Obesity embargo alert for March 2020

All print, broadcast and online journalists who receive the Obesity embargo alert agree to abide by the embargo and may not publish, post, broadcast or distribute embargoed news releases or details of the embargoed studies before the embargo date and time.

When writing about these studies, journalists are asked to attribute the source as the journal Obesity and to include the online link to the Obesity articles as provided below. Links become active when articles post at 3:00 a.m. on Feb. 24, 2020, unless indicated differently below.

About the journalObesity is the peer-reviewed, scientific journal of The Obesity Society.

Editors’ Choice 1 -Proposed Coding System Addresses Pathophysiology, Therapeutic Goals, W. Timothy Garvey, [email protected], and Jeffrey I. Mechanick

Also see accompanying commentary by Johannes Hebebrand (http://onlinelibrary.wiley.com/doi/10.1002/oby.22740), posting online on Feb. 24, 2020

Editors’ Choice 2 -Liraglutide Enhances Weight Loss from IBT in a Primary Care Setting, Thomas A. Wadden, [email protected], Jena Shaw Tronieri, Danny Sugimoto, Michael Taulo Lund, Pernille Auerbach, Camilla Jensen, and Domenica Rubino

Editors’ Choice 3 -miRNA Profiling in Omentum Adipose Before and After Gastric Bypass, Donia Macartney-Coxson, [email protected], Kirsty Danielson, Jane Clapham, Miles C. Benton, Alice Johnston, Angela Jones, Odette Shaw, Ronald D. Hagan, Eric P. Hoffman, Mark Hayes, Jacquie Harper, Michael A. Langston, and Richard S. Stubbs

Editors’ Choice 4 -Measuring Physical Activity and Accumulation of Fat in Infants, Sara E. Benjamin-Neelon, [email protected], Jiawei Bai, Truls Østbye, Brian Neelon, Russell R. Pate, and Ciprian Crainiceanu
(http://onlinelibrary.wiley.com/doi/10.1002/oby.22738) – already online


Impact of Exposure to Antibiotics During Pregnancy and Infancy on Childhood Obesity: A Systematic Review and Meta-Analysis, Shengrong Wan, Man Guo, Ting Zhang, Qing Chen, Maoyan Wu, Fangyuan Teng, Yang Long, Zongzhe Jiang, [email protected], and Yong Xu, [email protected] (http://onlinelibrary.wiley.com/doi/10.1002/oby.22747) – embargo lifts March 4, 2020, at 3:00 a.m. (EST).

Scroll down to find abstracts for each of the above papers. To request the full text of any of these studies and agree to the embargo policy, or to arrange an interview with a study’s author or an obesity expert, please contact [email protected]

Editors’ Choice Abstracts

Editors’ Choice 1 – Proposal for a Scientifically Correct and Medically Actionable Disease Classification System (ICD) for Obesity

Objective: Obesity is responsible for a huge burden of suffering and social costs, and yet many patients lack access to evidence-based therapies. The diagnostic term “obesity” and inadequate International Classification of Diseases (ICD) codes contribute to suboptimal efforts to prevent and treat obesity as a chronic disease. The goal of this review is to develop a medically actionable classification system based on the diagnostic term “adiposity-based chronic disease” (ABCD) that reflects disease pathophysiology and specific complications causing morbidity and mortality.

Methods: A coding system based on the diagnosis of ABCD with four domains is proposed: A codes reflect pathophysiology, B codes indicate BMI classification, C codes specify specific biomechanical and cardiovascular complications remediable by weight loss, and D codes indicate the degree of the severity of complications. Supplemental codes identify aggravating factors that complicate care and that are relevant to a personalized therapeutic plan.

Results: The coding system addresses pathophysiology and therapeutic goals and differential risk, presence, and severity of specific complications that are integral to ABCD as a chronic disease.

Conclusions: The scientifically correct and medically actionable approach to diagnosis and disease coding will lead to greater acknowledgement of ABCD as a disease and accessibility to evidence-based therapies on behalf of patients across the life cycle.

Editors’ Choice 2 – Liraglutide 3.0 mg and Intensive Behavioral Therapy (IBT) for Obesity in Primary Care: The SCALE IBT Randomized Controlled Trial

Objective: Previous studies have shown additive weight loss when intensive behavioral therapy (IBT) was combined with weight-loss medication. The present multisite study provides the first evaluation, in primary care, of the effect of the Centers for Medicare and Medicaid Services-based IBT benefit, delivered alone (with placebo) or in combination with liraglutide 3.0 mg.

Methods: The Satiety and Clinical Adiposity–Liraglutide Evidence in individuals with and without diabetes (SCALE) IBT was a 56-week, randomized, double-blind, placebo-controlled, multicenter trial in individuals with obesity who received liraglutide 3.0 mg (n = 142) or placebo (n = 140) as an adjunct to IBT.

Results: At week 56, mean weight loss with liraglutide 3.0 mg plus IBT was 7.5% and 4.0% with placebo combined with IBT (estimated treatment difference [95% CI] ?3.4% [?5.3% to ?1.6%], P = 0.0003). Significantly more individuals on liraglutide 3.0 mg than placebo achieved ? 5% weight loss (61.5% vs. 38.8%; odds ratio [OR] 2.5% [1.5% to 4.1%], P = 0.0003), > 10% weight loss (30.5% vs. 19.8%; OR 1.8% [1.0% to 3.1%], P = 0.0469), and > 15% weight loss (18.1% vs. 8.9%; OR 2.3% [1.1% to 4.7%], P = 0.0311). Liraglutide 3.0 mg in combination with IBT was well tolerated, with no new safety signals identified.

Conclusions: In a primary care setting, Centers for Medicare and Medicaid Services-based IBT produced clinically meaningful weight loss at 56 weeks, enhanced by the addition of liraglutide 3.0 mg.

Editors’ Choice 3 – MicroRNA Profiling in Adipose Before and After Weight Loss Highlights the Role of miR-223-3p and the NLRP3 Inflammasome

Objective: Adipose tissue plays a key role in obesity-related metabolic dysfunction. MicroRNA (miRNA) are gene regulatory molecules involved in intercellular and inter-organ communication. It was hypothesized that miRNA levels in adipose tissue would change after gastric bypass surgery and that this would provide insights into their role in obesity-induced metabolic dysregulation.

Methods: miRNA profiling (Affymetrix GeneChip miRNA 2.0 Array) of omental and subcutaneous adipose (n = 15 females) before and after gastric bypass surgery was performed.

Results: One omental and thirteen subcutaneous adipose miRNAs were significantly differentially expressed after gastric bypass, including downregulation of miR-223-3p and its antisense relative miR-223-5p in both adipose tissues. mRNA levels of miR-223-3p targets NLRP3 and GLUT4 were decreased and increased, respectively, following gastric bypass in both adipose tissues. Significantly more NLRP3 protein was observed in omental adipose after gastric bypass (P = 0.02). Significant hypomethlyation of NLRP3 and hypermethylation of miR-223 were observed in both adipose tissues after gastric bypass. In subcutaneous adipose, significant correlations were observed between both miR-223-3p and miR-223-5p and glucose and between NLRP3 mRNA and protein levels and blood lipids.

Conclusions: This is the first report detailing genome-wide miRNA profiling of omental adipose before and after gastric bypass, and it further highlights the association of miR-223-3p and the NLRP3 inflammasome with obesity.

Editors’ Choice 4 – Physical Activity and Adiposity in a Racially Diverse Cohort of US Infants

Objective: Early life physical activity may help prevent obesity, but objective quantification in infants is challenging.

Methods: A total of 506 infants were examined from 2013 to 2016. Infants wore accelerometers for 4 days at ages 3, 6, 9, and 12 months. Daily log-transformed physical activity counts were computed, averaged, and standardized across assessments. A linear mixed model was used to examine trends in standardized physical activity counts as well as associations between physical activity and BMI z score, sum of subscapular and triceps skinfold thickness for overall adiposity (SS+TR), and their ratio for central adiposity (SS:TR).

Results: Among infants, 66% were black and 50% were female. For each additional visit, standardized physical activity counts increased by 0.23 (CI: 0.18 to 0.27; P

Conclusions: Physical activity increased over infancy and was associated with central adiposity. Despite limitations, researchers should consider objective measurement in infants.


Impact of Exposure to Antibiotics During Pregnancy and Infancy on Childhood Obesity: A Systematic Review and Meta-Analysis

Objective: This study aimed to investigate whether antibiotic exposure during pregnancy and infancy was associated with childhood overweight or obesity.

Methods: PubMed, Embase, and Cochrane Library databases were searched from the inception date to April 18, 2019, to identify observational studies that investigated the association between antibiotic exposure during pregnancy and infancy and childhood overweight or obesity. After study selection and data extraction, the meta-analysis was conducted using Stata software version 12.0 (StataCorp, LLC, College Station, Texas). The evaluation of the methodological quality was carried out by AMSTAR 2 (Bruyère Research Institute, Ottawa, Ontario, Canada).

Results: A total of 23 observational studies involving 1,253,035 participants was included. The meta-analysis showed that prenatal exposure to antibiotics was not significantly associated with childhood overweight or obesity, whereas an increased risk of overweight or obesity was seen in subgroup analysis of the second trimester (risk ratio=1.13; 95% CI: 1.06-1.22; P=0.001). In contrast, antibiotic exposure during infancy could increase the risk of childhood overweight or obesity (risk ratio=1.14; 95% CI: 1.06-1.23; P=0.001).

Conclusions: This meta-analysis found that antibiotic exposure during the second trimester and infancy could increase the risk of childhood overweight or obesity.

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