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PubMed2000

The effect of moderate weight loss on echocardiographic parameters in obese female patients.

Based on the data collected by KNOLL Hungary Ltd. in Hungary in 1999, 37% of the adult population is overweight while 23% is obese. Inappropriate diet containing excess calories and physical inactivity are responsible for these statistical values. In their former studies, the authors investigated the effects of different stages of obesity on the cardiovascular system, and have verified that even moderate obesity elicits pathological geometric and functional changes in the heart. In the present study, effect of a half-year-long life-style modification program on the morphologic and functional characteristics of the heart was investigated in twenty-one obese women. Life-style modification contained a diet with reduced energy uptake (1000-1300 Cal/day) and a regular physical training of minimum 3-4 hours weekly. By the end of the sixth month the weight loss was 5.1 kg (5.9%) on an average. There was a marked reduction in cardiac dimensions measured by echocardiography, with a very slight, non-significant decrease in left ventricular internal diameter, and a marked, significant reduction in the left ventricular wall thickness. Decrease of the left ventricular muscle mass exceeded the decrease of body weight. A marked elevation was found in the E/A quotient that reflected a definite improvement in diastolic function. Results indicate that physical training programs have a favourable effect on the echocardiographic parameters, therefore the process is reversible even without a pharmacological intervention.

Adult↗

PubMed2003

Associations of weight-based teasing and emotional well-being among adolescents.

BACKGROUND: Verbal harassment, such as bullying and hate speech, has received considerable attention recently, but less is known about weight-based teasing and its potential harmful effects on young people's psychosocial well-being. OBJECTIVE: To determine the associations of weight-based teasing and body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts using a large sample of adolescents. DESIGN: Secondary analysis of survey and anthropometric data. SETTING: Ethnically and socioeconomically diverse communities in the urban and suburban school districts of the Minneapolis/St Paul metropolitan area. PARTICIPANTS: A school-based sample of 4746 adolescents in grades 7 to 12 at 31 public middle schools and high schools. MAIN OUTCOME MEASURES: Weight-based teasing from peers or family members, body satisfaction, self-esteem, depressive symptoms, and suicidal ideation and suicide attempts. RESULTS: Of the eligible students, 81.5% participated; 30.0% of adolescent girls and 24.7% of adolescent boys were teased by peers, and 28.7% of adolescent girls and 16.1% of adolescent boys were teased by family members. Approximately 14.6% of adolescent girls and 9.6% of adolescent boys reported teasing from both of these sources. Teasing about body weight was consistently associated with low body satisfaction, low self-esteem, high depressive symptoms, and thinking about and attempting suicide, even after controlling for actual body weight. These associations held for adolescent boys and girls, across racial, ethnic, and weight groups. Furthermore, teasing from 2 sources was associated with a higher prevalence of emotional health problems than either teasing from a single source or no teasing. CONCLUSIONS: Physicians and other health care providers should recognize the importance of weight-based teasing for young patients. Policy, programs, and education should focus on increasing awareness of what constitutes weight-based teasing, its potentially harmful effects on adolescents' emotional well-being, and reduction of this behavior.

Adolescent↗

PubMed1997

Unchanged iron and copper and increased zinc in the blood of obese children after two hypocaloric diets.

Serum iron (sFe), and ferritin (sFert), transferrin saturation index (TSI), plasma zinc and copper (pZn, pCu), and erythrocyte zinc content (eZn) were measured in 55 obese children and adolescents (28 males and 27 females) before and after a 13-wk treatment with a hypocaloric balanced diet (HCBD, 22 subjects) or a 10-wk treatment with a protein sparing modified fast diet (PSMF, 33 subjects). The energy intake provided by the HCBD and PSMF diet was calculated to be 60 and 25%, respectively, of the recommended dietary allowances (RDAs) for age and sex. Neither diet was supplemented with trace elements or calcium. Using a visual memory system, all subjects had a 24-h dietary intake recall before starting the weight-loss program. Iron, zinc, and copper intakes from the 24-h recall were compared with those from prescribed diets. Both diets produced a significant (p < 0.001) weight reduction with a significant reduction in the arm muscle area of the PSMF group. After treatment, no significant change was observed in sFe, sFert, and TSI of either group, whereas eZn increased significantly in the HCBD and the PSMF groups (p = 0.001 and p < 0.006, respectively), with an improvement of the erythrocyte index (E.I.). A significant increase in pZn was also observed in the PSMF group (p = 0.007).

Adolescent↗

PubMed2006

Changes in serum leptin and beta endorphin levels with weight loss by electroacupuncture and diet restriction in obesity treatment.

This study aims to investigate the role of changes in leptin and beta endorphin (BE) levels in weight loss following electroacupuncture (EA) application in obesity treatment. EA was applied to 20 females who were 41.45 +/- 4.71 years old and had a body mass index of 36.00 +/- 2.66; and a diet program was applied to 20 females who were 42.30 +/- 4.35 years old and had a body mass index of 34.90 +/- 3.21. There was a 4.5% weight reduction in the patients with EA application, whereas patients on diet restriction had a 3.1% weight reduction. A decrease of loss of body weight was observed in the EA group (p < 0.000) when compared against the diet restricted group. A decrease of serum leptin levels (p < 0.000) and an increase in the serum BE (p < 0.05) levels were observed in the EA group compared to the diet restricted group. In this study, reduced serum leptin levels paralleling to weight loss were observed in the EA group. Furthermore, it is thought that in the EA applied group, increasing serum BE level probably enhanced the lipolitic activity which may have caused weight loss in obese people by mobilizing energy stores. It may be considered that the EA application with diet restriction in obesity treatment is more effective than the diet restriction alone.

Adult↗

PubMed2001

An initiative to retain reserve soldiers failing to meet weight and physical fitness standards: the Wisconsin Army National Guard experience.

This paper presents the Wisconsin Army National Guard's attempt to retain soldiers failing to meet weight and annual physical fitness test standards. Soldiers failing or at risk of failing weight and fitness standards attend a wellness program one weekend per month for three consecutive months. Instruction includes topics in exercise training, nutrition, general wellness, stress reduction, and motivational lectures. A total of 324 soldiers who completed the program were evaluated for retention rates. At 48 months, graduates of the program had a 55% retention rate. This program is cost effective and soldier caring.

Adult↗

PubMed1998

Programmed administration of parathyroid hormone increases bone formation and reduces bone loss in hindlimb-unloaded ovariectomized rats.

Gonadal insufficiency and reduced mechanical usage are two important risk factors for osteoporosis. The beneficial effects of PTH therapy to reverse the estrogen deficiency-induced bone loss in the laboratory rat are well known, but the influence of mechanical usage in this response has not been established. In this study, the effects of programed administration of PTH on cancellous bone volume and turnover at the proximal tibial metaphysis were determined in hindlimb-unloaded, ovariectomized (OVX), 3-month-old Sprague-Dawley rats. PTH was administered to weight-bearing and hindlimb-unloaded OVX rats with osmotic pumps programed to deliver 20 microg human PTH (approximately 80 microg/kg x day) during a daily 1-h infusion for 7 days. Compared with sham-operated rats, OVX increased longitudinal and radial bone growth, increased indexes of cancellous bone turnover, and resulted in net resorption of cancellous bone. Hindlimb unloading of OVX rats decreased longitudinal and radial bone growth, decreased osteoblast number, increased osteoclast number, and resulted in a further decrease in cancellous bone volume compared with those in weight-bearing OVX rats. Programed administration of PTH had no effect on either radial or longitudinal bone growth in weight-bearing and hindlimb-unloaded OVX rats. PTH treatment had dramatic effects on selected cancellous bone measurements; PTH maintained cancellous bone volume in OVX weight-bearing rats and greatly reduced cancellous bone loss in OVX hindlimb-unloaded rats. In the latter animals, PTH treatment prevented the hindlimb unloading-induced reduction in trabecular thickness, but the hormone was ineffective in preventing either the increase in osteoclast number or the loss of trabecular plates. Importantly, PTH treatment increased the retention of a baseline flurochrome label, osteoblast number, and bone formation in the proximal tibial metaphysis regardless of the level of mechanical usage. These findings demonstrate that programed administration of PTH is effective in increasing osteoblast number and bone formation and has beneficial effects on bone volume in the absence of weight-bearing and gonadal hormones. We conclude that the actions of PTH on cancellous bone are independent of the level of mechanical usage.

Animals↗

PubMed2000

A prospective study of gestation and birthweight in Aboriginal pregnancies in far north Queensland.

This study aimed to determine the cause(s) of the increased incidence of low birthweight birth in Aboriginal pregnancies. The study prospectively examined a cohort of Aboriginal women presenting for antenatal care before 20 weeks gestation (ultrasound proven) and a reference cohort of Caucasian women in four remote North Queensland communities served by the Far North Regional Obstetric and Gynaecological Service (FROGS) and the antenatal clinic at Cairns Base Hospital. Women with no known medical factors affecting fetal growth or gestation were recruited. Of the 102 Aboriginal and 101 Caucasian women recruited, 96 Aboriginal and 96 Caucasian women completed the study, providing groups of sufficient size to allow statistical assessment at 80% power and 95% significance. Outcomes measured were gestation at delivery, planned or spontaneous birth, neonatal anthropometric measurements and Dubowitz score. The phenotypic and demographic characteristics of the women, their pregnancies, and their babies were also compared to understand the major associations with low birthweight birth in the Aboriginal women. Apart from Aboriginal ethnicity, excessive alcohol use in pregnancy, low maternal body mass index (BMI), and low maternal age had significant negative correlations with birthweight, and excessive tobacco use in pregnancy and high maternal gravidity showed strong similar trends. Culturally appropriate programs need to be funded and developed to reduce the incidence of low birthweight Aboriginal birth, rather than medical programs primarily aimed at the reduction of the incidence of preterm labour.

Adult↗

PubMed1979

Effects of physical conditioning on cardiorespiratory function, body composition and serum lipids in relatively normal-weight and obese middle-aged women.

The primary purpose was to investigate the effects of a 12-week (4 day/week) physical conditioning program on cardiorespiratory function, body composition, and serum lipids (cholesterol and triglyceride concentration) in sedentary, middle-age women. A secondary purpose was to clarify the influence of excessive body fatness on the conditioning response. Forty-two 29 to 47-year-old premenopausal women volunteered; four were excluded and two dropped out, leaving 36 who completed the study, ie, 23 obese (O) (greater than 30 per cent fatness, mean = 38 per cent) and 13 lean to normal (N) (less than 30 per cent body fatness, mean = 25 per cent). The conditioning program included a 10-minute warm-up, 15 to 25 minutes of walking-jogging at an individually prescribed training heart rate corresponding to 75 per cent of maximal oxygen intake (VO2max) and a five-minute recovery period. Heart rate and systolic blood pressure at a given submaximal work load decreased in both N and O. VO2max increased (P less than 0.001 in both groups. The average increase in O was 15.0 per cent and 18.9 per cent and in N 12.6 per cent and 12.7 per cent when VO2max was expressed inlitre .min-1 and cm3.kg-1.min-1 respectively. HRmax remained unchanged in N, but decreased slightly (P less than 0.01) in O. Body weight remained essentially unchanged in N, yet decreased (P less than 0.001) in O. The sum of ten skinfolds decreased significantly (P less than 0.001) in both groups, but with a greater reduction in O. Fatness decreased slightly in N (P less than 0.05) and more in O (P less than 0.001) while fat-free weight remained unchanged in both groups. The conditioning program had no effect on serum lipids in either group. Thus, a physical conditioning program of moderate intensity affected obese and leaner women in a similar fashion.

Adult↗

PubMed2002

Fondaparinux: basic properties and efficacy and safety in venous thromboembolism prophylaxis.

The synthetic pentasaccharide fondaparinux is the first in a novel class of antithrombotic agents. By selectively inactivating factor Xa in an antithrombin-dependent mechanism of action, fondaparinux exerts its anticoagulant effect through inhibition of thrombin generation, without any direct effect on thrombin activity. Unlike unfractionated heparin and low-molecular-weight heparins, fondaparinux is a single molecular entity produced by total chemical synthesis. Its favorable pharmacokinetic profile and pharmacodynamics allow for safe and effective once-daily dosing in the majority of populations. Initial clinical development of fondaparinux has focused on the prevention of venous thromboembolism following major orthopedic surgery--that is, hip and knee replacement and hip fracture. Results of the largest phase III clinical trial program to date in these major hip and knee surgeries demonstrate comparable safety, in terms of clinically relevant bleeding, and an overall 55% reduction in risk of venous thromboembolism with fondaparinux relative to the low-molecular-weight heparin enoxaparin.

Anticoagulants↗

PubMed2002

Body weight and nutritional changes after reduction pneumoplasty for severe emphysema: a randomized study.

BACKGROUND: The impact of reduction pneumoplasty on body weight and nutritional status has not previously been tested in a controlled study. METHODS: We investigated 60 patients with severe emphysema who were randomly assigned to receive either reduction pneumoplasty (n = 30) or a 6-week respiratory rehabilitation program (n = 30). Nutritional status was evaluated by means of body mass index, triceps skin fold measurement, midarm muscle circumference, and biochemical blood values. Fat mass and fat-free mass were calculated by bioelectric impedance. Two treatment-related deaths occurred after reduction pneumoplasty and 1 death occurred after respiratory rehabilitation. RESULTS: Functional and subjective improvements were significantly showed in reduction pneumoplasty group. Despite insignificant differences in energy intake, the reduction pneumoplasty group showed significant gain (P <.0001) relative to the respiratory rehabilitation group in mean weight changes at 3 months (1.82 +/- 2.63 kg vs -0.57 +/- 2.25 kg), 6 months (2.87 +/- 3.79 kg vs -1.11 +/- 2.64 kg), and 12 months (3.29 +/- 4.01 kg vs -0.95 +/- 1.90 kg). Both fat mass and fat-free mass increased after surgery, but only fat-free mass had a significant improvement (P =.001). Six-month weight gain in the reduction pneumoplasty group was significantly correlated with low baseline weight (rho = -0.437, P =.02) and residual volume reduction (rho = -0.446, P =.01). Total proteins (P =.003), albumin (P =.03), transferrin (P =.04), cholesterol (P =.003), hemoglobin (P =.01), triceps skin fold measurement (P <.0001), and midarm muscle circumference (P <.0001) were significantly increased only in the reduction pneumoplasty group. Conversely, in the respiratory rehabilitation group no nutritional index was significantly increased at 6 months after rehabilitation. CONCLUSIONS: Body weight and nutritional status improved only after reduction pneumoplasty and not after respiratory rehabilitation, and this was significantly related to fat-free mass increment. In the reduction pneumoplasty group, the residual volume result was significantly correlated with postoperative weight gain.

Algorithms↗

PubMed2001

The effects of dietary L-carnitine supplementation on the performance, organ weights and circulating hormone and metabolite concentrations of broiler chickens reared under a normal or low temperature schedule.

1. The present study examined the effects of the addition of 100 mg/kg L-carnitine to the basal starter (containing 17.8 mg/kg L-carnitine) and finisher (containing 22.9 mg/kg L-carnitine) diets on performance, organ weights and plasma hormone and metabolite concentrations of male and female broiler chickens. The broiler chickens were reared either in a room with a normal temperature (NT) program or with a low temperature (LT) program (rapid decrease from 28 degrees C to 20 degrees C at 14 d of age). 2. Broiler chickens reared under the LT schedule consumed more food and attained a greater body weight at 42 d of age than their counterparts reared under NT schedule, without any difference in food efficiency or abdominal fat content. Dietary L-carnitine supplementation had no significant effects on any of these production parameters, except for a reduction in the abdominal fat content of female NT chickens. However, the LT schedule and dietary L-carnitine supplementation greatly increased absolute and proportional heart weights. The elevated heart weights were not due to right ventricle hypertrophy. 3. Both the LT program and L-carnitine supplementation increased circulating plasma triiodothyronine concentrations. There were also some transient effects of both experimental variables on plasma growth hormone, glucose and triglyceride concentrations. 4. L-carnitine did not improve broiler performance. However, this result does not mean that L-carnitine supplementation cannot have beneficial effects in other circumstances. In view of the elevated proportional heart weights, it can also be argued that L-carnitine is a potential agent for reducing the incidence of metabolic diseases in broiler chickens.

Adipose Tissue↗

PubMed1997

Decreasing blood donor exposure in the neonates by using dedicated donor transfusions.

Critically ill infants receive frequent red cell transfusions for replacement of blood drawn for laboratory analysis and in treatment of symptomatic anemia. Since blood for multiple transfusions on a given day is typically obtained from one fresh RBC unit, each multiply transfused neonate is exposed to many donors increasing the risk of transfusion transmitted disease. We hypothesized that the number of donor exposures per infant would decrease by instituting DDTP and that more infants will be exposed to only a single donor. We started a Dedicated Donor Transfusion Program (DDTP) in our NICU. One unit of red cells is dedicated to each baby for the life of the unit (35 days). We compared the donor exposure in infants for one year, before and after DDTP. The infants were divided into three birth weight groups. Group I were infants < 1000 g; Group II infants were 1000-1500 g; Group III infants were > 1500g. The average number of transfusions per patient decreased significantly from 7.5 +/- 6.0 to 4.7 +/- 4.2 (P < 0.001) in Group I while it remained unchanged in Groups II and III. The Dedicated Donor Transfusion Program significantly reduced the donor exposure in NICU infants. The program also facilitated the reduction of the number of transfusions in the infants under 1000 g.

Blood Donors↗

PubMedDate not supplied

Teaching children self-care for chronic disease prevention: obesity reduction and smoking prevention.

A general health education program was developed for 1,252 students in six New York city area school districts. The purpose of the three-year project was to reduce the prevalence of risk factors associated with increased cardiovascular and cancer risk in adults. The curriculum included nutrition, antitobacco, and hypertension-control materials. A smaller, experimental intensive health behavior program was also developed for obese children (weight greater than or equal to 120% ideal for height, age, and sex). A smoking prevention program was offered to children with the aim of discouraging new smokers. Findings show that: 1) such a school-based primary disease prevention program is feasible and highly acceptable; and 2) reduction of obesity and new cigarette smoking occurred with intensive intervention involving small groups of students. On the other hand, a general health education itself had little effect in the total population in reducing the incidence of extreme clinical values (such as physical inactivity, high blood pressure, as well as smoking and obesity) for their age and sex. It is recommended that future programs for higher risk children concentrate on behavioral change rather than on general education.

Activities of Daily Living↗

PubMedDate not supplied

Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital.

OBJECTIVES: The authors examined clinical outcomes in 71 male and female patients with coronary atherosclerosis who enrolled in a 2-year, independent-living, lifestyle modification program. The findings in 43 patients who completed the program were compared with those in 28 patients who dropped out of the program. BACKGROUND: Clinical studies suggest that lifestyle modification of risk factors for coronary atherosclerosis reduces subsequent cardiac events but there are very few reports of the effect of these programs in patients living independently. METHODS: Patients with diagnosed coronary atherosclerosis were managed for a 2-year period in a structured multidisciplinary program by a team that included two cardiologists, a nurse, a dietitian, an exercise physiologist, and a clinical psychologist. The overall aim of the program was to normalize or control all major reversible cardiovascular risk factors. Patients were required to participate in several weekly sessions for exercise, meditation/stress reduction training, dietary education and counseling, and participatory dinners. There was a strong emphasis on patient's self care, inclusion of support members, and regular monitoring of and feedback to patients. RESULTS: Data comparing baseline and 2-year outcomes showed a significant reduction in body weight, dietary intake of total/saturated fat and cholesterol, serum low- and high-density lipoprotein concentration, and an increase in exercise capacity. In the compliant group, the incidence of cardiac events was 2.3% over 2 years. CONCLUSION: Multidisciplinary lifestyle modification programs addressing cardiovascular risk factors are known to have a significant impact upon cardiac risk factors in patients with coronary atherosclerosis. Data show that these changes can be accomplished in independent-living patients in a program offered through a routine cardiology service. However, compliance is an important issue in these self-regulated programs.

Behavior Therapy↗

PubMed1984

Mood changes in behavioral weight loss programs.

Ten studies investigating the relationship between mood change and weight loss in behavioral weight loss programs were reviewed. Significant positive changes in mood were observed in 6 of the 10 studies. There was no evidence to indicate that untoward reactions to dieting were frequent, that patients with juvenile-onset obesity experienced more negative mood changes than those with adult-onset obesity, or that dropping out of treatment was a response to increasing depression. The positive changes in mood were related to active participation in a treatment program, and occurred in behavioral and nonbehavioral treatment programs. Differences between the studies reviewed and the earlier research on mood and weight loss are discussed and suggestions made for subsequent studies of mood changes during weight reduction.

Anxiety↗

PubMed2003

Treatment for patients with the metabolic syndrome.

The metabolic syndrome, or insulin resistance syndrome, is associated with increased risk for cardiovascular disease and related mortality and has an estimated age-adjusted US prevalence of 23.7%. Dyslipidemia in the syndrome is characterized by hypertriglyceridemia, low high-density lipoprotein cholesterol, and small, dense low-density lipoprotein (LDL) particles in the context of normal/slightly elevated LDL cholesterol. Outcomes in treatment studies in or including diabetic patients suggest that a variety of therapies may be of benefit in reducing cardiovascular risk in patients with the metabolic syndrome, including physiologic therapies and pharmacologic treatments, such as aspirin, antihypertensive therapy, anti-ischemic therapy, and lipid-modifying therapies. The recently updated National Cholesterol Education Program Adult Treatment Panel III guidelines identify the metabolic syndrome as a secondary target of lipid-lowering therapy after LDL cholesterol reduction and recommend use of weight reduction and increased physical activity to address underlying risk factors as well as therapies to address specific lipid and nonlipid risk factors.

Adult↗

PubMed1990

Very-low-calorie diets. Safe treatment for moderate and morbid obesity.

Very-low-calorie diets are a tedious but effective treatment for moderate and morbid obesity. An exercise program, nutrition counseling, and behavior modification are essential elements in the total program. Careful supervision by a knowledgeable physician and commitment by both the patient and the physician are essential. Although some side effects are inevitable with drastic weight reduction, current formulas are safer than those used in the past.

Behavior Therapy↗

PubMed1999

Obesity medications and the treatment of type 2 diabetes.

Obesity is a chronic disease and requires ongoing treatment. Type 2 diabetes is associated with obesity and improves with weight loss. Diets of 800 kcal/d induce twice the weight loss induced by weight loss medications. The strength of weight loss medication, which should be used with diet and a lifestyle change program, is the maintenance of weight loss. Sibutramine and orlistat are the only two medications approved for the long-term treatment of obesity. Orlistat gives a reduction of low-density lipoprotein (LDL) cholesterol in excess of that expected with weight loss, and the drop in blood pressure expected with weight loss is not seen with sibutramine. Except in newly diagnosed patients with diabetes subjects, patients with diabetes lose half the weight of subjects who do not have diabetes when treated with weight loss medications. Metformin and, to a lesser extent, acarbose cause weight loss, making them attractive choices for the treatment of obese type 2 diabetic subjects. Repaglinide appears to be weight-neutral, but other medications for patients with diabetes can be associated with weight gain. Many new medications are in development for the treatment of obesity. These new medications act through a variety of mechanisms and will surely play an increasingly important role in the treatment of obese patients with type 2 diabetes.

Acarbose↗