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PubMed1996

[Ambulatory, comprehensive, behavior therapy-oriented weight reduction program (Optifast Program). An alternative therapy in obstructive sleep apnea].

We investigated the therapeutic effect of marked body weight reduction on the predominantly obstructive sleep apnea syndrome by the application of an out-patient, behaviour therapy based body weight reduction program (Optifast-program) in five of our obese apnea patients (mean overweight by Broca 53.6 +/- 24.8 kg). Mean body weight reduction was 32.7 +/- 15.8 kg after six months. The mean apnea-index of 34.5 +/- 23.1/h prior to the weight reduction dropped to 7.8 +/- 6.1/h after therapy. The mean apnea-hypopnea-index (so called "respiratory disturbance index", RDI) could be reduced from 45,7 +/- 26.0/h to 14.0 +/- 11.4/h. The best therapeutic effect on the sleep related respiratory parameters was seen in patients who reached their normal weight whereas the absolute weight reduction itself seems to be less important. Our results should encourage this causal therapy in appropriate patients.

Adult↗

PubMedDate not supplied

[Effects of a one-year weight reduction program and physical activity on obesity and comorbid conditions].

INTRODUCTION: Obesity prevalence is increasing all over the world. Obese patients are at increased risk for developing many medical problems, including insulin resistance and type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular diseases and stroke. Excess body weight is associated with substantial increase in mortality from all causes, cardiovascular diseases in particular. Weight control is part of the major health priorities identified for the future. The aim of the study was to evaluate effects of a one-year weight reduction program on obesity and its comorbid conditions and to make a model for long term weight reducing program. MATERIAL AND METHODS: Two hundred obese (ITM > 30 kg/m2) subjects, who attended a 15-day weight reduction ("Cigota") program, three times during a year, were followed up. Participants from group A strictly adhered to the prescribed regimen, while participants from group B followed their own routine of diet and physical activity. Two groups were comparable in terms of gender, age, duration of obesity, previous and concomitant diseases. RESULTS: A year later, a statistically significant mean weight loss was established in both groups, but it was greater in group A (p<0.05). In both groups, all serum lipid parameters, parameters of glycemic control, as well as values of systolic and diastolic blood pressures improved. There was a further decrease in serum levels of total cholesterol, LDL-cholesterol, and LDL/HDL ratio in group A. As compared to group B, group A experienced better glycemic control in diabetic and non-diabetic obese patients, and enhanced reversion from diabetes to impaired glucose tolerance or normal glucose tolerance. This study has demonstrated a well-known fact that body mass reduction is associated with a decrease in blood pressure. CONCLUSION: Treatment of obesity can make a substantial contribution to reducing hyperlipidemia, improving glycemic control, and treating hypertension. Prevention and treatment of obesity may reduce overall morbidity and mortality in the years to come. We suggest starting with weight reducing program "Cigota" and combining it with balanced program of diet and physical activity until normalizing body weight.

Adolescent↗

PubMedDate not supplied

Changes in leptin, insulin and body composition in obese children during a weight reduction program.

BACKGROUND: Girls have higher leptin concentrations than boys at all stages of biological development and this is also seen in the state of obesity. Little is known about whether gender and biological development of obese children influence changes in leptin associated with a short-term weight reduction program. OBJECTIVE: To study whether leptin concentration, body composition and insulin levels in obese children were influenced by a 3-week intervention program including diet and sports. STUDY DESIGN: Sixty-two obese children (32 boys and 30 girls) were examined before and after the intervention program. Body composition was measured by bioelectrical impedance and BMI-SDS was calculated. Serum leptin and serum insulin were determined by RIA. RESULTS: Girls had higher leptin levels than boys, before and after the weight reduction program. Body mass, fat mass (FM), leptin and insulin were decreased after the intervention in both sexes. We found a greater change in serum leptin in girls but the change in FM was of greater magnitude in boys. However, percentage changes in leptin were not significantly different between the sexes. Before the intervention, leptin concentrations were correlated with %FM, FM and moderately with BMI-SDS in all children. Only in pubertal boys did correlation of leptin with %FM increase after the intervention (from r=0.57 to r=0.75, p<0.01). Changes in leptin were found to be associated with initial leptin values in boys (r=0.95, p<0.01) and in girls (r=0.93, p<0.01), independent of Tanner stages. CONCLUSION: Serum leptin levels were positively correlated with adiposity in obese children and a diet and sports intervention program decreased serum leptin, insulin and body fat in all children. Changes in leptin were best described by the initial leptin concentration. The increase in correlation of leptin with %FM in obese pubertal boys after the intervention could have its underlying mechanism in an increased sensitivity to leptin and anabolic hormones.

Adolescent↗

PubMed1972

Experience with a hospital-based weight reduction program.

A pilot project "Nutritional Service for Weight Reduction", utilizing allied health personnel, was organized by the Departments of Medicine and Dietetics at the Calgary General Hospital. Body measurements and biochemical tests were required at the beginning and end of the 12-week program. Meetings were held at which the subjects submitted their weekly food record, received counselling by nutritionists, and attended lectures on physiology, metabolism of food, nutrition and the importance of exercise. Thirty-one subjects completed the program. All lost weight, the total for the group being 197 kg. At the first follow-up meeting, 17 subjects showed further weight loss, three maintained their weight and 11 regained some weight.

Adult↗

PubMed1980

Restricted environmental stimulation therapy in a weight reduction program.

Forty-eight female volunteers, between the ages of 22 and 55 years and at least 25% overweight, participated in a weight reduction program. The program factorially varied 24 hr of restricted environmental stimulation (lying on a bed in a dark, silent room) and a set of self-management messages. The combined treatment was significantly more effective than the other three conditions during a 6 month follow-up period; the mean weight loss during the first 2 months was primarily a function of the messages, while the reduced stimulation environment effect became dominant during the last 4 months of follow-up.

Adult↗

PubMed1991

[Evaluation of a weight reduction program: slender without diets].

"Schlank ohne Diät" ("Weight-Reduction Without Diet") is a strategy to normalize body weight, by influencing multiple factors that appear to influence and promote obesity. The base line of therapy is the modification of nutritional habits. Self-control, especially monitoring and recording of calorie intake and the loss of energy by physical activities is the key that trains every client to change his nutritional habits and helps to reduce body weight and keep normal body weight stable. In a retrospective study, including 134 persons, 84 clients (62,69%) were able to reduce body weight, 9 clients (6,72%) reached starting point of weight and in 30,60% (41 clients) during the participation in this methods an increase of body weight was seen. On an average 120 clients achieved a weight reduction of 5.98 kg during the participation in this method. The loss of weight ranged from 1 to 31 kg per person.

Adult↗

PubMed1990

[Evaluation of the weight reduction program "Reducing without Diet"].

"Schlank ohne Diät" ("Weight-Reduction Without Diet") is a strategy to normalize body weight, by influencing multiple factors that appear to influence and promote obesity. The base line of therapy is the modification of nutritional habits. Self-control, especially monitoring and recording of caloric intake and the loss of energy by physical activities is the key that trains every client to change his nutritional habits and helps to reduce body weight and keep normal body weight stable. In a retrospective study, including 134 persons, 84 clients (62.69%) were able to reduce body weight, 9 clients (6.72%) reached starting point of weight and in 30, 60% (41 clients) during the participation in this methods an increase of body weight was seen. On an average 120 clients achieved a weight reduction of 5.98 kg during the participation in this methode. The loss of weight ranged from 1 to 31 kg per person.

Adult↗

PubMed2003

Effects of a 3-week integrated body weight reduction program on leptin levels and body composition in severe obese subjects.

The effects of short-term (3 weeks) integrated body weight reduction (BWR) program (including energy-restricted diet, aerobic and strength exercise (5 days/week), nutritional education and psychological counseling) on plasma leptin levels and body composition were investigated in 54 morbidly obese patients (38 females/16 males; mean BMI +/- SE: 41.8 +/- 0.1 kg/m2, range 35-58 kg/m2; mean age: 29.8 +/- 1.0 yr, age range: 18-46 yr). The BWR program induced a significant (p < 0.001) weight loss (BMI reduction: -4.8%) and a significant modification in body composition, consisting in a fat mass (FM) decrease (-7.0 +/- 0.4%, p < 0.001) with a concomitant fat-free (FFM) mass increase (1.8 +/- 0.3%, p < 0.001). On average, plasma leptin levels decreased significantly both in males (from 19.4 +/- 2.6 ng/ml to 11.6 +/- 1.3 ng/ml, p < 0.001) and in females (from 41.1 +/- 3.6 ng/ml to 29.9 +/- 3.0 ng/ml, p < 0.001). Both before and after weight loss, leptin levels were positively correlated (p < 0.001) with BMI and percent fat mass (FM) values. Weight changes after the BWR program were negatively correlated with baseline leptin concentrations both in absolute terms and expressed per unit FM. In conclusion, a short-term diet plus aerobic/strength training effectively induces body composition changes and reduces plasma leptin levels. Body FM reduction appears to be not the unique determinant of leptin levels regulation and the degree of leptin over-expression may negatively affect weight loss in morbidly obese patients.

Adipose Tissue↗

PubMed2005

Longitudinal changes in activity patterns, physical capacities, energy expenditure, and body composition in severely obese adolescents during a multidisciplinary weight-reduction program.

OBJECTIVE: To determine the longitudinal changes in body composition, physical capacities, and time and energy expenditure (EE) devoted to various activities in the course of a 9-month weight-reduction period. DESIGN: Longitudinal, clinical intervention including lifestyle education, moderate energy restriction, progressive training, and psychological follow-up. SUBJECTS: A total of 27 (13 boys and 14 girls) severely obese adolescents (mean BMI: 33.9 kg/m2; 41.5% fat mass (FM)), aged 12-16 y. MEASUREMENTS: Before the beginning and after the weight-reduction program, body composition was assessed by dual-energy X-ray absorptiometry (DXA), physical capacities by multistage treadmill test, and EE both by whole-body calorimetry and in free-living conditions using the heart rate-recording method. During 8 months of the weight-reduction period, type and duration of each activity were recorded using a daily controlled activity diary. RESULTS: One boy resigned after 5 months. Body weight (BW) and FM decreased (-19 and -42%, respectively, P<0.001) both in boys and in girls, but fat-free mass (FFM) decreased only in girls (-6%, P<0.001). VO2max (l/min) did not vary significantly, but strength and fitness were improved (P<0.001). Time and EE spent at sedentary activities decreased significantly (P<0.001) to the benefit of moderate (recreational) activities and total physical activities (P<0.001) at the institution during the weekdays, and at home during the weekends and holidays. CONCLUSION: The great BW and FM losses, preservation of FFM, and improvement of physical capacities of obese adolescents obtained under experimental conditions were associated with increases in leisure physical activities in free-living conditions at the expense of sleep and sedentary activities.

Absorptiometry, Photon↗

PubMed2004

Response of Taiwanese obese binge eaters to a hospital-based weight reduction program.

OBJECTIVE: To investigate the characteristics and prevalence of binge eating among overweight Taiwanese and to determine the effect of binge eating on outcome of weight loss treatment. METHODS: One hundred and eighty-nine participants in a 12-week traditional weight-reduction program were classified on the basis of the Bulimic Investigation Test, Edinburgh (BITE) scores into binge eaters (>/=20), subthreshold binge eaters (10-19), and nonbinge eaters (0-9). RESULTS: This study found a 15.9% prevalence of binge eating. The binge-eating groups (binge eaters and subthreshold binge eaters) were younger, had an earlier onset of obesity, and more psychological distress than nonbinge eaters. Differences in obesity treatment weight loss among binge eaters, subthreshold binge eaters, or nonbingers by last observation carried forward (LOCF) method were not significant. At the end of treatment, the subthreshold binge eaters had the greatest weight loss. Although their binge eating and mood significantly improved, binge eaters and subthreshold binge eaters still had significant pathology in eating behaviors at completion of the program. CONCLUSION: Alternative treatment strategies focusing on disordered eating behaviors are needed to supplement standard dietary management of overweight treatment-seeking binge eaters.

Adolescent↗

PubMed2003

Almonds vs complex carbohydrates in a weight reduction program.

OBJECTIVE: To evaluate the effect of an almond-enriched (high monounsaturated fat, MUFA) or complex carbohydrate-enriched (high carbohydrate) formula-based low-calorie diet (LCD) on anthropometric, body composition and metabolic parameters in a weight reduction program. DESIGN: A randomized, prospective 24-week trial in a free-living population evaluating two distinct macronutrient interventions on obesity and metabolic syndrome-related parameters during weight reduction. SUBJECTS: In total, 65 overweight and obese adults (age: 27-79 y, body mass index (BMI): 27-55 kg/m(2)). INTERVENTION: A formula-based LCD enriched with 84 g/day of almonds (almond-LCD; 39% total fat, 25% MUFA and 32% carbohydrate as percent of dietary energy) or self-selected complex carbohydrates (CHO-LCD; 18% total fat, 5% MUFA and 53% carbohydrate as percent of dietary energy) featuring equivalent calories and protein. MAIN OUTCOME MEASUREMENTS: Various anthropometric, body composition and metabolic parameters at baseline, during and after 24 weeks of dietary intervention. RESULTS: LCD supplementation with almonds, in contrast to complex carbohydrates, was associated with greater reductions in weight/BMI (-18 vs -11%), waist circumference (WC) (-14 vs -9%), fat mass (FM) (-30 vs -20%), total body water (-8 vs -1%) and systolic blood pressure (-11 vs 0%), P=0.0001-0.05. A 62% greater reduction in weight/BMI, 50% greater reduction in WC and 56% greater reduction in FM were observed in the almond-LCD as compared to the CHO-LCD intervention. Ketone levels increased only in the almond-LCD group (+260 vs 0%, P<0.02). High-density lipoprotein cholesterol (HDL-C) increased in the CHO-LCD group and decreased in the almond-LCD group (+15 vs -6%, P=0.05). Glucose, insulin, diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) and LDL-C to HDL-C ratio decreased significantly to a similar extent in both dietary interventions. Homeostasis model analysis of insulin resistance (HOMA-IR) decreased in both study groups over time (almond-LCD: -66% and CHO-LCD: -35%, P<0.0001). Among subjects with type 2 diabetes, diabetes medication reductions were sustained or further reduced in a greater proportion of almond-LCD as compared to CHO-LCD subjects (96 vs 50%, respectively) [correction]. CONCLUSION: Our findings suggest that an almond-enriched LCD improves a preponderance of the abnormalities associated with the metabolic syndrome. Both dietary interventions were effective in decreasing body weight beyond the weight loss observed during long-term pharmacological interventions; however, the almond-LCD group experienced a sustained and greater weight reduction for the duration of the 24-week intervention. Almond supplementation of a formula-based LCD is a novel alternative to self-selected complex carbohydrates and has a potential role in reducing the public health implications of obesity.

Adult↗

PubMed2001

Short-term changes of cardiovascular risk factors after a non-pharmacological body weight reduction program.

OBJECTIVE: To test the short-term effectiveness of a 3 week hospital-based body weight reduction (BWR) program on selected coronary heart disease (CHD) risk factors in obese subjects. DESIGN: Intervention study to assess the modifications in CHD risk factor scores estimated according to Framingham risk factor categories (age, total cholesterol, high density lipoprotein (HDL) cholesterol, blood pressure, diabetes and smoking). SETTING: 3rd Division of Metabolic Diseases, Italian Institute for Auxology, Piancavallo (VB), Italy. SUBJECTS: Two-hundred and sixty-eight obese patients (43 men, 225 women, age range 19-81 y; body mass index (BMI) range 30-67). INTERVENTION: The BWR program consisted of a 3 week integrated energy-restricted diet (1200-1800 kcal/day), associated with moderate aerobic exercise, psychological counselling and educational lectures. RESULTS: Substantial reductions of total cholesterol (16.7%), HDL cholesterol (14.8%), systolic (11.2%) and diastolic blood pressure (8.7%) were observed at the end of the intervention, even with relatively moderate decrease in weight (4.1%) and in persistence of elevated BMI (over 40 kg/m2). The mean CHD Framingham score decreased by 16.1%, from 7.8 to 6.2. The BWR-induced changes were similar in both sexes, and across strata of age and BMI. CONCLUSIONS: The full-time participation of the patients in the hospital-based, integrated BWR program may explain the positive clinical outcome in all the subgroups considered, although the long-term results need to be quantified. SPONSORSHIPS: Partially supported by Progetti di Ricerca Corrente, Istituto Auxologico Italiano, IRCCS, Milan, Italy.

Adult↗

PubMed2005

Longitudinal evaluation of a weight reduction program for patients on peritoneal dialysis.

OBJECTIVES: Patients on peritoneal dialysis (PD) are exposed to glucose-based dialysate solutions with consequent risk of obesity and its attendant health problems. We wished to examine the role of changes in dialysis prescription, individualized dietaryinput, and exercise on body weight and composition. DESIGN: A 1 year, prospective interventional study integrating the care of the renal nurse, dietitian, and physiotherapist to support, educate, and encourage overweight patients on PD in a weight-reduction program. PATIENTS: Patients were considered for the study if they had been on PD for more than 3 months, had a body mass index (BMI) > 25, and were considered medically fit to undergo the planned exercise program. Recruitment was intentionally limited to a maximum of 12 patients to facilitate group interaction. Weight, BMI, and bioimpedance were measured every 3 months. RESULTS: 8 of 11 enrolled patients completed the study; 3 received transplants. There was a significant fall in median body weight at initiation, from 94.6 kg to 92.4 kg at 6 months and 89.5 kg at 12 months (p = 0.017). This equates to a reduction in BMI from 33.2 (range 26.6 - 38.4) kg/m2 at initiation to 32.1 (range 24.5 - 37.6) kg/m2 at 6 months and 32.1 (range 23.9 - 36.5) kg/m2 at 12 months. There were no significant changes in total body water, lean body mass, or percentage body fat during the study. CONCLUSION: 7 of 8 patients achieved significant weight loss during the study. The use of an informal group setting motivated patients to continue with exercise and sensible eating patterns. This study demonstrates that, with adequate support, PD patients can achieve and maintain weight loss.

Diet, Reducing↗

PubMed2006

Food neophobia in the context of a varied diet induced by a weight reduction program in massively obese adolescents.

Previous studies in humans have shown that short to middle-term pre-exposure to multiple foods can reduce the negative response to novel foods (neophobia). In order to explore the effects of a long-term exposure to varied foods on food neophobia, we studied a population of obese adolescents observed in a longitudinal protocol in which the multiple food experiences are induced by a residential weight reduction program (WRP) that encourages the consumption of a wide variety of foods. Seventy-two massively obese adolescents (22 boys) filled the food neophobia scale (FNS, [Pliner, P., & Hobden, K. (1992). Development of a scale to measure the trait of food neophobia in humans. Appetite 19, 105-120]) and an ad hoc food familiarity and liking questionnaire at the beginning and at the end of the program (mean duration: 8.9 months). Their scores were compared to those of a control group of 51 adolescents (14 boys) tested within a similar period. FNS results show a decrease of food neophobia, without significant difference between the control group and the WRP subjects, although only WRP have encountered new foods experiences as attested by the familiarity and liking results. Methodological considerations, concerning the characteristics of the participants, the nature of the multiple food exposure and the food neophobia measurements, will be proposed to explain differences among studies.

Adolescent↗

PubMed1990

Attributions for previous failures and subsequent outcomes in a weight reduction program.

This prospective study examines the effects of causal attributions given to previous weight control failures on subsequent success in controlling weight. Adult participants enrolled in a weight control program were screened to identify those who had made previous weight reduction attempts through a formal program. Once identified, subjects (n = 158) were asked to make causal attributions for their previous failures. Subjects were then followed through the 15-week program to determine their degree of success. Subjects who attributed the cause of previous failures to stable, immutable conditions were more likely to have low expectations of success. Low success expectancies, in turn, were associated with lack of goal attainment through the program. The number of previous failures in formal weight control programs was associated with a perception of the respondents that previous failures had stable causes. Neither the number of former failures nor the attributions of their causes were directly related to goal attainment. Practice implications of the results are discussed.

Achievement↗

PubMed1986

Behavioral weight reduction program for mentally retarded adult females.

Behavioral treatment approaches to obesity in 17 mild-to-moderate retarded female adults were assigned to one of two experimental conditions, (a) behavioral self-control along with a physical activity component and (b) behavioral self-control. No significant differences were noted between groups on the indices of body weight and tricep skinfold thickness. A one-way analysis of variance with a repeated measure yielded a significant main effect of time for change in weight for both groups at the end of the 8-week treatment. Questions were raised about the possible role of nonspecific motivational factors versus cognitive factors in behavioral-weight reduction programs.

Adult↗

PubMed1984

A comprehensive outpatient weight reduction program: dietary patterns, psychological considerations, and treatment principles.

A comprehensive outpatient approach to weight reduction has the best chance of long-term success. This article outlines the dietitian's role and summarizes dietary patterns and psychological problems encountered in such a program at the University of Virginia Clinical Nutrition Center. Patients were assisted in making gradual changes in eating patterns through nutrition education and the use of behavior modification techniques. Initial food diaries often reflected a low intake of fruits, vegetables, whole grains, and legumes; increased consumption of these high-fiber foods is advocated as an aid to weight loss. Psychological support is an important component of the weight reduction process. The dietitian must be adequately prepared to provide this therapy but also must be able to recognize when patients should be referred for further psychological counseling. Two case studies are presented to illustrate the sabotage which must be dealt with by patients as they lose weight and struggle to maintain that weight loss.

Adult↗

PubMed2005

Postural instability of extremely obese individuals improves after a body weight reduction program entailing specific balance training.

The purposes of this study were to compare postural stability between obese and lean subjects and to investigate the effect of a 3-week body weight reduction (BWR) program entailing specific balance training on postural stability of extremely obese patients. Time of balance maintenance and mean error on the medial-lateral direction at the trunk and lower limb level were assessed during a single limb stance on a movable platform in 19 non-obese and in 20 extremely obese individuals (age range: 20-40 yr). Time of balance maintenance was shorter (obese: 21.1+/-7.7 vs lean: 27.3+/-3.1 sec) and medial-lateral sway of the trunk was larger in obese (5.4+/-3.2 degrees) than in lean (3.2+/-1.1 degrees) subjects (p<0.05). Two subgroups of obese subjects were also tested after a BWR program (energy-restricted diet, moderate physical exercise, nutritional education and psychological counselling) combined with or without 6 sessions of specific balance training on a movable platform. BWR plus specific balance training enhanced time of balance maintenance (pre: 23.8+/-7.2 vs post: 30.0+/-0.0 sec) and reduced the trunk sway (5.2+/-2.8 degrees vs 2.6+/-0.9 degrees ) more than BWR alone (p<0.05). The present findings indicate that extremely obese individuals have inadequate postural stability (compared to their lean counterparts) that could however be improved by few sessions of specific balance training incorporated into a multidisciplinary BWR program. It was concluded that balance improvement is an important goal of rehabilitation, that would probably reduce the propensity of overweight individuals to fall while performing everyday activities.

Adult↗