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Background and Objective: Lung volume loss, airway obstruction and air flow limitation, and also hypertension are risk factors for mortality in patients with type 2 diabetes. This study was done to determine the effect of supplementation of saffron and exercise training on blood pressure changes, pulmonary function and spirometric indices in obese and overweight women affected by type 2 diabetes.

Methods: In this quasi-experimental study, forty-eight type 2 diabetic obese and overweight women were non randomly divided into four equal groups including placebo, saffron + training, training + placebo, saffron plus placebo). The saffron group + training and training + placebo groups did aerobic training with intensity of 60-75% of maximal heart rate for 8 weeks (three sessions per week). A daily dose of 400 mg of saffron sprout powder (once a day) was used for two months. The variables were measured in the pre-test, 48 hours and two weeks after the last training session.

Results: Intra-group results showed a significant increase in pulmonary function variables (VO2max, FVC, FEV1, FVC/FEV1, PEF, MVV), and significant reduction in systolic blood pressure and anthropometric indices (weight, BMI, and body fat percentage) in all three groups of exercise, saffron and practice + saffron (P<0.05). However, the results intra-group showed a significant difference in the above variables between the exercise + saffron supplement group in compared to other intervention groups (P<0.05), also, the highest effect was observed in the exercise + supplemental group.

Conclusion: According to the results of this study, saffron with exercise led to significant improvement in pulmonary volume and capacities, as well as a decrease in blood pressure in obese and overweight women affected by type 2 diabetes.

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Background and Objective: Obesity by releasing inflammation factors such as Interleukin-6 (IL-6) cause atherosclerosis and cardiovascular diseases. Also, L-carnitine reduces inflammatory factor such as IL-6. The study was done to determine the effect of eight week endurance training with L-carnitine supplementation on IL-6, nitric oxide (NO), blood pressure, and body composition in young obese women.
Methods: In this clinical trial study, 40 volunteer young obese women (age: 23.3±2.3 yrs. and BMI: 31.1±1.4 kg/m²) randomly assigned in the endurance training with L-carnitine (ETL; n=10), endurance training with placebo (ETP; n=10), L-carnitine supplementation (LCS; n=10) and control (Con; n=10). The training protocol consisted of endurance training with gradually increasing of duration and intensity (25-min at 50% HR max and increased to 45-min at 70% HR max), three session a week for 8 weeks. The supplement groups consumed 3gr of L-carnitine daily, while the placebo group ingested the same amount of maltodextrin. Blood pressure and blood samples were obtained before and 36 hours after training protocol, and serum levels of IL-6 and NO were measured by ELISA method.
Results: IL-6, weight, fat mass and fatty percent was significantly reduced in ETL and ETP groups compared to control and LCS groups (P<0.05), and this reduction was lower in the ELT than ETP group (P<0.05). Also, NO was significantly increased in the ELT and ETP groups compared to the LCS and controls (P<0.05).
Conclusion: Although the implementation of endurance training with and without L-carnitine for 8 weeks caused to decrease of IL-6, increase of NO and improved body composition, but the effect of endurance training with L-carnitine on decreasing of IL-6, weight and fat mass was significantly better.

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Background and Objective: Obesity considered to be one of the major health problems and risk factors of a wide range of diseases including diabetes, cardiovascular diseases, blood pressure and various types of cancer. This study was performed to compare the effectiveness of integrated group psychotherapy and cognitive-behavioral stress management on body image and mindful eating of obese women.
Methods: In this clinical trial study, 45 obese women were randomly divided into three groups including integrated group therapy (first intervention), behavioral-cognitive stress management (second intervention) and control groups. All of the three groups fulfilled a pretest but the control group did not receive any intervention. Intervention groups received nine sessions of therapy. Data were collected through questionnaires of body image and mindful eating.
Results: Reduction in worry in body image and mindful eating were observed in integrated group therapy and behavioral-cognitive stress management (P<0.05). However, the difference between mean values of body image and mindful eating scores in behavioral-cognitive stress management and integrated groups were 0.852 and 22.93, respectively which was not significant.
Conclusion: Integrated group therapy and cognitive-behavioral stress management was shown to have an effect on the body image and mindful eating in obese women.

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Background and Objective: Mood disorders such as depression, anxiety, stresses, and low sleep quality are common among overweight / obese people. Accumulating evidence support the role of diet quality in brain function and behavior. This study was done to determine the relationship between dietary energy density and indices of mental health in overweight and obese women.
Methods: This descriptive-analytical study was performed on 301 women, referring to Tehran health centers, with mean BMI 30.7±3.7 kg/m² aged 18-56 years during 2017-18. Based on a semi-quantitative food frequency questionnaire, dietary energy density was calculated by dividing the total dietary energy intake from consumed food (kcal/d) by the total weight (g/d) of consumed foods (excluding beverages). Physical activity was measured using International Physical Activity Questionnaire (IPAQ). The questionnaire includes 7 items to assess the intensity of activities by the vigorous, medium, and light for at least 10 minutes during the last week. Mental health was assessed using the 21-question version of the Depression Anxiety Stress Scales (DASS-21) and the Pittsburgh Sleep Quality Index was applied for screening sleep quality. Weight, height, BMI, hip, and waist circumference were measured for all participants.
Results: Women in the highest quartile of dietary energy density had higher systolic and diastolic blood pressure but lower serum triglyceride (P<0.05), compared with subjects in the first quartile. Univariate (95% CI: 1.01-4.56, P=0.04, OR=2.15) and multivariate (95% CI: 1.13-5.79, P=0.02, OR=2.56) logistic regression analysis, adjusted for age, BMI, and physical activity, showed that dietary energy density was significantly related to increased risk of stress. No significant association was detected between dietary energy density with sleep quality, depression, and anxiety.
Conclusion: Dietary energy density was directly associated with the presence of stress, but not depression, anxiety and low sleep quality.

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Background and Objective: Inactivity and physical inactivity can be one of the main causes of obesity, especially abdominal obesity, hypertension, cardiovascular disease. Abdominal obesity is a serious risk factor for cardiovascular disease which being inversely related to VO₂ max (maximal oxygen consumption). This study was done to determine the non-invasive monitoring of cardiorespiratory fitness and its association with abdominal obesity in men.
Methods: In this descriptive-analytical study, men aged 20-60 years were selected by cluster sampling from different areas of the centers of the three provinces including Qazvin, East Azarbajan and Hamedan in Iran. In accordance with Morgan method, the sample size was 384 men from all provinces which were divided into four age groups. Aerobic power of subjects was assessed by utilizing Bruce, Rockport, Pedometer and International Physical Activity Questionnaire (IPAQ). Waist-to-height ratio (WHtR), Waist-to-hip ratio (WHR), Body adiposity index (BAI), Surface-Based Body Shape Index (SBSI) and body mass index (BMI) was measured for each subject.
Results: Based on the results, in all three provinces as well as the provinces themselves, VO₂ max was significantly different between different age groups (P<0.05). Also, in abdominal obesity indices, a significant difference was in abdominal obesity indices BMI, WHR, WHtR and BAI (P<0.05). There was a significant inverse correlation of the VO₂ max with central obesity indices, except for the SBSI.
Conclusion: Reducing physical activity and consequent cardiorespiratory fitness led to an increase in abdominal obesity indices in different age groups that shows a significant inverse correlation of the VO₂ max with central obesity indices, except for the SBSI.

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Background and Objective: Obesity plays an important role in the development of chronic diseases including diabetes, hyperlipidemia, and cardiovascular diseases (CVD). This study was conducted to evaluate the association of the age of onset of obesity with resting metabolic rate (RMR) in overweight and obese women during adulthood.
Methods: This descriptive-analytical study was done on 295 overweight and obese women aged 18-50 years in Tehran, Iran. The anthropometric measurements of all participants were measured. Dietary intake and total daily energy intake were assessed by using a semi-quantitative food-frequency questionnaire (FFQ) which the list including 147 food items. Resting metabolic rate was measured by indirect calorimetric method. In order to measure the physical activity International Physical Activity Questionnaire (IPAQ) was used. The questionnaire includes 7 items to assess the intensity of activities by the vigorous, medium, and light for at least 10 minutes during the last week.
Results: There was a significant difference between those whose age of onset of obesity was under 18 or over 18, in RMR per body weight (kg) (Beta: 0.16, CI: 0.11 to 0.00, P: 0.03). In addition, it was seen a significant inverse correlation between age of onset of obesity and body weight (Beta: -0.11, CI: -0.30 to 0.00, P: 0.005) and adipose tissue content (Beta: -0.13,
CI: -0.23 to -0.01, P: 0.02). After adjustment for confounders including (age, physical activities, and energy intake), the correlations still remain significant.
Conclusion: Age of onset of obesity was associated with increased weight and fat and decreased resting metabolic rate in adulthood. In fact, people with lower obesity age have higher body weight and fat and lower RMR.

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Background and Objective: Differentiation of white adipose tissue into brown through hormonal and non-hormonal factors, causes weight loss and weakens in obese and overweight people. This study was performed to determine the effect of 12 weeks of interval exercise with different intensities on serum levels of fibroblast growth factor 21 and myostatin in obese and overweight males.
Methods: This clinical trial study was done on 47 obese and overweight males (20.5±0.73 years old). Subjects were randomly divided into four groups: control, interval exercise with low intensity, moderate intensity and high intensity. The exercise program consisted of 12weeks of interval exercise with light, medium and heavy intensity respectively with 58-63, 73-78 and 88-93 percent of Reserve heart rate for 25 to 63 minutes and three sessions per week. Serum indices of fibroblast growth factor 21 and myostatin were measured using fasting blood sample 48 hours before and after exercise program using ELISA method.
Results: Performing 12 weeks of interval training with different intensities was not contribute to significant changes in the serum levels of fibroblast growth factor 21 and myostatin. Implementation of interval exercise at moderate and high intensities was associated with reduction of body fat percentage and increasing in maximal oxygen consumption (VO₂max) in overweight and obese men (P<0.05).
Conclusion: Performing 12 weeks of low, medium and high intensity interval training without changing the serum level of fibroblast growth factor 21 and myostatin has a beneficial effect on improving body composition and increasing VO₂max in obese and overweight young males.

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Background and Objective: Previous studies have advanced our understanding of the impact of executive functions on eating behavior. Given the considerable evidence of executive dysfunction among obese individuals and the bidirectional relationship between cognition and obesity, it is crucial to include educational components in interventions aimed at enhancing executive functions among obese populations. This study aimed to evaluate the effectiveness of cognitive hypnotherapy in improving executive functions among women with obesity.
Methods: This clinical trial enrolled 30 obese women who were randomly assigned to either an intervention or control group (n=15). The mean ages of the experimental and control groups, respectively, were 40.80±6.02 and 38.47±7.50 years, while their BMIs (kg/m2) were 33.45±3.50 and 33.12±3.47, and hypnotizability scores were 39.67±5.98 and 37.40±7.09. The intervention group received 12 sessions of 2-hour cognitive hypnotherapy. Data collection instruments included the Stanford Hypnosis Susceptibility Scale (1962), Life Experiences, Interests and Values Checklist (1998), and Cognitive Ability Questionnaire (2013).
Results: The results demonstrated that cognitive hypnotherapy significantly improved executive functions (F=7.02, P≤0.01), including inhibitory control and selective attention (F=2.83, P≤0.05), decision making (F=4.13, P≤0.05), planning (F=3.32, P≤0.05), and sustained attention (F=2.83, P≤0.05) in the intervention group.
Conclusion: Given the relationship between cognitive abilities, eating behaviors, and obesity, and the effectiveness of cognitive hypnotherapy in enhancing executive functions, this approach can be used to enhance cognitive functions among individuals with obesity.
 

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Background and Objective: Obesity is a well-known public health problem that affects people of all ages. It has myriad effects on several body tissues, including the thyroid, in both human and animal models. Some treatments, such as dietary modification and physical activity, may be effective or ineffective in reducing obesity. Accordingly, the present research investigated the effects of obesity on thyroid tissue and the impact of diet modification and aerobic exercises on histopathological and hormonal changes in the thyroid tissue of obese male rats.
Methods: In this experimental study, for obesity induction, 50 three-week-old male Wistar rats were exposed to a high-fat diet (including 40% fat, 40% protein, and 20% carbohydrate) for 12 weeks. Then, 25 rats were randomly divided into 5 groups: healthy control, obese + high-fat diet, obese + normal diet, obese + high-fat diet + aerobic, obese + normal diet + aerobic. After the induction of obesity, 2 groups were given a standard diet (including 20% fat, 10% protein, and 70% carbohydrates). Aerobic exercises for 8 weeks included 30 minutes per day, 8 m/min, and 5 days per week. After anesthesia, an autopsy was performed, and the thyroid tissue was sent to the laboratory for histopathological studies. Also, 5 cc of blood was taken to study TSH, T3, and T4 using a radioimmunoassay kit.
Results: The serum levels of TSH hormone increased slightly in the high-fat diet groups compared to the control group and the normal diet with/without aerobic activity group. Also, the amount of T3 hormone in the group receiving a normal diet along with aerobic activity was significantly lower than in the control, high-fat diet, and high-fat diet along with aerobic activity groups (P<0.05). The T4 hormone increased significantly in all obesity groups compared to the control group (P<0.05), and these values were at the level of the control group (P<0.05) only in the group receiving the normal diet along with aerobic activity. Regarding the histopathological results, many changes were found in the follicular, parafollicular, and follicle cells of the thyroid tissue in the obesity group continuing the high-fat diet; these changes were significantly reduced in the groups for which the diet was changed to the normal diet alone and with aerobic activity.
Conclusion: Induction of obesity causes significant structural and biochemical changes in the thyroid, and the combination of diet modification and aerobic activity is more effective in alleviating these changes.

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Background and Objective: Weight regain following bariatric surgery is a significant challenge for this obesity treatment method. This study aimed to identify factors associated with weight regain after bariatric surgeries in obese patients in Gorgan, Iran.
Methods: This longitudinal study included 143 obese individuals (125 women and 18 men) with a mean age of 43.13±9.83 years who underwent bariatric surgery in Gorgan, Iran during 2013-19. Participants were invited to join the study via phone calls. Research variables (type of surgery, blood group, pre-surgery weight, and body mass index [BMI]) were extracted from patient records, and their current weight and waist circumference were measured and recorded. Weight regain was determined based on one of three different criteria: (1) regaining more than 25% of the maximum weight lost post-surgery, (2) regaining more than 10 kg from the minimum weight post-surgery, or (3) an increase of more than 5 BMI units from the lowest BMI post-surgery.
Results: Overall, 33% of individuals experienced weight regain, with 26.6% according to the first definition, 29.4% according to the second definition, and 18.2% according to the third definition. Men had a higher rate of weight regain (P<0.05). Additionally, 93.6% (44 cases) of those with weight regain had abdominal obesity. On average, 79.7% of participants who were 48 months post-bariatric surgery experienced some degree of weight regain. Individuals with a pre-surgery BMI of 50 or higher had a 2.69 times greater chance of weight regain compared to those with BMI lower 50 (P<0.05). The mean weight loss after surgery was significantly higher in individuals who experienced weight regain than those who did not (P<0.05). There was no significant statistical association between weight regain and the type of surgery, age, education level, marital status, or blood group.
Conclusion: Weight regain over time is a reality after bariatric surgery, indicating that this method is not a definitive cure for obesity. Therefore, long-term follow-up for weight control is crucial, especially for individuals with a pre-surgery BMI of 50 or higher or those who experienced significant weight loss post-surgery.

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Vitamin D deficiency affects a broad range of health-related factors. Both obesity and vitamin D deficiency are associated with the development of oxidative stress and systemic inflammation. Inflammation can culminate in decreased vitamin D levels through the induction of oxidative stress. Evidence suggests that exercise may improve vitamin D status. However, the effects of exercise interventions on inflammation and oxidative stress in the coexistence of vitamin D deficiency and obesity/overweight are not well-established. Therefore, this review aimed to evaluate the effects of exercise on inflammation and oxidative stress in vitamin D deficiency status accompanied by obesity/overweight. A search for articles from 2006 to 2023 was conducted in specialized databases of PubMed, Scopus, and state inpatient database (SID). The searched studies were original research articles, reviews, and clinical trials selected using the keywords of vitamin D deficiency, systemic inflammation, oxidative stress, chemokine, exercise, obesity, and overweight. According to the studies, regular exercise can inhibit the vicious cycle of oxidative stress-inflammation in vitamin D deficiency status accompanied by obesity/overweight by negatively regulating some inflammatory factors and chemokines, reducing lipid peroxidation levels, and increasing antioxidant status. Moreover, the increase in 25-hydroxyvitamin D levels resulting from exercise can be considered another mechanism for reducing oxidative stress-inflammation in vitamin D deficiency status accompanied by obesity/overweight.