Erratum to: From simplicity towards complexity: the Italian multidimensional approach to obesity

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Weight Loss Expectations in Obese Patients Seeking Treatment at Medical Centers

Objective: To investigate weight loss expectations (expected 1-year BMI loss, dream BMI, and maximum acceptable BMI) in obese patients seeking treatment and to examine whether expectations differ by sex, weight, diet and weight history, age, psychological factors, and primary motivations for weight loss. Research Methods and Procedures: 1891 obese patients seeking treatment in 25 Italian medical centers (1473 women; age, 44.7 11.0 years; BMI, 38.2 6.5 kg/m2) were evaluated. 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 by self-administered questionnaires (Symptom CheckList-90, Binge Eating Scale, and Body Uneasiness Test). Results: In 1011 cases (53.4%), 1-year expected BMI loss was 9 kg/m2, dream BMI was 26.0 3.4 kg/m2 (corresponding to a 32% loss), and maximum acceptable BMI was 29.3 4.4 kg/m2 (23%). BMI and age were the strongest predictors of weight goals. Weight loss necessary to reach the desired targets was largely in excess of weight loss observed during previous dieting. Psychiatric distress, body dissatisfaction, and binge eating did not predict weight loss expectations. The primary motivation for weight loss was concern for future or present health; women seeking treatment to improve appearance had a lower grade of obesity, were younger, and had first attempted weight loss at a younger age. Discussion: Obese Italian patients had unrealistic weight loss expectations. There were significant disparities between patients\u2019 perceptions and physicians\u2019 weight loss recommendations of desirable treatment outcome

The Domains of Human Nutrition: The Importance of Nutrition Education in Academia and Medical Schools

open28noHuman nutrition encompasses an extremely broad range of medical, social, commercial, and ethical domains and thus represents a wide, interdisciplinary scientific and cultural discipline. The high prevalence of both disease-related malnutrition and overweight/obesity represents an important risk factor for disease burden and mortality worldwide. It is the opinion of Federation of the Italian Nutrition Societies (FeSIN) that these two sides of the same coin, with their sociocultural background, are related to a low "nutritional culture" secondary, at least in part, to an insufficient academic training for health-care professionals (HCPs). Therefore, FeSIN created a study group, composed of delegates of all the federated societies and representing the different HCPs involved in human nutrition, with the aim of identifying and defining the domains of human nutrition in the attempt to more clearly define the cultural identity of human nutrition in an academically and professionally oriented perspective and to report the conclusions in a position paper. Three main domains of human nutrition, namely, basic nutrition, applied nutrition, and clinical nutrition, were identified. FeSIN has examined the areas of knowledge pertinent to human nutrition. Thirty-two items were identified, attributed to one or more of the three domains and ranked considering their diverse importance for academic training in the different domains of human nutrition. Finally, the study group proposed the attribution of the different areas of knowledge to the degree courses where training in human nutrition is deemed necessary (e.g., schools of medicine, biology, nursing, etc.). It is conceivable that, in the near future, a better integration of the professionals involved in the field of human nutrition will eventually occur based on the progressive consolidation of knowledge, competence, and skills in the different areas and domains of this discipline.openDonini, Lorenzo M; Leonardi, Francesco; Rondanelli, Mariangela; Banderali, Giuseppe; Battino, Maurizio; Bertoli, Enrico; Bordoni, Alessandra; Brighenti, Furio; Caccialanza, Riccardo; Cairella, Giulia; Caretto, Antonio; Cena, Hellas; Gambarara, Manuela; Gentile, Maria Gabriella; Giovannini, Marcello; Lucchin, Lucio; Migliaccio, Pietro; Nicastro, Francesco; Pasanisi, Fabrizio; Piretta, Luca; Radrizzani, Danilo; Roggi, Carla; Rotilio, Giuseppe; Scalfi, Luca; Vettor, Roberto; Vignati, Federico; Battistini, Nino C; Muscaritoli, MaurizioDonini, Lorenzo M; Leonardi, Francesco; Rondanelli, Mariangela; Banderali, Giuseppe; Battino, Maurizio; Bertoli, Enrico; Bordoni, Alessandra; Brighenti, Furio; Caccialanza, Riccardo; Cairella, Giulia; Caretto, Antonio; Cena, Hellas; Gambarara, Manuela; Gentile, Maria Gabriella; Giovannini, Marcello; Lucchin, Lucio; Migliaccio, Pietro; Nicastro, Francesco; Pasanisi, Fabrizio; Piretta, Luca; Radrizzani, Danilo; Roggi, Carla; Rotilio, Giuseppe; Scalfi, Luca; Vettor, Roberto; Vignati, Federico; Battistini, Nino C; Muscaritoli, Maurizi

Management Strategy of Obesity in the Public Health System: Proposal of a New Model to Optimize Human Resources and Patient\u2019s Motivation

Introduction: Obesity, a disease characterized by an excess of adipose tissue, is a worldwide issue of growing interest in public health. Methods: The multifactorial etiology and pathogenesis of obesity strongly orient the scientific community in considering it as a chronic disease without an effective therapy that works for all patients affected by this clinical condition. This leads to a proliferation of non-scientific and dangerous treatment proposals and fake news. The Dietetic and Clinical Nutrition Unit at Bolzano Hospital in Italy has adopted a new strategy based on transparency to optimize time for the first visit and particularly to increase patients\u2019 knowledge and motivation. Results: This new strategy provides a preliminary consultation between patients who ask for a nutritional examination and a clinical team composed of a clinician, a dietician and a psychologist. We discuss the preliminary results obtained during the period between February 2010 and March 2016

From Obesity-Induced Low-Grade Inflammation to Lipotoxicity and Mitochondrial Dysfunction: Altered Multi-Crosstalk between Adipose Tissue and Metabolically Active Organs

Obesity is a major risk factor for several metabolic diseases, including type 2 diabetes, hyperlipidemia, cardiovascular diseases, and brain disorders. Growing evidence suggests the importance of inter-organ metabolic communication for the progression of obesity and the subsequent onset of related disorders. This review provides a broad overview of the pathophysiological processes that from adipose tissue dysfunction leading to altered multi-tissue crosstalk relevant to regulating energy homeostasis and the etiology of obesity. First, a comprehensive description of the role of adipose tissue was reported. Then, attention was turned toward the unhealthy expansion of adipose tissue, low-grade inflammatory state, metabolic inflexibility, and mitochondrial dysfunction as root causes of systemic metabolic alterations. In addition, a short spot was devoted to iron deficiency in obese conditions and the role of the hepcidin–ferroportin relationship in the management of this issue. Finally, different classes of bioactive food components were described with a perspective to enhance their potential preventive and therapeutic use against obesity-related diseases

From simplicity towards complexity: the Italian multidimensional approach to obesity

Obesity is the result of a complex interplay among several factors leading to medical, functional and psychosocial consequences that markedly reduce life expectancy and impair quality of life. Is obesity itself a disease? Is obesity a brain disease? Who should treat obesity? This paper is a narrative review aimed to describe and to argue the prevalent position of some major Italian scientific and academic institutions dealing with obesity. According to the recent statements and recommendations published by the Italian Society for Obesity (SIO) and the Italian Society for the Study of Eating Disorders (SISDCA), the management of obese patients should include five main levels of care: (1) primary care, (2) outpatient treatment, (3) intensive outpatient treatment, (4) residential rehabilitative treatment, and (5) hospitalization. Ideally, patients suffering from obesity need a multidimensional evaluation intended to design an individualized treatment plan applying different procedures and therapeutic strategies (diet, physical activity and functional rehabilitation, educational therapy, cognitive-behavior therapy, drug therapy, and bariatric surgery). This thorough approach should address not only weight loss but also quality of weight loss, medical and psychiatric comorbidity, psychosocial problems, and physical disability. Such management of obesity requires an effective multiprofessional team, while health services have to overcome a number of administrative and organizational barriers that do not account for diseases requiring resources and professionals from different areas of medicine. Integrating several competences in a team-based approach demands specific education, skills and expertise. As for other diseases, the principles of complexity theory may offer a model useful to implement both teamwork and care delivery for patients with obesity

An Italian investigation on nutritional risk at hospital admission: The PIMAI (Project: Iatrogenic MAlnutrition in Italy) study

Background & aims: Nutritional risk on admission to hospital, which turns out to be high in most countries, was investigated. However, when consulting the "malnutrition-mapping" in Europe, the lack of Italian data raises attention. Accordingly, we designed a multidisciplinary, cross-sectional survey: the PIMAI study (Project: Iatrogenic MAlnutrition in Italy). Methods: Patients were enrolled from 13 large (>400 beds) multidisciplinary hospitals. Randomly selected adult (>18-year-old) patients were included according to a 4-strata model by gender and age (<65 and ≥65 years). Nutritional risk was assessed by the Nutritional Risk Screening 2002 tool. Results: A total of 1284 patients were evaluated. Overall prevalence of nutritional risk was 28.6% with similar distribution between sexes and higher rates in medical rather than in surgical departments (33.6% vs 22.8%; p < 0.0001). Risk prevalence was markedly heterogeneous among specialties, ranging between 4.8% (ophthalmology) and 62.5% (oncology units). Moreover, in adults aged 18-65 years the prevalence of "risk of malnutrition" was significantly lower than in those ≥65 years (18.3% vs 41.9%; p < 0.0001). Conclusions: The prevalence of nutritional risk on admission to hospital is high also in Italy. However, in patients aged 18-65 years nutritional risk appears a less prevalent comorbidity, thus supporting the role of age as an important determinant. © 2009 European Society for Clinical Nutrition and Metabolism

A nationally representative survey of hospital malnutrition: The Italian PIMAI (Project: Iatrogenic MAlnutrition in Italy) study

Hospital malnutrition is high in every country it was investigated, but no nationally representative prevalence study, considering potential geographical interfering factors, has yet been performed. We designed a multidisciplinary, cross-sectional, nation-wide survey: the PIMAI study (Project: Iatrogenic MAlnutrition in Italy). Adult (>18 years old) patient inclusion was managed on a four-strata randomisation model according to sex and age (<65 and ≥65 years). Malnutrition was defined by analytical criteria related to recent food intake and both physical (body mass index, weight loss, midupper arm anthropometry) and biochemical (albumin, prealbumin and lymphocyte count) malnutrition correlates. Thirteen hospitals (n = 1583) completed the study. The survey is likely to represent the country of Italy. Overall prevalence of malnutrition was 30.7%, with higher rates in the northern macroarea (36.7%) than in central (28.0%), southern (26.9%) and island (16.7%) ones (p < 0.0001). This discrepancy appeared to be mainly related to the prevalence of overweight/obesity. By a multivariate model, malnutrition was significantly lower in males (p < 0.05) and surgical wards (p < 0.002), associated with geography (p < 0.05) and consistently higher in patients aged ≥65 years (p < 0.01), presenting with malignancies (p < 0.005) and having multidrug therapy (p < 0.05). The prevalence of hospital malnutrition is high also in Italy. It presents with different geographical distribution also according to overweight prevalence. This evidence should be considered when designing national nutritional policies. © 2009 Springer-Verlag Italia