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PubMed2006

Leptin, superoxide dismutase, and weight loss: initial leptin predicts weight loss.

OBJECTIVE: Our goal was to study how plasma leptin concentration, superoxide dismutase (SOD) activity, and weight loss are related in obese adults. RESEARCH METHODS AND PROCEDURES: Serum leptin concentration, SOD activities, general biochemical data, and body composition measurements were obtained for 62 overweight and obese subjects before and after an 8-week body weight reduction (BWR) regimen. The subjects were on dietary control, performed moderate aerobic and strength training exercises, and attended educational lectures. RESULTS: The measurement results indicated that the following criteria were significantly reduced: body weight [84.4 +/- 17.0 vs. 79.3 +/- 16.1 (standard error) kg, p < 0.001]; BMI (31.5 +/- 4.3 vs. 29.4 +/- 4.2 kg/m(2), p < 0.001), and fat mass (33.3 +/- 10.0 vs. 29.8 +/- 10.4 kg, p < 0.001). Plasma leptin levels also significantly decreased from 31.5 +/- 17.6 to 26.5 +/- 17.2 ng/mL (p < 0.001). Additionally, SOD activity was significantly increased from 261.4 +/- 66.0 to 302.7 +/- 30.9 U/mL (p < 0.001). Based on linear regression analysis results, a 3.78- to 8.13-kg reduction in weight can be expected after the 8-week BWR regimen when initial leptin concentration was 5 to 30 ng/mL. DISCUSSION: We found that an 8-week exercise and diet program was effective in reducing weight and fat mass and, notably, had further beneficial effects on leptin resistance and SOD activity. Additionally, this study demonstrated that initial plasma leptin concentration may be used as a predictor for weight loss outcome.

Adolescent↗

PubMed2001

Dose-response trend tests for tumorigenesis adjusted for differences in survival and body weight across doses.

A relationship between rodent body weight and tumor incidence for some tissue/organ sites has been demonstrated in many studies. It is not uncommon for a chemical tested for carcinogenicity to also affect body weight due to toxicity and/or food consumption. In such cases, comparisons of tumor incidence may be biased by body weight differences across dose groups. A simple procedure was investigated for reducing this bias. This procedure divides the animals into a few groups on the basis of body weight. Body weight at 12 months was used, before the appearance of a tumor was likely to affect body weight. Statistics for dose-response trend tests are calculated within body weight strata and pooled to obtain an overall dose-response trend test. This procedure is analogous to stratifying animals on the basis of age at the time of removal from a study to account for differences in ages of animals across dose groups that can affect comparisons of tumor incidence. In this paper, differences in survival times of animals were adjusted by the Poly-3 technique used by the National Toxicology Program. This technique does not require the assignment of cause of death. Several examples from rodent chronic bioassays were investigated, where the high dose group had reduced body weights and associated reductions in tumor incidence. When we analyzed the data by body weight strata, some positive dose-response trends for tumor incidence were demonstrated. In one case, the body weight adjusted analysis indicated that a negative dose-response trend in tumor incidence was a real effect in addition to a body weight reduction. These examples indicate that it is important to consider the effects of body weight changes as low as 10%, and perhaps less, as possibly being caused by chemicals in 2-year bioassays for carcinogenesis. The simple procedure of analyzing tumor incidence within body weight strata can reduce the bias introduced by body weight differences across dose groups.

Animals↗

PubMed1998

Weight loss management: a path lit darkly.

This article reviews recent research on the prevalence and virulence of obesity as a causal risk factor for mortality and morbidity. The prevailing assumption that obesity, by itself, is a chronic disease or a primary risk factor for health is challenged. A historical perspective is used to analyze the efficacy of various medical and educational approaches that have attempted to alter body size in the pursuit of enhanced physical health. The motivational discrepancies between society's media-induced desire for thinness and the health field's risk reduction approach to weight loss are outlined. Finally, ethical issues are raised in relation to current weight control measures, implications for future educational efforts are discussed, and potential guidelines for future weight management programs are presented.

Diet, Fat-Restricted↗

PubMed1998

Evaluation of the topical delivery of a prednisolone derivative based upon percutaneous penetration kinetic analysis.

Prednisolone (PN) and an esterified derivative (PND) were evaluated in pharmacological and pharmacokinetic studies. The pharmacological study was performed using a rat croton-oil induced ear edema model. The results for the topical effect in skin and the systemic effect through multiple topical applications showed that PN and PND were equally potent in suppressing edema, and that PN caused a reduction in thymus weight, whereas PND had little effect. The concentration of these steroids in hairless mouse skin was estimated from an in vitro percutaneous absorption study using the computer simulation program MULTI(FILT). PND was found to be poorly absorbed. In fact, the PND concentration in the viable skin remained low (0.79 microg/cm2), even after 7 d. However, the estimated concentration of PND in the viable skin appears to be in excess of the threshold for effective topical effect during the pharmacological evaluation. In contrast, in the case of PN, the estimated PN concentration increased gradually after application and reached a level of 10.22 microg/cm2 at day 7, suggesting that this increase in PN concentration in the viable skin could result in a systemic effect. The difference between PN and PND concentration in the skin during the time course could be due to the metabolism of PND to PN in the viable skin. Consequently, the difference between the pharmacological study is reflected from the results of the pharmacokinetics of PN and PND in the skin.

Administration, Topical↗

PubMed1985

Exercise during pregnancy: maternal and fetal responses. A brief review.

Since many physiological, metabolic, and endocrine changes that occur during pregnancy are evident even at rest, the alterations found during exercise may not necessarily be the same as those found in the normal population. Nonetheless, the exercise-induced cardiopulmonary changes are essentially normal or slightly exaggerated during pregnancy. The energy cost of cycle exercise is unchanged during pregnancy; however, the increased weight bearing, especially evident in late pregnancy, adds to the exercise effort during walking, climbing, or jogging. Aerobic work capacity remains unchanged during pregnancy, and typical training adaptations can be found during pregnancy. Hypoglycemia occurs more easily during exercise in pregnant women, even though lipid provision is exaggerated during late pregnancy. The influence of maternal exercise on the fetus is evident in changed heart rhythm and breathing patterns of the fetus. Pregnant patients with utero-placental insufficiency are more likely to have these fetal changes during exercise. Severe hyperthermia should be avoided during pregnancy. Animal studies indicate that some aspects of fetal metabolism are affected by maternal exercise; whether the reduction in uterine blood flow found during heavy exercise exacerbates this response is not known. Birth weight is unaffected when healthy well-nourished mothers participate in mild to moderate exercise programs during pregnancy. However, more intense exercise programs during pregnancy in animals can cause changes in fetal growth and litter size.

Animals↗

PubMedDate not supplied

Changing patient behavior.

OBJECTIVE: To discuss barriers and strategies relevant to initiating lifestyle modifications for the prevention and treatment of type 2 diabetes. METHODS: Findings from previously published studies are reviewed. In light of reported successful changes in patient behavior and resultant improved outcomes pertinent to reduction or control of diabetes, methods to achieve optimal results are outlined. RESULTS: Both the Diabetes Prevention Program and the Finnish Diabetes Prevention Study demonstrated that intensive lifestyle interventions, such as weight loss as a result of physical activity, can delay and prevent the development of type 2 diabetes. Key barriers to initiating behavioral modifications in patients include the following: (1) health-care provider experience, (2) patient experience and beliefs, (3) lack of health-care system support, and (4) minimal availability of community support. These barriers can be overcome through use of proven strategies--promoting patient awareness of health risks, selecting patients who are willing to participate in a behavioral modification program, defining realistic goals, establishing patient accountability, and maintaining regular follow-up for review of progress, providing assistance with problem solving, and reinforcement of efforts and successes. CONCLUSION: The feasibility of initiating successful lifestyle interventions has been shown in numerous studies. The effective implementation of these interventions in clinical practice will necessitate fundamental changes in the health-care system and society in general.

Behavior Therapy↗

PubMed2002

A community-based obesity prevention program for minority children: rationale and study design for Hip-Hop to Health Jr.

UNLABELLED: BACKGROUND; The increasing prevalence of overweight among children in the United States presents a national health priority. Higher rates of overweight/obesity among minority women place their children at increased risk. Although increased rates of overweight are observed in 4- to 5-year-old children, they are not observed in 2- to 3-year-old children. Therefore, early prevention efforts incorporating families are critical. METHODS: The primary aim of Hip-Hop to Health Jr. is to alter the trajectory toward overweight/obesity among preschool African-American and Latino children. This 5-year randomized intervention is conducted in 24 Head Start programs, where each site is randomized to either a 14-week dietary/physical activity intervention or a general health intervention. RESULTS: This paper presents the rationale and design of the study. Efficacy of the intervention will be determined by weight change for the children and parent/caretaker. Secondary measures include reductions in dietary fat and increases in fiber, fruit/vegetable intake, and physical activity. Baseline data will be presented in future papers. CONCLUSIONS: The problem of overweight/obesity is epidemic in the United States. Behaviors related to diet and physical activity are established early in life and modeled by family members. Early intervention efforts addressing the child and family are needed to prevent obesity later in life. This paper describes a comprehensive, family-oriented obesity prevention program for minority preschool children.

Black or African American↗

PubMed2001

Exercise characteristics and the blood pressure response to dynamic physical training.

PURPOSE: The purpose of this study was to assess the influence of the characteristics of the exercise program, particularly exercise intensity, on the blood pressure response to dynamic physical training in otherwise healthy normotensive and hypertensive subjects. METHODS: This study is a meta-analysis of randomized controlled intervention trials and a description of studies in which different training regimens have been compared. RESULTS: The weighted net reduction of blood pressure in response to dynamic physical training averaged 3.4/2.4 mm Hg (P < 0.001). Interstudy differences in the changes in pressure were not related to weekly frequency, time per session, or exercise intensity, which ranged from approximately 45--85%; these three characteristics combined explained less than 5% of the variance of the blood pressure response. The response of diastolic blood pressure was not different according to training intensity in studies that randomized patients to training programs with different intensities. Some studies reported a greater reduction of systolic blood pressure when intensity was about 40% than when participants exercised at about 70%, but this finding was not consistent, neither within nor between studies. CONCLUSION: Training from three to five times per week during 30--60 min per session at an intensity of about 40--50% of net maximal exercise performance appears to be effective with regard to blood pressure reduction. The evidence that higher intensity exercise would be less effective is at present inconsistent.

Adult↗

PubMed1998

The independent and combined effects of weight loss and aerobic exercise on blood pressure and oral glucose tolerance in older men.

The independent and combined effects of aerobic exercise training (AEX) and weight loss (WL) on blood pressure (BP) and oral glucose tolerance were studied in 97 nondiabetic, sedentary, older men. The men were assigned to either a WL (n = 31), AEX (n = 35), AEX+WL (n = 20) intervention, or to a control (CON) group (n = 11). The AEX regimen consisted of 3 days/week for 9 months, whereas WL consisted of a behavioral modification weight loss program that met weekly for 9 months. Maximal oxygen uptake increased significantly (P < .05) in both the AEX and AEX+WL groups (delta change: 0.45 +/- 0.06 and 0.43 +/- 0.07 L/min, respectively; mean +/- SEM), but did not change in the WL (delta change: 0.00 +/- 0.04 L/min) and CON (-0.05 +/- 0.07 L/min) groups. The AEX+WL and WL groups had comparable reductions in body weight (-8.6 +/- 0.7 and -8.8 +/- 0.7 kg,) and %fat (-5.4 +/- 0.5 and -5.2 +/- 0.6%) that were significantly greater than the CON and AEX groups, in which neither body weight nor %fat changed. The AEX, WL, and AEX+WL groups had significant reductions in both systolic (-6.4 +/- 1.3, -9.2 +/- 1.6, and -9.7 +/- 2.2 mm Hg, respectively) and diastolic (-5.2 +/- 1.0, -6.2 +/- 1.3, and -7.2 +/- 1.5 mm Hg, respectively) BP after their respective interventions compared with the change in systolic (3.2 +/- 3.6 mm Hg) and diastolic (-0.5 +/- 1.9 mm Hg) BP in the CON group. The AEX, WL, and AEX+WL groups also had significant reductions in glucose and insulin responses to an oral glucose tolerance test compared with the CON group. The reduction in the insulin area in the AEX+WL group was significantly greater than in the AEX and WL groups. The results of this study demonstrate that AEX and WL are effective nonpharmacologic therapies to lower BP and alter glucose and insulin responses to an oral glucose challenge. However, combining the two interventions does not result in any further improvement in BP.

Aged↗

PubMed1990

Evaluation of an employee health risk appraisal program.

1. After 2 years of employee participation, a computerized health risk assessment program managed by occupational health nurses was evaluated to determine whether health risk factor levels had undergone any significant change. 2. Data on 387 hospital employees were examined. Statistically significant reductions in risk factor levels were found for diastolic blood pressure, serum cholesterol, and smoking. The risk factor "weight" remained unchanged from year 1 to year 2 for both groups. 3. These findings suggest that the nursing interventions of focused, written feedback on risk factors, private counseling, and risk reduction education classes may have been important in motivating employees to make significant lifestyle changes.

Female↗

PubMed2000

[The Freiburg Intervention Trial for Obesity in Chidren (FITOC)].

Freiburg Intervention Trial for Obese Children (FITOC) is an interdisciplinary treatment program for obese children, which is established in Freiburg since 1987. Obese children at the age of 8-11 are treated in an eight months intensive period and a follow-up period of 4 months or more. Since 1990 data from 283 children coming out of 15 treatment groups (about 2 groups per year) were collected and analyzed. The program consists of regular physical training (3 times a week), comprehensive nutrition and behaviour training (overall 7 parents evenings each 4 to 6 weeks and 7 cookery courses for the kids in the same time scale). The parents evenings are filled with theoretical and practical information about nutrition as well as background information about the psychological and physiological problems in obese children. In the first examination and the regular control examinations anthropometric, biochemical and exercise physiology data are investigated. In addition, questionnaires for nutrition and behaviour are analysed on a regular basis. At each examination, depending on the progress in therapy, a new orientation with adapted goals will be discussed with the child and the parents. For the growing children a moderate reduction or long term stabilisation of weight will lead to success. Teaching goal for the children in the intensive period is to control themselves and, depending on their specific situation, to establish individual recommendations on a long term basis. The sports program should lead to an increase in self-esteem and a raise in daily energy expenditure. The team includes a physician, a nutritionist, a psychologist and a sports teacher. From 1997 the program was spread to institutions in the surroundings of Freiburg. Training for the external teams is provided for in continuous seminars. Teaching material includes a manual, forms and transparencies. The major goal is to secure quality by continuous training and close interaction between the institutions. Till now the program is performed by a couple of multiplication groups in different regions of Germany. First data analysis has shown that the out-patient program is transferable and comparable results are reachable after a standardized training course for the included therapists. The plan for 2000 and 2001 is to increase the number of centers involved to a total of 20 all over Germany.

Behavior Therapy↗

PubMed1998

Effect of weight gain on pulmonary function after smoking cessation in the Lung Health Study.

The objective of this study was to determine if the weight gain that accompanies smoking cessation is independently associated with reductions in FEV1 and FVC, using a multicenter randomized intervention trial of smoking cessation in 10 communities in the United States and Canada. Enrollees were currently smoking women and men 35 to 60 yr of age with mild-to-moderate airway obstruction. Participants were randomized to one of three study groups: an intensive smoking cessation program with an inhaled bronchodilator (or a placebo), and usual care. Changes in absolute and percent predicted FEV1 and FVC between baseline and fifth annual follow-up visit were monitored in relation to changes in body weight during the interval. At the baseline examination, percent predicted FEV1 was maximal at 90 to 100% ideal body weight (IBW) and was lower as body weight deviated from this range. The FVC decreased linearly when IBW exceeded 100%. Weight gain was greatest during the first 12 mo after smoking cessation. Weight gain was associated with lower fifth-year FEV1 and FVC in all smoking categories: continuous smokers, intermittent smokers, and sustained quitters. The FVC was affected by weight gain more than was the FEV1, and the FEV1 was affected by smoking cessation more than FVC. Men showed more impairment of FVC with weight gain than did women, possibly because of differential patterns of fat deposition. In sustained quitters, after adjustment for baseline factors, the estimated reduction of FVC was 17.4 ml/kg weight gain for men and 10.6 ml/kg for women. The estimated loss of FEV1 was 11.1 ml/kg weight gain for men and 5.6 ml/kg for women. Lung function after smoking cessation is significantly influenced by weight gain and affects men more than women. The deleterious effects of weight gain are small, however, in comparison with the beneficial effects of smoking cessation.

Adipose Tissue↗

PubMed1997

Physiological adaptations to a weight-loss dietary regimen and exercise programs in women.

Thirty-one women (mean age 35.4 +/- 8.5 yr) who were overweight were matched and randomly placed into either a control group (Con; n = 6), a diet-only group (D; n = 8), a diet+aerobic endurance exercise training group (DE; n = 9), or a diet+aerobic endurance exercise training+strength training group (DES; n = 8). After 12 wk, the three dietary groups demonstrated a significant (P </= 0.05) reduction in body mass, %body fat, and fat mass. No differences were observed in the magnitude of loss among groups, in fat-free mass, or in resting metabolic rate. The DE and DES groups increased maximal oxygen consumption, and the DES group demonstrated increases in maximal strength. Weight loss resulted in a similar reduction in total serum cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol among dietary groups. These data indicate that weight loss during moderate caloric restriction is not altered by inclusion of aerobic or aerobic+resistance exercise, but diet in conjunction with training can induce remarkable adaptations in aerobic capacity and muscular strength despite significant reductions in body mass.

Adaptation, Physiological↗

PubMed1998

Change in body fat, but not body weight or metabolic correlates of obesity, is related to symptomatic relief of obese patients with knee osteoarthritis after a weight control program.

OBJECTIVE: To determine the variable most closely related to symptomatic relief of osteoarthritis (OA) of the knee in response to a weight control program. METHODS: Twenty-two patients diagnosed with knee OA whose body mass index (BMI) was more than 26.4 were treated with a low calorie diet, an appetite suppressant, and nonsteroidal antiinflammatory drugs for 6 weeks. The patients were instructed to follow a walking program. We analyzed BMI, percent body fat, the average number of steps per day by pedometer, and the metabolic correlates of obesity (blood pressure, fasting blood serum glucose, total cholesterol, triglycerides, and serum insulin) at the beginning and end of therapy. The correlation between the change in each variable and the remission score (delta score) using the Severity Index of Lequesne, et al was evaluated. RESULTS: Delta score of knee OA was more strongly associated with reduction in percent body fat (p= 0.0013, r=0.62) than other variables. Significant correlation was also observed between the number of steps per day and delta score (p=0.0031, r=-0.58). No other variable, including weight loss, was significantly correlated with delta score. There was a significant correlation between delta percent body fat and the number of steps per day (p=0.012, r=-0.62). CONCLUSION: In a weight control program, decreasing body fat and increasing physical activity are more important than body weight loss or decreasing other indices of obesity in producing symptomatic relief of knee OA, although there is not necessarily a cause and effect relationship between body fat and OA score.

Adipose Tissue↗

PubMed1989

The effect of weight control on lipid changes in obese children.

The effects of weight change on serum lipid changes were assessed in a sample of 56 obese children randomly assigned to family-based behavioral obesity treatment vs controls given no treatment. Fasting serum lipid levels, height, weight, and fitness were measured at program entry and after 6 months of treatment. Children assigned to treatment showed significantly greater relative weight and weight changes than children in the control group, and the weight changes were significantly related to reductions in fasting serum triglyceride and total serum cholesterol levels and increases in high-density lipoprotein serum cholesterol. Results after 5 years of follow-up available for a small sample of treated children showed that a change in relative weight and fitness from 6 months to 5 years was also associated with changes in the high-density lipoprotein level. These results suggest that weight control in obese preadolescent children may be associated with improvement in lipoprotein profiles.

Child↗

PubMed1993

Effects of differing intensities and formats of 12 months of exercise training on psychological outcomes in older adults.

The 12-month effects of exercise training on psychological outcomes in adults ages 50-65 years were evaluated. Ss (N = 357) were randomly assigned to assessment-only control or to higher intensity group, higher intensity home, or lower intensity home exercise training. Exercisers showed reductions in perceived stress and anxiety in relation to controls (p < .04). Reductions in stress were particularly notable in smokers. Regardless of program assignment, greater exercise participation was significantly related to less anxiety and fewer depressive symptoms, independent of changes in fitness or body weight (p < .05). It was concluded that neither a group format nor vigorous activity was essential in attaining psychological benefits from exercise training in healthy adults.

Adult↗

PubMed2004

Promoting more modest weight losses: a pilot study.

OBJECTIVE: This pilot study assessed the short- and long-term effects of a modified cognitive behavioral treatment designed to facilitate obese patients' acceptance of a 5% to 10% reduction in initial weight. RESEARCH METHODS AND PROCEDURES: Participants were 17 women with a mean age of 46.5 +/- 9.7 years and BMI of 34.7 +/- 2.9 kg/m2. They participated in a 40-week program that included four phases. The first discussed the benefits of modest weight losses and the potential adverse effects of unrealistic expectations. Phase II provided instruction in traditional cognitive behavioral methods of weight control Phase III focused on methods to improve body image and self-esteem. Phase IV addressed skills for weight maintenance. Changes in weight, self-esteem, body image, and quality of life were assessed at the end of treatment and 1 year later (week 92). RESULTS: At week 40, participants lost an average of 5.7 +/- 5.3% of initial weight, which was associated with significant improvements in body image, self-esteem, and quality of life. Improvements in psychosocial status were maintained at week 92, although mean weight loss at this time had declined to 2.9 +/- 5.6% of initial weight. Increased satisfaction with body weight at week 40 was associated with significantly better maintenance of weight loss at follow-up (r = -0.70; p = 0.02). DISCUSSION: Having participants seek only modest initial weight losses does not appear to facilitate weight maintenance. However, increasing patients' satisfaction with their body weight at the end of treatment may help improve weight maintenance. More research is needed on the relation between satisfaction with initial weight loss and long-term success.

Adult↗

PubMed2006

Weight loss in overweight patients maintained on atypical antipsychotic agents.

BACKGROUND: Weight gain and associated medical morbidity offset the reduction of extrapyramidal side effects associated with atypical antipsychotics. Efforts to control weight in antipsychotic-treated patients have yielded limited success. METHODS: We studied the impact of an intensive 24-week program of diet, exercise, and counseling in 17 chronically psychotic patients (10 women, seven men) who entered at high average body weight (105.0+/-18.4 kg) and body mass index (BMI) (36.6+/-4.6 kg/m(2)). A total of 12 subjects who completed the initial 24 weeks elected to participate in an additional 24-week, less intensive extension phase. RESULTS: By 24 weeks, weight-loss/patient averaged 6.0 kg (5.7%) and BMI decreased to 34.5 (by 5.7%). Blood pressure decreased from 130/83 to 116/74 (11% improvement), pulse fell slightly, and serum cholesterol and triglyceride concentrations changed nonsignificantly. With less intensive management for another 24 weeks, subjects regained minimal weight (0.43 kg). CONCLUSIONS: These findings add to the emerging view that weight gain is a major health problem associated with modern antipsychotic drugs and that labor-intensive weight-control efforts in patients requiring antipsychotic treatment yield clinically promising benefits. Improved treatments without weight-gain risk are needed.

Adult↗