Management of male obesity-related secondary hypogonadism:A clinical update

The global obesity pandemic has resulted in a rise in the prevalence of male obesity-related secondary hypogonadism(MOSH)with emerging evidence on the role of testosterone therapy.We aim to provide an updated and practical approach towards its management.We did a comprehensive literature search across MEDLINE(via PubMed),Scopus,and Google Scholar databases using the keywords“MOSH”OR“Obesity-related hypogonadism”OR“Testosterone replacement therapy”OR“Selective estrogen receptor modulator”OR“SERM”OR“Guidelines on male hypogonadism”as well as a manual search of references within the articles.A narrative review based on available evidence,recommendations and their practical implications was done.Although weight loss is the ideal therapeutic strategy for patients with MOSH,achievement of significant weight reduction is usually difficult with lifestyle changes alone in real-world practice.Therefore,androgen administration is often necessary in the management of hypogonadism in patients with MOSH which also improves many other comorbidities related to obesity.However,there is conflicting evidence for the appropriate use of testosterone replacement therapy(TRT),and it can also be associated with complications.This evidence-based review updates the available evidence including the very recently published results of the TRAVERSE trial and provides comprehensive clinical practice pearls for the management of patients with MOSH.Before starting testosterone replacement in functional hypogonadism of obesity,it would be desirable to initiate lifestyle modification to ensure weight reduction.TRT should be coupled with the management of other comorbidities related to obesity in MOSH patients.Balancing the risks and benefits of TRT should be considered in every patient before and during longterm management.

Effect of Acupressure Therapy on Anti-inflammatory Mechanism in Obesity-induced IR Rats

[Objectives] To study the effect of "acupressure therapy" on anti-inflammatory mechanism in obesity-induced IR rats. [Methods] 10 rats were randomly selected and fed with normal diet as blank group, and the remaining 30 rats were fed with high-fat diet for 8 weeks. The obesity-induced IR model was induced and divided into two groups: model group and acupressure group. The acupressure group was treated by "acupressure therapy" three times a week for 6 weeks;the model group was taken 3 times at the same time every week, and the supine binding experiment lasted for 10 min for 6 weeks. Morphological observation was carried out before and after the experiment, mainly observing the general conditions and body weight. After the last intervention, the animals were killed and samples were collected. Western Blot method was used to detect the expression of TNF-α and IL-6 protein in adipose tissue of the three groups. [Results] Compared with the blank group, the expression of TNF-α and IL-6 protein in adipose tissue of the model group increased significantly ( P <0.01);compared with the model group, the expression of TNF-α and IL-6 protein in adipose tissue of the acupressure group decreased significantly ( P <0.01). [Conclusions] After intervening in the obesity-induced IR rats with acupressure method, the status of insulin resistance in obese rats was improved by inhibiting the expression of inflammatory factors.

Adipose tissue macrophages:implications for obesity-associated cancer

Obesity is one of the most serious global health problems,with an incidence that increases yearly and coincides with the development of cancer.Adipose tissue macrophages(ATMs)are particularly important in this context and contribute to linking obesity-related inflammation and tumor progression.However,the functions of ATMs on the progression of obesity-associated cancer remain unclear.In this review,we describe the origins,phenotypes,and functions of ATMs.Subsequently,we summarize the potential mechanisms on the reprogramming of ATMs in the obesity-associated microenvironment,including the direct exchange of dysfunctional metabolites,inordinate cytokines and other signaling mediators,transfer of extracellular vesicle cargo,and variations in the gut microbiota and its metabolites.A better understanding of the properties and functions of ATMs under conditions of obesity will lead to the development of new therapeutic interventions for obesity-related cancer.

Electroconvulsive Therapy for Obesity Treatment

ECT is most often used as a treatment for severe major depression which has not responded to other treatment, and it is also used in the treatment of mania (often in bipolar disorder), and catatonia. Its use for obesity treatment was never suggested before. However, incidental information from several studies revealed that “Five of 10 patients were obese pre-ECT, all of whom had a significant weight loss after ECT.” and “Once-daily ECS over 10 days (which significantly reduced weight gain in rats)”. A new hypothesis is made for the use of ECT for obesity treatment.

Advances in Research of Simple Obesity and Its Manipulative Therapy in Recent Ten Years

The simple obesity is a common clinical disease and its incidence is increasing year by year.With the increasing pace of work,increasing pressure,and changing eating habits,the incidence of simple obesity tends to be younger.Among the treatment protocols for this disease,TCM manipulative(Tuina)therapy has remarkable curative effect and few adverse reactions,and has been well recognized.Modern research has also proposed a variety of treatment protocols with different characteristics and good curative effects.This paper reviews the related literature on simple obesity and its manipulative therapy in the past ten years,and summarizes its disease name,etiology and pathogenesis,manipulation and related therapies,so as to provide new ideas and new angles for the treatment of the simple obesity.

Investigation of the Effect of Acceptance and Commitment Psychotherapy (ACT) on Quality of Life of Adult Women Suffering from Obesity

Background and Purpose: Quality of life as an important factor in health is very important. This study is looking for an appropriate and effective treatment for improving quality of life. This research aims to study the psychological effect of acceptance and commitment therapy (ACT) on quality of life of adult women suffering from obesity. Methods and Materials: This research is a kind of half-trail, with pattern of pre-test, post-test and group control. Statistical population includes all over-weight women with body mass index (BMI) range (30 - 40) who participated in family training sessions held in Shahin Shahr city. 40 patients who had the characteristics for sampling were selected and randomly placed in test and control groups (each group 20 people). Participants in each group before and after intervention quality of life questionnaire with 100 question sample World Health Organization Quality of Life (WHOQOL)-100 were evaluated. 12 sessions of acceptance and commitment therapy in group was used. The obtained data were analyzed with the use of Sciences Statistical Package for the Social (SPSS) 18 statistical software and methods of analysis of covariance. Findings: After selection of adult women having a BMI between 30 and 40 based on availability who had attended the meeting of family education, by invitation and voluntary, they were randomized into experimental and control groups. Intervention was done for experimental group. Due to the result of covariance analysis on the post-test stage, examination group showed significant improvement in variants physical health dimensions, level of independence in social and environmental relationships and spirituality (p < 0.01). Conclusion: According to the findings of this research based on the impact of acceptance and commitment intervention on promotion and improving in quality of life, this treatment can be used for improving the variants in women suffering from over-weight and obesity.

Advances in Acupuncture and its Associated Therapies for the Prevention and Treatment of Obesity Type 2 Diabetes Mellitus

Obesity type 2 diabetes mellitus is a common metabolic disease in clinical practice,and its prevalence is increasing rapidly with the aging of the population and changes in lifestyle.Acupuncture,as a distinctive therapy,has its unique advantages in the treatment of obesity type 2 diabetes and has an irreplaceable role in a variety of treatment methods.The author organized the literature on acupuncture and its related therapies to prevent and treat obesity type 2 diabetes in recent years and found that acupuncture and its associated therapies to prevent and treat obesity type 2 diabetes mainly include:simple acupuncture,electroacupuncture,acupoint catgut embedding therapy,auricular-plaster therapy and other treatments,all of which can safely and effectively improve clinical symptoms,acupuncture and its related therapies to treat obesity type 2 diabetes has a broad prospect,worthy of further clinical promotion.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACUPUNCTURE THERAPY FOR SIMPLE OBESITY COMPLICATED WITH PREMENSTRUAL TENSION SYNDROME

Objective: To observe the therapeutic effect of acupuncture therapy in the treatment of simple obesity complicated with premenstrual tension syndrome. Methods: A total of 39 cases of simple obesity complicated with premenstrual tension were treated by combination of body acupuncture and otoacupuncture based on syndrome-differentiation of traditional Chinese medicine (TCM). Symptoms, physical signs, obesity indexes and cumulative scores of clinical disease-syndrome before and after treatment were analyzed and compared. Results: After one, two and three courses of treatment, the effective rates were 69.23%, 79.49% and 87.18% respectively. Conclusion: Acupuncture therapy works well in the treatment of simple obesity with concurrent premenstrual tension syndrome.

Screening of acupuncture treatment for simple obesity

Objective:Observe the advantages and characteristics of Acupuncture therapy and Point Thread Embedding therapy in the treatment of simple obesity and to select the superior treatment schemes.Methods:on the basis of syndrome differentiation,acupuncture and Point Thread Embedding therapy were adopted respectively for 3 courses of treatment.Observe the changes of body weight and abdomen/waist/hip circumference in different stages of treatment and evaluate the curative effect.Results:Both acupuncture and Point Thread Embedding could lessen the weight and the abdomen/waist/hip circumference of simple obesity.Acupuncture and Point Thread Embedding can not only reduce body weight,but also improve clinical symptoms of simple obesity.The effect rate of clinical symptoms is better than that of weight(P<0.05);The efficiency of Point Thread Embedding group is better than that of Acupuncture group(P<0.05).There was no significant weight loss from the second course of treatment especially in acupuncture group(P>0.05).Conclusion:Acupuncture and Point Thread Embedding in the treatment of simple obesity focus more on the adjustment of body shape and constitution of obese patients;Compare with acupuncture treatment,point thread embedding group had a slower onset time and a longer duration of curative effect while acupuncture group had a faster onset time but a shorter duration.When the body weight is reduced to 5kg,the plateau stage occurs.Point Thread Embedding therapy is easier to be popularized and applied in clinic Because of its convenient and stable therapeutic effect.

The Effect of Balanced Hypocaloric Diet on the Anthropometric and Basic Metabolic Indicators in Infertile Women with Gluteofemoral Obesity

Purpose: To evaluate the effect of balanced hypocaloric diet therapy on the anthropometric and basic metabolic indicators in obese women with infertility. Methods: The follow up interventional clinical study included 23 infertile women in reproductive age with grade I gluteofemoral obesity. All patients have prescribed a balanced hypocaloric diet (1200 kcal/day), underwent exercise and behavioral therapy. Before and after 12-month treatment, an anthropometric study was conducted, determining the level of metabolic and hormonal indicators. Results: The total final number of study participants was 20 patients. A decrease in body weight was achieved in 87% of patients from 4 to 24 kg, on the average, by 10.58 ± 5.70 kg, there was also a decrease in BMI from 32.53 ± 1.40 to 28.55 ± 2.50 kg/m2 (p 0.001). The decrease in body weight was accompanied by a statistically significant decrease in leptin levels (p 0.001), E1 (p = 0.049), E2 (p = 0.032), fasting glucose (p 0.001), HOMA-IR (p = 0.002), cholesterol (p < 0.001), TG (p = 0.004), LDL-C (p = 0.001), atherogenic index of plasma (p <0.001) and an increase in progesterone levels (p = 0.030). Ovulatory menstrual cycles were resumed in all women (p = 0.007) and pregnancy occurred within a year in 1 patient. Conclusion: The implementation of a hypocaloric diet for 12 months in infertile women with first-degree obesity helps to normalize metabolic and hormonal indicators, reduces body weight and restores ovulatory menstrual cycle in all patients.

Research Progress of Non-drug Therapy of Traditional Chinese Medicine in the Treatment of Obese Polycystic Ovary Syndrome

Polycystic ovarian syndrome(PCOS)as a relatively common clinical reproductive endocrine disease,the incidence is increasing year by year and the treatment is difficult,among which obese PCOS accounts for nearly 50%of the total.In recent years,non-drug therapy of traditional Chinese medicine(TCM)has been effective in the treatment of PCOS.This article summarizes the relevant literature in the past ten years from acupuncture,acupoint embedding,moxibustion,and auricular points,and observes the effects of TCM non-drug therapy on endocrine and glucose and lipid metabolism in obese PCOS patients.The impact of various indicators such as body mass index,body mass index,etc.,and discuss the problems in such treatments,as well as put forward suggestions to achieve the purpose of better guiding the clinical treatment of obese PCOS.

A Pilot Experience in the training of healthcare professionals to face the childhood obesity epidemic through family therapeutic education

Background: Obesity is a high-cost social disease, the management of which, usually assigned to general practice, is less supported by evidence-based medicine. Most general practitioners feel unprepared to face the problem. Objectives: In 2000, at the Pediatric Department of Ferrara, we started a Family Group Therapeutic Education Program for the treatment of childhood obesity. More than 300 families have attended the program. Following our positive results, we created a professional training course on therapeutic education, addressed to healthcare personnel involved in the treatment of childhood obesity. The purpose of the present study is to discover if it is possible to promote the development of a shared therapeutic education strategy for obesity, involving primary care physiccians/pediatricians, specialists and dietitians. Methods: The integrated professional training course consists of a four-day seminar along with an on-line course for distance learning. The assessment of the project takes into account the following criteria: a multidimensional questionnaire (a pre- and post-test which explores: knowledge, motivation, self-efficacy, methodology, communication, modeling, etc.), an appreciation questionnaire with responses collected over the course of 2 years. Moreover, the nine participants of our 2008 training course began to use the new therapeutic tools in their practice and six of them sent us the anthropometric measurements of patients whom they have treated over the past two years using this approach allows us to present outcomes in terms of implementation of this therapeutic education program in everyday professional practice. Results and Conclusions: The course was attended by 15 healthcare professionals: ten in 2008 and five in 2009, from different Italian centers. Results seem to indicate a great interest and appreciation by the participants. Results based on BMI z-score reduction of the children cared for by our trainees seem to support the efficacy of our educational method in clinical practice. If these preliminary results are confirmed, new training projects for the management of childhood obesity can be planned and addressed to a wider healthcare professional public.

The Effect of Obesity and Diabetes on Intermediate to High Grade Prostate Cancer Patients Treated with Radical Prostatectomy

Aims: The relationships between obesity, diabetes and prostate cancer are unclear. A retrospective study was performed to determine the effects of body mass index (BMI) and diabetes on patients with intermediate to high grade prostate cancer treated with radical prostatectomy. Methods: We reviewed 582 patients with Gleason score ≥ 7 non-metastatic prostate cancer treated with radical prostatectomy. Patients were stratified by BMI. End points were biochemical failure free survival (BFFS), overall survival (OS), and cancer specific survival (CSS). Results: Mean pre-treatment PSA decreased with increasing BMI (12.5, 7.6, 7.8 and 5.3 ng/mL with BMI 35, respectively;p 35, respectively. However, for overall mortality the adjusted hazard ratio was 0.39 (0.18, 0.82;p = 0.01) for overweight patients (BMI 25 - 30) compared to patients with a BMI in the normal range. Patients with a BMI of 30 - 35 and > 35 had increased rates of positive margins than those with a BMI of 25 - 30 or 35 2.04) on multivariate analysis, margin positivity alone was not a significant factor. Conclusions: Patients with increasing BMI tend to have a lower PSA at diagnosis but are more likely to have biochemical failure after radical prostatectomy. In our cohort, this was not due to the increased incidence of positive margins. Having diabetes had no effect.

Maternal Perception on Obesity;Its Complications and Gestational Weight Gain in Pregnant Mothers Presenting to Antenatal Clinics in a South Asian Teaching Hospital (De Soyza Hospital for Women Colombo—DSHW)

The rates of overweight and obesity are rising to epidemic proportions globally, especially among women. Obesity is increasingly common in the obstetric population as well. Sri Lanka is not an exception to this regard. There is limited published data on maternal perceptions on obesity in pregnancy, gestational weight gain and its complications. The current study aimed to describe the maternal perception on obesity, their knowledge on complications of obesity in pregnancy and gestational weight gain in pregnant mothers. Hospital based descriptive cross sectional study was conducted among a systematic sample of 416 pregnant women registered for antenatal clinic care at De Soyza Maternity Hospital. Pre-tested interviewer administered questionnaire was used for data collection. Maternal BMI at booking visit was taken from the pregnancy record to assess the overweight/obesity prevalence among the study population. Nearly one third (32.2%) of the study population were overweight and 11.8% were obese. Fifty three percent (53%) of overweight women identified themselves as such, but 45% of them considered themselves to be normal weight. Most of the pregnant women in the study sample (59.6%) were unable to estimate the recommended weight gain in pregnancy. Women’s knowledge on the specific risks associated with maternal obesity was poor. Pregnant mother’s knowledge on obesity, gestational weight gain and its consequences were unsatisfactory. Bridging this knowledge gap is an important step towards improving perinatal outcomes for all pregnant mothers in the current obesity epidemic.

COMPARISON OF THE THERAPEUTIC EFFECT OF AURICULAR ACUPUNCTURE, BODY ACUPUNCTURE AND COMBINATION OF AURICULAR PLUS BODY ACUPUNCTURE FOR TREATMENT OF SIMPLE OBESITY

Objective: To observe the therapeutic effect of auricular acupuncture (AA), body acupuncture (BA) and AA + BA for treatment of simple obesity. Methods: A total of 195 cases of obesity patients including 8 males and 187 females were randomly divided into AA group (n=55), BA group (n=64) and AA+ BA group (n=76). Acupuncture treatment was given to the patient once every other day, with 12 sessions being a therapeutic course. Results: Af ter one course of treatment, ofthe55 cases in AA group, 1 case (1.8%) was cured, 15(27.3%) had marked improvement, 11(20.0%) had improvement and 28 (50.9%) failed in treatment, with the total effective rate being 49.9%.In BA group, of the 64 cases, 11(17.2%) were cured, 23 (35.9%) had striking improvement, 18 (28. 1%) had improvement and 12 (18.8%) failed in treatment, with an effective rate of 81.2%. In AA+ BA group, of the 76 cases, 16 (21. 1%) were cured, 35 (46. 1%) had significant amelioration, 20 (26.3%) had amelioration and 5 (6. 6%) failed in treatment, with the effective rate being 93.4%. Statistical analysis showed that the therapeutic effect of BA and AA+ BA groups was significantly superior to that of AA group (P< 0.05); and that of AA+ BA group was higher than that of BA group. Conclusion: The therapeutic effect of BA and AA+ BA was superior to that of AA in treatment of simple obesity.

EFFECT OF ACUPUNCTURE ON HYPERLEPTINAEMIA AND HYPERINSULINEMIA IN OBESITY RATS

Objective: To observe the effect of acupuncture on hyperleptinaemia and hyperinsulinemia for studying its underlying mechanism about anti-obesity and reducing blood lipid in obesity rats. Methods: A total of 80 SD rats were randomized into normal control, model, acupuncture and medication groups, with 20 cases in each group. Hypothalamic obesity model was established by subcutaneous injection of 15% sodium glutamate (0.2 mL/10 g body weight), once daily and continuously for 5 days. “Zusanli” (足三里 ST 36), “Sanyinjiao”(三阴交 SP 6), “Guanyuan”(关元 CV 4) and “Zhongwan”(中脘 CV 12) were punctured and stimulated electrically (100 Hz, dense-sparse waves, and a suitable strength inducing local muscular tremor) for 15 min, once daily. In medication group, rats were fed with Sibutramine 4 mg/kg, once daily. After 4 weeks’ treatment, Lee’s index was detected, and serum leptin and insulin contents were determined by radioimmunoassay (RIA). Results: Compared with normal control group, Lee’s index, serum leptin and insulin contents of model group increased significantly (P<0.01). Comparison between acupuncture and model groups, Lee’s index and serum leptin of acupuncture group decreased significantly (P<0.01), and serum insulin level also lowered. In comparison with model group, Lee’s index, serum leptin and insulin levels of medication group also lowered. Comparison between acupuncture and medication groups showed that Lee’s index and serum leptin level of acupuncture group were significantly lower than those of the later group (P<0.01), displaying that the therapeutic effect of acupuncture is better than that of Sibutramine in lowering Lee’s index and serum leptin. No significant differences were found between acupuncture and medication groups in body weight and length and serum insulin(P>0.05). Conclusion: Acupuncture can effectively reduce Lee’s index, serum leptin and insulin contents in fasting obese rats, which may contribute to its effect in anti-obesity.

EFFECT OF ACUPUNCTURE TREATMENT ON CELLULAR HEMORHEOLOGY, CHOLESTEROL AND TRIGLYCERIDE OF SIMPLE OBESITY PATIENTS

Objective: To observe the effect of acupuncture on simple obesity and cellular hemorheology. Methods: Thirty-two cases of simple obesity patients were enrolled into this study. Acupoints of the Stomach Meridian and Spleen Meridian as Zhongwan (中脘CV 12), Liangmen (梁门ST 21), Tianshu (天枢ST 25), Guanyuan (关元CV 4), etc. were punctured, once daily in the first 5 days, and once every other day afterwards, with 10 sessions being a therapeutic course. Before treatment and after 3 courses of treatment, the body weight, waistline, weight index, serum cholesterol (CH), triglyceride and aggregation index of red blood cell (RBC) were detected. Results: After acupuncture treatment, all the indexes of body weight, waistline, weight index, serum CH, triglyceride and aggregation index of RBC decreased significantly in comparison with those of pre-treatment (P<0.05). Conclusion: Acupuncture can apparently improve cellular hemorheology, reduce body weight, serum cholesterol and TG levels in simple obesity patients.

Endoscopic management of intragastric penetrated adjustable gastric band for morbid obesity

这份报告与疾病的肥胖在一个病人描述胃内的渗透的可调节的胃的乐队的成功的内视镜的管理的一个案例。这里描述的案例的有利功课证明在移植的过程的可调节的胃的乐队不必在无征状的病人通过手术被移开。

Meta Analysis of the Efficacy of Nonpharmaceutical Chinese Medicine Therapy in the Treatment of Obese Polycystic Ovary Syndrome

Objective:To systematically evaluate the effects of acupuncture,auricular point sticking,acupoint catgut embedding,cupping and other non-pharmaceutical Chinese medicine therapies on sex hormone as well as glucose and lipid metabolism in patients with obese polycystic ovary syndrome.Method:The databases such as China National Knowledge Infrastructure were searched by computer to collect the literature on the treatment of obese polycystic by non-pharmaceutical Chinese medicine therapy combined with western medicine or lifestyle change,and the literature quality of the included literature was evaluated,and finally the data were analyzed.A total of 15 randomized controlled trial(RCT)literature were included in this study,with a total of 1263 patients.Results:Non-pharmaceutical Chinese medicine therapy combined with metformin or lifestyle can reduce body mass index,insulin resistance index,fasting plasma insulin,fasting blood glucose,luteinizing hormone,ratio of luteinizing hormone to follicle stimulating hormone,testosterone,but it has no obvious advantage over follicle stimulating hormone(FSH).Conclusion:Compared with simple application of metformin or lifestyle change,traditional Chinese medicine non drug therapy combined with metformin or lifestyle change can better improve sex hormone and blood glucose metabolism in obese PCOS patients.

CLINICAL EXPERIENCE IN ACUPUNCTURE TREATMENT OF OBESITY

Obesity manifests itself as derangement of qi and blood with disorder of the defensive qi inparticular to be a causative factor of primary importance,meanwhile,deficiency of theprimary qi in Sanjiao may also contribute to it.Fundamentally,its pathological changesare also related to dysfunction of the spleen and stomach.According to syndromedifferentiation,obesity can be classified into three types,namely,heat in the stomach andintestine,spleen and stomach qi deficiency,and deficiency of primary qi.The mainmethods of treatment include clearing and reducing heat in the stomach and intestine;regulating qi in the fu organs and promoting water metabolism;balancing and regulatingqi and blood,yin and yang,and removing stagnation of defensive qi.