The Impact of COVID-19 Lockdown on Weight Loss Program in Infertile Polycystic Ovary Syndrome Women with Obesity

IntroductionLockdown due to the COVID-19 pandemic has caused gym closures and adjustments to ongoing weight loss programs were needed in order to keep the programs running. Little is known whether adjustments affected the success of weight reduction. Weight reduction of at least 5% is related to improved fertility and better pregnancy outcomes in obese women. This study compared success of the weight loss program in infertile polycystic ovary syndrome women with obesity who attended the program before and during lockdown due to COVID-19 pandemic. Furthermore, we checked whether there were any differences in spontaneous pregnancy rates between both groups at the end of the program.MethodsAltogether, 27 women were prospectively included to the weight loss program. Twelve women attended the 8 − week program before COVID-19 pandemic. Fifteen women began the program before the lockdown and ended it during lockdown. Due to lockdown, the program was prolonged for 4 weeks and taken online.ResultsOn average, prior to lockdown women achieved a BMI reduction of 6.8% whereas women that attended the program during the lockdown reduced their BMI for 3.7%. This difference was not statistically significant. No significant differences were seen in other measured anthropometric and endocrine parameters between both groups. Furthermore, there were no differences in spontaneous pregnancy rates between both groups. In women who reduced their BMI for 5% or more, spontaneous pregnancy rate was 29.4%.Discussion/ConclusionsAlthough statistical significance has not been reached in the present study, we have shown that lockdown due to COVID-19 pandemic has led to almost half lower BMI reduction despite adaptations and longer duration of the weight loss program. On average, BMI in the group of women that attended the program during lockdown was 3.7% lower after the end of the weight loss program. This means they did not reach the wanted 5% reduction which is known to improve fertility. We have also shown that weight reduction is the correct approach for treating infertile women with obesity, as almost 30% of those who reduced their body weight by 5% or more conceived spontaneously.     

Spousal support in a behavior change intervention for cholesterol management

Objective

To evaluate spousal involvement in a nurse-led intervention for patients with high cholesterol in which patients set health goals and spouses learned support strategies.

Methods

Qualitative interviews were conducted with 29 patients and 26 spouses who received the intervention during a trial. Interviews were stratified by patient LDL-C change (better, same, worse). Coded text was content analyzed, and organized into thematic matrices, with columns indicating individuals (spouse or patient) and rows indicating dyads.

Results

Patients and spouses reported no drawbacks to spousal involvement; some patients whose LDL-C did not improve wanted more focus on spouse health. Spouses said that the nurse's expertise and interest were helpful and they were better able to communicate with patients about health. Although the program helped couples work together, spouses with better or same LDL-C talked more about functioning as a unit, whereas those whose partners had worse LDL-C talked more about functioning as individuals.

Conclusion

Although the spousal role was accepted, there were variations in level of involvement. More active spousal involvement might relate to better patient outcomes. For less involved spouses, more focus on their health may improve commitment or involvement.

Practice implications

These findings can inform ways to generate spousal support in future trials.     

Experiences of the encounter with the diabetes team—A comparison between obese and normal-weight type 2 diabetic patients

Objective

The aim of this study was to highlight and compare obese and normal-weight type 2 diabetic patients’ perceptions and reported behaviors in terms of their care encounter with the diabetes team.

Methods

Interviews were conducted with 28 diabetic patients. Qualitative content analysis was used as analysis method.

Results

The experiences revealed that when the care encounters took place from a health care perspective, there were no opportunities for individual support.For the obese diabetic patients, especially women, this gave rise to feelings of being stuck, defiance and shame, for those of normal weight, it created a sense of being left, despair and confusion.When encounters took place from the perspective of the individual, the diabetic patients need for support was fulfilled.For the obese diabetic patients this meant that the health care professionals recognised their needs and for those of normal weight, a feeling of security was created.

Conclusions

The results demonstrate differences in the experiences of obese and normal-weight diabetic patients’ men and women in terms of their encounters with the diabetes team.

Practice implication

Diabetic patients, especially the obese diabetic women, require tailor-made support provided by the health professionals in the diabetes team.     

Lose weight and win: a church-based weight loss program for blood pressure control among black women.

The Baltimore Church High Blood Pressure Program (CHBPP) offers a behaviorally oriented weight control program consisting of eight weekly 2-h diet counseling/exercise sessions. Pre- and post-program weight and blood pressure measurements were analyzed for 184 black and 3 white women aged 18-81 years (mean 51) who participated in the program in 1984-1986: 88 were taking antihypertensive medication (Rx) and 99 were not (no Rx). Mean weight loss was 6 lb in both groups: -18 to +7 lb in the Rx group and -31 to +3 lb in the no Rx group. The mean systolic/diastolic blood pressure (SBP/DBP) decrease was 10/6 mmHg in the Rx group and 5/3 mmHg in the no Rx group (P < 0.001 for all pre/post comparisons). Final SBP was < 140 mmHg for 74% of participants, versus 52% initially. Final DBP was < 90 mmHg in 92% versus 65% initially. Supporting the inference that BP decreases among weight control program participants reflect program effects, percent changes in SBP and DBP (week 2 to week 8) were significantly correlated with percent change in weight (rs = 0.23-0.36; P < 0.05). Comparison data for 25 women from the CHBPP population showed a mean SBP/DBP increase of 8/2 mmHg over an 8-week interval. Based on follow up measurements 6 months after the end of the 8-week program for 74 of the 187 women, weight lost during the 8-week program was maintained or exceeded by 65%. Net weight change at 8 months from baseline for women in the follow up subsample ranged from -28 to +4 lb; mean (SD) -6 (7) lb. Weight loss and related dietary or behavioral changes resulting from participation in a weight control program can enhance blood pressure control among black women.     

A comparison of younger-aged and older-aged women in a behavioral self-control smoking program

This study examines differences in motivation for quitting smoking, withdrawal experiences and weight changes in younger and older aged women who entered a smoking cessation program designed specifically for women smokers. In an assessment prior to quitting smoking 26 women aged 20-49 years (younger-aged women) and 19 women aged 50-75 years (older-aged women) did not show differences in number of prior quit attempts or their dependence on nicotine (as measured in the Fagerstrom Tolerance Questionnaire). The older aged women smoked for a significantly greater number of years but smoked fewer cigarettes per day than the younger women. In a self-report questionnaire the two age groups differed in their reasons stated for wanting to give up cigarettes and symptoms of illness they experienced related to smoking. The average weight gains for women who quit smoking were minimal (3.5 lb, younger; 3.9 lb, older; 1 lb = 0.453 592/37 kg) although more younger women than older women reported they expected difficulty with weight gain after cessation. Changes in withdrawal experiences were not significantly different at any point during the initial phase of quitting (24, 48 and 72 h).     

A 5-HT2C receptor promoter polymorphism (HTR2C - 759C/T) is associated with obesity in women, and with resistance to weight loss in heterozygotes.

The serotonin 5-HT(2C) receptor (HTR2C) helps regulate appetite and body weight. An HTR2C promoter polymorphism (-759C/T) has been associated with obesity and with weight gain in response to antipsychotic (neuroleptic) drugs. We studied this polymorphism in 120 obese women (BMI > or = 30) and 104 non-obese (BMI < or = 25) women. The C allele was commoner in the obese group (OR = 1.72 [95% CI, 1.13-2.64], P = 0.008). Ninety-five of the obese women participated in a randomized trial of psychological treatments for weight loss. Among these women, heterozygotes lost less weight during the trial than did homozygotes (6.8 vs. 9.7 kg; P = 0.047) and weighed more 6 months (90.1 vs. 83.6 kg; P = 0.006) and 12 months (91.8 vs. 84.6 kg; P = 0.009) later. Heterozygotes also had higher triglyceride levels than homozygotes. C/C subjects in the obesity trial did not differ from T/T subjects in terms of weight loss or triglycerides. In a separate RT-PCR study of 43 subjects, we found that HTR2C mRNA abundance in frontal cortex was unaffected by -759C/T status. Our data extend the evidence that HTR2C promoter variation may be a risk factor for obesity and, perhaps through heterosis, influences weight loss by obese women. Pharmacogenetic testing of HTR2C promoter variants may be valuable when evaluating anti-obesity drugs which act directly or indirectly on the receptor.     

Group counseling in cardiac rehabilitation: effect on patient compliance

A multicenter clinical trial was conducted to evaluate the effects on compliance of a group counseling program for cardiac patients and spouses. The sample comprised 58 couples in which one of the partners had documented atherosclerotic heart disease and was enrolled in an outpatient cardiac rehabilitation program. The experimental intervention involved a ten-week series of group sessions based on symbolic interactionist role theory. The research used a quasi-experimental, three-group, time-series design: Experimental group 1 consisted of 17 patients and their spouses who participated in group counseling; experimental group 2 consisted of 22 patients and their spouses, but only the patients participated in the group series; the control group consisted of 19 patients and their spouses who did not participate in the experimental program. Data were collected at baseline, ten weeks, and six months on four cardiac risk factors: weight loss, blood pressure, exercise, and smoking. Repeated measures analysis of variance showed a significant difference (P less than 0.01) in mean body fat among treatment groups, with experimental group 2 having the greatest decrease over time. Patients in both experimental groups demonstrated lowered blood pressure, with a significant decrease (P less than 0.05) in systolic blood pressure. Again, the largest decrease was in experimental group 2. Changes in weekly exercise level were not significantly different among groups, although the highest compliance was reported by experimental group 1 patients. Results support the efficacy of group counseling based on an interactionist role theory framework to increase compliance. The anticipated effect of spouse participation was not confirmed.     

New psycho-pedagogic approach to obesity treatment: A 5-year follow-up

Objective

The aim of the present study was to evaluate the body weight evolution in obese patients admitted for a 2-week residential program and followed-up on ambulatory basis, as well as to evaluate factors having impact on weight evolution after 5 years.

Methods

Thirty-nine obese patients participated in a 2-week structured interdisciplinary weight loss program, involving individual and group therapies, and including physical activity, nutritional education and standard cognitive-behavioral techniques. Patients were then followed-up regularly by their general practitioners for 5 years.

Results

After 5 years, 33 subjects completed the study. Seventy percent of the patients lost weight or maintained their weight loss. Total score for dietary structure, eating behavior disorders, dietary surveillance and weight management strategies, as evaluated by a validated questionnaire, was significantly lower in the weight loss group (22.4 ± 4.3) as compared to maintenance group (24.4 ± 6.1, p < 0.05) and regain group (29.7 ± 4.0, p < 0.01). Patients who lost weight presented a more important follow-up on long-term weight management (p < 0.05), a better dietary results (p < 0.01) as well as more physical activity (p < 0.05) that the regain group.

Conclusion

The present study demonstrated that an initial multidimensional and multidisciplinary in-hospital program with a consecutive long-term ambulatory follow-up may lead to a significant weight loss (55%) and/or weight maintenance (15%).

Practice implications

A multidisciplinary and well-designed initial treatment and long-term follow-up program is mandatory for obesity management.     

Changes in weight during treatment for depression

Changes in appetite and weight were examined in a group of 47 carefully diagnosed primary depressives who were treated in a random design with either placebo (N = 17) or amitryptyline (N = 30) over a 35-day protocol. While the amitriptyline treated group as a whole showed a greater gain in weight than did the placebo group (4.5 vs. 0.5 lb, p less than 0.05), no differential effects could be demonstrated between drug responders and nonresponders. Likewise, while a consistent relationship between the self-report of decreased appetite and final weight change was noted in the placebo group, no simple relationship between final weight change and self-reported changes in appetite were apparent in the drug-treated patients. There was, however, a relationship between the report of decreased appetite and clinical severity of depression in the drug nonresponder subgroup despite significant weight gain during the protocol. Thus, weight change during this study period did not appear to show a simple relationship to corresponding clinical change. The clinical lore that has supported the notion that increased appetite and weight gain in patients being treated with tricyclic antidepressants are "good" signs cannot be confirmed by our findings.     

A controlled study of weight reduction in type 2 diabetics treated by two reinforcers

The aim of this clinical study was to evaluate a practicable method to improve metabolic control and body weight in obese patients suffering from Type 2 diabetes. Eighteen overweight Type 2 diabetic patients received an outpatient psychoeducational group program over 1 year, which was centered on aspects of metabolic control in diabetes. This group was compared with 18 control patients who did not obtain any special psychoeducational training. There was a significant reduction of glycosylated hemoglobin and body weight over 1 year in the treatment group compared with the controls. In conclusion, 1 year of psychoeducational training of obese Type 2 diabetic patients significantly improved body weight and glycosylated hemoglobin. Implications are described for professional health care management of the disorder and aspects of the learning theory.     

Insulin resistance in women with hirsutism

Introduction

There are still not enough data showing whether patients with idiopathic hirsutism (IH) also have insulin resistance. The association between polycystic ovary syndrome (PCOS) and insulin resistance is well documented in the literature, but the Rotterdam Consensus has concluded that principally obese women with PCOS should be screened for the metabolic syndrome. We intended to investigate the presence/absence of insulin resistance in non-obese women with hirsutism.

Material and methods

Twenty-eight women with PCOS (14 non-obese and 14 obese), 12 non-obese with IH, and 16 non-obese healthy women were included in the study. The presence of insulin resistance was investigated by using basal insulin levels and the homeostasis model assessment (HOMA) score in the study group.

Results

Patients with obese and nonobese PCOS had significantly (p < 0.05) higher basal insulin levels and HOMA scores than IH and control subjects. Insulin levels and HOMA scores did not differ between obese and non-obese PCOS patients. Patients with IH did not show any difference from the control group.

Conclusions

Insulin resistance exists in non-obese women with PCOS as well as obese women with PCOS. The PCOS is associated with insulin resistance independent of obesity. Insulin resistance should be assessed in all hirsute women with PCOS regardless of their body mass index. More studies in larger numbers of patients should be performed to investigate the role of insulin resistance in women with IH.     

Effects of a nutritional intervention in obese postmenopausal women on atypical antipsychotics

Objectives

To investigate the effects of a nutritional intervention on the body weight, body composition, blood glucose and lipid levels of obese postmenopausal women taking atypical antipsychotics in Greece.

Study design

In a case–control design, 25 obese postmenopausal women treated with antipsychotic medications and 28 obese healthy comparisons were followed for 3 months. A nutritional program was individually designed for each participant.

Main outcome measures

At baseline and at 3 months of the study, anthropometric, body composition, blood glucose and lipid measurements were performed.

Results

Significant reductions in body weight, body mass index (BMI), fat and waist circumference were found both in the patients and their healthy comparisons from baseline to 3 months (P < 0.05). Patients reduced significantly less their BMI (P = 0.044) and body fat percentage compared to the healthy women (P = 0.023). Waist circumference was significantly reduced in both subject groups, with no significant difference found between them (P = 0.07). Glucose and lipid levels were not altered during the intervention in the patients’ group, while significant changes were observed in the healthy women in total cholesterol (P = 0.016), low density lipoprotein cholesterol (P = 0.022) and triglycerides (P = 0.042).

Conclusions

Obese postmenopausal women on atypical antipsychotic medication appear to respond favorably to a nutritional program. The improvements seen in BMI and body fat are attenuated in the patients compared to their healthy counterparts; moreover no change in lipid levels was found in the patients’ group. These findings suggest that atypical antipsychotics may play an adverse role in fat loss and lipid metabolism in this population.     

A comparison of weight control and weight control plus body image therapy for obese men and women

Participants were 65 obese men and women who were randomly assigned to either weight control or weight control plus cognitive behavioral body image therapy. Both conditions showed clinically significant improvements in body image at posttreatment and 1-year follow-up. Adding body image therapy to weight control did not result in greater psychological improvements and did not result in better maintenance of body image change when participants regained weight after treatment. Weight loss and maintenance were equivalent between groups. Adding body image therapy did not improve or detract from weight loss. Although body image therapy has been shown to be effective in obese persons, it appears that a well-rounded cognitive-behavioral weight control program is effective as well.     

Changes in body mass index around menopause: a population study of Chilean woman.

OBJECTIVE: To evaluate the influence of menopause and hormone replacement therapy (HRT) on weight and the effect of weight gain on coronary risk factors. DESIGN: From 1991 to 1992 cardiovascular risk factors were assessed in 271 premenopausal women between the ages of 40 and 53 years. The women were not receiving HRT at that time. Five years later, these women were reevaluated. RESULTS: Weight and body mass index (BMI) increased steadily with age. During the observation period there was an average increase of 4.0 kg +/- 4.6 (p < 0.0001). Women who experienced menopause and those who did not experience menopause had a similar weight increase (3.8 +/- 4.4 kg vs. 4.3 +/- 4.8, p = 0.37). Likewise, weight gain was similar in those who did or did not use HRT (nonusers, 4.3 +/- 4.6 kg; users, 3.5 +/- 3.7 kg; ex-users, 3.4 +/- 5.8 kg). At their first checkups, overweight women and obese women already had significant differences in their risk factors, including higher systolic pressure (p < 0.02), diastolic pressure (p < 0.01), glucose (p < 0.02) and triglycerides (p < 0.0001), and lower high-density lipoprotein cholesterol (p < 0.004) as compared with women of normal weight. Unexpectedly, women of normal weight who became overweight or obese during the monitoring period did not show any deterioration in their risk factors. CONCLUSIONS: During the perimenopausal period there is a weight gain that does not seem to depend on the menopause or HRT. Being overweight or obese during the menopausal transition is not necessarily associated with deterioration in coronary risk factors. This seems to imply the existence of different metabolic populations within this group of women.     

A randomised controlled trial on the effectiveness of a primary health care based counselling intervention on physical activity, diet and CHD risk factors

Objective

The aim of the study was to determine if multiple patient-centred lifestyle counselling sessions would be of interest to patients at risk of coronary heart disease (CHD), in a primary care setting, and if such sessions would result in changes in physical activity and diet, and health status. A randomised trial was conducted to compare the counselling intervention with usual care (health promotion leaflet), among 334 mostly obese patients.

Methods

Patients were randomised into an intervention group that received standard exercise and nutrition information plus up to five face-to-face counselling sessions with a Physical Activity Specialist (PAS) and Registered Dietitian (RD) over a 6-month period or to a control group that only received the standard information.

Results

Of those invited, patients randomised tended to be more obese, older and female. The mean (S.D.) sessions attended was 2.0 (1.6) with 50% attending at least 3. At 6 months, the counselling group were more active, particularly with respect to walking, and had reduced weight, blood pressure and cholesterol, but had not changed their diet, compared with the control group. Furthermore, those who did more sessions had greater increases in activity and reductions in weight, blood pressure and cholesterol.

Conclusion

Attending multiple sessions of client-centred counselling in primary care was of interest to patients, and generally reduced CHD risk factors.

Practice implications

The primary care setting can be used effectively to promote particularly walking, using physical activity specialists and dietitians trained to use an adapted motivational interviewing (MI) counselling style.     

Motivational interviewing fails to improve outcomes of a behavioral weight loss program for obese African American women: a pilot randomized trial

Compared to other racial/ethnic groups, African American (AA) women are more likely to be obese but less likely to participate in weight loss interventions or to successfully lose weight. Sustained motivation for weight loss may be especially difficult for AA women due to socioeconomic and cultural factors. The purpose of this study was to examine whether the addition of motivational interviewing (MI) to a culturally-targeted behavioral weight loss program for AA women improved adherence to the program, diet and physical activity behaviors, and weight loss outcomes. Forty-four obese (mean BMI = 39.4, SD = 7.1) AA women were randomized to receive a 16-week behavioral weight loss program plus four MI sessions, or the same behavioral weight loss program plus four health education (HE; attention control) sessions. Results showed that participants in both MI and HE conditions lost a significant amount of weight, reduced their energy intake and percent calories from fat, and increased their fruit and vegetable consumption (ps < .05). However, adherence to the behavioral weight loss program and changes in diet, physical activity, and weight did not differ across MI and HE conditions. Future research is warranted to determine the subpopulations with which MI is most effective.     

Does Depression Reduce the Effectiveness of Behavioral Weight Loss Treatment?

Limited evidence suggests that depression is associated with poorer outcomes in behavioral weight loss programs; however, people with major depression are typically excluded from weight loss intervention trials. This study examined the effect of depression on women's participation and weight loss in behavioral treatment. Non–treatment seeking obese women over 40 years of age with major depressive disorder (MDD, n = 65) and without MDD (n = 125) were recruited into a 26-session group intervention. Primary analyses compared participants' mean weight change from baseline to 6 and 12 months; at 6 months, women with MDD lost a mean of 3.8 kg vs 4.3 kg for women without MDD (t = 0.54, p = .59). At 12 months, women with MDD lost 3.0 kg and women without MDD lost 3.6 kg (t = 0.44, p =.66). Women who attended at least 12 treatment sessions lost more weight than women who attended fewer sessions, regardless of depression status (ie, there was no significant interaction between depression and session attendance). Results suggest that depression should not be an exclusion criterion for weight loss intervention programs.     

Changes of body weight and inflammatory markers after 12-week intervention trial: results of a double-blind, placebo-control pilot study

Purpose

Low grade inflammation is a well-known characteristic in obese subjects. We investigated body weight changes and inflammatory markers after 12-week intervention trial.

Materials and Methods

Twenty-six obese subjects were enrolled and 19 (13 men and 6 women) completed the study. Sibutramine is an FDA-approved drug for body weight control; therefore, we chose this drug as the standard treatment medication in this study. Patients were randomly allocated to receive an anti-inflammatory agent (Diacerein treatment group; n = 12) or placebo (n = 7) for 12 weeks. Anthropometry, body proportion by dual-energy X-ray absorptiometry, and metabolic parameters at the beginning and end of study were measured and compared.

Results

The treatment group had a tendency towards more reduction in anthropometry as compared to the placebo group, in body weight reduction (- 7.0 kg vs. - 4.6 kg), body mass index (- 2.51 kg/m² vs. - 1.59 kg/m²), and waist circumference (- 7.3 cm vs. - 4.4 cm). These reductions were not statistically significant. Changes in levels of high-sensitivity C-reactive protein and adiponectin in the treatment group were more favorable than in the placebo group.

Conclusion

This small pilot study showed no statistical difference for changes in anthropometry, and inflammatory markers between the two groups. Therefore, we could not find any additional effects of Diacerein on weight loss and inflammatory variables in this study.     

The associations of obesity, lymph node status and prognosis in breast cancer patients: dependence on estrogen and progesterone receptor status

Breast cancer patients who are obese have a higher risk of lymph node metastases and a poorer prognosis than those who are slim. It has been claimed that estrogens derived from fat are important for these associations. If estrogens are important, these relationships must be stronger in the hormone receptor-positive than in the hormone receptor-negative groups. Body mass index (BMI) was used as a measure of obesity. The second, third, and fourth quintiles of BMI were treated as one group and termed 'medium'. Patients in the fifth quintile were termed 'obese' and those in the first quintile 'slim'. The number of women with unilateral disease treated with modified radical mastectomy and included in the study was 1211. Of all patients included, obese patients had a 1.53 higher risk of lymph node metastases compared to slim patients (p=0.02). In the PgR-negative group, obesity gave a 3.08 times higher risk of lymph node metastases (p=0.03). The risk of dying of breast cancer tended to be higher in obese than in slim patients when all patients in the study were compared (relative risk=1.38, p=0.06). BMI did not show a statistically significant relationship with prognosis if only hormone receptor status was considered. However, if lymph node status and hormone receptor status were taken together, the association was strong and reversed in the lymph node-positive group with ER-negative tumours. The adjusted relative risk was 0.33, showing that slim patients had a 3.03 (1.0/0.33) times higher risk of dying of breast cancer compared to obese patients (p=0.002). These results indicate that non-hormonal mechanisms could be important.     

Bone turnover biomarkers in obese postmenopausal Saudi women with type-II diabetes mellitus

BackgroundThere is a high prevalence of diabetes mellitus type-2 (T2DM) and osteoporosis are problems worldwide. In this study, we evaluated the correlation between T2DM and bone turnover in diabetic obese postmenopausal Saudi women.ResultsSerum OC levels were significantly decreased in diabetic obese postmenopausal group compared to their respective healthy group (P < 0.004). PICP and Cath K were significantly elevated in diabetic postmenopausal group compared to the healthy group (P < 0.024 & 0.001). A significant elevation in 1,25(OH)2 Vitamin D3, Ca and Pi levels in diabetic obese postmenopausal patients group compared to the healthy group. However, a non-significant changes was observed in serum PTH level between different groups.ConclusionIn this study, the changes in the biochemical parameters and bone turnover markers in obese women are strong risk factors for diabetes development that may contribute to osteopenia and osteoporosis. The study showed the strong effect of T2DM on biochemical markers of bone turnover in obese postmenopausal Saudi women.