Weight loss and clinical characteristics of young adults patients seeking treatment at medical centers: Data from the QUOVADIS Study

OBJECTIVE: To compare clinical characteristics, attrition, weight loss, and psychological changes of obese young adults and obese adults seeking treatment. MATERIALS AND METHODS: 1530 individuals seeking treatment in 18 Italian medical centers were evaluated. 382 cases (25%) were classified as young adults (age≤35 years), 1148 (75%) as adults (>35 years). Psychological distress, binge eating, body uneasiness, and attitude towards eating were evaluated, at baseline and after a 12-month weight-loss program, together with BMI changes. Weight-loss expectations and primary motivation for seeking treatment were also recorded. RESULTS: At baseline, young adults reported significantly higher BMI at age 20, weight loss expectations and body uneasiness scores than adults. A significantly higher percentage of young adults also reported improving appearance as primary reason for seeking treatment. The attrition rate was significantly larger in young adults. Among completers, the mean percent weight loss at 12 months and improvement of psychosocial variables were significantly higher in young adults than in adults. By intention to treat, BMI changes were no longer significant between groups. DISCUSSION: Obese young adults lose more weight and considerably improve psychological distress, but show a higher attrition rate after 12 months of continuous care in a real world medical setting

Weight Loss Expectations in Obese Patients and Treatment Attrition: An Observational Multicenter Study

Objective: To investigate the influence of weight loss expectations (expected 1-year BMI loss, dream and maximum acceptable BMI) on attrition in obese patients seeking treatment. Research Methods and Procedures: Obese subjects (1785; 1393 women; median age, 46 years; median BMI, 36.7 kg/m2) seeking treatment in 23 medical Italian centers were evaluated. Baseline diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating, and body image dissatisfaction were tested at baseline by self-administered questionnaires (Symptom Check List-90, Binge Eating Scale, and Body Uneasiness Test). Attrition and BMI change at 12 months were prospectively recorded. Results: At 12 months, 923 of 1785 patients (51.7%) had discontinued treatment. Compared with continuers, dropouts had a significantly lower age, a lower age at first dieting, lower dream BMI, a higher expected 1-year BMI loss, and a higher weight phobia. At logistic regression analysis, the strongest predictors of attrition at 12 months were lower age and higher expected 1-year BMI loss. The risk of drop-out increased systematically for unit increase in expected BMI loss at 12 months (hazard ratio, 1.12; 95% confidence interval, 1.04 to 1.20; p 0.0018). The risk was particularly elevated in the first 6 months. Discussion: Baseline weight loss expectations are independent cognitive predictors of attrition in obese patients entering a weight-losing program; the higher the expectations, the higher attrition at 12 months. Unrealistic weight goals should be tackled at the very beginning of treatment

Psychological Distress in Morbid Obesity in Relation to Weight History

Background: Very few data are available on psychological distress in morbidly obese subjects in relation to the history of their weight. In subjects with childhood obesity, psychological distress might be better than in adult-onset obesity, because of progressive adaptation to the social stigma. Methods: Psychological distress was tested in relation to BMI at age 20 years (BMI-20), weight history and somatic co-morbidities in 632 treatment-seeking, morbidly obese participants from the QUOVADIS cohort (130 men, 502 women; mean age 45.5 years). The number of dieting attempts/year, BMI increase and cumulative BMI loss since age 20 were calculated as weight cycling parameters.The Symptom Check List-90 (SCL-90), the Psychological General Well- Being (PGWB), the Binge-Eating Scale, and the ORWELL-97 questionnaire were used to score psychometry and health-related quality of life (HRQL). Complications were quantitatively assessed by a modified Charlson\u2019s score. Results: BMI-20 was normal in 35% of cases and >35 kg/m2 in only 14%. Psychometric scores were not different in relation to BMI-20, when corrected for age, with the exception of the General Health scale of PGWB, showing a greater distress in subjects with normal BMI-20. In most cases, the prevalence of pathological results of questionnaires showed a Jshaped curve, with participants with normal BMI-20 or those with Class II-III obesity in early adulthood having the highest prevalence of psychological/psychiatric distress and poor HRQL.Weight cycling was a risk factor for binge-eating, depression and interpersonal sensitivity in SCL-90, whereas somatic co-morbidities adversely affected most SCL-90 and all PGWB scales. Conclusion: Weight cycling and somatic co-morbidities, but not age of onset of obesity, are the main factors negatively influencing psychological health in treatment-seeking, morbidly obese subjects

Comparison of four methods to measure haemoglobin concentrations in whole blood donors (COMPARE): A diagnostic accuracy study.

OBJECTIVE: To compare four haemoglobin measurement methods in whole blood donors. BACKGROUND: To safeguard donors, blood services measure haemoglobin concentration in advance of each donation. NHS Blood and Transplant's (NHSBT) customary method have been capillary gravimetry (copper sulphate), followed by venous spectrophotometry (HemoCue) for donors failing gravimetry. However, NHSBT's customary method results in 10% of donors being inappropriately bled (ie, with haemoglobin values below the regulatory threshold). METHODS: We compared the following four methods in 21 840 blood donors (aged ≥18 years) recruited from 10 NHSBT centres in England, with the Sysmex XN-2000 haematology analyser, the reference standard: (1) NHSBT's customary method; (2) "post donation" approach, that is, estimating current haemoglobin concentration from that measured by a haematology analyser at a donor's most recent prior donation; (3) "portable haemoglobinometry" (using capillary HemoCue); (4) non-invasive spectrometry (using MBR Haemospect or Orsense NMB200). We assessed sensitivity; specificity; proportion who would have been inappropriately bled, or rejected from donation ("deferred") incorrectly; and test preference. RESULTS: Compared with the reference standard, the methods ranged in test sensitivity from 17.0% (MBR Haemospect) to 79.0% (portable haemoglobinometry) in men, and from 19.0% (MBR Haemospect) to 82.8% (portable haemoglobinometry) in women. For specificity, the methods ranged from 87.2% (MBR Haemospect) to 99.9% (NHSBT's customary method) in men, and from 74.1% (Orsense NMB200) to 99.8% (NHSBT's customary method) in women. The proportion of donors who would have been inappropriately bled ranged from 2.2% in men for portable haemoglobinometry to 18.9% in women for MBR Haemospect. The proportion of donors who would have been deferred incorrectly with haemoglobin concentration above the minimum threshold ranged from 0.1% in men for NHSBT's customary method to 20.3% in women for OrSense. Most donors preferred non-invasive spectrometry. CONCLUSION: In the largest study reporting head-to-head comparisons of four methods to measure haemoglobin prior to blood donation, our results support replacement of NHSBT's customary method with portable haemoglobinometry

Psychological distress in morbid obesity in relation to weight history

Background: Very few data are available on psychological distress in morbidly obese subjects in relation to weight history. In subjects with childhood obesity, psychological distress might be better than in adult-onset obesity, because of progressive adaptation to the social stigma. Method: we tested psychological distress in relation to BMI at age 20 years (BMI-20), weight history and somatic comorbidities in 632 treatment-seeking, morbidly obese participants from the QUOVADIS cohort (130 men, 502 women; mean age 45.5 years). The number of dieting attempts/year, BMI increase and cumulative BMI loss since age 20 were calculated as weight cycling parameters. The Symptom Check List-90 (SCL-90), the Psychological General Well-Being (PGWB), the Binge-Eating Scale and the ORWELL-97 questionnaire were used to score psychometry and health-related quality of life. Complications were quantitatively assessed by a modified Charlson\u2019s score. Results: BMI-20 was normal in 35% of cases and >35 kg/m2 in only 14%. Psychometric scores were not different in relation to BMI-20, when corrected for age, with the exception of the General Health scale of PGWB, showing a greater distress in subjects with normal BMI-20. In most cases, the prevalence of pathological results of questionnaires showed a J-shaped curve, with participants with normal BMI-20 or those with Class II-III obesity in early adulthood having the highest prevalence of psychological/ psychiatric distress and poor HRQL. Weight cycling was a risk factor for binge-eating, depression and interpersonal sensitivity at SCL-90, whereas somatic comorbidities adversely affected most SCL-90 and all PGWB scales. Conclusion: Weight cycling and somatic comorbidities, but not age of onset of obesity, are the main factors negatively influencing psychological health in treatment-seeking, morbidly obese subjects

Weight loss and clinical characteristics of young adults patients seeking treatment at medical centers: Data from the QUOVADIS Study

Objective: To compare the clinical characteristics, attrition, weight loss, and psychological changes of young adults and adults treated at Italian medical centers. Research Methods and Procedures: 1530 individuals seeking treatment in 18 Italian medical centers (1194 females and 336 males; age, 44.6\ub111.0 years; BMI, 37.9\ub16.2 kg/m2) were evaluated. Three hundred eighty two cases (25%) were classified as young adults (age 64 35 years), and 1148 (75%) as adults (>35 years). Measurements were obtained at baseline and after a 12-month weight-loss program in patients compliant to follow-up. Psychological distress, binge eating, body uneasiness, and attitude towards eating were evaluated by self-administered questionnaires together with BMI changes. Weight-loss expectations and primary motivation for seeking treatment (health or improving appearance) were also recorded. Results. At baseline, young adults showed significantly higher BMI at age 20, higher weight loss expectations and body uneasiness score than adults. A significantly higher percentage of young adults than adults also reported improving appearance as the primary reason for seeking treatment. Attrition rate was significant higher in young adults (73.6% vs. 65.2% in adults, respectively; Chi-Square=9.01, p=0.003). Among completers, the mean percentage of weight loss after 12 months was significantly higher in young adults (10.9%, SD=9.8) than in adults (7.2%, SD=7.7, t=3.46; p=0.001). Young adults also had a larger improvement of psychosocial variables, compared to adults. By intention to treat, no significant difference emerged between young adults and adults on BMI change. Discussion: Obese young adults have larger weight loss and improvement of psychological distress, but higher attrition rate after 12-month of continuous care in a real world medical setting

Weight loss expectations in obese patients and treatment attrition: an observational multicenter study

Abstract Objective: To investigate the influence of weight loss expectations (Expected One-Year BMI Loss, Dream and Maximum Acceptable BMI) on attrition in obese patients seeking treatment. Research Methods and Procedures: 1,785 obese subjects (1,393 females; median age 46 years; median BMI, 36.7 kg/m2), seeking treatment in 23 medical Italian centers were evaluated. Baseline diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating and body image dissatisfaction were tested at baseline by self-administered questionnaires (Symptom CheckList-90, Binge Eating Scale and Body Uneasiness Test). Attrition and BMI change at 12 months were prospectively recorded. Results: At 12 months, 923 of 1,785 patients (51.7%) had discontinued treatment. Compared with continuers, dropouts had a significantly lower age, a lower age at first dieting, lower Dream BMI, a higher Expected One-Year BMI Loss, and a higher Weight Phobia. At logistic regression analysis, the strongest predictors of attrition at 12 month were lower Age, and higher Expected One-Year BMI Loss. The risk of drop-out increased systematically for unit increase in Expected BMI loss at 12 months (hazard ratio, 1.12; 95% confidence interval, 1.04 \u2013 1.20; P = 0.0018). The risk was particularly elevated in the first 6 months. Discussion: Baseline weight loss expectations are independent cognitive predictors of attrition in obese patients entering a weight-losing program; the higher the expectations the higher attrition at 12 months. Unrealistic weight goals should be tackled since the very beginning of treatment