Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100074
Vera Voorwinde , Sahar Moukadem , Maartje M. van Stralen , Ignace M.C. Janssen , Valerie M. Monpellier , Ingrid H.M. Steenhuis
{"title":"How to get back on track? Experiences of patients and healthcare professionals regarding weight recurrence and needs for an intervention after bariatric-metabolic surgery","authors":"Vera Voorwinde , Sahar Moukadem , Maartje M. van Stralen , Ignace M.C. Janssen , Valerie M. Monpellier , Ingrid H.M. Steenhuis","doi":"10.1016/j.obpill.2023.100074","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100074","url":null,"abstract":"<div><h3>Background</h3><p>Multidisciplinary lifestyle interventions are recommended as a first step in treating weight recurrence after bariatric-metabolic surgery (BMS). However, little is known about the experience of patients and healthcare professionals (HCP) with these interventions and how they should be tailored to the patients’ needs. The aim of this study was to gain more insight into the experiences and needs of patients and HCP regarding weight recurrence after BMS and an intervention to get Back on Track. In addition, attitudes towards integrating e-Health into the care program were explored.</p></div><div><h3>Methods</h3><p>A qualitative process evaluation of an intervention for weight recurrence, the Back on Track (BoT), was conducted by means of in-depth interviews and focus groups with 19 stakeholders, including patients and HCP involved in BoT. Interviews were transcribed verbatim. Data were analyzed through thematic analysis.</p></div><div><h3>Results</h3><p>Patients and HCP reported a wide array of causes of weight recurrence. Patients found it difficult to decide when weight recurrence is problematic and when they should ask for help. Patients reported feeling like the exception and ashamed, therefore experiencing a high threshold to seek help. E-Health was seen as a promising way to improve tailoring, screening, autonomy for the patient, and accessible contact.</p></div><div><h3>Conclusion</h3><p>Patients should be adequately counselled on weight recurrence after BMS and the importance of intervening early. It is important to lower the threshold for seeking help. For example by offering more long-term standard care or by adding e-Health to the intervention.</p></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49728030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100078
Lisanne Arayess , Sanne M. Gerards , Junilla K. Larsen , Ester F.C. van der Borgh-Sleddens , Anita C.E. Vreugdenhil
{"title":"Comparing the use of food and physical activity parenting practices: Parents of children with overweight and obesity versus parents of children with a healthy weight","authors":"Lisanne Arayess , Sanne M. Gerards , Junilla K. Larsen , Ester F.C. van der Borgh-Sleddens , Anita C.E. Vreugdenhil","doi":"10.1016/j.obpill.2023.100078","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100078","url":null,"abstract":"<div><h3>Background</h3><p>Paediatric overweight and obesity are caused by a complex imbalance between energy intake and expenditure. Parents may influence this imbalance through energy balance-related parenting practices. This study aims to compare the use of energy balance-related parenting practices between parents of children with overweight and obesity and children with a healthy weight.</p></div><div><h3>Methods</h3><p>This study compares energy balance-related parenting practices among a group of parents with children with overweight and obesity at the start of a lifestyle intervention (N = 107) and children with a healthy weight (N = 137). Specifically, it compares the feeding practices ‘overt control’ (open control over eating), ‘encouragement’, ‘instrumental feeding’, ‘emotional feeding’, and ‘covert control’ (hidden control over eating), as well as the physical activity parenting practice ‘promoting physical activity’. Multiple regression analyses are used to calculate associations between child weight groups and parenting practices when corrected for children's characteristics.</p></div><div><h3>Results</h3><p>Parents of children with overweight and obesity reported significantly different scores on control over eating practices than parents of children with a healthy weight, namely a significantly higher score on covert control (B = 0.397, S.E. 0.123, p = 0.001) and a significantly lower score for overt control (B = −0.136, S.E. 0.068, p = 0.046).</p></div><div><h3>Conclusion</h3><p>Covert control is reported more, while overt control is reported less in parents of children with overweight and obesity compared to parents of children with a healthy weight, even after correction for the child's, family, and maternal characteristics. Future longitudinal research and intervention trials are recommended to determine <em>whether</em> and <em>how</em> the use of control over eating practices changes.</p></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49700767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100070
Angela Fitch , Lydia Alexander , Carolynn Francavilla Brown , Harold Edward Bays
{"title":"Comprehensive care for patients with obesity: An Obesity Medicine Association Position Statement","authors":"Angela Fitch , Lydia Alexander , Carolynn Francavilla Brown , Harold Edward Bays","doi":"10.1016/j.obpill.2023.100070","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100070","url":null,"abstract":"","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100070"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49699920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100077
Gitanjali Srivastava
{"title":"Diagnostic challenge: A pediatric patient with severe obesity and complications of imminent death","authors":"Gitanjali Srivastava","doi":"10.1016/j.obpill.2023.100077","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100077","url":null,"abstract":"<div><h3>Background</h3><p>A 15-year-old patient suffering from severe obesity (400 pounds, BMI 71.6 kg/m<sup>2</sup>) with a clinical phenotype suggestive of syndromic obesity was hospitalized for severe heart failure and cardiogenic shock. The hospital admission prompted a palliative care and heart transplant consultation given end-stage-disease and poor prognosis. It further necessitated a pediatric inpatient obesity consult, which was complicated by several significant hurdles including lack of insurance coverage, FDA approvals, availability of medications, and inadequate knowledge among the medical community.</p></div><div><h3>Methods</h3><p>Innovative treatment, proactive, persistent advocacy, anti-obesity medication combination strategies modeled after diabetes and hypertension treatment algorithms, and latest evidence in obesity management were utilized to effectively and expeditiously overcome major challenges to care and the medical emergency.</p></div><div><h3>Results</h3><p>The patient was stabilized and ultimately discharged home, after −25.2% weight loss over 4 months (weight down to 299 pounds, BMI 49.9 kg/m<sup>2</sup>) through collaborative medical obesity intervention.</p></div><div><h3>Conclusion</h3><p>The typical delay in care sought by patients suffering from obesity, often due to stigma and lack of disease awareness, results in missed opportunities to prevent serious obesity-related complications. Skilled specialist expertise, fund of obesity-specific knowledge, and constant advocacy can be crucial in surmounting regulatory barriers to obesity care and in generating successful weight loss outcomes.</p></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49699922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100080
Jesse Richards , Neha Bang , Erin L. Ratliff , Maria A. Paszkowiak , Zhamak Khorgami , Sahib S. Khalsa , W. Kyle Simmons
{"title":"Successful treatment of binge eating disorder with the GLP-1 agonist semaglutide: A retrospective cohort study","authors":"Jesse Richards , Neha Bang , Erin L. Ratliff , Maria A. Paszkowiak , Zhamak Khorgami , Sahib S. Khalsa , W. Kyle Simmons","doi":"10.1016/j.obpill.2023.100080","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100080","url":null,"abstract":"<div><h3>Objective</h3><p>Binge eating disorder (BED) is the most common eating disorder, and yet only one pharmacotherapy (lisdexamfetamine), which has known abuse-potential, is FDA-approved. Topiramate is also commonly prescribed off-label for binge eating but has many contraindications. In contrast, the glucagon-like peptide-1 (GLP1) analog semaglutide has profound effects on central satiety signaling leading to reduced food intake, and has been approved for the treatment of obesity based on its efficacy and safety profile. Semaglutide would thus seem to be a potential candidate for the treatment of BED.</p></div><div><h3>Methods</h3><p>This open-label study examined the effects of semaglutide on Binge Eating Scale (BES) scores in individuals with BED. Patients were divided into three groups: those prescribed semaglutide, those prescribed either lisdexamphetamine or topiramate, and those prescribed a combination of semaglutide with lisdexamphetamine or topiramate.</p></div><div><h3>Results</h3><p>Patients receiving semaglutide only exhibited greater reductions in BES scores compared to the other groups. Combined pharmacotherapy with both semaglutide and the other anti-obesity medications did not result in greater reductions in BES scores compared to the semaglutide-only group. Findings were similar in patients with moderate/severe BED, as well as the full sample.</p></div><div><h3>Conclusion</h3><p>The therapeutic effects of semaglutide in binge eating disorder warrant further investigation.</p></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49700031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100073
Bryant H. Keirns , Christina M. Sciarrillo , Austin R. Medlin , Samantha M. Hart , Elyse M. Cronic , Sam R. Emerson
{"title":"Whole-body bone mineral density and markers of bone homeostasis in adults with normal-weight obesity","authors":"Bryant H. Keirns , Christina M. Sciarrillo , Austin R. Medlin , Samantha M. Hart , Elyse M. Cronic , Sam R. Emerson","doi":"10.1016/j.obpill.2023.100073","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100073","url":null,"abstract":"<div><h3>Background</h3><p>Normal-weight obesity (NWO) describes individuals with a normal body mass index (BMI), but high body fat percent. NWO are at-risk for cardiometabolic diseases, but little is known about their bone health.</p></div><div><h3>Methods</h3><p>Adults (N = 24) were classified as NWO (n = 12; 5M/7F) or low body fat percent controls (Con; n = 12; 6M/6F). Body composition and whole-body bone mineral density (BMD) were assessed using DXA. A serum bioplex assay was performed to examine markers related to bone formation and resorption.</p></div><div><h3>Results</h3><p>In addition to higher body fat percent and visceral fat, NWO had lower whole-body BMD relative to Con (<em>p</em>'s < 0.05). Circulating leptin was higher in NWO than Con (<em>p</em> < 0.05). Two biomarkers generally associated with lower bone mass – sclerostin and parathyroid hormone – were higher in NWO compared to Con (<em>p</em>'s < 0.05).</p></div><div><h3>Conclusion</h3><p>In this preliminary study, adults with NWO displayed lower whole-body BMD alongside evidence of bone resorption. Impaired bone health may be another subclinical risk factor present in NWO.</p></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49700032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100076
Harold Edward Bays
{"title":"Why does type 2 diabetes mellitus impair weight reduction in patients with obesity? A review","authors":"Harold Edward Bays","doi":"10.1016/j.obpill.2023.100076","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100076","url":null,"abstract":"<div><h3>Background</h3><p>A common adiposopathic complication of obesity is type 2 diabetes mellitus. Healthful weight reduction in patients with obesity can improve glucose metabolism and potentially promote remission of type 2 diabetes mellitus. However, weight-reduction in patients with increased adiposity is impaired among patients with type 2 diabetes mellitus compared to patients without diabetes mellitus.</p></div><div><h3>Methods</h3><p>Data for this review were derived from PubMed and applicable websites.</p></div><div><h3>Results</h3><p>Among patients with increased body fat, the mechanisms underlying impaired weight reduction for those with type 2 diabetes mellitus are multifactorial, and include energy conservation (i.e., improved glucose control and reduced glucosuria), hyperinsulinemia (commonly found in many patients with type 2 diabetes mellitus), potential use of obesogenic anti-diabetes medications, and contributions from multiple body systems. Other factors include increased age, sex, genetic/epigenetic predisposition, and obesogenic environments.</p></div><div><h3>Conclusions</h3><p>Even though type 2 diabetes mellitus impairs weight reduction among patients with increased adiposity, clinically meaningful weight reduction improves glucose metabolism and can sometimes promote diabetes remission. An illustrative approach to mitigate impaired weight reduction due to type 2 diabetes mellitus is choosing anti-diabetes medications that increase insulin sensitivity and promote weight loss and deprioritize use of anti-diabetes medications that increase insulin exposure and promote weight gain.</p></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49699840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100072
Hong Kan , Jason P. Swindle , Jay Bae , Julia P. Dunn , Erin K. Buysman , Noelle N. Gronroos , Lindsay Bengtson , Chanadda Chinthammit , Janet Ford , Nadia Ahmad
{"title":"Weight management treatment modalities in patients with overweight or obesity: A retrospective cohort study of administrative claims data","authors":"Hong Kan , Jason P. Swindle , Jay Bae , Julia P. Dunn , Erin K. Buysman , Noelle N. Gronroos , Lindsay Bengtson , Chanadda Chinthammit , Janet Ford , Nadia Ahmad","doi":"10.1016/j.obpill.2023.100072","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100072","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this study was to describe demographic and clinical characteristics among patients who have medical encounters for weight management treatments and to investigate the association of those characteristics with treatment modality.</p></div><div><h3>Methods</h3><p>This was a retrospective database study using medical claims, pharmacy claims, and enrollment information from commercial and Medicare Advantage with Part D members in the Optum Research Database from 01/01/2011−2/29/2020. Adult patients with a claim for a weight management treatment from 01/01/2012−2/28/2019 were categorized into cohorts according to the highest intensity intervention received. To examine the association between patient characteristics and treatment modality received, a multinomial logit model was performed.</p></div><div><h3>Results</h3><p>Cohorts by increasing intensity included lifestyle intervention (LSI, n = 67,679), weight reduction pharmacotherapy (WRRx) with an anti-obesity medication (AOM, n = 6,905), weight reduction procedure (WRP, n = 1,172), and weight reduction surgery (WRS, n = 18,036). Approximately 32.1% and 16.6% of patients who received WRS or WRP had an LSI during the 12-month baseline, and only 0.6% and 0.4% had treatment with long-term AOMs. In a multinomial logit model, patients with type 2 diabetes (not including WRRx cohort), respiratory disorders, cardiovascular risk factors, pain disorders, and mental health conditions had increased odds of treatment with higher intensity intervention versus LSI. Patients who were male, received an intervention more recently (2016-2019), or had a Charlson comorbidity score of 1 (compared to 0) had decreased odds of treatment with higher intensity interventions.</p></div><div><h3>Conclusion</h3><p>In this study, age, sex, body mass index, obesity-related complications, and Charlson comorbidity score appeared to influence the type of weight management treatment modality received. This study improves understanding of weight management treatment utilization and identifies gaps and opportunities to improve obesity care with the appropriate use of different treatment modalities.</p></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49699805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100081
Beau L. Mansker , Katherine Schwartzkopf , Jose A. Velez II , Anthony J. Perkins , Sara K. Naramore
{"title":"Physical and psychosocial determinants of quality of life in children with obesity","authors":"Beau L. Mansker , Katherine Schwartzkopf , Jose A. Velez II , Anthony J. Perkins , Sara K. Naramore","doi":"10.1016/j.obpill.2023.100081","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100081","url":null,"abstract":"<div><h3>Background</h3><p>Obesity has a negative impact on the physical and psychosocial quality of life of children. As rates of obesity continue to increase, it is important to recognize the widespread effects obesity has on children and their families.</p></div><div><h3>Methods</h3><p>This clinical investigation evaluated the self-reported quality of life of children with obesity in a weight management program and compared this to a parent/guardian’s perspective of the child’s quality of life using the Pediatric Quality of Life survey 4.0. The quality of life of children with obesity was compared to children with other chronic diseases and healthy children.</p></div><div><h3>Results</h3><p>An association was discovered between the guardians’ responses to the Pediatric Quality of Life survey and the child’s age. Guardians with children younger than 11 years reported higher quality of life scores than guardians of children 11 years and older. Race, comorbidities of obesity, insurance type, household structure, and parental education attainment were not significantly associated with a child’s quality of life. Children with obesity had a lower quality of life compared to children who were organ transplant recipients and children with organic gastrointestinal disease.</p></div><div><h3>Conclusions</h3><p>These results emphasize the need to evaluate and treat the physical and psychosocial components of wellbeing in children with obesity at an early age.</p></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49700769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obesity PillarsPub Date : 2023-09-01DOI: 10.1016/j.obpill.2023.100069
Rama Hritani , Mahmoud Al Rifai , Anurag Mehta , Charles German
{"title":"Obesity management for cardiovascular disease prevention","authors":"Rama Hritani , Mahmoud Al Rifai , Anurag Mehta , Charles German","doi":"10.1016/j.obpill.2023.100069","DOIUrl":"https://doi.org/10.1016/j.obpill.2023.100069","url":null,"abstract":"<div><h3>Background</h3><p>Obesity is a complex disease that leads to higher morbidity and mortality and its rate in the United States is rapidly rising. Targeting obesity management is one of the cornerstones of preventive medicine. Early intervention can significantly reduce the risk of developing cardiovascular disease. While it is well known that lifestyle interventions such as healthful nutrition and routine physical activity are the first and most important step in management, some do not achieve the desired results and require further therapies.</p></div><div><h3>Methods</h3><p>A literature review was conducted, that included clinical documents, public scientific citations and peer review articles to evaluate anti-obesity medications, endoscopic procedures and bariatric surgeries in the management of obesity. We also included effects of these interventions on weight loss, cardiovascular disease risk reduction and side effects.</p></div><div><h3>Results</h3><p>This clinical review summarizes recent evidence for the different approaches in obesity management including medications, common endoscopic procedures and bariatric surgeries. For more detailed review on the different management options discussed, we recommend reviewing Obesity Medicine Association Clinical Practice Statement [1].</p></div><div><h3>Conclusion</h3><p>Management of obesity reduces cardiovascular risk, improves metabolic parameters and other important health outcomes. Different management approaches are available, hence, a high level of awareness of the growing epidemic of obesity is needed to ensure timely referrals to obesity medicine specialists.</p></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"7 ","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49699879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}