BACKGROUND: The distribution of time across physical activity, sedentary behaviors, and sleep appears to be essential for the management of obesity. However, the impact of reallocating time among these behaviors, collectively known as 24-h movement behaviors, remains underexplored. OBJECTIVE: This study examines the theoretical effects of reallocating time between 24-h movement behaviors on obesity indicators across different age groups. METHODS: We performed a pooled data meta-analysis of 9818 participants from 11 observational and experimental studies. To estimate the time spent in movement behaviors, we reprocessed and harmonized individual-level raw accelerometer-derived data. Isotemporal substitution models estimated theoretical changes in body mass index (BMI) and waist circumference (WC) associated with time reallocation between movement behaviors. We performed the analysis separately for children, adolescents, adults, and older adults. RESULTS: Even minor reallocations of 10 min led to significant changes in obesity indicators, with pronounced effects observed when 30 min were reallocated. The most substantial adverse effects on BMI and WC occurred when moderate-to-vigorous physical activity (MVPA) was reallocated to other movement behaviors. For 30-min reallocations, the largest increase in BMI (or BMI z-score for children) occurred when MVPA was reallocated to light-intensity physical activity (LPA) in children (0.26 units, 95% confidence interval [CI] 0.15, 0.37) and to sedentary behavior (SB) in adults (0.72 kg/m2, 95% CI 0.47, 0.96) and older adults (0.73 kg/m2, 95% CI 0.59, 0.87). The largest increase in WC was observed when MVPA was substituted with LPA in adults (2.66 cm, 95% CI 1.42, 3.90) and with SB in older adults (2.43 cm, 95% CI 2.07, 2.79). Conversely, the highest magnitude of the decrease in obesity indicators was observed when SB was substituted with MVPA. Specifically, substituting 30 min of SB with MVPA was associated with a decrease in BMI z-score by - 0.15 units (95% CI - 0.21, - 0.10) in children and lower BMI by - 0.56 kg/m2 (95% CI - 0.74, - 0.39) in adults and by - 0.52 kg/m2 (95% CI - 0.61, - 0.43) in older adults. Reallocating time away from sleep and LPA showed several significant changes but lacked a consistent pattern. While the predicted changes in obesity indicators were generally consistent across age groups, inconsistent findings were observed in adolescents, particularly for reallocations between MVPA and other behaviors. CONCLUSIONS: This investigation emphasizes the crucial role of MVPA in mitigating obesity risk across the lifespan, and the benefit of substituting SB with low-intensity movement behaviors. The distinct patterns observed in adolescents suggest a need for age-specific lifestyle interventions to effectively address obesity. Emphasizing manageable shifts, such as 10-min reallocations, could have significant public health implications, promoting sustainable lifestyle changes that accommodate individuals with diverse needs, including those with severe obesity.

• MeSH
• akcelerometrie MeSH
• časové faktory MeSH
• cvičení * MeSH
• dítě MeSH
• dospělí MeSH
• index tělesné hmotnosti MeSH
• léčba obezity * metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• obezita * MeSH
• obvod pasu MeSH
• sedavý životní styl * MeSH
• senioři MeSH
• spánek MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH

Global obesity rates have risen dramatically, now exceeding deaths from starvation. Metabolic and bariatric surgery (MBS), initially for severe obesity (BMI ≥35 kg/m2), is performed globally over 500 000 times annually, offering significant metabolic benefits beyond weight loss. However, varying eligibility criteria globally impact patient care and healthcare resources. Updated in 2022, ASMBS and IFSO guidelines aim to standardise MBS indications, reflecting current understanding and emphasising comprehensive preoperative assessments. Yet, clinical variability persists, necessitating consensus-based recommendations. This modified Delphi study engaged 45 global experts to establish consensus on perioperative management in MBS. Experts selected from bariatric societies possessed expertise in MBS and participated in a two-round Delphi protocol. Consensus was achieved on 90 of 169 statements (53.3%), encompassing multidisciplinary team composition, patient selection criteria, preoperative testing, and referral pathways. The agreement highlighted the critical role of comprehensive preoperative assessments and the integration of healthcare professionals in MBS. These findings offer essential insights to standardise perioperative practices and advocate for evidence-based guidelines in MBS globally. The study underscores the need for unified protocols to optimise outcomes and guide future research in MBS.

• MeSH
• bariatrická chirurgie * normy   metody   MeSH
• delfská metoda * MeSH
• konsensus * MeSH
• lidé MeSH
• morbidní obezita chirurgie   MeSH
• předoperační péče * normy   metody   MeSH
• výběr pacientů MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION AND OBJECTIVES: With increases in obesity and metabolic syndrome because of lifestyle-related factors, the prevalence of non-alcoholic fatty liver disease (NAFLD) also is increasing worldwide. In a subset of patients with NAFLD, an inflammatory process arises in the steatotic liver, known as non-alcoholic steatohepatitis, that leads to liver fibrosis and liver cirrhosis. In selected patients with obesity, bariatric surgery, and bariatric endoscopy are important therapeutic options. MATERIALS AND METHODS: This prospective interventional pilot study was conducted to investigate two types of intragastric balloons (IGB). The IGBs were the Orbera and the Spatz3. Liver fibrosis changes were monitored non-invasively using point and 2D shear wave ultrasound elastography (SWE) and transient elastography that allowed for quantification of liver steatosis using the controlled attenuation parameter (CAP). Patients were followed for 12 months. RESULTS: Of 34 patients implanted with an IGB, 30 completed follow-up at month 12; results for one patient were excluded because of initiation of obesity pharmacotherapy. Fifteen patients received the Orbera IGB, and nineteen patients received the Spatz3 type. In month 12, total and excess weight loss was 7.88 % and 30.13 %. Elastography values decreased from baseline (3.88 kPa) to 3.61 kPa at month 12 (p 0.024). 2D SWE values decreased from baseline (5.42 kPa) to a value of 4.91 kPa at month twelve (p 0.135). Transient elastography values decreased from baseline (5.62 kPa) to a value of 4.17 kPa at month twelve (p 0.009). CONCLUSIONS: Bariatric endoscopy in the form of IGB implantation leads to weight reduction and improvement of liver fibrosis and steatosis. GOV REGISTRATION: NCT04895943.

• MeSH
• bariatrická chirurgie * MeSH
• časové faktory MeSH
• design vybavení MeSH
• dospělí MeSH
• elastografie MeSH
• hmotnostní úbytek MeSH
• jaterní cirhóza * etiologie   diagnostické zobrazování   diagnóza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nealkoholová steatóza jater * diagnostické zobrazování   diagnóza   etiologie   MeSH
• obezita * komplikace   chirurgie   diagnóza   MeSH
• pilotní projekty MeSH
• prospektivní studie MeSH
• výsledek terapie MeSH
• žaludeční balónek * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

Vysokoškolská učebnica, ktorá sa zameriava na liečbu extrémnej obezity. Určené aj odborníkom v praxi.

• MeSH
• léčba obezity MeSH
• morbidní obezita MeSH

• Konspekt
• Patologie. Klinická medicína
• Učební osnovy. Vyučovací předměty. Učebnice
• NLK Obory
• obezitologie
• NLK Publikační typ
• učebnice vysokých škol

Celosvetovo patrí obezita k najrozšírenejším chronickým ochoreniam ako v dospelej, tak aj v detskej a adolescentnej populácii. V súčasnosti je jedným z najvýznamnejších problémov verejného zdravia nielen kvôli narastajúcej prevalencii, ale najmä asociácii so širokým spektrom ďalších chronických a život ohrozujúcich ochorení. Na Slovensku sa prevalencia nadhmotnosti pohybuje v rozmedzí okolo 63 %, prevalencia obezity okolo 29 %. V júni 2024 v Nature Medicine publikovala a zaviedla Európska spoločnosť pre štúdium obezity (European Association for the Study of Obesity – EASO) rámec na zosúladenie diagnostiky, hodnotenia závažnosti a liečby obezity so štandardmi iných chronických ochorení. Ciele liečby chronického ochorenia – (pre)obezity by mali byť holistické, mali by ísť „za“ pokles hmotnosti v kilogramoch, čo prináša so sebou dlhodobé prínosy pre zdravie, duševnú pohodu, fyzické fungovanie a zlepšenie kvality života. Holistické ciele môžeme dosiahnuť zmenou životného štýlu (behaviorálne, nutričné a pohybové intervencie). Zhodnotenie závažnosti ochorenia ovplyvňuje individuálnu liečbu (personalizovaná medicína) a v súčasnosti máme možnosť využívať kombináciu zmeny životného štýlu s farmakoterapiou, prípadne aj bariatrickými chirurgickými postupmi. V ostatnom čase nám pribudlo veľa nových informácií, výsledkov zo zaujímavých klinických štúdií týkajúcich sa farmakologického manažmentu založeného na báze inkretínov. V blízkej budúcnosti sa dočkáme aj ďalších noviniek zacielených na chronický manažment obezity.

Worldwide, obesity is one of the most widespread chronic diseases in the adult, child and adolescent population. It is currently one of the most significant public health problems not only due to its increasing prevalence, but especially due to its association with a wide range of other chronic and life-threatening diseases. In Slovakia, the prevalence of overweight is around 63 %, and the prevalence of obesity is around 29 %. In June 2024, the European Association for the Study of Obesity (EASO) published and introduced a framework to align the diagnosis, assessment of severity and treatment of obesity with the standards of other chronic diseases. The goals of treatment of chronic disease – (pre)obesity should be holistic, they should go “beyond” weight loss in kilograms, which brings with it long-term benefits for health, mental well-being, physical functioning and improved quality of life. Holistic goals can be achieved by changing lifestyle (behavioral, nutritional and exercise interventions). The assessment of the severity of the disease influences individual treatment (personalized medicine) and currently we have the opportunity to use a combination of lifestyle changes with pharmacotherapy, or even bariatric surgical procedures. Recently, we have received a lot of new information, results from interesting clinical studies related to pharmacological management based on incretins. In the near future we will also see other news aimed at chronic management of obesity.

• MeSH
• agonisté receptoru pro glukagonu podobný peptid 1 farmakologie   terapeutické užití   MeSH
• látky proti obezitě farmakologie   terapeutické užití   MeSH
• léčba obezity metody   MeSH
• lidé MeSH
• obezita * farmakoterapie   MeSH
• tirzepatid farmakologie   terapeutické užití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Práca sa venuje otázkam prevalencie, diagnostiky a manažmentu obezity a s obezitou asociovaných komorbidít v populácii detí a adolescentov. Okrem štandardného spektra terapeutických možností (individuálna alebo skupinová modifikácia životného štýlu, nutričné odporúčania, modifikácia fyzickej aktivity, kognitívno-behaviorálna terapia a psychologická intervencia) od roku 2022 je na Slovensku možnosť medikamentóznej liečby liraglutidom u adolescentov s obezitou. Vzhľadom na stúpajúci trend ochorenia sa do popredia dostáva otázka vytvorenia novej infraštruktúry zdravotnej starostlivosti o dieťa či adolescenta s obezitou. Európska spoločnosť pre štúdium obezity (EASO) publikovala kritériá pre centrá manažmentu obezity s cieľom zlepšiť starostlivosť o pacientov s obezitou.

This paper addresses prevalence, diagnosis and management of obesity and obesity-associated comorbidities in the child and adolescent population. In addition to the standard spectrum of therapeutic options (individual or group lifestyle modification, nutritional recommendations, physical activity modification, cognitive-behavioral therapy and psychological intervention) the drug treatment with liraglutide has been available in Slovakia for adolescents with obesity since 2022. Due to the increasing trend of the disease, up to fourth comes the need of creating a new healthcare infrastructure for adolescents with obesity. The European Association for the Study of Obesity (EASO) has published criteria for obesity management centers with the aim of improving the care of patients with obesity.

• MeSH
• dítě MeSH
• léčba obezity metody   MeSH
• lidé MeSH
• liraglutid farmakologie   terapeutické užití   MeSH
• mladiství MeSH
• obezita dětí a dospívajících * diagnóza   terapie   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• Publikační typ
• přehledy MeSH

Postbariatrický manažment u pacientov s nárastom hmotnosti predstavuje klinickú výzvu, najmä u žien s gynoidnou obezitou. Tento fenotyp je charakteristický zvýšenou akumuláciou tuku v oblasti bokov a stehien a je častejšie rezistentný na bežné redukčné intervencie a môže byť spojený s lipedémom. Jednou z možností v prípade zlyhania bariatrickej liečby je bariatrická reoperácia, alebo liečba GLP1-agonistami. Tirzepatid, duálny agonista receptorov pre GLP1 a GIP, predstavuje perspektívnu liečebnú možnosť v tomto špecifickom kontexte. V predkladanej kazuistike popisujeme prvý prípad pacientky s gynoidným typom obezity, u ktorej došlo k opätovnému nárastu telesnej hmotnosti napriek bariatrickej liečbe (laparoskopickej sleeve resekcii), ale následnou 7-mesačnou liečbou tirzepatidom bol dosiahnutý signifikantný pokles hmotnosti.

Postbariatric management in patients with weight regain poses a significant clinical challenge, particularly in women with a gynoid obesity. This phenotype, characterized by adipose tissue accumulation in the hips and thighs, is often resistant to conventional weight-loss strategies and may be overlap with lipedema. Tirzepatide, a dual GLP-1 and GIP receptor agonist, has emerged as a promising pharmacological option for weight reduction, with evidence supporting its efficacy even in patients with prior bariatric surgery. In this case-based report, we present first case of female patient with gynoid obesity, progressive weight regain after bariatric surgery (laparoscopic gastric sleeve resection), and after seven months of treatment with tirzepatide, she achieved a significant weight reduction in body weight.

• MeSH
• bariatrická chirurgie MeSH
• dospělí MeSH
• léčba obezity metody   MeSH
• lidé MeSH
• obezita * chirurgie   farmakoterapie   MeSH
• tirzepatid farmakologie   terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND AND AIMS: Gastric restriction techniques have recently emerged as minimally invasive bariatric procedures. Endoscopic sutured gastroplasty (ESG) with the Endomina (Endo Tools Therapeutics, Gosselies, Belgium) triangulation platform proved to be safe and effective for the treatment of class I and II obesity in prospective studies. In this registry, we aimed to further assess on a larger scale the safety and efficacy of the procedure in routine practice with a dedicated device. METHODS: This was a multicenter, observational, prospective post-market study including patients with obesity undergoing Endomina ESG. The primary safety outcome was the occurrence of serious adverse device effects (SADEs) at 12 months. The primary efficacy outcome was the technical success defined by completing the procedure without premature abortion owing to technical issues. The rates of procedure-related adverse events, weight loss outcomes, and quality of life changes were collected. RESULTS: A total of 142 patients underwent ESG in 3 centers from July 2020 to March 2023. Of these, 67 (mean body mass index, 38.5 ± 6.3 kg/m2) reached at least 12 months of follow-up up to October 2022. Technical success was 100%. No SADEs occurred. Seven mild procedure-related adverse events were reported overall. Mean percentage of excess weight loss and total body weight loss at 12 months' follow-up were 48.5% ± 38.6 and 15.3% ± 10.6, respectively (n = 67). Improved quality of life was observed following ESG. CONCLUSIONS: ESG is safe and effective, thus offering a satisfactory therapeutic option for a wide range of obese patients on a large scale.

• MeSH
• dospělí MeSH
• gastroplastika * metody   škodlivé účinky   MeSH
• gastroskopie metody   MeSH
• hmotnostní úbytek MeSH
• kvalita života MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidní obezita chirurgie   MeSH
• obezita chirurgie   komplikace   MeSH
• pooperační komplikace MeSH
• postmarketingový dozor * MeSH
• prospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH

• Klíčová slova
• Wernicke-Korsakovův syndrom,
• MeSH
• bariatrická chirurgie škodlivé účinky   MeSH
• dospělí MeSH
• lidé MeSH
• nedostatek thiaminu * farmakoterapie   komplikace   patofyziologie   MeSH
• thiamin terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

BACKGROUND: Randomized, controlled trials (RCTs) comparing the effectiveness of metabolic bariatric surgery (MBS) in addition to one or more treatment interventions for obesity (i.e., lifestyle structured interventions-LSI, medical therapy-MT, obesity management medication-OMM or endobariatric procedures-EP) are lacking. This study aims to assess the effectiveness of multiple simultaneous (before or immediately after MBS) interventions for treating obesity. METHODS: We performed a meta-analysis including all RCTs enrolling patients undergoing different MBS procedures add-on to other anti-obesity strategies (LSI, MT, OMM or ES) versus MBS alone, with a duration of at least 6 months. The primary outcome was BMI at the end-point; secondary end-points included percentage total and excess weight loss (%TWL%, and EBWL%), total weight loss (TWL), fasting plasma glucose (FPG), HbA1c, surgical and non-surgical severe adverse events (SAE), mortality, remission of type 2 diabetes, hypertension, dyslipidemia and health-related quality of life (HR-QoL). RESULTS: A total of 25 RCTs were retrieved. The addition of either OMM (i.e., liraglutide) or EP (i.e., intragastric balloon-IB, endosleeve-ES) to MBS was associated with a significantly lower BMI at the end-point (p = 0.040). The addition of liraglutide only to MBS was associated with a greater %EWL%, but not %TWL and TBWL (p = 0.008). Three trials evaluated end-point HbA1c, showing a significant reduction in favour of liraglutide as an add-on therapy to MBS (p = 0.007). There was no mortality. CONCLUSIONS: MBS combined with non-surgical approaches appears more effective than MBS alone in reducing BMI. Further RCTs on combined therapies to MBS for severe obesity are needed to enhance the tailoring of treatment for severe obesity.

• MeSH
• bariatrická chirurgie * metody   MeSH
• hmotnostní úbytek MeSH
• index tělesné hmotnosti MeSH
• kombinovaná terapie MeSH
• kvalita života MeSH
• lidé MeSH
• obezita * chirurgie   terapie   MeSH
• randomizované kontrolované studie jako téma MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH