Nutrients. 2016 Jun 1;8(6). pii: E320. doi: 10.3390/nu8060320.
The relationship between obesity and other metabolic diseases have been deeply studied. However, there are clinical inconsistencies, exceptions to the paradigm of "more fat means more metabolic disease", and the subjects in this condition are referred to as metabolically healthy obese (MHO).They have long-standing obesity and morbid obesity but can be considered healthy despite their high degree of obesity. We describe the variable definitions of MHO, the underlying mechanisms that can explain the existence of this phenotype caused by greater adipose tissue inflammation or the different capacity for adipose tissue expansion and functionality apart from other unknown mechanisms. We analyze whether these subjects improve after an intervention (traditional lifestyle recommendations or bariatric surgery) or if they stay healthy as the years pass. MHO is common among the obese population and constitutes a unique subset of characteristics that reduce metabolic and cardiovascular risk factors despite the presence of excessive fat mass. The protective factors that grant a healthier profile to individuals with MHO are being elucidated.
Prescripción de actividad física antes de cirugía bariátrica. Viabilidad, impacto sobre la salud, y las implicaciones prácticas.
Physical activity prescription before bariatric surgery: Feasibility, health impacts, and practical implications.
Al-Hazzaa HM. Saudi J Obesity 2016;4:3-12
Obesity is a challenging health problem. For people with morbid obesity who cannot lose weight, using conventional weight loss methods, they may resort to bariatric surgery. However, despite increasing evidence that physical activity (PA) can reduce weight and improve postsurgical outcomes, most preoperative obese patients are inactive. Therefore, the aim of the present paper was to review the evidence for the feasibility and beneficial health impact of prebariatric surgery PA program for obese patients and to discuss the practical implications of PA counseling and exercise prescription to healthcare providers. A systematic electronic search was conducted utilizing keywords related to PA, exercise, and prebariatric surgery using MEDLINE databases. The findings of this review indicated that a presurgical intervention targeting PA among obese patients awaiting bariatric surgery is feasible and has the potential to increase patient's engagement in PA postoperatively. In addition, higher levels of preoperative PA or physical fitness were associated with lower postsurgical complications and a shorter length of stay in hospital. There is also evidence to support that higher levels of preoperative PA may improve weight loss outcomes following laparoscopic surgery. Research showed that the daily time spent being sedentary among obese patients was quite excessive. In adult population, the available evidence demonstrates a dose-response relationship between the amount of moderate-to-vigorous intensity PA and reduced weight loss and increased health benefits. It is recommended that healthcare providers to increase their use of the five A's (Assess, Advise, Agree, Assist, and Arrange) counseling model when counseling obese patients about PA and weight loss. Finally, the future studies must seek to make PA more effective and compliant for obese patients and focus on identifying major barriers that are preventing most patients from assuming active lifestyles.
INTRODUCTION: Pharmacotherapy for the management of obesity is primarily aimed at weight loss, weight loss maintenance and risk reduction (reduction in body fat, risk factors for cardiovascular disease and the incidence of diabetes mellitus). Among drugs that have been evaluated for weight loss include antidepressants (fluoxetine) and antiepileptic (topiramate). MATERIAL AND METHODS: We analyzed eating behavior and weight loss in a sample of morbid obesity patients before bariatric surgery. The patients suffering eating disturbances symptoms were grouped into three groups: one group received 40 mg of flouxetine/day (Group A); another group received topiramate 200 mg/day (Group B); and the third group of patients were treated with fluoxetine 40 mg and 200 mg of topiramate/day (Group C). RESULTS: Patients treated with fluoxetine plus topiramate lost more weight at 3 and 6 months before surgery. CONCLUSIONS: The use of the psychopharmaceutical drug (fluoxetine and topiramate) in morbid obese patients with eating disorders could represent a new approach to the management of eating behavior before bariatric surgery.