Achievement of Guideline-Recommended Weight Loss Among Patients With Ischemic Stroke and Obesity

Abstract

Background and Purpose: The proportion of patients with acute ischemic stroke or transient ischemic attack (TIA) and obesity who successfully achieve goals for weight reduction recommended by major professional organizations is unknown. Methods: We examined the experience of participants in the placebo group of the Insulin Resistance Intervention after Stroke (IRIS) trial with a body mass index (BMI) ≥30 kg/m 2 at entry. Patients were age 40 or greater, with a qualifying stroke or TIA within 180 days of randomization and documented insulin resistance without diabetes. Weights at baseline and at years 1 and 2 after entry were analyzed to determine the proportion of patients achieving a 5% weight loss and/or achievement of BMI <27 kg/m 2. Results: Of 1937 subjects assigned to placebo, 855 (44%) had obesity at entry. Median age of these 855 subjects was 60 years (interquartile range, 53 to 68), 41% were women and median time from stroke/TIA to trial entry was 79 days. Among 788 subjects in the trial at one year, 166 (21%) had lost at least 5% of their starting weight and 12 (2%) had achieved a BMI <27 kg/m 2. 109 (14%) participants gained at least 5% of their baseline weight at one year. Among 744 subjects in the trial at two years, 185 (25%) had lost at least 5% of their baseline weight, and 23 (3%) had achieved a BMI <27 kg/m 2. 140 (19%) participants gained at least 5% of their starting weight at two years. Conclusions: Only one-quarter of obese patients with a recent ischemic stroke or TIA lost a clinically significant amount of weight after their vascular event. Many patients gained weight. Enhancing weight loss after ischemic stroke or TIA may help improve functional outcome and

Stages and Processes of Change for Weight Loss in Acute Stroke or TIA Patients Living with Obesity

“…More than one-third of the US adult population is living with obesity [ 1 ]. Among patients with recent stroke or TIA, the prevalence of obesity is likely even higher [ 2 ]. Obesity is associated with increased prevalence of vascular risk factors such as diabetes, hyperlipidemia, and hypertension [ 3 ] and increased incidence of stroke [ 4 ].…”

A cross-sectional study of the association between breastfeeding history and overweight/obesity in postmenopausal women

“…Potential confounders for depression were chosen, grounded upon antecedent investigations, encompassing factors like chronological age, age at birth, education level, energy intake, sitting time, leisure physical activity (LPA), smoking, acyeterion, diabetes, cancer or malignancy, myocardial infarction, cerebral stroke, coronary heart disease, chronic gastroenteritis, gastroduodenal ulcer, chronic bronchitis, emphysema, and parity 17‐22 …”

“…Potential confounders for depression were chosen, grounded upon antecedent investigations, encompassing factors like chronological age, age at birth, education level, energy intake, sitting time, leisure physical activity (LPA), smoking, acyeterion, diabetes, cancer or malignancy, myocardial infarction, cerebral stroke, coronary heart disease, chronic gastroenteritis, gastroduodenal ulcer, chronic bronchitis, emphysema, and parity. [17][18][19][20][21][22] A thorough questionnaire, administered by skilled nursing practitioners, gathered sociodemographic and lifestyle data. The survey elicited information regarding participants' age (y), age at childbirth (y), smoking status (nonsmokers, former smokers, current smokers), level of education (ranging from illiteracy to college education or higher), parity, menopausal status (premenopausal, postmenopausal), total duration of breastfeeding (exclusive breastfeeding, formula free), contraceptive usage (ever used, never used), and diabetes history (positive or negative), chronic gastroenteritis (positive or negative), cancer or malignancy (positive or negative), myocardial infarction (positive or negative), cerebral stroke (positive or negative), gastroduodenal ulcer (positive or negative), chronic bronchitis (positive or negative), and emphysema (positive or negative).…”

Primary Care of Adult Patients After Stroke: A Scientific Statement From the American Heart Association/American Stroke Association

“…17,18 Only 17% achieve a healthy weight (body mass index <25 kg/m 2 ). 16,19 Unmet needs for physical rehabilitation, activities of daily living, mobility, pain control, and communication remain prevalent. 20 Many factors beyond the control of primary care clinicians contribute to shortfalls in poststroke care, including social factors (eg, lack of health insurance, lack of access to care for other reasons, social isolation, structural racism), lack of perceived benefit from therapy, or fear of side effects.…”