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PubMed1990

Obesity and hypertension: epidemiological aspects of the relationship.

A large proportion of hypertensive men and women in Europe and North America are overweight. In obesity, the expanded blood volume increases cardiopulmonary volume, cardiac filling, left ventricular preload, stroke volume and, thereby, left ventricular work. Given enough exposure time, it is probable that all obese persons in the Western hemisphere would become hypertensive unless they succumb to competing causes of death. A postulated causal role of obesity in hypertension is based on epidemiological observations. In prospective studies weight gainers in adolescence are more often hypertensive than weight stable individuals. In the lower socio-economic strata of industrialized countries there is a higher prevalence of obesity and hypertension. Persons with high body weight show the greatest rise of BP with age. More relevant demonstration of a causal relationship is weight reduction in hypertensive patients. The evidence from a variety of sources, a) risk factor reduction and enhanced BP reduction in the Hypertension Detection and Follow-up Program patients on antihypertensive medication who experienced modest weight loss, b) clinical observations of formerly obese hypertensives who can forego BP lowering drugs, and c) the reversibility of haemodynamic change found in many overweight hypertensive patients after losing 10 kg, strongly suggests that the impact of obesity on hypertension is considerable.

Adult↗

PubMed1991

Health benefits of aerobic exercise.

Regular aerobic exercise has significant cardiovascular benefits, including a reduction in incidence of and mortality from coronary artery disease--probably because of positive effects on blood lipid levels and blood pressure. Aerobic exercise can also be an important adjunct to a weight-loss program. Many persons who continue an exercise program do so because of its positive mental benefits, including reduction in anxiety and depression and modulation of stress levels. Aerobic exercise has a place in the management of diabetes, pregnancy, and aging. The problems associated with aerobic exercise are minimal compared with its benefits.

Adult↗

PubMed1985

Weight reduction methods of college women.

Weight reduction attitudes and practices were obtained from a sample of 400 female students. Forty-eight percent reported using a weight loss program since admission to college. The programs most often selected included hypocaloric diets and exercise. Although the majority of subjects rated hypocaloric diets and exercise as good methods for weight reduction and indicated that they would recommend them to others, these methods supported the slowest rate of weight loss. Evidently, the side effects and costs of the other programs offset the rapid weight loss. Other methods, in descending order of use, included the Cambridge diet, drugs, weight loss clinics, and low-carbohydrate diets. Improved appearance was most often given as the reason for losing weight.

Adolescent↗

PubMed1984

Cardiac rehabilitation.

Exercise training is a major, and the most important, component of cardiac rehabilitation. Besides providing psychological benefits and promoting a "sense of well being," it elicits a number of adaptations in patients with ischemic heart disease. Among the clinically important adaptations are changes in the trained skeletal muscles and autonomic nervous system, resulting not only in increased maximum exercise capacity but also a slower heart rate and, at times, a lower systolic blood pressure during submaximal exercise. The reduction in the rate pressure product decreases myocardial O2 demand at any given submaximal exercise intensity and may thus alleviate myocardial ischemia and angina in patients with coronary artery disease. These adaptive responses occur even with a relatively modest exercise intensity. Although short-term exercise training of moderate intensity has not been reported to result in improvement in left ventricular performance, recent data suggest that exercise training of higher intensity and longer duration (12 months or longer) than has conventionally been used in cardiac rehabilitation programs may favorably affect the heart. This is characterized by improvements in left ventricular function, diminished electrocardiographic criteria of myocardial ischemia and increased stroke volume during exercise. Modest weight reduction accompanies regularly performed prolonged exercise training. It is important, however, to recognize that high-intensity exercise programs are suitable for only some patients with coronary artery disease who are stable and should be used only under strict medical supervision.

Adaptation, Physiological↗

PubMed2003

[Therapeutic management of osteoarthritis in the beginning of the third millennium. Part II: non pharmacological strategies].

COMMENT: Osteoarthritis represents one of the most frequent pathologies today, and its current management requires the combination of pharmaceutical and non pharmacological strategies. Moreover, osteoarthritis constitutes one of the main diseases leading to the requirement to the alternative medicines. NEWS AND KEY POINTS: This overview resumes the main recommendations in the light of recent controlled clinical trials concerning the not medicinal coverage of osteoarthritis : importance of the information and the education of the patient, the importance of the establishment of programs of physical exercises, the need for a reduction of the weight excess for knee osteoarthitis. Some controlled studies tried to estimate the symptomatic efficiency of acupuncture, homoeopathy or the contribution of minerals, vitamins. The appeal to the alternative said medicines is approached on this review. PERSPECTIVES AND PROJECTS: If certain not medicinal strategies have a sufficient proof of efficiency today, on the other hand number of propositions still have not, at the moment, demonstrated by superiority and by efficiency versus placebo. Numerous controlled studies should be organized to confirm or exclude the place of treatments such as homoeopathy, minerals.

Complementary Therapies↗

PubMed2001

[Fat distribution and metabolism].

It is well known that adipose tissue distribution is an important factor involved in the etiology of type 2 diabetes and cardiovascular diseases. Adipose tissue distribution is obviously different between men and women, men being prone to accumulate their excess of energy in the abdominal region, more specifically in the intra-abdominal depot (visceral) whereas women show a selective deposition of adipose tissue in the gluteo-femoral region. Several studies have demonstrated an association between age and adipose tissue distribution and a selective deposition of visceral adipose tissue has been reported with age, in both men and women. In this regard, the menopause transition also appears to be a factor associated with an accelerated accumulation of abdominal adipose tissue. This increase in visceral adipose tissue has been suggested to play a significant role in the etiology of metabolic complications increasing the risk of type 2 diabetes and cardiovascular diseases. However, a selective mobilization of visceral adipose tissue in response to a weight loss program has been noted among viscerally obese patients, this reduction in visceral adipose tissue being associated with improvements in the lipoprotein-lipid profile and insulin sensitivity. Thus, the distribution of adipose tissue is an important factor to take into account in the evaluation of the patient. Furthermore, the amount of abdominal adipose tissue should also be considered as an important therapeutic target for the optimal management of cardiovascular disease risk.

Abdomen↗

PubMed1997

The impact of obesity on hypertension management in African Americans.

Blood pressure is strongly related to body weight, and control of obesity is a critical component of hypertension prevention and control. Data from multicenter studies such as the Trials of Hypertension Prevention, the Trials of Antihypertensive Interventions and Management, and the Trial of Nonpharmacologic Interventions in the Elderly help to set aside previous questions about whether the association of obesity with hypertension applies to African Americans. Given the high prevalence of overweight among African Americans, especially women, the issue is not whether weight reduction should be a component of hypertension prevention and treatment but how to design and implement programs that will help overweight African American men and women achieve permanent weight loss. Modest weight losses can not only prevent or reverse blood pressure elevations but also have a favorable impact on obesity-related cardiovascular risk factors such as diabetes and hyperlipidemia.

Adult↗

PubMed2004

Reductions in plasma cytokine levels with weight loss improve insulin sensitivity in overweight and obese postmenopausal women.

OBJECTIVE: The purpose of this study was to determine whether improvements in insulin sensitivity with weight loss are mediated by changes in inflammation in obese, postmenopausal women. RESEARCH DESIGN AND METHODS: We studied 58 sedentary, overweight, and obese (BMI 33 +/- 1 kg/m(2), means +/- SEM) postmenopausal (58 +/- 1 year) women at baseline and 37 women who completed 6 months of weight loss induced by diet and exercise. The women underwent 3-h hyperinsulinemic-euglycemic clamps (40 mU x m(-2) x min(-1)) to determine glucose utilization (M). Insulin sensitivity was determined as M/I, the amount of glucose metabolized per unit of plasma insulin (I). Visceral adipose tissue (VAT) and plasma concentrations of C-reactive protein (CRP), cytokines interleukin (IL)-6, and tumor necrosis factor (TNF)-alpha, as well as their soluble receptors, were measured. RESULTS: At baseline, CRP concentration was a predictor of both glucose utilization and insulin sensitivity, independent of adiposity, race, and aerobic fitness (M: partial r = -0.30, P = 0.03, and M/I: partial r = -0.32, P = 0.02). Weight loss resulted in significant reductions in body weight, fat mass, VAT, and fasting glucose and insulin levels (P < 0.05). Both glucose utilization and insulin sensitivity increased by 16% (P < 0.05). CRP, IL-6, and soluble TNF receptor (sTNFR)-1 concentrations decreased (P < 0.05), but concentrations of TNF-alpha, sTNFR-2, and soluble IL-6 receptor (IL-6sR) did not change. In stepwise regression models to predict changes in glucose homeostasis, changes in VAT and sTNF-R1 independently predicted changes in glucose utilization (r = -0.49 and cumulative r = -0.64, P < 0.01), while changes in VAT and IL-6 were both independent predictors of changes in insulin sensitivity (r = -0.57 and cumulative r = -0.68, P < 0.01). CONCLUSIONS: Improvements in glucose metabolism with weight loss programs are independently associated with decreases in cytokine concentrations, suggesting that a reduction in inflammation is a potential mechanism that mediates improvements in insulin sensitivity.

Aged↗

PubMed2004

[Obesity and cardiovascular diseases-theoretical background and therapeutic consequences].

In the normal population, the prevalence of obesity is almost 20%. It is a condition influenced by genetic factors, so that individual behavior cannot be regarded as its sole cause. The amount of food is essentially determined by the hormone leptin, the feedback regulation of which can be disturbed by a modification of the molecule or a mutation of the receptor. A further important determinant is energy consumption, which is subject to large individual variations, which partly result from thermogenesis. With regard to the fat distribution, it is concentrated on the trunk in the android form as compared to the hips in the gynecoid form. The android form is subject to a higher incidence of cardiovascular morbidity and mortality. The indirect determination of body fat by measuring the body mass index (weight [kg]/body weight [m(2)]) is hence less reliable than measuring the waist (women > 80 cm, men > 94 cm). The effects of generalized obesity on cardiovascular function are chiefly an increase of blood volume and an eccentric left ventricular hypertrophy. This first of all results in diastolic dysfunction, which can give rise to a disturbance of systolic function in left ventricular dilatation. Concentric hypertrophy develops in the presence of arterial hypertension. This is twice as frequent in obese patients than in the normal population, which is due to increased activity of the sympathetic nervous system and stimulation of the renin-angiotensin system. A disturbance of lipid metabolism is observed four to six times more frequently. The qualitative change in LDL fraction with a raised concentration of low density LDL particles appears to be of crucial importance. With increasing fat mass, the sensitivity to insulin is lowered, so that in obesity the risk of developing diabetes mellitus type 2 is tripled. Since there has been a dramatic increase in the numbers of overweight children and adolescents (from 10.5% to 15.5% within the past five years), prevention programs should be started in good time. A reduction in calorie intake and an altered dietary composition (55% complex carbohydrates, 30% fat and 15% to 20% protein) on the one hand, and increased physical activity on the other hand continue to be the central components. The latter is especially effective when it regularly gives rise to an increased turnover of fatty acids as a result of an increased energy metabolism at moderate intensity. This leads to adaptation, i. e. an increase in the activity of lipoprotein lipase. If prevention programs and/or changes in lifestyle do not give rise to the desired weight reduction, medication is indicated in some adults. Sibutramine (Reductil and orlistate (Xenical) lead to an additional weight loss of up to 10%. However, consistent treatment of any cardiovascular risk factors present is more important. Treatment of arterial hypertension is of greatest prognostic significance, especially in concomitant diabetes mellitus. In individual cases and after thorough discussion of indication surgical options should be considered.

Adolescent↗

PubMed1993

Nonpharmacological interventions as an adjunct to the pharmacological treatment of hypertension: a statement by WHL. The World Hypertension League.

Nonpharmacological approaches lower medication requirements in patients with hypertension. A decreased salt intake to a sodium value of about 80 mmol/day lowers BP in the presence of diuretics, beta-blockers, converting enzyme antagonists and sympatholytics but apparently not in patients treated solely with calcium antagonists. A reduced medication requirement is seen in about half of the patients suggesting that the phenomenon of 'salt-sensitivity' still applies. Weight loss is an effective adjunctive therapy and simultaneously improves other cardiovascular risk factors. A high alcohol consumption is a confounding factor in the drug treatment of hypertension. Reducing the alcohol intake of hypertensive heavy drinkers significantly lowers their BPs and drug requirements. Aerobic exercise is an effective nonpharmacological treatment which simultaneously fosters weight loss and improves risk factors. Potassium supplementation does not decrease medication requirements in drug-treated patients who are ingesting a low salt diet but may do so in those eating large amounts of salt. Nonpharmacological approaches should be included in the management of all hypertensive patients irrespective of their drug therapy. These should include weight reduction through decreased food and alcohol consumption as well as regular, programmed exercise. Patients should be instructed in a low calorie diet rich in fresh rather than processed products and high in fruits and vegetables. Such a diet will contain relatively little salt, reduced fat, and ample amounts of potassium and calcium. However, physicians should not lose sight of the fact that cigarette smoking remains the most important risk factor to be addressed in their hypertensive patients.

Alcohol Drinking↗

PubMedDate not supplied

Worksite wellness programs: incremental comparison of screening and referral alone, health education, follow-up counseling, and plant organization.

BACKGROUND: Worksite wellness programs vary considerably in their design. This study tested four models to compare effectiveness at controlling high blood pressure, obesity, and cigarette smoking. METHODS: Baseline screening was conducted in four manufacturing plants. Site 1 offered screening only, with referral recommendations for those found to have CVD risks. Site 2 also provided health education information and classes. Site 3 added routine follow-up counseling and a menu of intervention types, and Site 4 added social organization within the plant. Random samples of 400 to 500 employees were rescreened at the end of three years. RESULTS: Major improvements in risk levels were found with the addition of routine follow-up counseling and a menu of interventions (Sites 3 and 4, compared with Sites 1 and 2). More hypertensives entered treatment and showed greater reductions in blood pressure. Participation in worksite weight loss and smoking cessation programs was significantly increased, and those who participated showed significantly better maintenance of improvements where follow-up was provided. DISCUSSION: The program models that offered short-term interventions promoted through local media suffered in comparison with models that included personal outreach to people at risk, a variety of health improvement intervention modalities, and ongoing follow-up counseling to help people make decisions and sustain health improvements.

Adult↗

PubMed2002

Effects of caffeine and exercise on the development of bone: a densitometric and histomorphometric study in young Wistar rats.

High doses of caffeine will induce calcium loss and influence the normal development of bone, whereas the proper exercise has positive effects on bone metabolism. This study investigated the possible effects of exercise to antagonize the caffeine-induced impairment of bone development in young male Wistar rats. A total of 32 male rats (5 weeks old) were divided randomly into four groups: group 1 rats were fed caffeine; group 2 rats were prescribed an exercise program; group 3 rats were fed caffeine and prescribed an exercise program; and group 4 rats served as the control group. The caffeine was fed via the animals' dietary water and the dosage was 10 mg/100 g body weight per day, 3 days a week. The exercise program was carried out on a treadmill for 10 weeks (5 days/week, 1 h/day, 70% VO(2)max). Body weight was measured weekly. After sacrifice, the tibia length was measured and the tibia was processed for histomorphometric analysis. Bone mineral density was measured by dual-energy X-ray absorptiometer at three different sites of the tibia. In addition, the calcium content of the right femur was measured by atomic absorptiometry. The results showed that both exercise and caffeine significantly lowered the body weight gain. Rats fed with caffeine (groups 1 and 3) had a significantly longer tibia as compared with the non-caffeine-fed rats (groups 2 and 4) (p = 0.0149). The histomorphometry study showed that thickness of the growth plate in the proliferative zone, the hypertrophic zone, and total growth plate was greater in caffeine-fed groups than in non-caffeine-fed groups. The cell number in the proliferative zone was higher in the caffeine-fed groups. Area ratio of trabeculae in the primary spongiosa of rats in groups 1 and 2 were significantly greater than the control group. Caffeine feeding (groups 1 and 3) induced a lower area ratio of bone trabeculae in the secondary spongiosa, whereas exercise training (groups 2 and 3) increased the thickness of the trabeculae. The exercise program counteracted the negative effect of caffeine on the trabecular thickness, but did not correct the trabecular bone ratio. The bone mineral density (BMD) of the tibia was significantly lower in caffeine-fed rats, and the exercise program did not show any counteracting effect on the caffeine-induced BMD reduction. The calcium content assay showed that caffeine feeding decreased the weight and total calcium content of the femur. Again this exercise program did not counterbalance the negative effects of caffeine. In conclusion, high doses of caffeine seemed to stimulate the growth of long bone. However, it caused more serious negative effects on bone, including bone mineral loss, lower BMD, and lower calcium content. Exercise training at 70% VO(2)max had little antagonizing effect on caffeine-induced impairment of bone formation. Therefore, the best way to prevent caffeine-induced negative effects on bone development is to lower caffeine exposure.

Animals↗

PubMed1994

Clinical evaluation of a minimal intervention meal replacement regimen for weight reduction.

OBJECTIVE: The purpose of this study was to evaluate a simplified weight loss program in which subjects were provided a widely available meal replacement product and its package insert information (Ultra Slim-Fast). METHOD: Weekly follow-up visits were carried out by non-physician personnel for weight measurement, distribution of product, and completion of a subjective questionnaire. No dietary counseling was provided. A total of 273 of 301 subjects (91%) completed 12 weeks of study. Men lost 50% (from 119 to 108% of ideal body weight) and women lost 35% (from 122 to 111% of ideal body weight) of excess body weight. Thirty-five patients who lost < 9 lbs in 12 weeks were considered non-adherent and were excluded from the next phase of the study during which 238 subjects were followed biweekly. RESULTS: Despite a $25/week payment for participation nearly 44% of subjects dropped out or were judged non-compliant prior to the end of the study. At 116 weeks, 133 (97 females, 36 males) of 238 subjects remained in the study (44% of the initial population), with average weight loss from baseline of 13.6 +/- 10.5 lb in females and 14.0 +/- 10.5 lb in males. DISCUSSION: The weight loss observed (approximately 10% of body weight) is significant and has been associated with important health benefits particularly for patients with hypertension and non-insulin dependent diabetes. The potential advantages of using meal replacements for mild obesity include wide availability to aid compliance, low cost and minimal professional intervention.

Adult↗

PubMedDate not supplied

Pharmacologic agents for weight reduction.

Obesity is a major health problem in U.S. adults. Most successful weight loss programs have multiple components, including lifestyle modifications, reduced caloric intake, and exercise. Short-term use of medications for weight loss may be a part of such a plan. Currently, most medications are adrenergic stimulants and can produce adverse CNS and cardiovascular effects. Antiabsorptive agents appear to be safer but have significant GI side effects. An important finding is the potential for adverse life-threatening effects with over-the-counter products and dietary supplements that do not undergo evaluation similar to prescription drugs. The search continues for safe and effective pharmacologic agents to assist in weight loss.

Anti-Obesity Agents↗

PubMed1982

The challenge of obesity in childhood. II. Treatment guidelines by stage.

A treatment model for obesity is proposed which uses the attitudinal staging technique previously described from our studies of obesity in school-age children. The model utilizes an assessment of attitude as a measure of the progress in effective weight reduction and as a measure of problems that need to be met and corrected during the treatment program. Illustrative examples are provided which include the possible role of the weight counselor in the treatment of obesity.

Adolescent↗

PubMedDate not supplied

Worksite intervention for weight control: a review of the literature.

PURPOSE: Published research on worksite weight-control programs is reviewed with the objective of assessing success in (1) reaching populations in need, (2) achieving sustained weight loss, and (3) improving employee health and productivity. SEARCH METHOD: Reviewed are 44 data-based articles published between 1968 and 1994. The initial search was part of a larger review on the health impact of worksite health promotion programs conducted by Centers for Disease Control and described in the introduction to this issue. We supplemented the resulting list with articles found in a search of our own reference files. IMPORTANT FINDINGS: Methodologically the literature is relatively weak, consisting largely of uncontrolled case studies. Worksite interventions appear to be successful in reaching large numbers of people: the median participation rate among overweight employees was 39% in the six studies that provided this type of information. Worksite programs produced reasonable short-term weight loss: typically 1 to 2 pounds per week. Long-term weight loss, reductions in sitewide obesity prevalence, and health or productivity benefits have yet to be demonstrated. MAJOR CONCLUSIONS: Recommendations for future research include improved methods, more attention to recruitment and secondary outcomes, more direct comparison of different programs, and more creative use of worksites as environments and social units in designing programs.

Health Promotion↗

PubMed1991

Differences in locus of control between obese adult and adolescent females undergoing weight reduction.

Rotter's (1966) Internal-External (I-E) Scale was administered to 65 adult and adolescent females in two outpatient obesity treatment programs. The adults were significantly higher in internal locus of control (LOC) and the adolescents higher in external LOC. These differences suggest that although the adults felt limited control over their weight and eating behavior, this did not reflect a lack of perceived control over other factors in their lives. In contrast, the adolescents appeared to feel that they had limited control over an array of factors in their lives.

Adolescent↗

PubMed2002

[An exercise program for the hypertensive patient. Leaving hypertension behind].

Today, regular exercise is considered an important therapeutic principle in arterial hypertension. Apart from weight reduction, the positive effects of sports (moderately practiced) include a reduction in peripheral resistance, improvement of endothelial dysfunction, and an increase in insulin sensitivity of the skeletal muscles. Training programs should be tailored to the physical and mental status of the patient, in particular to the severity of the hypertension, where indicated, with consideration being given to the hypertensive drugs used. In the case of marked hypertension or already existing secondary complications, training should be started only when the patient's blood pressure has been brought under pharmacological control. Ideally, training should be applied as 20-60 minute sessions at least twice weekly, with exercise keeping within aerobic capacity.

Antihypertensive Agents↗