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Bariatric dentistry is the branch of dental medicine focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing US and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy, it is necessary that proper accommodations are made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. The aim of the present case report was to bring awareness and start professional discussions on the importance of dental practitioners in the community and dental academic programs working together to assure access for primary oral health for bariatric patients. [ABSTRACT FROM AUTHOR]

Obesity has been correlated with heightened risk of complications after orthopedic surgeries. Bariatric surgery (BS) is an effective tool commonly utilized for the reduction of body mass index. However, the impact of BS on complications in total shoulder arthroplasty (TSA) remains inadequately investigated. This study examines the 5-year risk of revision following TSA in patients with a history of BS compared to matched cohorts without history of BS. Utilizing the PearlDiver Mariner database, a retrospective cohort analysis was conducted on over 157 million U.S. patients from January 2010 to October 2021. Inclusion criteria identified patients undergoing primary TSA with a minimum 2-year follow-up. Propensity-score matching was employed to control for covariates, comparing BS patients with a matched control and a matched class III obesity control without history of BS. Demographics, comorbidities, and outcomes, including 5-year cumulative incidence of revision were analyzed. The 5-year cumulative incidence of all-cause revision within the BS group was found to be 4.6%. While this represented a higher risk than that of the general population (hazard ratio 1.70; 95% confidence interval 1.21-2.39), there was no significant difference when compared to controls with class III obesity. The BS cohort had higher risk of revision secondary to dislocation/subluxation and rotator cuff tear than in the general population. When compared to the class III obesity cohort, only the risk of revision due to rotator cuff tear was found to be higher. Individuals with a history of BS showed a higher risk of revision than a cohort without history of BS and an equivalent risk of revision compared to a cohort of class III obesity controls after undergoing TSA. Though obesity is an important risk factor for complications after TSA, BS might not be an effective tool for preoperative risk optimization. [ABSTRACT FROM AUTHOR]

Background: The extremely obese patient deserves special consideration: significant comorbidities, technical difficulties, and increased postoperative morbidity and mortality are all expected in this patient population. The study compared early postoperative complications (≤30‐day) following one‐anastomosis gastric bypass (OAGB) morbidity in patients with morbid obesity class IV obesity, body mass index (BMI) ≥50–59.9 kg/m2, and class V obesity, BMI ≥60 patients. Methods: We retrospectively reviewed perioperative OAGB outcomes in three BMI groups. Operative time, length of stay (LOS), and overall early postoperative complication rates were studied. Patient‐reported complications were ranked by Clavien–Dindo Classification (CDC). Results: Between January 2017–December 2021, consecutive patients with obesity class III (n = 2950), IV (n = 256), and V (n = 23) underwent OAGB. BMI groups were comparable in sex, age, and associated comorbidities. Mean operative time was significantly longer in the higher BMI groups: class III (66.5 ± 25.6 min), IV (70.5 ± 28.7 min), and V (80.0 ± 34.7 min), respectively (p = 0.018); no difference in LOS. In respective BMI classes, ≤30‐day complication rates were 3.2%, 3.5%, and 4.3% (p = 0.926). The respective number of patients with CDC grades of one to two were 45 (1.5%), 6 (2.3%), and 1 (4.3%), p = 0.500; and in grade ≥3a, 25 (0.8%), 1 (0.4%), 0 (0.0%), p = 0.669. There was 0.06% mortality (n = 2 in 3229), both in BMI class III. Conclusions: OAGB is a safe BS procedure in patients with class III, IV, and V obesity in the perioperative term with comparable ≤30‐day morbidity in the three BMI groups. [ABSTRACT FROM AUTHOR]

Summary: The measurement of habitual energy intake remains a challenge in nutrition research. High levels of misreporting, particularly among adults with obesity, have been observed when comparing self‐reported energy intake to energy expenditure assessed via the doubly labeled water technique. Little is known about misreporting in adults with class III obesity (body mass index ≥40 kg/m2). This systematic review assessed the representation of adults with class III obesity in dietary validation studies and the validity of self‐reported dietary energy intake for this group. Studies were included in this review if they: compared self‐reported energy intake assessment method(s) to doubly labeled water, had participants ≥18 years old, and included participants with class III obesity. Fifteen studies met these criteria. Of those, eight included information about the number of participants with class III obesity. Out of 1784 participants across eight studies, 63 (3.5%) participants had class III obesity, compared to 9.2% of US adults with class III obesity. Six studies provided data on validity of energy intake assessment for class III obesity, with five of these showing underreporting. Participants with class III obesity are underrepresented in dietary validation studies. Future research should explore the role of weight status on dietary reporting accuracy. [ABSTRACT FROM AUTHOR]

Background: Glycine is an integral component of the human detoxification system as it reacts with potentially toxic exogenous and endogenously produced compounds and metabolites via the glycine conjugation pathway for urinary excretion. Because individuals with obesity have reduced glycine availability, this detoxification pathway may be compromised. However, it should be restored after bariatric surgery because of increased glycine production. Objective: To examine the impact of obesity-associated glycine deficiency on the glycine conjugation pathway. We hypothesize that the synthesis rates of acylglycines from endogenous and exogenous sources are significantly reduced in individuals with obesity but increase after bariatric surgery. Methods: We recruited 21 participants with class III obesity and 21 with healthy weight as controls. At baseline, [1,2-13C2] glycine was infused to study the glycine conjugation pathway by quantifying the synthesis rates of several acylglycines. The same measurements were repeated in participants with obesity six months after bariatric surgery. Data are presented as mean ± standard deviation, and p-value < 0.05 is considered statistically significant. Results: Baseline data of 20 participants with obesity were first compared to controls. Participants with obesity were significantly heavier than controls (mean BMI 40.5 ± 7.1 vs. 20.8 ± 2.1 kg/m²). They had significantly lower plasma glycine concentration (168 ± 30 vs. 209 ± 50 µmol/L) and slower absolute synthesis rates of acetylglycine, isobutyrylglycine, tigylglycine, isovalerylglycine, and hexanoylglycine. Pre- and post-surgery data were available for 16 participants with obesity. Post-surgery BMI decreased from 40.9 ± 7.3 to 31.6 ± 6.0 kg/m². Plasma glycine concentration increased from 164 ± 26 to 212 ± 38 µmol/L) and was associated with significantly higher rates of excretion of acetylglycine, isobutyrylglycine, tigylglycine, isovalerylglycine, and hexanoylglycine. Benzoic acid (a xenobiotic dicarboxylic acid) is excreted as benzoylglycine; its synthesis rate was significantly slower in participants with obesity but increased after bariatric surgery. Conclusion: Obesity-associated glycine deficiency impairs the human body's ability to eliminate endogenous and exogenous metabolites/compounds via the glycine conjugation pathway. This impairment is ameliorated when glycine supply is restored after bariatric surgery. These findings imply that dietary glycine supplementation could treat obesity-associated metabolic complications due to the accumulation of intramitochondrial toxic metabolites. Clinical trial registration: https://clinicaltrials.gov/study/NCT04660513, identifier NCT04660513. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity has been increasing worldwide. It has been reported that physiological and environmental factors such as diet, culture, physical activity, and genetics are the principal factors related to obesity. The fat mass and obesity-associated (FTO) gen variant (rs9939609: T>A) has been associated with class III obesity. The A variant has been correlated with anthropometric and metabolic alterations. Therefore, the purpose of this study was to analyze the association of the FTO rs9939609: T>A variant and environmental factors with clinical, anthropometric, and biochemical variables in subjects with class III obesity. Results: The A variant frequency was higher in the class III obesity group compared with the normal weight group (44% vs. 25%, p < 0.001). Subjects with the AA genotype had a higher body mass index (BMI) than those with the AT genotype (35.46 kg/m2 (31–39.8) vs. 26.91 kg/m2 (23.7–30), p = 0.005). Women with the AA genotype showed higher waist circumferences than the AT group (101.07 cm (90.9–111.1) vs. 85.45 cm (77–93.8) p = 0.047). The FTO A variant increases the risk by 3.54 times and physical inactivity increases the risk by 6.37 times for class III obesity. Conclusions: Our results suggest that among the studied variables, those most related to class III obesity were the FTO risk genotype (A allele) and physical inactivity. [ABSTRACT FROM AUTHOR]

Nonclassic congenital adrenal hyperplasia (NCCAH) is characterized by mild cortisol deficiency, excess androgens and adrenocorticotropin (ACTH) production, and often with various features of dysmetabolic syndrome. Elective bariatric surgery is one of the most effective long-term management strategies for severe obesity. Our case presents a 34-year-old woman with symptomatic NCCAH and class III obesity who status post Roux-en-Y gastric bypass (RYGB) had significant weight loss with metabolic resolution of NCCAH, and no longer required glucocorticoid (GC) therapy. At 11 months post operation and off GC therapy, she had a weight deficit of approximately 160 pounds (72.57 kg) with continued metabolic resolution of NCCAH markers including ACTH, 17-hydroxyprogesterone, and androstenedione. Presently, GC therapy remains one of the few available treatments for symptomatic NCCAH; however, long-term GC therapy has the potential for various complications and side effects. Our case presents elective bariatric surgery as a potential and unique treatment option for patients with NCCAH with associated class III obesity. The exact pathophysiologic basis for this effect and its potential role in long-term management of appropriate NCCAH patients requires further study. [ABSTRACT FROM AUTHOR]

(1) Background: There are conflicting results on whether weight loss after bariatric surgery (BS) might be associated with quality of life (QoL)/depressive symptomatology. We aim to determine whether BS outcomes are associated with QoL/depressive symptomatology in studied patients at the 8-year follow-up after BS, as well as their relationship with different serum proteins and miRNAs. (2) Methods: A total of 53 patients with class III obesity who underwent BS, and then classified into "good responders" and "non-responders" depending on the percentage of excess weight lost (%EWL) 8 years after BS (%EWL ≥ 50% and %EWL < 50%, respectively), were included. Basal serum miRNAs and different proteins were analysed, and patients completed tests to evaluate QoL/depressive symptomatology at 8 years after BS. (3) Results: The good responders group showed higher scores on SF-36 scales of physical functioning, role functioning—physical, role functioning—emotional, body pain and global general health compared with the non-responders. The expression of hsa-miR-101-3p, hsa-miR-15a-5p, hsa-miR-29c-3p, hsa-miR-144-3p and hsa-miR-19b-3p were lower in non-responders. Hsa-miR-19b-3p was the variable associated with the response to BS in a logistic regression model. (4) Conclusions: The mental health of patients after BS is limited by the success of the intervention. In addition, the expression of basal serum miRNAs related to depression/anxiety could predict the success of BS. [ABSTRACT FROM AUTHOR]

Background: Gut microbial composition seems to change in association with prediabetes. The purpose of this prospective cross-sectional study was to compare the composition of gut microbiota and energy metabolites between individuals with class III obesity but without type 2 diabetes mellitus (OB) and healthy normal weight controls. Methods: The subjects of this prospective cross-sectional study were participants recruited from a previous clinical trial (No: NCT02325804), with intervention focused on weight loss. We recruited 19 OB [mean age ± standard deviation (SD) was 35.4 ± 7.0 years, mean body mass index (BMI) ± SD was 48.8 ± 6.7 kg/m2] and 23 controls (mean age ± SD was 31.7 ± 14.8 years, mean BMI ± SD was 22.2 ± 1.7 kg/m2). Their fecal microbiota was categorized using specific primers targeting the V1–V3 region of 16S rDNA, whereas serum metabolites were characterized by nuclear magnetic resonance spectroscopy. Multivariate statistical analysis and Random Forest models were applied to discriminate predictors with the highest variable importance. Results: We observed a significantly lower microbial α-diversity (P = 0.001) and relative abundance of beneficial bacterium Akkermansia (P = 0.001) and the short-chain fatty acid-producing bacteria Eubacterium hallii (P = 0.019), Butyrivibrio (P = 0.024), Marvinbryantia (P = 0.010), and Coprococcus (P = 0.050) and a higher abundance of the pathogenic bacteria Bilophila (P = 0.018) and Fusobacterium (P = 0.022) in OB compared with controls. Notably, the Random Forest machine learning analysis identified energy metabolites (citrate and acetate), HOMA-IR, and insulin as important predictors capable of discriminating between OB and controls. Conclusions: Our results suggest that changes in gut microbiota and in serum acetate and citrate are additional promising biomarkers before progression to Type 2 diabetes. The non-invasive manipulation of gut microbiota composition in OB through a healthy lifestyle, thus, offers a new approach for managing class III obesity and associated disorders. ClinicalTrials.gov identifier: NCT02325804 [ABSTRACT FROM AUTHOR]

Background: The burden of asthma remains steady with no decline observed in the past few decades. Obesity prevalence has been steadily increasing with a rate of 41.9% in the United States between 2017–2020. Obesity is an inflammatory chronic condition that may partially contribute to the burden and severity of asthma. This study aimed to examine whether the association between obesity and asthma varies with the categories of obesity (class I, II, and III) and persistent asthma (mild, moderate, and severe asthma). We hypothesized that subjects with elevated body mass index (BMI) are more likely to be diagnosed with persistent asthma than subjects without obesity with asthma. Methods: As a retrospective and cross-sectional study, this study used a total of 1,977 records of subjects with asthma (age ≥ 19 y) hospitalized in Nevada between 2016–2021. BMI and persistent asthma were evaluated as the main exposure and outcome of interest. Logistic regression was used to estimate the magnitude of the association between obesity and persistent asthma. Results: Among the selected subject records, subjects with obesity were more likely to be diagnosed with persistent asthma compared to subjects without obesity (odds ratio 1.50 [CI 1.10–2.05]). Subgroup analyses revealed that subjects with class III obesity (BMI ≥ 40) were more likely than subjects without obesity to be diagnosed with mild persistent asthma (odds ratio 2.21 [CI 1.18–4.16]) and severe persistent asthma (odds ratio 1.74 [CI 1.12–2.70]). Conclusions: Obesity was identified as a risk factor for persistent asthma, particularly class III obesity. This in turn increases the potential for greater health care utilization and economic burden. Public health and clinical interventions are necessary among those with comorbid asthma and obesity. [ABSTRACT FROM AUTHOR]

Abstract Background Patients with Class III obesity pose unique challenges to health care staff and organisations. Care requirements of this population are unique and require specialised equipment and knowledge to meet these needs, maintain the quality of care, as well as the safety of patients and staff. Aim To synthesise the evidence on the nursing care of Class III obese patients in acute care settings. Methods A scoping review informed by JBI. CINAHL Plus, Medline, Scopus, Proquest Central, Web of Science and Embase were searched for primary research articles about the nursing management of people classified as Class III obese in acute care. Methodological quality of included studies was assessed; data extracted and synthesised into themes. Results Fourteen studies were included in the review. The synthesis generated three themes: Access to equipment, knowledge and training, patient care, and opportunities to improve care. Conclusions A paucity of high-quality evidence informs the nursing care of people with Class III obesity in acute care. Access to appropriate equipment dominated the findings of this review. Adequate provision of equipment and education on its use are required. Education to promote engagement with patients, adapting clinical practice and promotion of self-care could improve care and outcomes.

Introduction: Endometrial cancer is often directly related to obesity and interventions for weight loss have mixed results. Risk factors for continued weight gain after diagnosis are not clearly defined in the literature. The objective of this study is to describe risk factors associated with increased body mass index (BMI) trajectory among endometrial cancer patients. Methods: Patients who were surgically treated for endometrial cancer at a single institution between 2010 and 2015 were identified. Demographics including age, race/ethnicity and estimated median income at diagnosis were obtained. BMI at five time points after diagnosis were calculated. BMI trajectories were estimated by latent class growth modeling using the PROC TRAJ procedure in SAS. Chi-squared tests and ANOVA were used to assess differences between trajectory groups. Statistical significance was set to a p-value 40 kg/m2) were most likely to experience increasing BMI, p

BACKGROUND: Although obesity is a known risk factor for cesarean delivery, there is a paucity of data on the course of induction of labor in these patients. OBJECTIVE: With emerging data on the safety of 39-week inductions, we aimed to: (1) determine if Class III obesity, including morbid obesity, is an independent risk factor for nonachievement of complete dilation and vaginal delivery after induction of labor, (2) evaluate the characteristics of the induction of labor course and immediate complications, and (3) evaluate the number of induction agents necessary to be associated with vaginal deliveries. We hypothesized that as body mass index increased, it would take longer to achieve complete cervical dilation, more induction agents would be required, and there would be a higher rate of cesarean delivery. STUDY DESIGN: This was a retrospective cohort study of singleton gestations undergoing induction of labor from 2013 to 2020 at a single center. Study groups were defined as nonobese (body mass index

This study evaluated the influence of early gestational weight gain (GWG) on neonatal outcomes among women with class III obesity. Retrospective cohort of women with class III obesity who gained more than the Institute of Medicine (IOM) guidelines (>20lbs). Women gaining ≥75% of total gestational weight prior to 28 weeks (EWG) were compared to women gaining <75% of their total weight prior to 28 weeks (SWG). The primary outcome was a neonatal composite morbidity and mortality. Secondary outcomes included individual components of composite and LGA. Of 144 women identified, 42 (29.2%) had EWG and 102 (70.8%) had SWG. Though 11% of the total population had composite neonatal morbidity, this did not differ between groups (p =.4). LGA was nearly twice as common in the SWG group (41% vs 26%, p =.13). EWG was associated with decreased risk of LGA (AOR 0.25 95% CI 0.08, 0.78) and lower median birth weight (AOR −312 g 95% CI −534.7, −90.2). Though adverse neonatal outcomes were common in this population, timing of gestational weight gain was not correlated. Increased rates of LGA and higher median birth weight in the SWG group suggests excessive GWG continuing in the third trimester of pregnancy may be of import for neonatal size. [ABSTRACT FROM AUTHOR]

Objectives: Class II (120% > body mass index [BMI] < 140% of the 95th percentile for age and sex) and Class III (BMI >140% of the 95th percentile for age and sex) obesity are the fastest growing subcategories of obesity in the United States pediatric population. Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for with class II/III obesity. The primary objectives of this analysis were to determine the (1) current US MBS utilization rates in those with class II/III obesity and (2) utilization rates and 30-day postoperative outcomes. Background: The 2015 to 2018 National Health and Nutrition Examination Survey cross-sectional data (N = 19,225) generated US with class II/III obesity prevalence estimates. The 2015 to 2018 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) longitudinal (30 days) cohort data were used to compare adolescent and adult (N = 748,622) postoperative outcomes and to calculate utilization rates. Methods: The 2015 to 2018 youth and adult MBS utilization rates were calculated using MBSAQIP data (numerator) and National Health and Nutrition Examination Survey data (denominator). Two-sample tests of proportions were performed to compare the MBS utilization rates by age, ethnicity, and sex and expressed per 1000. Results: Mean age of the analytical MBSAQIP sample was 17.9 (1.15) years in youth (n = 3846) and 45.1 (11.5) in adults (N = 744,776), majority female (77.4%, 80.7%, respectively) and non-Hispanic White (68.5%, 59.4%, respectively). The overall 2015 to 2018 MBS utilization rate for youth was 1.81 per 1000 and 5.56 per 1000 for adults (P < 0.001). Adult patients had slightly higher percentage (4.2%) of hospital readmissions compared to youth (3.4%, P = 0.01) but there were no other post-MBS complication differences. From 2015 to 2018 the US prevalence of youth with class II/III obesity increased in Hispanics and non-Hispanic Blacks (P trend < 0.001), but among youth who did complete MBS non-Hispanic Whites had higher rates of utilization (45.8%) compared to Hispanics (22.7%) and non-Hispanic blacks 14.2% (P = 0.006). Conclusions: MBS is an underutilized obesity treatment tool for both youth and adults, and among ethnic minority groups in particular. [ABSTRACT FROM AUTHOR]

Obesity in the USA continues to be a prominent medical and public health concern. Due to increasing rates of maternal obesity, the current Institute of Medicine (IOM) guidelines recommend 11–20 pounds of total weight gain during pregnancy in women with a BMI ≥30 kg/m2. The impact of maternal obesity on adverse perinatal outcomes has been well documented however, there is minimal data on the effect of gestational weight gain on neonatal outcomes. In this study, we assessed the association between gestational weight gain (GWG) and neonatal outcomes at term in women with class III obesity. A retrospective cohort of women delivering at a tertiary care institution between July 2013 and December 2017 with a first-trimester baseline BMI ≥40 kg/m2 was studied. Pregnancies complicated by multiple gestations, preterm delivery, fetal anomalies, intrauterine fetal demise or with missing data were excluded. The primary outcome was a composite of adverse neonatal outcomes including 5 min Apgar <7, neonatal intubation, grade 3 or 4 intraventricular hemorrhage (IVH), confirmed neonatal sepsis or Neonatal Intensive Care Unit (NICU) admission. Secondary outcomes included individual components of composite and NICU admission for >7 days. Demographic, pregnancy complications & delivery characteristics of women who gained more than IOM guidelines (>20 lbs.) were compared to women who gained at or less than IOM guidelines (≤20 lbs.) using bivariate statistics. Stepwise backward regression was used to estimate the odds of outcomes as appropriate. Of 374 women included, 144 (39.5%) gained more than guidelines. Women who gained above IOM recommendations were less likely to be multiparous and use tobacco. Additional demographic, obstetric and delivery characteristics, including BMI at the entry to care, did not differ. The neonatal composite occurred in 30 (8.0%) of all neonates; corresponding to 11.1% of women who gained more than IOM recommendations and 6.1% of those who gained at or below recommendations (p =.12, OR = 1.71, 95%CI 0.74–3.96). Additionally, neonates born to women gaining more than IOM recommendations were more likely to be admitted to the NICU (10.4 vs. 4.3%, p =.03) and have a NICU length of stay >7 days (6.9 vs. 2.2%, p =.03). When adjusted for mode of delivery, delivery BMI, tobacco use, and chorioamnionitis, women who gained more were not more likely to have an adverse neonatal outcome (1.54, 95%CI 0.62–3.80), they were 3.6 times more likely to have a neonate admitted to the NICU for more than 7 days (95%CI 1.00–13.42). In women with class III obesity, excess gestational weight gain was associated with increased odds of NICU stay >7 days, with trends toward increased NICU admission risk, further emphasizing the importance of appropriate weight gain counseling in this population at risk. [ABSTRACT FROM AUTHOR]

Background: Patients with Class III obesity pose unique challenges to health care staff and organisations. Care requirements of this population are unique and require specialised equipment and knowledge to meet these needs, maintain the quality of care, as well as the safety of patients and staff. Aim: To synthesise the evidence on the nursing care of Class III obese patients in acute care settings. Methods: A scoping review informed by JBI. CINAHL Plus, Medline, Scopus, Proquest Central, Web of Science and Embase were searched for primary research articles about the nursing management of people classified as Class III obese in acute care. Methodological quality of included studies was assessed; data extracted and synthesised into themes. Results: Fourteen studies were included in the review. The synthesis generated three themes: Access to equipment, knowledge and training, patient care, and opportunities to improve care. Conclusions: A paucity of high-quality evidence informs the nursing care of people with Class III obesity in acute care. Access to appropriate equipment dominated the findings of this review. Adequate provision of equipment and education on its use are required. Education to promote engagement with patients, adapting clinical practice and promotion of self-care could improve care and outcomes. [ABSTRACT FROM AUTHOR]

Background: Concern exists regarding adequacy of visualization of stress echocardiograms performed without intravenous contrast in persons with Class III obesity (body mass index ≥ 40 kg/m2). Methods: Dobutamine stress echocardiography (DSE) was performed on 128 candidates for bariatric surgery with class III obesity without chest pain or pre‐existent coronary artery disease (CAD). DSE without intravenous contrast was initially performed on 62 patients with class III obesity, then was subsequently was performed with intravenous contrast on 66 patients with class III obesity. Left ventricular (LV) regional wall motion was assessed at baseline and peak stress using the 16‐segment model. Results: In the intravenous contrast group, 1046 of 1056 LV segments studied (99.1%) were well‐visualized and interpretable at baseline and 1044 of 1056 LV segments studied (98.9%) were well‐visualized and interpretable at peak stress. In the non‐contrast group, 905 of 992 segments studied (91.2%) were well‐visualized and interpretable at baseline and 886 of 992 segments studied (89.3%) were well‐visualized and interpretable at peak stress. A significantly greater number of LV segments were well‐visualized and interpretable in the intravenous contrast group than in the group compared to the non‐contrast group, at baseline and at peak stress (p < 0.00001 for both). DSE was positive for ischemia in one patient. All patients underwent bariatric surgery without cardiovascular complications. Six months after surgery, all patients were alive; none developed cardiovascular events. Conclusion: The use of intravenous contrast during DSE significantly improves visualization and interpretability of LV segments in patients with class III obesity. [ABSTRACT FROM AUTHOR]

There is no clear research showcasing bariatric surgery's (BS's) impact on long-term surgical complications following total hip arthroplasty (THA). Therefore, this study compared the 10-year cumulative incidence and risk of revision following THA in patients who underwent BS when compared to the general population and class III obesity patients who did not undergo BS. Patients who underwent elective THA from 2010 to 2021 were identified using an all-payer claims database. Patients who underwent BS prior to THA were separately matched to a control of the general population and those who had class III obesity (body mass index ≥40) by age, sex, Charlson Comorbidity Index, and diabetes using a 1:4 ratio. Kaplan-Meier analyses generated 10-year cumulative incidence rates, and a Cox proportional hazard ratio (HR) model generated HRs and 95% confidence intervals (CIs). When compared to the general control, patients who have a history of BS had an elevated 10-year risk of all-cause revision (HR 1.31, 95% CI: 1.16 to 1.47, P <.001), prosthetic joint infection (HR: 1.62, CI: 1.30 to 2.04; P <.001), mechanical loosening (HR: 1.20, CI: 1.01 to 1.44; P =.040), and dislocation/instability (HR: 1.35, CI: 1.09 to 1.68; P =.007). There was no difference in the 10-year risk of all-cause revision or other indications for revision in the BS cohort compared to the matched class III obesity cohort (P =.142). Those who underwent BS before THA had comparable 10-year revision rates when compared to those who had class III obesity and higher rates compared to the general population. This suggests BS may not reduce the 10-year surgical risks associated with obesity when compared to a class III obese surgical population. [ABSTRACT FROM AUTHOR]

Purpose: Obesity is a chronic disorder characterized by a low-grade inflammatory state and immune cell irregularities. The study aimed to follow up on the changes in the peripheral CD4+ T lymphocytes and the pro-inflammatory cytokines; IL-6, TNF-alpha, MCP-1, and IL-10 at baseline and 12 weeks post-surgical intervention by the laparoscopic gastric sleeve (LGS) in morbidly obese patients (class III obesity subjects). Materials and Methods: A prospective longitudinal research included 24 class III obesity subjects with a BMI > 40 kg/m2. The subjects were enrolled from the Metabolic/Surgical Department at Hamad Medical Corporation (HMC)-Qatar. Fasting blood samples were collected at admission to LGS for weight loss and after 12 weeks of LGS. The immunophenotype of CD4+ T-cell populations; naïve (CD45RA+and CD27+), central memory T cells (CD45RO+ and CD27+), and effector memory (CD45RO+and CD27−) and T-regulatory cell (CD4+CD25+ FoxP3+) were identified using flow cytometry. Plasma pro-inflammatory cytokines and adipokines were evaluated. A control group of lean subjects was used to compare changes of T-regulatory and inflammatory biomarkers with postoperative changes in obese patients. Results: The means (SD) of age and BMI of class III obesity subjects was 32.32 (8.36) years and 49.02 (6.28) kg/m2, respectively. LGS caused a significant reduction in BMI by 32%, p< 0.0001. LGS intervention significantly decreased CD4+ T-lymphocytes and effector memory (TEM) cells but increased T-regulatory (Treg), naïve, and central memory (TCM) cells, with all p values < 0.05. The increase of Treg cells postoperative is significantly lower compared to lean subjects, p < 0.05. A significant reduction of plasma IL-6, TNF-α, and MCP-1, but IL-10 significantly increased after LGS, with all p< 0.05. Adiponectin/leptin ratio improved after LGS by 2.9 folds, p< 0.0001. Conclusion: Weight loss by LGS accomplished a substantial rise of Treg and decreased EM T-lymphocytes with a shift from pro-inflammatory to the anti-inflammatory pattern. [ABSTRACT FROM AUTHOR]

Introduction: The US population has witnessed an epidemic expansion of obesity in the past several decades; nearly 50% of the population is projected to be obese by 2030 and 25% morbidly obese. This study examined trends, characteristics and outcomes of morbidly obese women who underwent benign hysterectomy. Material and methods: This is a population‐based retrospective observational study querying the National Inpatient Sample from January 2012 to September 2015. The study population included 509 395 women who underwent hysterectomy for benign gynecological disease: 430 865 (84.6%) non‐obese women, 50 435 (9.9%) women with class I‐II obesity and 28 095 (5.5%) women with class III obesity. Main outcome measures were (i) cohort‐level trends of obesity and perioperative complications assessed by piecewise linear regression with log transformation and (ii) patient‐level perioperative complication risk by body habitus assessed with a generalized estimating equation after using a multiple‐group generalized boosted model. Results: The rate of class III obesity increased by 40.4%, higher than the rate of class I‐II obesity (22.2%) (both, P <.001). In parallel, cohort‐level rates of perioperative complication and prolonged hospitalization for ≥7 days increased by 19.4% and 54%, respectively (P <.001). In a weighted model, class I‐II obesity (16.4% vs 14.6%, odds ratio 1.15, 95% confidence interval 1.08‐1.21) and class III obesity (19.2% vs 14.6%, odds ratio 1.39, 95% confidence interval 1.28‐1.51) had a significantly increased risk of perioperative complications compared with non‐obesity. Larger body habitus was associated with higher total charge (median, $35 180, $36 094 and $39 382; all values cited in US dollars) and prolonged admission rate for ≥7 days (2.9%, 3.1% and 3.9%) (both, P <.001). Conclusions: The rate of obesity, particularly morbid obesity, has significantly increased among women undergoing benign hysterectomy in the USA. Morbidly obese women had adverse perioperative outcomes, and the increasing number of morbidly obese women resulted in both an increased perioperative morbidity and total charges as a cohort. National and society‐based approaches are necessary to reduce the obesity rate and hysterectomy morbidity. [ABSTRACT FROM AUTHOR]

Background: The burden of asthma remains steady with no decline observed in the past few decades. Obesity prevalence has been steadily increasing with a rate of 41.9% in the United States between 2017-2020. Obesity is an inflammatory chronic condition that may partially contribute to the burden and severity of asthma. This study aimed to examine whether the association between obesity and asthma varies with the categories of obesity (class I, II, and III) and persistent asthma (mild, moderate, and severe asthma). We hypothesized that subjects with elevated body mass index (BMI) are more likely to be diagnosed with persistent asthma than subjects without obesity with asthma., Methods: As a retrospective and cross-sectional study, this study used a total of 1,977 records of subjects with asthma (age ≥ 19 y) hospitalized in Nevada between 2016-2021. BMI and persistent asthma were evaluated as the main exposure and outcome of interest. Logistic regression was used to estimate the magnitude of the association between obesity and persistent asthma., Results: Among the selected subject records, subjects with obesity were more likely to be diagnosed with persistent asthma compared to subjects without obesity (odds ratio 1.50 [CI 1.10-2.05]). Subgroup analyses revealed that subjects with class III obesity (BMI ≥ 40) were more likely than subjects without obesity to be diagnosed with mild persistent asthma (odds ratio 2.21 [CI 1.18-4.16]) and severe persistent asthma (odds ratio 1.74 [CI 1.12-2.70])., Conclusions: Obesity was identified as a risk factor for persistent asthma, particularly class III obesity. This in turn increases the potential for greater health care utilization and economic burden. Public health and clinical interventions are necessary among those with comorbid asthma and obesity., (Copyright © 2024 by Daedalus Enterprises.)

Background : Obesity is one of the most neglected public health problems affecting both developed and developing countries. The most clinically severe obesity (Class 3 obesity) has both clinical and service delivery implications on dental services. However, associations between Class 3 obesity and oral health are minimally explored in the literature and thus poorly understood. Aims: This scoping review aimed to explore the existing evidence on Class 3 obesity and oral health. Methods: A literature search was performed via Medline, Scopus, Google scholar and Embase research databases. Results : A total of 375 papers were sourced from the database search. Twenty seven full-text papers were included in the final literature review. Results revealed findings from both quantitative and qualitative studies. Papers included results pertaining to associations with dental disease, oral health and associated behaviours, oral health-related quality of life and the barriers experienced by adults with Class 3 obesity in accessing dental services. Conclusions : While mixed findings were identified, this scoping review reports associations between Class 3 obesity and poor oral health across various domains including clinical parameters and oral health related quality of life. The literature has also highlighted important barriers to dental care in those with the most severe Class 3 obesity. Based upon our findings, we have summarised current oral health management implications and directions for future research.

Objective: Assess the effect of class III (body mass index [BMI, kg/m2] 40–49.9) and class IV obesity (≥ 50) on clinical pregnancy and live birth outcomes after first oocyte retrieval and fresh embryo transfer cycle. Design: Cohort study Setting: Academic center Patients: Patients undergoing their first oocyte retrieval with planned fresh embryo transfer in our clinic between 01/01/2012 and 12/31/2018. Patients were stratified by BMI: 18.5–24.9 (n = 4913), 25–29.9 (n = 1566) 30–34.9 (n = 559), 35–39.9 (n = 218), and ≥ 40 (n = 114). Intervention: None Main outcome measure: Live birth rate Results: Following embryo transfer, there were no differences in pregnancy rates across all BMI groups (p value, linear trend = 0.86). However among pregnant patients, as BMI increased, a significant trend of a decreased live birth rate was observed (p value, test for linear trend = 0.004). Additionally, as BMI increased, a significant trend of an increased miscarriage rate was observed (p value, linear trend = < 0.001). Compared to the normal-weight cohort, women with a BMI ≥ 40 had a significantly higher rate of cancelled fresh transfers after retrieval (18.4% vs. 8.2%, OR 2.51; 95%CI 1.55–4.08). Among singleton deliveries, a significant trend of an increased c-section rate was identified as the BMI increased (p value, linear trend = <0.001). Conclusion: Overall, patients with a BMI > 40 have worse IVF treatment outcomes compared to normal-weight patients. After embryo transfer, their pregnancy rate is comparable to normal-weight women; however, their miscarriage rate is higher, leading to a lower live birth rate for pregnant women in this population. Patients with a BMI > 40 have a c-section rate that is 50% higher than normal-weight patients. [ABSTRACT FROM AUTHOR]

The incidence rates of acute pancreatitis (AP) and the prevalence of class III obesity, and metabolic syndrome (MetS) are increasing in the US. Since class III obesity was associated with adverse clinical outcomes of AP, we sought to understand if the presence of metabolic comorbidities collectively recognized, as MetS were associated with worse clinical outcomes and increased health-care utilization. The Nationwide Readmissions Database (NRD) (2010–2014) was reviewed to identify all adult subjects with a principal discharge diagnosis of AP. Inpatient mortality, severe AP (SAP), and 30-day readmissions were the primary outcomes analyzed. Propensity score weighted analyses were used to compare AP subjects with and without MetS and were further stratified by class III obesity status. MetS was associated with 12.91% (139,165/1,078,183) of all admissions with AP. Propensity score weighted analyses showed that MetS was associated with an increased proportion of SAP (OR 1.21, 95% CI 1.17, 1.25), but decreased mortality (OR 0.62, 95% CI 0.54, 0.70) and 30-day readmissions (OR 0.86, 95% CI 0.83, 0.89). Propensity score weighted analyses also revealed that class III obesity was independently associated with increased mortality in AP subjects with (OR 1.92, 95% CI 1.41, 2.61) and without MetS (OR 1.55, 95% CI 1.26, 1.92), and increased SAP in subjects with and without MetS. Class III obesity appears to be the primary factor associated with adverse clinical outcomes in subjects with MetS admitted with AP. This has significant implications for patient management and future research targeting AP. [ABSTRACT FROM AUTHOR]

The Abdominal Re-Approximation Anchor (ABRA ® ) is a pivotal dynamic wound closure system utilized for achieving primary fascial closure in patients undergoing open abdomen surgeries. However, its efficacy can be hindered in patients with class III obesity due to anatomical complexities and compromised tissue characteristics. Here, we present the unique case of a 25-year-old woman with class III obesity (body mass index (BMI) ≥ 40 kg/m 2 ) who required primary abdominal closure following complications of an ileostomy repair. Traditional placement of the ABRA device was not feasible due to thick subcutaneous tissue layers. Consequently, a modified application of ABRA was decided based on clinical judgment, whereby the ABRA button anchors were strategically placed internally under the subcutaneous tissue instead of externally on the skin surface. The patient completed six intraoperative tightenings of the ABRA device via this novel technique and was treated with washouts over the course of two months until complete resolution was achieved. The presented case demonstrates a successful modification of the ABRA wound closure device to suit an open abdomen patient with class III obesity., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Nguyen et al.)

Introduction: Objective: To compare the diagnosis of NB through the use of the standardized interview of the World Health Organization/Pan American Health Organization (WHO/PAHO) with electroretinography, and also to evaluate the association of these diagnoses with serum concentrations of retinol in class III obesity individuals. Methods: Adult patients of both genders, in the 20-60 age group, with BMI ≥ 40 kg/m² were studied. NB was diagnosed through electroretinography and the standardized interview validated by the WHO/PAHO. Serum level of retinol was quantified by the HPLC-UV method, and VAD was diagnosed when levels were <1.05 µmol /L, and severity was also evaluated. Statistical analysis was carried out through the Statistical Package for the Social Sciences, version 21.0 (p < 0.05). Results: Mean BMI was 44.9  11.8 kg/m², and a negative correlation was found in serum levels of retinol (p= 0.01). The prevalence of VAD, according to the serum concentrations of retinol, was 14%, and of this percentage 23.3% had NB according to the standardized interview, and 22.0% according to electroretinography. NB diagnosed by both methods showed an association with VAD according to the serum concentrations of retinol. Of these individuals with NB, according to the standardized interview, 6.9% showed severe VAD, 10.3% moderate VAD and 82.8% marginal VAD. Conclusion: The standardized interview for the diagnosis of NB can be a good strategy to evaluate the nutritional status of vitamin A, and it is a simple, non-invasive and low-cost method. [ABSTRACT FROM AUTHOR]

Class III obese (body mass index ≥ 40 kg/m²) patients, now regularly encountered clinically, have increased perioperative risks, including potentially from suboptimal drug dosing. However, current dosing guidelines are based on low-level evidence and may not be widely accepted. This study aimed to investigate anaesthetists' dosing practices for class III obese surgical patients, explore if they had experienced an increased incidence of adverse events potentially related to drug dosing with these patients and assess which resources they consulted for dosing advice in this population. An electronic survey was emailed to 1000 randomly selected members of the Australian and New Zealand College of Anaesthetists. Data were summarised and the Pearson's χ² test was used to compare respondents' genders, geographic locations and seniority designations with the greater Australian and New Zealand College of Anaesthetists' membership. There were 230 completed responses (response rate 23%). A large proportion (46%-76%) of respondents indicated they dose class III obese patients in keeping with current recommendations; however, substantial heterogeneity in dosing practices was found. Lean body weight was the most frequently used regimen for dosing propofol, non-depolarising muscle relaxants, sugammadex and opioids, whereas total body weight was most frequently used for suxamethonium. Nearly 70% of respondents reported using at least one resource to assist their dosing practices in obesity. Importantly, increased incidences of adverse events in class III obese patients related to drug dosing were commonly experienced by respondents. Until higher-level evidence is available for dosing class III obese patients, anaesthetists should consider current recommendations and exercise increased attention to dosing. Further clinician education may assist in optimising dosing in this patient group. [ABSTRACT FROM AUTHOR]

Bariatric dentistry is the branch of dental medicine focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing US and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy, it is necessary that proper accommodations are made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. The aim of the present case report was to bring awareness and start professional discussions on the importance of dental practitioners in the community and dental academic programs working together to assure access for primary oral health for bariatric patients.

Summary Objectives To analyze the mRNA expression of interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) in the liver and white adipose tissue samples of individuals with class III obesity (body mass index ≥40.0 kg/m 2 ) with non-alcoholic fatty liver disease (NAFLD). Methods This cross-sectional study included patients with class III obesity exhibiting early or late morphological presentation of NAFLD (non-alcoholic hepatic steatosis [NAFL], n = 8 and non-alcoholic steatohepatitis [NASH], n = 13, respectively). All patients underwent bariatric surgery and peripheral blood, liver, and visceral white adipose tissue (WAT) samples were collected. Socio-demographic, anthropometric, clinical, plasma biochemical, and nutritional characteristics of each study subject were assessed and compared between patients presenting with NAFL and NASH. IL-6 and TNF-α mRNA expression in the liver and WAT samples were measured by using quantitative real time-polymerase chain reaction (qRT-PCR). Results Individuals with class III obesity and NASH showed higher body mass index (BMI) and higher IL-6 and TNF-α mRNA expression in the WAT compared to that of patients with NAFL ( p = 0.01, for all associations). Conclusions Individuals with class III obesity with higher morphological severity of NAFLD exhibited higher BMI and higher IL-6 and TNF-α expression in the WAT. Future prospective studies are warranted to determine how BMI, IL-6, and TNF-α affect the progression of NAFLD in individuals with class III obesity. [ABSTRACT FROM AUTHOR]

Obesity represents a major global health challenge. Female sexual dysfunctions have a negative impact on quality of life and overall health balance. A higher rate of female sexual dysfunctions in obese women has been suggested. This systematic review summarized the literature on female sexual dysfunction prevalence in obese women. The review was registered (Open Science Framework OSF.IO/7CG95) and a literature search without language restrictions was conducted in PubMed, Embase and Web of Science, from January 1990 to December 2021. Cross-sectional and intervention studies were included, the latter if they provided female sexual dysfunction rate data in obese women prior to the intervention. For inclusion, studies should have used the female sexual function index or its simplified version. Study quality was assessed to evaluate if female sexual function index was properly applied using six items. Rates of female sexual dysfunctions examining for differences between obese vs class III obese and high vs low quality subgroups were summarized. Random effects meta-analysis was performed, calculating 95% confidence intervals (CI) and examining heterogeneity with I 2 statistic. Publication bias was evaluated with funnel plot. There were 15 relevant studies (1720 women participants in total with 153 obese and 1567 class III obese women). Of these, 8 (53.3%) studies complied with >4 quality items. Overall prevalence of female sexual dysfunctions was 62% (95% CI 55-68%; I 2 85.5%). Among obese women the prevalence was 69% (95% CI 55-80%; I 2 73.8%) vs 59% (95% CI 52-66%; I 2 87.5%) among those class III obese (subgroup difference p=0.15). Among high quality studies the prevalence was 54% (95% CI 50-60%; I 2 46.8%) vs 72% (95% CI 61-81%; I 2 88.0%) among low quality studies (subgroup difference p=0.002). There was no funnel asymmetry. We interpreted that the rate of sexual dysfunctions is high in obese and class III obese women. Obesity should be regarded as a risk factor for female sexual dysfunctions., (Copyright © 2023 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Endoscopic sleeve gastroplasty (ESG) is an effective therapy for class I-II obesity, but there are knowledge gaps in the published literature about its implementation in patients with class III obesity [body mass index (BMI) ≥ 40 kg/m 2 ]., Aim: To evaluate the safety, clinical efficacy, and durability of ESG in adults with class III obesity., Methods: This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m 2 who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss (TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss (EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration., Results: 404 consecutive patients (78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m 2 ) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type II diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization (0.2% serious adverse event rate)., Conclusion: When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class III obesity, with improvement in comorbidities and an acceptable safety profile., Competing Interests: Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript except as specified below: Christopher E. McGowan: consultant for Apollo Endosurgery. Anna C. Hoff: consultant for Apollo Endosurgery. Daniel B. Maselli: consultant for Apollo Endosurgery. No author has a proprietary relationship in Apollo Endosurgery., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: To compare the costs between planned cesarean delivery (CD) and induction of labor (IOL) in women with class III obesity.Methods: We conducted a cost-minimization analysis using data from a previous study of women with a BMI ≥40 kg/m(2) delivering term singletons via planned CD or after IOL. Decision trees were built with branches for two "treatments": planned CD and IOL (probabilities derived from parent study). Direct and total costs were obtained for each mother-infant pair. Sensitivity analyses for probability of successful IOL were performed.Results: A total of 661 mother-infant pairs were included - 399 IOLs and 262 planned CDs. Of 399 IOLs, 236 (59%) delivered vaginally and 163 (41%) had a CD. IOL was slightly less costly. For IOL and planned CD, respectively, direct costs were $7416 versus $7474, and total costs were $11 545 versus $11 665. Sensitivity analyses indicated that IOL was the least costly strategy if the probability of vaginal delivery after IOL was >57% (0.575 for direct costs; 0.570 for total costs). There was, however, a slight cost advantage to planned CD in women with a prior cesarean.Conclusions: In women with class III obesity, IOL is less costly than planned CD if the probability of vaginal delivery after IOL in an individual patient is greater than 57%. [ABSTRACT FROM AUTHOR]

Objective: to explore the barriers and facilitators to physical activity and lifestyle interventions in pregnant women with Class III obesity (body mass index 4 40 kg/m²). Design: qualitative study using in-depth, semi-structure interviews framed by the Theory of Planned Behaviour. Semi-structured, in-depth interviews were conducted using a topic guide. Data analysis was undertaken using a Framework Approach and was informed by the theory of planned behaviour. Recruitment and analysis continued until data saturation was reached. Setting: participants were recruited from an antenatal clinic for women with Class III obesity. Participants: pregnant women (n = 13) with Class III obesity. Measurements and outcomes: three major themes emerged from the data analysis: having a healthy lifestyle awareness, complex barriers to lifestyle changes and having personalised solutions to promote healthy lifestyle. Women were aware of the benefits of physical activity during pregnancy but had complex barriers to engaging with activity. Conclusions and implications for practice: future lifestyle interventions for women with Class III in pregnancy should take into account individual, societal and support barriers towards weight management and lifestyle choices in pregnancy. Programs that provide personalised support which are sensitive to the specific physical and psychological needs of women with Class III obesity which focus on the benefits and safety of physical activity for both mother and baby may be more likely to be successful. Further research is needed to explore the feasibility and acceptability of tailored programs. [ABSTRACT FROM AUTHOR]

Obesity is associated with numerous adverse health effects for pregnant women and their newborns. Unintended pregnancy is associated with suboptimal prenatal health behaviors and adverse birth outcomes. While research has suggested a link between obesity and unintended pregnancy, the evidence has been contradictory. Research has not focused on women at the highest level of obesity, Class III (body mass index ≥40). Pregnancy Risk Assessment Monitoring System data for 4,161 women in New York City with a live birth from 2004 to 2007 and complete data on pregnancy intention, height, and weight were examined. The primary outcome, having a live birth that resulted from an unwanted pregnancy (not wanted at that time or at any time in the future), was compared across 6 groups of pre-pregnancy body mass index (BMI). Logistic regression models adjusting for sociodemographic factors and stressors during pregnancy were conducted. The proportion of women reporting their pregnancy was unwanted increased with increasing BMI level to a high of 24 % among women with Class III obesity. After adjustment for confounding sociodemographic factors, women classified as Class III obese were significantly more likely than women with normal BMI to report an unwanted pregnancy [AOR = 2.81 (95 % CI: 1.41-5.60)]; this relationship held after adjusting for stressors during pregnancy. No significant association was found for women of other BMI groups. Previous analyses may have masked a relationship between BMI and unwanted pregnancy among women with Class III obesity. Further research exploring underlying mechanisms which are amenable to intervention is of critical public health importance. [ABSTRACT FROM AUTHOR]

Introduction: Endometrial cancer is often directly related to obesity and interventions for weight loss have mixed results. Risk factors for continued weight gain after diagnosis are not clearly defined in the literature. The objective of this study is to describe risk factors associated with increased body mass index (BMI) trajectory among endometrial cancer patients., Methods: Patients who were surgically treated for endometrial cancer at a single institution between 2010 and 2015 were identified. Demographics including age, race/ethnicity and estimated median income at diagnosis were obtained. BMI at five time points after diagnosis were calculated. BMI trajectories were estimated by latent class growth modeling using the PROC TRAJ procedure in SAS. Chi-squared tests and ANOVA were used to assess differences between trajectory groups. Statistical significance was set to a p-value < 0.05., Results: Of 695 patients included in the study, the average age at diagnosis was 62 years and over 70% of patients were obese at baseline. Patients experienced increasing, stable, or decreasing BMI over 2 years following diagnosis. Patients with younger age and lower estimated median income were most likely to be in the increasing BMI group. Among obese patients, those with Class I obesity (BMI 30 to 34.9 kg/m 2 ) were most likely to experience decreasing BMI and those with Class III obesity (BMI > 40 kg/m 2 ) were most likely to experience increasing BMI, p < 0.0001., Conclusion: A third of endometrial cancer survivors experience increasing BMI. Severity of obesity at diagnosis matters, patients with severe obesity (Class III) were most likely to experience weight gain., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Shariska Petersen Harrington: This work was supported by a CTSA grant from NCATS awarded to the University of Kansas (# TL1TR002368). This work was a result of TREC Training Workshop R25CA203650 (PI: Melinda Irwin). HERON is funded by CTSA Award #UL1TR002366., (© 2022 The Authors. Published by Elsevier Inc.)

Objectives: To compare outcomes of neonates born from women with Class III obesity with those whose mothers were of normal body weight. Methods: A retrospective cohort study of live-born singleton infants was undertaken. Maternal prepregnancy body mass index (BMI) defined matched normal and Class III obese cohorts. Multivariable regression models were used to determine adjusted relative odds ratios (aOR) and 95% confidence intervals (CI) for selected adverse neonatal outcomes. Results: Newborns exposed to maternal Class III obesity had greater risks of fetal overgrowth and low cord artery pH. Class III obesity was protective against small for gestational age and low birthweight. There was no difference in the risk of preterm delivery, meconium in the amniotic fluid or breastfeeding initiation. Conclusions: The new knowledge generated by this study provides further information on unique challenges faced by newborns of women with Class III obesity, suggesting more specialized care in the intrapartum and neonatal periods may be beneficial. [ABSTRACT FROM AUTHOR]

The article discusses a study based on metabolic program in skeletal muscles of severely obese individuals. It informs that fatty acid oxidation (FAO) in skeletal muscles was measured for the study using labeled carbon dioxide. The study also investigated the insulin signaling pathway in severely obese individuals by using purified insulin receptors from biopsy tissue and it revealed that the insulin receptors of severely obese subjects had lower tyrosine kinase activity.

Background: Studies showed a rise in obesity prevalence in world population and evidences point to a possible association with vitamin A deficiency (VAD). The objective of this study is to assess vitamin A nutritional status through functional [night blindness diagnosis-xerophthalmia (XN)] and biochemical (serum levels and retinol liver store) indicators of class III obesity individuals and its association. Methods: We studied 114 patients of both genders with BMI ≥40 kg/m, candidates to bariatric surgery at Clínica Cirúrgica Carlos Saboya in Rio de Janeiro, Brazil. XN was diagnosed through a standardized interview (WHO and MacLaren and Frigg), and serum levels and retinol liver store were quantified by HPLC-UV with <1.05 μmol/L and < 20 mg/g cutoffs for VAD, respectively. Results: XN prevalence was 23.8%, and serum levels and retinol liver store inadequacy were 14.0% and 80%, respectively. The association between VAD and XN presence ( p = 0.003) was observed with the biochemical indicator and the gold standard, retinol liver store ( p = 0.003 and p = 0.018, respectively). Means were 59.3% (sensitivity), 87.4% (specificity), and 80.8% (accuracy) as regards to the XN role in predicting VAD according to the biochemical indicator. As regards to retinol liver store, XN diagnosis presented 48% of sensitivity and 75% of specificity. VAD highest indexes occurred in patients with highest BMI (rs-0.21, p = 0.02). Distribution of XN prevalence was 59.2% according to serum retinol. Conclusions: VAD and XN prevalence was high in class III obesity individuals, and the functional indicator for XN diagnosis may be a promising method for diagnosis in this group. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to analyze the impact of bariatric surgery on the body composition of patients suffering from class III obesity at different postoperative time intervals. Methods: The body composition of 114 patients undergoing Roux-en-Y gastric bypass surgery was measured prior to surgery (T0) and then 30 (T30) and 180 (T180) days following surgery. Body composition was evaluated using the following parameters: total body mass, body mass index, excess weight, percentage of excess weight loss, relative body fat (%F), lean body mass (LBM), and fat tissue mass (FTM). To determine these variables, validated formulas and equations proper to obese men and women were employed. Results: A significant reduction in %F (41.5%), LBM (20.3%), FTM (37.9%) was noted at each time interval ( p ≤ 0.01). Conclusions: Bariatric surgery proved to be effective in reducing total body mass and body fat at every time interval. However, dietary measures emphasizing adequate protein intake may be implemented in order to reduce loss of LBM and, coupled with frequent physical activity, may help curtail the impact the surgery has on morphological variables. [ABSTRACT FROM AUTHOR]

Background: We have reported a reduction in fatty acid oxidation (FAO) at the whole-body level and in skeletal muscle in severely obese (BMI ≥ 40 kg/m2) individuals; this defect is retained in cell culture suggesting an inherent component. The purpose of the current study was to determine if an impairment in whole-body fatty acid oxidation (FAO) was also evident in children with a severely obese parent. Methods: Substrate utilization during submaximal exercise (cycle ergometer) was determined in children ages 8-12 y with a severely obese parent (OP, n = 13) or two lean/non-obese (BMI range of 18 to 28 kg/m2) parents (LP, n = 13). A subgroup of subjects (n = 3/group) performed 4 weeks of exercise training with substrate utilization measured after the intervention. Results: The children did not differ in age (LP vs. OP, respectively) (10.7 ± 0.5 vs. 10.2 ± 0.5 y), BMI percentile (65.3 ± 5.2 vs. 75.9 ± 7), Tanner Stage (1.4 ± 0.2 vs. 1.5 ± 0.2), VO2peak (40.3 ± 2.7 vs. 35.6 ± 2.6 ml/kg/min) or physical activity levels (accelerometer). At the same absolute workload of 15 W (~38% VO2peak), RER was significantly (P≤ 0.05) lower in LP vs. OP (0.83 ± 0.02 vs. 0.87 ± 0.01) which was reflected in a reduced reliance on FAO for energy production in the OP group (58.6 ± 5.1 vs. 43.1 ± 4.0% of energy needs during exercise from FAO). At a higher exercise intensity (~65% VO2peak) there were no differences in substrate utilization between LP and OP. After exercise training RER tended to decrease (P = 0.06) at the 15 W workload, suggesting an increased reliance on FAO regardless of group. Conclusions: These findings suggest that the decrement in FAO with severe obesity has an inherent component that may be overcome with exercise training. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate whether menstrual irregularity in morbidly obese women is indicative of metabolic dysfunction. Patients and Methods. Fifty-seven women with morbid obesity were evaluated. They were divided into two groups: one comprising women without menstrual dysfunctions or hirsutism (Group 1), and another obese women showing menstrual dysfunction with or without hirsutism (Group 2). The following were evaluated: age, colour, childbirth, marital status, profession, socio-economic level, education, age at menarche, body weight, height, body mass index, presence of hirsutism (Ferriman Gallwey Index), abdominal circumference, hip circumference, waist-to-hip ratio, menstrual cycle, blood pressure, presence of acanthosis nigricans, insulin resistance (IR), fasting glycaemia, total cholesterol, HDL-C, LDL-C, triglycerides, thyroid-stimulating hormone, free T4, luteinising hormone (LH), follicle-stimulating hormone, prolactin, total testosterone, dehydroepiandrosterone sulfate, insulin and the Homeostasis Model Assessment (HOMA test). Results. Clinical and epidemiological aspects did not present statistical differences. Clinical and laboratory parameters did not show statistically significant alterations; however, HOMA test values for Group 2 were significantly higher than those for Group 1. Conclusions. The presence of IR in class III obese women can cause menstrual dysfunctions such as amenorrhoea or oligomenorrhoea even in the absence of hyperandrogenism, suggesting that IR plays an important role in the ovarian mechanisms involved in the menstrual cycle control. [ABSTRACT FROM AUTHOR]

Background and Objectives: To compare the immediate operating room (OR), inpatient, and overall costs between three surgical modalities among women with endometrial cancer (EC) and Class III obesity or higher., Methods: A multicentre prospective observational study examined outcomes of women, with early stage EC, treated surgically. Resource use was collected for OR costs including OR time, equipment, and inpatient costs. Median OR, inpatient, and overall costs across surgical modalities were analyzed using an Independent-Samples Kruskal-Wallis Test among patients with BMI ≥ 40., Results: Out of 520 women, 103 had a BMI ≥ 40. Among women with BMI ≥ 40: median OR costs were $4197.02 for laparotomy, $5524.63 for non-robotic assisted laparoscopy, and $7225.16 for robotic-assisted laparoscopy (p < 0.001) and median inpatient costs were $5584.28 for laparotomy, $3042.07 for non-robotic assisted laparoscopy, and $1794.51 for robotic-assisted laparoscopy (p < 0.001). There were no statistically significant differences in the median overall costs: $10 291.50 for laparotomy, $8412.63 for non-robotic assisted laparoscopy, and $9002.48 for robotic-assisted laparoscopy (p = 0.185)., Conclusion: There was no difference in overall costs between the three surgical modalities in patient with BMI ≥ 40. Given the similar costs, any form of minimally invasive surgery should be promoted in this population., (© 2021 Wiley Periodicals LLC.)

The effects of weight loss following bariatric surgery on autonomic balance, arrhythmias and insulin resistance are still of interest. We prospectively investigated 50 patients with BMI > 40 kg/m2, aged 36.5 (18–56) years who underwent laparoscopic sleeve gastrectomy. Among other examinations, all subjects had 24-h Holter monitoring with heart rate variability (HRV) and heart rate turbulence (HRT) evaluation. After a median of 15 months, BMI decreased from 43.9 to 29.7 kg/m2, the incidence of hypertension decreased from 54 to 32% (p = 0.04) and any carbohydrate disorders decreased from 24 to 6% (p = 0.02). Fasting insulin concentration and insulin resistance index improved significantly (p < 0.001). Improvements in HRV parameters related to the sympathetic autonomic division were also observed (p < 0.001), while HRT evaluation was not conclusive. The enhancement of autonomic tone indices was correlated with reduction of BMI (SDNN-I r = 0.281 p = 0.04; SDNN r = 0.267 p = 0.05), but not with reduction of waist circumference, and it was also associated with decrease of mean heart rate (OR 0.02, 95%CI 0.0–0.1, p < 0.001). The incidence of arrhythmias was low and similar before and after follow-up. In conclusion, improvement of homeostasis of carbohydrate metabolism and autonomic function is observed in relatively young patients after weight loss due to laparoscopic sleeve gastrectomy. [ABSTRACT FROM AUTHOR]

Objectives: The incidence rates of acute pancreatitis (AP) and the prevalence of class III obesity, and metabolic syndrome (MetS) are increasing in the US. Since class III obesity was associated with adverse clinical outcomes of AP, we sought to understand if the presence of metabolic comorbidities collectively recognized, as MetS were associated with worse clinical outcomes and increased health-care utilization., Methods: The Nationwide Readmissions Database (NRD) (2010-2014) was reviewed to identify all adult subjects with a principal discharge diagnosis of AP. Inpatient mortality, severe AP (SAP), and 30-day readmissions were the primary outcomes analyzed. Propensity score weighted analyses were used to compare AP subjects with and without MetS and were further stratified by class III obesity status., Results: MetS was associated with 12.91% (139,165/1,078,183) of all admissions with AP. Propensity score weighted analyses showed that MetS was associated with an increased proportion of SAP (OR 1.21, 95% CI 1.17, 1.25), but decreased mortality (OR 0.62, 95% CI 0.54, 0.70) and 30-day readmissions (OR 0.86, 95% CI 0.83, 0.89). Propensity score weighted analyses also revealed that class III obesity was independently associated with increased mortality in AP subjects with (OR 1.92, 95% CI 1.41, 2.61) and without MetS (OR 1.55, 95% CI 1.26, 1.92), and increased SAP in subjects with and without MetS., Conclusions: Class III obesity appears to be the primary factor associated with adverse clinical outcomes in subjects with MetS admitted with AP. This has significant implications for patient management and future research targeting AP., Competing Interests: Declaration of competing interest None., (Copyright © 2020. Published by Elsevier B.V.)

Background: Obese subjects are at higher risk of development and progression of ARDS. There are limited data regarding mechanical ventilation practices and use of adjunctive therapies in subjects with ARDS across different obesity classes. We hypothesized that the adherence to lung-protective ventilation would be worse with rising body mass index class in patients with ARDS., Methods: We conducted a retrospective observational study of subjects with ARDS. We evaluated the differences in ventilator settings, airway pressures, gas exchange, use of rescue therapies, length of hospital stay, and mortality among subjects based on the obesity classes of the WHO., Results: The study included 613 subjects with ARDS: 21.4% were normal weight, 25% were overweight, and 53.7% were obese; 33.3% of the obese subjects met criteria for class I-II obesity, while 20.4% were class III obese (morbid obesity). On day 1, 53% of subjects with class III obesity had tidal volumes > 8 mL/kg, compared to 26% of the subjects with normal weight. In addition, 48% of the morbidly obese subjects received at least one rescue therapy as compared to 37% of normal weight subjects and 36% of overweight subjects. There were significant differences in the use of rescue therapies among the groups. In a multivariable model, subjects with class III obesity were significantly more likely to receive tidal volume > 8 mL/kg predicted body weight on day 1 when compared with subjects with normal weight (odds ratio 3.14, 95% CI 1.78-5.57). There was no difference in length of stay in ICU or hospital, duration of mechanical ventilation, or adjusted ICU or hospital mortality among the 4 groups., Conclusions: In this study, the risk of exposure to higher tidal volumes and the need for specific rescue therapies rose with higher classes of obesity in subjects with ARDS. More research is needed to identify how to better implement lung-protective ventilation in patients with obesity., Competing Interests: Mr Chatburn has disclosed relationships with IngMar Medical, Drive/DeVilbiss, and imtmedical. The remaining authors have disclosed no conflicts of interest., (Copyright © 2020 by Daedalus Enterprises.)

Background: Women with prepregnancy class III obesity (body mass index ≥40 kg/m 2 ) are at an increased risk of perinatal complications and adverse obstetrical outcomes. Estimates of the magnitude of risk that these women face vary widely, which may reflect differences in institutional experience caring for women with obesity., Objective: We sought to characterize the relationship between institutional prevalence of prepregnancy class III obesity and the risk of adverse perinatal outcomes among these women, hypothesizing that higher-prevalence institutions would have lower rates of adverse maternal and perinatal outcomes among this population., Study Design: We conducted a retrospective cohort study using chart-abstracted data on births in Washington state from Jan. 1, 2012, to Dec. 31, 2017. The analysis was restricted to hospitals that delivered at least 1 patient per month with prepregnancy class III obesity. Institutional prevalence of prepregnancy class III obesity was calculated, and hospitals were classified as either high or low prevalence. We included nulliparous women with vertex-presenting singleton pregnancies at ≥37 weeks of gestation. We excluded births with missing initial body mass index. The primary outcome was the incidence of cesarean delivery. Secondary outcomes were induction of labor, postpartum complications, postpartum readmission, and neonatal intensive care unit admissions. We compared outcomes between women with prepregnancy class III and all obesity at high- and low-prevalence hospitals using the χ 2 test or the Fishers exact test as appropriate. Binary logistic regression was performed to compare outcomes at high- and low-prevalence hospitals. A hospital-adjusted multivariable regression model that controlled for baseline institutional rates of each outcome and compared outcomes between high- and low-prevalence hospitals was developed. A final multivariable logistic regression that controlled for both baseline institutional variation as well as potential clinical confounders was performed., Results: A total of 20,556 women at 6 hospitals were eligible for inclusion; the prevalence of prepregnancy class III obesity was 6.2% and 2.1% in high- and low-prevalence hospitals, respectively. Obese women, including those with class III obesity in a high-prevalence hospital, were more likely to be Latina and less likely to be of advanced maternal age and carry private insurance. After adjusting for the institutional cesarean delivery rate, women with prepregnancy class III obesity had significantly increased odds of cesarean delivery (odds ratio, 1.53, 95% confidence interval, 1.12-2.10); however, after adjusting for significant covariates, the association no longer achieved significance (odds ratio, 1.68, 95% confidence interval, 0.97-2.94). The hospital-adjusted odds of postpartum readmission were significantly increased for women with prepregnancy class III obesity when delivering in low-prevalence institutions (odds ratio, 6.61, 95% confidence interval, 1.93-22.56), and the association was further strengthened after controlling for significant covariates (odds ratio, 15.20, 95% confidence interval, 2.32-99.53). None of the models demonstrated significantly different odds of induction of labor, postpartum complications, or neonatal intensive care unit admission by institutional prevalence of prepregnancy class III obesity., Conclusion: Even after controlling for underlying hospital and subject characteristics, women with prepregnancy class III obesity had significantly increased odds of postpartum readmission, and a trend toward increased odds of cesarean delivery, when delivering in institutions with less experience caring for women with obesity., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Obesity is a risk factor for infectious morbidity and wound complications after cesarean delivery. There are currently insufficient data to determine optimal skin closure technique for cesarean delivery, specifically for those women with class III obesity, defined as a body mass index ≥40 kg/m2.Objective: We sought to compare stainless steel staples vs subcuticular suture for skin closure for cesarean delivery in class III obese women with body mass index ≥40 kg/m2.Study Design: We conducted a randomized controlled trial at 2 teaching hospitals from 2015 through 2016 in which women with body mass index ≥40 kg/m2 undergoing cesarean delivery were randomly assigned to stainless steel staples or subcuticular suture skin closure. The primary outcome was composite wound complication defined as superficial or deep separation and infection occurring up to 6 weeks following delivery. Secondary outcomes included operative time, and patient pain and satisfaction scores.Results: A total of 242 women were enrolled. In all, 119 in the staples group and 119 in the subcuticular suture group were analyzed. Maternal demographics and characteristics were similar in both groups. The composite wound complication frequency was 19.3% in the staples group and 17.6% in the subcuticular suture group (P = .74) with an overall wound complication incidence of 18.5% in the entire study cohort. There were also no differences in the frequencies of infection, or in superficial or deep wound separation between the 2 study groups. In a univariate analysis of predictors of wound complications, only current tobacco use was a significant predictor of wound complications (relative risk, 4.97; 95% confidence interval, 1.37-18.03; P = .02). Fewer women with staple closure would choose the same method with a future delivery (P = .01), however, self-reported pain and concern about wound healing were equal between the 2 groups.Conclusion: In class III obese women undergoing cesarean delivery, there was no difference in composite wound outcome up to 6 weeks postpartum between those who had staples and those who had subcuticular suture skin closure. [ABSTRACT FROM AUTHOR]