Pharmacotherapy for psychotropic drug-related weight gain

Weight gain is a significant problem for many patients taking various psychotropic medications. The U.S. Food and Drug Administration (FDA) has approved certain medications for the treatment of obesity. Other medications known to be associated with weight loss could be used for treating obesity, although they are not FDA approved for this indication. This article briefly describes the sympathomimetic, antidepressant, anticonvulsant, histamine-modulating, antidiabetic, and gastrointestinal drugs that have been found to cause weight loss and might be considered for adjunctive use in the overall management of psychotropic drug-related weight gain. However, even if such drugs are effective, all patients should receive ongoing dietary and physical activity counseling.     

Obesity and urinary incontinence

Obesity is growing at an alarming rate worldwide. It poses a major health problem that in turn places a huge financial burden on health services. Medical conditions such as diabetes mellitus and ischaemic heart disease are commonly associated with obesity, but less well documented is the association between obesity and urinary incontinence. This article reviews the current literature to see whether: (1) obesity predisposes to urinary incontinence; (2) weight loss improves urinary incontinence and (3) obesity affects the surgical outcome. It also covers the surgical and anaesthetic implications of obesity. New minimally invasive surgical techniques make surgical risks acceptable for the obese patient but the anaesthetic risks remain high. Obese patients should not be denied surgery but be made aware of the higher risks. Future research should focus on the impact of obesity on surgical outcomes for continence surgery, particularly on intraoperative and postoperative complication rates as well as long-term cure rates.     

Marriage,Obesity and Dieting

Despite the importance of marriage as a basic social institution, there has been little analysis of the relationship between marriage and obesity. This paper reviews work on the prevalence of obesity by marital status; factors associated with obesity as a criterion for entry into marriage; the similarity of fatness in marital partners; changes in weight in relationship to marital problems; and the relationship between obesity and marital termination. The application of knowledge about marriage and obesity to weight loss therapy is also considered. More research is needed to specify the extent, form and dynamics of the relationship between obesity and marriage.     

Pelvic organ prolapse: review of the aetiology, presentation, diagnosis and management

Pelvic organ prolapse is a common condition affecting a large number of women. Incidence increases after the menopause. Age, parity and obesity are the most consistently reported risk factors. Many women can be asymptomatic of prolapse but common symptoms include a sensation of a bulge or fullness in the vagina or urinary, bowel or sexual dysfunction. Management depends upon symptoms and the type and grade of the prolapse as well as any associated medical co-morbidities. Management options include expectant, conservative or surgical approaches. Up to 10% of women having a surgical procedure for prolapse will require a second procedure. It is, therefore, important to consider lifestyle modifications such as weight loss and conservative measures including pelvic floor muscle training, topical estrogens and pessaries as initial management options.     

My Student Body: Effects of an Internet-Based Prevention Program to Decrease Obesity Among College Students

Abstract

Objective: To determine the impact of My Student Body (MSB)–Nutrition, an Internet-based obesity prevention program for college students. Participants: Three hundred and twenty ethnically diverse undergraduate students were randomly assigned to 1 of 3 conditions: MSB-Nutrition program, an on-campus weight management course, and a comparison group. Methods: Students completed baseline and follow-up surveys regarding their nutrition and physical activity behaviors, self-efficacy, stress, attitudes, and body weight. Results: Compared with the on-campus course and a comparison group, the MSB-Nutrition program increased fruit and vegetable consumption, reduced stress, and increased fruit and vegetable self-efficacy but had no significant effect on students’ exercise self-efficacy, exercise behavior, or weight loss. Conclusions: The MSB-Nutrition program was effective in changing students’ nutrition behaviors but had no effect on physical activity behaviors or weight loss. Suggestions for improving Internet-based interventions aimed at decreasing obesity rates among college students are offered.     

The “Obesity Epidemic”: Evolving Science,Unchanging Etiology

“Obesity epidemic” discourse relies on scientific and epidemiological research to justify subjecting certain bodies to healthist messaging and disciplinary technologies. The science and framing of obesity has evolved, potentially partially due to critical obesity scholars. However, critical obesity scholars are now reliant on outdated critiques of ever progressing evolving/adapting discourse. Recent discoveries have been made concerning the determinants of obesity and the complexity of weight loss. Scientific discourse often now references environmental factors as contributors to obesity, low levels of sustained weight loss, and limitations of common measures such as the body mass index. Despite this refinement, the ultimate conclusion of studies, as presented within the scientific articles or in related media reportage, remains unchanged. Individuals are still expected to attempt to “correct” their non‐normative bodies through lifestyle changes, regardless of the evidence underscoring the likely futility of these endeavors. This paper updates obesity science and public health responses and evaluates the extent to which new findings, with the potential to greatly subvert standard weight loss advice, have altered supposedly evidence‐based public health communications and recommendations. As emerging scientific insights have further muddied already‐complex obesity‐related pathways, solutions have largely remained the same.     

Does Metabolic Syndrome Impair Sexual Functioning in Adults With Overweight and Obesity?

Objectives: Obesity is a growing public health concern worldwide, and results in increased risk of cardiovascular disease, type 2 diabetes, metabolic syndrome, insulin resistance, dyslipidemia, hypertension, and reduced sex hormone production. Previous research suggests that obesity may contribute to sexual dysfunction. This review aims to determine the relationship between obesity and sexual dysfunction, and ascertain the associated cardiometabolic conditions that may contribute to impaired sexual functioning in individuals with obesity. Methods: Literature searches were conducted through PubMed and Embase from 1980 to 2016, to identify original research articles, reviews including systematic reviews and meta-analyses, using the search terms: obese, obesity, overweight, sexual function, sexual dysfunction, metabolic syndrome, CVD, T2D, hormones and weight loss. Results: This review found that individuals with obesity and cardiometabolic comorbidities were more likely to report the greatest degree or sexual dysfunction and/or reduction in sexual quality of life, compared to those without. Conclusions: Current evidence supports an association between sexual dysfunction and factors associated with obesity, such as reduced insulin sensitivity, dyslipidaemia, hypertension, and low oestrogen or testosterone. To establish efficacious treatments, research examining the impact of weight loss on the conditions associated with obesity, such as hypertension, reduced insulin sensitivity, dyslipidaemia, and low sex hormones and sexual functioning in individuals with overweight and obesity should be a priority.     

From the Freak Show to the Living Room: Cultural Representations of Dwarfism and Obesity1

This article examines how cultural representations of deviant bodies vary based on historically informed narratives of bodily stigma. Using content analysis of 40 episodes of reality television programming, I contrast cultural representations of dwarfism and obesity. Over time, dwarfism became constructed as an identity project with the aim of bodily acceptance, whereas obesity became regarded as a body project with the goal of body transformation through weight loss. The mostly positive historical characterizations of dwarfs allowed them to easily adopt the tenets of the disability rights movement as they evolved from freak show performances to television as an educational platform. They have adopted a social model of disability, positive social identity, self‐acceptance, and full social participation. By contrast, the past and contemporary representations of obesity have been overwhelmingly negative. Obese freak show performers were openly mocked, and classifying obesity as a disability has not yet gained traction as a civil rights movement. Instead, obesity is viewed through the lens of individual responsibility and limits of social participation are emphasized. Body modification through weight loss constructs an identity based on self‐change. Generally, this article suggests that cultural representations as de‐stigmatization projects are enabled or constrained by historical factors and the nature of the bodily stigma.     

Cumulative Disadvantage and Health: Long-Term Consequences of Obesity?

Drawing from cumulative disadvantage theory, the health consequences of obesity are considered in light of the accumulation of risk factors over the life course. Two forms of compensation are also examined to determine if the risk due to obesity is persistent or modifiable. Analyses make use of data from a national survey to examine the consequences of obesity on disability among respondents 45 years of age or older, tracked across 20 years (N = 4,106). Results from tobit models indicate that obesity, especially when experienced early in life, is consistently related to lower-body disability. The results also show that obesity has long-term health consequences during adulthood, altering the life course in an enduring way. Compensation was not manifest from risk-factor elimination (weight loss), but rather through regular exercise. Although there is evidence for long-term consequences of risk factors on health, the findings suggest that more attention should be given to compensatory mechanisms in the development of cumulative disadvantage theory.     

Pilot Study on Childhood Sexual Abuse,Diurnal Cortisol Secretion,and Weight Loss in Bariatric Surgery Patients

Childhood sexual abuse increases risk for adult obesity. A potential contributing factor is altered cortisol secretion. In this pilot study, relationships among childhood sexual abuse, diurnal salivary cortisol secretion, and weight loss were explored in 17 bariatric surgery patients. Measurement points were before surgery (baseline) and 3 and 6 months after surgery. Childhood sexual abuse was measured by the Childhood Trauma Questionnaire. The results showed moderate but nonsignificant positive correlations between the childhood sexual abuse subscale score and baseline morning cortisol, evening cortisol, and daily mean cortisol. An unexpected positive correlation was noted between the Childhood Trauma Questionnaire total score and weight loss at six months. Diurnal cortisol secretion did not change over time after surgery nor correlate significantly with weight loss at six months.     

Risk factors associated with overweight and obesity in college students

College obesity is increasing, but to the authors' knowledge, no researchers to date have evaluated risk factors in this population. OBJECTIVE: The authors assessed whether abnormal eating perceptions and behaviors were associated with overweight in college students. PARTICIPANTS AND METHODS: A sample of undergraduates (N = 4,201) completed an online survey containing demographic questions and the Eating Attitudes Test-26 (EAT-26) questionnaire. The authors stratified participants into normal-weight and overweight/obese groups and evaluated physical activity, EAT-26 score, purging behaviors, and answers to selected overweight screening questions on the basis of body mass index. A modified EAT-26 score of > or = 11 was associated with overweight (p = .016). RESULTS: Compared with normal-weight peers, overweight participants displayed an increased fear of bingeing, preoccupation with food, desire to be thinner, and engagement in dieting behavior. Mean body mass index also increased with age and physical inactivity (p < .001). CONCLUSIONS: Because physical inactivity, disordered eating perceptions, and disordered behaviors are associated with increased rates of overweight and obesity, identification of these risk factors in obese youths may increase understanding of weight loss barriers and facilitate the treatment of adolescent obesity.     

Group Dieting,the Stigma of Obesity,and Overweight Adolescents

Natalie Allon was one of the pioneers in the sociological analysis of obesity and dieting, and a consistent voice on the topic in the 1970s. Her contributions to the study of the obese are reviewed in this paper. As an ethnographer who used participant observation and unstructured interviewing to examine organized dieting groups, she provided insight into the structure and function of these groups. She showed how group dieting was a form of religious ritual for the participants, as well as performing the latent function of providing social support. Her analysis of the stigma of obesity examined stigmatization of fatness in four areas: as sin, as disease, as crime, and as ugliness. Work on overweight adolescents showed that they had problems in social interaction. Because obesity often served as the exclusive focus of interaction, it overwhelmed others with mixed emotions, it clashed with positive attributes of a person, and it was an uncertain predictor of joint activity. Negative self image and a mixture of self responsibility for fatness and the negation of responsibility were related to actual weight loss. Allon's analyses provide us with a basis for further sociological analysis of obesity and dieting.     

Social Distance and the Formerly Obese: Does the Stigma of Obesity Linger?*

Research has documented the stigma of obesity extensively, but little attention has been given to the study of stigma toward formerly obese individuals. The present study examines whether the stigma of obesity in romantic relationships carries over to formerly obese individuals by using primary data collected from a Midwestern university in the United States (N = 363). We consider how an individual's own body weight, demographic characteristics, familiarity, and attitudes affect the willingness to form a romantic relationship with a formerly obese person. Results suggest that obese individuals are less likely to hesitate about engaging in a romantic relationship with a formerly obese person than underweight or normal weight individuals, but only when attitudes toward obese and formerly obese individuals are controlled. In terms of demographic characteristics, men and African Americans are more likely to hesitate about forming a romantic relationship than their respective counterparts. More familiarity with currently obese family members and formerly obese close friends appears to reduce the stigma minimally. Greater social distance is also desired if weight loss is believed to be temporary.     

Early weight loss predicts the reduction of obesity in men with erectile dysfunction and hypogonadism undergoing long-term testosterone replacement therapy

We and others have previously shown that testosterone replacement therapy (TRT) results in sustained weight loss in the majority of middle-aged hypogonadal men. Previously, however, a small proportion failed to lose at least 5% of their baseline weight. The reason for this is not yet understood. In the present study, we sought to identify early indicators that may predict successful long-term weight loss, defined as a reduction of at least 5% of total body weight relative to baseline weight (T0), in men with hypogonadism undergoing TRT. Eight parameters measured were assessed as potential predictors of sustained weight loss: loss of 3% or more of baseline weight after 1 year of TU treatment, severe hypogonadism, BMI, waist circumference, International Prostate Symptom Score (IPSS), glycated hemoglobin (HbA_1C), age and use of vardenafil. Among the eight measured parameters, three factors were significantly associated with sustained weight loss over the entire period of TU treatment: (1) a loss of 3% of the baseline body weight after 1 year of TRT; (2) baseline BMI over 30; and (3) a waist circumference >102?cm. Age was not a predictor of weight loss.     

Associations Between Romantic Relationship Factors and Body Mass Index Among Weight Loss Surgery Patients

The current study utilized a sample of 183 patients, in romantic relationships, who were either pre‐ or post‐weight loss surgery (WLS), to assess (a) associations between romantic relationship factors and pre‐ and post‐surgery body mass index (BMI), (b) the positive and negative influences of obesity in romantic relationships, and (c) the influence of romantic relationship factors on BMI and the reciprocal. Correlations, confirmatory factor analysis, and multiple linear regression were conducted. Patients endorsed greater negative influence of obesity in their romantic relationships compared to positive influences, and their romantic relationship quality was predicted by several variables, including BMI, in pre‐ and post‐surgery patient groups.     

Advances in the surgical management of prolapse

Prolapse is an extremely common condition, for which 11% of women will have a surgical procedure at some point in their lives. The recurrence rate after most of the traditional surgical procedures is high and upto 29% of women who have had surgery for prolapse will require a further operation. In order to improve the surgical outcome, there is currently much interest in the use of grafts to augment traditional repairs and new procedures have been developed using specifically developed grafts. These have been combined with minimally invasive surgical techniques in an attempt to reduce surgical morbidity. These procedures may improve the outcome of surgery for prolapse. However, there is currently a lack of long-term data from randomized trials to demonstrate their effectiveness and safety.     

Effects of testosterone replacement therapy withdrawal and re-treatment in hypogonadal elderly men upon obesity,voiding function and prostate safety parameters

Whether testosterone replacement therapy (TRT) is a lifelong treatment for men with hypogonadism remains unknown. We investigated long-term TRT and TRT withdrawal on obesity and prostate-related parameters. Two hundred and sixty-two hypogonadal patients (mean age 59.5) received testosterone undecanoate in 12-week intervals for a maximum of 11 years. One hundred and forty-seven men had TRT interrupted for a mean of 16.9 months and resumed thereafter (Group A). The remaining 115 patients were treated continuously (Group B). Prostate volume, prostate-specific antigen (PSA), residual voiding volume, bladder wall thickness, C-reactive protein (CRP), aging male symptoms (AMS), International Index of erectile function – erectile function (IIEF-EF) and International Prostate Symptoms Scores (IPSS) were measured over the study period with anthropometric parameters of obesity, including weight, body mass index (BMI) and waist circumference. Prior to interruption, TRT resulted in improvements in residual voiding volume, bladder wall thickness, CRP, AMS, IIEF-EF, IPSS and obesity parameters while PSA and prostate volume increased. TRT interruption reduced total testosterone to hypogonadal levels in Group A and resulted in worsening of obesity parameters, AMS, IPSS, residual voiding volume and bladder wall thickness, IIEF-EF and PSA while CRP and prostate volume were unchanged until treatment resumed whereby these effects were reversed. TRT interruption results in worsening of symptoms. Hypogonadism may require lifelong TRT.