{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T16:19:14Z","timestamp":1773332354432,"version":"3.50.1"},"reference-count":59,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,21]],"date-time":"2021-11-21T00:00:00Z","timestamp":1637452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Lifestyle modification is the cornerstone of management for patients with severe and complicated obesity, but the effects of structured lifestyle programmes on quality of life, anxiety and depression scores and cardiovascular risk factors are not well-described. We sought to describe changes in self-reported quality of life and mental health-related outcomes as well as cardiovascular risk factors in patients completing a 10-week multidisciplinary lifestyle-modification programme. Methods: We conducted a prospective cohort study of all patients referred from our bariatric service who completed the programme between 2013 and 2019. In addition to weight, body mass index (BMI), blood pressure, HbA1c, lipid profile and functional capacity, we quantified health-related quality of life using the Dartmouth COOP Questionnaire and the European Quality of Life Questionnaire Visual Analogue Scale (EQVAS) and mental health using the Hospital Anxiety and Depression Scale (HADS). Results: Of 1122 patients who started the programme, 877 (78.2%) completed it and were included in per protocol analyses. Mean age was 47.3 \u00b1 11.9 years, 66.9% were female, 34.8% were in full- or part-time employment and 69.4% were entitled to state-provided medical care. BMI decreased from 47.0 \u00b1 7.8 to 46.2 \u00b1 7.8 kg m\u22122 and weight decreased from 131.6 \u00b1 25.5 to 129.5 \u00b1 25.4 kg (both p &lt; 0.001). There were significant reductions in anxiety and depression scores and improvements in all Dartmouth COOP domains. The EQVAS score increased from 52 \u00b1 22 to 63 \u00b1 19 (p &lt; 0.001). Small but statistically significant reductions in LDL cholesterol, systolic blood pressure and HBA1c were also observed. Conclusions: Adults with severe and complicated obesity completing a specialised bariatric lifestyle-modification programme showed significant improvements in self-reported mental health and quality of life, in addition to reductions in cardiovascular risk factors.<\/jats:p>","DOI":"10.3390\/nu13114172","type":"journal-article","created":{"date-parts":[[2021,11,21]],"date-time":"2021-11-21T21:00:50Z","timestamp":1637528450000},"page":"4172","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Improved Quality of Life, Fitness, Mental Health and Cardiovascular Risk Factors with a Publicly Funded Bariatric Lifestyle Intervention for Adults with Severe Obesity: A Prospective Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"given":"John Francis","family":"Brazil","sequence":"first","affiliation":[{"name":"Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, HRB Clinical Research Facility, Galway University Hospital, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Gibson","sequence":"additional","affiliation":[{"name":"Heart and Stroke Center, Croi, The West of Ireland Cardiac Foundation, Moyola Lane, Newcastle, H91 FF68 Galway, Ireland"},{"name":"National Institute for Prevention and Cardiovascular Health (NIPC), Newcastle, H91 FF68 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Dunne","sequence":"additional","affiliation":[{"name":"Heart and Stroke Center, Croi, The West of Ireland Cardiac Foundation, Moyola Lane, Newcastle, H91 FF68 Galway, Ireland"},{"name":"National Institute for Prevention and Cardiovascular Health (NIPC), Newcastle, H91 FF68 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa B.","family":"Hynes","sequence":"additional","affiliation":[{"name":"Heart and Stroke Center, Croi, The West of Ireland Cardiac Foundation, Moyola Lane, Newcastle, H91 FF68 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aisling","family":"Harris","sequence":"additional","affiliation":[{"name":"Heart and Stroke Center, Croi, The West of Ireland Cardiac Foundation, Moyola Lane, Newcastle, H91 FF68 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"Bakir","sequence":"additional","affiliation":[{"name":"Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, HRB Clinical Research Facility, Galway University Hospital, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0863-4222","authenticated-orcid":false,"given":"Dylan","family":"Keegan","sequence":"additional","affiliation":[{"name":"Heart and Stroke Center, Croi, The West of Ireland Cardiac Foundation, Moyola Lane, Newcastle, H91 FF68 Galway, Ireland"},{"name":"National Institute for Prevention and Cardiovascular Health (NIPC), Newcastle, H91 FF68 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"McGuire","sequence":"additional","affiliation":[{"name":"Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, HRB Clinical Research Facility, Galway University Hospital, H91 YR71 Galway, Ireland"},{"name":"School of Psychology, National University of Ireland, H91 TK33 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Hynes","sequence":"additional","affiliation":[{"name":"Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, HRB Clinical Research Facility, Galway University Hospital, H91 YR71 Galway, Ireland"},{"name":"School of Psychology, National University of Ireland, H91 TK33 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Upper Gastrointestinal Surgery, Galway University Hospital, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siobhan","family":"Foy","sequence":"additional","affiliation":[{"name":"Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, HRB Clinical Research Facility, Galway University Hospital, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne","family":"Seery","sequence":"additional","affiliation":[{"name":"National Institute for Prevention and Cardiovascular Health (NIPC), Newcastle, H91 FF68 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Bassett","sequence":"additional","affiliation":[{"name":"Statsconsultancy Ltd., Amersham HP7 9EN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin","family":"Davenport","sequence":"additional","affiliation":[{"name":"Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, HRB Clinical Research Facility, Galway University Hospital, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Jones","sequence":"additional","affiliation":[{"name":"Heart and Stroke Center, Croi, The West of Ireland Cardiac Foundation, Moyola Lane, Newcastle, H91 FF68 Galway, Ireland"},{"name":"National Institute for Prevention and Cardiovascular Health (NIPC), Newcastle, H91 FF68 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis M.","family":"Finucane","sequence":"additional","affiliation":[{"name":"Bariatric Medicine Service, Centre for Diabetes, Endocrinology and Metabolism, HRB Clinical Research Facility, Galway University Hospital, H91 YR71 Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1056\/NEJMsa1909301","article-title":"Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity","volume":"381","author":"Ward","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_2","first-page":"1052","article-title":"Unmet need for bariatric surgery","volume":"13","author":"Finucane","year":"2016","journal-title":"Surg. Obes. Relat. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1056\/NEJMoa1614362","article-title":"Health Effects of Overweight and Obesity in 195 Countries over 25 Years","volume":"377","author":"Collaborators","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e006189","DOI":"10.1136\/bmjopen-2014-006189","article-title":"Overweight and obesity on the island of Ireland: An estimation of costs","volume":"5","author":"Dee","year":"2015","journal-title":"BMJ Open"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Keaver, L., Webber, L., Dee, A., Shiely, F., Marsh, T., Balanda, K., and Perry, I.J. (2013). Application of the UK foresight obesity model in Ireland: The health and economic consequences of projected obesity trends in Ireland. PLoS ONE, 8.","DOI":"10.1371\/annotation\/3dd20b6b-2a94-4542-a058-2cc7effe881a"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1001\/jama.2018.13022","article-title":"Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: US Preventive Services Task Force Recommendation Statement","volume":"320","author":"Curry","year":"2018","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"g6608","DOI":"10.1136\/bmj.g6608","article-title":"Identification, assessment, and management of overweight and obesity: Summary of updated NICE guidance","volume":"349","author":"Stegenga","year":"2014","journal-title":"BMJ"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2985","DOI":"10.1016\/j.jacc.2013.11.004","article-title":"2013 AHA\/ACC\/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines and The Obesity Society","volume":"63","author":"Jensen","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1056\/NEJMoa1212914","article-title":"Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes","volume":"369","author":"Wing","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1016\/S0140-6736(08)60766-7","article-title":"The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: A 20-year follow-up study","volume":"371","author":"Li","year":"2008","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1016\/S0140-6736(06)69701-8","article-title":"Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: Follow-up of the Finnish Diabetes Prevention Study","volume":"368","author":"Lindstrom","year":"2006","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1056\/NEJMoa012512","article-title":"Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin","volume":"346","author":"Knowler","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"659","DOI":"10.7326\/0003-4819-143-9-200511010-00010","article-title":"Meta-analysis: Secondary prevention programs for patients with coronary artery disease","volume":"143","author":"Clark","year":"2005","journal-title":"Ann. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1056\/NEJMoa066254","article-title":"Effects of bariatric surgery on mortality in Swedish obese subjects","volume":"357","author":"Sjostrom","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1056\/NEJMoa1200225","article-title":"Bariatric surgery versus intensive medical therapy in obese patients with diabetes","volume":"366","author":"Schauer","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_16","first-page":"CD003641","article-title":"Surgery for weight loss in adults","volume":"8","author":"Colquitt","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1111\/cob.12161","article-title":"Lifestyle interventions for weight loss in adults with severe obesity: A systematic review","volume":"6","author":"Hassan","year":"2016","journal-title":"Clin. Obes."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1001\/archinternmed.2009.508","article-title":"Nonsurgical weight loss for extreme obesity in primary care settings: Results of the Louisiana Obese Subjects Study","volume":"170","author":"Ryan","year":"2010","journal-title":"Arch. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"197","DOI":"10.2147\/DMSO.S226327","article-title":"Effects of a Milk-Based Meal Replacement Program on Weight and Metabolic Characteristics in Adults with Severe Obesity","volume":"13","author":"Rafey","year":"2020","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"551068","DOI":"10.3389\/fnut.2020.551068","article-title":"Long-Term Changes in Weight in Patients With Severe and Complicated Obesity After Completion of a Milk-Based Meal Replacement Programme","volume":"7","author":"Abdalgwad","year":"2020","journal-title":"Front Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1755","DOI":"10.1016\/j.jada.2007.07.017","article-title":"Weight-loss outcomes: A systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up","volume":"107","author":"Franz","year":"2007","journal-title":"J. Am Diet. Assoc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1016\/j.jand.2014.07.005","article-title":"Diet or Exercise Interventions vs Combined Behavioral Weight Management Programs: A Systematic Review and Meta-Analysis of Direct Comparisons","volume":"114","author":"Johns","year":"2014","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1159\/000362191","article-title":"An EASO position statement on multidisciplinary obesity management in adults","volume":"7","author":"Yumuk","year":"2014","journal-title":"Obes. Facts"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1093\/pubmed\/fdi025","article-title":"The impact of obesity on health-related quality-of-life in the general adult US population","volume":"27","author":"Jia","year":"2005","journal-title":"J. Public. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1001\/jama.289.14.1813","article-title":"Health-Related Quality of Life of Severely Obese Children and Adolescents","volume":"289","author":"Schwimmer","year":"2003","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1080\/07315724.2016.1261053","article-title":"Overweight and Obesity Associated with Higher Depression Prevalence in Adults: A Systematic Review and Meta-Analysis","volume":"36","author":"Costa","year":"2017","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1038\/ijo.2009.252","article-title":"The association between obesity and anxiety disorders in the population: A systematic review and meta-analysis","volume":"34","author":"Gariepy","year":"2010","journal-title":"Int. J. Obes."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1111\/obr.12752","article-title":"A systematic review and meta-analysis of lifestyle interventions in women of reproductive age with overweight or obesity: The effects on symptoms of depression and anxiety","volume":"19","author":"Wekker","year":"2018","journal-title":"Obes. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1038\/ijo.2011.2","article-title":"Intentional weight loss and changes in symptoms of depression: A systematic review and meta-analysis","volume":"35","author":"Fabricatore","year":"2011","journal-title":"Int. J. Obes."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1002\/hec.3383","article-title":"Measuring Socioeconomic Inequality in Obesity: Looking Beyond the Obesity Threshold","volume":"26","author":"Bilger","year":"2017","journal-title":"Health Econ."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1016\/S0140-6736(08)60868-5","article-title":"Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asymptomatic individuals at high risk of cardiovascular disease: A paired, cluster-randomised controlled trial","volume":"371","author":"Wood","year":"2008","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1177\/2047487313498831","article-title":"Translating guidelines to practice: Findings from a multidisciplinary preventive cardiology programme in the west of Ireland","volume":"21","author":"Gibson","year":"2014","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1177\/0890117120931711","article-title":"Evaluation of a Community-Based Cardiovascular Prevention Program in Patients With Type 2 Diabetes","volume":"35","author":"Finn","year":"2021","journal-title":"Am. J. Health Promot."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12902-015-0038-x","article-title":"Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults","volume":"15","author":"Crowe","year":"2015","journal-title":"BMC Endocr. Disord."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/eurheartj\/ehy339","article-title":"2018 ESC\/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)","volume":"39","author":"Williams","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1136\/thx.47.12.1019","article-title":"Development of a shuttle walking test of disability in patients with chronic airways obstruction","volume":"47","author":"Singh","year":"1992","journal-title":"Thorax"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/1477-7525-1-29","article-title":"The Hospital Anxiety And Depression Scale","volume":"1","author":"Snaith","year":"2003","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1097\/00005650-199711000-00002","article-title":"Modeling valuations for EuroQol health states","volume":"35","author":"Dolan","year":"1997","journal-title":"Med. Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1093\/fampra\/16.2.190","article-title":"Questions you didn\u2019t ask? COOP\/WONCA Charts in clinical work and research. World Organization of Colleges, Academies and Academic Associations of General Practitioners\/Family Physicists","volume":"16","author":"Bentsen","year":"1999","journal-title":"Fam. Pr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1093\/clinchem\/18.6.499","article-title":"Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge","volume":"18","author":"Friedewald","year":"1972","journal-title":"Clin. Chem."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1093\/eurheartj\/ehs092","article-title":"European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts)","volume":"33","author":"Perk","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1017\/S1352465809005128","article-title":"Ten things that motivational interviewing is not","volume":"37","author":"Miller","year":"2009","journal-title":"Behav. Cogn. Psychother."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.1093\/eurheartj\/ehw272","article-title":"2016 ESC\/EAS Guidelines for the Management of Dyslipidaemias","volume":"37","author":"Catapano","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2315","DOI":"10.1093\/eurheartj\/ehw106","article-title":"2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)","volume":"37","author":"Piepoli","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e029473","DOI":"10.1136\/bmjopen-2019-029473","article-title":"Acceptability and feasibility of weight management programmes for adults with severe obesity: A qualitative systematic review","volume":"9","author":"Skea","year":"2019","journal-title":"BMJ Open"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/cob.12011","article-title":"The effectiveness of secondary and tertiary care lifestyle intervention in morbidly obese patients: A 1-year non-randomized controlled pragmatic clinical trial","volume":"3","author":"Gjevestad","year":"2013","journal-title":"Clin. Obes."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1001\/jama.2018.7777","article-title":"Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the U.S. Preventive Services Task Force","volume":"320","author":"LeBlanc","year":"2018","journal-title":"JAMA"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1038\/oby.2011.102","article-title":"Validity of weight loss to estimate improvement in body composition in individuals attending a wellness center","volume":"19","author":"Cruz","year":"2011","journal-title":"Obesity"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1001\/jama.282.16.1547","article-title":"Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men","volume":"282","author":"Wei","year":"1999","journal-title":"JAMA"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s12902-019-0394-z","article-title":"Associations between cardiorespiratory fitness and weight loss in patients with severe obesity undergoing an intensive lifestyle intervention program: Retrospective cohort study","volume":"19","author":"Berge","year":"2019","journal-title":"BMC Endocr. Disord."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e653","DOI":"10.1161\/CIR.0000000000000461","article-title":"Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association","volume":"134","author":"Ross","year":"2016","journal-title":"Circulation"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1007\/s00125-018-4729-5","article-title":"Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)","volume":"61","author":"Davies","year":"2018","journal-title":"Diabetologia"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/PSY.0b013e3181651651","article-title":"Overweight and obesity are associated with psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"70","author":"Petry","year":"2008","journal-title":"Psychosom. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.jpsychores.2008.09.008","article-title":"Associations of obesity with psychiatric disorders and suicidal behaviors in a nationally representative sample","volume":"66","author":"Mather","year":"2009","journal-title":"J. Psychosom. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"273","DOI":"10.3109\/07853890.2013.874660","article-title":"Beyond weight reduction: Improvements in quality of life after an intensive lifestyle intervention in subjects with severe obesity","volume":"46","author":"Danielsen","year":"2014","journal-title":"Ann. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.2337\/dc13-1928","article-title":"Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: The Look AHEAD Trial","volume":"37","author":"Rubin","year":"2014","journal-title":"Diabetes Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e3458","DOI":"10.1002\/dmrr.3458","article-title":"Improvement in mood symptoms after post-bariatric surgery among people with obesity: A systematic review and meta-analysis","volume":"37","author":"Loh","year":"2021","journal-title":"Diabetes Metab Res. Rev."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e12998","DOI":"10.1111\/obr.12998","article-title":"Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review","volume":"21","author":"Spirou","year":"2020","journal-title":"Obes. Rev."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/4172\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:33:38Z","timestamp":1760168018000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/11\/4172"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,21]]},"references-count":59,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["nu13114172"],"URL":"https:\/\/doi.org\/10.3390\/nu13114172","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,21]]}}}