News in brief February 17th, 2014
Le concept d’une obésité à poids normal. (The concept of normal weight obesity). Oliveros E, Somers VK, Sochor O, Goel K, Lopez-Jimenez F. Prog Cardiovasc Dis. 2014 Jan-Feb;56(4):426-33.
Individuals with a normal body weight but a high proportion of fatty body mass run a serious risk of metabolic dysregulation. This situation, which is known as normal weight obesity (it affects 2-28% of women and 3% of men), is associated with a high risk of metabolic syndrome and cardiometabolic disorders, and with high mortality rates. It was recently established that the mortality of patients with central obesity and coronary disease is higher than that of obese subjects with no central obesity. The distribution of the body fat is an important factor which should be taken into account: it is therefore essential to be able to identify high-risk subjects (based on their waist circumference measurements). The concept of obesity needs to be redefined, based on the adiposity rather than the body weight.
Effet d’une perte de poids de 5 % via un régime, associé ou non à de l’exercice, sur les paramètres cardiovasculaires chez l’obèse : un essai clinique randomisé (Effects of 5 % weight loss through diet or diet plus exercise on cardiovascular parameters of obese: a randomized clinical trial.) Fayh AP, Lopes AL, da Silva AM, Reischak-Oliveira A, Friedman R. Eur J Nutr. 2013 Aug;52(5):1443-50.
A 5% weight loss achieved via dieting with or without physical training improved the lipidic profiles of obese subjects (by decreasing the total cholesterol and -HDL and triglyceride levels) and reduced their inflammatory vascular symptoms (based on high-sensitivity CRP tests), regardless of whether or not these subjects underwent physical training. Weight loss alone had decisive effects on these cardiovascular risk factors.
Poids durant la jeunesse, gain de poids à l’âge adulte et risque futur de cancer de l’endomètre chez des femmes sans traitement hormonal substitutif. (Body weight in early adulthood, adult weight gain, and risk of endometrial cancer in women not using postmenopausal hormones.) Stevens VL, Jacobs EJ, Patel AV, Sun J, Gapstur SM, McCullough ML. Cancer Causes Control. 2014 Mar;25(3):321-8
A high BMI at the age of 18 increases the risk of endometrial cancer by 30%, whereas a 9-point increase in the BMI in adulthood multiplies the risk by 6. In addition, the risk increases proportionally with the amount of weight gained. It is lower, however, in women who were slim at the age of 18. These findings show the importance of avoiding being overweight or obese during both youth and adulthood.
Effet de la restriction énergétique et de l’exercice sur les muscles des extrémités chez des femmes âgées obèses : Une étude pilote. (Effect of dietary restriction and exercise on lower extremity tissue compartments in obese, older women: a pilot study.) Manini TM, Buford TW, Lott DJ, Vandenborne K, Daniels MJ, Knaggs JD, Patel H, Pahor M, Perri MG, Anton SD. J Gerontol A Biol Sci Med Sci. 2014 Jan;69(1):101-8
Weight loss in sedentary elderly women (BMI=36 kg/m²) on a low-energy diet (750 kcal less per day) associated with physical training (walking for 15 minutes twice a week plus flexion-extension leg movements) for 6 months helped to preserve their waist measurements and their limb (calf and thigh) performances, and hence their mobility. The decrease in the subcutaneous and intermuscular adipous tissue induced in these muscles resulted in better walking performances (in terms of speed).
Potentiel des entretiens motivationnels pour améliorer le suivi dans la gestion du diabète et de l’obésité dans des populations d’adultes et d’enfants : une revue clinique. (The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review. Christie D, Channon S. Diabetes Obes Metab. 2013 Sept.
The aim of personally-focused motivational interviews should be to examine whether patients’ behaviour shows any ambivalence and what motives they have for making changes. One important point to be remembered in these interviews is that patients have the right not to make any changes at all. These interviews are based on a style of communication which encourages them to take a new look at their situation and find their own ways of overcoming the barriers to making changes. Consultants should guide the process and contribute their knowledge in order to facilitate positive changes and prevent their patients from rejecting the advice and recommendations they are given. Patients should be made to feel it is up to them to decide what changes they are prepared to make.