Oxidative stress and potential interventions to reduce oxidative stress in overweight and obesity

PURPOSE: Obesity may be a state of chronic oxidative stress. Oxidative stress may be the mechanism underlying the development of co-morbidities in obesity. This review provides a summary of the available evidence regarding systemic oxidative stress in young, older and clinical obese populations. METHODS: Medline was searched for all available articles published between 1975 and 2006 that evaluated oxidative stress biomarkers in resting conditions or following various interventions in overweight and obese humans. RESULTS: Obesity elevates oxidative stress in young, old and clinical populations as shown by elevations in lipid peroxidation (malondialdehyde, hydroperoxides, 4-hydroxynonenal, isoprostanes, conjugated dienes) or protein oxidation (8-hydroxy-deoxyguanosine). Lipid peroxidation is associated with several indices of adiposity and a low systemic antioxidant defence (i.e. antioxidant enzymes, tissue dietary antioxidants, glutathione). Oxidative stress may be exacerbated with acute exercise, advancing age or co-existing clinical conditions and may be corrected by improving antioxidant defences through fat volume reduction via surgery, pharmacological agents, exercise and/or dietary modification. CONCLUSION: Oxidative stress is related to chronic disease in obesity, but is reversible with one or more interventions described above.     

The cost-effectiveness of shopping to a predetermined grocery list to reduce overweight and obesity

Background:

Pre-commitment strategies can encourage participants to commit to a healthy food plan and have been suggested as a potential strategy for weight loss. However, it is unclear whether such strategies are cost-effective.

Objective:

To analyse whether pre-commitment interventions that facilitate healthier diets are a cost-effective approach to tackle obesity.

Methods:

Effectiveness evidence was obtained from a systematic review of the literature. For interventions demonstrating a clinically significant change in weight, a Markov model was employed to simulate the long-term health and economic consequences. The review supported modelling just one intervention: grocery shopping to a predetermined list combined with standard behavioural therapy (SBT). SBT alone and do nothing were used as comparators. The target population was overweight or obese adult women. A lifetime horizon for health effects (expressed as quality-adjusted life years (QALYs)) and costs from the perspective of the UK health sector were used to calculate incremental cost-effectiveness ratios (ICERs).

Results:

In the base case analysis, the pre-commitment strategy of shopping to a list was found to be more effective and cost saving when compared against SBT, and cost-effective when compared against ‘do nothing'' (ICER=£166 per QALY gained). A sensitivity analysis indicated that shopping to a list remained dominant or cost-effective under various scenarios.

Conclusion:

Our findings suggest grocery shopping to a predetermined list combined with SBT is a cost-effective means for reducing obesity and its related health conditions.     

A plant-based diet for overweight and obesity prevention and treatment

The goal of this paper is to review the evidence related to the effect of plant-based dietary patterns on obesity and weight loss, including both observational and intervention trials. Literature from plant-based diet (PBD) epidemiological and clinical trial research was used to inform this review. In addition, data on dietary quality, adherence, and acceptability were evaluated and are presented. Both clinical trials and observational research indicate an advantage to adoption of PBDs for preventing overweight and obesity and promoting weight loss. PBDs may also confer higher levels of diet quality than are observed with other therapeutic diet approaches, with similar levels of adherence and acceptability. Future studies should utilize health behavior theory to inform intervention development and delivery of PBD studies and new technologies to bring interventions to scale for greater public health impact. Research examining PBDs and weight loss is also needed with more diverse populations, including older adults. Based on the available evidence, PBDs should be considered a viable option for the treatment and prevention of overweight and obesity.     

Systematic review of family and home-based interventions targeting paediatric overweight and obesity

The family and home environment is a highly influential psychosocial antecedent of paediatric obesity. The purpose of this investigation was to systematically analyze family and home-based randomized control trials aimed at treating overweight and obesity in children ages 2-7 years. In gathering materials for this review, a search of Cumulative Index to Nursing and Allied Health, MEDLINE, Education Resources Information Center, Psychology and Behavioural Sciences Collection and CENTRAL databases was conducted for the time frame of January 2001 to August 2011. The data extraction spanned three phases resulting in a total of nine interventions that met the specified inclusion criteria. Among the identified studies, eight produced significant outcomes. The majority of the programmes incorporated educational sessions targeting parents as the primary modality for intervention delivery. Less than one-quarter of the interventions included home visitations; however, all of the interventions included home-based activities to reinforce behaviour modification. Only three of the interventions applied social and behavioural theory, and only two interventions employed process evaluation. Additional research is needed to gauge the efficacy of the home and family milieu for treating paediatric obesity.     

A systematic review of economic evaluations of interventions targeting childhood overweight and obesity

This systematic review critically appraised and synthesized evidence from economic evaluations of interventions targeting childhood excess weight. We conducted systematic searches in 11 databases from inception to April 19, 2023. Studies were eligible if they evaluated interventions targeting children up to 18 years and the study intervention(s) targeted childhood excess weight or sought to improve diet or physical activity, regardless of the type of economic evaluation or the underpinning study design. We synthesized evidence using narrative synthesis methods. One-hundred fifty-one studies met the eligibility criteria and were classified into three groups based on the intervention approach: prevention-only (13 studies), prevention and treatment (100 studies), and treatment-only (38 studies). The predominant setting and study design differed considerably between the three groups of studies. However, compared with usual care, most interventions were deemed cost-effective. The study participants' ages, sex, and socioeconomic status were crucial to intervention cost-effectiveness. Interventions whose effects were projected beyond childhood, such as bariatric surgery, lower protein infant formula, and home-based general practitioner consultations, tended to be cost-effective. However, cost-effectiveness was sensitive to the assumptions underlying the persistence and intensity of such effects. Our findings can inform future recommendations on the conduct of economic evaluations of interventions targeting childhood overweight and obesity, as well as practice and policy recommendations.     

Components of primary care interventions to treat childhood overweight and obesity: a systematic review of effect

The primary care setting presents an opportunity for intervention of overweight and obese children but is in need of a feasible model‐of‐care with demonstrated effectiveness. The aims were to (i) identify controlled interventions that treated childhood overweight or obesity in either a primary care setting or with the involvement of a primary healthcare professional and (ii) examine components of those interventions associated with effective outcomes in order to inform future intervention trials in primary care settings. Major health and medicine databases were searched: MEDLINE, CINAHL, EMBASE, Cochrane Reviews, CENTRAL, DARE, PsychINFO and ERIC. Articles were excluded if they described primary prevention interventions, involved surgical or pharmacological treatment, were published before 1990 or not published in English. Twenty‐two papers describing 17 studies were included. Twelve studies reported at least one significant intervention effect. Comparison of these 12 interventions provides evidence for: training for health professionals before intervention delivery; behaviour change options (including healthy diet, activity and sedentary behaviour); effecting behaviour change via a combination of counselling, education, written resources, support and motivation; and tailoring intensity according to whether behavioural, anthropometric or metabolic changes are the priority. These components are practicable to future intervention studies in primary care.     

Maternal obesity: A potential disruptor of female fertility and current interventions to reduce associated risks

Currently, obesity has achieved epidemic levels in reproductive-aged women with a myriad of consequences. Obesity is susceptible to several reproductive complications that eventually affect fertility rates. These complications originate from the deteriorated quality of oocytes from mothers with obesity, which increases the probability of chromosomal aneuploidy, elevated reactive oxygen species production, compromised embryonic developmental competency, and eventually reduced fertility. Maternal obesity is linked to pregnancy complications such as implantation error, abortion, miscarriage, and early pregnancy loss. This review highlights the adverse effects of maternal obesity on female fertility, with a focus on the mechanistic link between maternal obesity and oocyte quality and discusses possible measures to reduce its associated risks.     

Infant and young child feeding interventions targeting overweight and obesity: A narrative review

Summary findings from systematic reviews into infant feeding and later adiposity are largely negative. World Health Organization (WHO) is auspicing Healthy Life Trajectories Initiative (HeLTI), a suite of trials aiming to prevent overweight/obesity in childhood. To inform planning, this narrative review sought to detail potentially effective components of nutrition‐related interventions involving children aged 0 to 2 years. Systematic searches of PubMed and the Cochrane Library (2006‐2016) identified 108 systematic reviews. These included 31 randomized trials in the age group of interest. Of these, 11 reported greater than or equal to 1 statistically significant (P < 0.05) benefit on body weight and/or composition. Six multicomponent trials whose interventions incorporated education to promote breastfeeding (four trials), responsive feeding (two trials), and healthy diet (eg, increasing fruit and vegetables and limiting unhealthy snack foods; five trials), delivered through home visits or at baby health clinics, reported relative reductions in body mass index (BMI) at the end of intervention. Early benefits were not maintained in the two trials reporting follow‐up 1 to 3 years later. Other potentially effective approaches included lower protein formulas in formula‐fed infants and education around reducing sugar‐sweetened beverages. There is some evidence that infant feeding interventions can have a transient positive impact on a child's BMI. It is not known whether ongoing intervention can avoid the subsequent expected wash‐out.     

Adherence to a healthy plant diet may reduce inflammatory factors in obese and overweight women-a cross-sectional study

ObjectiveObesity and overweight which are consequence of some interaction factor such as genetics and behavioral habit. Obesity as a metabolic disorder and chronic inflammation is a trigger to countless disease. The main goal of this study is to investigate the interaction of herbal diet on the levels of liver enzymes, inflammatory factors and adipocytes profile.Materials and methodsA total of 240 adult women range of 18–48 years were included in the current comparative cross-sectional study. Body composition and dietary intake (using a validated semi-quantitative food frequency questionnaire (FFQ)) were assessed in all participants. In determining a plant based diet index (PDI), vegetarian foods were taken positive score and reverse points for animal foods. For determining a healthful plant based diet index (hPDI), healthy plant foods received positive scores, while less healthy plant foods and animal foods received reverse scores. To create an unhealthful plant-based diet index (uPDI), positive scores were assigned to less healthy plant foods and reverse scores to healthy plant foods and animal foods. For the measurement of serum liver enzymes and inflammatory factors, an enzyme-linked immunosorbent assay (ELISA) method was used.ResultsHealthy diet like whole grains, fruits, vegetables, cereals, and beverages such as tea and coffee, based on dietary guidelines, significantly reduced the amount of hs-CRP and TGF-β (P < 0.0001). Higher adhering to hPDI may as a result in higher intake of fiber intake, antioxidants, unsaturated fats, micronutrients, could reduce saturated fats and iron content, and finally weight loss, and reduce inflammation in the body.ConclusionBase on our finding, in those people who intake higher amounts of healthy plant foods, (vegetable types), instead of unhealthy herbal foods (sweets and desserts), might be useful to reduce inflammation factor like TGF-β and hs-CRP. Women with a higher compliance score in uPDI group (juices, refined grains, starches sweetened with sugar, sweets, and desserts) did not have significantly increase in inflammatory factors levels.     

Nutrition‐related interventions targeting childhood overweight and obesity: A narrative review

Systematic reviews of nutritional interventions indicate limited efficacy in reducing childhood obesity, but their blanket conclusions could obscure promising components. This narrative review sought more detail on effective components within nutrition‐related interventions involving children aged 2 to 11 years. In May 2016, the World Health Organization (WHO) searched the Cochrane Library and PubMed for relevant reviews. From 36 reviews, we screened 182 nutrition‐related randomized trials for inclusion. We then reviewed those that reported at least 1 statistically significant (P < 0.05) treatment benefit on body weight and/or composition outcomes at their longest follow‐up assessment. Fourteen trials met inclusion criteria (median n = 554; mean intervention duration = 10.8 mo; follow‐up = 4.4 mo). “Effective” approaches included environmental changes such as school water fountain installations and cafeteria menu changes and possibly less sustainable strategies such as health education lessons. However, effect sizes even of these selected significant treatment benefits were modest—significant body mass index z‐score effects range from ?0.1 to ?0.2. Each trial was associated with very small improvements in body composition. Because this is a “best‐case” scenario (reflecting our design), trialists should rigorously test these strategies alone and possibly together; be open to novel strategies; and ensure that each strategy is culturally relevant and self‐sustainable.     

Maintenance of weight loss after lifestyle interventions for overweight and obesity,a systematic review

Lifestyle interventions can reduce body weight, but weight regain is common and may particularly occur with higher initial weight loss. If so, one may argue whether the 10% weight loss in clinical guidelines is preferable above a lower weight loss. This systematic review explores the relation between weight loss during an intervention and weight maintenance after at least 1 year of unsupervised follow‐up. Twenty‐two interventions (during at least 1 month) in healthy overweight Caucasians were selected and the mean percentages of weight loss and maintenance were calculated in a standardized way. In addition, within four intervention groups (n > 80) maintenance was calculated stratified by initial weight loss (0–5%, 5–10%, >10%). Overall, mean percentage maintenance was 54%. Weight loss during the intervention was not significantly associated with percentage maintenance (r = ?0.26; P = 0.13). Percentage maintenance also not differed significantly between interventions with a weight loss of 5–10% vs. >10%. Consequently, net weight loss after follow‐up differed between these categories (3.7 vs. 7.0%, respectively; P < 0.01). The analyses within the four interventions confirmed these findings. In conclusion, percentage maintenance does not clearly depend on initial weight loss. From this perspective, 10% or more weight loss can indeed be encouraged and favoured above lower weight loss goals.     

A review of electronic interventions for prevention and treatment of overweight and obesity in young people

The objective of this systematic review is to provide a qualitative comparison of interactive electronic media interventions for the prevention or treatment of obesity and/or obesity‐related behaviours in children and adolescents. Literature searches of 12 databases from the earliest publication date until March 2010 were conducted. Twenty‐four studies in which children and/or adolescents interacted with electronic interventions delivered as adjunct or sole interventions for the prevention or treatment of obesity and/or obesity‐related behaviours met the inclusion criteria. Fifteen focussed on obesity prevention and nine on treatment interventions. The average study quality design score was 45%. Most studies demonstrated some form of significant outcome (e.g. reported changes in dietary and/or physical activity behaviours) in participants receiving interactive electronic interventions, with 11 out of 15 studies leading to positive changes in measured or reported adiposity outcomes. In 87% of studies, the effects of interactive electronic interventions were not separately evaluated from other intervention components. These results should be viewed with caution because of the overall poor quality of the studies. Studies were mostly conducted in the USA, largely in minority populations, and the direct transferability of interventions to other populations is unclear. Further high quality research is needed in this area to accurately inform the evidence base.     

Effect of a short-term diet and exercise intervention on metabolic syndrome in overweight children

Overweight and the metabolic syndrome are increasing radically in children. The present study was designed to examine the effects of lifestyle modification in 16 children who were placed on a high-fiber, low-fat diet in a 2-week residential program where food was provided ad libitum and daily aerobic exercise was performed. In each subject, pre- and postintervention fasting blood was drawn. Insulin (27.2 +/- 3.5 vs 18.3 +/- 1.7 microU/mL, P < .01), homeostasis model assessment for insulin resistance (5.79 +/- 0.81 vs 4.13 +/- 0.38, P < .05), and body weight (92.0 +/- 7.0 vs 88.0 +/- 6.8 kg, P < .01) were reduced significantly. Total cholesterol (165 +/- 7.8 vs 127 +/- 7.4 mg/dL, P < .01), low-density lipoprotein (94.1 +/- 8.2 vs 68.5 +/- 6.7 mg/dL, P < .01), triglycerides (146 +/- 16.2 vs 88.1 +/- 8.1 mg/dL, P < .01), and total cholesterol-high-density lipoprotein (4.16 +/- 0.30 vs 3.34 +/- 0.30, P < .01) and low-density lipoprotein-high-density lipoprotein ratios (2.41 +/- 0.3 vs 1.86 +/- 0.2, P < .01) were reduced, with no change in high-density lipoprotein observed (42.3 +/- 2.4 vs 40.8 +/- 3.0 mg/dL). Systolic blood pressure (130 +/- 3.1 vs 117 +/- 1.8 mm Hg, P < .001) and diastolic blood pressure (74.3 +/- 3.0 vs 67.2 +/- 2.3 mm Hg, P = .01) also decreased. Most notably, before the intervention, 7 of the 16 subjects were classified with metabolic syndrome. After the 2-week intervention, despite remaining overweight, reversal of metabolic syndrome was noted in all 7 subjects. All of these changes occurred despite only modest improvements in the percentage of body fat (37.5% +/- 1.1% vs 36.4% +/- 1.2%, P < .01) and body mass index (33.2 +/- 1.9 vs 31.8 +/- 1.9 kg/m(2), P < .01). These results indicate that a short-term rigorous diet and exercise regimen can reverse metabolic syndrome, even in youth without documented atherosclerosis.     

The prevention of overweight and obesity in children and adolescents: a review of interventions and programmes

Overweight and obesity are serious, large-scale, global, public health concerns requiring population-based childhood overweight and obesity prevention. The overall objective of this review is to identify aspects of successful childhood overweight prevention programmes. This objective will be met by assessing existing interventions quantitatively as well as qualitatively, identifying efficacy, effectiveness and implementation, and evaluating potential adverse effects of previous studies. This review was limited to school-based studies with a quantitative evaluation using anthropometric outcomes and that intervene on diet or activity-related behaviours. Quantitative and qualitative approaches are used to identify factors related to successful interventions as well as adverse consequences. Sixty-eight per cent of the interventions, or 17 of the 25, were 'effective' based on a statistically significant reduction in body mass index (BMI) or skin-folds for the intervention group. Four interventions were effective by BMI as well as skin-fold measures. Of these, two targeted reductions in television viewing. The remaining two studies targeted direct physical activity intervention through the physical education programme combined with nutrition education. Of the interventions reported here, one was effective in reducing childhood overweight but was also associated with an increase in underweight prevalence. Few other studies reported outcomes for underweight. The majority of overweight/obesity prevention programmes included in this review were effective. Physical education in schools and reducing television viewing are two examples of interventions that have been successful. Because few studies report on underweight prevalence, this review recommends giving more attention to preventing adverse outcomes by reporting the intervention impact on the frequency distribution for both BMI and adiposity measures.     

A systematic review to determine the effectiveness of interventions designed to prevent overweight and obesity in pre‐adolescent girls

Childhood overweight/obesity is recognized as an increasing health problem. The objective of this review was to determine the effectiveness of interventions designed to prevent overweight and obesity in pre‐adolescent girls. The papers included were those studying children (must include results for girls) from within the 7–11 years age range from any country and ethnic background. The included interventions lasted at least 12 weeks and modified a combination of nutrition, physical activity, knowledge, attitudes or health‐related behaviours associated with the development of childhood overweight and obesity. Effect sizes were calculated where possible using Cohen's classifications of small (0.2–0.5), medium (0.5–0.8) and large (>0.8) effect sizes. Thirty studies met the inclusion criteria of which four were cluster randomized controlled trials, 14 were randomized controlled trials, 11 were controlled trials and one was a cohort pre–post trial. There were four weak, 11 moderate and 15 strong quality studies. Eleven studies were considered short term and 19 long term (≥12 months). There were 66 effect sizes less than 0.2, 56 categorized as low, 16 as medium and two as high. There is the potential for interventions aimed at pre‐adolescent girls to reduce the risk factors associated with childhood overweight and obesity, although the sustainability of the effects of such interventions is less clear.     

Metabolic profile and exercise capacity outcomes: their relationship to overweight and obesity in a Canadian cardiac rehabilitation setting

PURPOSE: Obesity remains a significant health problem for cardiac rehabilitation patients. The purpose of this study was to examine the relation of overweight and obesity to cardiovascular risk factors in patients, and to compare the change in cardiovascular risk factor profiles in patients with coronary artery disease undergoing cardiac rehabilitation at a tertiary care hospital center in Ontario, Canada. METHODS: Retrospective analysis of cross-sectional data for 3542 patients, ages 63 +/- 11 years, stratified by body mass index (BMI), was performed. RESULTS: The findings showed that 81% of the patients had a BMI exceeding 25 kg/m(2), and that 35% of the patients were obese (BMI > or =30 kg/m(2)). After adjustment for age, sex, smoking, hypertension, diabetes, and peak power output, BMI was a significant independent predictor of a higher total cholesterol level, higher fasting blood glucose and triglyceride levels, and lower levels of high-density lipoprotein cholesterol. The Adult Treatment Panel III criteria were used to examine the prevalence of the metabolic syndrome for each BMI group. At baseline, 77% of the obese males in classes 2 and 3 had three or more risk factors for the metabolic syndrome, as compared with 68% of the obese females in classes 2 and 3. After 24 weeks of intervention, the outcome data for 1353 patients showed that despite no change in body weight, all the BMI groups demonstrated significant improvements in metabolic profiles and peak exercise capacity. CONCLUSIONS: Cardiac rehabilitation results in significant improvement in the cardiovascular risk profile at all levels of BMI, independently of weight loss. Future studies should examine whether targeting weight loss in cardiac rehabilitation further improves outcomes and the overall cardiovascular risk profile.