BACKGROUND: Various methods and equations are available to predict the basal metabolic rate (BMR). A published study comparing the Harris-Benedict Equation, Bioelectrical Impedance Analysis, and Indirect Calorimetry (IC), was done among Filipinos, and was able to obtain a novel formula for BMR. The purpose of this study is to validate this novel formula. METHODS: This is a multi-center, cross-sectional, validation study of the novel BMR equation, done among adult overweight and obese Filipinos, who were seen at St. Luke’s Medical Center and Providence Hospital in Quezon City, Outpatient Clinics from August 2019 to March 2020. Purposive sampling was done, and upon giving consent, subjects had undergone interview, anthropometrics measurement, and IC. RESULTS: 174 samples were enrolled. Mean age is 43 years old, majority are females. 27% have no co-morbidities; of those with co-morbidities, half have diabetes mellitus (DM). Mean weight is 74.30 kg; mean BMI is 29.78 kg/m2 . The mean computed BMR is 1174.70 kcal/day, which is 145.83 significantly lower than the BMR derived with calorimetry: 1320.53 kcal/day (P-value 0.000). However, the scatterplot reveals the linearity of positive direction for both values. 31% of the computed BMR fell within the +/-10% estimate of the actual BMR. Stratification of the results between those with DM and without, lowered the difference between the calculated and actual BMR to 46 kcal/day (from 145.83) among the DM subgroup, and increased the estimated accuracy to 38% falling within the +/- 10% estimate of the actual values. CONCLUSION: The novel BMR formula is linearly reflective of the basal metabolism of adult overweight and obese Filipinos, but the numerical values are lower compared to actual calorimetry results, yielding more accuracy when applied among patients with diabetes.
Calorimetry, Indirect ; Basal Metabolism ; Obesity Management

Since the first use of the flexible fibreoptic bronchoscope, a plethora of new airway equipment has become available. It is essential for clinicians to understand the role and limitations of the available equipment to make appropriate choices. The recent 4th National Audit Project conducted in the United Kingdom found that poor judgement with inappropriate choice of equipment was a contributory factor in airway morbidity and mortality. Given the many modern airway adjuncts that are available, we aimed to define the role of flexible fibreoptic intubation in decision-making and management of anticipated and unanticipated difficult airways. We also reviewed the recent literature regarding the role of flexible fibreoptic intubation in specific patient groups who may present with difficult intubation, and concluded that the flexible fibrescope maintains its important role in difficult airway management.
Airway Management ; methods ; Airway Obstruction ; complications ; Anesthesia ; methods ; Bronchoscopy ; methods ; Equipment Design ; Fiber Optic Technology ; Humans ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngoscopes ; Manikins ; Obesity ; complications ; Respiratory System ; Skull Fractures ; complications

Introduction: Local profiles on the use of weight loss products are scarce. The study aims to address this together with concerns on the users’ misperception of the safety of these products, and the absence of high-quality evidence to support such use. Methods: This was a cross-sectional study conducted in overweight and obese patients attending a public primary care clinic in Penang. Selected patients were given a set of self-administered questionnaire that assessed types of weight loss products used, factors that influenced the usage and the users’ perception of their own body weight and the diet products they are taking. Results: From 332 participants of this study, 18.7% were users. Mean age of users were 44.6 (SD 11.9) years. The majority (66.1%) only used dietary supplements, 11.3% used weight loss medications and the rest (22.6%) used both products. Reasons for its use were for health, a faster result to lose weight and failing dieting and exercise regimes. The average amount spent on this was RM100 per month. Commonest source of weight loss products were friends. Majority (80.6%) did not discuss the use of the products with doctors. Factors associated with the use of weight loss products were being female (AOR=5.59), had tertiary level education (AOR=2.27), being employed (AOR=3.42), self-perceived of overweight (AOR=3.61) and perception that weight loss products as safe (AOR 2.48). Conclusion: Users of weight loss products are among highly educated working females who perceived themselves as being overweight and assume the products are safe
Diet ; Obesity Management

Huge goitor can lead to tracheal compression and hence difficulty in intubation. This is compounded by severe obesity. Failed tracheal intubation in difficult intubation is a serious event that may lead to increased patient morbidity and mortality. Current intubation rescue techniques and combination of different rescue techniques may increase the success rate of difficult intubation. In a 47-year-old female patient, with severe obesity and a huge goiter, our attempts at intubation using direct laryngoscope, video laryngoscope, and awake fiberoptic bronchoscope had failed. We succeeded by applying video laryngoscope to improve visualization of the airway and fiberoptic bronchoscope as a stylet for endotracheal tube.
Airway Management* ; Bronchoscopes* ; Female ; Goiter* ; Humans ; Intubation ; Laryngoscopes* ; Middle Aged ; Mortality ; Obesity, Morbid

Diabetic neuropathy is a complex and common disorder with multiple etiologies and affects about 43.1% of the Korean diabetes population. Good glycemic control slows progression of diabetic neuropathy in subjects with type 1 diabetes but seems to provide little benefit in subjects with type 2 diabetes. Moreover, neuropathy has been shown to develop in humans at stages of prediabetes and in the absence of overt hyperglycemia. Given the increasing incidence of both type 1 and type 2 diabetes and obesity and the impact of diabetic neuropathy on the quality of life of patients, a strategy for early diagnosis and discovery of an effective treatment is important for prevention and progression of diabetic neuropathy. Approximately 14.4% of Korean diabetics with neuropathy have associated pain, and management of this pain has been unsuccessful for many clinicians and patients. Choice of the correct drug(s), dosage, and patient management seems to be based on individualized conditions and needs. Overall, for good management and prevention for diabetic foot morbidities, early and proper diagnosis of diabetic neuropathy is essential, and simple and precise diagnostic methods must be developed.
Diabetic Foot ; Diabetic Neuropathies* ; Diagnosis ; Early Diagnosis ; Humans ; Hyperglycemia ; Incidence ; Obesity ; Pain Management ; Prediabetic State ; Quality of Life

OBJECTIVES: This study was conducted to investigate the current status and to suggest future directions for health management of teenagers who use healthy school tuck shops to improve teenagers' eating habits while reducing and preventing obesity. METHODS: A total of 29 students (16 middle school students and 13 high school students) took part in the interview for this study, and the interview was conducted for each school's focus group by using qualitative research methodology. RESULTS: The current status of using healthy school tuck shops and suggested future directions were divided into two categories. Personal barriers such as discrepancies between personal perceptions and behaviors and lack of food choice suitable to individual tastes can be solved by rebuilding the operating system to provide intuitive promotion of behavior and customized products through improvements in existing products and new product development. A lack of consistent management from low utilization convenience and difficulty in maintaining a constant purchase price can be handled by establishing a solution to restricted physical access for products, as well as seeking profit by improving distribution costs via continuous cooperation between the school and community. CONCLUSIONS: Continuous funding and a system that reflects the needs and preferences of healthy school tuck shop users should be applied for sustainable operation of healthy school tuck shops to improve teenagers' eating habits.
Adolescent ; Eating ; Financial Management ; Focus Groups ; Humans ; Obesity ; Qualitative Research

OBJECTIVES: This study was conducted to investigate the current status and to suggest future directions for health management of teenagers who use healthy school tuck shops to improve teenagers' eating habits while reducing and preventing obesity. METHODS: A total of 29 students (16 middle school students and 13 high school students) took part in the interview for this study, and the interview was conducted for each school's focus group by using qualitative research methodology. RESULTS: The current status of using healthy school tuck shops and suggested future directions were divided into two categories. Personal barriers such as discrepancies between personal perceptions and behaviors and lack of food choice suitable to individual tastes can be solved by rebuilding the operating system to provide intuitive promotion of behavior and customized products through improvements in existing products and new product development. A lack of consistent management from low utilization convenience and difficulty in maintaining a constant purchase price can be handled by establishing a solution to restricted physical access for products, as well as seeking profit by improving distribution costs via continuous cooperation between the school and community. CONCLUSIONS: Continuous funding and a system that reflects the needs and preferences of healthy school tuck shop users should be applied for sustainable operation of healthy school tuck shops to improve teenagers' eating habits.
Adolescent ; Eating ; Financial Management ; Focus Groups ; Humans ; Obesity ; Qualitative Research

BACKGROUND: Health risk assessments (HRA) are used by many organisations as a basis for developing relevant and targeted employee health and well-being interventions. However, many HRA's have a western-centric focus and therefore it is unclear whether the results can be directly extrapolated to those from non-western countries. More information regarding the differences in the associations between country status and health risks is needed along with a more global perspective of employee health risk factors and well-being overall. Therefore we aimed to i) quantify and compare associations for a number of health risk factors based on country status, and then ii) explore which characteristics can aid better prediction of well-being levels and in turn workplace productivity globally. METHODS: Online employee HRA data collected from 254 multi-national companies, for the years 2013 through 2016 was analysed (n = 117,274). Multiple linear regression models were fitted, adjusting for age and gender, to quantify associations between country status and health risk factors. Separate regression models were used to assess the prediction of well-being measures related to productivity. RESULTS: On average, the developing countries were comprised of younger individuals with lower obesity rates and markedly higher job satisfaction compared to their developed country counterparts. However, they also reported higher levels of anxiety and depression, a greater number of health risks and lower job effectiveness. Assessment of key factors related to productivity found that region of residency was the biggest predictor of presenteeism and poor pain management was the biggest predictor of absenteeism. CONCLUSIONS: Clear differences in health risks exist between employees from developed and developing countries and these should be considered when addressing well-being and productivity in the global workforce. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40557-017-0172-1) contains supplementary material, which is available to authorized users.
Absenteeism ; Anxiety ; Depression ; Developed Countries ; Developing Countries ; Efficiency ; Internship and Residency ; Job Satisfaction ; Linear Models ; Obesity ; Occupational Health* ; Pain Management ; Presenteeism ; Risk Assessment ; Risk Factors ; Work Performance*

Through continuous development, metabolic and bariatric surgery (MBS) has become widely recognized in academic and medical circles. In China, the volume of MBS operations has increased year by year. Therapeutic goals of MBS have evolved from treating obesity to treating Type 2 diabetes mellitus, and further to treating a series of obesity-associated metabolic diseases (including conditions in the endocrine system, circulatory system, respiratory system, reproductive system, and etc). Surgical approach of MBS has also been evolving continuously. Currently the common surgical procedures include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB) and bilio-pancreatic diversion with duodenal switch (BPD-DS). All surgical procedures have pros and cons, and the choice of surgical procedures should be based on the conditions of patients, the surgeon's technical ability, and benefits and operative risks. With the development of MBS, the proportions of different surgical procedures also changed in China. In recent five years, the proportion of AGB has decreased continuously and LAGB is no longer a common procedure. The proportion of LSG has increased rapidly, rising from 9% in 2010 to 55% in 2015. The proportion of RYGB has increased from 57% to 64% between 2010 and 2013, and remained at 45% afterwards. Since 2010, most MBS operations are laparoscopic surgery. 3D Laparoscopic surgery, laparoendoscopic single-site surgery and da Vinci Robotic Surgery have also been introduced in MBS. This review discusses the status quo and changes of MBS in china, as well as the new technology in MBS, aiming to strengthen the information and comprehension of MBS in china.
Bariatric Surgery ; methods ; statistics & numerical data ; trends ; Biliopancreatic Diversion ; statistics & numerical data ; trends ; China ; Diabetes Mellitus, Type 2 ; surgery ; Disease Management ; Endoscopy, Digestive System ; statistics & numerical data ; trends ; Gastrectomy ; statistics & numerical data ; trends ; Gastric Bypass ; statistics & numerical data ; trends ; Humans ; Laparoscopy ; statistics & numerical data ; trends ; Metabolic Diseases ; surgery ; Obesity ; surgery ; Robotic Surgical Procedures ; statistics & numerical data ; trends

Along with the soaring prevalence of obesity and type 2 diabetes mellitus (T2DM) globally, metabolic and bariatric surgery (MBS) has been rapidly developing into a major surgical subspecialty. However, the indications, benefits and potential risks of MBS are still controversial so far. In September 2015, the 2nd Diabetes Surgery Summit (DSS-II() was successfully convened, and later on an international joint statement on metabolic surgery in the treatment algorithm for T2DM was released based upon the consensus reached in DSS-II(, aiming to serve as a new global clinical guideline. The DSS-II( joint statement was initiated and endorsed by 5 leading international diabetes organizations, including American Diabetes Association (ADA), International Diabetes Federation (IDF), Chinese Diabetes Society (CDS), Diabetes India, as well as Diabetes UK, and was developed by an expert committee comprised of 48 international authorities as voting delegates. Up to the date of publication, the DSS-II( statement has been officially endorsed by 45 international professional associations/societies, including 30 non-surgical and 15 surgical organizations. In this statement, the following six aspects were recommended to differentiate MBS from traditional bariatric surgery: 1)The primary goal of MBS is to treat T2DM and to reduce the risk of T2DM complications; 2) In addition to a 50% or more of excess weight loss and normalization of glycemia, outcomes of diabetes complications should also be considered as clinical endpoints of MBS; 3) For patient selection, body mass index (BMI), T2DM treatment, as well as long-term risks versus benefits, including its effects on cardiovascular events (CVD), should all be considered; 4) T2DM and its complications, as well as pancreatic function reserve should be assessed pre-operatively; 5) Major surgical options include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB), and bilio-pancreatic diversion with duodenal switch(BPD-DS). BPD-DS has the best outcome in T2DM remission followed by LRYGB, LSG and LAGB; 6) Glycemic variation should be intensively monitored, and if needed, managed following surgery. Clinical follow-up should be conducted at least once every six months within two years after surgery. For patients achieving complete remission from T2DM, diabetes complications should still be monitored within five years after surgery with the same frequency and protocols as pre-operatively.
Aftercare ; standards ; Bariatric Surgery ; methods ; standards ; Biliopancreatic Diversion ; Blood Glucose ; physiology ; Body Mass Index ; Diabetes Mellitus, Type 2 ; surgery ; Disease Management ; Gastrectomy ; Gastric Bypass ; Gastroplasty ; Humans ; Hyperglycemia ; surgery ; Laparoscopy ; Obesity ; surgery ; Patient Care Planning ; standards ; Practice Guidelines as Topic ; standards ; Remission Induction ; methods ; Treatment Outcome ; Weight Loss