Publications by authors named "Volkan Yumuk"

36 Publications

European Guidelines for Obesity Management in Adults with a Very Low-Calorie Ketogenic Diet: A Systematic Review and Meta-Analysis.

Obes Facts 2021 21;14(2):222-245. Epub 2021 Apr 21.

Dipartimento di Medicina, Università degli Studi di Padova, Padova, Italy.

Background: The very low-calorie ketogenic diet (VLCKD) has been recently proposed as an appealing nutritional strategy for obesity management. The VLCKD is characterized by a low carbohydrate content (<50 g/day), 1-1.5 g of protein/kg of ideal body weight, 15-30 g of fat/day, and a daily intake of about 500-800 calories.

Objectives: The aim of the current document is to suggest a common protocol for VLCKD and to summarize the existing literature on its efficacy in weight management and weight-related comorbidities, as well as the possible side effects.

Methods: This document has been prepared in adherence with Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Literature searches, study selection, methodology development, and quality appraisal were performed independently by 2 authors and the data were collated by means of a meta-analysis and narrative synthesis.

Results: Of the 645 articles retrieved, 15 studies met the inclusion criteria and were reviewed, revealing 4 main findings. First, the VLCKD was shown to result in a significant weight loss in the short, intermediate, and long terms and improvement in body composition parameters as well as glycemic and lipid profiles. Second, when compared with other weight loss interventions of the same duration, the VLCKD showed a major effect on reduction of body weight, fat mass, waist circumference, total cholesterol and triglyceridemia as well as improved insulin resistance. Third, although the VLCKD also resulted in a significant reduction of glycemia, HbA1c, and LDL cholesterol, these changes were similar to those obtained with other weight loss interventions. Finally, the VLCKD can be considered a safe nutritional approach under a health professional's supervision since the most common side effects are usually clinically mild and easily to manage and recovery is often spontaneous.

Conclusions: The VLCKD can be recommended as an effective dietary treatment for individuals with obesity after considering potential contra-indications and keeping in mind that any dietary treatment has to be personalized. Prospero Registry: The assessment of the efficacy of VLCKD on body weight, body composition, glycemic and lipid parameters in overweight and obese subjects: a meta-analysis (CRD42020205189).
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http://dx.doi.org/10.1159/000515381DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138199PMC
April 2021

Comparison of 12-Week Fitness Protocols Following Bariatric Surgery: Aerobic Exercise Versus Aerobic Exercise and Progressive Resistance.

Obes Surg 2021 Apr 6;31(4):1475-1484. Epub 2021 Jan 6.

Cerrahpasa Medical Faculty, Department of Cardiology, Istanbul University Cerrahpasa, Istanbul, Turkey.

Background: Successful bariatric surgery outcomes are better maintained with an exercise program. This pilot study compared the effects on short-term functional capacity and body composition of 2 post-bariatric surgery home-based programs: aerobic exercise alone versus aerobic exercise combined with progressive resistance conditioning.

Methods: Laboratory measures and self-assessments of post-bariatric surgery patients (BMI ≥ 30 kg/m) undergoing either aerobic exercise (AE group) or aerobic + progressive-resistance exercise (AEPR group) were compared at postoperative months 1 and 3. Anthropometric characteristic changes were recorded, as well as changes in functional capacity (e.g., 6-min walking test), muscle strength (e.g., hand grip strength test; five-times-sit-to-stand test), and quality of life (i.e., Beck Depression Inventory).

Results: Between July 2018 and March 2019, 35 patients completed the AE (n = 17) or AEPR (n = 18) program. The AEPR group lost statistically significantly more weight (mean 2.2 kg) relative to baseline than the AE group (p < 0.05). The AEPR group achieved significantly greater mean total muscle, liquid, and bone mass; upper-extremity muscle strength; uric acid levels; body fat loss; and performed better on the 6-min walking test (all p < 0.05). In month 3, the AEPR group achieved a greater mean walking distance (p = 0.029) and O saturation related to dyspnea (p = 0.001) than the AE group. Group quality of life scores were comparable.

Conclusions: In a comparative 12-week post-bariatric surgery study, both aerobic exercise alone and aerobic exercise plus progressive-resistance training were positively correlated with general health improvement. However, the progressive-resistance regimen resulted in significantly greater weight loss, functional capacity, muscle mass, and upper-body strength.
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http://dx.doi.org/10.1007/s11695-020-05144-5DOI Listing
April 2021

Does treatment with sodium-glucose co-transporter-2 inhibitors have an effect on sleep quality, quality of life, and anxiety levels in people with Type 2 diabetes mellitus?

Turk J Med Sci 2020 12 28;51(2):735-742. Epub 2020 Dec 28.

Department of Internal Medicine, Faculty of Medicine, İstanbul University-Cerrahpasa, İstanbul, Turkey

Background/aim: To evaluate the impact of treatment with sodium-glucose co-transporter-2 (SGLT2) Inhibitors on quality of life (QoL), sleep quality (SQ), and anxiety levels in patients with Type 2 diabetes mellitus (T2DM).

Materials And Methods: Ninety-seven patients with type 2 diabetes admitted to tertiary care hospital diabetes clinic were included. Fifty patients were randomized to receive SGLT2 inhibitors in addition to baseline treatment (Group A), 47 subjects continued with their baseline treatment or were added other medications as needed (Group B). Thirty healthy controls (HC) were recruited (Group C). All groups were subjected to the Turkish version of Short Form-36 (SF-36), Pittsburgh Sleep Quality (PSQ), and Beck Anxiety Inventory (BAI) scales both at baseline and final visit.

Results: Physical function, emotional role limitation, vitality, mental health, pain, general health perception scores of SF-36 were significantly improved in Group A, at the end of the follow-up period. There was no significant change in terms of PSQ, BAI scores, and hypoglycaemia documented in all groups. The intervention-related change in HbA1c level, body weight, and body mass index were significantly higher in Group A.

Conclusion: The QoL was improved in people with diabetes who were taking SGLT2 inhibitors. This may be explained by weight loss observed in participants.
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http://dx.doi.org/10.3906/sag-2008-37DOI Listing
December 2020

Utilization of statins and LDL-cholesterol target attainment in Turkish patients with type 2 diabetes - a nationwide cross-sectional study (TEMD dyslipidemia study).

Lipids Health Dis 2020 Nov 11;19(1):237. Epub 2020 Nov 11.

Department of Endocrinology and Metabolism, Istanbul University, School of Medicine, Istanbul, Turkey.

Background: Attaining acceptable levels of LDL Cholesterol (LDL-C) significantly improves cardiovascular (CV) outcomes in patients with type 2 diabetes mellitus (T2DM). The LDL-C target attainment and the characteristics of patients attaining these targets were investigated in this study. Furthermore, the reasons for not choosing statins and the physicians' attitudes on the treatment of diabetic dyslipidemia were also examined.

Methods: A nationwide, cross-sectional survey was conducted in tertiary centers for diabetes management. Adult patients with T2DM, who were under follow-up for at least a year in outpatient clinics, were consecutively enrolled for the study. LDL-C goals were defined as below 70 mg/dL for patients with macrovascular complications or diabetic nephropathy, and below 100 mg/dL for other patients. Data about lipid-lowering medications were self-reported.

Results: A total of 4504 patients (female: 58.6%) were enrolled for the study. The mean HbA1c and diabetes duration was 7.73 ± 1.74% and 10.9 ± 7.5 years, respectively. The need for statin treatment was 94.9% (n = 4262); however, only 42.4% (n = 1807) of these patients were under treatment, and only 24.8% (n = 448) of these patients achieved LDL-C targets. The main reason for statin discontinuation was negative media coverage (87.5%), while only a minority of patients (12.5%) mentioned side effects. Physicians initiated lipid-lowering therapy in only 20.3% of patients with high LDL-C levels. It was observed that the female gender was a significant independent predictor of not attaining LDL-C goals (OR: 0.70, 95% CI: 0.59-0.83).

Conclusions: Less than 50 % of patients with T2DM who need statins were under treatment, and only a quarter of them attained their LDL-C targets. There exists a significant gap between the guideline recommendations and the real-world evidence in the treatment of dyslipidemia in T2DM.
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http://dx.doi.org/10.1186/s12944-020-01408-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659134PMC
November 2020

Obesity and COVID-19: The Two Sides of the Coin.

Obes Facts 2020 13;13(4):430-438. Epub 2020 Jul 13.

European Association for the Study of Obesity (EASO), Teddington, United Kingdom.

The World Health Organization declared COVID-19, the infectious disease caused by the coronavirus SARS-CoV-2, a pandemic on March 12, 2020. COVID-19 is causing massive health problems and economic suffering around the world. The European Association for the Study of Obesity (EASO) promptly recognised the impact that the outbreak could have on people with obesity. On one side, emerging data suggest that obesity represents a risk factor for a more serious and complicated course of COVID-19 in adults. On the other side, the health emergency caused by the outbreak diverts attention from the prevention and care of non-communicable chronic diseases to communicable diseases. This might be particularly true for obesity, a chronic and relapsing disease frequently neglected and linked to significant bias and stigmatization. The Obesity Management Task Force (OMTF) of EASO contributes in this paper to highlighting the key aspects of these two sides of the coin and suggests some specific actions.
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http://dx.doi.org/10.1159/000510005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841065PMC
October 2020

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study).

Obes Facts 2019 20;12(2):167-178. Epub 2019 Mar 20.

Department of Endocrinology and Metabolism, Medical Faculty, Istanbul University, Istanbul, Turkey.

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent.

Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes.

Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy.

Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes.

Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity.
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http://dx.doi.org/10.1159/000496624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547285PMC
February 2020

The ABCD of Obesity: An EASO Position Statement on a Diagnostic Term with Clinical and Scientific Implications.

Obes Facts 2019 7;12(2):131-136. Epub 2019 Mar 7.

European Association for the Study of Obesity (EASO), Teddington, United Kingdom.

Obesity is a frequent, serious, complex, relapsing, and chronic disease process that represents a major public health problem. The coining of obesity as an adiposity-based chronic disease (ABCD) is of particular relevance being in line with EASO's proposal to improve the International Classification of Diseases ICD-11 diagnostic criteria for obesity based on three dimensions, namely etiology, degree of adiposity, and health risks. The body mass index as a unique measurement of obesity does not reflect the whole complexity of the disease. Obesity complications are mainly determined by 2 pathological processes, i.e., physical forces (fat mass disease) as well as endocrine and immune responses (sick fat disease), which are embedded in a cultural and physical context leading to a specific ABCD stage.
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http://dx.doi.org/10.1159/000497124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547280PMC
February 2020

European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care.

Obes Facts 2019 23;12(1):40-66. Epub 2019 Jan 23.

Department of Integrative Physiology, Faculty of Medicine, University of Fribourg, Fribourg, Switzerland,

The first contact for patients with obesity for any medical treatment or other issues is generally with General Practitioners (GPs). Therefore, given the complexity of the disease, continuing GPs' education on obesity management is essential. This article aims to provide obesity management guidelines specifically tailored to GPs, favouring a practical patient-centred approach. The focus is on GP communication and motivational interviewing as well as on therapeutic patient education. The new guidelines highlight the importance of avoiding stigmatization, something frequently seen in different health care settings. In addition, managing the psychological aspects of the disease, such as improving self-esteem, body image and quality of life must not be neglected. Finally, the report considers that achieving maximum weight loss in the shortest possible time is not the key to successful treatment. It suggests that 5-10% weight loss is sufficient to obtain substantial health benefits from decreasing comorbidities. Reducing waist circumference should be considered even more important than weight loss per se, as it is linked to a decrease in visceral fat and associated cardiometabolic risks. Finally, preventing weight regain is the cornerstone of lifelong treatment, for any weight loss techniques used (behavioural or pharmaceutical treatments or bariatric surgery).
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http://dx.doi.org/10.1159/000496183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465693PMC
February 2020

Sarcopenic Obesity: Time to Meet the Challenge.

Obes Facts 2018 18;11(4):294-305. Epub 2018 Jul 18.

Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italyey.

The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social, and multidisciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures, and cancer as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability, and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term 'sarcopenic obesity' has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification, and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria, and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has a strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.
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http://dx.doi.org/10.1159/000490361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6189532PMC
September 2019

Sarcopenic obesity: Time to meet the challenge.

Clin Nutr 2018 12 7;37(6 Pt A):1787-1793. Epub 2018 May 7.

Department of Medicine, University of Padova, Italy; Center for the Study and the Integrated Management of Obesity (EASO COM), Padova University Hospital, Padova, Italy.

The prevalence of overweight and obesity has reached epidemic proportions worldwide due to increasingly pervasive obesogenic lifestyle changes. Obesity poses unprecedented individual, social and multi-disciplinary medical challenges by increasing the risk for metabolic diseases, chronic organ failures and cancer, as well as complication rates in the presence of acute disease conditions. Whereas reducing excess adiposity remains the fundamental pathogenetic treatment for obese individuals, complex metabolic and lifestyle abnormalities as well as weight-reduction therapies per se may also compromise the ability to preserve muscle function and mass, especially when chronic disease co-exists with obesity. Emerging evidence indicates that low muscle mass and quality have a strong negative prognostic impact in obese individuals and may lead to frailty, disability and increased morbidity and mortality. Awareness of the importance of skeletal muscle maintenance in obesity is however low among clinicians and scientists. The term "sarcopenic obesity" has been proposed to identify obesity with low skeletal muscle function and mass, but its utilization is largely limited to the aging patient population, and consensus on its definition and diagnostic criteria remains insufficient. Knowledge on prevalence of sarcopenic obesity in various clinical conditions and patient subgroups, on its clinical impacts in patient risk stratification and on effective prevention and treatment strategies remain therefore dramatically inadequate. In particular, optimal dietary options and medical nutritional support strategies to preserve muscle mass in obese individuals remain largely undefined. The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) recognize and indicate obesity with altered body composition due to low skeletal muscle function and mass (sarcopenic obesity) as a scientific and clinical priority for researchers and clinicians. ESPEN and EASO therefore call for coordinated action aimed at reaching consensus on its definition, diagnostic criteria and optimal treatment with particular regard to nutritional therapy. We are convinced that achievement of these goals has strong potential to reduce the burden of morbidity and mortality in the rapidly increasing obese patient population.
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http://dx.doi.org/10.1016/j.clnu.2018.04.018DOI Listing
December 2018

Obesity Management Task Force of the European Association for the Study of Obesity Released "Practical Recommendations for the Post-Bariatric Surgery Medical Management".

Obes Surg 2018 07;28(7):2117-2121

Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Bariatric patients may face specific clinical problems after surgery, and multidisciplinary long-term follow-up is usually provided in specialized centers. However, physicians, obstetricians, dieticians, nurses, clinical pharmacists, midwives, and physical therapists not specifically trained in bariatric medicine may encounter post-bariatric patients with specific problems in their professional activity. This creates a growing need for dissemination of first level knowledge in the management of bariatric patients. Therefore, the Obesity Management Task Force (OMTF) of the European Association for the Study of Obesity (EASO) decided to produce and disseminate a document containing practical recommendations for the management of post-bariatric patients. The list of practical recommendations included in the EASO/OMTF document is reported in this brief communication.
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http://dx.doi.org/10.1007/s11695-018-3283-zDOI Listing
July 2018

Sugar-Sweetened Beverages and Weight Gain in Children and Adults: A Systematic Review from 2013 to 2015 and a Comparison with Previous Studies.

Obes Facts 2017 14;10(6):674-693. Epub 2017 Dec 14.

Special Institute for Preventive Cardiology And Nutrition SIPCAN, Salzburg, Austria.

Objective: Partly inconsistent findings from previous reviews have fueled discussions on the impact of sugar-sweetened beverages (SSBs) on obesity development. The aim was to systematically review the recent evidence in children and adults.

Methods: Data were retrieved from the databases MEDLINE, EMBASE, and Cochrane library for the period January 2013 to October 2015. A systematic review of prospective cohort studies and randomized controlled trials (RCTs) relating SSBs to weight measures was conducted.

Results: 30 publications met the inclusion criteria. Prospective cohort studies (96%; n = 26) showed a positive association between consumption of SSBs and weight/BMI in adults and children (n = 242,352), and only one cohort study in children showed no association. Findings from three RCTs in children demonstrated that SSB consumption had an effect on BMI/BMI z-score. The one RCT in adults showed no significant effect of the intervention. 63% of the studies were of good, 30% of medium quality, and none was funded by industry.

Conclusion: Recent evidence suggests that SSB consumption is positively associated with or has an effect on obesity indices in children and adults. By combining the already published evidence with the new one, we conclude that public health policies should aim to reduce the consumption of SSBs and encourage healthy alternatives such as water.
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http://dx.doi.org/10.1159/000484566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836186PMC
July 2019

Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management.

Obes Facts 2017 6;10(6):597-632. Epub 2017 Dec 6.

Department of Internal Medicine, University of Padova, Padova, Italy.

Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations.
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http://dx.doi.org/10.1159/000481825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836195PMC
July 2019

Obesity and Type 2 Diabetes: Two Diseases with a Need for Combined Treatment Strategies - EASO Can Lead the Way.

Obes Facts 2017 12;10(5):483-492. Epub 2017 Oct 12.

Department of Medicine, Medical University Graz, Graz, Austria.

Obesity is a chronic metabolic disease affecting adults and children worldwide. It has become one of the leading causes of death, as obesity is known to be the main risk factor for a number of non-communicable diseases, in particular type 2 diabetes. This close relationship led to the connotation 'diabesity', highlighting the fact that the majority of individuals with diabetes are overweight or obese. Until today the BMI is still used to classify overweight and obesity. Since reduced muscle mass is highly prevalent throughout the BMI range, the measurement of body composition is strongly recommended. Moreover, it is essential for monitoring the course of weight reduction, which is part of every effective anti-obesity treatment. Weight reduction can be achieved via different weight loss strategies, including lifestyle intervention (diet and exercise), pharmacotherapy, or bariatric surgery. However, not all of these strategies are suitable for all patients, and any further needs should be considered. Besides, attention should also be drawn to concomitant therapies. These therapies may promote additional weight gain and further trigger the deterioration of blood glucose control. Thus, therapeutic strategies are warranted, which can be easily used for the management of obese patients with type 2 diabetes to achieve their glycemic and weight loss goals.
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http://dx.doi.org/10.1159/000480525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741209PMC
April 2018

A Proposal of the European Association for the Study of Obesity to Improve the ICD-11 Diagnostic Criteria for Obesity Based on the Three Dimensions Etiology, Degree of Adiposity and Health Risk.

Obes Facts 2017 22;10(4):284-307. Epub 2017 Jul 22.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.

Diagnostic criteria for complex medical conditions caused by a multitude of both genetic and environmental factors should be descriptive and avoid any attribution of causality. Furthermore, the wording used to describe a disorder should be evidence-based and avoid stigmatization of the affected individuals. Both terminology and categorizations should be readily comprehensible for healthcare professionals and guide clinical decision making. Uncertainties with respect to diagnostic issues and their implications may be addressed to direct future clinical research. In this context, the European Association of the Study of Obesity (EASO) considers it an important endeavor to review the current ICD-11 Beta Draft for the definition of overweight and obesity and to propose a substantial revision. We aim to provide an overview of the key issues that we deem relevant for the discussion of the diagnostic criteria. We first discuss the current ICD-10 criteria and those proposed in the ICD 11 Beta Draft. We conclude with our own proposal for diagnostic criteria, which we believe will improve the assessment of patients with obesity in a clinically meaningful way.
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http://dx.doi.org/10.1159/000479208DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644953PMC
February 2018

Perceived Health Status: Is Obesity Perceived as a Risk Factor and Disease?

Obes Facts 2017 10;10(1):52-60. Epub 2017 Mar 10.

European Association for the Study of Obesity, New Investigators United, London, UK.

One might expect that a perception of obesity being a risk factor and disease, contributes to effective obesity prevention and management strategies. However, obesity rates continue to increase worldwide. The question arises whether obesity is truly perceived as a risk factor and a disease. This paper aims at describing perception of obesity as risk factor and disease among individuals seeking care, individuals not seeking care, the society, and different professionals having a role in the field of obesity. The paper is a reflection of the lecture on the topic that was given at the EASO's New Investigators United's Summer School 2016 in Portugal and the discussion with the new investigators and other senior speakers. Individual obese patients seeking help are very much aware of obesity being a risk factor and disease, but perceptions regarding obesity seem to be flawed among those who do not seek help for obesity. Also, misperceptions regarding obesity play a role at different levels, including society, different political levels, the fields of health care and social work, prevention organizations, and the food and marketing industry. The food and marketing industry has an enormous role in changing perceptions by the society and policy makers. Obesity rates will continue to increase as long as individuals, the society, and professionals at different levels have false interpretations of the severity of obesity. Severe action is needed against those who are playing a role in maintaining false perceptions of obesity as a risk factor and disease.
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http://dx.doi.org/10.1159/000457958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644964PMC
September 2017

A Simple Food-Diverting Operation for Type 2 Diabetes Treatment. Preliminary Results in Humans with BMI 28-32 kg/m.

Obes Surg 2017 01;27(1):22-29

Department of General Surgery, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.

Background: The feasibility of a simple side-to-side jejunoileal anastomosis (SJA) in non-morbidly obese individuals to control type 2 diabetes mellitus (T2DM) was studied in six diabetic patients with BMI 28-32. This novel procedure was performed in two Academic Centers and preliminary data is presented.

Methods: SJA bypassing a significant part of the small bowel and diverting food and biliopancretic secretions to the distal ileum was performed laparoscopically in six diabetic patients with BMI 28-32 kg/m. SJA was performed at a distance of 100 cm from the Treitz ligament and 150 cm from the ileocecal valve, thus a total bowel alimentary and biliopancreatic loop length of 2.5 m was created.

Results: Three of the patients (two female, one male) experienced complete remission of diabetes from the immediate postoperative period and up to 3 years after the procedure. Two other patients remained medication-free after the operation experiencing partial diabetes remission, and the third patient significantly reduced his daily insulin requirements immediately after surgery. There were no early or late postoperative complications.

Conclusions: A simple SJA, diverting the food and biliopancreatic secretion to the distal small bowel, was able to control T2DM in all patients offering total or partial remission of the disease soon after the procedure. Those preliminary data and the simplicity of the operation are encouraging and promising. However, further studies are in progress in both Institutions to reveal the possible mechanism of diabetes control and investigate the effect of this operation on larger number of patients, with longer follow-up period.
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http://dx.doi.org/10.1007/s11695-016-2251-8DOI Listing
January 2017

Obesity Management in Europe: Current Status and Objectives for the Future.

Obes Facts 2016 20;9(4):273-83. Epub 2016 Aug 20.

Research Center for the Prevention of Overweight Zwolle, Windesheim University of Applied Science and VU University, Zwolle, The Netherlands.

Objective: This study aims at assessing the status of obesity management in the European region and identifying future goals and objectives of professionals working in the field of obesity.

Methods: Presidents of all 31 EASO-affiliated (EASO = European Association for the Study of Obesity) national associations for the study of obesity were asked to invite 5 obesity experts from their country to participate in a survey. A total of 74 obesity professionals out of 23 countries participated. Questions addressed the development of guidelines, the status of obesity management, and goals and objectives for the future in obesity management. Further, EASO's three vice-presidents participated in in-depth, semi-structured interviews, in which they were asked to provide their reflection on the survey data.

Results: Most countries define obesity as a clinical and chronic disease, but various differences in obesity management standards exist across Europe. Existing guidelines mainly focus on the acute treatment of obesity rather than on long-term approaches.

Conclusion: Multidisciplinary approaches for obesity management and the collaboration between general practitioners and hospitals as well as between professionals at the local level and networks of obesity management centers need to be improved across Europe. Good practices and evidence are available.
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http://dx.doi.org/10.1159/000445192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644860PMC
September 2017

Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and heart failure.

J Hypertens 2016 09;34(9):1678-88

aInstitute for Clinical Pharmacology, Medical School Hannover, Hannover, Germany bDepartment of Medicine, Medical University Graz, Graz, Austria cClinica Medica, Dipartimento di Medicina e Chirurgia, Universita Milano-Bicocca dIRCCS Multimedica, Milan, Italy eDepartment of Medicine, Division of Endocrinology and Metabolism, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey fHypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece gIRCCS Istituto Auxologico, Milan, Italy hDepartment of Clinical Sciences, Lund University, University Hospital, Malmö, Sweden iNational Centre for Cardiovascular Prevention and Outcomes, UCL Institute of Cardiovascular Science, London, UK jCenter for Stroke Research Berlin (CSB) kDepartment of Cardiology, Virchow Campus, Charite Charité - Universitätsmedizin Berlin lPartner Site of the German Center for Cardiovascular Diseases (DZHK), Berlin, Germany *Nick Finer and Wolfram Doehner contributed equally to the manuscript.

Obese individuals are more likely to develop heart failure. Yet, once heart failure is established, the impact of overweight and obesity on prognosis and survival is unclear. The purpose of this joint scientific statement of the European Association for the Study of Obesity and the European Society of Hypertension is to provide an overview on the current scientific literature on obesity and heart failure in terms of prognosis, mechanisms, and clinical management implications. Moreover, the document identifies open questions that ought to be addressed. The need for more tailored weight management recommendations in heart failure will be emphasized and, in line with the emerging evidence, aims to distinguish between primary disease and secondary outcome prevention. In the primary prevention of heart failure, it appears prudent advising obese individuals to lose or achieve a healthy body weight, especially in those with risk factors such as hypertension or type 2 diabetes. However, there is no evidence from clinical trials to guide weight management in overweight or obese patients with established heart failure. Prospective clinical trials are strongly encouraged.
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September 2016

European Guidelines for Obesity Management in Adults.

Obes Facts 2015 5;8(6):402-24. Epub 2015 Dec 5.

Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management.
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http://dx.doi.org/10.1159/000442721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644856PMC
July 2016

2014 EASO Position Statement on the Use of Anti-Obesity Drugs.

Obes Facts 2015 1;8(3):166-74. Epub 2015 May 1.

Department of Internal Medicine, Medical University, Graz, Austria.

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http://dx.doi.org/10.1159/000430801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644876PMC
June 2016

Opportunities for intervention strategies for weight management: global actions on fluid intake patterns.

Obes Facts 2015 29;8(1):54-76. Epub 2015 Jan 29.

Inserm/University Paul Sabatier UMR 1048, Institute of Metabolic and Cardiovascular Diseases, Hôpital Rangueil, Toulouse cedex, France.

Water is an essential nutrient for all physiological functions and particularly important for thermoregulation. About 60% of our body weight is made of water. Under standard conditions (18-20 °C and moderate activity), water balance is regulated within 0.2 % of body weight over a 24-hour period. Water requirement varies between individuals and according to environmental conditions. Concerning considerations related to obesity, the health impact of fluid intake is commonly overlooked. Fluid intake advices are missing in most of food pyramids offered to the public, and water requirements and hydration challenges remain often neglected. The purpose of this paper is to emphasize and discuss the role of water consumption in the context of other important public health measures for weight management. Attention will be focused on fluid intake patterns and hydration-related questions in the context of global interventions and/or physical activity programs settled in weight management protocols.
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http://dx.doi.org/10.1159/000375103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644897PMC
October 2015

Joint scientific statement of the European Association for the Study of Obesity and the European Society of Hypertension: Obesity and early vascular ageing.

J Hypertens 2015 Mar;33(3):425-34

aInstitute of Clinical Pharmacology, Hannover Medical School, Hannover, Germany bDepartment of Clinical Sciences, Lund University, University Hospital, Malmö, Sweden cHypertension-24 h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University Thessaloniki, Thessaloniki, Greece dThe Cardiovascular and Metabolic Preventive Clinic, Department of Endocrinology, Center for Individualized Medicine in Arterial Diseases (CIMA), Odense University Hospital, Odense, Denmark eHypertension in Africa Research Team (HART), School for Physiology, Nutrition and Consumer Sciences, North-West University, Mahikeng, South Africa fClinica Medica, Università Milano-Bicocca, and Istituto di Ricerche a Carattere Scientifico IRCCS Multimedica, Sesto san Giovanni, Milan, Italy gDivision of Endocrinology, Metabolism and Diabetes, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey hElse Kröner-Fresenius Center for Nutritional Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany iObesity Management Clinic 'WAGA', Katowice, Poland jUniversity Clinic of Internal Medicine, Medical University Graz, Graz, Austria kNational Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science, University College London, London, UK.

Current cardiovascular risk scores do not include obesity or fat distribution as independent factors, and may underestimate risk in obese individuals. Assessment of early vascular ageing (EVA) biomarkers including arterial stiffness, central blood pressure, carotid intima-media thickness and flow-mediated vasodilation may help to refine risk assessment in obese individuals in whom traditional cardiovascular risk scores and factors suggest no need for specific medical attention. A number of issues need to be addressed before this approach is ready for translation into routine clinical practice. Methodologies for measurements of vascular markers need to be further standardized and less operator-dependent. The utility of these nontraditional risk factors will also need to be proven in sufficiently large and properly designed interventional studies. Indeed, published studies on vascular markers in obesity and weight loss vary in quality and study design, are sometimes conducted in small populations, use a variety of differing methodologies and study differing vascular beds. Finally, current vascular measurements are still crude and may not be sufficient to cover the different aspects of EVA in obesity.
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March 2015

Need for a paradigm shift in adult overweight and obesity management - an EASO position statement on a pressing public health, clinical and scientific challenge in Europe.

Obes Facts 2014 5;7(6):408-16. Epub 2014 Dec 5.

European Association for the Study of Obesity on behalf of the Executive Committee, Clínica Universidad de Navarra, University of Navarra, Obesity & Adipobiology Group of the Instituto de Investigación Sanitaria de Navarra, CIBERobn, Instituto de Salud Carlos III, Pamplona, Spain.

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http://dx.doi.org/10.1159/000370038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644793PMC
July 2015

Obesity: a gateway disease with a rising prevalence.

Obes Facts 2014 4;7 Suppl 2:33-6. Epub 2014 Apr 4.

European Association for the Study of Obesity, University of Navarra, Pamplona, Spain.

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http://dx.doi.org/10.1159/000361004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5646210PMC
January 2015

An EASO position statement on multidisciplinary obesity management in adults.

Obes Facts 2014 26;7(2):96-101. Epub 2014 Mar 26.

Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.

Obesity has proven to be a gateway to ill health. It has already reached epidemic proportions becoming one of the leading causes of death and disability in Europe and world-wide. Obesity plays a central role in the development of a number of risk factors and chronic diseases like hypertension, dyslipidaemia and type 2 diabetes mellitus inducing cardiovascular morbidity and mortality. Therefore weight management plays a central role in controlling the respective risk factors and their consequences. Obesity is a complex condition of multifactorial origin. Biological but also psychological and social factors interfere to lead to excess body weight and its deleterious outcomes. Obesity management cannot focus any more only on weight (and BMI) reduction. More attention is to be paid to waist circumference (or waist-to-hip ratio, especially in females), the improvement in body composition (measured with body composition tracking systems like BOD POD, dual energy X-ray absorptiometry or bioelectrical impedance analysis) which is focusing on ameliorating or maintaining fat-free mass and decreasing fat mass. Management of co-morbidities, improving quality of life and well-being of obese patients are also included in treatment aims. This statement emphasises the importance of a comprehensive approach to obesity management.
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http://dx.doi.org/10.1159/000362191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644787PMC
December 2014

Interdisciplinary European Guidelines on metabolic and bariatric surgery.

Obes Facts 2013 11;6(5):449-68. Epub 2013 Oct 11.

OB Klinika, Centre for Treatment of Obesity and Metabolic Disorders, 1st Faculty of Medicine, Charles University, Prague, Czech Republic.

In 2012, an outstanding expert panel derived from IFSO-EC (International Federation for the Surgery of Obesity-European Chapter) and EASO (European Association for the Study of Obesity), composed by key representatives of both Societies including past and present presidents together with EASO's OMTF (Obesity Management Task Force) chair, agreed to devote the joint Medico-Surgical Workshop of both institutions to the topic of metabolic surgery as a pre-satellite of the 2013 European Congress on Obesity (ECO) to be held in Liverpool given the extraordinarily advancement made specifically in this field during the past years. It was further agreed to revise and update the 2008 Interdisciplinary European Guidelines on Surgery of Severe Obesity produced in cooperation of both Societies by focusing in particular on the evidence gathered in relation to the effects on diabetes during this lustrum and the subsequent changes that have taken place in patient eligibility criteria. The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.
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http://dx.doi.org/10.1159/000355480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644681PMC
May 2014

Obesity: the gateway to ill health - an EASO position statement on a rising public health, clinical and scientific challenge in Europe.

Obes Facts 2013 3;6(2):117-20. Epub 2013 Apr 3.

Department of Endocrinology and Nutrition, Clínica Univ. de Navarra, University of Navarra, CIBERobn, Instituto de Salud Carlos III, Pamplona, Spain. gfruhbeck @ unav.es

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http://dx.doi.org/10.1159/000350627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644725PMC
October 2013