Biomedical subjects
J S Garrow
Publications and source records attributed to J S Garrow.
Predisposition, early recognition, and intervention with overweight.
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The management of obesity. Another view.
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Would clinical nutrition benefit from meta-analyses and trials registers?
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Is it possible to prevent obesity?
No-one is immune to obesity, but those with a family history of obesity, or those who have in the past lost weight, are particularly liable to excessive weight gain. There is no useful way of identifying that portion of the population which is at particularly high risk of obesity so that preventive measures can be focussed on that subgroup. Prevention of obesity therefore requires early detection and treatment of excessive weight gain. For various reasons the age range 5-12 years is particularly advantageous for correcting obesity in children, since normal weight-for-height can be achieved without actual weight loss. Obesity in adults is to a small extent genetically determined, but weight loss is always possible with the appropriate dietary treatment. The most difficult problem in preventing adult obesity is to ensure that excess weight which has been lost is not regained. Reasons are given for believing that a waist cord provides a necessary cognitive clue to this weight regain, and thus assists in maintaining normal weight in formerly obese people.
Comparison of estimates of fat-free mass in normal and obese women from measurements of body potassium, body water and body density.
The relation between the estimates of fat-free mass (FFM) obtained from measurements of density, total body potassium and water was investigated in 104 women with Quetelet's Index between 19.9 and 49.7 kg/m2, body weight between 42.3 and 133.5 kg. The mean difference between the estimates based on water and potassium, previously reported as 2.2 kg or 4.4 per cent, was found to be independent of Quetelet's Index. The mean difference (s.e.m.) between the estimates of FFM based on density, compared with the average values from water and potassium, was found to be +7.0 (1.0), +6.3 (0.7) and +7.4 (1.1) kg in the ranges of Quetelet's Index 19.9-30.0, 30.1-40.0, and 40.1-49.7, respectively. The relative independence on Quetelet's Index of the difference between the estimates based on density compared with (water + potassium) is consistent with the idea that tissues of a higher density (ie, skin and bone) make up a larger proportion of the fat-free body weight in thin subjects than in fat ones.
Effects on weight and metabolic rate of obese women of a 3.4 MJ (800 kcal) diet.
103 obese women (mean [SD] Quetelet's index [weight/height2] 38 [8] kg/m2) were admitted to a metabolic ward and were kept strictly to a diet providing 3.4 MJ (800 kcal) daily for 3 weeks. Body weight was measured daily and fasting resting metabolic rate (RMR) on days 1, 7, and 21. Both weight and RMR fell more rapidly in the first week than later. The thermic effect of feeding fell immediately on the lower energy intake, and there was an adaptive reduction of about 6% in RMR in week 1. After 3 weeks, the average weight loss was 4.9 (1.2) kg (about 5% of initial weight) and the average fall in RMR 8.8%. If after substantial weight loss a woman eats just enough to maintain energy balance the adaptive reduction in metabolic rate is restored to normal, and the thermic effect of feeding is restored in proportion to the new energy intake, but total energy requirements remain less than in the obese state to the extent that fat-free mass has been reduced. Thus, an obese woman who reduces weight by 30% over a year will thereafter have requirements for weight maintenance which are reduced by about 15%.
Weight loss in 108 obese women on a diet supplying 800 kcal/d for 21 d.
A series of 108 obese women were studied for 21 d in a metabolic ward on a diet supplying 800 kcal/d (3.4 MJ/d), with 4.5 g protein nitrogen, 40% energy from fat, and 46% from carbohydrate. The average total weight loss was 5.0 kg. During the second and third week on the diet the rate of weight loss was 211 +/- 77 g/d (mean +/- SD) and individual values were well predicted by admission resting metabolic rate (RMR) (r = 0.66, p less than 0.0001). The calculated energy density of the weight lost in this phase was 7000 kcal/kg (29.3 MJ/kg). However, the weight loss in the first week had a labile component of 815 +/- 1202 g, which was not well predicted by RMR (r = 0.20, p less than 0.05). The effect of this labile component was to obscure the overall rate of weight loss so some of the patients did not show net weight loss until day 13 of the diet, although they were in negative energy balance.
When to advise surgery for severe obesity.
A typical severely obese patient will have about 50 kg excess weight to lose, which is equivalent to a store of 350,000 kcal. The optimum rate of weight loss in such a patient is about 1 kg/week, which involves an energy deficit of 1000 kcal/day for about a year. It is difficult to maintain this degree of dietary restriction over such a long period, and procedures such as jaw wiring or stomach stapling may help in some cases. Maintenance of weight loss is difficult to achieve and may be helped by fitting a nylon waist cord after weight loss. On theoretical grounds, patients who do not lose weight despite keeping to a properly-designed reducing diet would not benefit from surgery, but in practice this problem does not arise. It is dangerous to resort to surgery for the treatment of severely obese patients who cannot diet by reason of psychiatric disorder.
Recent developments in clinical nutrition. A review.
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Effect of triiodothyronine on leucine kinetics, metabolic rate, glucose concentration and insulin secretion rate during two weeks of fasting in obese women.
We investigated the effect of the fasting-induced reduction in triiodothyronine (T3) on metabolic changes that occur during fasting. In five obese women (T3 group) the serum T3 level during a 2200 kcal/day diet was 3.34 +/- 0.23 nmol/l while taking 20 micrograms T3 8-hourly, 0.65 +/- 0.04 after one week of fasting while not taking T3, and 2.9 +/- 0.3 after a second week of fasting while taking T3 20 micrograms 8-hourly. In three other obese women (control group) who did not take T3, T3 concentrations decreased during fasting and remained low at the end of both the first and second week of fasting. In the T3 group, resting metabolic rate (RMR) (O2 ml/min) decreased 11.7 percent at the end of one week of fasting, but then increased by 5.3 percent at the end of the second week of fasting, whereas in the control group RMR decreased by 13.1 percent after one week of fasting and a further fall of 13.3 percent occurred by the end of the second week of fasting. The RMR at the end of 2 weeks of fasting of the control group was significantly lower (P less than 0.05) than predicted using the equation of Dore, whereas that of the T3 group was as predicted using the same equation. The changes in leucine flux, leucine oxidation and non-oxidative portion of leucine flux were not different during fasting between the T3 group and the control group. Plasma concentrations of glucose, insulin and C-peptide increased from the end of one week of fasting to the end of 2 weeks of fasting in the T3 group, whereas they decreased in the control group. It is concluded that the changes in T3 concentration during fasting affected RMR, glucose metabolism and insulin secretion but failed to influence leucine metabolism.
Very low calorie diets should not be used.
I think that VLCD should not be used because the commercial basis for these diets makes it necessary to undermine the faith of obese patients in conventional diets. This attitude is reinforced, for commercial reasons, by counsellors who are neither as independent nor as expert as the company suggests. The net effect is that obese people are put to additional expense to buy a product that they do not need, and their confidence in their ability to control their own diet is unnecessarily destroyed.
Inpatient-outpatient randomized comparison of Cambridge diet versus milk diet in 17 obese women over 24 weeks.
Twenty-two obese women were recruited for a prospective cross-over trial of the effects of either the Cambridge Diet (CD) or 1200 ml milk with iron and vitamin supplements (milk) during a three-week inpatient study, then 20 weeks as outpatients, then a final week as inpatients. Five dropped out, leaving eight who took initially milk and then CD and nine who took CD and then milk. Within each diet group five women had their jaws wired together during the outpatient phase. The four groups (CD/milk, with/without jaw wiring) were initially well matched for age, height, weight and resting metabolic rate (RMR). There was no significant difference (by unpaired t test) between the groups during the initial inpatient phase in rate of weight loss, or N loss/kg weight loss, but patients on CD during days 13-22 had a greater daily N loss than those on milk (2.08 vs 0.28 g N/day, P = 0.02). When the change in weight loss, N loss and N/kg weight loss on changing diet within a patient group was compared by paired t test the patients changing from milk to CD showed no significant change, but patients changing from CD to milk showed a reduced rate of weight loss (0.36-0.23 kg/day; P = 0.012), a reduced N loss (2.02-0.28 g N/day; P = 0.0013) and reduced loss of N/kg (6.26 to 1.02 g N/kg; P = 0.025). During the outpatient phase weight loss was not significantly related to the diet, but patients with jaws wired lost more weight than those without jaw wiring (0.151 vs 0.077 kg/day; P = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)
Obesity and postoperative complications of abdominal operation.
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Kinesiology and food allergy.
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