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PubMed1989

The long term effectiveness of combined therapy by behavior modification and very low calorie diet: 2 years follow-up.

Seventy refractory obese subjects were assigned to one of three treatments; (a) very low calorie diet (VLCD) alone; (b) behavior modification alone; and (c) combined therapy by VLCD and behavior modification. Fifteen obese patients were treated by VLCD for 1-2 months on the outpatient clinic; 16 obese patients were treated by a combined therapy and 39 subjects were treated by behavior modification alone. Formula diet used in this program was Optifast 70 (420 kcal/day). The behavior modification had been performed for 4 months with eight group meetings, using the revised textbook based on the Learn Program (University of Pennsylvania). Effects on weight reduction and its maintenance during 2 years follow-up were compared in each treatment group. There were no significant differences between average weight loss of patients treated by VLCD (7.5 +/- 2.1 kg/month) and that attained by the combined therapy (8.3 +/- 2.3 kg/month). At 2 years after the termination of the VLCD treatment, 67 percent of patients had regained more than half of their reduced weight, with an average weight regain of 4.3 +/- 3.5 kg. In contrast, 12 of 16 (75 percent) and 33 of 39 (85 percent) patients had maintained their reduced weight for 2 years after the combined therapy or the behavior modification program. Continuing weight loss of 1.0 +/- 0.7 kg by the combined therapy and 1.3 +/- 2.2 kg by the behavior modification were observed at 2 years of follow-up. Weight reducing effect of combined therapy by behavior modification and VLCD was almost identical with that obtained by VLCD alone in a short term observation of one month.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavior Therapy↗
PubMed2001

Is the relationship between adipose tissue and waist girth altered by weight loss in obese men?

OBJECTIVE: The aim of the present study was to examine whether the association of waist girth to visceral adipose tissue (AT) accumulation was altered by weight loss in abdominally obese men. RESEARCH METHODS AND PROCEDURES: We studied 45 dyslipidemic abdominally obese men (45.4 +/- 6.2 years of age; body mass index [BMI], 31.3 +/- 3.0 kg/m(2); waist circumference, 103.4 +/- 7.6 cm; total cholesterol, <6.72 mM; triglycerides, > or =1.7 mM but < or =5.65 mM; high density lipoprotein cholesterol, < or =1.2 mM). Each of them followed nutritional recommendations combined with a prescription of gemfibrozil (1200 mg/d) or a placebo for 1 year. After 6 months, a training exercise program was added at a frequency of four sessions of 60 minutes per week at 50% of maximal oxygen uptake. RESULTS: In response to the 1-year intervention program, men showed significant reductions in body weight, BMI, waist circumference, and in the partial volume of visceral and abdominal subcutaneous AT measured from two abdominal computed tomography scans performed at lumbar vertebra (L)2 to L3 and L4 to L5 levels. No change in waist-to-hip ratio was observed. Changes in visceral AT were strongly correlated with changes in body weight, BMI, and waist circumference (0.83 < r < 0.85; p < 0.001). However, a weak association was noted between waist-to-hip ratio and changes in visceral AT (r = 0.40; p < 0.05). There was no change in slopes or in intercepts before and after treatment in the relationships between volume or area of abdominal AT and anthropometric markers. DISCUSSION: Despite a greater level of the partial volume of subcutaneous AT than of the partial volume of visceral AT at baseline (p < 0.001), the greater relative reduction in the visceral AT volume in comparison with the subcutaneous AT volume suggested a preferential mobilization of visceral AT with weight loss in these abdominally obese men. The close relationship between changes in the partial volume of visceral AT and changes in cross-sectional areas of visceral AT measured at L2 to L3 (r = 0.94; p < 0.001) or L4 to L5 (r = 0.88; p < 0.001) suggests that a single computed tomography scan performed at L2 to L3 or L4 to L5 could predict changes in the partial volume of visceral AT secondary to weight loss.

Adipose Tissue↗
PubMed1986

Does self-monitoring of blood glucose levels improve dietary compliance for obese patients with type II diabetes?

Self-monitoring of blood glucose levels is currently being recommended for obese patients with type II diabetes to improve weight loss and glycemic control. To determine whether self-monitoring of blood glucose levels improves dietary compliance in these patients, 50 obese patients with type II diabetes were randomly assigned either to a standard behavioral weight control program or to a weight control program that included self-monitoring of blood glucose levels and focused on the weight-blood glucose relationship. Both groups lost significant amounts of weight and maintained their losses for at least one year; reductions in medication could be made for 70 percent of patients. These data suggest that the behavioral weight control used in this study may be of benefit to patients with type II diabetes. However, there was no evidence that the addition of self-monitoring of blood glucose levels to the treatment program improved the outcome in terms of weight loss, reduction in medication, dietary compliance, or mood state.

Adult↗
PubMed1998

Obesity and cardiovascular disease.

Obesity, diabetes mellitus, and hypertension are common, interrelated medical problems in Westernized, industrialized societies. These interrelated medical conditions are associated with an increased risk of cardiovascular disease and are more prevalent in several minority groups, including African-American and Hispanic populations. The associated cardiovascular risks of these problems are more thoroughly addressed in another review in this supplement. Obesity markedly enhances the development of Type 2 diabetes. Moreover, it enhances the cardiovascular risk associated with other risk factors, such as hypertension and dyslipidemia. Weight reduction in association with an aerobic exercise program improves metabolic abnormalities and reduces blood pressure in individuals with diabetes and hypertension.

Body Weight↗
PubMedDate not supplied

Safety and efficacy evaluation of a fitness club weight-loss program.

It is well documented that excess weight is a major risk factor for many chronic diseases, and, despite considerable expenditure of time, money, and effort, little or no progress has been made in reversing the trend toward increased weight. Although fitness and athletic clubs offer one potential for tackling this problem, few provide information about the efficacy of their weight-loss programs. There is general agreement that an efficacious weight-loss program should reduce body fat, maintain or increase fat-free mass (FFM), and lower total and low-density lipoprotein (LDL) cholesterol. This study was designed to compare changes in body composition and serum cholesterol associated with participation in a fitness club program (EXP) versus changes that occurred when participants pursued a program of their own choosing (CTL). The EXP group participated in the Bally's Total Fitness program that included exercise, behavior modification, and dietary supplements. Although only small differences in body weight were noted between groups, participation in the EXP program led to significant (sixfold) reductions in fat mass, increases in FFM, and improvements in body composition. These data highlight the importance of using measures of body composition rather than scale weight in evaluating the efficacy of weight-loss programs. Additionally, the EXP group achieved significant reductions in total and LDL cholesterol, particularly among individuals with baseline total cholesterol levels above 200 micrograms/dL. It is also worth noting that respective cholesterol levels were maintained for participants with total cholesterol levels between 150 and 199 micrograms/dL and were increased for those with levels at or below 150 micrograms/dL.

Adult↗
PubMed2001

Aerobic and anaerobic performance before and after a short-term body mass reduction program in obese subjects.

The cardiovascular response to an aerobic cycloergometer exercise test (ACET, 15 min at 60 W, 60 rpm) and the maximally attainable muscle power output, assessed by a stair climbing test (SCT), were evaluated in 60 obese patients (41 females and 19 males; age: 18-68 yr; body mass index, BMI: 40.8+/-4.8 kg/m2) before and after a 3-week body mass reduction (BMR) program, entailing integrated energy-restricted diet (1200-1500 kcal/day), low-grade aerobic exercise conditioning and individual and/or group psychological therapy. The daily conditioning protocol (5 days/week) consisted of: 1) 30 min of indoor jogging and dynamic aerobic standing and floor exercises performed with arms and legs, under the guidance of a therapist; 2) 30 min of cycloergometer exercise at 60 W; and/or 3) 4-km outdoor leisure walking on flat terrain. Three weeks of BMR program induced a significant weight loss (-4.5 %; p<0.001), a reduction of systolic (-11+/-14 mmHg, -7.3%,p<0.001) and diastolic (-7+/-9 mmHg, -7.3%,p<0.001) resting arterial blood pressure, as well as a reduction of heart rate at rest (-18.6%,p<0.001), during ACET (-11.3%,p<0.001) and 5 min thereafter (-14.8%,p<0.001). The subjective rating of perceived exertion in terms of breathlessness and general fatigue during ACET, scored on a 0-100 visual analogic scale, was significantly reduced (p<0.001) after BMR program. A 11.2% decrease in SCT time (p<0.001) was also observed, corresponding to a 9.6% increase (p<0.001) in average muscle power (W) and 14.6% increase (p<0.001) in specific muscle power (W.kg(-1)). In conclusion, a combination of energy restricted diet, low intensity aerobic exercise and psychological counselling appears to significantly improve both aerobic and anaerobic performance in morbidly obese subjects. Different factors (ie, reduction of body mass, shift in the balance between parasympathetic and sympathetic activity, a weight-loss dependent shift toward a more favourable region of the muscle power-velocity curve, acquisition of a certain degree of motor skillfulness during the conditioning program, improvement of self-esteem and motivation) might be responsible, alone or in combination, for these short-term positive effects of BMR program.

Adolescent↗
PubMed1997

A multicenter evaluation of a proprietary weight loss program for the treatment of marked obesity: a five-year follow-up.

OBJECTIVE: The traditional goal of obesity therapy has been the reduction of body weight to an ideal standard. Patient difficulties, however, in reaching this goal have led to a reassessment of weight loss criteria. The Institute of Medicine of the National Academy of Sciences recently proposed that successful long-term weight loss be defined as the reduction of initial weight by 5% or more and the maintenance of this loss for at least 1 year. The present study used these criteria to evaluate the long-term efficacy of a proprietary weight loss program. METHODS: Patients were 621 persons who had completed a 26-week weight loss program that included 12 weeks of treatment by a very-low-calorie diet. They were recruited from a total of 1,283 eligible persons who had been treated at 36 clinics nationwide. Clinics were randomly selected to participate. Patients' weights were determined in telephone interviews initially conducted 2 years after treatment and then at yearly intervals through 5 years of follow-up. RESULTS: At the end of treatment, men achieved a mean reduction in initial weight of 25.5 +/- 1% and women 22.6 +/- 1%. Subjects regained substantial amounts of weight by the 2-year follow-up but 77.5% of men and 59.9% of women still maintained losses of 5% or more of body weight. At the 3-year follow-up, 53% of the original sample (of 621 persons) maintained losses of 5% or more and 35% losses of 10% or more. These trends were apparent 4 and 5 years after treatment but the dwindling sample sizes prevented definitive assessments. DISCUSSION: The findings showed that a program of lifestyle modification combined with the brief use of a very-low-calorie diet was associated with successful weight control in a substantial portion of patients several years after treatment. Long-term weight losses of 5% or more of initial weight are likely to be associated with improvements in health complications.

Adult↗
PubMed1996

Body composition assessment and minimal weight recommendations for high school wrestlers.

OBJECTIVE: To describe a procedure to estimate a minimal wrestling weight based on percent body fat. BACKGROUND: Weight reduction and weight restriction are health issues that have sparked much debate among those involved with high school wrestling. Recently, programs have been developed to curtail dangerous weight loss practices and severe weight reduction in this population. DESCRIPTION: Skinfold sites, measurement technique, and an equation, based on skinfolds, specific to the high school wrestling population are presented. Recommendations for minimizing error are also presented. CLINICAL ADVANTAGES: This article provides a detailed program for measuring skinfold sites and interpreting these measurements.

Journal Article↗
PubMed1993

Evaluation of a structured treatment and teaching program for non-insulin-treated type II diabetic outpatients in Germany after the nationwide introduction of reimbursement policy for physicians.

OBJECTIVE: To evaluate the practicability and efficacy of a structured treatment and teaching program for non-insulin-treated type II diabetic patients in routine primary health care. RESEARCH DESIGN AND METHODS: All physicians (n = 139) and their office staffs in Hamburg, Germany, who had participated in a special training course from 1 April 1991 to 31 December 1991 were contacted for a standardized interview. A random sample of 17 of these offices was selected for office visits during which the documented data of all patients who had received the standardized treatment and teaching in the same period were collected and evaluated. RESULTS: The program was well received by the physicians, and the data collected on 179 patients (5.1 mo median after the intervention) demonstrated the efficacy of the program at the treatment level: reduction of body weight (mean 2.8 kg, P < 0.0001) and HbA1c levels (from 8.11 +/- 1.68 to 7.47 +/- 1.64%, P < 0.0001) was substantial. The individual prescribed volume of oral antidiabetic agents was approximately 50% lower after patient attendance of the program (significant decrease from 1.41 +/- 1.42 to 0.76 +/- 1.11 tablets/patient/day, P < 0.0001). The proportion of patients treated with oral antidiabetic drugs decreased from 63 to 42% (P < 0.0001). CONCLUSIONS: Subsequent to the introduction of nationwide remuneration of outpatient education for type II diabetic patients by office-based physicians, a relevant improvement was observed in the quality of care, comparable with the effects of the program in a previous prospective controlled trial.

Adult↗
PubMed2004

[Weight-control intervention in overweight subjects at high risk of cardiovascular disease: a trial of a public health practical training program in a medical school].

OBJECTIVE: To evaluate the effectiveness of a weight-control intervention for overweight subjects at high risk of cardiovascular disease (CVD) at a worksite conducted by medical students as a public health practical training program. METHODS: A total of 45 men and women who were obese (BMI > or = 24.0 kg/m2) and found to be hypertensive (SBP > or = 140 mmHg or DBP > or = 90 mmHg) or suffering from hypercholesterolemia (total serum cholesterol > or = 220 mg/dl) in an annual health check up in November 2001 were invited to participate in a weight-control intervention program. Eight individuals agreed (intervention group) and other sixteen control subjects whose sex and age (+/- 3 years) were matched to the intervention subjects were selected. The duration of the program was three months (from July to October 2002) and a 2 kg weight reduction in that period was set as the goal. The baseline survey consisted of a dietary questionnaire and a health quiz. Subjects had two counseling sessions and received four personal letters in the three months. A semi-quantitative food frequent questionnaire, a photograph method (Diet Agent Service, Matsushita Electric Works, Ltd.) and three day food records were conducted for dietary surveys. Changes in bodyweight, BMI, blood pressure, and serum total cholesterol concentration from November 2001 to November 2002 were compared between the intervention and control groups. Food group intakes and nutrient intakes were compared between weight reduction achievers and non-achievers. RESULTS: Mean bodyweight changes from November 2001 to November 2002 were -2.3 kg (SD 3.3 kg) for the intervention group and +0.3 kg (SD 1.5 kg) for the control group, the difference being significant (p = 0.013). For the intervention group mean bodyweight change from July to October 2002 was -1.5 kg (SD 2.4 kg). For total serum cholesterol, the mean changes were -32.1 mg/dl vs. +0.5 mg/dl (p = 0.005), for SBP -9.5 mmHg vs. +4.7 mmHg (p = 0.083) and for DBP -2.8 mmHg vs. +1.4 mmHg (p = 0.438). These were thought to be consequences of weight-control intervention. From dietary surveys, weight reduction achievers increased fish intake and decreased fats, snacks and sweets. Those who answered the health quiz more correctly demonstrated more reduction of bodyweight. CONCLUSIONS: Effectiveness of a weight-control intervention for reduction of CVD risk factors was found in the present public health practical training program for medical students. Dietary advice based on various dietary surveys was indicated to be effective in the weight-control program. A population strategy to distribute health information appeared necessary for effective health education programs for high-risk subjects.

Cardiovascular Diseases↗
PubMed1999

The spread of the obesity epidemic in the United States, 1991-1998.

CONTEXT: The increasing prevalence of obesity is a major public health concern, since obesity is associated with several chronic diseases. OBJECTIVE: To monitor trends in state-specific data and to examine changes in the prevalence of obesity among adults. DESIGN: Cross-sectional random-digit telephone survey (Behavioral Risk Factor Surveillance System) of noninstitutionalized adults aged 18 years or older conducted by the Centers for Disease Control and Prevention and state health departments from 1991 to 1998. SETTING: States that participated in the Behavioral Risk Factor Surveillance System. MAIN OUTCOME MEASURES: Body mass index calculated from self-reported weight and height. RESULTS: The prevalence of obesity (defined as a body mass index > or =30 kg/m2) increased from 12.0% in 1991 to 17.9% in 1998. A steady increase was observed in all states; in both sexes; across age groups, races, educational levels; and occurred regardless of smoking status. The greatest magnitude of increase was found in the following groups: 18- to 29-year-olds (7.1% to 12.1%), those with some college education (10.6% to 17.8%), and those of Hispanic ethnicity (11.6% to 20.8%). The magnitude of the increased prevalence varied by region (ranging from 31.9% for mid Atlantic to 67.2% for South Atlantic, the area with the greatest increases) and by state (ranging from 11.3% for Delaware to 101.8% for Georgia, the state with the greatest increases). CONCLUSIONS: Obesity continues to increase rapidly in the United States. To alter this trend, strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.

Adult↗
PubMed2003

Prevalence of obesity in an elderly Hungarian population.

BACKGROUND: There are few cross-sectional population-based studies on obesity in Hungary. Aim of this study was to characterize the prevalence, associated diseases and metabolic laboratory parameters for obesity in men and women in Budapest, Hungary. METHODS: A random sample of 641 persons (307 males and 334 females) aged 50 years and over were recruited from a population register in Budapest. Subjects were interviewed, had height and weight measured in standard fashion. Those who were obese (BMI > 30.0 kg/m2) were matched individually with non-obese subjects. Altogether 101 pairs (48 women and 53 men pairs) were taking part and these subjects had blood taken for amount of serum glucose, lipids and uric acid. RESULTS: The mean age of men and women was 65.0 (SD = 9.1) years and 64.6 (SD = 8.9) years, respectively. The prevalence of obesity was 18.1% in men and 15.4% in women (p < 0.05). In both sexes the mean body mass index was higher at age of 50-64 years than at older ages [in men 27.2 (SD = 3.7) kg/m2 vs. 26.7 (SD = 3.3) kg/ m2, p = 0.286 and in women 26.7 (SD = 4.2) kg/m2 vs. 25.4 (SD = 4.0) kg/m2, p = 0.005]. Body mass index was higher in men than in women at all ages. In the case-control study the mean age of obese and non-obese individuals were 63.1 (SD = 7.8) years and 63.2 (SD = 7.9) years, respectively. Obesity was significantly associated with a history of diabetes mellitus (18 vs. 7%, p < 0.05) and hypertension (48 vs. 28%, p < 0.05). Compared to the non-obese, those who were obese had a higher level of serum uric acid (311 +/- 102 vs. 280 +/- 96 micromol/l, p < 0.05) and triglyceride (2.67 +/- 1.95 vs. 1.86 +/- 0.95 mmol/l, p < 0.05). CONCLUSION: The high prevalence of obesity both in elderly men and women and its strong association with chronic diseases causes economical and social burden for Hungary. Strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.

Age Distribution↗
PubMed1984

Hyperlipidemia. What is 'normal,' who should be treated and how.

Considering that over half of Americans will die from cardiovascular disease, the over-whelming majority of those deaths being from atherosclerosis, we need to accept and act on the vast body of information derived from investigation of coronary risk factors. Identification of persons at risk needs to be done early--when the patient is in his or her 20s or 30s--not after an infarction has occurred or an angiogram indicates a problem. Although high serum lipid levels are obviously not the only factor involved in development of atherosclerosis, their early identification is a simple, cost-effective way to start preventive care. The concept of "normal" levels of cholesterol and triglyceride must be revised, and that of "safe" levels should be adopted instead. Patients with abnormal electrophoretic patterns should not be the only target; they are only the tip of the iceberg. A typical workup in a young patient consists merely of measurement of cholesterol and triglyceride levels. Further evaluation is necessary if the levels are high or the family history suggests a problem. Lipoprotein electrophoresis and computation of the ratio of high-density lipoprotein to low-density lipoprotein are then used not just as predictors but as a guide to therapy. Basic therapy begins with a change in life-style to incorporate dietary reduction of saturated fats and cholesterol and substitution of polyunsaturated fats. Other measures such as cessation of cigarette smoking, introduction of an appropriate exercise program and, most importantly, reduction of body weight complete the game plan.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholesterol↗
PubMed1977

[Behavior modification and obesity (author's transl)].

Good results were obtained treating 49 obese patients with an elaborated selfcontrol behavior modification program. This program was an addition to the normal program of the obesity clinic of the 2. Medizinische Klinik der Universität Düsseldorf. The normal program contains some principles of behavior modification but less accentuated. After the initial 12 weeks of controlled training patients tried to reduce weight further decreasing external control. Only few patients were able to loose additional pounds during this period of 8 weeks. At the end of the initial 12 weeks patients had asked for another control before the vacational season, but only 10 out of 49 appeared at the control sessions 9 months after the program's start. If an additional behavior modification program is considered for incorporation into an already existing weight reduction clinic, additional costs and expected results have to be checked. Durative success of behavior modification techniques in weight loss programs has still to be submitted to proof.

Behavior Therapy↗
PubMed1998

Gender differences in changes in subcutaneous and intra-abdominal fat during weight reduction: an ultrasound study.

OBJECTIVE: In weight-reducing programs, men usually display greater improvement in metabolic risk factors than women. This gender difference may be related to enhanced weight and fat loss due to a greater energy deficit in men. To clarify the relationship between changes in metabolic profile, body fat composition, and weight loss, both sexes were studied under a regimen in which similar amounts of weight were lost. RESEARCH METHODS AND PROCEDURES: A cross-sectional study using anthropometric (body mass index and waist-to-hip ratio), impedance (bioelectrical impedance analysis) and ultrasound measurement methods (thickness of subcutaneous fat layers, intra-abdominal sagittal diameter) were conducted. The metabolic risk profile was determined by measuring lipids, lipoproteins, and blood pressure. The weight loss program lasted 15 weeks: 3 weeks under controlled conditions in the hospital and 12 weeks on an ambulatory basis. Patients were instructed to follow a mixed diet. Calorie intake was restricted to 1500 kcal/day for the men and 1200 kcal/day for the women. Thirty-two subjects with obesity (16 men and 16 women), with a mean body mass index of 35 kg/m2--matched with regard to age, height, and body weight--took part in the study. RESULTS: As expected, weight loss was similar for both sexes (-13.4 kg vs. -12.8 kg). Also, body fat mass changed to the same extent in absolute and relative terms. The waist-to-hip ratio was identical before and after treatment in both sexes. The men lost more visceral fat than the women. This result is based on changes in intra-abdominal diameter as well as abdominal subcutaneous fat in relation to waist circumference. Changes in abdominal diameter were paralleled by reductions in triglycerides and increases in high-density lipoprotein-cholesterol. Subcutaneous fat loss was more pronounced in women than in men. DISCUSSION: Where absolute and relative reductions in body weight and body fat are similar, men mobilize more intra-abdominal fat than women, whereas women lose more subcutaneous fat. The greater reduction in intra-abdominal fat seen in men is accompanied by a more pronounced improvement in the metabolic risk profile. Therefore, greater improvement of risk factors in men is not only related to a greater negative energy balance, as shown in most studies, but is also sex-specific.

Abdomen↗
PubMed1977

Predictors of successful weight loss in an outpatient obesity clinic.

Patients attending weight reduction clinics were tested at the beginning of the program to assess a variety of background variables which might influence successful weight loss. These included measures of self-esteem, social acceptance, locus of control, responsiveness to external stimuli, attitudes toward weight loss, and knowledge about nutrition. Success was related to social conformity and desire for social acceptance but not to self esteem or locus of control. Individuals who believed that poor eating habits caused their obesity and those who were less responsive to environmental cues which may trigger feeding, were also more successful.

Adolescent↗
PubMed1983

Weight and sodium reduction for the prevention of hypertension: a comparison of group treatment and individual counseling.

Ninety-three overweight adult males with labile blood pressure elevation participated in a 20-week dietary intervention program to achieve a 10 per cent reduction in body weight and a reduction in dietary sodium intake to 70 milliequivalents per day. By random assignment, half were treated with intensive group treatment procedures and half with individual counseling. Written handouts and assignments were identical, as was the schedule of treatment visits. Both techniques produced significant decreases in weight, sodium intake, calorie intake, and blood pressure. Calorie and sodium knowledge also increased significantly with both intervention approaches. The two treatment modalities did not differ in effectiveness.

Counseling↗