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Results for “Weight Reduction Programs”

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At least 235 records · Page 13Linked to original sources

PubMed1997

Lipolytic catecholamine resistance linked to alpha 2-adrenoceptor sensitivity--a metabolic predictor of weight loss in obese subjects.

OBJECTIVE: The weight loss achieved during treatment with very-low-calorie diets (VLCD) varies between individuals. The aim of this study was to investigate whether interindividual variations in catecholamine-induced lipolysis are of importance for the rate of weight loss during VLCD. DESIGN: Prospective study. SUBJECTS: Twenty-eight obese, but otherwise healthy and drug-free women aged 20-57 y with BMI 33.3-47.5 kg/m2 were investigated before entering a four week weight reduction program with a calorie-restricted diet. MEASUREMENTS: A subcutaneous adipose tissue biopsy was obtained from the abdominal area. Isolated fat cells were prepared and incubated in vitro with agents acting on lipolysis at defined steps in the lipolytic cascade. Glycerol release was measured and used as a lipolytic index. Following the biopsy, the subjects underwent a four week VLCD treatment. RESULTS: The decrease in body weight in the whole group ranged between 4.8 and 13.5 kg. Dietary compliance was ascertained by daily measurements of urine-ketones and regular interviews and was satisfactory in all subjects throughout the study. Based on percent body weight reduction, the material was divided into two equally sized groups, classified as rapid or slow weight losers. The rapid weight losers were 10-fold more sensitive to the lipolytic effect of noradrenaline (P = 0.04) and 10-fold less sensitive (P = 0.002) to the antilipolytic effect induced by the alpha 2-adrenoceptor agonist clonidine than the slow weight losers. In the whole material, weight loss was significantly correlated (adjusted r2 = 0.25) with alpha 2-adrenoceptor sensitivity. CONCLUSION: Rapid weight loss during VLCD is associated with increased adipocyte lipolytic sensitivity to catecholamines due to decreased alpha 2-adrenoceptor sensitivity, which in turn may promote lipid mobilization. It appears that variations in alpha 2-adrenoceptor sensitivity in adipocytes may be predictive of weight loss during VLCD.

Adenosine Deaminase↗

PubMed2004

Additive effect of the mutations in the beta3-adrenoceptor gene and UCP3 gene promoter on body fat distribution and glycemic control after weight reduction in overweight subjects with CAD or metabolic syndrome.

OBJECTIVE: To analyze the effects of the mutations in the beta3-adrenoceptor (beta3-AR) gene and/or uncoupling protein3 (UCP3) gene promoter on body fat distribution and glycemic control after mild weight reduction in overweight-obese subjects with coronary artery disease (CAD) or metabolic syndrome. DESIGN: Clinical intervention study of the -300 kcal/day mild weight reduction program for 12 weeks. SUBJECTS: A total of 224 overweight-obese subjects with CAD or metabolic disorder, subdivided into the following four categories: (1) wild type (TT-CC, n=73); (2) only UCP3 promoter variant (TT-CT/TT, n=90); (3) only beta3-AR variant (TA/AA-CC, n=29); (4) both variants (TA/AA-CT/TT, n=32). MEASUREMENT: Body mass index (BMI), blood pressure, calorie intakes, body fat distribution, serum glucose, insulin, free fatty acids, C-peptide and lipids before and after weight reduction. RESULTS: After 12 weeks, all subjects lost approximately 5% of their initial body weight. Despite similar weight reduction, the highest decreases in abdominal adipose tissue at both L1 and L4 levels were observed in the 'wild-type' group (P<0.001) and the second highest in 'only UPC3 promoter variant' group (P<0.001). On the other hand, both variant-carriers had the smallest reduction only in visceral fat area at the L4 level. All subjects except both variant-carriers showed significant reductions in the fasting levels of glucose and FFA. The response areas of glucose (P<0.01) and insulin (P<0.05) were reduced largest in the 'wild-type' group and second largest in the 'UCP3 promoter variant' group. CONCLUSION: All the four groups showed similar weight reduction after -300 kcal/d for 12 weeks. However, the beneficial effects on body fat distribution and glycemic control were greatest in the 'wild-type' group and smallest in 'both variants' group. In addition, these effects were less beneficial in carriers with beta3-AR gene variant than with UCP3 gene promoter variant.

Adipose Tissue↗

PubMed1994

Effect of caloric restriction on colonic proliferation in obese persons: implications for colon cancer prevention.

Dietary intervention to prevent colon cancer is a major health issue. At present it is not clear which dietary factors modify colon cancer risk. Caloric restriction reduces the incidence of many spontaneous and carcinogen-induced tumors in rodents, but its role in human carcinogenesis is unknown. The relationships of body mass index (BMI), body composition, and resting metabolic rate (RMR) to colon cancer risk are also undefined. In this study involving obese persons, we measured the effect of reducing caloric intake on rectal cell proliferation, a biomarker in colon carcinogenesis, and studied the relation of BMI, body composition, and RMR to rectal cell proliferation. Colonic cell proliferation was measured in rectal biopsies from persons weighing more than 130% of ideal body weight. Follow-up biopsies were performed in patients who enrolled in and completed a 16-week behavior modification weight-reduction program in which caloric intake was reduced. Baseline measurements included body composition by total body electrical conductance, RMR, and BMI. Rectal biopsies were processed for autoradiography following incubation with [3H]thymidine. Epithelial proliferation measurements were evaluable in 35 persons at baseline and in 8 persons before and after caloric restriction. Before caloric restriction, mean (+/- SD) BMI was 38 +/- 4 kg/m2 and percentage of body fat 41 +/- 2%. Subjects reduced their caloric intake by a mean of 34 +/- 4% and their weight by 8.6 +/- 1%. Caloric restriction resulted in a 39% reduction in whole-crypt labeling index (P < 0.001) and a 57% reduction in upper crypt labeling index (P < 0.05) without reduction in crypt depth. Labeling index was unrelated to BMI, RMR, or body composition. We conclude that caloric restriction reduced rectal cell proliferation measurements--intermediate biomarkers related to colon carcinogenesis. BMI, RMR, and body composition were unrelated to colonic proliferation. Caloric restriction may have a role in colon cancer prevention.

Adult↗

PubMed2001

The relationship between health-related quality of life and weight loss.

OBJECTIVE: This is a report of health-related quality of life (HRQOL) changes in obese patients completing at least 1 year of outpatient treatment in a weight reduction program combining phentermine-fenfluramine and dietary counseling. RESEARCH METHODS AND PROCEDURES: Participants were 141 women (87.6%) and 20 men (12.4%) who had an average body mass index at intake of 41.1 kg/m(2) (SD = 7.0, range = 29.5 to 67.0 kg/m(2)) and an average age of 44.9 years (SD = 9.3, range = 23 to 65 years). HRQOL was assessed at intake and at 1-year follow-up using the Impact of Weight on Quality of Life (IWQOL)-Lite questionnaire. The relationship between HRQOL changes and weight loss was examined using Pearson correlations. Clinically meaningful change in HRQOL was defined as a 1.96 SEM reduction in IWQOL-Lite total score. RESULTS: On average, participants lost 20.2 kg or 17.6% of their weight over the 1-year period. Of the participants, 15.5% lost <10% of their weight, 24.2% lost 10% to 14.9%, 23.6% lost 15% to 19.9%, and 36.6% lost 20% or more. All five IWQOL-Lite scales and total score showed statistically significant improvement over the 1-year period. Changes in IWQOL-Lite scores from intake to 1 year showed statistically significant correlations with percentage of weight loss for all subscales and total score. Subscale correlations with weight loss ranged from 0.166 (Public Distress) to 0.396 (Physical Function) and was 0.370 for the total score. Forty-four percent of participants losing <10% met the criterion of clinically meaningful change, compared with 51.3% losing 10% to 14.9%, 55.3% losing 15% to 19.95%, and 76.3% losing >20%. For total score and for three of the five IWQOL-Lite scales (Physical Function, Self-Esteem, and Sexual Life), the relationship between weight loss and clinically meaningful change was linear and was significant at p < 0.05. Physical Function and Self-Esteem were most strongly affected by weight loss. DISCUSSION: HRQOL changes, as measured by an obesity-specific instrument (IWQOL-Lite), are strongly related to weight reduction.

Adult↗

PubMed2005

Prognostic impact of body weight and abdominal obesity in women and men with cardiovascular disease.

BACKGROUND: Increased body mass index (BMI) and abdominal adiposity increase the risk of cardiovascular disease (CVD) in persons free of these diseases, but their independent prognostic impact in persons with CVD has not been well defined. METHODS: BMI, waist-to-hip ratio (WHR), and waist circumference (WC) were measured in 6620 men and 2182 women with a mean age of 66 and stable CVD without congestive heart failure (CHF) participating in the Heart Outcomes Prevention Evaluation (HOPE) study. The main outcomes were CVD death, myocardial infarction, stroke, hospitalization for CHF, and all-cause mortality. RESULTS: During the 4.5-year follow-up, 658 had a CVD death, 1018 a myocardial infarction, 364 a stroke, 297 a CHF event, and 1034 died. When compared with the first tertile, the third tertile of BMI increased the adjusted relative risk (RR) of myocardial infarction by 20% (P < .02). Patients in the third tertile of WC had an increased adjusted RR of 23% for myocardial infarction (P < .01), 38% for heart failure (P < .03), and 17% for total mortality (P < .05). For WHR, there was an increased adjusted RR of 24% for CVD death (P < .03), 20% for myocardial infarction (P < .01), and 32% for total mortality (P < .001). CONCLUSIONS: Obesity, particularly abdominal adiposity, worsens the prognosis of patients with CVD; weight reduction program should be integrated in the active management of these patients.

Abdomen↗

PubMed1999

Impact of adipose tissue on plasma plasminogen activator inhibitor-1 in dieting obese women.

The increased incidence of cardiovascular diseases in obese subjects could be partially attributed to impaired fibrinolysis due to elevated plasma levels of tissue plasminogen activator inhibitor 1 (PAI-1). The associations between changes in plasma PAI-1, metabolic variables, and adipose tissue during weight loss and regain were studied in 52 healthy, premenopausal, obese women participating in a weight reduction program with a hypocaloric diet. PAI-1, insulin, triglyceride, leptin, and adipsin levels were determined at entry, after the first week, after completion of the program, and after 5 months of follow-up. In the 33 obese women who completed the program, decreases in PAI-1 antigen (-54%), PAI activity (-74%), and leptin (-51%), but not of adipsin, were observed. Changes in PAI-1 were associated with changes in body mass index (BMI), body fat, leptin, and insulin. The decreased level of PAI-1 remained low after follow-up in the 14 women who maintained their reduced weight but increased in the 16 women who regained weight. This increase in PAI-1 was correlated with an increase in body fat and leptin. On multivariate analysis, BMI was the major determinant of PAI-1 level. In conclusion, during weight reduction with a hypocaloric diet, the decrease in PAI-1 is more closely related to changes in adipose tissue than to changes in metabolic variables, suggesting a significant role for adipose tissue in regulating plasma levels of PAI-1.

Adipose Tissue↗

PubMed1993

Comparison of two hypocaloric diets in obese children.

OBJECTIVE: To examine whether a protein-sparing modified fast diet and a hypocaloric balanced diet are safe and effective for children in an outpatient weight reduction program. DESIGN: Randomization of two groups to either diet, with follow-up at 14.5 months. SETTING: Physician or parent referral to outpatient program at Children's Hospital of New Orleans, La. PARTICIPANTS: Nineteen children, ranging in age from 7.5 to 16.9 years, weighing 45% to 131% more than the mean weight for age, sex, and height. INTERVENTION: During the first 10 weeks, 10 children were placed on a protein-sparing modified fast diet (2520 to 3360 J), and nine children and adolescents were placed on a hypocaloric balanced diet (3360 to 4200 J). Subsequently, all participants were placed on a hypocaloric diet; calories were increased from 4200 to 5040 J in a 3-month period and maintained for 1 year. SELECTION PROCEDURES: Children were assigned to one of two diets for the first 10 weeks according to their time of enrollment. MEASUREMENTS/MAIN RESULTS: Both diets produced significant weight loss during the first 6 months. However, the protein-sparing modified fast diet produced significantly greater changes in the percentage of overweight at 10 weeks (-30% vs -14%) and at 6 months (-32% vs -18%). At 10 weeks, a significant loss of adipose tissue with preservation of lean body mass occurred in the protein-sparing modified fast group. A transient slowing of growth velocity was noted at 6 months in both dietary groups compared with values at 14.5 months. Growth velocity approached normal levels at 14.5 months compared with standards for North American children. When dietary groups were combined, the initial mean blood pressure decreased significantly at all points in the study. The initial mean serum cholesterol value also decreased significantly at 10 weeks. No biochemical or clinical complications were observed. CONCLUSIONS: These hypocaloric diets appear to be safe and effective in the short-term management of pediatric obesity. However, these diets should not be used without close medical supervision.

Adolescent↗

PubMed1999

Randomized trial on protein vs carbohydrate in ad libitum fat reduced diet for the treatment of obesity.

OBJECTIVE: To study the effect on weight loss in obese subjects by replacement of carbohydrate by protein in ad libitum consumed fat-reduced diets. DESIGN: Randomized dietary intervention study over six months comparing two ad libitum fat reduced diets (30% of total energy) strictly controlled in composition: High-carbohydrate (HC, protein 12% of total energy) or high-protein (HP, protein 25% of total energy). SETTING AND PARTICIPANTS: Subjects were 65 healthy, overweight and obese subjects (50 women, 15 men, aged 18-55 y) randomly assigned to HC (n = 25), HP (n = 25) or a control group (C, n = 15). All food was provided by self-selection in a shop at the department, and compliance to the diet composition was evaluated by urinary nitrogen excretion. MAIN OUTCOME MEASURE: Change in body weight, body composition and blood lipids. RESULTS: More than 90% completed the trial. Weight loss after six months was 5.1 kg in the HC group and 8.9 kg in the HP group (difference 3.7 kg, 95% confidence interval (CI)(1.3-6.2 kg) P < 0.001), and fat loss was 4.3 kg and 7.6 kg, respectively (difference 3.3 kg (1.1-5.5 kg) P < 0.0001), whereas no changes occurred in the control group. More subjects lost > 10 kg in the HP group (35%) than in the HC group (9%). The HP diet only decreased fasting plasma triglycerides and free fatty acids significantly. CONCLUSIONS: Replacement of some dietary carbohydrate by protein in an ad libitum fat-reduced diet, improves weight loss and increases the proportion of subjects achieving a clinically relevant weight loss. More freedom to choose between protein-rich and complex carbohydrate-rich foods may allow obese subjects to choose more lean meat and dairy products, and hence improve adherence to low-fat diets in weight reduction programs.

Adolescent↗

PubMedDate not supplied

Binge eating in overweight women.

Data on the prevalence and characteristics of binge eating in a series of 64 obese women participating in a controlled weight-reduction program are presented. Twenty-two (34.4%) reported recurrent binge eating episodes defined as overeating plus loss of control as assessed by patients' self-report and confirmed by a clinical interview. Six of those indicated that they engaged in either self-induced vomiting or laxative use to control their weight, but only two met full criteria for current bulimia nervosa according to DSM-III-R. A detailed description of the binge eating behavior revealed similarities to the eating pattern described in patients with bulimia nervosa: obese binge eaters tended to overeat in the evening, when they were alone and at home. Compared with their non-binge eating counterparts, binge eaters were significantly younger when they presented for treatment. The prevalence of childhood obesity was higher, and they were significantly younger when they first started on a diet than the non-binge eaters. Binge eaters reported more psychological problems such as body image distortion, and there was a slight tendency for binge eaters to exhibit more depressive symptomatology at baseline. No association between binge eating and weight at baseline, or weight loss during therapy or at follow-up could be found. Fluvoxamine (100 mg) did not seem to be of specific benefit in this subgroup of the obese with regard to weight loss.

Adult↗

PubMed1977

Management of the obese adolescent.

Obesity as a health problem appears to be increasing in incidence. Adolescent obesity is generally exogenous in type. The teenagers are basically healthy with advanced sexual and bone maturation. They suffer from peer ridicule and exclusion from activities. The weight problem bars them from successful adult adjustment in their social lives and career choice. To the physician who treats the obese adolescent, it would be wise to review the pitfalls of previous programs. The multidisciplinary approach is an attempt to combine dietary restriction and increased physical activity to gradually mobilize fat stores and provide psychologic support. Motivation is reinforced by a committed staff and by the patients' own obese peers with whom they meet weekly. Despite the repeated record of failure in adolescent weight reduction programs, it is hoped that the challenge of obesity management spurs the interest of physicians to increase their knowledge of nutrition and to intervene with early effective preventive measures.

Adolescent↗

PubMed1997

Effects of cardiac rehabilitation, exercise training, and weight reduction on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in obese coronary patients.

Obesity is strongly associated with coronary artery disease (CAD) and may be an independent risk factor; however, limited data are available on obesity intervention in patients with CAD. We studied 588 consecutive patients, including 235 (40%) who were obese by body mass index criteria (body mass index > or = 27.3 kg/m2 in women and > or = 27.8 kg/m2 in men) before and after out-patient phase II cardiac rehabilitation to determine the effects of this therapy and weight reduction on exercise capacity, CAD risk factors, behavioral characteristics, and quality of life in obese patients with CAD. At baseline, obese patients were younger (p < 0.0001) and had more systemic hypertension (p < 0.01), and diabetes mellitus (p < 0.05) and higher percent body fat (p < 0.0001), total cholesterol (p = 0.02), triglycerides (p < 0.0001), fasting glucose (p = 0.04), and low-density lipoprotein (LDL)-high-density lipoprotein (HDL) cholesterol (p < 0.0001), but had lower HDL cholesterol (p < 0.01) and exercise capacity (p = 0.07) than patients not classified as obese. After rehabilitation, obese patients had significant improvements in body mass index (-2%; p < 0.0001), percent body fat (-5%; p < 0.0001), exercise capacity (+27%; p < 0.0001), HDL cholesterol (+4%; p < 0.01), LDL/HDL ratio (-6%; p < 0.01), as well as scores for anxiety (p < 0.0001), depression (p < 0.01), somatization (p < 0.0001) and quality of life (p < 0.0001); nonobese patients, however, had significantly greater improvements in exercise capacity (+39% vs +27%; p < 0.001). In a subgroup of 45 obese patients with > or = 5% weight reduction, improvements in exercise capacity (p < 0.001), total cholesterol (p = 0.03), triglycerides (p < 0.01), HDL cholesterol (p < 0.001), LDL cholesterol (p = 0.02), and LDL/HDL ratio (p < 0.0001) were greater than improvements in 81 obese patients who did not lose weight. These data indicate that greater emphasis on more successful weight reduction programs is needed to further enhance CAD risk reduction in the 40% CAD patients with obesity.

Aged↗

PubMed1992

Disparate effects of weight loss on insulin sensitivity and erythrocyte sodium-lithium countertransport activity.

Previous investigations have demonstrated an association between impaired insulin sensitivity and elevated erythrocyte sodium-lithium countertransport (Na(+)-Li+ CT) activity. It has been speculated that insulin resistance and endogenous hyperinsulinemia are causally related to the development of elevated Na(+)-Li+ CT activity. To test this hypothesis, we measured insulin sensitivity (euglycemic insulin clamp technique) and Na(+)-Li+ CT activity in eight obese women before (weight = 102 +/- 5 kg) and after (weight = 88 +/- 5 kg; P < .001) a 10 week weight reduction program. Maximal velocity of Na(+)-Li+ CT activity did not change (0.50 +/- 0.09 v 0.49 +/- 0.10 mmol/L red blood cells/h; P = NS) despite the significant improvement in insulin sensitivity (73 +/- 12 vs 110 +/- 7 mg/m2/min; P < .0025) and reduction in fasting insulin levels (17 +/- 2 v 10 +/- 2 microU/mL; P < .05) that accompanied weight loss. These results suggest that insulin resistance and hyperinsulinemia are not linked pathophysiologically to the development of elevated Na(+)-Li+ CT activity.

Adult↗

PubMedDate not supplied

Childhood obesity in Taiwan.

As other developed countries of the world, obesity has become a major health problem of children and adolescents in Taiwan. According to an island-wide survey, the prevalence of obesity varied from 4.3% to 17.4% in children aged three to nineteen years. Obesity is defined as an excess of body fat. Since the standard references of weight-for-height and body mass index for Taiwanese are not available, a weight-for-length index has been introduced. We have found that its easy computation and interpretation with high reliability make it a desirable measure of relative weight either in clinical practice or in research. The family background of the obese children has been investigated by many workers. In our own series, the obese children were about five times as likely to have an obese parent as control. There was also a significant difference in the chance of having an obese sibling between the obese and control groups. Several health sequelae of childhood obesity have been studied in Taiwan. Obese children appear to have high prevalence of hypertension, hyperlipidemia, and abnormal glucose metabolism. Of several cutaneous manifestations of obesity, colored striae were sometimes overlooked. In our experience, 40% of the moderate to severe obese cases have such striking marks prominently located on the thighs, arms and abdomen. A few pediatric weight-losing programs have been carried out in Taiwan. In our Pediatric Anti-Obesity Club, four fundamental components: diet, exercise, behavior modification and parent involvement were included in the treatment program. In family-based parent-directed program, 11% of the participants showed decreases in degree of obesity after one year follow-up, compared to 3% of a control group. In another individualized outpatient counseling clinic, the success rate was 59% after one year. Although the long-term effectiveness cannot determined, it seems rational that a realistic and culturally sensitive weight reduction program should be developed for countries, such as Taiwan, with increasing prevalence of childhood obesity.

Adolescent↗

PubMed2003

Adiponectin levels do not change with moderate dietary induced weight loss and exercise in obese postmenopausal women.

OBJECTIVE: The purpose of this study was to determine changes in adiponectin levels with moderate weight loss, weight loss plus aerobic exercise, or weight loss plus resistive exercise in overweight and obese, sedentary postmenopausal women. DESIGN: Longitudinal, clinical intervention study of 6-month (3 x /week) program of either weight loss (WL, n=15), weight loss + aerobic exercise (WL+AEX, n=16), or weight loss + resistive exercise (WL+RT, n=9) SUBJECTS: We studied 40 sedentary, overweight and obese (body mass index, BMI=32+/-1 kg/m(2), X+/-s.e.m.) postmenopausal (57+/-1y) women. MEASUREMENTS: Fat mass and fat-free mass (FFM) by dual-energy X-ray absorptiometry, plasma insulin, leptin, and adiponectin by radioimmunoassay. RESULTS: Age, body weight, BMI, waist and hip circumferences, waist-to-hip ratio, VO(2)max, percent fat, total body fat mass, FFM, and fasting plasma glucose, insulin, leptin, and adiponectin concentrations were similar among WL, WL+AEX, and WL+RT groups before the interventions. In all women combined, body weight, BMI, and waist and hip circumferences decreased (P < 0.001). There was a significant absolute decrease in percent body fat from 47 to 44%, representing a 13% decrease in total fat mass and a -1.6% change in FFM. Fasting concentrations of plasma adiponectin did not change (40+/-16%, P=NS), whereas fasting plasma glucose, insulin, and leptin all decreased (P<0.001). CONCLUSIONS: Plasma adiponectin levels do not change with a 6-month moderate weight reduction program even when accompanied by aerobic or resistive exercise training in overweight and obese postmenopausal women.

Adiponectin↗

PubMed2003

Sibutramine enhances insulin sensitivity ameliorating metabolic parameters in a double-blind, randomized, placebo-controlled trial.

AIM: To assess the effect of sibutramine-assisted weight reduction program on insulin sensitivity and metabolic parameters in obese normal glucose tolerant individuals over a period of 24 weeks. RESEARCH DESIGN AND METHODS: A double-blind, placebo-controlled, parallel, prospective clinical trial was carried out at our medical centre. Forty female normal glucose tolerant patients, body mass index: 34.3 +/- 2.9 kg/m2 and age: 41.1 +/- 9.9 (range: 19-58 years), were randomized to placebo or sibutramine, 10 mg once daily. RESULTS: Seventeen patients from sibutramine group and 14 placebo had completed the study protocol. Significant weight change was seen in sibutramine (p < 0.01) (-5.6 kg or -6.1% vs. +0.9 kg or +1.1% in placebo). Insulin sensitivity enhanced in sibutramine group (Kitt: from 4.03 +/- 1.97 to 5.09 +/- 2.48%/min; p < 0.05). Homeostasis model assessment-IR (HOMA-IR) decreased from 7.8 +/- 6.9 to 5.6 +/- 4.5 (p < 0.05). HOMA-beta also decreased from 508 +/- 381 to 374 +/- 256 (p < 0.05). No changes were observed in the placebo control group regarding insulin sensitivity or secretion. Concomitant reductions were observed in the sibutramine group in lipid parameters (triglycerides and high-density lipoprotein-cholesterol), uric acid and gamma-glutamyl transferase (p < 0.05). CONCLUSIONS: Sibutramine has demonstrated efficacy in reducing weight in non-diabetic women along with amelioration in insulin sensitivity and additional improvement in metabolic parameters.

Adult↗

PubMedDate not supplied

Obesity: a move from traditional to more patient-oriented management.

BACKGROUND: Family physicians have been encouraged to be aggressive in their treatment of obesity in their overweight patients. This article examines our traditional management of obesity and presents a management approach that is relatively safe, healthy, and patient-oriented. METHODS: A review of the literature on obesity and its treatment was performed by searching MEDLINE, PsychINFO, ERIC, and SOCA data bases from 1980 to 1993. Additional references were accessed by cross-referencing the bibliographies of the articles obtained through this search. RESULTS AND CONCLUSIONS: Both physicians and society in general tend to be biased against obese individuals, and this bias has negative consequences in that it reinforces patients' negative stereotypes about their fatness and could contribute to their avoidance of physicians. To circumvent this tendency, physicians should make a conscious effort to treat their obese patients with understanding and respect and to offer treatment that optimizes their risk-benefit profile. Regardless of weight, all patients should be asked about their diet and exercise history, and a brief mental status evaluation should be performed to screen for eating disorders and other psychosocial disorders. In addition, all patients should be encouraged to follow a healthy lifestyle, which includes regular, moderate exercise and a balanced, low-fat diet. Repeated dieting should be avoided, because it can produce more harm than benefit by contributing to binge eating, loss of self-esteem, and increased risk of sudden death and cardiovascular disease. Thus, only obese patients who have never attempted comprehensive weight reduction programs should be encouraged to try such a program. Patients who have severe obesity that interferes with their lives or who have moderate obesity and a comorbid condition can be offered a gastroplasty or gastric bypass procedure, coupled with an explanation and discussion of the success and failure rates involved. Regardless of whether patients are able to lose weight, the family physician can still provide long-term support and care and encourage a healthy lifestyle in these patients.

Combined Modality Therapy↗

PubMed2007

Psychobiological effects observed in obese men experiencing body weight loss plateau.

Our objective was to investigate the psychobiological impact associated with resistance to further weight loss in obese men. Anthropometric and body composition measurements, resting metabolic rate (RMR) measurement, appetite sensation markers, and three questionnaires [Short Form-36 Health Survey (SF-36), Three-Factor Eating Questionnaire (TFEQ), and Beck Depression Inventory (BDI)] were assessed at baseline and after 1 month of body weight loss plateau induced by a supervised diet and exercise clinical intervention in 11 obese men. The weight loss plateau corresponded to 11.2% of initial body weight (93.9% from fat stores). However, this amount of weight loss induced a significant decrease in RMR (P <.05) and a significant increase in hunger (P <.05) and desire to eat (P <.05). Using the SF-36 Health Survey, physical and mental health were shown to be unchanged at plateau as compared to baseline. The TFEQ showed that cognitive dietary restraint increased (P <.001) compared to baseline. Finally, depression risk as measured by the BDI significantly increased at plateau (P <.01) compared to baseline. Weight loss until resistance to further weight loss may be detrimental for some psychobiological variables including depression, which emphasizes the relevance of caution and reasonable objectives when prescribing a weight reduction program for obese individuals.

Adult↗

PubMed2003

[New therapeutic options in obesity].

The basis for a therapeutic concept for obesity comprises specific measures aimed at changing inappropriate lifestyle habits (overeating, unsuitable diet, sedentary lifestyle) and psychological counseling (identification of bad eating habits, motivation, intensive coaching). Education by a physician on an individual or small-group basis, with emphasis on the practical implementation of fitness training (endurance and muscle building!), together with modification of the diet, has proved successful. In parallel with this, supportive anti-obesity medication makes a useful contribution to weight reduction and the control of risk factors. Evidence-based anti-obesity drugs such as sibutramine and orlistat facilitate the start of weight reduction, thus providing additional motivation of success, and support the long-term effect by stabilizing the weight loss. Health insurance carriers should, in future, selectively support evaluated and approved medication-based and non-medication-based weight-reduction programs, and reimburse the patient who has successfully participated in one.

Adult↗