151
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Bihan H, Choleau C, Catheline JM, Reach G, Fournier JL, Garnier N, Robert F, Poulhès C, Sidotmane F, Bénichou J, Cohen R. Parcours multidisciplinaire du candidat à une gastroplastie. Presse Med 2008; 37:470-6. [PMID: 17618077 DOI: 10.1016/j.lpm.2007.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The decision to perform gastroplasty must be made by a multidisciplinary team. This organization ensures compliance with good practice guidelines. Multidisciplinary management after surgery is also essential but patients' adhesion to follow-up is relatively poor.
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Affiliation(s)
- Hélène Bihan
- Service d'endocrinologie et Université Paris XIII (Centre de recherche en nutrition humaine)
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152
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Bruno RS, Dugan CE, Smyth JA, DiNatale DA, Koo SI. Green tea extract protects leptin-deficient, spontaneously obese mice from hepatic steatosis and injury. J Nutr 2008; 138:323-31. [PMID: 18203899 DOI: 10.1093/jn/138.2.323] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The incidence of nonalcoholic fatty liver disease (NAFLD) has risen along with the ongoing obesity epidemic. Green tea extract (GTE) inhibits intestinal lipid absorption and may regulate hepatic lipid accumulation. The objective of this study was to determine whether GTE protects against hepatic lipid accumulation during the development of NAFLD in an obese mouse model. Five-wk-old ob/ob (obese) mice and their lean littermates (8 mice x genotype(-1) x dietary treatment(-1)) were fed GTE at 0, 1, or 2% (wt:wt) for 6 wk. The body weights of obese mice and lean littermates fed diets containing GTE were 23-25% and 11-20% lower (P < 0.05) than their respective controls fed no GTE. Histologic evaluation showed a significant reduction in hepatic steatosis in GTE-fed obese mice only and histologic scores were correlated with hepatic lipid concentration (r = 0.84; P < 0.05), which was reduced dose dependently by GTE. GTE protected against hepatic injury as suggested by 30-41% and 22-33% lower serum alanine aminotransferase and aspartate aminotransferase activities, respectively. Hepatic alpha-tocopherol was 36% higher in obese mice than lean mice. GTE tended (P = 0.06) to lower hepatic alpha-tocopherol, which was not fully explained by the GTE-mediated reduction in hepatic lipid. Hepatic ascorbic acid was lower in obese mice than in lean mice (P < 0.05) and was unaltered by GTE. Obese mice had lower serum adiponectin than lean mice and this was not affected by GTE. The results suggest that GTE protects against NAFLD by limiting hepatic lipid accumulation and injury without affecting hepatic antioxidant status and adiponectin-mediated lipid metabolism. Further study is underway to define the events by which GTE protects against obesity-triggered NAFLD.
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Affiliation(s)
- Richard S Bruno
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT 06269-4017, USA.
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153
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Adipositas ist mehr als eine Essstörung - die multidimensionale Betrachtung einer Pandemie. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2008; 54:4-31. [DOI: 10.13109/zptm.2008.54.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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154
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Svendsen M, Rissanen A, Richelsen B, Rössner S, Hansson F, Tonstad S. Effect of orlistat on eating behavior among participants in a 3-year weight maintenance trial. Obesity (Silver Spring) 2008; 16:327-33. [PMID: 18239640 DOI: 10.1038/oby.2007.82] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the effect of orlistat on dietary restraint, disinhibition, hunger, and binge eating and to understand the relation between changes in eating behavior and weight maintenance. METHODS AND PROCEDURES Subjects were 306 women and men (age: 19-45 years; BMI: 37.5 +/- 4.1 kg/m(2)) included in the Scandinavian Multicenter study of Obese subjects with the Metabolic Syndrome, a 3-year clinical trial of orlistat or placebo following an 8-week very low energy diet (VLED). Outcomes were changes in weight and in the Three Factor Eating Questionnaire (TFEQ) and Binge Eating Scale (BES) between screening and 17 and 33 months after randomization. As reported previously, weight gain following VLED was lower in subjects treated with orlistat than with placebo. RESULTS Compared to screening results, dietary restraint was increased and disinhibition, hunger, and binge eating were decreased in both groups. These changes were similar in both groups with the exception of the hunger score at month 33 that was reduced more in the placebo than in the orlistat group (difference between groups -1.1 (95% CI (-2.0, -0.2)) P = 0.014). In multivariate analyses, scores for restraint, disinhibition and binge eating were associated with weight loss after adjustment for BMI, gender, age, and treatment (all P < or = 0.002, model R (2) = 0.12-0.17). DISCUSSION Orlistat did not affect eating behavior differently in any substantial way than the placebo did in this long-term weight maintenance trial. The results indicate that increased restraint and decreased disinhibition and binge eating are important for sustained weight maintenance in obese subjects with the metabolic syndrome.
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Affiliation(s)
- Mette Svendsen
- Department of Preventive Cardiology, Ullevål University Hospital, Oslo, Norway.
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155
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Giusti V. Management of Obesity in Patients with Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2007; 34:576-82. [PMID: 17683956 DOI: 10.1016/j.ejvs.2007.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 05/09/2007] [Indexed: 10/23/2022]
Abstract
Obesity is a major risk factor for cardiovascular disorders, including peripheral arterial disease. This review outlines the evidence for a 6-step process for the management of obesity, starting with identifying the degree and type of obesity, followed by target setting, life style and behavioural changes, imposed hypocaloric diet and physical activity, pharmacological treatment and consideration of eating disorders and/or bariatric surgery.
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Affiliation(s)
- V Giusti
- Service of Endocrinology, Diabetology and Metabolism, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
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156
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Abstract
The goal of good concepts for treating obesity is to achieve sustained changes in lifestyle. Formula diets are in fact superior to hypocaloric diets, but the results of diet only approaches are consistently disappointing. Formula diets or very low calorie diets should thus be undertaken in conjunction with an overall therapeutic concept under a physician's supervision together with psychological and nutritional education as well as guidance in exercise therapy. These treatment strategies can be carried out successfully in the outpatient setting. On a long-term basis, reducing the costs of health care will only be feasible by implementing prevention programs during childhood and adolescence. Preventive measures focusing on nutrition should lay the foundation in kindergartens and schools to control the epidemic-like spread of obesity.
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Affiliation(s)
- J G Wechsler
- Abteilung Innere Medizin, Krankenhaus Barmherzige Brüder München, Romanstrasse 93, 80639, München, Germany.
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157
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Trinko R, Sears RM, Guarnieri DJ, DiLeone RJ. Neural mechanisms underlying obesity and drug addiction. Physiol Behav 2007; 91:499-505. [PMID: 17292426 DOI: 10.1016/j.physbeh.2007.01.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 01/08/2007] [Accepted: 01/08/2007] [Indexed: 11/29/2022]
Abstract
Increasing rates of obesity have alarmed health officials and prompted much public dialogue. While the factors leading to obesity are numerous, an inability to control intake of freely available food is central to the problem. In order to understand this, we need to better define the mechanisms by which the brain regulates food intake, and why it is often difficult to control consumption. From this point of view, it seems valuable to consider the commonalities between food intake and drug abuse. While research in the two fields has historically emphasized different neural substrates, recent data have increased interest in better defining elements that may underlie both drug addiction and obesity. Here we discuss some of these shared elements with an emphasis on emerging areas of research that better define common mechanisms leading to overconsumption.
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Affiliation(s)
- Richard Trinko
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA
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158
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159
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Martínez JJG, Ruiz FA, Candil SD. Baseline serum folate level may be a predictive factor of weight loss in a morbid-obesity-management programme. Br J Nutr 2007; 96:956-64. [PMID: 17092388 DOI: 10.1017/bjn20061899] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prompt identification of responders to non-surgical therapy is of utmost importance in attempting medical treatment in patients with clinically severe obesity before indication of bariatric surgery. The objectives of the present study were to assess the outcome at 1 year of morbidly obese patients undergoing a weight-loss medical programme and to detect baseline predictors of a loss ≥10 % of initial weight at the end of the follow-up. A longitudinal, prospective study of a cohort of morbidly obese patients (n 182; females 78 %; age 40·5 (sd 11·5) years; BMI 45·4 (sd 6·0) kg/m2) enrolled in a 1-year obesity-management programme based on lifestyle changes and pharmacological therapy. Significant laboratory and clinical variables were included in a binary logistic regression model in order to identify baseline independent factors for the prediction of a successful outcome in the programme. At 12 months of follow-up, twenty-one subjects (11·5 % of the initial cohort) had lost ≥10 % of baseline weight. A high serum folic acid level was the only independent predictor of weight loss at 1 year. A rise of 1 ng/ml in serum folate increased the chance of success by 28 % (adjusted odds ratio 1·28; 95 % CI 1·04, 1·58). We concluded that a medical-management programme of morbid obesity obtained limited results at 1 year, in agreement with other intervention studies. Serum folate may be useful as a pre-treatment predictor of response to a medical-management programme in patients with morbid obesity. Patients with low basal serum folate levels probably should be urged to change unhealthy eating patterns.
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Affiliation(s)
- J J Gorgojo Martínez
- Unit of Endocrinology and Nutrition, Fundación Hospital Alcorcón, C/ Budapest 1, 28922 Alcorcón, Madrid, Spain.
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160
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Beutel ME, Dippel A, Szczepanski M, Thiede R, Wiltink J. Mid-term effectiveness of behavioral and psychodynamic inpatient treatments of severe obesity based on a randomized study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2007; 75:337-45. [PMID: 17053334 DOI: 10.1159/000095439] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objective of this study was to compare the effectiveness of psychodynamic and behavioral inpatient treatments of severely obese patients regarding weight and distress. METHODS In a longitudinal study obese patients (body mass index, BMI >or=35) were randomly assigned to behavioral or to psychodynamic inpatient treatment. Mostly female (n = 267; 85%) obese patients with psychiatric and somatic comorbidity (age 20-64 years, BMI 35-74) were examined with standardized self-report scales on distress (SCL-90R), interpersonal problems (Inventory of Interpersonal Problems), eating behavior (Fragebogen zum Essverhalten) and body image (Fragebogen zum Korperbild). RESULTS During 49 days (mean) of inpatient treatment, patients lost an average of 5.6 kg (4.4%) in the behavioral (n = 130) and 5.7 kg (4.4%) in the psychodynamic setting (n = 137). In both settings, eating behavior, well-being and body image also improved significantly. One year after discharge, return rate was 73%. Forty percent had further reduced their weight (by more than 5% compared to intake), 36% had regained weight, but were still below intake level, and another 24% had increased weight above intake. CONCLUSION Behavioral and psychodynamic treatments were equally effective reducing weight and distress over 1 year.
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Affiliation(s)
- M E Beutel
- Clinic of Psychosomatic Medicine and Psychotherapy, Johannes Gutenberg University, Mainz, Germany
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161
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Richelsen B, Tonstad S, Rössner S, Toubro S, Niskanen L, Madsbad S, Mustajoki P, Rissanen A. Effect of orlistat on weight regain and cardiovascular risk factors following a very-low-energy diet in abdominally obese patients: a 3-year randomized, placebo-controlled study. Diabetes Care 2007; 30:27-32. [PMID: 17192328 DOI: 10.2337/dc06-0210] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the efficacy of orlistat on the maintenance of weight loss over 3 years following a major weight loss induced by very-low-energy diet (VLED) in obese patients with metabolic risk factors such as dyslipidemia, impaired fasting glucose, and diet-treated type 2 diabetes. RESEARCH DESIGN AND METHODS Initially, weight loss was induced by an 8-week VLED (600-800 kcal/day) in 383 patients with a mean BMI of 37.5 kg/m(2) (range 30.0-45.2). Those who lost > or = 5% of their body weight (309 of 383 patients) were then randomized to receive lifestyle counseling for 3 years together with either orlistat 120 mg t.i.d. or matching placebo capsules. Primary end points were the maintenance of > or = 5% weight loss after 3 years. Additionally, differences in the development of type 2 diabetes between orlistat and placebo were analyzed. RESULTS The VLED induced a mean weight loss of 14.4 +/- 2.0 kg among the subsequently randomized patients. The mean weight gain after 3 years was lower with orlistat than with placebo (4.6 +/- 8.6 vs. 7.0 +/- 7.1 kg; P < 0.02). The number of participants who achieved > or =5% weight loss also favored orlistat (67 vs. 56%; P = 0.037). Waist circumference was significantly more reduced in the orlistat group (P < 0.05), but no other differences in the risk factors were observed between the two groups. The incidences of new cases of type 2 diabetes were significantly reduced in the orlistat group (8 cases out of 153 subjects) versus placebo (17 cases out of 156 subjects) (P = 0.041). CONCLUSIONS The addition of orlistat to lifestyle intervention was associated with maintenance of an extra 2.4 kg weight loss after VLED for up to 3 years in obese subjects. The combination of orlistat and lifestyle intervention was associated with a reduced occurrence of type 2 diabetes.
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Affiliation(s)
- Bjørn Richelsen
- Department of Endocrinology and Metabolism, Aarhus University Hospital, Aarhus, Denmark.
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162
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Ogden J, Sidhu S. Adherence, behavior change, and visualization: a qualitative study of the experiences of taking an obesity medication. J Psychosom Res 2006; 61:545-52. [PMID: 17011364 DOI: 10.1016/j.jpsychores.2006.04.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2005] [Revised: 03/30/2006] [Accepted: 04/25/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Our objective was to examine patients' experiences of taking orlistat as a means to explore adherence and behavior change. METHOD We performed qualitative interviews with 12 participants who had taken orlistat in the past 2 years. RESULTS Their experiences were described in terms of beliefs about the causes of their obesity, their motivations for taking orlistat, and highly visual side effects. These themes have implications for understanding adherence and behavior change. For some, the side effects led to nonadherence and absence of behavior change. These individuals seemed to be motivated by routine effects of being overweight, such as lowered self-esteem. In contrast, those who were motivated by a life crisis seemed to tolerate the side effects of the drug, leading to adherence. In turn, these highly visual side effects enabled them to make an explicit link between food consumed and weight, creating a shift in their beliefs about the causes of obesity and making behavior change more likely. CONCLUSION Orlistat use illustrates how treatment and illness beliefs interact to create both adherence and behavior change, particularly in the context of a life crisis and particularly when symptoms can be visualized.
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Affiliation(s)
- Jane Ogden
- Department of Psychology, University of Surrey, Guildford, Surrey GU1 7XH, United Kingdom.
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163
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Affiliation(s)
- Kishore M Gadde
- Obesity Clinical Trials Program, Box 3292, Duke University Medical Center, Durham, NC 27710, USA.
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164
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Abstract
The escalating obesity epidemic has prompted healthcare professionals to seek interventions that can reach large numbers of individuals in a timely and cost-effective manner. The Internet, with its growing audience, seems an obvious solution. Commercial weight loss programs already abound on the Internet. The purpose of this review is to describe the efficacy of weight loss programs delivered via the Internet in the United States. A search for clinical trials evaluating weight loss via Internet programs was conducted using PubMed, CINAHL, Cochrane Library, Academic Search Premier, the National Institutes of Health Clinical Trials Database, and the Internet as well as a cross-check of reference lists. Eight published studies that met the inclusion criteria were reviewed. Data were extracted on study design, sample characteristics, attrition, weight loss, duration of treatment, and maintenance of weight loss. Of the 8 studies, 3 evaluated the Internet as a means to maintain long-term weight loss. All studies examining weight loss via Internet programs reported positive results, except for one investigating a commercial program. Results from the 3 weight loss maintenance programs conducted on the Internet were equivocal. Because the subjects of all these studies were predominately white, educated women, generalization of findings is limited. Data from the reviewed studies suggest that the Internet may be an alternative to traditional face-to-face weight loss programs. Questions still remain as to the efficacy of using the Internet for long-term weight loss maintenance. Findings from these studies provide beginning guidelines for healthcare providers who may choose to use Internet-based weight loss interventions. Future research is still needed to determine the applicability of such interventions in diverse age, ethnic, and socioeconomic groups.
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165
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Abstract
OBJECTIVE Very-low-calorie diets (VLCDs), providing <800 kcal/d, have been used since the 1970s to induce rapid weight loss. Previous reviews of the literature have disagreed concerning the relative efficacy of VLCDs vs. conventional low-calorie diets (LCDs) for achieving long-term weight loss. RESEARCH METHODS AND PROCEDURES We sought to update findings on the clinical use, safety, and efficacy of VLCDs and to perform a meta-analysis of randomized trials that compared the long-term efficacy of LCDs and VLCDs. Original research articles were retrieved by a Medline search and from prior reviews of VLCDs. Trials were included only if they were randomized comparisons of LCDs and VLCDs and included a follow-up assessment at least 1 year after maximum weight loss. Data were abstracted by both authors regarding: duration of VLCD, total length of treatment, attrition, short- and long-term weight loss, changes in weight-related comorbidities, and adverse effects. RESULTS Six randomized trials were found that met inclusion criteria. VLCDs, compared with LCDs, induced significantly greater short-term weight losses (16.1 +/- 1.6% vs. 9.7 +/- 2.4% of initial weight, respectively; p = 0.0001) but similar long-term losses (6.3 +/- 3.2% vs. 5.0 +/- 4.0%, respectively; p > 0.2). Attrition was similar with VLCD and LCD regimens. DISCUSSION VLCDs did not produce greater long-term weight losses than LCDs. In the United States, the use of liquid meal replacements as part of a 1000 to 1500 kcal/d diet may provide an effective and less expensive alternative to VLCDs. In Europe, VLCDs are used with less intensive medical supervision than in the United States, which reduces the cost of this approach.
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Affiliation(s)
- Adam Gilden Tsai
- Department of Psychiatry, Center for Weight and Eating Disorders, University of Pennsylvania School of Medicine, 3535 Market Street, Suite 3029, Philadelphia, PA 19104, USA
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166
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Moran LJ, Noakes M, Clifton PM, Wittert GA, Williams G, Norman RJ. Short-term meal replacements followed by dietary macronutrient restriction enhance weight loss in polycystic ovary syndrome. Am J Clin Nutr 2006; 84:77-87. [PMID: 16825684 DOI: 10.1093/ajcn/84.1.77] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS), a common condition in women, improves with weight loss. Meal replacements in short-term weight loss and strategies for weight maintenance have not been investigated in PCOS. OBJECTIVE We compared in overweight women with PCOS the effects of meal replacements in short-term weight-loss and longer-term carbohydrate- or fat-restriction strategies on weight maintenance and improvements in reproductive and metabolic variables. DESIGN Overweight women with PCOS (n = 43; x +/- SD age: 32.1 +/- 5.2 y; weight: 96.1 +/- 18.4 kg) followed an 8-wk weight-loss regimen (2 meal replacements/d, 4904.4 +/- 127 kJ; phase 1) and then a 6-mo weight-maintenance carbohydrate- (<120 g/d) or fat- (<50 g/d) restriction regimen (phase 2). RESULTS Thirty-four women completed phase 1, and 23 women completed phase 2; the proportion of dropouts was similar in the 2 groups. During phase 1, significant (P < 0.05) reductions in weight (5.6 +/- 2.4 kg), waist circumference (6.1 +/- 2.5 cm), body fat (4.1 +/- 2.2 kg), insulin (2.8 +/- 1.1 mU/L), total testosterone (0.3 +/- 0.7 nmol/L), and free androgen index (3.1 +/- 4.6) occurred; these changes were sustained during phase 2. No significant differences between diet groups were seen for any variables. At 6 mo, both approaches resulted in a net weight loss of 4.7 +/- 4.6 kg. Improvements in menstrual cyclicity occurred for 16 (57.1%) of 28 subjects. CONCLUSIONS Meal replacements are an effective strategy for the short-term management of PCOS. Advice on moderate fat or carbohydrate restriction was equally effective in maintaining weight reduction and improving reproductive and metabolic variables.
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Affiliation(s)
- Lisa J Moran
- Discipline of Obstetrics and Gynaecology (Research Centre for Reproductive Health), School of Paediatrics and Reproductive Health, Adelaide, Australia.
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167
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Moreno O, Meoro A, Martinez A, Rodriguez C, Pardo C, Aznar S, Lopez P, Serrano J, Boix E, Martin MD, Pico Alfonso AM. Comparison of two low-calorie diets: a prospective study of effectiveness and safety. J Endocrinol Invest 2006; 29:633-40. [PMID: 16957412 DOI: 10.1007/bf03344163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the cost-effectiveness and safety of two distinct low calorie diets (LCD). DESIGN Prospective controlled study. METHODS 67 obese patients [body mass index (BMI) 40 kg/m2] were included in two study groups. Group A: 26 patients followed a 458 kcal diet given in three meals for 1 month. Group B: 41 patients followed a 800 kcal diet for 3 months and with outpatient control. MEASUREMENTS Anthropometric, cardiovascular risk and nutritional profile changes were evaluated, as well as total direct and indirect costs, and the incidence of complications. RESULTS No significant initial differences were observed between the two study groups. Eighty-six point two per cent of the patients completed the therapy correctly. After treatment a significant decrease was observed in the following variables for both groups, but no differences were detected between Groups A and B: mean weight loss (A= 9.28 kg, B= 8.7 kg), ponderal loss percentage (A/B= 7.2/6.8%), glycemia (A/B= 18.6/12.1 mg/dl), systolic blood pressure (SBP) (A/B= 11.8/6.5 mmHg), diastolic blood pressure (DBP) (A/B 5.9/6.8 mmHg), and final insulin-resistance (IR) index (A= 4.4, B= 4.3). Group A had the highest drop in total cholesterol (37.7 vs 8.1 mg/dl) and triglycerides (54.4 vs 2.5 mg/dl). No changes were observed in ureic acid, renal function and serum albumin. Thirty-six patients (55.3%) suffered trivial complications associated to the VLCD (16.9% gastrointestinal, 20% anxiety), with no differences between groups. Group A patients were on sick leave due to asthenia, and two patients in this group had serious complications (transient ischemic attack and atrial fibrillation). The total cost of Group A treatment was 3018.9 against 582.6 euros for Group B. CONCLUSIONS The 3-month 800 kcal/day VLCD was more cost-effective and safer than the 1-month 458 kcal/day diet.
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Affiliation(s)
- O Moreno
- Endocrinology and Nutrition Section, Alicante General University Hospital, CP03010, Alicante, Spain.
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168
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Abstract
Obesity is a problem among all ages and races, in both genders, and across all socioeconomic classes, and the prevalence of obesity has been increasing. Efforts are being made to combat the increasing prevalence, but only modest success has been achieved. Obesity is affected by multiple factors. There are genetic and environmental components involved, yet pinpointing specific genetic and environmental influences has been difficult. Development of treatments has ranged from pharmaceuticals to behavioral modification. Extant treatments aimed at the individual and administered for relatively brief portions of the lifespan have shown only modest results. If we are to make pervasive and enduring changes to population adiposity levels, it is likely that we will need to make pervasive and enduring changes to the ways in which we live across the lifespan.
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Affiliation(s)
- Mark B Cope
- Department of Nutrition Sciences, University of Alabama at Birmingham, Ryals Public Health Building 327, 1665 University Boulevard, Birmingham, AL 35294, USA
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169
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Gill JMR, Malkova D. Physical activity, fitness and cardiovascular disease risk in adults: interactions with insulin resistance and obesity. Clin Sci (Lond) 2006; 110:409-25. [PMID: 16526946 DOI: 10.1042/cs20050207] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There is a considerable body of evidence gathered from studies over the past half a century indicating that a high level of physical activity and a moderately high or high degree of cardiorespiratory fitness reduces the risk of CVD (cardiovascular disease). Recent data suggest that high levels of physical activity or fitness may be particularly beneficial to individuals with insulin-resistant conditions, such as the metabolic syndrome, Type II diabetes or obesity. These individuals, if unfit and sedentary, exhibit increased CVD risk, but their dose-response relationship for physical activity/fitness appears to be particularly steep such that, when they undertake high levels of activity (or have high fitness), their level of risk becomes closer to that of their normal weight or nondiabetic peers. This may be due to effects of physical activity in normalizing the metabolic dysfunction particularly associated with insulin-resistant conditions.
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Affiliation(s)
- Jason M R Gill
- Institute of Diet, Exercise and Lifestyle (IDEAL), Institute of Biomedical and Life Sciences, West Medical Building, University of Glasgow, UK.
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170
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Ash S, Reeves M, Bauer J, Dover T, Vivanti A, Leong C, O'Moore Sullivan T, Capra S. A randomised control trial comparing lifestyle groups, individual counselling and written information in the management of weight and health outcomes over 12 months. Int J Obes (Lond) 2006; 30:1557-64. [PMID: 16534529 DOI: 10.1038/sj.ijo.0803263] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the effect of an 8-week group-based cognitive behaviour therapy lifestyle intervention with monthly follow-up to 6 months and further follow up at 12 months on change in weight and other weight-related variables, change in physical activity and change in health and well being compared to individualised dietetic treatment or giving an information booklet only (BO). DESIGN A randomised controlled trial of two intervention groups, a group-based cognitive behaviour therapy lifestyle intervention, Fat Booters Incorporated--(FBI) and individualised dietetic treatment (IDT) and control group receiving an information booklet only (BO). The intervention groups involved weekly contact for 8 weeks with monthly follow-up to 6 months and further follow-up at 12 months, conducted in real practice setting. SUBJECTS A total of 176 adults with body mass index (BMI)>27 kg/m2, mean (+/-s.d.) age 48+/-13 years, mean BMI 34+/-5.5 kg/m2. MAIN OUTCOME MEASURES Weight, percent body fat, waist circumference, physical activity, health status, self-efficacy and satisfaction with life were measured at baseline, 3, 6 and 12 months. RESULTS A statistically significant difference between groups was observed for weight change over time (P=0.05). The change in weight (mean+/-s.e.) for the FBI group was significantly greater than the BO group at 3 and 12 months (-2.8+/-0.7 compared to -1.0+/-0.6 kg, P<0.05 and -2.9+/-0.9 compared to +0.5+/-0.9 kg, P<0.005, respectively). Change in weight in the IDT group did not differ from the FBI group at any time point. For all groups, waist circumference was significantly less than baseline at all time points (P<0.001). Significant differences in self-efficacy were observed over time (P=0.02), with both intervention groups having greater self-efficacy than the BO group. Significant drop-outs occurred over time for all three groups. CONCLUSIONS A cognitive behaviour-based lifestyle intervention was more effective than providing an information booklet alone and as effective as intensive individualised dietetic intervention in weight loss and improvements in self-efficacy.
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Affiliation(s)
- S Ash
- Princess Alexandra Hospital and Health Service District, Woolloongabba, Brisbane, Australia
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171
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Laredo SE. Obesity, polycystic ovary syndrome, infertility treatment: asking obese women to lose weight before treatment increases stigmatisation. BMJ 2006; 332:609. [PMID: 16528092 PMCID: PMC1397751 DOI: 10.1136/bmj.332.7541.609-b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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172
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Abstract
Excess adiposity over the pre- and postmenopausal years is linked to risk of postmenopausal breast cancer. Weight loss could potentially reduce risk amongst those with excess weight via beneficial effects on the hormonal (decreased circulating levels of oestradiol, testosterone, insulin) and secretory profiles of adipocytes (decreased production of leptin, tumour necrosis factor-alpha, interleukin 6 and increased production of adiponectin). Only modest reductions in adipose tissue are achieved and sustained with current weight loss programmes, which makes strategies to mitigate the adverse metabolic effect of adiposity a priority for cancer prevention. The adverse hormonal and secretory effects of adipose tissue are influenced substantially by acute changes in energy balance prior to changes in adiposity. Human and animal studies have shown dietary energy restriction to bring about favourable changes in circulating levels of insulin, leptin, sex hormone binding globulin, insulin-like growth factor-1, oestradiol, testosterone, reactive oxygen species, and the production and secretion of locally acting adipokines and inflammatory cytokines, that is, increased adiponectin and decreased interleukin-6. Achieving and sustaining energy restriction remains a difficult challenge. Intermittent energy restriction is a potential strategy for promoting periods of energy restriction on a long-term basis. Animal and human data suggest that intermittent energy restriction may have cancer preventative effects beyond that of chronic energy restriction and weight loss. Intermittent energy restriction may be a potential strategy for the primary prevention of breast cancer.
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Affiliation(s)
- M Harvie
- CRUK University Department of Medical Oncology, Christie Hospital, Manchester, UK.
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173
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Haaz S, Fontaine KR, Cutter G, Limdi N, Perumean-Chaney S, Allison DB. Citrus aurantium and synephrine alkaloids in the treatment of overweight and obesity: an update. Obes Rev 2006; 7:79-88. [PMID: 16436104 DOI: 10.1111/j.1467-789x.2006.00195.x] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Obesity is a major health problem facing the developed and developing world. Efforts by individuals, health professionals, educators, and policy makers to combat the escalating trend of growing obesity prevalence have been multifaceted and mixed in outcome. Various dietary supplements have been marketed to reduce obesity. These products have been suggested to accomplish this by decreasing energy intake and energy absorption, and/or increasing metabolic rate. Ephedra, one such supplement, was banned from sale in the US market because of concerns about adverse events. Another substance, Citrus aurantium, which contains several compounds including synephrine alkaloids, has been suggested as a safe alternative. This review examines the evidence for safety and efficacy of C. aurantium and synephrine alkaloids as examined in animal studies, clinical weight loss trials, acute physiologic studies and case reports. Although at least three reviews of C. aurantium have been published, our review expands upon these by: (i) distinguishing and evaluating the efficacy of C. aurantium and related compounds; (ii) including results from previously unreviewed research; (iii) incorporating recent case reports that serve to highlight, in an anecdotal way, potential adverse events related to the use of C. aurantium and related compounds; and (iv) offering recommendations to guide the design of future trials to evaluate the safety and efficacy of C. aurantium. While some evidence is promising, we conclude that larger and more rigorous clinical trials are necessary to draw adequate conclusions regarding the safety and efficacy of C. aurantium and synephrine alkaloids for promoting weight loss.
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Affiliation(s)
- S Haaz
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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174
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Abstract
Overweight and obesity are rapidly growing to epidemic proportions in the United States and globally. Since sustainable weight loss is only achieved by bariatric surgery, medicine has seen an explosion in the diversity and number of bariatric procedures performed over the past few years. Systematic studies of postoperative outcomes and investigations into the physiology and biology of weight loss provide a more comprehensive understanding of the sequelae of bariatric surgery. Adipose tissue is the predominant site of fat stores. Increasing obesity results in an overload of lipids within the body's natural storage sink (i.e., the adipocyte) followed by the necessary deposition of fat within ectopic sites such as muscle, liver, and pancreas. The resulting metabolic derangements are associated with insulin resistance, central obesity, and chronic inflammation as adipose tissue acts as an endocrine organ, producing and secreting a host of biologic mediators. Whereas there are conflicting data on the cardiovascular effects of peripheral, subcutaneous liposuction, malabsorptive bariatric procedures result almost universally in significant amelioration of insulin resistance, hypertension, dyslipidemia, and hepatic steatosis. Concomitant changes in adipocyte-derived hormones may provide mechanistic explanations to the observed improvements.
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Affiliation(s)
- Erik N Hansen
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2736;
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175
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Abstract
The health risks of overweight and obesity have been well documented. For example, even a 15-lb. weight gain increases a person's risk of diabetes by 50%. In turn, losing as little as 11 lbs. can reduce a person's risk of diabetes by the same percentage. Why, then, aren't more Americans losing weight? This article explores the rising incidence of overweight and obesity in the United States, the reasons so many people fail to lose weight or maintain a weight loss, and the potential for nurses to turn the tide on this epidemic.
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Affiliation(s)
- Judi Daniels
- University of Kentucky College of Nursing, Lexington, KY, USA.
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Viguerie N, Poitou C, Cancello R, Stich V, Clément K, Langin D. Transcriptomics applied to obesity and caloric restriction. Biochimie 2005; 87:117-23. [PMID: 15733746 DOI: 10.1016/j.biochi.2004.12.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 12/20/2004] [Indexed: 01/01/2023]
Abstract
Caloric restriction still remains the most efficient way to promote weight loss. Deciphering the molecular basis of adaptation to energy restriction is critical for the tailoring of new therapeutic strategies. This review focuses on the recent input of gene profiling on adipose tissue in obesity pathogenesis and on the new insights on adaptations occurring during very low caloric diet (VLCD) in humans. Hypocaloric diets improve a wide range of metabolic parameters including lipolytic efficiency, insulin sensitivity, and inflammatory profile. In the subcutaneous white adipose tissue (scWAT) the VLCD induced a decrease in the mRNA levels for the antilipolytic alpha2-adrenergic receptor associated with changes in catecholamine-induced adipocyte lipolytic capacity. The improvement in insulin sensitivity was not associated with a change in subcutaneous adipose tissue adiponectin gene expression or in its plasma level, suggesting that adiponectin is not involved in the regulation of VLCD-induced improvement of insulin sensitivity and that there is a small contribution of subcutaneous adipose tissue to plasma adiponectin levels. Pangenomic microarray studies in human scWAT revealed that a panel of inflammatory markers and acute phase reactants were over expressed in obese compared to lean subjects. Caloric restriction improved the inflammatory profile of obese subjects through a decrease of pro-inflammatory factors and an increase of anti-inflammatory molecules. These genes were mostly expressed in the stroma vascular fraction of the adipose tissue. Specific cell-type isolation and immunohistochemistry demonstrated that monocyte/macrophage lineage cells were responsible for the expression of both mRNA and protein inflammatory markers. The acute phase proteins serum amyloid A was highly expressed in mature adipocytes from obese subjects. Caloric restriction decreased both serum amyloid mRNA and circulating levels. Obesity now clearly appears as chronic low-grade inflammation state. Modulation of the inflammatory pathways may represent new therapeutic targets for the treatment of obesity-related complications.
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Affiliation(s)
- N Viguerie
- Unité de Recherches sur les Obésités Inserm UPS U586, Institut Louis Bugnard, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France.
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Dahlman I, Linder K, Arvidsson Nordström E, Andersson I, Lidén J, Verdich C, Sørensen TIA, Arner P. Changes in adipose tissue gene expression with energy-restricted diets in obese women. Am J Clin Nutr 2005; 81:1275-85. [PMID: 15941876 DOI: 10.1093/ajcn/81.6.1275] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The effect of energy restriction and macronutrient composition on gene expression in adipose tissue is not well defined. OBJECTIVE The aim of the study was to investigate the effect of different low-energy diets on gene expression in human adipose tissue. DESIGN Forty obese women were randomly assigned to a moderate-fat, moderate-carbohydrate diet or a low-fat, high-carbohydrate hypoenergetic (-600 kcal/d) diet for 10 wk. Subcutaneous adipose tissue samples were obtained before and after the diet period. High-quality RNA samples were obtained from 23 women at both time points, and these samples were hybridized to microarrays containing the 8500 most extensively described human genes. The results were confirmed by separate messenger RNA measurements. RESULTS Both diets resulted in weight losses of approximately 7.5% of baseline body weight. A total of 52 genes were significantly up-regulated and 44 were down-regulated as a result of the intervention, and no diet-specific effect was observed. No major effect on lipid-specific transcription factors or genes regulating signal transduction, lipolysis, or synthesis of acylglycerols was observed. Most changes were modest (<25% of baseline), but all genes regulating the formation of polyunsaturated fatty acids from acetyl-CoA and malonyl-CoA were markedly down-regulated (35-60% decrease). CONCLUSIONS Macronutrients have a secondary role in changes in adipocyte gene expression after energy-restricted diets. The most striking alteration after energy restriction is a coordinated reduction in the expression of genes regulating the production of polyunsaturated fatty acids.
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Affiliation(s)
- Ingrid Dahlman
- Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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178
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Ritt M, Piza H, Rhomberg M, Aigner F, Lechleitner M. Metabolic risk factors in formerly obese women--effects of a pronounced weight loss by gastric band operation compared with weight loss by diet alone. Diabetes Obes Metab 2005; 7:216-22. [PMID: 15811137 DOI: 10.1111/j.1463-1326.2004.00415.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to evaluate differences in the metabolic risk profile in formerly obese women, in whom a significant weight loss was obtained by Swedish adjustable gastric band (SAGB) operation or by diet alone. METHODS A total of 40 patients (24 after SAGB and 16 after diet) participated in the study. Clinical data, including body mass index (BMI), waist-to-hip ratio, body fat content and blood pressure values, as well as laboratory results [fasting glucose, insulin, homeostasis model assessment (HOMA) index, leptin, lipid values and markers of subclinical inflammation] were evaluated before a planned abdominoplastic operation. RESULTS Patients in the SABG group had lost a significantly greater amount of weight (52.7 +/- 10.0 kg) compared with the diet group (20.0 +/- 11.5 kg; p < 0.001), and the percent excess weight loss was 69.1 +/- 11.4 in the SAGB group and 54.5 +/- 17.7 (p < 0.040) in the diet group. Before the abdominoplastic operation neither the mean BMI nor the percentage of fat mass revealed a significant difference between the groups. Fasting insulin (6.1 +/- 3.0 microU/ml) and the HOMA index (1.4 +/- 0.7) as a measure of insulin resistance were significantly lower in the SAGB than in the diet group (fasting insulin: 8.2 +/- 3.8 microU/ml; p < 0.048; HOMA index: 2.0 +/- 1.0; p < 0.031). Swedish adjustable gastric band patients showed significantly lower plasma leptin levels (9.4 +/- 10.8 ng/ml) than the dietary-treated patients (13.9 +/- 9.6 ng/ml; p < 0.014), while tumour necrosis factor-alpha serum levels were increased in the SAGB group (17.6 +/- 7.3 pg/ml) compared with the diet group (11.9 +/- 0.49 pg/l; p < 0.048). CONCLUSIONS The extensive weight loss in formerly obese women after SAGB operation was paralleled by a favourable metabolic profile indicating a higher degree of insulin sensitivity than in women after a successful, but less pronounced weight loss by diet alone.
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Affiliation(s)
- M Ritt
- Department of Internal Medicine, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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180
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Herpertz S, Kielmann R, Wolf AM, Hebebrand J, Senf W. Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review. ACTA ACUST UNITED AC 2005; 12:1554-69. [PMID: 15536219 DOI: 10.1038/oby.2004.195] [Citation(s) in RCA: 216] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to present a systematic review of psychological and psychosocial predictors of weight loss and mental health after bariatric surgery. This systematic review included all controlled and noncontrolled trials of the last 2 decades with either a retrospective or prospective design and a follow-up period of at least 1 year. RESEARCH METHODS AND PROCEDURES The relevant literature was identified by a search of computerized databases. All articles published in English and German between 1980 and 2002 were reviewed. RESULTS Using the above inclusion/exclusion criteria, 29 articles were identified focusing on psychosocial predictors of weight loss and mental health after obesity surgery. DISCUSSION Personality traits have no predictive value for the postoperative course of weight or mental state. Apart from serious psychiatric disorders including personality disorders, psychiatric comorbidity seems to be of more predictive value for mental and physical well-being as two essential aspects of quality of life than for weight loss postsurgery. However, depressive and anxiety symptoms as correlates of psychological stress with regard to obesity seem to be positive predictors of weight loss postsurgery. The severity of the symptoms or the disorder is more relevant for the outcome of obesity surgery than the specificity of the symptoms. It is also not solely the consumption of distinct "forbidden" foods, such as sweets or soft drinks, but rather a general hypercaloric eating behavior, either as an expression of the patient's inadequate compliance or a dysregulation in energy balance, which is associated with a poor weight loss postsurgery.
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Affiliation(s)
- S Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, Westfälische Klinik Dortmund, Ruhr-University Bochum, Marsbruchstrasse 179, 44287 Dortmund, Germany.
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181
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Inelmen EM, Toffanello ED, Enzi G, Gasparini G, Miotto F, Sergi G, Busetto L. Predictors of drop-out in overweight and obese outpatients. Int J Obes (Lond) 2005; 29:122-8. [PMID: 15545976 DOI: 10.1038/sj.ijo.0802846] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To investigate the impact on drop-out rates of several baseline clinical characteristics of a sample of overweight and obese outpatients. DESIGN Retrospective clinical trial. SUBJECTS The charts of 383 patients aged 15-82 y attending an outpatient clinic for the treatment of obesity were examined from the first clinical evaluation until 1 y of diet ambulatory treatment. MEASUREMENTS We characterised the participants at baseline on the basis of their somatic characteristics, socioeconomic status, obesity-related diseases and dietary habits. The most significant factors resulting in univariate statistical analysis (waist, body mass index (BMI), full-time job, depressive syndrome, number of obesity-related diseases, daily frequency of fruit consumption) were then examined as independent variables in direct multiple logistic regression with the dependent variable drop-out. RESULTS The 1-y drop-out rate was 77.3%. A total of 87 patients completed the follow-up study. The noncompleter patients had slightly lower BMI and waist circumference mean values, and they were further regularly employed in full-time jobs, while the completer patients were principally pensioners and housewives. Drop-outs had a lower number of obesity-related diseases and as a result were less depressed. By the logistic regression, full-time job is the best predictor of premature withdrawal (odds ratio=2.40). Age, gender, anthropometric measurements, lifestyle and dietary habits did not result as significant predictors of drop-out. CONCLUSION The overweight and obese outpatients at higher risk of ambulatory treatment drop-out are more likely to work full hours, have less obesity-related complications and be less depressed. In our study, the full-time job condition seems to be the strongest predictor of premature withdrawal.
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Affiliation(s)
- E M Inelmen
- Department of Medical and Surgical Science, Division of Geriatrics, University of Padua, Italy.
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Pender JR, Pories WJ. Surgical treatment of obesity. Psychiatr Clin North Am 2005; 28:219-34, x. [PMID: 15733620 DOI: 10.1016/j.psc.2004.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- John R Pender
- Department of Surgery, Brody School of Medicine, East Carolina University, Brody Medical Science Building, 2E-67 Greenville, NC 27858, USA
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183
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Wamsteker EW, Geenen R, Iestra J, Larsen JK, Zelissen PMJ, van Staveren WA. Obesity-related beliefs predict weight loss after an 8-week low-calorie diet. ACTA ACUST UNITED AC 2005; 105:441-4. [PMID: 15746833 DOI: 10.1016/j.jada.2004.12.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this study was to examine whether beliefs about the cause, consequences, time line, and control of obesity are predictors of the amount of weight loss after an 8-week, low-calorie diet consisting of meal replacements. Forty-eight women and 18 men, mean age=45.9 (range=23 to 73 years) years and body mass index between 30 and 50 participated in a weight-loss program. Beliefs were measured at baseline by the Obesity Cognition Questionnaire and by an eating behavior self-efficacy scale. Correlational and regression analyses were performed to examine whether beliefs predicted weight change. Changes in body mass index, waist circumference, and blood pressure were significant (P <.001). Less weight reduction was associated with poor self-efficacy (r =-0.34, P <.01) and the beliefs that obesity had a physical origin (r =0.27, P =.04) and was not under behavioral control (r =-0.25, P =.04). Self-efficacy remained a significant predictor in regression analysis. The results suggest that the outcome of dietary interventions may be improved when adjusting beliefs, especially self-efficacy.
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Affiliation(s)
- Erika W Wamsteker
- University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands.
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184
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Borg P, Fogelholm M, Kukkonen-Harjula K. Food selection and eating behaviour during weight maintenance intervention and 2-y follow-up in obese men. Int J Obes (Lond) 2005; 28:1548-54. [PMID: 15543160 DOI: 10.1038/sj.ijo.0802790] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim was to assess long-term changes in food consumption and eating behaviour during and 2 y after dietary counselling in weight-reduced obese men. DESIGN Observational study from a randomised controlled trial. SETTING Outpatient clinic of a research institute. SUBJECTS A total of 36 subjects with complete data on food intake during the study. Subjects were obese (mean body mass index (BMI) 32.8 kg/m2) men aged 35-50 y, recruited by media advertising. INTERVENTIONS Dietary counselling was included in 2 months weight reduction with very-low-energy-diet and in 6 months weight maintenance programme, which also included physical activity counselling. This was followed by a 23 months unsupervised follow-up with yearly assessments. Food intake was assessed six times during the study by 4-day food records. Eating behaviour was assessed by Three-Factor Eating Questionnaire (TFEQ). RESULTS Increased consumption of low-fat cheese, low-fat margarine, vegetables and high-fibre bread, and decreased consumption of sugar, sausage, high-fat cheese, high-fat margarine, fat products and sweets were observed during dietary counselling. Most of these changes returned later to prestudy consumption level. The relapse in dietary changes was partly associated with scoring low in restraint and high in disinhibition and hunger. CONCLUSION In obese men, long-term maintenance of dietary changes was difficult. New ways to ease self-monitoring and increase self-efficacy might be necessary to improve maintenance of dietary changes.
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Affiliation(s)
- P Borg
- UKK Institute for Health Promotion Research, Tampere, Finland.
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185
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Moran L, Norman RJ. Understanding and managing disturbances in insulin metabolism and body weight in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2005; 18:719-36. [PMID: 15380143 DOI: 10.1016/j.bpobgyn.2004.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common clinical and metabolic condition in women of reproductive age. It is associated with short-term reproductive and long-term metabolic dysfunction. Treatment has traditionally focused on fertility and hormonal therapy. However, general obesity, central obesity and insulin resistance are strongly implicated in its aetiology and improving these factors has proved highly successful in some clinical situations, reducing the need for costly assisted reproduction. A low-fat, high-carbohydrate diet is thought to improve insulin sensitivity, aid in weight loss and reduction of metabolic and reproductive symptoms and improve the long-term maintenance of a reduced weight. However, there has been recent community interest in adopting a protocol advocating a moderate increase in dietary protein for improving weight loss and PCOS symptoms. Altering the glycaemic index of the diet has also received considerable attention as a regime for promoting satiety and reducing metabolic risk factors for type 2 diabetes mellitus and cardiovascular disease. Exercise and other lifestyle changes are essential for altering the short- and long-term effects of PCOS. It is vital that the efficacy of these strategies is assessed so that accurate medical and dietetic advice can be given both to patients and to the health-care community.
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Affiliation(s)
- L Moran
- Department of Obstetrics and Gynaecology, CSIRO Human Nutrition, Kintore Avenue, Adelaide, Australia
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186
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Coffey CS, Steiner D, Baker BA, Allison DB. A randomized double-blind placebo-controlled clinical trial of a product containing ephedrine, caffeine, and other ingredients from herbal sources for treatment of overweight and obesity in the absence of lifestyle treatment. Int J Obes (Lond) 2004; 28:1411-9. [PMID: 15356670 DOI: 10.1038/sj.ijo.0802784] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the efficacy and side effects of an herbal formulation to promote weight loss, as compared to placebo. DESIGN 12-week multicenter double-blind, placebo-controlled, randomized parallel groups design. Study conducted at three clinical sites in New York State. Subjects were randomized to receive either the 'active' product or a 'placebo' supplement for 12 weeks. Minimal steps were taken to influence lifestyle changes with regard to diet or exercise. SUBJECTS 102 overweight/obese (30<BMI</=39.9 kg/m(2)) volunteers between the ages of 18 and 65 y. MAIN OUTCOME MEASURES Weight, percent body fat, fat mass, waist circumference, BMI, blood pressure, and pulse measured at 2 days, 1 week, 2 weeks, 4 weeks, 8 weeks, and 12 weeks postrandomization. RESULTS Subjects receiving the 'active' treatment experienced, on average, an additional 1.5 kg of weight loss compared with subjects receiving the placebo. In addition, subjects receiving the 'active' treatment experienced greater reductions in BMI and waist circumference over the 12-week period. No differences were observed with respect to percent body fat, fat mass, diastolic or systolic blood pressure, pulse, the occurrence of any adverse event, or the occurrence of any presumed treatment-related adverse event. Testing of the study product by two independent laboratories indicated that it had only approximately half of the intended amount of ephedrine alkaloids and caffeine. CONCLUSIONS Over the 12-week trial, subjects on the active treatment experienced significantly greater weight loss than subjects on placebo, without an increase in blood pressure, pulse, or the rate of adverse events. These benefits were achieved in the absence of any lifestyle treatment to change dietary or exercise behavior and with lower doses of ephedrine alkaloids and caffeine than those commonly utilized.
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Affiliation(s)
- C S Coffey
- Department of Biostatistics, University of Alabama at Birmingham, AL 35294-0022, USA
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188
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Arvidsson E, Viguerie N, Andersson I, Verdich C, Langin D, Arner P. Effects of different hypocaloric diets on protein secretion from adipose tissue of obese women. Diabetes 2004; 53:1966-71. [PMID: 15277374 DOI: 10.2337/diabetes.53.8.1966] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little is known about common factors (e.g., macronutrients and energy supply) regulating the protein secretory function of adipose tissue. We therefore compared the effects of randomly assigned 10-week hypoenergetic (-600 kcal/day) diets with moderate-fat/moderate-carbohydrate or low-fat/high-carbohydrate content on circulating levels and production of proteins (using radioimmunoassays and enzyme-linked immunosorbent assays) from subcutaneous adipose tissue in 40 obese but otherwise healthy women. Similar results were obtained by the two diets. Body weight decreased by approximately 7.5%. The secretion rate of leptin decreased by approximately 40%, as did that of tumor necrosis factor-alpha (TNF-alpha), and interleukin (IL)-6 and -8 decreased by 25-30%, whereas the secretion of plasminogen activator inhibitor 1 (PAI-1) and adiponectin did not show any changes. Regarding mRNA expression (by real-time PCR), only that of leptin and IL-6 decreased significantly. Circulating levels of leptin and PAI-1 decreased by 30 and 40%, respectively, but there were only minor changes in circulating TNF-alpha, IL-6, or adiponectin. In conclusion, moderate caloric restriction but not macronutrient composition influences the production and secretion of adipose tissue-derived proteins during weight reduction, leptin being the most sensitive and adiponectin and PAI-1 the least sensitive.
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Affiliation(s)
- Elisabet Arvidsson
- Department of Medicine, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
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189
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Müller MJ, Danielzik S. [Prevention and nutrition related illnesses. Obesity, diabetes mellitus]. Internist (Berl) 2004; 45:166-72. [PMID: 14991158 DOI: 10.1007/s00108-003-1125-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Faced with the obesity epidemic there is need for therapy as well as public health strategies for health promotion and obesity prevention. Both strategies add to each other, none should be done in isolation. Obesity is not only an individual problem. It is also a problem of our society. We are now an overweight society, which is on the way to a fat society. There is urgent need for a national public health strategy for population wide prevention of overweight and obesity. Health authorities as well as politicians are asked to support public health strategies creating a supportive environment for making healthy choices the easier choices.
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Affiliation(s)
- M J Müller
- Institut für Humanernährung und Lebensmittelkunde, Christian-Albrechts-Universität zu Kiel.
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190
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Mönnichs G, von Lengerke T. Unzufriedenheit mit dem eigenen Gewicht nach Reduktionsdiät bei Frauen und Männern:. ACTA ACUST UNITED AC 2004. [DOI: 10.1026/0943-8149.12.3.116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Es werden Unzufriedenheit mit und Einschränkung durch Körpergewicht in Abhängigkeit von Diätverhalten zur Gewichtsreduktion, Diätfolgen, Übergewicht, soziodemographischen Variablen und Lebensstil untersucht. Daten der 4261 Teilnehmer des KORA-Survey 2000 wurden mittels logistischer Regressionen bzgl. der Zusammenhänge von Diätverhalten, Diäterfolg, Jojo-Effekt, BMI, Alter/Familienstand/Sozialschicht/Wohnort und Rauchen/Alkoholkonsum/Bewegung/Ernährung mit gewichtsbedingter Unzufriedenheit und Einschränkung analysiert. Unzufriedenheit mit dem Körpergewicht nimmt mit steigendem BMI zu; gleichzeitig sind Jüngere und Männer höherer sozialer Schichten unzufriedener, wohingegen bei Frauen keine soziale Stratifizierung auftritt. Personen, die im letzten Jahr eine Reduktionsdiät gemacht hatten, waren unzufriedener als Personen ohne Diät, wobei dieser Zusammenhang durch die Subgruppen, die keinen Diäterfolg und/oder Jojo-Effekt-Erfahrungen hatten, erklärbar ist. Die Ergebnisse für gewichtsbedingte Einschränkungen sind entsprechend, allerdings weniger ausgeprägt. Diätverhalten und Diätmisserfolg sind eigenständige, von Übergewicht unabhängige Korrelate der Unzufriedenheit mit und Einschränkung durch Körpergewicht. Die Arbeit ergänzt die klinisch orientierte Forschung zum Zusammenhang zwischen Körperwahrnehmung und (Über-)Gewicht durch einen bevölkerungsbezogenen Ansatz.
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191
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Hanusch-Enserer U, Cauza E, Brabant G, Dunky A, Rosen H, Pacini G, Tüchler H, Prager R, Roden M. Plasma ghrelin in obesity before and after weight loss after laparoscopical adjustable gastric banding. J Clin Endocrinol Metab 2004; 89:3352-8. [PMID: 15240614 DOI: 10.1210/jc.2003-031438] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Weight reduction after gastric bypass surgery has been attributed to a decrease of the orexigenic peptide ghrelin, which may be regulated by insulin and leptin. This study examined effects of long-term weight loss after laparoscopical adjustable gastric banding on plasma ghrelin and leptin concentrations and their relationship with insulin action. Severely obese patients (15 women, three men, 36 +/- 12 yr) underwent clinical examinations every 3 months and modified oral glucose tolerance tests to assess parameters of insulin sensitivity and secretion every 6 months. After surgery, body mass index fell from 45.3 +/- 5.3 to 37.2 +/- 5.3 and 33.6 +/- 5.5 kg/m(2) at 6 and 12 months, respectively (P < 0.0001). This was associated with lower (P < 0.0001) plasma glucose, insulin, insulin resistance, waist circumference, and blood pressure. Plasma leptin decreased from 27.6 +/- 9.5 to 17.7 +/- 9.8 (P = 0.0005) and 12.7 +/- 5.1 ng/ml (P < 0.0001). Plasma ghrelin was comparable before and at 6 months (234 +/- 53; 232 +/- 53 pmol/liter) but increased at 12 months (261 +/- 72 pmol/liter; P = 0.05 vs. 6 months). At 6 and 12 months, ghrelin levels correlated negatively with fasting plasma insulin levels and hepatic insulin extraction but not with body mass or insulin action. In conclusion, prolonged weight loss results in a rise of fasting ghrelin concentrations that correlates with fasting insulin concentrations but not improvement of insulin sensitivity.
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192
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Abstract
Obesity in middle-aged humans is a risk factor for many age-related diseases and decreases life expectancy by about 7 years, which is roughly comparable to the combined effect of all cardiovascular disease and cancer on life span. The prevalence of obesity increases up until late middle age and decreases thereafter. Mechanisms that lead to increased obesity with age are not yet well understood, but current evidence implicates impairments in hypothalamic function, especially impairments in the ability of hypothalamic pro-opiomelanocortin neurons to sense nutritional signals. The rapid increase in the prevalence of obesity at all ages in the past decade suggests that, in the next two or three decades, diseases associated with obesity, especially diabetes, will begin to rise rapidly. Indeed, these trends suggest that for the first time in modern history, the life expectancy of people in developed societies will begin to decrease, unless the rapid increase in the prevalence of obesity can be reversed.
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Affiliation(s)
- Tooru Mizuno
- Fishberg Center for Neurobiology, Neurobiology of Aging Laboratories, Department of Geriatrics, Mt. Sinai School of Medicine, New York, NY 10029, USA
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193
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Laws R. A new evidence-based model for weight management in primary care: the Counterweight Programme. J Hum Nutr Diet 2004; 17:191-208. [PMID: 15139891 DOI: 10.1111/j.1365-277x.2004.00517.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS Obesity has become a global epidemic, and a major preventable cause of morbidity and mortality. Management strategies and treatment protocols are however poorly developed and evaluated. The aim of the Counterweight Programme is to develop an evidence-based model for the management of obesity in primary care. METHODS The Counterweight Programme is based on the theoretical model of Evidence-Based Quality Assessment aimed at improving the management of obese adults (18-75 years) in primary care. The model consists of four phases: (1) practice audit and needs assessment, (2) practice support and training, (3) practice nurse-led patient intervention, and (4) evaluation. Patient intervention consisted of screening and treatment pathways incorporating evidence-based approaches, including patient-centred goal setting, prescribed eating plans, a group programme, physical activity and behavioural approaches, anti-obesity medication and weight maintenance strategies. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation. Eighty practices were recruited of which 18 practices were randomized to act as controls and receive deferred intervention 2 years after the initial audit. RESULTS By February 2004, 58 of the 62 (93.5%) intervention practices had been trained to run the intervention programme, 47 (75.8%) practices were active in implementing the model and 1256 patients had been recruited (74% female, 26% male, mean age 50.6 years, SD 14). At baseline, 75% of patients had at one or more co-morbidity, and the mean body mass index (BMI) was 36.9 kg/m(2) (SD 5.4). Of the 1256 patients recruited, 91% received one of the core lifestyle interventions in the first 12 months. For all patients followed up at 12 months, 34% achieved a clinical meaningful weight loss of 5% or more. A total of 51% of patients were classed as compliant in that they attended the required level of appointments in 3, 6, and 12 months. For fully compliant patients, weight loss improved with 43% achieving a weight loss of 5% or more at 12 months. CONCLUSION The Counterweight Programme is an evidence-based weight management model which is feasible to implement in primary care.
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Affiliation(s)
- Rachel Laws
- SRD, Nutrition & Dietetic Service, Royal United Hospital, Bath, UK.
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194
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Anderson JW, Kendall CWC, Jenkins DJA. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr 2004; 22:331-9. [PMID: 14559925 DOI: 10.1080/07315724.2003.10719316] [Citation(s) in RCA: 276] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Obesity is a major risk factor for development of diabetes, and excessive energy intake is a major contributor to poor glycemic control in Type 2 diabetes. The impact of obesity on risk for diabetes as well as coronary heart disease (CHD) risk factors and the benefits of weight loss in decreasing risk for developing diabetes and improving glycemia and CHD risks were reviewed. A systematic review of the medical literature to assess the impact of obesity and weight gain on risk for diabetes and CHD was done. We performed a meta-analysis of the effects of weight loss for obese diabetic individuals. Controlled clinical trials assessing lifestyle changes on risk for developing diabetes and weight loss effects on glycemia and CHD risk factors were reviewed. Obesity and weight gain can increase risk for diabetes by greater than ninetyfold and CHD by about sixfold. Very-low-energy diets (VLED) decrease fasting plasma glucose values by approximately 50% within two weeks and these changes are sustained with continued energy restriction. Twelve weeks of energy-restricted diets were associated with these significant decreases: body weight, 9.6%; fasting plasma glucose, 25.7%; serum cholesterol, 9.2%; serum triglycerides, 26.7%; systolic blood pressure, 8.1%; and diastolic blood pressure, 8.6%. Larger weight losses were associated with larger reductions in these values. The reviewed data suggest that US health care providers should endorse the American Heart Association's and European diabetes associations' recommendations that diabetic persons achieve and maintain a BMI of
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Affiliation(s)
- James W Anderson
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA.
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195
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Yeh MC, Rodriguez E, Nawaz H, Gonzalez M, Nakamoto D, Katz DL. Technical skills for weight loss: 2-y follow-up results of a randomized trial. Int J Obes (Lond) 2004; 27:1500-6. [PMID: 14634681 DOI: 10.1038/sj.ijo.0802430] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the sustained effectiveness of a novel skill-based intervention for weight loss. DESIGN Randomized, controlled trial. SUBJECTS A total of 80 overweight/obese women living in Connecticut. MEASUREMENTS Absolute weight difference measured in pounds and absolute change in body mass index (BMI). Secondary outcomes included changes in food frequency questionnaire (FFQ) data and waist-to-hip ratio. RESULTS In all 61, 35, and 34% of study participants completed the 6-, 12-, and 24-month assessments, respectively. At 6 months postintervention, both counseling-based (CBI) and skill-based (SBI) intervention groups had statistically significant decreases in absolute weight (4.0+/-3.6 and 1.7+/-3.0 kg, respectively). Compared to their baseline values, both CBI and SBI groups still maintained weight losses at 24 months (1.1+/-5.8 and 0.59+/-3.3 kg, respectively); however, the differences were not statistically significant. FFQ results showed that, within the SBI group, there was a significant decrease (P<0.05) in percent fat from baseline to 12 months and a nearly significant decrease in saturated fat from baseline to 24 months (P=0.07). CONCLUSIONS Both the novel SBI and conventional dietary counseling demonstrated some residual weight loss benefit at 2 y. Effects of the SBI on dietary intake patterns are encouraging, and warrant further study.
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Affiliation(s)
- M-C Yeh
- Yale Prevention Research Center, Derby, CT 06418, USA
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196
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Miguel Rubio A, Moreno C. Tratamiento médico de la obesidad mórbida: alternativas actuales, límites y perspectivas. Cir Esp 2004. [DOI: 10.1016/s0009-739x(04)72306-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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197
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Woo JT. Dietetic Therapy for Obesity. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2004. [DOI: 10.5124/jkma.2004.47.4.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jeong-taek Woo
- Department of Endocrinology and Metabolism, Kyung-hee University College of Medicine & Hospital, Korea.
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198
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Abstract
OBJECTIVE The major aim of this paper is to review findings from weight management intervention studies to consider clozapine and/or olanzapine induced weight gain. A parallel aim is to summarize the challenges facing future research and provide an overview of best practice in the management of weight in mental health patients. METHOD A systematic literature search was conducted using Medline, Cinahl and PsychINFO data bases and reference lists from relevant published articles. Five studies which reported weight control practices in patients taking atypical antipsychotic medications were located and reviewed. RESULTS The studies reviewed provide some important descriptive clinical insights; however, common shortcomings include small subject numbers and methodological drawbacks such as lack of a control group. CONCLUSIONS There is some evidence that weight gain associated with atypical antipsychotic medication can be ameliorated by lifestyle changes such as improved nutritional practices and increased physical activity. Lifestyle interventions for individuals with psychotic disorders may need to be adapted to be most effective; for example, using strategies to counter increased appetite and to enhance physical activity. Clinicians need to be vigilant and persistent in monitoring and intervening if weight gain occurs. A standardized screening tool and clinical pathway would help clinicians to target appropriate interventions for each person prescribed atypical antipsychotic medication.
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Affiliation(s)
- Jenny-Kay Sharpe
- General Health Services, The Park Centre for Mental Health, Wacol, Queensland, Australia.
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199
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Westenhoefer J, von Falck B, Stellfeldt A, Fintelmann S. Behavioural correlates of successful weight reduction over 3 y. Results from the Lean Habits Study. Int J Obes (Lond) 2003; 28:334-5. [PMID: 14647175 DOI: 10.1038/sj.ijo.0802530] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine behavioural characteristics of subjects with successful long-term weight reduction. DESIGN Prospective cohort study with 3 y follow-up. SETTING Multicentre study of participants of a commercial weight-reduction programme (BCM-Programme). SUBJECTS Until February 2000, 6857 voluntary study participants were included. Analyses are based on 1247 subjects with complete 3 y data. INTERVENTIONS Open-group dietary and behavioural counselling with initial meal substitutions. RESULTS Subjects show a number of significant behavioural improvements, for example, choice of low-fat food, flexible control of eating behaviour and coping with stress. Subjects who maintain these changes by the end of the first year have a higher probability of successful weight reduction after 3 y. CONCLUSIONS Successful weight maintenance is associated with more pronounced improvements of health behaviours after 1 y. The likelihood of success increases with the number of behavioural patterns which are involved in the process of change.
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Affiliation(s)
- J Westenhoefer
- Department of Nutrition and Home Economics, Hamburg University of Applied Sciences, Hamburg, Germany.
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200
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Compe A, Papoz L, Avignon A. Outcome of patients consulting in an outpatient nutrition clinic for excessive body weight. DIABETES & METABOLISM 2003; 29:519-24. [PMID: 14631329 DOI: 10.1016/s1262-3636(07)70066-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Few data are available concerning long-term outcome of patients after individually consulting a nutrition specialist, without entering a structured program. The objective of the present study was to evaluate outcome and predictors of body weight loss (BWL) after consulting in an outpatient nutrition clinic. METHODS Phone interview of 95 patients (age 46.1 +/- 1.4 years, BMI 33.8 +/- 0.7 kg/m(2)) out of 299 who consulted consecutively for the first time in an outpatient nutrition clinic for excessive body weight. RESULTS The mean time interval between first visit and phone interview was 2.1 +/- 1.3 years. Average BWL was 6.7 +/- 1.2 kg for the entire group. Forty-eight patients (50.5%) had lost more than 5% of initial body weight and were considered to be successful. Initial BMI was associated with% BWL (r=0.42, p<0.0001). Underreporting of energy-intake at initial dietary history was positively associated with BWL (- 11.8 +/- 1.1 vs. - 5.1 +/- 3.9 kg, p<0.05) as well as the number of visits attended by the patient (p=0.04). No relation was found between sex, age and physical activity at initial visit, past history of dieting or time elapsed since first or last visit and BWL. In multivariate analysis under reporters had 4.3 times more chances to lose more than 5% of their body weight (p<0.05). CONCLUSION Visiting a nutrition specialist to receive individual counseling and prescription of a balanced low calorie diet is part of a positive behavior change leading to body weight loss.
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Affiliation(s)
- A Compe
- Metabolic Diseases Department, Montpellier University Hospital, France
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