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PubMed2002

[Proper Weight Loss with Intelligence (MIRA). 2 programs for weight reduction in general practice trial].

Applying the MIRA (German acronym for losing weight intelligently) concept, weight-losing programs were tested for guideline conformity and suitability in practice. The core of the concept comprises instruments for the analysis and evaluation of quality criteria for weight-reduction programs. A total of 116 men and women participated in the BCM program of PreCon GmbH & Co. KG, and the "Ich nehme ab" (l'm slimming) program (designed as a self-help aid) of the Deutsche Gesellschaft für Ernährung (German Society for Nutrition), and received counseling over a period of one year. Initial results of follow-up at 40 weeks showed a weight reduction of at least 5% in 66% of all participants, and at least 10% in 24%. The weight loss correlated with the number of counselings. On the basis of the 89 questionnaires evaluated to date, quality of life as measured by the IWQOL-Lite score showed an improvement in 80% of the subjects. These preliminary results indicate that the MIRA concept would appear to be a suitable quality control tool for obesity treatment programs.

Adult↗

PubMed1981

Locus of control as a predictor of attendance and success in the management of obesity.

For subjects attending a suburban self-help weight reduction program, successful weight reduction was associated with a relatively more 'internal' score. Although it may be expecting too much of the locus of control construct to provide confirmation of an overall theoretical basis or understanding to obesity, it would appear to warrant further evaluation with specific groups of obese subjects undergoing different weight reduction programs.

Adult↗

PubMed2001

Weight reduction and pharmacologic treatment in obese hypertensives.

This study was conducted to evaluate the mechanisms of weight loss-induced blood pressure (BP) reduction focusing, in particular, on the contributions of sympathetic nervous system activity, fasting plasma insulin, and leptin to BP levels, and to delineate the additional influence of antihypertensive drug therapy. Each of five groups of obese hypertensives were treated with the long-acting calcium channel blocker (CCB) amlodipine, the angiotensin converting enzyme (ACE) inhibitor enalapril with or without a weight reduction program, or a weight reduction program alone. The goal BP was less than 140/90 mm Hg for the pharmacologic treatment groups. The weight reduction program groups with or without pharmacologic treatment were divided into two groups; weight loss groups who succeeded in weight reduction (> or = 10%) and nonweight loss groups who failed in weight reduction (<10%) in the first 6 months. The final dose of CCB and ACE inhibitor were less in the combined pharmacologic and weight loss groups than in the pharmacologic treatment alone groups or in the pharmacologic and nonweight loss groups. In the weight reduction groups regardless of pharmacologic treatment, the percent reductions from baseline in plasma insulin, leptin, and norepinephrine (NE) were greater in the weight loss groups (> or = 10%) than in the nonweight loss groups (<10%). The reductions in plasma NE, insulin, and leptin were significantly greater and earlier in combined pharmacologic and weight loss groups than in the pharmacologic treatment alone groups. In ACE inhibitor groups, the reductions in plasma NE, in insulin, and especially in leptin were greater than the other groups. In the CCB alone group, reductions in insulin and leptin occurred, but there was no change in plasma NE. Reductions in insulin and leptin in CCB groups were less and occurred later than in the ACE inhibitor groups or the weight reduction alone group. These results show that weight loss associated with favorable metabolic improvements and these improvements are amplified when combined with pharmacologic treatment. Therefore, weight loss should be regarded as an essential component of any treatment program for obesity-related hypertension. A novel finding from this study is that ACE inhibition had a striking effect to lower plasma leptin. Suppression of sympathetic activity, insulinemia, and leptinemia appeared to play a role in the BP reduction accompanying weight loss.

Adult↗

PubMed2005

Role of dehydroepiandrosterone sulfate levels on body composition after laparoscopic adjustable gastric banding in pre-menopausal morbidly obese women.

UNLABELLED: In humans, dehydroepiandrosterone (DHEAS) has been postulated to have anabolic and lipolytic properties that could potentially counteract the catabolic effect of cortisol. DHEAS secretion is reduced in morbid obesity, likely due to hyperinsulinemia, and laparoscopic adjustable gastric banding (LASGB), by inducing considerable and rapid weight loss, reduces insulin levels. To investigate the role of decreased insulin levels after LASGB-induced weight loss on DHEAS levels and on body composition changes, we studied 30 pre-menopausal morbidly obese women (BMI ranging 37-62 kg/m2) before, 6, 12 and 24 months after LASGB. Total body water (TBW), fat-free mass (FFM) and fat mass (FM) were measured by bioelectrical impedance analysis; tissue hydration was also assessed by impedance vector analysis. At study ending, the subjects had a total weight loss of 28% of baseline body weight (15% after 6 months). After LASGB, weight loss was mainly due to decreased FM, and TBW, FFM, and body hydration were not significantly reduced. Weight loss was associated with an 82% rise in serum DHEAS already after 6 months while cortisol, cortisol/DHEAS molar ratio, and insulin levels fell by 5.5, 62 and 50%, respectively, after 6, 12 and 24 months (p<0.05). CONCLUSIONS: LASGB associated with a well balanced low-calorie diet permits a satisfactory 2-yr weight loss, sparing FFM and without body fluid alterations. As the result of a stable weight reduction program weight loss is associated to decrease in cortisol, cortisol/DHEAS molar ratio, and insulin plasma levels with marked rise in DHEAS. Higher cortisol/DHEAS molar ratio values at baseline are also associated to lower weight loss after LASGB, with lower decrease in FM and higher reduction in FFM and body cell mass, in spite of no differences in dietary regimes. Cortisol/DHEAS molar ratio is likely to represent a reliable marker of favourable modifications in body composition.

Adult↗

PubMed2006

Intragastric balloons: a temporary treatment for obesity.

(1) Intragastric balloons are a temporary non-surgical obesity treatment that induces short-term weight loss by partially filling the stomach to achieve satiety and reduce food intake. (2) Moderate weight loss may be achieved if patients adhere to a weight-reduction program. Weight gain often recurs when the balloon is removed after six months. (3) Abdominal pain, nausea, and vomiting are common, particularly in the first week after balloon implantation. (4) More data on benefits, harm, and cost effectiveness are required before the intragastric balloon can be compared with other short-term weight loss interventions, including low-calorie diets.

Bariatrics↗

PubMed1995

[Treatment of obstructive sleep apnea syndrome by ambulatory, comprehensive, behavior therapy oriented weight reduction (Optifast program)].

We investigated the therapeutic effect of marked body weight reduction on the predominantly obstructive sleep apnea syndrome by the application of an out-patient, behaviour therapy based body weight reduction program (Optifast-program) in 5 of our obese apnea patients. Mean body weight reduction was 32.7 +/- 15.8 kg after 6 months. The mean apnea-index of 34.5 +/- 23.1/h prior to the weight reduction dropped to 7.8 +/- 6.1/h after therapy. The mean apnea-hypopnea-index could be reduced from 45.7 +/- 25.9/h to 14.0 +/- 11.4/h. The best therapeutic effect on the sleep related respiratory parameters, was seen in patients who reached their normal weight. Our results shows that even severe, predominantly obstructive sleep apnea syndromes could be treated successfully with a marked body weight reduction.

Adult↗

PubMed2000

Leptin serum concentrations predict the responsiveness of obese children and adolescents to weight excess reduction program.

BACKGROUND: A role for leptin to predict weight gain is still controversial. OBJECTIVE AND DESIGN: To determine the relationship between baseline serum leptin values and responsiveness to an educational-based weight excess reduction program (WERP), 418 (241 males and 185 females) obese subjects, aged 9-15 y, were recruited. WERP required 2 y of follow-up. Body mass index (BMI) was evaluated at baseline and at each semester of follow-up. The obese subjects were subdivided into responsives and non-responsives, according to reduction or not of their BMI Z-scores during the WERP. Leptin concentrations were assayed at baseline and were included together with other independent variables in statistical multiple regression analysis. RESULTS: At a preliminary multiple regression analysis, a significant positive correlation between leptin values and BMI Z-score reduction at the second, third and fourth semester of follow-up was registered. To determine the odds ratio of the subjects who were responsive or non-responsive at the various semesters of WERP follow-up, a stepwise logistic regression was used incorporating the same predictors, with the serum leptin values subdivided into quintiles and responsiveness and non-responsiveness as a binary outcome variable. The model offered a satisfying goodness of fit as shown by the sensitivity and specificity. The odds ratio of being responsive were significantly increased by greater quintiles of leptin serum concentrations. Furthermore, such odds ratios were much higher in pubertal than in prepubertal subjects. CONCLUSIONS: These findings support a significant role for serum leptin concentration in predicting BMI changes as a response to an educational excess weight reduction program.

Adolescent↗

PubMed1980

Three-year follow-up data in overweight treatment.

Reassessed 3 years after the termination of a weight reduction program the body weight of former participants to control long-term efficiency of behavior-oriented weight reduction programs. Of 31 former participants, 21 could be rechecked. Most of the Ss stabilized their body weight or continued to reduce weight. Only 4Ss regained weight over the 3-year period. On an average, the group of former Ss lost 4.4 kilograms over the follow-up period. The whole reduction (therapy time and follow-up) resulted in 11.3 kilograms. Three results are encouraging, but difficult to discuss because no member of the former control group could be reassessed after 3 years and 10 Ss of the former therapy-groups could not be motivated to renewed collaboration. However, these results support the behavior-oriented approach to weight reduction and give evidence for the stabilizing function of such a therapy.

Behavior Therapy↗

PubMed2005

[Longitudinal changes in body composition and basal metabolic rate in institutionalized or domiciled obese adolescents].

UNLABELLED: The prevalence of obesity in children has increased dramatically during the past decades, and requires efficient care. OBJECTIVES: To determine changes in anthropometric parameters and basal metabolic rate (BMR) in obese adolescents during and after 2 types of weight-reduction programs. SUBJECTS AND METHODS: Twenty-six adolescents (group I, Z-score of BMI = 4.72) followed a 9-month-weight reduction program including a moderate energy restriction and regular physical activities in a specialized institution. In addition, 39 adolescents (group E, Z-score of BMI = 2.83) followed at home a 9-month-weight reduction program including medical and dietetic advices. Body composition (by impedancemetry) and BMR (by indirect calorimetry) were assessed before the beginning (M0), 4 months after (M4) and at the end (M9) of the programs, then 4 months (M13) and 16 month (M25) after the end of the weight-reduction programs. RESULTS: Twenty-two adolescents in group I and 20 adolescents in group E completed the study. At M0, age, body weight (BW), fat-free mass (FFM) and BMR of subjects of group I were higher (1.0 year, 36 %, 30 % and 23 %, respectively, P < 0.001), than those of group E. Pubertal stage and percentage of fat mass (FM) were not significantly different between the 2 groups. At M9, adolescents of group I showed significant reductions in BW and FM (-19 and -37 %, respectively, P < 0.001), but not significant differences in FFM. In addition, BMR decreased significantly between M0 and M4, both in absolute value (-6.7%, P < 0.001) and after adjustment for FFM (-5.8%, P < 0.001), and the difference was maintained until M9. Between M9 and M13, BW and Z-score of BMI were maintained in 12 adolescents, but increased (+9.7% and 14.8%, respectively, P < 0.001) in 10 adolescents. However, BMR did not change significantly in all adolescents. Between M13 and M25, BW, FM, FFM and BMR increased significantly (+13%, +34%, +6% et +5%, respectively, P < 0.001). During the 25 month period, adolescents of group E showed significant increases in BW, FFM and BMR (+8%, +14% and +10%, respectively, P < 0.001), and maintained their Z-score and FM. CONCLUSION: The reduction in BMR during the weight-reduction program at the institution could contribute to body weight regain in the post-obese adolescents if they do not maintain the lifestyle habits taught during the weight-reduction period. In other respects, Z-score was stabilized in 51% of domiciled obese adolescents.

Adipose Tissue↗

PubMed1976

Alopecia in crash dieters.

Nine patients experienced profuse hair loss two of five months after starting a vigourous weight reduction program resulting in weight loss of 11.7 to 24.75 kg. Telogen counts of 25% to 50% were observed. Regrowth of hair occurred within several months. Three patients had experienced hair loss closely following a successful weight reduction program on several occasions. Rigorous caloric restriction with subsequent inadequate energy supply of the hair matrix is thought to be the cause for the precipitation of the telogen effluvium of the crash dieter.

Adult↗

PubMed1992

[Effect of daily energy intake and amount of walking on body weight reduction and its maintenance].

The relationship of daily energy intake and the amount of walking performed, based on pedometer readings, for effective body weight reduction were studied based on results of a weight reduction program at the Aichi Prefectural Center of Health Care from 1983 to 1990. In addition, a follow-up study based on a mailed questionnaire was performed, to further determine the relationship to maintenance of body weight reduction of energy intake and amount of walking after the conclusion of program. The subjects were two-hundred and forty middle-aged obese women who were placed on a 5-month weight reduction program consisting of diet (1500 kcal/day) and exercise (10000 walk steps/day). At the end of the program, the mean energy intake and the mean number of steps per day had reached target levels and the mean body weight reduction was 4.2 kg. The relationship of energy intake, and the number of steps walked at the end of program to the amount of reduction in body weight during the program was analyzed by multiple regression analysis, and the amount of walking expressed in the number of steps necessary for weight reduction were calculated for various energy intakes. A follow-up study was performed in 1988, with sixty-six women responding to the mailed questionnaire. Since the end of the program, body weight increase of 1.1 kg occurred, but body weight was still lower than initially. Although mean energy intake increased after the program, a level about 200 kcal less than at the beginning of the program was being maintained, so the effect of diet recommendation in the program appeared to be retained.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1996

Weight reduction and fluid intake in an obese and fluid noncompliant ESRD patient.

This case study describes the application of a behavioral weight reduction program to an obese ESRD patient who was also fluid noncompliant. The major purpose of the study was to determine whether the behavioral weight reduction program could be successfully applied to a hemodialysis patient, and if so, what effect reduced caloric intake would have on fluid intake. Based on animal and human studies showing a strong relation between eating and drinking, it was expected that body weight reduction would be accompanied by reduced fluid intake. On the other hand, an alternative psychological hypothesis suggested that increased fluid intake might be substituted for reduced food intake. The results of the weight reduction program indicated that a successful weight reduction of 42 lbs was maintained over an 18-month follow-up period. However, fluid intake increased during periods when caloric intake was reduced. Overall, the results indicated that behavioral weight reduction programs can be successfully applied to weight reduction in obese hemodialysis patients but that ways to avoid increased fluid intake need to be carefully addressed by such programs.

Adult↗

PubMed1999

The impact of significant weight loss on resting energy expenditure in obese youth.

BACKGROUND: The prevalence of obesity in American youth is increasing and treating the condition is difficult. METHODS: We have developed a multidisciplinary weight-reduction program that includes a very low calorie diet followed by a hypocaloric diet, exercise, and behavior modification. Based on data collected at baseline and at the end of the acute intervention phase (10 weeks), we assessed the impact of the weight loss that resulted from participation in this weight reduction program on the resting energy expenditure and body composition of obese children and adolescents. RESULTS: There was a significant decrease in body weight and body fat as assessed by weight determinations and skin-fold measurements after 10 weeks. The body mass index decreased significantly from 33.8 on entry to 29.6 (P < 0.0001). Despite the significant weight loss, resting energy expenditure and lean body mass remained constant from entry until the completion of the acute phase. CONCLUSION: We conclude that a multidisciplinary weight-reduction program that combines a very low calorie diet followed by a balanced hypocaloric diet, with a moderate-intensity progressive exercise program and behavior modification is an effective means for weight-reduction in obese children and adolescents. Furthermore, fat mass is significantly reduced while lean body mass and resting energy expenditure are unaltered.

Adolescent↗

PubMed2005

Weight loss: a novel and effective treatment for urinary incontinence.

PURPOSE: We evaluated the effect of weight loss on urinary incontinence (UI) in overweight and obese women. MATERIALS AND METHODS: A randomized, controlled clinical trial was conducted among overweight and obese women experiencing at least 4 UI episodes per week. Women were randomly assigned to a 3-month liquid diet weight reduction program (24 in the immediate intervention group) or a wait-list delayed intervention group (24 in the wait-list control group). Participants in the wait-list control group began the weight reduction program in month 3 of the study. All women were followed for 6 months after completing the weight reduction program. Wilcoxon tests were used to compare intergroup differences in change in weekly UI episodes and quality of life scores. RESULTS: A total of 48 women were randomized and 40 were assessed 3 months after randomization. Median (with 25% to 75% interquartile range [IQR]) baseline age was 52 years (IQR 47 to 59), weight was 97 kg (IQR 87 to 106) and UI episodes were 21 weekly (IQR 11 to 33). Women in the immediate intervention group had a 16 kg (IQR 9 to 20) weight reduction compared with 0 kg (IQR -2 to 2) in the wait-list control group (p <0.0001). The immediate intervention group experienced a 60% reduction (IQR 30% to 89%) in weekly UI episodes compared with 15% (IQR -9% to 25%) in the wait-list control group (p <0.0005) and had greater improvement in quality of life scores. Stress (p =0.003) and urge (p =0.03) incontinent episodes decreased in the immediate intervention vs wait-list control group. Following the weight reduction program the wait-list control group experienced a similar median reduction in weekly UI episodes (71%). Among all 40 women mean weekly UI episodes decreased 54% (95% CI 40% to 69%) after weight reduction and the improvement was maintained for 6 months. CONCLUSIONS: Weight reduction is an effective treatment for overweight and obese women with UI. Weight loss of 5% to 10% has an efficacy similar to that of other nonsurgical treatments and should be considered a first line therapy for incontinence.

Adolescent↗

PubMed2005

Prospective evaluation of folic acid supplementation on plasma homocysteine concentrations during weight reduction: a randomized, double-blinded, placebo-controlled study in obese women.

Elevated total homocysteine concentrations and obesity are both associated with an increased risk of cardiovascular disease. However, previous studies of weight reduction on serum homocysteine concentrations have obtained inconsistent reports. We investigated the effect of folic acid supplementation on serum homocysteine concentrations via a randomized, double-blinded, placebo-controlled study. Seventy-four obese women [age (mean +/- SEM) 41 +/- 1 years; body mass index, 29.6 +/- 0.5 kgs/m2] completed a 12 weeks weight reduction program with dietary advice and light exercise. They were also randomized to take either folic acid supplementation (5 mg daily, n = 36) or placebo (n = 38) groups. This program led to a weight reduction of 7.7% and 8.9% of initial weight for folic acid supplementation and placebo groups, respectively. Serum folate concentrations increased for 3 folds (p < 0.001) in the folic acid group. In the folic acid group, there was a trend of lower fasting serum homocysteine concentrations (7.6 +/- 0.2 vs. 7.3 +/- 0.3 micromol/L), but it did not reach statistical significance (p = 0.170). However, we found that serum homocysteine concentrations decreased significantly in those with higher baseline homocysteine concentrations (8.7 +/- 1.3 vs. 7.8 +/- 1.5 micromol/L, p = 0.004), while it did not change in those with lower baseline homocysteine concentrations (6.6 +/- 0.6 vs. 6.8 +/- 1.2 micromol/L, p = 0.334). Reduction of serum homocysteine concentrations did not correlate with elevation of serum folate concentrations (p = 0.646) in obese women with higher baseline homocysteine concentrations. In conclusion, serum homocysteine concentrations can be maintained in obese women during mild to moderate weight loss. Folic acid supplementation decreased serum homocysteine concentrations in those women who had higher serum homocysteine concentrations before participating in the weight reduction program.

Adult↗

PubMed1988

Treatment of obesity in adults. Council on Scientific Affairs.

Concern with weight control should begin sufficiently early in life to reduce the risk of developing obesity. The complex etiology of obesity is, in part, responsible for the difficulty physicians encounter in treating this condition. Prevention is the "treatment" of choice. Early identification of individuals genetically at risk can be helpful in targeting those most likely to gain excess weight. Numerous dietary regimens have been devised in an attempt to achieve progressive weight loss in obese individuals. Since the ultimate goal of a weight-reduction program is to lose weight and maintain the loss, a nutritionally balanced, low-energy diet that is applicable to the patient's life-style is most appropriate. Increasing energy expenditure through physical activity, in addition to decreasing energy intake, generally improves results in the management of obesity. Major changes in eating and exercise behaviors are necessary to ensure long-term weight control. Diet, exercise, and behavior modification are interdependent and mutually supportive. A comprehensive weight-reduction program that incorporates all three components is more likely to lead to long-term weight control.

Adult↗

PubMed1997

The effect of aspartame as part of a multidisciplinary weight-control program on short- and long-term control of body weight.

This study investigated whether the addition of the high-intensity sweetener aspartame to a multidisciplinary weight-control program would improve weight loss and long-term control of body weight. One hundred sixty-three obese women were randomly assigned to consume or to abstain from aspartame-sweetened foods and beverages during 16 wk of a 19-wk weight-reduction program (active weight loss), a 1-y maintenance program, and a 2-y follow-up period. Women in both treatment groups lost approximately 10% of initial body weight (10 kg) during active weight loss. Among women assigned to the aspartame-treatment group, aspartame intake was positively correlated with percentage weight loss during active weight loss (r = 0.32, P < 0.01). During maintenance and follow-up, participants in the aspartame group experienced a 2.6% (2.6 kg) and 4.6% (4.6 kg) regain of initial body weight after 71 and 175 wk, respectively, whereas those in the no-aspartame group gained an average of 5.4% (5.4 kg) and 9.4% (9.4 kg), respectively. The aspartame group lost significantly more weight overall (P = 0.028) and regained significantly less weight during maintenance and follow-up (P = 0.046) than did the no-aspartame group. Percentage weight losses at 71 and 175 wk were also positively correlated with exercise (r = 0.32, P < 0.001; and r = 0.34, P < 0.01, respectively) and self-reported eating control (r = 0.37, P < 0.001; and r = 0.33, P < 0.01, respectively). These data suggest that participation in a multidisciplinary weight-control program that includes aspartame may facilitate the long-term maintenance of reduced body weight.

Adult↗

PubMed1979

Reducing adolescent obesity through a school health program.

The feasibility and effectiveness of conducting a school-based multi-component behavioral weight reduction program was tested on 119 overweight junior high school students. Four schools in the metropolitan New York area were randomly assigned to either the experimental or control conditions. After participating in a school-wide health-profile screening, students in the experimental group were invited to participate in a ten-session weight reduction program that included behavior modification, nutrition education, and exercise management. Comparison of the experimental and control groups with respect to changes on weight and triceps skinfold measures indicated significant differences between the two groups. Although the long-term effectiveness of the weight reduction program cannot be determined, the present study clearly demonstrates the short-term effectiveness and feasibility of conducting such a program in a school setting.

Adolescent↗