Efficacy and safety of once‐weekly subcutaneous semaglutide on weight loss in patients with overweight or obesity without diabetes mellitus—A systematic review and meta‐analysis of randomized controlled trialsKommu, Sharath; Berg, Richard L.
doi: 10.1111/obr.13792pmid: 38923272
Semaglutide is found to be efficient for weight loss in patients with overweight or obesity with diabetes mellitus (DM). With a wide range of adverse events reported, the efficacy and safety of once‐weekly subcutaneous semaglutide in individuals without DM, with overweight or obesity, is unclear. We conducted a comprehensive meta‐analysis of randomized studies on once‐weekly semaglutide in this patient population. We identified nine studies with 11,641 patients in the semaglutide group and 10,479 in the placebo group. We observed that semaglutide resulted in significant benefits, including change in body weight (%): mean difference (MD) of −11.49% (p < 0.0001), change in absolute body weight: MD of −11.74 kg (p < 0.0001), and change in waist circumference: MD of −9.06 cm (p < 0.0001). Gastrointestinal side effects are predominant including nausea: odds ratio (OR) of 4.06 (p < 0.0001), vomiting: OR of 4.43 (p < 0.0001), diarrhea: OR of 2.10 (p < 0.0001), constipation: OR of 2.43 (p < 0.0001), gallbladder disorders: OR of 1.26 (p = 0.010), and cholelithiasis: OR of 2.06 (p = 0.04). Serious adverse events were not statistically significant: OR of 1.06 (p = 0.82). However, the percentage of participants discontinuing due to adverse events and gastrointestinal side effects was statistically significant: ORs of 2.22 (p < 0.0001) and 3.77 (p < 0.0001), respectively. This study shows that in patients with overweight or obesity without DM, once‐weekly subcutaneous semaglutide can significantly decrease body weight without risk of serious adverse events when compared with a placebo. However, gastrointestinal side effects are predominant with semaglutide, which can result in medication discontinuation.
A systematic review and meta‐analysis combining adolescent and adult data to evaluate weight loss and the effect of age following the laparoscopic sleeve gastrectomyKarasko, Danielle
doi: 10.1111/obr.13770pmid: 38804033
Obesity is a grave concern within the United States, resulting in lost productivity, increased medical costs, and comorbidities with lifelong repercussions. The laparoscopic sleeve gastrectomy is a treatment option for obesity. The following meta‐analysis sought to combine adolescent and adult literature to determine the overall effect of the sleeve gastrectomy on weight loss, to evaluate the effect of age at the time of surgery on weight loss, and to describe and explore variation in weight loss by sample characteristics. Overall weight loss was assessed at proximal and distal points, a dichotomous moderator variable analysis was conducted with subjects ≤21 years of age and >21 years of age, and a meta‐regression assessing % male, % female, and baseline BMI was conducted to assess moderator variables. The laparoscopic sleeve gastrectomy was effective at facilitating weight loss with effect sizes varying from 0.916 to2.816. Age, biological sex, and baseline BMI were not found to have an impact on weight loss. The clinical consequences of prolonged obesity are evident and earlier intervention may be justified to counter the long‐term effects caused by obesity related comorbidities. Standardized reporting of comorbidities and the effect of bariatric surgery on comorbid conditions is essential to allow further analysis.
Exploring factors of adherence to weight loss interventions in population with overweight/obesity: an umbrella reviewWang, Deng; Benito, Pedro J.; Rubio‐Arias, Jacobo Á.; Ramos‐Campo, Domingo J.; Rojo‐Tirado, Miguel A.
doi: 10.1111/obr.13783pmid: 38807509
Adherence is key for achieving the optimal benefits from a weight loss intervention. Despite the number of studies on factors that promote adherence, their findings suggest inconsistent and fragmented evidence. The aim of this study was to review the existing factors of adherence to weight loss interventions and to find factors that facilitate the design of effective intervention programs. Six databases were searched for this umbrella review; after the screening process, 21 studies were included. A total of 47 factors were identified in six groups as relevant for adherence: (i) sociodemographic (n = 7), (ii) physical activity (n = 2), (iii) dietary (n = 8), (iv) behavioral (n = 4), (v) pharmacological (n = 3), and (vi) multi‐intervention (n = 23). In addition, a map of adherence factors was created. The main findings are that with respect to demographic factors, the development of personalized intervention strategies based on the characteristics of specific populations is encouraged. Moreover, self‐monitoring has been shown to be effective in behavioral, dietary, and multi‐interventions, while technology has shown potential in dietary, behavioral, and multi‐interventions. In addition, multi‐interventions are adherence‐promoting strategies, although more evidence is required on adherence to pharmacological interventions. Overall, the factor map can be controlled and modified by researchers and practitioners to improve adherence to weight loss interventions.
A systematic review and qualitative synthesis of weight management interventions for people with spinal cord injuryMadigan, Claire D.; King, James A.; Taylor, Carolyn; Hoekstra, Sven P.; Graham, Heneritta E.; Kirk, Natasha; Fenton, Jordan M.; Goosey‐Tolfrey, Vicky L.
doi: 10.1111/obr.13785pmid: 38853150
People with spinal cord injury (SCI) are at greater risk of developing obesity and related co‐morbidities than those without SCI. The objectives of this systematic review were to examine the effectiveness of weight management interventions for people with SCI and to synthesize the experiences of people involved with SCI weight management (e.g., SCI healthcare professionals and caregivers). Five databases were searched (up to July 31, 2023) and 5,491 potentially eligible articles were identified. Following screening, 22 articles were included, comprising 562 adults. There was considerable heterogeneity in study design and weight loss interventions included behavioral nutritional and exercise education sessions, recalling food diaries, exercise interventions, and pharmaceuticals. The mean percentage change of the pooled body mass data equated to −4.0 ± 2.3%, with a range from −0.5 to −7.6%. In addition, 38% of the individuals with SCI who completed a weight loss intervention (N = 262) had a ≥5% reduction in body weight. Collectively, although on average the included interventions led to moderate weight loss, the finding that just over a third of individuals achieved clinically meaningful 5% weight loss suggests that available interventions for this population may need to be improved.
Mitochondrial puzzle in muscle: Linking the electron transport system to overweightCasuso, Rafael A.
doi: 10.1111/obr.13794pmid: 38923169
Human skeletal muscle mitochondria regulate energy expenditure. Research has shown that the functionality of muscle mitochondria is altered in subjects with overweight, as well as in response to nutrient excess and calorie restriction. Two metabolic features of obesity and overweight are (1) incomplete muscular fatty acid oxidation and (2) increased circulating lactate levels. In this study, I propose that these metabolic disturbances may originate from a common source within the muscle mitochondrial electron transport system. Specifically, a reorganization of the supramolecular structure of the electron transport chain could facilitate the maintenance of readily accessible coenzyme Q pools, which are essential for metabolizing lipid substrates. This approach is expected to maintain effective electron transfer, provided that there is sufficient complex III to support the Q‐cycle. Such an adaptation could enhance fatty acid oxidation and prevent mitochondrial overload, thereby reducing lactate production. These insights advance our understanding of the molecular mechanisms underpinning metabolic dysregulation in overweight states. This provides a basis for targeted interventions in the quest for metabolic health.
Evaluation of visceral adipose tissue thresholds for elevated metabolic syndrome risk across diverse populations: A systematic reviewBennett, Jonathan P.; Prado, Carla M.; Heymsfield, Steven B.; Shepherd, John A.
doi: 10.1111/obr.13767pmid: 38761009
Beyond obesity, excess levels of visceral adipose tissue (VAT) significantly contribute to the risk of developing metabolic syndrome (MetS), although thresholds for increased risk vary based on population, regions of interest, and units of measure employed. We sought to determine whether a common threshold exists that is indicative of heightened MetS risk across all populations, accounting for sex, age, BMI, and race/ethnicity. A systematic literature review was conducted in September 2023, presenting threshold values for elevated MetS risk. Standardization equations harmonized the results from DXA, CT, and MRI systems to facilitate a comparison of threshold variations across studies. A total of 52 papers were identified. No single threshold could accurately indicate elevated risk for both males and females across varying BMI, race/ethnicity, and age groups. Thresholds fluctuated from 70 to 165.9 cm2, with reported values consistently lower in females. Generally, premenopausal females and younger adults manifested elevated risks at lower VAT compared to their older counterparts. Notably, Asian populations exhibited elevated risks at lower VAT areas (70–136 cm2) compared to Caucasian populations (85.6–165.9 cm2). All considered studies reported associations of VAT without accommodating covariates. No single VAT area threshold for elevated MetS risk was discernible post‐harmonization by technology, units of measure, and region of interest. This review summarizes available evidence for MetS risk assessment in clinical practice. Further exploration of demographic‐specific interactions between VAT area and other risk factors is imperative to comprehensively delineate overarching MetS risk.