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The purpose of this study was to determine if overweight, mentally retarded students could safely lose weight and maintain their individual losses through a given time period (6 months). Minor changes in nutrition, and a simple activity program planned by school professionals was used. The program was implemented by school personnel and parents.
The decline in glucose homeostasis with aging may be due to the physical deconditioning and obesity that often develop with aging. The independent and combined effects of aerobic exercise training (AEX) and weight loss (WL) on glucose metabolism were studied in 47 nondiabetic sedentary older men. There were 14 men in a weekly behavioral modification/WL program, 10 in a 3 times/wk AEX program, 14 in an AEX+WL program, and 9 in the control (Con) group. The 10-mo intervention increased maximal oxygen consumption (VO2max) in both the AEX and AEX+WL groups [0.33 +/- 0.05 and 0.37 +/- 0.09 (SE) l/min, respectively], but VO2max did not significantly change in the WL (0.01 +/- 0.06 l/min) and Con groups (-0.04 +/- 0.05 l/min; P > 0.05). The AEX+WL and WL groups had comparable reductions in body weight (-8.5 +/- 0.9 and -8.8 +/- 1.2 kg, respectively) and percent fat (-5.5 +/- 0.7 and -5.9 +/- 1.1%, respectively) that were significantly greater than those in the Con and AEX groups. Oral glucose tolerance tests showed significant reductions in insulin responses in the AEX, WL, and AEX+WL groups, but the decrease in insulin response in the AEX+WL group was significantly greater than that in the other three groups. The glucose area decreased significantly in the WL and AEX+WL groups but did not change in the Con or AEX groups. There were significant increases in insulin-mediated glucose disposal rates as measured by the hyperinsulinemic (600 pmol.m-2.min-1) euglycemic clamps in the AEX and AEX+WL groups [1.66 +/- 0.50 and 1.76 +/- 0.41 mg.kg fat-free mass (FFM)-1.min-1, respectively] that were significantly greater than those in the WL (0.13 +/- 0.31 mg.kg FFM-1.min-1) and Con groups (-0.05 +/- 0.51 mg.kg FFM-1.min-1; n = 5). These data suggest that AEX and WL improve glucose metabolism through different mechanisms and that the combined intervention of AEX+WL is necessary to improve both glucose tolerance and insulin sensitivity in older men.
Long-term follow-up studies were conducted on massively obese hypertensive subjects during and after a successful protein supplemented fast (PSMF) in order to correlate blood pressure changes with caloric intake and body weight. The blood pressures in 43 subjects were compared during rapid weight loss and at identical weights during post-fast weight gain (Study A). Blood pressures and body weights in 50 subjects were compared prior to starting PSMF and prior to restarting the program 21 months later (Study B). One hundred twenty-five compliant subjects were observed after one month of weight maintenance (Study C-1), and 39 subjects were followed during six months of weight maintenance (Study C-2). In Study A, during subsequent weight gain on an unrestricted diet blood pressure was significantly higher than at identical weight during continuous weight loss on PSMF. However, this increase in blood pressure was only approximately 30 percent of the original decrease. In Study B, weight loss and blood pressure reduction were significantly correlated. After one month of weight maintenance following continuous weight loss of 73 lb, there was no increase in blood pressure (Study C-1). A small but significant increase in blood pressure after six months (Study C-2) was associated with similar small weight increment. However, all blood pressures remained well within the normotensive range and significantly lower than control values. In this study, long-term changes in blood pressure correlated with changes in body weight.
OBJECTIVES: Three aspects of obesity and physical activity are reviewed: whether the obese are inactive; how the activity level can be increased; and which are the effects of an increase in physical activity in combination with a reduction of energy intake. METHOD: The focus is on an objective approach that is, activity associated energy expenditure as measured with doubly labelled water. RESULTS: Activity associated energy expenditure increases with body mass index while the average physical activity level does not change. The majority of obese subjects is moderately active. An increase in the activity level of obese subjects is limited by the ability to perform exercise of higher intensity. Training programs obese subjects can cope with are until now not rewarded by weight loss. A possible loss in fat mass is compensated by a gain in fat-free mass. CONCLUSIONS: Obese subjects can only reach a significant weight loss with an energy restricted diet. Mild energy restriction will already result in very significant weight loss when one complies with the diet. An increase in physical activity is necessary to compensate for the reduction in activity induced energy expenditure and should be facilitated by the lower body mass.
Concentrations of total and weakly bound plasma estradiol were significantly (P less than .01) reduced in 73 healthy post-menopausal women after 10-22 weeks of participation in a low-fat diet intervention program. Nonsignificant reductions in estrone sulfate and sex hormone-binding protein were also observed. The 17% reduction in average estradiol concentration was accompanied by an average reduction of 12 mg/dL in total plasma cholesterol (P less than .001), an average weight loss of 3.4 kg (P less than .001), and an average reduction in daily dietary fat from 68.5 to 29.5 g. Our review of case-control studies indicates that a 17% reduction in plasma estradiol may explain a noteworthy component of the international variation in breast cancer incidence. We find a need for further studies of (a) disease risk in relation to hormone concentrations and (b) changes in hormone concentrations as a function of the duration of low-fat diet intervention.
Restriction of maternal protein intake during rat pregnancy produces offspring that are hypertensive in adulthood, but the mechanisms are not well understood. Our purpose was to determine whether this adult hypertension could be programmed during development by suppression of the fetal/newborn renin-angiotensin system (RAS) and a consequent reduction in nephron number. Pregnant rats were fed a normal protein (19%, NP) or low-protein (8.5%, LP) diet throughout gestation. Birth weight was reduced by 13% (p < 0.0005), and the kidney/body weight ratio was reduced in LP pups. Renal renin mRNA levels were significantly reduced in newborn LP pups; renal renin concentration and renin immunostaining were suppressed. Renal tissue angiotensin II levels were also suppressed in newborn LP (0.079 +/- 0.002 ng/mg, LP versus 0.146 +/- 0.016 ng/mg, NP, p < 0.01). Mean arterial pressure in conscious, chronically instrumented adult offspring (21 wk) was higher in LP (135 +/- 1 mm Hg, LP versus 126 +/- 1 mm Hg, NP, p < 0.00007), and GFR normalized to kidney weight was reduced in LP (p < 0.04). The number of glomeruli per kidney was lower in adult LP offspring (21,567 +/- 1,694, LP versus 28,917 +/- 2,342, NP, p < 0.03), and individual glomerular volume was higher (1.81 +/- 0.16 10(6) microm(3), LP versus 1.11 +/- 0.10 10(6) microm(3), NP, p < 0.005); the total volume of all glomeruli per kidney was not significantly different. Thus, perinatal protein restriction in the rat suppresses the newborn intrarenal RAS and leads to a reduced number of glomeruli, glomerular enlargement, and hypertension in the adult.
Since most obese patients with type II diabetes are unable to achieve ideal body weight, this study examined whether more modest weight losses would provide a long-term benefit. Type II diabetic patients (N = 114) were treated in a behavioral weight control program and followed up for one year. Weight loss was significantly correlated with improvements in glycosylated hemoglobin values at posttreatment (r = .55) and one year (r = .51). Patients who lost more than 6.9 kg or had more than 5% reduction in body weight had significant improvements in glycosylated hemoglobin values at one year, while patients losing less weight had nonsignificant changes and those gaining weight had significant worsening. Thus, modest weight loss can have a long-term impact on glycemic control. However, the improvement in glycemic control for a given weight loss was greater initially than at one year, suggesting that energy restriction, in addition to weight loss, may contribute to initial improvement. Neither percent overweight nor diabetes treatment affected weight loss.
In conclusion, the findings of most recent studies show that moderate-intensity aerobic exercise training can lower BP in patients with stage 1 and 2 essential hypertension. The average reduction in BP is 10.5 mm Hg for systolic and 7.6 mm Hg for diastolic BP. The reductions do not appear to be gender- or age-specific. Significant reductions in BP and LVH regression in patients with stage 3 hypertension have also been reported following aerobic exercise training. Resistance training exercise has not consistently shown to significantly lower BP and is not recommended as the only form of exercise for hypertensive patients. The exercise training program for optimal benefits should consist of 3 to 5 times per week, 30 to 60 minutes per session, at 50% to 80% of PMHR. However, exercise programs should be individualized to meet the patient's needs and abilities. Exercise intensity and duration should be manipulated to promote a safe and effective antihypertensive program. Initially, the exercise intensity should be low and the duration short. Both intensity and duration should progressive increase over a period of weeks until the desired goal, is achieved. The rate of progression must be tailored to meet individual patient needs and abilities. The exercise program for overweight or obese hypertensive patients should aim to promote a caloric expenditure of 300 to 500 Kcal per day and 1000 to 2000 Kcal per week. Such an approach, combined with a prudent diet, is likely to reduce body weight. The mechanisms mediating exercise-induced BP reduction are poorly understood. BP reductions appear to be independent of changes in body weight or body composition. There are also no indications of age- or gender-related differences in BP response to exercise. The use of ambulatory blood pressure measuring devices in exercise studies is not extensive. The few studies available indicate a more moderate reduction in BP than that reported by casual observations.
The efficacy of an exercise program was investigated in a study of 89 post-menopausal women with osteoporosis over a 5-year follow-up period. The study attempted to examine and compare potential differences in bone mineral density (BMD), incidence of fracture, and loss of height, between a group of patients (n = 42) who attended the supervised exercise program in the hospital, and a group (n = 47) who exercised at home. Habitual physical activity, as estimated using the Harvard Alumni Questionnaire, and a Physical Activity Index were combined to obtain an estimate of overall weekly caloric expenditure over the 5-year period. The exercise program involved weight-bearing aerobic activities of moderate intensity, and muscle strengthening exercise using free weights. The mean percentage change for the lumbar BMD was + 4.4% in the hospital group and +3.4% in the home group while for the femoral neck BMD was + 1.1% in the hospital group and -0.9% in the home group. There was a significant reduction in the number of fractures and no significant loss of height over the 5-year follow-up period for both groups. As the correlation between BMD and weekly caloric expenditure of the subjects was not significant, no conclusion can be drawn as to the minimum level of caloric expenditure necessary in order to retard bone loss. It was concluded that for the post-menopausal women with osteoporosis who participated in the program it was possible to stabilize their height and the BMD of the lumbar site, and to reduce fractures over the 5-year study period regardless if they exercised in a supervised or in an unsupervised setting.
Drawing upon the epidemiological, clinical, and behavioral studies suggesting the importance and feasibility of multidisciplinary efforts to reduce levels of risk variables for cardiovascular and other chronic diseases, a short-term live-in intervention program was developed. The program includes efforts to reduce smoking, weight, blood lipids, blood pressure, and stress through improving habits of exercise, nutrition, weight management, and stress control delivered to individuals with varying levels of health risk based on measurable biochemical and physiological variables and medical history. Major changes occurred during the 24-day program in 459 individuals enrolled in the program: 68% of smokers ceased, average cholesterol fell from 240 to 200 mg%, ideal body weight fell from 134 to 129% (82 to 79 kg), systolic blood pressure (BP) fell from 131 to 119 mm Hg, diastolic BP fell from 81 to 73 mm Hg. and reported feelings of general well-being increased. Greater changes were observed in the high-risk groups. Follow-up results at 1 year (48% of patients reporting) for those defined as high risk were a net decrease of 22 mg% in cholesterol, 7 mm Hg in systolic BP, 6 mm Hg in diastolic BP, and 6.8% of ideal body weight; 45% of those smoking at admission were still not smoking at 1 year (32% reporting). For those at lower risk there was a general return of risk levels toward baseline values.
The effect of a cost-containment program focused on decreasing the lengths of hospital stay of high-risk neonates was assessed by comparison of discharge weights and lengths of stay for 257 study infants, discharged from a neonatal intensive care unit (NICU) after an early-discharge program began, with those of 477 control infants discharged during a prior 1-year period. Demographic data and costs, as well as data on emergency department use and hospital readmissions, were included in the comparisons. There was a significant decrease in mean discharge weight and length of stay for infants in the study group. During a 7-month period, an estimated 2073 days of hospital care and approximately $2,700,000 in hospital charges were saved, or $10,609 per infant discharged. The cost of instituting and maintaining the program was $120,413, or $468 per infant. Seven visits were made to the emergency department by the study infants during the first 14 days after discharge. One infant was readmitted for a 4-day hospital stay for suspected sepsis. Significantly earlier discharge of high-risk neonates produced a decrease in hospital charges without causing excessive morbidity. The success of the program was coincident and presumed related to the institution of multiple elements focused toward family support through early-discharge planning. The reduction in hospital charges was 30 times higher than program expenses.
The largest single unit cost in the hospital cost for total knee arthroplasty (TKA) is the cost of knee implants. We developed a knee implant standardization program to provide guidelines for knee implant selection and to reduce the cost of knee implants for hospitals. Patients are assigned to demand categories based on five criteria: age, weight, expected activity, general health, and bone stock. Implants are assigned to demand categories based on an implant's projected capacity to handle the patient's projected demand. The program was applied retrospectively to 127 knee replacement operations performed on 93 patients during 1992. If this program had been in place, 8.4% of what was actually spent on knee implants for these 127 patients would have been saved. If the most expensive implants allowed in each demand category had actually been used, the program would have saved our hospital 12.8% of the cost of knee implants for these patients. Potential savings were noted in higher demand categories I and II by reducing the use of expensive cementless, porous-coated implants. The greatest potential savings were noted in lower demand categories III and IV: 11% savings could have been realized in demand category III, and 27% savings could have been achieved in the cost of knee implants in demand category IV. Potential savings would have been realized in these lower demand categories because of the recommended use of an all-polyethylene tibial component in 38 of 92 patients. This knee implant standardization program has the potential to assist surgeons in selecting knee implants and reduce the cost of knee implants without compromising outcome following TKA.
Seven pairs of young adult male identical twins completed a negative energy balance protocol during which they exercised on cycle ergometers twice a day, 9 out of 10 days, over a period of 93 days while being kept on a constant daily energy and nutrient intake. The total energy deficit caused by exercise above the estimated energy cost of body weight maintenance reached 244 +/- 9.8 MJ (Mean +/- SEM). Baseline energy intake was estimated over a period of 17 days preceding the negative energy balance protocol. Mean body weight loss was 5.0 kg (SEM = 0.6) (p < 0.001) and it was entirely accounted for by the loss of fat mass (p < 0.001). Fat-free mass was unchanged. Body energy losses reached 191 MJ (SEM = 24) (p < 0.001) which represented about 78% of the estimated energy deficit. Subcutaneous fat loss was slightly more pronounced on the trunk than on the limbs as estimated from skinfolds, circumferences, and computed tomograply (CT). The reduction in CT-assessed abdominal visceral fat was quite striking, from 81 cm2 (SEM = 5) to 52 cm2 (SEM = 6) (p < 0.001). At the same submaximal power output level, subjects oxidized more lipids than carbohydrates after the program as indicated by the changes in the respiratory exchange ratio (p < or = 0.05). Intrapair resemblance was observed for the changes in body weight (p < 0.05), fat mass (P < 0.01), percent fat (p < 0.01), body energy content (p < 0.01), sum of 10 skinfolds (p < 0.01), abdominal visceral fat (p < 0.01), fasting plasma triglycerides (p < 0.05) and cholesterol (p < 0.05), maximal oxygen uptake (p < 0.05), and respiratory exchange ratio during submaximal work (p < 0.01). We conclude that even though there were large individual differences in response to the negative energy balance and exercise protocol, subjects with the same genotype were more alike in responses than subjects with different genotypes particularly for body fat, body energy, and abdominal visceral fat changes. High lipid oxidizers and low lipid oxidizers during submaximal exercise were also seen despite the fact that all subjects had experienced the same exercise and nutritional conditions for about three months.
Taiwan is the second most densely populated country in the world; its 22.604 million residents (2002) live in an area of 35,967 km2 (628 people/km2). Taiwan's economy has grown rapidly during the last 20 years, resulting in a corresponding increase in the amount of municipal solid waste (MSW). This study describes and evaluates the municipal solid waste management system in Taiwan. The study's results indicate that the amount of MSW began to decline after 1997, when the government enforced aggressive MSW management policies. By 2002, total MSW production had dropped by 27%, and the average daily per capita weight of MSW had fallen from 1.14 kg in 1997 to 0.81 kg in 2002. Summarizing the successful experience of MSW reduction in Taiwan, the most important factor was the government's combining of the MSW collection system with reduction/recycling programs. The second most important factor was the policy of extended producer responsibility, which laid a foundation of recycling by producers and retailers and promoted public recycling.
In the Chicago Coronary Prevention Evaluation Program (CPEP), 115 men had definite mild hypertension at entry; another 101 men had high-normal diastolic blood pressure (BP). The nutritional-hygienic nonpharmacologic CPEP regimen achieved years-long moderate weight loss, slowing of pulse rate, and reduction in serum cholesterol levels. Sustained falls in BP were recorded-about 10/13 mm Hg for hypertensive men, resulting in long-term normalization of BP, and about 7/4 mm Hg for men with high-normal BP at entry. Change in weight and change in BP were significantly correlated. Long-term improvements in eating and exercise habits yielding moderate sustained weight loss are apparently useful in preventing high BP in hypertension-prone persons and in controlling established "mild" hypertension.
The effect of tylosine and sulphadimidine, chlortetracycline, and bacitracin in feed was studied in 1275 piglets from 120 litters; the values obtained were compared with the control group given no antibiotics. Three Tylan injections were applied to a half of the animals on the 2nd, 5th, and 28th day after birth. The Tylan program did not lead to any significant reduction of piglet mortality before the 50th day of life. In neither of the groups did Tylan injections reduce mortality at the level of statistical significance. From the age of 56 days, the Tylan-application program provides statistically significant weight gains, as compared with other groups. The group with Czechoslovak antibiotics had the same weight as the group fed without antibiotics. The occurrence of pathological and anatomic findings on lungs showed no statistically significant differences in the two groups. The presence of tylosine in blood could not be ascertained after the oral application of even much higher doses than those used in the Tylan-application program. Small incidence of rhinitis does not allow for drawing any conclusions concerning the effects of Tylan.
OBJECTIVE: The purpose of this study was to evaluate the effects of a combination weight loss program using intermittent low-calorie diets, energy-controlled meal replacement products, and sibutramine on weight loss, diabetes control, and cardiovascular risk factors in overweight or obese subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: Overweight or obese individuals with type 2 diabetes treated with diet or oral medication were randomly assigned to either a standard therapy or combination therapy group. Both groups received a standardized program to facilitate weight loss. The combination therapy group also received 10-15 mg sibutramine daily, low-calorie diets using meal replacement products for 1 week every 2 months, and between low-calorie diet weeks, once daily use of meal replacement product and snack bars to replace one usual meal and snack. Primary outcome measures were changes in body weight, glycemic control, plasma lipids, blood pressure, pulse, and body composition at 1 year. RESULTS: At 1 year, combination therapy, compared with standard therapy, resulted in significantly more weight loss (-7.3 +/- 1.3 kg vs. -0.8 +/- 0.9 kg, P < 0.001) and reduction in HbA(1c) (-0.6 +/- 0.3 vs. 0.0 +/- 0.2%, P = 0.05). Combination therapy resulted in reduced requirement for diabetes medications and decreased fat mass and lean body mass. A 5-kg decrease in weight at 1 year was associated with a decrease of 0.4% in HbA(1c) (P = 0.006). Changes in fasting glucose, lipids, pulse, and blood pressure did not differ between groups. CONCLUSIONS: This combination weight loss program resulted in greater weight loss and improved diabetes control compared with a standard weight loss program in overweight or obese subjects with type 2 diabetes.
OBJECTIVE: The goal of the present study was to identify covariates and predictors of post-treatment weight reduction. To clarify the impact of the individual factors, we compared "winners" (losing more than 2 BMI-points in the follow-up period) with "losers" (gaining more than 2 BMI-points in the same time). DESIGN: In a questionnaire based study, we evaluated the psychological impact on eating behavior, general psychopathology and depressive symptoms at three points in time: three months prior to admission (T0), at the beginning (T1) and at the end of in-patient treatment (T2) as well as 6, 12, and 18 months after treatment (T3-T5). SUBJECTS: One hundred and thirty eight obese patients (BMI<30 kg/m(2)) were recruited to the study. All patients participated in a multimodal in-patient treatment program over a period of 10 weeks. Treatment elements were cognitive behavioral therapy, movement therapy, and nutritional counseling. The aim of treatment was to regulate food intake, to minimize dysfunctional emotional influences on eating behavior, to enhance physical exercise and to treat comorbid psychiatric disorders. Twenty nine patients (13%) of the initial sample dropped out or were excluded during the treatment and post-treatment period. RESULTS: During in-patient treatment eating behavior improved and body weight decreased considerably in all patients. The weight reduction continued slightly in the follow-up period. Moreover, general psychopathology, depressive symptoms and eating behavior improved and remained stable during follow-up. These benefits were closely related to weight reduction. Neither eating behavior, nor eating related cognition nor psychopathology measured at T0 and T1 predicted long term success at T5. "Winners" as compared to "losers" at follow-up showed less psychopathology, less depressive symptoms and a less disturbed eating behavior. Already at discharge (T2), winners were less prone to eating triggered by external stimuli and reported fewer feelings of hunger. These differences predicted post-treatment weight reduction (T3-T5). CONCLUSION: Reported feelings of hunger and the tendency to disinhibited eating behavior measured at discharge were able to predict post-treatment weight reduction in our sample. Patients suffering from a feeling of hunger during in-patient treatment were less likely to show further weight reduction in the follow-up period. Similarly, reduction of "disinhibition" during treatment is a precondition for post-treatment weight loss.