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PubMed1998

Self-selected diets of lactating women often fail to meet dietary recommendations.

OBJECTIVE: To assess longitudinally nutrient intakes of lactating women during the postpartum period. DESIGN: Dietary data from lactating women were collected by means of 2-day food records at 3 and 6 months postpartum. Intake of energy and selected nutrients was tabulated and compared with dietary standards. SUBJECTS: The 52 lactating women enrolled in the study lived in a university community, were apparently healthy, had a body mass index within normal range, were successfully nursing a term infant, and planned to nurse for at least 6 months. STATISTICAL ANALYSES PERFORMED: Paired t tests and Stuart-Maxwell chi(2) analyses. RESULTS: Mean energy intakes were below the Recommended Dietary Allowance. Mean intakes of most nutrients met or exceeded recommended standards except for zinc and vitamins D and E at both 3 and 6 months postpartum. Calcium and folate intakes were also below standards at 6 months. Although mean iron intake exceeded the standard at both measurement times, there was a significant decline from 3 to 6 months. Relative frequencies of mothers meeting various percentages of standards differed significantly from 3 to 6 months for calcium; iron; folate; and vitamins E, D, and B-6. At 6 months, significant increases were noted in the number of women reporting calcium, folate, and vitamin B-6 intakes at less than one half of the recommended amounts. APPLICATIONS/CONCLUSIONS: Guidance for lactating women should stress food sources of nutrients likely to be limited in their diets: calcium; zinc; folate; and vitamins E, D, and B-6.

Adult↗

PubMed2006

A pair-feeding study reveals that a Y5 antagonist causes weight loss in diet-induced obese mice by modulating food intake and energy expenditure.

Neuropeptide Y (NPY) is thought to have a significant role in the physiological control of energy homeostasis. We recently reported that an NPY Y5 antagonist inhibits body weight gain in diet-induced obese (DIO) mice, with a moderate reduction in food intake. To clarify the mechanism of the antiobesity effects of the Y5 antagonist, we conducted a pair-feeding study in DIO mice. The Y5 antagonist at 100 mg/kg produced a moderate feeding suppression leading to an 18% decrease in body weight, without altering body temperature. In contrast, the pair-fed group showed only a transient weight reduction and a reduced body temperature, thus indicating that the Y5 antagonist stimulates thermogenesis. The Y5 antagonist-treated mice showed an up-regulation of uncoupling protein mRNA in brown adipose tissue (BAT) and white adipose tissue (WAT), suggesting that both BAT and WAT contribute to energy expenditure. Thus, the Y5 antagonist induces its antiobesity effects by acting on both energy intake and expenditure.

Adipose Tissue↗

PubMed2007

Dietary intake, physical activity and TV viewing as mediators of the association of socioeconomic status with body composition: a cross-sectional analysis of Australian youth.

BACKGROUND: There is emerging evidence of socioeconomic gradients in adiposity among Australian youth. Behavioral mechanisms for these trends are unexplained. METHODS: In total, 194 South Australian children (97 boys, 11.48+/-0.43 years; 97 girls, 11.60+/-0.38 years) were assessed for pubertal status, stature, weight, skinfolds and waist girth. Socioeconomic status (SES) was represented by postcode of residence (Socioeconomic Index for Areas) and parent education. Children reported moderate-to-vigorous physical activity (MVPA), TV viewing (TV) and dietary intake (daily energy intake as a ratio of predicted basal metabolic rate (DEI/BMR); and fat intake), using three x 24 h recall. Path analysis (partial least-squared method) was used to analyze the independence and interdependence of pathways linking SES, anthropometric variables and measured behaviors. RESULTS: SES was negatively associated with waist girth and skinfolds in girls, and waist girth in boys. In models including behavioral variables, these SES gradients in girls were largely unattenuated; accordingly, physical activity and dietary intake were not confirmed as mediators of the association of SES and girls' adiposity. In boys there was evidence that the negative relationship between SES and waist girth was mediated by fat intake. CONCLUSIONS: The inverse relationships between SES and girls' adiposity were unexplained by the behavioral attributes measured in this study. Mediators of SES gradients in youth adiposity remain elusive, and may require intensive methodologies to explicate.

Adipose Tissue↗

PubMed2004

Eating out in America, 1987-2000: trends and nutritional correlates.

BACKGROUND: Despite widely held beliefs about increasing popularity of eating away-from-home and its possible contribution to increasing adiposity of the US population, there are little published data on this topic. To address this issue, we examined trends in frequency of consumption of commercially prepared (CP) meals reported by Americans aged > or =18 years, and its nutritional correlates. METHODS: The data were from the National Health Interview Survey (NHIS) 1987 (n = 21,731), NHIS 1992 (n = 11,718), and the National Health and Nutrition Examination Survey (NHANES) 1999-2000 (n = 5,330). The information on CP meal consumption was obtained from questions included in the three surveys. The independent association of reported CP meal frequency with body mass index (BMI), and intakes of energy and macronutrients was examined using multiple linear regression methods. RESULTS: The mean reported number of CP meals per week was 2.5 in 1987 and 1992, and 2.8 in 1999-2000. In 1987, approximately 28% of the population reported 0 or <1 commercially prepared meal per week, decreasing to 24% in 1999-2000 (P for trend <0.0001). However, the proportion of the population reporting three or more weekly CP meals increased from 36% in 1987 to 41% in 1999-2000 (P for trend < or =0.0005). The odds of eating out at least one or more and three or more meals per week were 40% higher (95% CI 1.20-1.70) in 1999-2000 relative to 1987. The reported number of CP meals per week was positively associated with estimates of energy intake (P < or = 0.0001) in each survey. Self-reported and measured BMI were modestly associated with the reported number of weekly CP meals in women in 1999-2000 (P < or = 0.05). CONCLUSION: Our results confirm that in 1999-2000, more Americans ate out, and ate out more frequently than in 1987 and 1992. Higher eating-out frequency was associated with adverse nutritional consequences.

Adult↗

PubMed1996

Relationship between feeding pattern and body mass index in 220 free-living people in four age groups.

OBJECTIVE: To assess the relationship between feeding pattern and body mass index in free-living humans. DESIGN AND SUBJECTS: Feeding pattern was assessed from 220 7-day weighed dietary records. 187 records were obtained from three separate existing studies, and reanalysed. These studies contained data on three age groups in the British population; Elderly group (n = 88), Middle-aged group (n = 40), Working age group (n = 59). A separate study of 13-14 year olds living in Croydon was conducted from which 33 usable diet records were collected to produce a fourth, Adolescent group. RESULTS: 'Nibbling' and greater energy intakes at breakfast were associated with a lower body mass index (BMI) in the Adolescent group. In the Middle-aged group, greater energy intakes at breakfast and lower energy intakes during the evening were associated with a lower BMI. However, when diet records which produced unreasonably low energy intakes were removed from the analysis, these relationships disappeared except for energy intakes at breakfast and BMI in the Adolescent group. CONCLUSION: It is suggested that the relationship between feeding pattern and BMI observed in the Adolescent and Middle-aged groups was caused by underestimation of 'habitual' energy intake from snacks and the omission of breakfast by females and those who were overweight. The lack of relationship in the Working age group was attributed to the fact that more individuals in this group appeared to report valid diet records. Reported energy intake was directly related to BMI in the Working age group, but was not related to BMI in the other three age groups. It is concluded that feeding pattern is not a major factor in determining BMI in humans. Also, since snacks have a relatively high sugar and low fat composition compared with meals, it is suggested that biased under-reporting of snacks by the obese could produce spurious results from free-living studies which show that obesity is related to the proportion of energy from fat in the diet.

Adolescent↗

PubMed1992

Consumption of a dehydrated ration for 31 days at moderate altitudes: status of zinc, copper, and vitamin B-6.

Intake of energy zinc, copper, and vitamin B-6 and indexes of zinc, copper and vitamin B-6 status were determined for eight men who consumed a high-carbohydrate dehydrated ration for 31 days of high activity at moderate altitudes (2,400 to 4,300 m). Data were collected 2 months before exposure (PRE), four times during the month at moderate altitudes (ALT), and 1 month after return (RET). Mean (+/- standard error) energy intake was 2,725 +/- 215, 3,430 +/- 79, and 3,370 +/- 215 kcal/day during PRE, ALT, and RET, respectively. Zinc and copper intakes averaged 10.6 +/- 1.6 and 1.0 +/- 0.1 mg/day during PRE and increased significantly to 16.9 +/- 0.7 and 3.5 +/- 0.1 mg/day during ALT; zinc and copper intakes were 15.5 +/- 1.6 and 1.9 +/- 0.3 mg/day for RET, respectively. Similarly, vitamin B-6 intake was significantly higher during ALT (PRE = 2.2 +/- 0.5 mg/day; ALT = 4.2 +/- 0.4 mg/day; and RET = 2.6 +/- 0.4 mg/day) as compared with PRE and RET. No significant changes were noted for plasma zinc, copper, or their related proteins or plasma or erythrocyte pyridoxal-5'-phosphate. Finally, no changes in urinary excretion of zinc were observed. The results indicate that dehydrated rations provide zinc, copper, and vitamin B-6 in amounts above the Recommended Dietary Allowances. Such diets may be consumed for at least 1 month without compromising status for these nutrients.

Adult↗

PubMed1990

Eleven plasma proteins as indicators of protein nutritional status in very low birth weight infants.

Concentrations of 11 plasma proteins were measured in 28 healthy, growing, very low birth weight, appropriate-for-gestational-age infants fed varying levels of human milk protein intake (range 1.7 to 3.9 g/kg per day). Significant positive correlations were found between mean protein intake and concentrations of 7 of the plasma proteins studied (transthyretin, retinol-binding protein, and transferrin: P less than .001; vitamin D-binding protein and apolipoprotein B: P less than .01; albumin and apolipoprotein A I: P less than .05). A weak negative correlation with mean protein intake was seen for the plasma level of orosomucoid, whereas no significant correlations were found for the plasma concentrations of fibronectin and alpha 1-antichymotrypsin. Protein intake, not energy intake, constituted the main contribution to the changes in the concentrations of transthyretin, retinol-binding protein, and transferrin. The levels of plasma transthyretin and transferrin were also strongly correlated with weight and length growth of the infants during the study as well as with other indicators of protein nutritional status such as preprandial concentrations of plasma amino acids and serum and urine urea. These data indicate that of the 11 plasma proteins studied, transthyretin, transferrin, and retinol-binding protein are the most suitable to evaluate protein nutritional status in very low birth weight infants.

Blood Proteins↗

PubMed2001

What do users of reduced-fat dairy products know about the fat in their diets?

OBJECTIVES: To assess the fat intake and knowledge about the fat content of foods consumed by a sample of self reported users of reduced-fat dairy products. DESIGN: Cross-sectional study of a population-based sample of women shoppers. SETTING: A small, rural town (population approximately 6000) in central Victoria, Australia. SUBJECTS: Seventy-eight women aged 25-50 years, who regularly used at least one reduced-fat dairy product. RESULTS: Mean reported intake of total fat was lower while intake of dairy fat was similar to that of a national sample of women of the same age both in the whole sample and when under-reporters were excluded. The ability to identify major sources of fat in the diet as reported appeared to be limited. Less than half of the subjects were able to correctly estimate the fat content of reduced-fat dairy products relative to regular products and about one quarter of subjects reported replacing one kind of oil or fat with another as a strategy to reduce fat intake. Subjects were generally aware of the need to 'eat less fat' but few could articulate specific recommendations. A number of subjects reported using low fat diets to control their weight but few subjects appeared to understand the connection between fat intake and energy intake. CONCLUSIONS: The findings of this study raise important questions about how nutrition advice is understood and implemented by consumers, particularly the message to reduce fat intake and the role of energy balance in weight management. They also highlight the difficulty of interpreting information on food intake, in subjects who have modified their diet by reducing intake of specific foods.

Adult↗

PubMed1989

Type 2 diabetes heredity and nutrient intake. A dietary history assessment in non-obese normoglycaemic men.

The impact of type 2 diabetes heredity on nutrient intake was studied, by means of dietary histories, in 51 normoglycaemic, non-obese men, aged 54-59 years; 29 with familial aggregation of type 2 diabetes, and 22 with no such family history. The average daily intake of energy, macronutrients and minerals was almost identical in the two groups. Mean energy intake was approximately 2400 kcal/d, about 15 per cent of the energy deriving from protein, 35 per cent from fat, 45 per cent from carbohydrate and 5 per cent from alcohol. The average daily intake or dietary fibre was approximately 17 g, or 7 g/1000 kcal. Mean daily sodium and potassium intake, estimated from food sources, was about 3000 and 4000 mg, respectively. The findings provide no support for the existence of any relationship between type 2 diabetes heredity and dietary habits or nutrient intake.

Diabetes Mellitus, Type 2↗

PubMed1999

Growth, development, and physical fitness of Flemish vegetarian children, adolescents, and young adults.

This study was designed to assess average daily dietary intakes of energy in 82 vegetarian children (group A: 6- 9-y-old girls and 6-11-y-old boys), adolescents (group B: 10- 15-y-old girls and 12-17-y-old boys), and young adults (group C: 16-30-y-old females and 18-30-y-old males) and included determination of height and weight; triceps, suprailiac, and calf skinfold thicknesses; puberty ratings; and physical fitness. Dietary energy intake was lower than recommended values in all 3 groups. Height and weight did not differ significantly from the reference data except in group B, which had significantly lower heights and weights and lower body mass indexes (P<0.05). Triceps and suprailiac skinfold thicknesses were lower in all age groups, whereas the calf skinfold thickness was only significantly lower in the 10-15-y-old girls (P<0.05). The vegetarian children were as physically fit as the reference group. The vegetarian adolescent boys and girls and the young adults scored significantly lower on the standing long jump and 30-s sit-up (P<0.05). The vegetarian subjects of groups B and C recovered significantly faster from the step test (P<0.05). Puberty ratings plotted on percentile graphs showed that all vegetarian subjects, except for 1 girl, were within the normal developmental range. We conclude that, within the limits of this study, vegetarian subjects have lower relative body weights and skinfold thicknesses in adolescence than do nonvegetarians. They scored lower on the strength tests and better on the cardiorespiratory test when compared with reference values. The growth and maturation status of the vegetarian population were within the normal range.

Adolescent↗

PubMed1996

Covert manipulation of the dietary fat to carbohydrate ratio of isoenergetically dense diets: effect on food intake in feeding men ad libitum.

OBJECTIVE: High-fat, high energy-density (HF, HED) diets promote an increase in energy intakes relative to low-fat lower-energy density diets (LF, LED). This study examined whether HF diets promote higher levels of energy intake when isoenergetically dense (IE) relative to LF (high carbohydrate) diets, as predicted by glucostatic and glycogenostatic models for energy intake regulation. SUBJECTS: Six normal-weight healthy men [mean age (SD) = 37.33 (13.32 y) mean weight = 73.03 (5.14 kg), mean height = 1.80 (0.05 m)]. DESIGN: Six men were each studied three times (factorial design) during 14-d throughout which they had ad libitum access to one of three covertly-manipulated diets. The fat, carbohydrate (CHO) and protein in each diet (as % energy) were 20:68:12, [low-fat (LF)]; 40:48:12, [medium-fat (MF)]; 60:28:12 [high-fat (HF)], with 2-d maintenance (1.4 x BMR, MF) beforehand. Within each diet every item was of the same composition and offered as a 3-d rotating menu. MEASUREMENTS: Energy and nutrient intakes, body weight, subjective pleasantness and satisfaction of the food. RESULTS: Energy intakes were 10.69, 11.02 and 10.90 MJ/d on the LF, MF and HF diets respectively. The increase in energy intake that occurred in previous studies when the energy density of the diet was increased by addition of fat was not apparent when LF, MF and HF diets were of the same energy density. CONCLUSION: Neither carbohydrate nor fat intake were tightly regulated. These data do not support an entirely glucostatic or glucogenostatic model of food intake regulation.

Adult↗

PubMed1997

Nutritional survey in Greek children: nutrient intake.

The aim of the survey was to record the food habits and nutrient intake of Greek children. Data was obtained by a 3 d household measured diet record from a random stratified sample (1936 children aged 2-14 y). Mean daily protein intake was much higher than PRI and none of the children had lower intake than AR. Mean energy intake from protein was 15%, carbohydrate 44% and fat 41%. Eighty-four percent of children had energy intake from fat higher than the AR. Saturated fatty acids (SFA) provided approximately 15%, monounsaturated (MUFA) 17% and polyunsaturated (PUFA) 6% of energy. Eighty-seven percent of children had higher intake of SFA than the AR. Six percent of children had SFA intake lower than the AR and 50% higher than the AR. None of the children had PUFA intake lower than PRI and 0.3% higher than the maximum limit. 4.2% of children had calcium intake lower than LTI and 88% higher or equal to PRI. All children had phosphorus intake higher than PRI and less than the lower safe ratio of Ca/P; 50% of them had P intake higher than 1.5 g/d. The majority of children had sufficient iron intake with the exception of menstruated girls. Mean vitamin A intake was higher than PRI and lower than the toxic levels. All children had vitamin C intake higher than LTI. Median vitamin D intake varied from 1.7-2.1 micrograms. Median energy intake was higher than the AR in preschool children, but lower in the older children. We conclude that Greek children do not underintake energy and protein, overintake SFA, have safe intake of PUFA, vitamin A and C and high intake of MUFA, underintake carbohydrates, have adequate Ca, but a considerably high P intake. Vitamin D is low in small children, but the biological available vitamin D is obviously higher due to sunlight.

Adolescent↗

PubMed1991

Life-time history of smoking and exocrine carcinoma of the pancreas: a population-based case-control study in The Netherlands.

From 1984 to 1988 a population-based case-control study was carried out in the Netherlands in collaboration with the International Agency for Research on Cancer, to examine the possible relationship between habitual, life-time consumption of varieties of tobacco and exocrine pancreatic carcinoma in 176 cases and 487 controls. An interviewer-administered questionnaire was used to list major life events and obtain estimates of usual frequency of tobacco consumption throughout life. About 58% of patients were interviewed directly. After adjustment for age, gender, response status, energy intake and consumption of vegetables compared with never-smokers, a positive dose-response effect of smoking of life-time number of total cigarettes, i.e. non-filter and filter, emerged (OR 1.00, 1.35, 1.40 and 2.10, p-value trend less than 0.05). Results of simultaneous estimation of the effects of life-time smoking of non-filter and filter cigarettes suggest that the effect was present primarily in non-filter cigarettes. The dose-response relationship was present in current smokers only. Compared with never-smokers, the risk pattern among relatively recent quitters, i.e. 2 to 14 years previously, still suggested a positive effect of past smoking (OR for low smokers 1.99, 95% CI 0.79-4.99 and for high smokers 1.69, 95% CI 0.63-4.58). The risk of quitting 15 years or more could be examined in the low smoking group only and was no different from those who had never smoked (OR 1.02, 95% CI 0.47-2.20). In brief, our results suggest that, independent of usual past intake of energy and vegetables, life-time smoking of cigarettes influences the development of exocrine pancreatic cancer, whereas cessation of smoking of cigarettes for 15 years or more reduces the risk to the levels found among those who have never smoked.

Adult↗

PubMed1995

Overexpression of the obese (ob) gene in adipose tissue of human obese subjects.

Obesity is accompanied by complications such as hypertension, non-insulin-dependent diabetes mellitus and atherosclerosis, which in turn cause ischaemic heart disease, stroke and premature death. The underlying mechanisms behind imbalance in energy intake and energy expenditure that lead to obesity are still controversial. In most populations, obesity is more common among women than men and is a multifactorial phenotype, which may result from a complex network of genetic and nongenetic factors. The relative importance of genetic factors for obesity is under debate. Genome searches using polymorphic markers in inbred mice with phenotypes that result in extreme obesity and studies of human candidate genes are being performed in an attempt to identify genes that contribute to obesity. There is evidence that body weight is physiologically regulated and it has been postulated that the storage of fat may provide signals to the brain that the body is obese, which in turn may make the subject eat less and burn more fuel. One of the molecules that may be involved in such signalling is the obese (ob) gene product. Mutations in ob result in profound obesity and type II diabetes in mice. The mouse ob gene and its human homologue have been cloned and sequenced. The gene is expressed in adipose tissue and the product has features of a secreted protein. We have investigated human ob expression in subcutaneous and omental adipose tissue obtained from non-obese and massively obese subjects using in situ hybridization histochemistry and report on overexpression in obese people.

Adipose Tissue↗

PubMed1997

Controversies surrounding diet and breast cancer.

What we know about prevention of breast cancer is related to lifetime oestrogen exposure and exposures to specific oestrogens at vulnerable periods of life. This can be influenced by diet. The strongest indicator of a diet-related effect to date is the fairly consistent increase in breast cancer among women who are tall or obese (Hunter & Willett, 1993). The other dietary factors summarized in Table 1 are less strongly associated with breast-cancer risk in epidemiological studies. The relationship between fat and breast-cancer risk has been extensively studied but remains somewhat uncertain. Fat, as a contributor to energy intakes and energy imbalance, is probably a factor in the higher breast-cancer rates in Western countries. Beyond its role as an energy source, the evidence for an independent effect of dietary fat on breast-cancer risk is weak. More focused analyses of the role of individual fatty acids, and on lipid-related pesticide exposures, may reveal strong effects which are currently masked by the use of inadequate exposure measures, as well as by measurement error. Currently, there is substantial evidence of a weak relationship with alcohol consumption, even at frequencies of drinking of less than once daily. The evidence of a protective role for antioxidants is weaker for breast cancer than for other cancers. This might by expected in a cancer which is not strongly associated with cigarette smoking. Specific foods are being studied for other potentially-active ingredients which may be involved in hormone metabolism, but conclusive results for soyabean or cruciferous vegetables are not yet available. Studying these relationships will continue to be a challenge for researchers because of the difficulties in measuring dietary exposures, which is complicated by the uncertainty of the relevant time frame for exposure assessment. While substantial attention has been focused on studying diet in relation to incidence, the potential for diet to reduce recurrence of breast cancer is thoroughly under-studied. There is little reason to believe that the factors which influence the incidence of breast cancer, perhaps during childhood and puberty, are the same as those which affect recurrence in adulthood. In this area, the very limited evidence available suggests that study of biologically-active fatty acids is promising.

Animals↗

PubMed2005

The link between nutritional status and insulin sensitivity is dependent on the adipocyte-specific peroxisome proliferator-activated receptor-gamma2 isoform.

The nuclear receptor peroxisome proliferator-activated receptor-gamma (PPARgamma) is critically required for adipogenesis. PPARgamma exists as two isoforms, gamma1 and gamma2. PPARgamma2 is the more potent adipogenic isoform in vitro and is normally restricted to adipose tissues, where it is regulated more by nutritional state than PPARgamma1. To elucidate the relevance of the PPARgamma2 in vivo, we generated a mouse model in which the PPARgamma2 isoform was specifically disrupted. Despite similar weight, body composition, food intake, energy expenditure, and adipose tissue morphology, male mice lacking the gamma2 isoform were more insulin resistant than wild-type animals when fed a regular diet. These results indicate that insulin resistance associated with ablation of PPARgamma2 is not the result of lipodystrophy and suggests a specific role for PPARgamma2 in maintaining insulin sensitivity independently of its effects on adipogenesis. Furthermore, PPARgamma2 knockout mice fed a high-fat diet did not become more insulin resistant than those on a normal diet, despite a marked increase in their mean adipocyte cell size. These findings suggest that PPARgamma2 is required for the maintenance of normal insulin sensitivity in mice but also raises the intriguing notion that PPARgamma2 may be necessary for the adverse effects of a high-fat diet on carbohydrate metabolism.

Adipocytes↗

PubMed1990

Energy supplementation of laying hen feed and drinking water.

Duplicate experiments were conducted with White Leghorn pullets (29 and 31 wk old) to determine the influence of sucrose additions to feed or drinking water upon performance and average daily energy intake. Treatments consisted either of 3.06 or 4.58% sucrose in drinking water or of 4.76% sucrose in the feed compared with a control diet containing 2,657 kcal ME/kg. In each experiment, six replicate pens of 5 individually caged hens received feed or water treatments ad libitum for 42 days. Egg production and body weight change were not affected in either experiment by sucrose addition. Feed intake was significantly reduced in association with either level of sucrose in the water. In Experiment 1, egg weights from hens receiving sucrose water were significantly below those of controls, probably because of lowered feed intake. Total energy consumed per gram of body weight was significantly higher in both studies for birds receiving the sucrose water.

Animal Feed↗

PubMed2000

Medical management of obesity.

Obesity is one of the most common medical problems in the United States and a risk factor for illnesses such as hypertension, diabetes, degenerative arthritis and myocardial infarction. It is a cause of significant morbidity and mortality and generates great social and financial costs. Obesity is defined as a body mass index greater than 30. Many patients accomplish weight loss with diet, exercise and lifestyle modification. Others require more aggressive therapy. Weight loss medications may be appropriate for use in selected patients who meet the definition of obesity or who are overweight with comorbid conditions. Medications are formulated to reduce energy intake, increase energy output or decrease the absorption of nutrients. Drugs cannot replace diet, exercise and lifestyle modification, which remain the cornerstones of obesity treatment. Two new agents, sibutramine and orlistat, exhibit novel mechanisms of action and avoid some of the side effects that occurred with earlier drugs. Sibutramine acts to block uptake of serotonin, norepinephrine and dopamine, while orlistat decreases fat absorption in the intestines.

Algorithms↗