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STUDY OBJECTIVES: To determine the prevalence of obstructive sleep apnea (OSA) in a cohort of women with class III obesity, and a comparator lean group, in the second and third trimesters of pregnancy. Secondary objectives were to compare characteristics of women with obesity with and without OSA and to assess factors that were predictive of OSA. METHODS: We performed a prospective cohort study involving 33 women with class III obesity (mean body mass index 43.5 ± 3.9 kg/m(2)) and 39 lean women (body mass index 22.0 ± 1.7 kg/m(2)) with singleton pregnancies. Participants completed 2 level 3 sleep studies between 12–22 weeks and 32–38 weeks gestation. OSA was defined as a respiratory event index ≥ 5 events/h (≥ 3% desaturation criteria). Levels of interleukin-6, glucose, and C-peptide were quantified in maternal blood. Logistic regression analysis was performed to determine predictors of OSA. RESULTS: OSA was identified in 12 (37.5%) and 14 (50.0%) women with obesity and in 1 (2.6%) and 3 (9.1%) lean women in the second and third trimesters, respectively. Women with obesity with OSA were older than those with no OSA but otherwise had similar characteristics. In unadjusted analysis of women with obesity, increased age, body mass index, homeostatic model assessment of insulin resistance, and history of nonsmoking were associated with increased odds of OSA. In multivariable analysis, only increased age remained significantly associated with OSA. CONCLUSIONS: OSA is highly prevalent in pregnant women with class III obesity. Further research is required to establish effective management strategies for the growing number of women in this high-risk group. CITATION: Johns EC, Hill EA, Williams S, et al. High prevalence of obstructive sleep apnea in pregnant women with class III obesity: a prospective cohort study. J Clin Sleep Med. 2022;18(2):423–432.

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 1 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.

Objective Women with obesity and other comorbidities such as hypertension and diabetes are at an increased risk of preeclampsia and perinatal morbidity. This study evaluates whether screening echocardiogram can identify women with obesity at a higher risk of preeclampsia. Methods We conducted a retrospective cohort study of women with class III obesity (body mass index [BMI] ≥40 kg/m2) and one or more medical comorbidities associated with an increased risk of preeclampsia (such as diabetes, hypertension, and rheumatologic disease) undergoing screening echocardiogram. Abnormal findings were defined as the presence of one or more of the following: diastolic dysfunction, ejection fraction of ≤45%, or cardiac chamber enlargement or hypertrophy. Multivariable logistic regression was used to estimate the odds ratio (OR) of gestational hypertension/mild preeclampsia, severe preeclampsia, and any preterm delivery Results Of 267 eligible women, 174 (64%) underwent screening echocardiograms. Sixty-nine women (40%) had abnormal echocardiograms. Maternal clinical characteristics were similar between women with normal echocardiographic findings and women with abnormal findings. Women with abnormal echocardiograms were more likely to have chronic hypertension (78 vs. 62%, p = 0.04) and a history of preeclampsia (27 vs. 10%, p = 0.02). After controlling for confounders, women with abnormal echocardiogram were at an increased risk of hypertensive disorders of pregnancy, OR 6.80 (95% confidence interval [CI] 3.32–13.93, p = 0.01), and in particular severe preeclampsia, OR 8.77 (95% CI 3.90–19.74, p = 0.01). Conclusion Among pregnant women with class III obesity and medical comorbidities, screening echocardiogram may help identify a subset of women at the highest risk of developing preeclampsia. Key Points

PURPOSE This study examined worker characteristics and behaviors, and the perceived importance of job-related tasks associated with the willingness to perform a proposed probation officer physical ability test (PROPAT). METHODS North Carolina probation officers (N = 1,213; 46.2% female; 39.8 ± 10.1 years; 30.7 ± 6.6 kg/m2) completed a survey including demographics, health history, and job-related tasks. A multivariable logistic regression model estimated the odds of being willing to perform the PROPAT. Adjusted odds ratios (ORadjusted) with 95% confidence intervals (CI) were calculated, with those excluding 1.00 deemed statistically significant. RESULTS The majority (72%) of probation officers were willing to perform the PROPAT. Being male (compared to female) (ORadjusted = 1.50; 95%CI = 1.12-2.02), having moderate (ORadjusted = 1.51; 95%CI = 1.10-2.08) and high physical activity status (ORadjusted = 2.89; 95%CI = 1.97-4.28) (compared to low) increased the odds of being willing to perform the PROPAT. Additionally, reporting a greater importance of tasks including running to pursue a suspect (TASKRUN; 1-unit-increase; ORadjusted = 1.25; 95%CI = 1.10-1.43) and dragging an unresisting person (TASKDRAG; 1-unit-increase; ORadjusted = 1.16; 95%CI = 1.01-1.32) increased the odds of being willing to perform the PROPAT. Increasing age (1-year increase; ORadjusted = 0.96; 95% CI = 0.94-0.98), class II (ORadjusted = 0.45; 95%CI = 0.28-0.71) and class III obesity (compared to normal weight; ORadjusted = 0.55; 95% CI = 0.32-0.93), and a previous musculoskeletal injury (ORadjusted = 0.57; 95%CI = 0.35-0.93) all decreased the odds of being willing to perform the PROPAT. CONCLUSIONS These results suggest being older, previously injured, obese (BMI ≥ 35 kg/m2), and less active is associated with being less willing to participate in the PROPAT, while males and reporting a higher importance of the TASKRUN and TASKDRAG activities is associated with being more willing to participate in the PROPAT. Departments can use these findings to identify feasible strategies (e.g., education, physical training) to improve the implementation of physical employment standards.

Introduction Class III obesity (BMI≥40kg/m2) during pregnancy predisposes mother and offspring to a range of adverse pregnancy complications and outcomes. Risk profiles vary between pregnancies and are affected by interpregnancy weight gain. We evaluated the risk of adverse outcomes in women with BMI≥40kg/m2 in first and second pregnancies, and the impact of interpregnancy weight change on this risk. Materials and methods Data were extracted for all women with BMI≥40kg/m2 at first antenatal visit, who completed antenatal and delivery care for first and second pregnancies in NHS Lothian between 1/1/2009–31/12/2018. Multiple pregnancies and recipients of bariatric surgery were excluded. Results 442 pregnancies among 221 women were included. In first pregnancy, median (interquartile range) weight was 117kg (108.5-126.7), age 28 years (24-31) and BMI 42kg/m2 (41.0-44.5), 14.4% had gestational diabetes (GDM), 11.3% had pregnancy-induced hypertension and 44.6% had a post-partum haemorrhage (PPH). 20.8% of babies were large for gestational age (LGA, ≥97% centile at birth). In second pregnancy, women were heavier with a median weight of 119.9kg (109.0-130.0, p=0.00) with 19.9% gaining over 10kg. Women were more likely to develop GDM (21.6%, p=0.02). Babies were heavier with 40% of babies LGA(p

Background Childhood obesity increases the risk of non-alcoholic fatty liver disease marked by elevated alanine aminotransferase (ALT). This study investigated the prevalence of increased ALT in children and adolescents with obesity, and its associations with sex, age, degree of obesity, and metabolic parameters. Methods Individuals between 5 and 17.99 years of age enrolled in the Swedish Childhood Obesity Treatment Register (BORIS) before March 2020 were included. Mildly increased ALT was defined by ALT 27–51 U/L (males) and 23–43 U/L (females), while markedly increased ALT by levels above. Multiple logistic regression models were used for statistical analysis. Results Among 11,776 individuals (age 11.0 ± 3.3 years, 53.5% males), the prevalence of mildly and markedly increased ALT were 37.9 and 10.6%, respectively. A sex-age interaction was found, where increasing age strengthened the odds of markedly increased ALT in males (OR, 99% CI: 1.34, 1.29–1.4 for each year) while the corresponding pattern in females with was minuscule (1.09, 1.02–1.10). Compared to class I obesity, class II and III obesity had greater odds ratios for mildly increased ALT (class II obesity OR, 99% CI: 1.51, 1.35–1.70; class III obesity OR, 99% CI: 2.17, 1.66–2.61) and for markedly increased ALT (class II obesity OR, 99% CI: 1.82, 1.51–2.20; class III obesity OR, 99% CI 3.38, 2.71–4.23). Dyslipidemia was associated with both mildly and markedly increased ALT, all p Conclusions The risk of markedly increased ALT increased exponentially with age among boys, but not among girls. Higher degree of obesity was observed in individuals with mildly and markedly increased ALT. Further, metabolic derangements were more prevalent among individuals with mildly and markedly increased ALT.

Aims The association between hyperglycemia at hospital admission and relevant short- and long-term outcomes in elderly population is known. We assessed the effects on mortality of hyperglycemia, disability, and multimorbidity at admission in internal medicine ward in patients aged ≥ 65 years. Methods Data were collected from an active register of 102 internal medicine and geriatric wards in Italy (RePoSi project). Patients were recruited during four index weeks of a year. Socio-demographic data, reason for hospitalization, diagnoses, treatment, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), renal function, functional (Barthel Index), and cognitive status (Short Blessed Test) and mood disorders (Geriatric Depression Scale) were recorded. Mortality rates were assessed in hospital 3 and 12 months after discharge. Results Of the 4714 elderly patients hospitalized, 361 had a glycemia level ≥ 250 mg/dL at admission. Compared to subjects with lower glycemia level, patients with glycemia ≥ 250 mg/dL showed higher rates of male sex, smoke and class III obesity. These patients had a significantly lower Barthel Index (p = 0.0249), higher CIRS-SI and CIRS-CI scores (p = 0.0025 and p = 0.0013, respectively), and took more drugs. In-hospital mortality rate was 9.2% and 5.1% in subjects with glycemia ≥ 250 and p = 0.0010). Regression analysis showed a strong association between in-hospital death and glycemia ≥ 250 mg/dL (OR 2.07; [95% CI 1.34–3.19]), Barthel Index ≤ 40 (3.28[2.44–4.42]), CIRS-SI (1.87[1.27–2.77]), and male sex (1.54[1.16–2.03]). Conclusions The stronger predictors of in-hospital mortality for older patients admitted in general wards were glycemia level ≥ 250 mg/dL, Barthel Index ≤ 40, CIRS-SI, and male sex.

Backgraund: obesity/overweight in women are often the causes of menstrual dysfunction and infertility.Aims: To identify the association between overweight/obesity and IVF outcomes.Materials and methods: retrospective study — data of 1874 patients undergoing IVF in the Endocrinology Research Centre (2012–2019) was analyzed. Exclusion criteria: BMI Results: Patients were divided into 5 groups (gr.): normal body weight (NBW) - 1061 people (ppl.) (gr. 1), overweight — 368 (gr. 2), class I obesity — 117 (gr. 3), class II obesity — 36 (gr. 4), class III obesity — 1 (gr. 5). In each group, the estimated pregnancy rate (PR) and its outcomes, the frequency of lightweight newborns (body weight at birth Conclusions: Correlation analysis of the dependence of PR and its outcomes on the BMI was not revealed (p=0.975 and p=0.469, respectively). Large fetus births were more often detected in obese patients (p=0.0016). A large prospective group is needed to expand the estimated body parameters to the IVF outcomes.

Adult inpatients with Class II or III obesity and comorbidities have a high health burden with frequent hospitalizations. Surgical risk and patient choice can be contraindications to bariatric surgery, which is considered the gold standard treatment. The best approach to non-surgical management for this adult inpatient group is currently unknown. The aim of this scoping review was to summarize current research in the inpatient setting. The unpublished literature and six electronic database searches identified 4,582 articles, with 12 articles (reporting on 10 studies) eligible and included. The literature on the interventions and their key components in the non-surgical care of the adult inpatient with Class II or III obesity were mapped identifying service provision successes and gaps. The articles reported on intensive lifestyle interventions, comparison of oxygen administration regimes, total parenteral nutrition regimens, and pre-surgical rapid weight loss. Study designs included evaluation (n=1), before–after intervention studies (n=3), and randomized/non-randomized controlled trials (n=6). The classification of obesity as a chronic disease is not universal resulting in reduced inpatient treatment options. Recommendations for consumers, practitioner practice, health policy-makers and future research priorities are reported. Further research in the development of cost-effective inpatient models of care is indicated., Video abstract Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/_Hrccaiab8A

OBJECTIVE The aim: To determine the influence of obesity on cutaneous microcirculation in patients with different stages of obesity and without cardio-vascular pathologies. PATIENTS AND METHODS Materials and methods: The 67 eligible patients with obesity were enrolled into the main group in this research. 20 healthy patients with normal body weight were included in the control group in this study. The mean age and gender were similar among the groups. Each patient underwent a clinical evaluation during the consultation, biological tests, electrocardiogram, Laser Doppler flowmetry. RESULTS Results: There was a significant decrease in IM and σ in patients with class II obesity and class III obesity compared with control group. IV was decreased in all groups, but the significant differences were recorded only among patients with obesity and not among overweight patients. During wavelet analysis a significant decrease of the AmaxE was detected in all 4 groups (by 14,7%, 37,7%, 52,4%, 57,4% respectively, P < 0,05). The most significant changes were recorded in the heart spectrum (AmaxC). CONCLUSION Conclusions: Overweight patients and patients with obesity without cardio-vascular pathology have initial manifestations of microcirculatory disorders, which deteriorate with an increase of BMI. Changes in microcirculation in patients with obesity characterized by the significant decrease of microvessels perfusion, decreasing endothelial and increasing heart specter modulations. Only high BMI was found to be associated with impaired microcirculation endothelial function (AmaxE B=0.446, 95% CI [0,15, 0,92]) according to the results of regression analysis.

Background : COVID-19, caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), emerged as a global pandemic with confirmed death cases of more than 1.27 million worldwide. Since the past pandemic, several studies discovered the adverse effects of excess fat accumulation on the severity of viral infections. This study aimed to investigate the association between high body mass index (BMI) and mortality risk in hospitalized COVID-19 patients based on four categories of high BMI ranges. Subjects and Method : A systematic review and Meta-Analysis was conducted using search articles from electronic databases including PubMed, Google Scholar, and Scopus, published from 2019 to 2021. The keywords used to retrieve articles were "Body Mass Index" OR BMI OR Obesity OR Overweight) AND (Mortality OR Death) AND COVID-19 OR SARS-CoV-2. The included studies were full-text articles published in the English language, reporting adjusted odds ratios from multivariate analysis. The eligibility criteria were defined using PICO model. The article selection was conducted using PRISMA flow chart. The included studies were analyzed by the Review Manager 5.3 application. Results : A total of nine cohort studies involving 12,907 COVID-19 patients with high BMI conducted from America, Europe, and Georgia regions was included in qualitative synthesis and Meta-Analysis. The pooled estimate showed hospitalized COVID-19 patients with morbid/ class III obesity had a higher risk of mortality (aOR= 1.77; 95% CI= 1.27 to 2.47; p= 0.001) than overweight (aOR= 1.10; 95% CI= 1.00 to 1.21; p= 0.060), class I (aOR= 1.16; 95% CI= 0.87 to 1.55; p= 0.300), and class II obesity (aOR= 1.54; 95% CI= 1.11 to 2.13; p= 0.009). Conclusion : High BMI increases the risk of mortality in hospitalized COVID-19 patients. A potential dose-response relationship may exist between different categories of high BMI range and mortality risk in COVID-19 patients. Keywords : BMI, obesity, mortality, COVID-19, SARS-CoV-2 Correspondence : Yuzana Maung. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: yuzmg5699@gmail.com. Mobile: +6281295346614. Journal of Epidemiology and Public Health (2021), 06(01) https://doi.org/10.26911/jepublichealth.2021.06.01.08

Objective: To assess the impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup (OPU). Design: Retrospective cohort study. Setting: Hospital-based fertility clinic. Patient(s): All women undergoing OPU procedures during autologous in vitro fertilization (IVF) and oocyte banking cycles, grouped by patient body mass index (BMI

BACKGROUND: Asian Americans are among the fastest growing subpopulations in the United States. However, evidence about maternal prepregnancy body mass index (BMI) and preterm birth among Asian Americans is lacking. METHODS: This population-based study used nationwide birth certificate data from the US National Vital Statistics System 2014 to 2018. All Asian American mothers who had a singleton live birth were included. According to Asian-specific cutoffs, maternal prepregnancy BMI was classified into underweight (BMI < 18.5 kg/m(2)), normal weight (BMI 18.5–22.9 kg/m(2)), overweight (BMI 23.0–27.4 kg/m(2)), class I obesity (BMI 27.5–32.4 kg/m(2)), class II obesity (BMI 32.5–37.4 kg/m(2)), and class III obesity (BMI ≥37.5 kg/m(2)). Preterm birth was defined as gestational age less than 37 weeks. Multivariable logistic regression models were used to estimate the odds ratio (OR) of preterm birth. RESULTS: We included 1 081 341 Asian American mother-infant pairs. The rate of preterm birth was 6.51% (n = 70 434). The rate of maternal prepregnancy overweight and obesity was 46.80% (n = 506 042). Compared with mothers with normal weight, the adjusted OR of preterm delivery was 1.04 (95% CI, 1.01–1.07) for underweight mothers, 1.18 (95% CI, 1.16–1.20) for overweight mothers, 1.41 (95% CI, 1.37–1.44) for mothers with class I obesity, 1.69 (95% CI, 1.63–1.76) for mothers with class II obesity, and 1.78 (95% CI, 1.66–1.90) for mothers with class III obesity. Similar patterns of associations were observed in Asian American mothers across different country origins. CONCLUSIONS: Among Asian American mothers, maternal prepregnancy overweight or obesity, defined by Asian-specific, lower BMI cutoffs, was significantly associated with an increased risk of preterm birth. The risk of preterm birth increased with increasing obesity severity. These findings highlight the importance of using Asian-specific BMI cutoffs in assessing risk of preterm birth among Asian American mothers.

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.

Objective To assess the impact of gestational weight gain >20 pounds (more than Institute of Medicine [IOM] recommendations) on postpartum infectious morbidity in women with class III obesity. Methods This is a retrospective cohort of term, nonanomalous singleton pregnancies with body mass index ≥40 at a single institution from 2013 to 2017. Pregnancies with multiple gestation, late entry to care, and missing weight gain data are excluded. Primary outcome is a composite of postpartum infection (endometritis, urinary tract, respiratory, and wound infection). Secondary outcomes include components of composite, wound complication, readmission, and blood transfusion. Bivariate statistics compared demographics, pregnancy complications, and delivery characteristics of women exceeding IOM guidelines (GT20) with those who did not (LT20). Regression models were used to estimate adjusted odds of outcomes. Results Of 374 women, 144 (39%) gained GT20 and 230 (62%) gained LT20. Primiparous, nonsmokers more likely gained GT20 (p Conclusion Women with class III obesity who gain more than the IOM recommends are at increased risk for postpartum infectious morbidity.

This study aimed to investigate the effects of obesity on the internal mechanical work, and its influence on the total mechanical work, energy cost, and mechanical efficiency in obese and nonobese adults while walking at different speeds. Body composition and anthropometrical characteristics were obtained for eleven obese [O; 39.9 ± 7.9 yr; body mass index (BMI): 43.0 ± 4.2 kg/m 2 ] and thirteen lean adults (L; 29.6 ± 5.7 yr; BMI: 22.0 ± 1.5 kg/m 2 ). Participants walked at five speeds (0.56, 0.83, 1.11, 1.39, 1.67 m/s) while oxygen consumption was measured to obtain net energy cost of walking (NC w ). A motion analysis system and instrumented treadmill were combined to obtain external (W ext ), internal (W int ), and total (W tot ) mechanical work, and pendular energy recovery. Mechanical efficiency was calculated as the ratio of W tot to NC w . Relative NC w (per unit body mass) was significantly higher in O than L (P ≤ 0.001). Relative W ext was significantly lower in O compared with L (P = 0.002), whereas no significant difference was found in relative W int (P = 0.16) and W tot (P = 0.6). Recovery was significantly higher (P ≤ 0.001), while mechanical efficiency was significantly lower in O than in L (P ≤ 0.001). These results suggest that individuals with obesity class III have similar mass-normalized W int and W tot compared with their lean counterparts, along with a higher relative NC w . Consequently, the efficiency of walking was reduced in this population. These results suggest that mass-normalized W int is unaffected by obesity and is not responsible for the higher relative NC w and lower efficiency of walking in these individuals.NEW & NOTEWORTHY It has been suggested that internal mechanical work (i.e., the work required to move the limbs with respect to the center of mass, W int ) may be responsible for the higher net cost of walking in obese adults, but this variable has not yet been studied in individuals with obesity. The main finding of the present study is that individuals with class III obesity exhibit a similar amount of mass-normalized W int to that of adults with a normal body weight, suggesting that body mass-relative W int is not affected by obesity and is not responsible for the higher energy cost and the lower efficiency of walking in this population.

Introduction Prior studies have identified associations between obesity and numerous conditions that increase risks for chronic pain. However, the impact of obesity on prescription opioid use is not well known. This study investigates the association between obesity and incidence of long-term prescription opioid use. Methods Fifteen panels of the Medical Expenditure Panel Survey from 2000 to 2015 were pooled to generate a sample of civilian non-institutionalized adults aged 30–84 years who were prescription opioid–naive for approximately 9 months. Incident long-term prescription opioid use was defined as reporting use at 2 of 3 interviews during a 15-month follow-up. BMI was reported at baseline. Analyses were completed in 2019. Results Among opioid–naive adults (n=89,629), obesity was strongly associated with incident long-term prescription opioid use. The association increased at progressively higher BMI values, with 24% elevated odds (95% CI=7%, 44%) in adults with overweight (25–29.9 kg/m2) and 158% increased odds (95% CI=106%, 224%) among adults with Class III obesity (40–49.9 kg/m2). These associations grew with higher-dosage opioids. Of the reasons for opioid use, joint pain, back pain, injury, and muscle/nerve pain contributed the most to the excess use observed among adults with obesity. At the population level, 27.0% of incident long-term prescription opioid use (95% CI=19.0%, 34.8%) was attributable to adults having a BMI above normal weight (25–49.9 kg/m2). Conclusions These findings suggest that obesity has contributed to prescription opioid use in the U.S. Future investments in chronic pain reduction may benefit from increased integration with obesity prevention and treatment.

Objective The recommendation for conventional body weight loss (BWL) treatment in obesity is 5-10%. It is not clear whether BWL is similar across the three different body mass index (BMI) obesity classes. The aim was to provide an overview on BWL across these classes in moderate lifestyle/diet intervention programs. Method A systematic literature search was conducted and the evidence of randomized controlled trials (RCTs) and pre-post design studies synthesized. The outcome was BWL. Results For RCTs, mean BWL in the intervention group was 3.6 kg (class I) and 5.3 kg (class II), which equates to 4 and 5% BWL, respectively. None of the assessed class III obesity studies met the inclusion criteria. For pre-post design studies, mean BWL was 5.4 kg (class I), 5.5 kg (class II) and 7.9 kg (class III), with high variation within and across studies in the latter. This equates to 6, 5 and, 6% BWL, respectively. Conclusions BWL of moderate BWL programs are similar across the different obesity classes. For class I obesity, the results differ between RCT and pre-post design studies by 2% BWL. The high variation of BWL in class III obesity might reflect different states of motivation such as the attitude towards bariatric surgery.

Introduction:This observational study aimed to investigate the effects of morbid obesity on the subarachnoid depth and spinal anaesthesia technique.Methods:Sixty American Society of Anesthesiologists Classification II women with term pregnancy who were candidates for elective caesarean section under spinal anaesthesia were enrolled in this prospective, observational study. Only patients with a Body Mass index (BMI) of

Summary Objective Osteoarthritis is highly prevalent and, on aggregate, is one of the largest contributors to US spending on hospital‐based health care. This study sought to examine body mass index (BMI)–related variation in the association of osteoarthritis with healthcare utilization and expenditures. Methods This is a retrospective study using administrative insurance claims linked to electronic health records. Study patients were aged ≥ 18 years with ≥1 BMI measurement recorded in 2014, with the first (index) BMI ≥ 25 kg m−2. Study outcomes and covariates were measured during a 1‐year evaluation period spanning 6 months before and after index. Multivariable regression analyses examined the association of BMI with osteoarthritis prevalence, and the combined associations of osteoarthritis and BMI with osteoarthritis‐related medication utilization, all‐cause hospitalization, and healthcare expenditures. Results A total of 256 459 patients (median age = 56 y) met study eligibility criteria; 14.8% (38 050) had osteoarthritis. In multivariable analyses, the adjusted prevalence of osteoarthritis increased with increasing BMI (12.7% in patients who were overweight [25.0‐29.9 kg m−2] to 21.9% in patients with class III obesity [BMI ≥ 40 kg m−2], P < .001). Among patients with osteoarthritis, increasing BMI (from overweight to class III obesity) was associated with increased (all P < .01): utilization rates for analgesic medications (41.5‐53.5%); rates of all‐cause hospitalization (26.3%‐32.0%); and total healthcare expenditures ($18 204‐$23 372). Conclusion The prevalence and economic burden of osteoarthritis grow with increasing BMI; primary prevention of weight‐related osteoarthritis and secondary weight management may help to alleviate this burden.

BACKGROUND: Patients who are obese are at risk for developing high pleural pressure, which leads to alveolar collapse. Esophageal pressure (P(es)) can be used as a surrogate for pleural pressure and can be used to guide PEEP titration. Although recent clinical data on P(es)-guided PEEP has shown no benefit, its utility in the subgroup of patients who are obese has not been studied. METHODS: The Medical Information Mart for Intensive Care-III critical care database was queried to gather data on P(es) in subjects on mechanical ventilation. P(es) in obese and non-obese groups were compared, and a subgroup analysis was performed in subjects with class III obesity. Thereafter, empirical and P(es)-guided PEEP protocols of a recently published trial were theoretically applied to the obese group and ventilator outcomes were compared. RESULTS: A total of 105 subjects were included in the study. The average end-expiratory P(es) in the obese group was 18.8 ± 5 cm H(2)O compared with 16.8 ± 4.8 cm H(2)O in the non-obese group (P < .05). If P(es)-guided PEEP protocol was to be applied to those in the obese group, then the PEEP setting would be significantly higher than empirical PEEP setting. These findings were accentuated in the subgroup of subjects with class III obesity. CONCLUSIONS: Individualization of PEEP with P(es) guidance may have a role in patients who are obese.

BACKGROUND: There are limited data comparing the relative associations of various BMI metrics with adiposity and cardiometabolic risk factors in youth. OBJECTIVE: Examine correlations of 7 different BMI metrics with adiposity, cardiometabolic risk factors, and biomarkers (i.e. blood pressure, waist circumference, cholesterol, leptin, insulin, high molecular weight adiponectin, high-sensitivity c-reactive protein (hsCRP)). METHODS: This was a cross-sectional analysis of youth in all BMI categories. BMI metrics: BMI z-score (BMIz), extended BMIz (ext. BMIz), BMI percentile (BMIp), percent of the BMI 95th percentile (%BMI(p95)), percent of the BMI median (%BMI(p50)), triponderal mass index (TMI), and BMI (BMI). Correlations between these BMI metrics and adiposity, visceral adiposity, cardiometabolic risk factors and biomarkers were summarized using Pearson’s correlations. RESULTS: Data from 371 children and adolescents ages 8–21 years old were included in our analysis: 52% were female; 20.2% with Class I obesity, 20.5% with Class II, and 14.3% with Class III obesity. BMIp consistently demonstrated lower correlations with adiposity, risk factors, and biomarkers (r = 0.190–0.768) than other BMI metrics. The %BMI(p95) and %BMI(p50) were marginally more strongly correlated with measures of adiposity as compared to other BMI metrics. The ext.BMIz did not meaningfully outperform BMIz. CONCLUSION: Out of all the BMI metrics evaluated, %BMI(p95) and %BMI(p50) were the most strongly correlated with measures of adiposity. %BMI(p95) has the benefit of being used currently to define obesity and severe obesity in both clinical and research settings. BMIp consistently had the lowest correlations. Future research should evaluate the longitudinal stability of various BMI metrics and their relative associations with medium to long-term changes in adiposity and cardiometabolic outcomes in the context of intervention trials.

Background Rates of adherence to available recommendations for dose adjustments in patients with severe obesity are generally low. Hence, antimicrobials are often underdosed in these patients. Antimicrobial stewardship programmes can improve the use of antimicrobials in hospitalised patients. The aim of the study was to analyse the impact of an antimicrobial stewardship programme based on a computerised clinical decision support system for optimal dosing and antimicrobial use in inpatients with severe obesity. Methods This quasi-experimental retrospective study using interrupted time series was conducted in an academic centre in Canada from August 2008 to June 2018. The Antimicrobial Prescription Surveillance System was implemented in August 2010 (intervention 1) and specific rules targeting patients with class III obesity (body mass index ≥ 40 kg/m2) were added in June 2014 (intervention 2). Data were collected from all hospitalised adults receiving antimicrobials which required dose adjustment for severe obesity and were stratified by body mass index. Segmented regression analysis of interrupted time series was used to evaluate the impact of the Antimicrobial Prescription Surveillance System on the proportion of inappropriate days of therapy according to posology and on antimicrobial consumption. Results Overall, 65 205 antimicrobial prescriptions (68% non-obese, 25% class I-II obesity, and 7% class III obesity) were analysed. In patients with class III obesity, the intervention was associated with a decrease in the proportion of inappropriate days of therapy (trend after the first intervention, −0.8% per 2-month period [95% CI −1.1 to −0.5], p p Conclusions Antimicrobial Prescription Surveillance System had a positive impact on dosing optimisation and antimicrobial consumption in patients with class III obesity. Improving antimicrobial prescriptions in these patients is important because suboptimal dosing could be associated with unfavourable outcomes.

Backgraund : obesity/overweight in women are often the causes of menstrual dysfunction and infertility. Aims : To identify the association between overweight/obesity and IVF outcomes. Materials and methods : retrospective study — data of 1874 patients undergoing IVF in the Endocrinology Research Centre (2012–2019) was analyzed. Exclusion criteria: BMI

Objective The aim of this study was to evaluate the effect of a policy to deliver at 39 weeks for class III obesity. Methods This was a retrospective cohort study of women with class III obesity delivering at ≥ 37 weeks before (May 2012 to April 2014) and after the policy (September 2014 to August 2016). The primary outcome was the cesarean rate. Secondary outcomes included maternal morbidities and a neonatal morbidity composite. Modified Poisson regression was used to adjust for demographic differences between groups. Results The study included a total of 1,210 patients, 580 before the policy and 630 after the policy. Before and after the policy, cesarean rates were similar (41.6% vs. 47.1%; risk ratio [RR]: 1.13 [95% CI: 1.00-1.29]; adjusted RR [aRR]: 1.03 [95% CI: 0.92-1.14]). In adjusted comparisons of women undergoing labor induction, parous women had lower cesarean rates (aRR: 0.62; 95% CI: 0.41-0.94) but nulliparous women had higher cesarean rates (aRR: 1.32; 95% CI: 1.04-1.68) after the policy (P for interaction = 0.01). Rates of chorioamnionitis, endometritis, and cesarean wound infection were not different between groups. Composite neonatal morbidity was not different between pre- and postpolicy groups. Conclusions A policy of delivery at 39 weeks for class III obesity did not affect overall cesarean rate or rates of maternal or neonatal morbidity. Further investigation should evaluate subsets of women who may have a higher cesarean rate with this policy.

Objective The obesity paradox is the association of increased survival for overweight and obese patients compared to normal and underweight patients, despite an increased risk of morbidity. The obesity paradox has been demonstrated in many disease states but has yet to be studied in trauma. The objective of this study is to elucidate the presence of the obesity paradox in trauma patients by evaluating the association between BMI and outcomes. Methods Using the 2014–2015 National Trauma Database (NTDB), adults were categorized by WHO BMI category. Logistic regression was used to assess the odds of mortality associated with each category, adjusting for statistically significant covariables. Length of stay (LOS), ICU LOS and ventilator days were also analyzed, adjusting for statistically significant covariables. Results A total of 415,807 patients were identified. Underweight patients had increased odds of mortality (OR 1.378, p

Aim. To study creatinine clearance, body mass index and to perform ROSE survey amomg patients with hypertension of different age groups at territorial internist's area. Methods. The study involved 112 patients aged 40 to 75 years. Patients were divided into two groups according to the age: group 1 40 to 61 years, 55 people (15 men and 40 women), the average age 52.67.1 years; group 2 62 to 75 years, 57 people (15 men and 42 women), the average age 69.84.4 years. Creatinine clearance and body mass index were measured, and ROSE survey was conducted. Results. In group 1 creatinine clearance 60 ml/min was in 5 (9%) subjects, in group 2 in 20 (35%; p=0.002). In group 1 15 (27%) subjects had normal body mass, in group 2 5 (9%). In group 1 overweight was registered in 18 (33%) subjects, and in group 2 in 24 (42%; p=0.407). Class I obesity in group 1 was found in 15 (27%) patients, in group 2 in 16 (28%; p=0.907). Class II obesity in group 1 was noted in 5 (9%) patients, in group 2 in 4 (7%; p=0.955). Class III obesity in group 1 was registered in 2 (4%) people and in 8 (14%) in group 2 (p=0.110). According to the results of ROSE questionnaire, signs of angina pectoris were found in 7 (13%) patients in group 1 and 17 (30%) in group 2 (p=0.048). Conclusion. In the territorial internist's area the proportion of cases of overweight and obesity among patients of groups 1 and 2 with hypertension did not differ significantly (p 0.05); in patients from group 2 with hypertension creatinine clearance less than 60 ml/min was identified 3.9 times more often than in the younger age group (p=0.002); in patients of group 2 with hypertension were 2.3 times more likely to have angina, according to ROSE questionnaire than in group 1 (p=0.048).

Purpose To describe clinical, biochemical and anthropometric profiles in adults with class III obesity classified as metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO). Patients and methods This is a cross-sectional study with patients classified as MHO and MUHO according to the NCEP-ATP III. Anthropometric, biochemical and clinical variables were analyzed. Results A total of 223 subjects were evaluated and 32.73% were classified as MHO and 67.26% as MUHO, respectively. The insulin resistance homeostasis model (HOMA-IR) showed elevation in the MUHO group (p=0.003) and anthropometric variables were correlated with bone markers [body index mass (BMI) vs phosphorus: r=0.31, p

To evaluate the efficacy of incisional negative pressure wound therapy in the prevention of postoperative wound morbidity in women with class III obesity undergoing cesarean delivery.In an open label randomized controlled trial, women admitted for delivery with class III obesity (body mass index 40 or higher) measured within 2 weeks of admission for delivery were offered participation in the study. They were consented either in the outpatient maternal-fetal medicine specialty clinic, during admission to labor and delivery and before a decision to perform cesarean delivery, or in the preoperative area of the hospital before scheduled cesarean delivery. Exclusion criteria included anticoagulation therapy, human immunodeficiency virus infection, and silver or acrylic allergy. Those who ultimately underwent cesarean delivery were randomized to standard surgical dressing or incisional negative pressure wound therapy dressing. The primary outcome was wound morbidity. Preplanned secondary outcomes included characteristics of composite wound morbidity, and hospital, emergency room, and clinic utilization. The sample size estimate required randomization of 440 women to detect a 50% decrease in composite outcome.Between January 1, 2015, and July 31, 2016, 850 women were screened and 677 women with class III obesity were enrolled. Of these, 441 underwent cesarean delivery and were subsequently randomized (219 to standard dressing and 222 to incisional negative pressure wound therapy). The primary outcome, overall composite wound morbidity rate, was 18%. This was not different between the two cohorts (incisional negative pressure wound therapy 17% vs standard dressing 19%, relative risk 0.9 [95% CI 0.5-1.4]).Prophylactic incisional negative pressure wound therapy use did not reduce postoperative wound morbidity when compared with a standard surgical dressing in women with class III obesity.ClinicalTrials.gov, NCT02289157.

AIMS To assess the association of body mass index (BMI) with heart failure (HF) outcomes after cardiac resynchronization therapy with defibrillator (CRT-D) implantation. METHODS AND RESULTS Medicare beneficiaries with HF aged ≥ 65 years (n = 18 922) undergoing first-time CRT-D from the National Cardiovascular Data Registry (NCDR) Implantable Cardioverter-Defibrillator Registry between 2010 and 2013, were followed for 3 years post-implantation. Survival curves and covariate adjusted hazard ratio (aHR) or odds ratio were used to assess the risks for death, readmission, and device-related complications by BMI status. Of 18 922 HF patients receiving CRT-D, 5265 (27.8%) were normal weight, 6896 (37%) were overweight, 6318 (33.4%) were obese, and 353 (1.8%) were underweight. Compared to those of normal weight (BMI 18.5-24.9 kg/m2 ), underweight patients had a higher 3-year post-device implantation risk of death [aHR: 1.34 (95% confidence interval 1.09-1.65); P

La obesidad es la alteración nutricia más común en el mundo, el exceso de grasa corporal es una condición preocupante debido a que representa un factor de riesgo que incrementa la morbilidad y la mortalidad. Después de haber sido considerada durante largo tiempo como un signo de buena salud e incluso como un índice de bienestar económico y social, la obesidad se contempla actualmente en su verdadero aspecto, es decir, como causa principal de diversas patologías, tanto metabólicas (diabetes, hiperlipidemias, etc.) como motoras (artrosis, trastornos circulatorios, etc.), sin olvidar la gran relación existente entre la obesidad y algunos trastornos psíquicos. Sin embargo, la publicidad que nos invade incita a comer golosinas y otros productos que pueden contribuir al aumento de peso. Además, los anuncios publicitarios de productos alimenticios suelen estar hechos por modelos de figura muy estilizada, lo que no deja de ser una paradoja (las modelos profesionales suelen seguir dietas de adelgazamiento a veces extremadamente estrictas y perjudiciales). Por todo ello, la obesidad es un problema de gran actualidad que, en los países industrializados, debido a su alta frecuencia, preocupa tanto al personal sanitario como a sociólogos, antropólogos y profesionales de la educación física. El presente trabajo tiene como objetivo principal el poder influir para disminuir significativamente el problema de obesidad en personal adultas mediante un programa de acondicionamiento físico. La obesidad forma parte del síndrome metabólico siendo un factor de riesgo conocido, es decir predispone, para varias enfermedades, particularmente enfermedades cardiovasculares, diabetes mellitus tipo 2, apnea del sueño, ictus, osteoartritis, así como a algunas formas de cáncer, padecimientos dermatológicos y gastrointestinales.[3][4]En forma práctica, la obesidad puede ser diagnosticada típicamente en términos de salud midiendo el índice de masa corporal (IMC), pero también en términos de su distribución de la grasa a través de la circunferencia de la cintura o la medida del índice cintura cadera. Además, la presencia de obesidad necesita ser considerada en el contexto de otros factores de riesgo y comorbilidades asociadas (otras condiciones médicas que podrían influir en el riesgo de complicaciones).[3]El índice de masa corporal es un método simple y ampliamente usado para estimar la proporción de grasa corporal.[6]El IMC fue desarrollado por el estadístico y antropometrista belga Adolphe Quetelet.[7] Este es calculado dividiendo el peso del sujeto (en kilogramos) por el cuadrado de su altura (en metros), por lo tanto es expresado en kg / m².La OMS (Organización Mundial de la Salud) establece una definición comúnmente en uso con los siguientes valores, acordados en 1997, publicados en 2000 y ajustados en el 2010[9]:IMC menos de 18,5 es por debajo del peso normal, IMC de 18,5-24,9 es peso normal, IMC de 25,0-29,9 es sobrepeso, IMC de 30,0-34,9 es obesidad clase I,IMC de 35,0-39,9 es obesidad clase II,IMC de 40,0 o mayor es obesidad clase III, grave (o mórbida),IMC de 35,0 o mayor en la presencia de al menos una u otra morbilidad significativa es también clasificada por algunas personas como obesidad mórbida.

Data are sparse on the safety and efficacy of commercially available energy-restricted meal plans in obese subjects with type 2 diabetes mellitus (T2DM). This study examined the safety and efficacy of a commercially available low-energy diet in insulin-treated obese men with type 2 diabetes. Eighteen men ≥ 35 years old who had class III obesity, had received insulin treatment for ≥ 1 year for type 2 diabetes, and had glycated hemoglobin (Hb) ≥ 6.5% were randomized to receive either a low-energy diet (N = 9) or standard medical nutrition intervention (N = 9) for 6 months. Compared with 1.5% (± 3.55) in the control group, the mean percentage weight loss in the intervention group at 6 months was 9.6% (±4.91) (p

Obesity increases the risks of diabetes, hypertension, and cardiovascular diseases, ultimately contributing to mortality. Korean Society for the Study of Obesity (KSSO) was established to improve the management of obesity through research and education; to that end, the Committee of Clinical Practice Guidelines of KSSO reviews systemic evidence using expert panels to develop clinical guidelines. The clinical practice guidelines for obesity were revised in 2018 using National Health Insurance Service Health checkup data from 2006 to 2015. Following these guidelines, we added a category, class III obesity, which includes individuals with body mass index (BMI) ≥35 kg/m². Agreeing with the International Federation for the Surgery of Obesity and Metabolic Disorders, Asian Pacific Chapter consensus, we determined that bariatric surgery is indicated for Korean patients with BMI ≥35 kg/m² and for Korean patients with BMI ≥30 kg/m² who have comorbidities. The new guidelines focus on guiding clinicians and patients to manage obesity more effectively. Our recommendations and treatment algorithms can serve as a guide for the evaluation, prevention, and management of overweight and obesity.

Background The obesity paradox has been recently demonstrated in trauma patients, where improved survival was associated with overweight and obese patients compared to patients with normal weight, despite increased morbidity. Little is known whether this effect is mediated by lower injury severity. We aim to explore the association between body mass index (BMI) and renal trauma injury grade, morbidity, and in-hospital mortality. Methods A retrospective cohort of adults with renal trauma was conducted using 2013–2016 National Trauma Data Bank. Multiple regression analyses were used to assess outcomes of interest across BMI categories with normal weight as reference, while adjusting for relevant covariates including kidney injury grade. Results We analyzed 15181 renal injuries. Increasing BMI above normal progressively decreased the risk of high-grade renal trauma (HGRT). Subgroup analysis showed that this relationship was maintained in blunt injury, but there was no association in penetrating injury. Overweight (OR 1.02, CI 0.83–1.25, p = 0.841), class I (OR 0.92, CI 0.71–1.19, p = 0.524), and class II (OR 1.38, CI 0.99–1.91, p = 0.053) obesity were not protective against mortality, whereas class III obesity (OR 1.46, CI 1.03–2.06, p = 0.034) increased mortality odds. Increasing BMI by category was associated with a stepwise increase in odds of acute kidney injury, cardiovascular events, total hospital length of stay (LOS), intensive care unit LOS, and ventilator days. Conclusions Increasing BMI was associated with decreased risk of HGRT in blunt trauma. Overweight and obesity were associated with increased morbidity but not with a protective effect on mortality. The obesity paradox does not exist in kidney trauma when injury grade is accounted for.

Populations with COPD demonstrate higher survival in overweight and obese compared with normal weight; the “obesity paradox”. Relationships in less-severe COPD are unclear, as is the impact of cardiovascular risk, and few studies include individuals at extremes of obesity. We examined the relationship between body mass index (BMI; defined as underweight: 40 kg·m−2, suggesting that obesity may not remain protective at the extremes in this population., In a population with moderate COPD, at heightened cardiovascular risk and containing a substantial proportion of individuals with BMI ≥40 kg/m2, BMI and mortality demonstrate a U-shaped (rather than J-shaped) relationship https://bit.ly/3hDztI6