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Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease

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A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Physiology and Pathology".

Deadline for manuscript submissions: closed (30 June 2024) | Viewed by 22339

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Special Issue Editor

Dr. Hanen Samouda

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Guest Editor

Precision Health Department, Luxembourg Institute of Health, Strassen, Luxembourg
Interests: obesity; body composition; visceral adiposity

Special Issue Information

Dear Colleagues,

Evidence has shown that obesity is a chronic multifactorial relapsing disease due to several internal and external factors, and a significant gene–environment interaction. Obesity is a global public health challenge, given its pandemic spread and associated comorbidities.

Beyond corpulence assessment using body mass index (BMI), the characterisation of obesity has evolved to take into consideration visceral adipose tissue (VAT) storage, a major independent risk factor for several cardiometabolic, autoimmune, neurodegenerative and oncological diseases and premature mortality. Furthermore, the Edmonton Obesity Staging System enables researchers to rank obesity severity based on the assessment of the metabolic, mechanical and psychological comorbidities associated with obesity and quality of life.

In addition, a clear paradigm shift has occurred, changing from the ‘eat less and move more’ message, to more personalized and evidence-based treatments, i.e., cognitive behavioural therapy, pharmacotherapy and bariatric surgery. The role played by the environmental exposure was highlighted as a key element of innovative prevention strategies. A patient-centred approach was recommended to understand the patient lived experience and promote shared decision-making.
Nevertheless, despite the evidence, most of countries still do not recognise obesity as a disease that requires personalised care and innovative prevention strategies, nor do they recognise the role played by patient insight in the therapeutic process.

The non-recognition of obesity as a disease results in a significant burden of stigma towards people living with obesity, leading to inadequate care and poor health.

This Special Issue is dedicated to the recent advancements in favour of the recognition of obesity as a disease and should be of interest to healthcare professionals, policymakers, people living with obesity and scientists. The scope of the Special Issue covers obesity diagnosis, treatment and prevention, patient engagement and health policies.
Specific areas of interest include, but are not limited to, obesity definition, assessment, causes and contributors, body composition, cognitive behavioural therapy, pharmacotherapy, bariatric and metabolic surgery, innovative prevention strategies.

We welcome contributions from researchers, clinicians, healthcare professionals, people and patients living with obesity, policymakers, and all professionals interested in the field.

The European Association for the Study of Obesity (https://easo.org/), the leading voice of obesity science, medicine, and community in Europe, representing scientists, obesity specialists, physicians, healthcare practitioners, public health practitioners, and patients, is supporting the Special Issue with the editorial foreword.

Dr. Hanen Samouda
Guest Editor

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Keywords

obesity policies
adipose tissue
body composition
patient advocacy
weight bias
genetics
physical pain
hormonal appetite dysregulation
eating disorders
trauma
mental health
environmental exposure
food exposure
market economy
sedentary work
family conflict

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Published Papers (9 papers)

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Research

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19 pages, 1772 KiB

Open AccessArticle

The Role of Paraclinical Investigations in Detecting Inflammation in Children and Adolescents with Obesity and Metabolic Syndrome

by Mihaela-Andreea Podeanu, Ștefănița Bianca Vintilescu, Claudiu Marinel Ionele, Raluca Elena Sandu, Carmen Elena Niculescu, Mirela-Marinela Florescu and Mioara Desdemona Stepan

Life 2024, 14(9), 1206; https://doi.org/10.3390/life14091206 - 23 Sep 2024

Viewed by 898

Abstract

Obesity is linked to the increasing prevalence of metabolic syndrome (MetS), even among the pediatric population. Some inflammatory and cardioembolic indexes derived from routine laboratory tests have captivated the attention of the medical community. Objectives: The aim of our study was to evaluate whether these markers are effective in distinguishing varying degrees of obesity and MetS in children and adolescents. Methods: We conducted a retrospective study. A total of 71 children and adolescents, aged between 6 and 16, were included in the study. Among them, 5 were overweight, 35 had obesity, and 31 had severe obesity. According to the NCEP ATP III criteria, 32 individuals had Metabolic Syndrome (MetS), while 39 did not have MetS. Results: The MetS positive group had higher values of TG/HDL-C (p < 0.001), TC/HDL-C (p < 0.001), MHR (p = 0.015), LHR (p = 0.001), NHR (p = 0.001), atherogenic index of plasma (p < 0.001), and PHR (p < 0.001). ESR, NLR, PLR, and SII did not progressively increase with the number of MetS criteria. The ROC curve analysis demonstrated that markers such as TG/HDL-C, the atherogenic index of plasma, TC/HDL-C, LHR, NHR, and PHR were effective in identifying MetS in children and adolescents with obesity. Conclusions: In conclusion, we determined that some novel inflammatory and cardioembolic indexes are useful in assessing MetS and obesity in children and adolescents. Full article

(This article belongs to the Special Issue Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease)

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16 pages, 325 KiB

Open AccessArticle

Blood Concentration of Macro- and Microelements in Women Who Are Overweight/Obesity and Their Associations with Serum Biochemistry

by Zuzana Knazicka, Maros Bihari, Ivona Janco, Lubos Harangozo, Julius Arvay, Anton Kovacik, Peter Massanyi, Branislav Galik, Jorge M. A. Saraiva and Marta Habanova

Life 2024, 14(4), 465; https://doi.org/10.3390/life14040465 - 2 Apr 2024

Cited by 4 | Viewed by 1670

Abstract

Risk elements in blood matrices can affect human health status through associations with biomarkers at multiple levels. The aim of this study was to analyze 15 macro- and microelements in the blood serum of women with overweight (BMI of ≥25 kg/m²) and obesity (BMI of ≥30 kg/m²) and to examine possible associations with biochemical, liver enzymatic parameters, and markers of oxidative stress. Based on the power calculation, the study involved women (in the postmenopausal stage) with overweight (n = 26) and obesity (n = 22), aged between 50–65 years. Multifrequency bioelectrical impedance analysis was used to measure body composition parameters. Concentrations of elements were determined by inductively coupled plasma optical emission spectrometry, and Hg was measured using cold-vapor atomic absorption spectroscopy. Individuals with obesity, as indicated by a higher BMI, percentage of body fat, and visceral fat area, had elevated serum levels of Ca, Mg, Fe, Al, Sr, Pb, and Hg. Concentrations of Al, Cu, K, Sb, Zn, and Pb significantly affected biochemical and liver function markers in women with overweight or obesity. Elements such as Cu and Al were associated with increased total cholesterol. The correlation analysis between total antioxidant status and Cu, Al, and Ni confirmed associations in both groups. Our findings underscore the importance of addressing excess body weight and obesity in relation to risk elements. The results of the research could be beneficial in identifying potential targets for the treatment or prevention of comorbidities in people with obesity. Full article

(This article belongs to the Special Issue Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease)

14 pages, 1915 KiB

Open AccessArticle

A Federated Database for Obesity Research: An IMI-SOPHIA Study

by Carl Delfin, Iulian Dragan, Dmitry Kuznetsov, Juan Fernandez Tajes, Femke Smit, Daniel E. Coral, Ali Farzaneh, André Haugg, Andreas Hungele, Anne Niknejad, Christopher Hall, Daan Jacobs, Diana Marek, Diane P. Fraser, Dorothee Thuillier, Fariba Ahmadizar, Florence Mehl, Francois Pattou, Frederic Burdet, Gareth Hawkes, Ilja C. W. Arts, Jordi Blanch, Johan Van Soest, José-Manuel Fernández-Real, Juergen Boehl, Katharina Fink, Marleen M. J. van Greevenbroek, Maryam Kavousi, Michiel Minten, Nicole Prinz, Niels Ipsen, Paul W. Franks, Rafael Ramos, Reinhard W. Holl, Scott Horban, Talita Duarte-Salles, Van Du T. Tran, Violeta Raverdy, Yenny Leal, Adam Lenart, Ewan Pearson, Thomas Sparsø, Giuseppe N. Giordano, Vassilios Ioannidis, Keng Soh, Timothy M. Frayling, Carel W. Le Roux and Mark Ibberson Show full author list Hide full author list

Life 2024, 14(2), 262; https://doi.org/10.3390/life14020262 - 16 Feb 2024

Cited by 1 | Viewed by 3252

Abstract

Obesity is considered by many as a lifestyle choice rather than a chronic progressive disease. The Innovative Medicines Initiative (IMI) SOPHIA (Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy) project is part of a momentum shift aiming to provide better tools for the stratification of people with obesity according to disease risk and treatment response. One of the challenges to achieving these goals is that many clinical cohorts are siloed, limiting the potential of combined data for biomarker discovery. In SOPHIA, we have addressed this challenge by setting up a federated database building on open-source DataSHIELD technology. The database currently federates 16 cohorts that are accessible via a central gateway. The database is multi-modal, including research studies, clinical trials, and routine health data, and is accessed using the R statistical programming environment where statistical and machine learning analyses can be performed at a distance without any disclosure of patient-level data. We demonstrate the use of the database by providing a proof-of-concept analysis, performing a federated linear model of BMI and systolic blood pressure, pooling all data from 16 studies virtually without any analyst seeing individual patient-level data. This analysis provided similar point estimates compared to a meta-analysis of the 16 individual studies. Our approach provides a benchmark for reproducible, safe federated analyses across multiple study types provided by multiple stakeholders. Full article

(This article belongs to the Special Issue Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease)

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9 pages, 575 KiB

Open AccessCommunication

Association between Sarcopenia and Reduced Bone Mass: Is Osteosarcopenic Obesity a New Phenotype to Consider in Weight Management Settings?

by Antonino De Lorenzo, Leila Itani, Paola Gualtieri, Massimo Pellegrini, Marwan El Ghoch and Laura Di Renzo

Life 2024, 14(1), 21; https://doi.org/10.3390/life14010021 - 21 Dec 2023

Cited by 2 | Viewed by 1503

Abstract

Sarcopenic obesity (SO) is a frequent phenotype in people with obesity; however, it is unclear whether this links with an impaired bone status. In this study, we aimed to investigate the association between SO and low bone mass, and to assess the prevalence of a new entity that combines excessive fat deposition, reduced muscle mass and strength, and low bone mass defined as osteosarcopenic obesity (OSO). Body composition was completed by a DXA scan in 2604 participants with obesity that were categorized as with or without SO, and with low or normal bone mineral content (BMC). Participants with both SO and low BMC were defined as OSO. Among the entire sample, 901 (34.6%) participants met the criteria for SO. This group showed a reduced mean BMC (2.56 ± 0.46 vs. 2.85 ± 0.57, p < 0.01) and displayed a higher prevalence of individuals with low BMC with respect to those without SO (47.3% vs. 25.9%, p < 0.01). Logistic regression analysis showed that the presence of SO increases the odds of having low BMC by 92% [OR = 1.92; 95% CI: (1.60–2.31), p < 0.05] after adjusting for age, body weight, and body fat percentage. Finally, 426 (16.4%) out of the total sample were affected by OSO. Our findings revealed a strong association between SO and reduced bone mass in adults with obesity, and this introduces a new phenotype that combines body fat, muscle, and bone (i.e., OSO) and appears to affect 16% of this population. Full article

(This article belongs to the Special Issue Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease)

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Review

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12 pages, 596 KiB

Open AccessReview

Digital Biometry as an Obesity Diagnosis Tool: A Review of Current Applications and Future Directions

by Florence Porterfield, Vladyslav Shapoval, Jérémie Langlet, Hanen Samouda and Fatima Cody Stanford

Life 2024, 14(8), 947; https://doi.org/10.3390/life14080947 - 28 Jul 2024

Cited by 1 | Viewed by 981

Abstract

Obesity is a chronic relapsing disease and a major public health concern due to its high prevalence and associated complications. Paradoxically, several studies have found that obesity might positively impact the prognosis of patients with certain existing chronic diseases, while some individuals with normal BMI may develop obesity-related complications. This phenomenon might be explained by differences in body composition, such as visceral adipose tissue (VAT), total body fat (TBF), and fat-free mass (FFM). Indirect measures of body composition such as body circumferences, skinfold thicknesses, and bioelectrical impedance analysis (BIA) devices are useful clinically and in epidemiological studies but are often difficult to perform, time-consuming, or inaccurate. Biomedical imaging methods, i.e., computerized tomography scanners (CT scan), dual-energy X-ray absorptiometry (DEXA), and magnetic resonance imaging (MRI), provide accurate assessments but are expensive and not readily available. Recent advancements in 3D optical image technology offer an innovative way to assess body circumferences and body composition, though most machines are costly and not widely available. Two-dimensional optical image technology might offer an interesting alternative, but its accuracy needs validation. This review aims to evaluate the efficacy of 2D and 3D automated body scan devices in assessing body circumferences and body composition. Full article

(This article belongs to the Special Issue Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease)

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18 pages, 1739 KiB

Open AccessReview

Barriers to Care for Pediatric Patients with Obesity

by Sreevidya Bodepudi, Malikiya Hinds, Kayla Northam, Noreen A. Reilly-Harrington and Fatima Cody Stanford

Life 2024, 14(7), 884; https://doi.org/10.3390/life14070884 - 17 Jul 2024

Viewed by 1670

Abstract

This review article emphasizes the challenges pediatric patients face during obesity treatment. Prior research has been compartmentalized, acknowledging that stigma, the ability to implement lifestyle changes, social health determinants, and healthcare accessibility are considerable impediments for obese children. These issues emerge at various levels, including the individual or family, the community and school, and even national policy. This suggests the need for a more comprehensive, team-based approach to tackle pediatric obesity. Understanding these barriers is the first step toward creating effective strategies and solutions to overcome these challenges. Full article

(This article belongs to the Special Issue Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease)

19 pages, 612 KiB

Open AccessReview

The Impact of Metabolic Health and Obesity on Liver Transplant Candidates and Recipients

by Alexander S. Vogel, Rebecca Roediger, Dagny von Ahrens, Brett E. Fortune, Jonathan M. Schwartz, Shalom Frager, Kristina R. Chacko and Clara Y. Tow

Life 2024, 14(6), 685; https://doi.org/10.3390/life14060685 - 27 May 2024

Viewed by 1588

Abstract

Poor metabolic health and obesity have significant impacts on the outcomes of patients suffering from chronic liver disease, particularly those with metabolic dysfunction-associated steatotic liver disease. Patients with such comorbidities who require liver transplant evaluation for advancing liver disease or liver failure require special consideration due to increased risk of cardiovascular disease, renal dysfunction, sarcopenic obesity, and cancer. Those who have had a history of prior bariatric surgery pose specific anatomical constraints and may also be at increased risk of alcohol use disorder. Pre-operative risk assessment as well as strict control of metabolic risk factors are essential to reduce intra-operative and post-liver transplant complications. As immunosuppressive therapy exacerbates metabolic dysfunction and risk for cancer, post-liver transplant care must focus on balancing the need to prevent rejection and the impact of progressive metabolic dysfunction in this unique, but growing, patient population. Full article

(This article belongs to the Special Issue Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease)

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15 pages, 279 KiB

Open AccessReview

Optimizing Childhood Obesity Management: The Role of Edmonton Obesity Staging System in Personalized Care Pathways

by Astrid De Wolf, Elise Nauwynck, Jesse Vanbesien, Willem Staels, Jean De Schepper and Inge Gies

Life 2024, 14(3), 319; https://doi.org/10.3390/life14030319 - 28 Feb 2024

Cited by 1 | Viewed by 1979

Abstract

Childhood obesity, affecting 29% of 7–9-year-olds across 33 European countries, is a significant public health challenge. Its persistence into adulthood poses grave health risks influenced by genetic, environmental, and socio-economic factors. Belgium introduced a new care pathway in December 2023, based on the Edmonton Obesity Staging System for Pediatrics (EOSS-P), addressing four health domains and staging obesity severity. This pathway operates across three levels: primary care physicians, Paediatric Multidisciplinary Obesity Management Centres (PMOCs), and Centers of Expertise for Paediatric Obesity Management (CEPOs). Each stage of EOSS-P demands tailored interventions. Early stages involve dietary interventions, physical activity promotion, and behavior modifications. As obesity severity progresses, treatments intensify, encompassing psychological support, anti-obesity medications, and, in some cases, bariatric surgery. Throughout these stages, the involvement of multidisciplinary teams is crucial, emphasizing family-based approaches and continuous monitoring. This article provides detailed guidelines for healthcare professionals, delineating interventions and recommendations tailored to each EOSS-P stage. It emphasizes a holistic approach that extends beyond BMI-based diagnosis, promoting personalized care and prompt escalations between care levels, thereby ensuring optimal management of childhood obesity. This comprehensive framework aims to address the complexities of childhood obesity, emphasizing the importance of timely and targeted interventions for better health outcomes. Full article

(This article belongs to the Special Issue Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease)

18 pages, 655 KiB

Open AccessReview

Pediatric Obesity: Complications and Current Day Management

by Mary Ellen Vajravelu, Emir Tas and Silva Arslanian

Life 2023, 13(7), 1591; https://doi.org/10.3390/life13071591 - 20 Jul 2023

Cited by 15 | Viewed by 7287

Abstract

Obesity affects approximately 1 in 5 youth globally and increases the risk of complications during adolescence and young adulthood, including type 2 diabetes, dyslipidemia, hypertension, non-alcoholic fatty liver disease, obstructive sleep apnea, and polycystic ovary syndrome. Children and adolescents with obesity frequently experience weight stigma and have an impaired quality of life, which may exacerbate weight gain. Pediatric obesity is typically defined using sex-, age-, and population-specific body mass index percentiles. Once identified, pediatric obesity should always be managed with lifestyle modification. However, adolescents with obesity may also benefit from anti-obesity medications (AOM), several of which have been approved for use in adolescents by the US Food and Drug Administration, including liraglutide, phentermine/topiramate, and semaglutide. For children with specific, rare monogenic obesity disorders, setmelanotide is available and may lead to significant weight loss. Metabolic and bariatric surgery may be used for the management of severe obesity in youth; though highly effective, it is limited to specialized centers and has had relatively low pediatric uptake. In this narrative review using pediatric-focused data from original research, reviews, clinical practice guidelines, governmental agencies, and pharmaceutical companies, we review obesity-related metabolic complications in youth and management strategies, including AOM and bariatric surgery. Full article

(This article belongs to the Special Issue Obesity: Precision Diagnosis, Personalised Treatment, Patient Engagement and Recognition as a Disease)

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