VLCKD in patients with obesity and mild kidney failure or chronic kidney disease (CKD).

At the end of the study, there's an improvement of metabolic parameters and no clinically relevant variation regarding liver and kidney function. No differences in efficacy and safety outcomes were found between the 2 groups - including the groups with and without renal condition (control). The average weight loss was nearly 20% of initial weight, with a significant reduction in fat mass. Interestingly, 27.7% of patients with mild renal failure reported normalization of glomerular filtration rate (GFR) after dietary intervention. There's evidence suggests that impact of dietary protein on renal function may depend on the protein source, with red meat being harmful in a dose dependent manner and plant based protein (soy/vegetable derived) may even play a renoprotective role.

When conducted under the supervision of healthcare professionals, a VLCKD is an effective and safe treatment for weight loss in patients with obesity, including those with CKD. As such, this might have potential benefits in clinical practice when integrating into dietary guideline for obesity. Some things to consider when implementing this diet include: 1) patients should consume <1.4g protein/kg ideal body weight, 2) protein intake should be carefully monitored during reintroduction phases, 3) red meat-derived protein should be discouraged through counseling.