Christine Brown

A cost-effective moderate-intensity interdisciplinary weight-management programme for individuals with prediabetes.

AIM To compare the effectiveness and cost of two lifestyle-modification programmes in individuals at high risk of developing type 2 diabetes. METHODS Forty-eight men and women with a body mass index ≥27 kg/m(2) and prediabetes were randomly assigned to either a 1-year interdisciplinary intervention including individual counseling every 6 weeks and 25 group seminars (group I; n=22) or a group intervention comprising seminars only (group G; n=26). These interventions were compared in terms of weight loss and improvement of anthropometric measures, metabolic variables and costs. RESULTS Participants in group I lost an average of 4.9 kg (95% CI: -7.3, -2.4; P<0.01) and 5 cm in waist circumference (95% CI: -7.0, -3.0; P<0.01), whereas no significant change was noted in those assigned to group G. Among the participants in group I, 50 and 27% lost at least 5 and 10% of their initial weight, respectively, compared with only 12 and 4%, respectively, in group G. Fasting glucose, 2-hour glucose and lipid profiles improved significantly in group I, and no participant (zero on 22) developed diabetes compared with 11.5% (3/26) in group G. Most participants (nine on 11) with impaired fasting glucose in group I returned to normal. The direct cost of the individual intervention was estimated to be

Adoption of American Heart Association 2020 Ideal Healthy Diet Recommendations Prevents Weight Gain in Young Adults

733.06/year per subject compared with

Age Differences in Expectations and Readiness Regarding Lifestyle Modifications in Individuals at High Risk of Diabetes

81.36/year per subject for the group intervention. CONCLUSION This study demonstrates that a low-cost, moderate-intensity, individual interdisciplinary approach combined with group seminars leads to clinically significant weight loss and metabolic improvement in people with prediabetes. Group seminars alone were not effective in this population (www.ClinicalTrial.gov, Identifier: NCT00991549).

Impact of health professionals’ contact frequency on response to a lifestyle intervention with individuals at high risk for diabetes

In 2010, the American Heart Association established the concept of ideal cardiovascular health. Nationally representative data estimated that <1% of Americans meet the seven health metrics required for achieving ideal cardiovascular health, with the main challenge residing in meeting the criteria for an ideal Healthy Diet Score. In a cohort of young adults (N=196), we aimed to investigate the prevalence of ideal cardiovascular health and ideal Healthy Diet Score and its association to weight gain over a 4-year follow-up period. Anthropometric measures, blood pressure, and blood samples were taken according to standardized procedures. Dietary intake was measured by a 3-day food diary and verified by a registered dietitian. We observed that only 0.5% of our sample met the criteria for ideal cardiovascular health and only 4.1% met the criteria for an ideal Healthy Diet Score. The components of the Healthy Diet Score with the lowest observance were consumption of fruits and vegetables (9.7%) and whole grains (14.8%). Meeting zero or one out of five of the Healthy Diet Score components was associated with increased risk of weight gain over 4 years compared with meeting at least two components (P=0.03). With the exception of dietary criteria, prevalence was high for achieving ideal levels of the remaining six cardiovascular health metrics. In conclusion, in this sample of young adults, a very low prevalence of ideal overall cardiovascular health was observed, mainly driven by poor dietary habits, and a poor Healthy Diet Score was associated with increased weight gain.

Ghrelin levels are associated with hunger as measured by the Three-Factor Eating Questionnaire in healthy young adults

OBJECTIVE The main objective of this study was to determine whether expectations and readiness to modify eating habits and physical activity (PA) level are different between young and older individuals with prediabetes who agreed to participate in a lifestyle modification program. DESIGN Cross-sectional analysis. SETTING Primary care or referral center. PARTICIPANTS Adults between ages 27 and 78 years (N=74) were tested before starting a 12-month lifestyle intervention. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The visual analog scale questionnaire was used to assess expectations and readiness (ie, intentions, conviction, and self-confidence) to modify the PA level and eating habits. The PA level was assessed with a pedometer and eating habits with a questionnaire. Analyses were stratified by the age group: <60 years old versus ≥60 years old. RESULTS Body mass loss expectations in terms of goal (-22.9% vs -17.9% of the current body mass; P=.04), acceptable (-15.6% vs -9.4%; P=.01), and failure (-7.6% vs -3.8%; P=.05) in future body mass loss were all greater for the younger group. Despite no significant age group difference in the initial PA level and eating habits, the youngest group had a greater intention to increase the PA level (89% vs 81%; P=.004) and to eat healthier (90% vs 85%; P=.001). Finally, the PA level and the consumption of fruits and vegetables, but not body mass, were associated with intentions or self-confidence to make some lifestyle modifications within age groups. CONCLUSIONS In individuals at high risk for diabetes, increasing age is associated with lower expectations and reduced readiness with regard to lifestyle modifications. Thus, age should be considered when planning a lifestyle modification program.

Lower leptin levels are associated with higher risk of weight gain over 2 years in healthy young adults.

AIM To determine the independent effects of total and each health professionals frequency of contacts, on changes in anthropometric measures and physical capacity following a lifestyle intervention offered by a multi-disciplinary team in adults at high risk for type 2 diabetes. MATERIALS AND METHODS A 12-month lifestyle intervention was performed in 48 adults with prediabetes. Participants were randomly assigned to either an individual counselling group (every six weeks)+an optional series of 25 group seminars (every week) or to the group seminars only. Physical activity level, energy intake, anthropometric measures, and physical capacity were assessed. RESULTS Total frequency of contacts with any professional was associated with change in body weight, BMI and, waist circumference (all P ≤.05). However, no frequency of contacts with a specific professional was associated with the studied outcomes, except for changes in physical capacity. The latest was significantly improved in participants who attended at least two group sessions with the kinesiologist (P=.02). DISCUSSION To improve anthropometric measures, total contact frequency seems to be more important than contact frequency with any specific professionals. However, to improve physical capacity, meeting with a kinesiologist for two or more occasions, in group sessions, seems to be an effective strategy.

Weight management in Canada: an environmental scan of health services for adults with obesity

Weight gain and appetite regulation are complex interplays between internal and external cues. Our aim was to investigate the association of eating behaviors with ghrelin taking into account lifestyle. We conducted a cross-sectional analysis in a sample of first-year university students at the Université de Sherbrooke. We collected medical history, anthropometric measurements, vital signs, fitness index, and fasting blood samples. Questionnaires included a lifestyle questionnaire and the Three-Factor Eating Questionnaire (TFEQ) estimating dietary restraint, disinhibition and hunger. We recruited 308 participants aged 20.7±3.2 years and a mean BMI of 23.3±3.4 kg/m(2). Hunger score was significantly associated with ghrelin levels (r=0.11, P<0.05). In women, this association was independent of age, BMI, dietary and lifestyle factors (P=0.02). The association between ghrelin level and hunger score was observable in leaner individuals (r=0.28, p<0.0001) but not in heavier individuals (r=-0.08, p=0.34; stratified by BMI < vs > 22.6 kg/m(2)). Restraint (R) and disinhibition (D) were not associated with ghrelin levels. The three eating behaviors demonstrated expected correlations with lifestyle supporting the validity of the TFEQ in this cohort. In conclusion, we demonstrated that ghrelin, a biological marker, is associated with self-reported perception of hunger, independently of anthropometric measures and lifestyle.

Obesity Preceptorship and Virtual Community Result in Changes of Primary Care Practice

Complete leptin deficiency is associated with weight gain and extreme obesity, according to studies of animals and of monogenic obesity in humans. It is still a matter of debate whether relative leptin deficiency plays a physiologic role in adiposity regulation in free-living humans. We hypothesized that leptin levels would be associated with subsequent weight changes in healthy normal-weight young adults. Our prospective cohort involved 150 healthy young adults (114 women and 36 men) followed over their years of study at the Université de Sherbrooke. Anthropometric measurements, fasting blood samples, 3-day food diaries, and a physical activity questionnaire were collected at baseline. Leptin levels were measured with radioimmunoassay. Associations between baseline leptin levels and subsequent anthropometric changes were assessed with multivariable linear regression models to account for adiposity at baseline, food intake, and energy expenditure. Over the 2-year follow-up, changes in body mass index (BMI) ranged from -0.8 to +2.6 kg·m(-2) in men (mean BMI change, +0.6 kg·m(-2)) and from -2.5 to +3.7 kg·m(-2) in women (mean BMI change, +0.1 kg·m(-2)). Lower leptin levels at baseline were associated with a higher risk of weight gain in women (r = -0.24; p = 0.01 for change in BMI) and in men (r = -0.27, p = 0.11), even after accounting for baseline BMI, total daily caloric intake, and energy expenditure (p = 0.02). In the subsample measured at 4 years (n = 63), baseline leptin levels were not associated with 4-year weight changes. Lower leptin levels are associated with a higher risk of weight gain over 2 years in healthy young adults.

Inflammatory Cytokine Profiles in Visceral and Subcutaneous Adipose Tissues of Obese Patients Undergoing Bariatric Surgery Reveal Lack of Correlation With Obesity or Diabetes

BackgroundObesity in Canada is a growing concern, but little is known about the available services for managing obesity in adults. Our objectives were to (a) survey and describe programs dedicated to weight management and (b) evaluate program adherence to established recommendations for care.MethodsWe conducted an online environmental scan in 2011 to identify adult weight management services throughout Canada. We examined the degree to which programs adhered to the 2006 Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children (CCPGO) and the analysis criteria developed by the Association pour la Santé Publique du Québec (ASPQ).ResultsA total of 83 non-surgical (34 community-based, 42 primary care-based, 7 hospital-based) and 33 surgical programs were identified. All programs encouraged patient self-management. However, few non-surgical programs adhered to the CCPGO recommendations for assessment and intervention, and there was a general lack of screening for eating disorders, depression and other psychiatric diseases across all programs. Concordance with the ASPQ criteria was best among primary care-based programs, but less common in other settings with deficits most frequently revealed in multidisciplinary health assessment/management and physical activity counselling.ConclusionsWith more than 60% of Canadians overweight or obese, our findings highlight that availability of weight management services is far outstripped by need. Our observation that evidence-based recommendations are applied inconsistently across the country validates the need for knowledge translation of effective health services for managing obesity in adults.

Corrigendum to “Inflammatory cytokine profiles in visceral and subcutaneous adipose tissues of obese patients undergoing bariatric surgery reveal lack of correlation with obesity or diabetes” EBioMedicine 30C (2018) 237–247

Obesity Preceptorship and Virtual Community Result in Changes of Primary Care Practice JEAN-PATRICE BAILLARGEON*, MARIANNE XHIGNESSE, ANDRE CARPENTIER, DENISE DONOVAN, ANDREW GRANT, MARTIN FORTIN, DENISE ST-CYR-TRIBBLE, JUDITH SIMONEAU-ROY, CHRISTINE BROWN, ANICK CHAMPOUX, MARIE-FRANCE LANGLOIS. Dept. of Medicine, Universite de Sherbrooke, Sherbrooke, QC Considering the growing prevalence of obesity, the majority of patients should be managed by primary care providers. Our objectives were to implement and evaluate a clinical preceptorship on obesity associated with an interdisciplinary obesity care network for primary care providers. Primary care providers practicing in Family Medicine Groups (FMGs) were offered a 2-day clinical preceptorship in conjunction with web-based documentation, teaching materials, monthly virtual meetings and forums. Current practice and management of obesity was assessed at baseline, 3 months and 1 year using questionnaires referring to 2 situations: an obese patient consulting for another problem (A) and an obese patient consulting for obesity (B). Only significant results (P<0.05) are reported. Thirty-eight participants (13 nurses and 25 physicians) from 8 FMGs were enrolled. Actual practice for management of obesity was improved: both vignettes were more likely to elicit an offer of follow up regarding weight management; and the vignette of a patient consulting for obesity was more likely to further elicit use of the Prochaska model, food diaries and pedometers. Qualitative assessment also showed many changes in the management of obese patients in FMGs. Participants reported to find the preceptorships really useful and that time was the major barrier to participate in the virtual community. Obesity preceptorships and associated interdisciplinary obesity care network changed reported management of obesity as well as reported practices in FMG’s primary care providers after one year. The next step would be to assess the impact of our intervention on obesity management directly among patients followed by FMG’s. This work was supported by Canadian Institutes for Health Research Operating Grant PHE78707 and Fonds de la Recherche en Sante du Quebec grant #5635. ABSTRACT #20