Subcutaneous fat loss is greater than visceral fat loss with diet and exercise, weight-loss promoting drugs and bariatric surgery: a critical review and meta-analysis

Background: Though a high amount of visceral fat is associated with insulin resistance, which can lead to type 2 diabetes (T2D) and cardiovascular diseases (CVDs), less is known about whether lifestyle modification (weight loss diet and exercise) induced changes in visceral fat are associated with improvements in glycemia. Methods: We randomized 77 individuals aged 35-65 years with T2D or pre-diabetes to 6-months of weight loss diet (D); or D combined with supervised moderate-intensity exercise training (D+E). Study measures were total abdominal, visceral and subcutaneous fat volumes by magnetic resonance imaging, aerobic fitness expressed as VO 2 peak during treadmill testing, body mass index (BMI), and HbA1c levels from blood samples. Results: Of 77 subjects (mean age, 54.8±7.8 years; mean BMI, 34.5 ± 4.7 kg/m 2 , women, 77.9%; Whites-65%, Blacks-34%, Asians-1%), n=37 had T2D and n=40 had pre-diabetes. At 6 months, both D and D+E groups improved from baseline (p<0.05 for all) but did not differ in their changes for body weight (D: -6.04 ± 4.54 kg; D+E: -6.68 ± 4.48 kg, p= 0.61 for the group differences in change), abdominal total fat (D: -101.93 ± 68.67 cm 2 ; D+E:-104.16 ± 72.37 cm 2 , p= 0.92), visceral fat (D:-25.53 ± 39.44 cm 2 ; D+E:,-23.24 ± 35.62 cm 2 , p=0.85), HbA1c (D:0.04 ± 0.46%; D+E:0.03 ± 0.63%, p=0.96), and VO 2 peak (D: 2.26 ± 3.92 ml/kg/min ; D+E:3.71 ± 2.65 ml/kg/min, p=0.11). In a multivariate analysis, adjusting for baseline visceral fat, T2D status, body weight loss and increases in aerobic fitness, a reduction in HbA1c (β=-0.49, p =0.007) was associated with a reduction in visceral fat (R 2 =0.34, p=0.02). Conclusion: The key finding was that diet or diet plus exercise-mediated reductions in visceral fat was associated with reduced HbA1c among individuals with T2D or pre-diabetes. These data contribute to growing body of evidence of the benefits of reducing abdominal obesity, in this case, resulting in better glycemic control in T2D and pre-diabetes.

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Fractures in Adults After Weight Loss from Bariatric Surgery and Weight Management Programs for Obesity: Systematic Review and Meta-analysis

Obesity Surgery ◽

10.1007/s11695-018-03685-4 ◽

2019 ◽

Vol 29 (4) ◽

pp. 1327-1342 ◽

Cited By ~ 12

Author(s):

Andrew D. Ablett ◽

Bonnie R. Boyle ◽

Alison Avenell

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Weight Loss ◽

Weight Management ◽

Meta Analysis ◽

Weight Management Programs

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PATIENT PERSPECTIVES ON OBESITY MANAGEMENT: NEED FOR GREATER DISCUSSION OF BMI AND WEIGHT-LOSS OPTIONS BEYOND DIET AND EXERCISE, ESPECIALLY IN PATIENTS WITH DIABETES

Endocrine Practice ◽

10.4158/ep-2019-0452 ◽

2020 ◽

Vol 26 (5) ◽

pp. 471-483 ◽

Cited By ~ 2

Author(s):

Sabrina Huq ◽

Supriya Todkar ◽

Sharon W. Lahiri

Keyword(s):

Bariatric Surgery ◽

Body Mass Index ◽

Weight Loss ◽

Body Mass ◽

Early Death ◽

Specific Weight ◽

Obesity Management ◽

Diet And Exercise ◽

Patients With Diabetes ◽

Chi Squared

Objective: To identify perceptions of obesity management in patients with and without diabetes. Methods: A 48-question survey was administered in 2018 to our Endocrinology Clinic's adult patients with a body mass index (BMI) ≥30 kg/m2. Chi-squared or Fisher's exact tests were used to compare variables between groups. Results: Of 146 respondents, 105 had diabetes and 41 did not. Most respondents were female (61.4%), African American (66.4%), and with an income <$50,000 (58.6%). Those with diabetes had significantly greater comorbidities of hypertension, high cholesterol, and arthritis. Over 90% in both groups agreed that obesity is related to hypertension, diabetes, heart disease, and early death. Only 48% were aware of their BMI, and only 30.5% with diabetes and 41.5% without diabetes perceived themselves to be obese. Over 60% in each group reported discussion of diet and exercise with their providers, whereas few in both groups reported referral to a formal weight-loss program (18.9%) or to a specialty that manages obesity (4.2%), or discussion of anti-obesity medications (11.2%) or bariatric surgery (8.4%). Reported concerns with anti-obesity medications and bariatric surgery included lack of knowledge and side effects or complications. Conclusion: These findings revealed excellent patient awareness of obesity as a health problem but misperception of obese status and unawareness of BMI. Presence of diabetes and other comorbidities did not result in greater discussion of weight-loss methods beyond diet and exercise. Increased patient education and discussion of specific weight-loss services, anti-obesity medications, and bariatric surgery are needed. Abbreviations: BMI = body mass index; DM = diabetes mellitus; HbA1c = hemoglobin A1c; HCP = healthcare provider

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Effects of Exercise Training on Weight Loss in Patients Who Have Undergone Bariatric Surgery: a Systematic Review and Meta-Analysis of Controlled Trials

Obesity Surgery ◽

10.1007/s11695-019-04096-9 ◽

2019 ◽

Vol 29 (10) ◽

pp. 3371-3384 ◽

Cited By ~ 5

Author(s):

Alejandro Carretero-Ruiz ◽

María del Carmen Olvera-Porcel ◽

Iván Cavero-Redondo ◽

Celia Álvarez-Bueno ◽

Vicente Martínez-Vizcaíno ◽

...

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Weight Loss ◽

Exercise Training ◽

Meta Analysis ◽

Controlled Trials

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Body Contouring Surgery Improves Weight Loss after Bariatric Surgery: A Systematic Review and Meta-Analysis

Aesthetic Plastic Surgery ◽

10.1007/s00266-020-02016-2 ◽

2020 ◽

Cited By ~ 1

Author(s):

Rawan ElAbd ◽

Osama A. Samargandi ◽

Khalifa AlGhanim ◽

Salma Alhamad ◽

Sulaiman Almazeedi ◽

...

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Weight Loss ◽

Meta Analysis ◽

Body Contouring ◽

Body Contouring Surgery

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TRANSITION TO A MORE EVEN DISTRIBUTION OF PROTEIN INTAKE IS ASSOCIATED WITH ENHANCED FAT LOSS IN OBESE OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3097 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S841-S841

Author(s):

Samaneh Farsijani ◽

Jane A Cauley ◽

Adam J Santanasto ◽

Nancy W Glynn ◽

Robert M Boudreau ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Weight Loss ◽

Body Composition ◽

Successful Aging ◽

Protein Intake ◽

Subcutaneous Fat ◽

Community Dwelling ◽

Protein Distribution ◽

Fat Loss

Abstract Background: Optimization of intentional weight loss in obese older adults, through preferential fat mass reduction, is challenging, as the concomitant lean mass loss may exacerbate sarcopenia. Here, we assessed whether changes in within-day protein intake distribution are related to improvements in body composition in overweight/obese older adults during a hypocaloric and exercise intervention. Methods: Thirty-six community-dwelling, overweight-to-obese (BMI 28.0-39.9 kg/m2), sedentary older adults (aged 70.6±6.1 years) were randomized into either physical activity plus successful aging health education (PA+SA; n=15) or physical activity plus weight loss (PA+WL; n=21) programs. Body composition (by CT and DXA) and dietary intake (by three-day food records) were determined at baseline, 6-month, and 12-month follow-up visits. Within-day protein distribution was calculated as the coefficient of variation of protein ingested at breakfast [5:00–10:59], lunch [11:00–16:59] and dinner [17:00–1:00]. Secondary analysis was performed to determine associations between changes in protein intake distribution and body composition. Results: In both groups, baseline protein intake was skewed towards dinner. The pattern of protein intake changed towards a more even within-day distribution in PA+WL, but it remained unchanged in PA+SA. Transition towards a more even pattern of protein intake was independently associated with a greater decline in BMI (P<0.05) and abdominal subcutaneous fat (P<0.05) in PA+WL. However, changes in protein CV were not associated with weight loss in PA+SA. Conclusion: Our results show that mealtime distribution of protein intake throughout the day was associated with improved weight and fat loss under hypocaloric diet combined with physical activity.

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