The decrease in plasma ghrelin concentrations following bariatric surgery depends on the functional integrity of the fundus.

BACKGROUND: Gastric bypass surgery, which involves the production of a reduced stomach pouch,has been shown to markedly suppress circulating ghrelin concentrations. Since bypassing the ghrelin-producing cell population may be relevant to the disruption of fundic-derived factors participating in food intake signaling, the effect of weight loss induced by either adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion (BPD) was studied. METHODS: 16 matched obese patients [35.0 + 2.4 years; initial body weight 124.8 +/- 5.7 kg; body mass index (BMI) 47.1 +/- 2.2 kg/m(2)] in whom similar weight loss had been achieved by either AGB (n=7), RYGBP (n=6) or BPD (n=3) were studied. Blood was obtained for biochemical and hormonal analyses. Body composition was assessed by air-displacement-plethysmography. RESULTS: Comparable weight loss (AGB: 26.1 +/- 5.1 kg; RYGBP: 32.1 +/- 5.0; BPD: 31.7 +/- 6.1; P=NS) and decrease in percentage body fat (AGB: 10.0 +/- 1.5%; RYGBP: 14.2 +/- 2.8; BPD: 10.3 +/- 1.0; P=NS) induced by bariatric surgery exerted significantly different (P=0.004) effects on plasma ghrelin concentrations, depending on the surgical procedure applied (AGB: 480 +/- 78 pg/ml; RYGBP: 117 +/- 34; BPD: 406 +/- 86). Without significant differences in BMI, body fat, glucose, triglycerides, cholesterol, insulin and leptin levels, patients who had undergone the RYGBP exhibited statistically significant diminished circulating fasting plasma ghrelin concentrations compared with the other two bariatric techniques which conserve direct contact of the fundus with ingested food (P=0.003 vs AGB and P=0.020 vs BPD). CONCLUSION: Fasting circulating ghrelin concentrations in patients undergoing diverse bariatric operations depend on the degree of dysfunctionality of the fundus.

Why lose weight? Reasons for seeking weight loss by overweight but otherwise healthy men.

OBJECTIVE: To identify the reasons for seeking weight loss in overweight or obese but otherwise healthy men. DESIGN: Interviews, prior to intervention, with subjects who had volunteered to participate in a work-site-based weight loss study. SUBJECTS: Ninety-one overweight/obese male workers. Mean age 41, range 18-55 y, mean body mass index (BMI) 31.0, range 26.2-41.6 kg/m(2). MEASUREMENTS: Anthropometric measurements; body weight and height. Body mass index calculated. A short interview using open questions to determine the individuals reason for seeking weight loss. RESULTS: The message that weight loss is beneficial to health for the overweight was recognized by all subjects regardless of BMI, and was reported as the main factor for attempting weight loss. Improved fitness and effects on appearance and well-being were reported half as often as the primary reason for weight loss. CONCLUSION: Overweight lay members of the public have accepted the health education message that weight loss can improve health. Overweight but otherwise healthy men who responded, of their own accord, to an electronic mail message offering help to lose weight did not regard obesity and overweight as primarily a cosmetic issue. This is still, however, important, especially to younger people. doi:10.1038/sj.ijo.0801999

Analysis of weight loss outcomes using VLCD in black and white overweight and obese women with and without metabolic syndrome.

OBJECTIVE:: To evaluate the efficacy of very low calorie diet (VLCD) in black and white obese women. Changes in weight, metabolic profile, and body composition are assessed. METHOD:: Patients are enrolled in a self-paid, university-based, outpatient weight loss program. All are prescribed VLCD (500-800 Cal/day), an exercise regimen, and group behavioral counseling. Black and white patients are matched for age, weight, body mass index, and by metabolic syndrome (MS) status. RESULTS:: A total of 304 black and white women (152 in each group) were included the analysis. Approximately 40% of patients had MS (white women: 39.5%; black women: 41.2%). Mean baseline weights were similar. After 12 weeks, weight reduction of 9.97% was seen in white women and 9.02% drop was seen in black women (both P<0.0001). However, the degree of weight change was not different between the groups (P=0.244). Marked improvements in fasting glucose, total cholesterol, LDL, triglyceride, and blood pressures (BP) were observed (all P<0.01); however, no difference between cohorts were seen. Patients with MS had higher baseline weight, BP, glucose and triglyceride levels when compared to patients without MS (all P<0.01). Significant reductions in % body fat were seen in white and black patients, independent of MS status. CONCLUSION:: Obese patients, independent of race, were able to achieve significant weight loss when enrolled in a structured outpatient program. weight loss significantly correlated with all aspects of MS. Our results suggest that differences seen in past studies may be influenced by socioeconomic and behavioral factors rather than differences in physiological response to dieting.International Journal of obesity (2005) 29, 436-442. doi:10.1038/sj.ijo.0802864 Published online 15 February 2005.

Weight-Loss intention in the well-functioning, community-dwelling elderly: associations with diet quality, physical activity, and weight change.

BACKGROUND: Many older adults desire to lose weight, yet the proportion with a health-related weight-loss indication, weight-loss strategies, and success is unknown. OBJECTIVE: We examined the associations of reported intention to lose weight with health-related indications for weight loss, diet quality, physical activity, and weight-loss success in well-functioning older adults. DESIGN: This prospective, community-based cohort included 2708 elderly persons aged 70-79 y at baseline. We determined indication for weight loss by using the modified National Institutes of Health guidelines, diet quality by using the Healthy Eating Index, and weight-loss intention and physical activity by using questionnaires. Measured weight change over 1 y was assessed. RESULTS: Twenty-seven percent of participants reported an intention to lose weight, and 67% of those participants had an indication for weight loss. Participants who reported a weight-loss intention were heavier than those who did not, had more depressive symptoms, and were more likely to be dissatisfied with their weight, regardless of weight-loss indication. Participants with an intention to lose weight reported better eating behaviors and a more active lifestyle than did participants without a weight-loss intention, independent of other health conditions. No significant difference in actual weight loss was found between participants intending and not intending to lose weight, regardless of indication for weight loss. CONCLUSIONS: Despite being associated with healthier behaviors, the intention to lose weight did not predict greater weight loss in this well-functioning elderly cohort. More attention needs to be focused on the necessity and efficacy of specific strategies for weight loss in older adults.

Laparoscopic adjustable gastric banding for the treatment of morbidly obese patients: early outcome in a Chinese cohort.

OBJECTIVE. To evaluate the efficacy of laparoscopic adjustable gastric banding in the management of morbid obesity in a cohort of Chinese patients. DESIGN. Cohort study. SETTING. University teaching hospital, Hong Kong. PATIENTS. From August 2002 to September 2003, 10 patients (6 male, 4 female) with a median age of 34 years (range, 23-48 years) underwent laparoscopic adjustable gastric banding to treat morbid obesity. Considerable co-existing diseases were present in 90% of the cases. We instituted a team approach that allowed every patient to see our dietitian, physician, psychiatrist (if necessary), and surgeon prior to deciding on the procedure to be used. MAIN OUTCOME MEASURES. Excessive body weight loss, quality-of-life score (SF36), and co-morbidities improvement. RESULTS. The 10 patients had a median weight of 127 kg (range, 115-196 kg) and median body mass index of 47 kg/m(2) (range, 38-67 kg/m(2)). The operation was successful in all patients with a median operating time of 110 minutes (range, 75-240 minutes). The median hospital stay was 3 days (range, 3-4 days) and three of the patients required overnight observation in the intensive care unit because of severe sleep apnoea and asthma. The median follow-up period was 12 months (range, 1-18 months). The mean weight loss at 6, 12, and 18 months was 19.3, 22.4, and 25.9 kg, respectively. Mean percentage of excessive weight loss at 6, 12, and 18 months was 34.9%, 36.5%, and 40.5%, respectively. Unsatisfactory weight loss (<20 kg) occurred in three patients because of poor dietary compliance and non-follow-up. Surgery also considerably improved the patients' co-morbidities (hypertension, diabetes, and obstructive sleep apnoea) and the quality of life. CONCLUSION. In the short term, laparoscopic adjustable gastric banding is certainly an effective procedure for morbid obesity, which results in a substantial weight loss and improvement of co-existing morbidities. Longer follow-up will show whether this weight loss is maintainable.

Rate and correlates of weight change in Huntington's disease.

OBJECTIVE: To determine the rate and correlates of weight change in a large, well characterised sample of patients with Huntington's disease followed at 44 sites by the Huntington Study Group. Participants and methods: Weight change was assessed in 927 adults with a definite diagnosis of Huntington's disease who were followed prospectively for (mean (SD)) 3.4 (1.4) years. The unified Huntington's disease rating scale was used to assess weight, motor dysfunction (including chorea and dystonia), depressive symptoms, and functional decline. RESULTS: Random effects modelling determined that patients gained an average of 0.11 (1.7) kg/year and their chorea scores increased by 0.36 (0.78) points/year. There were significant but weak relations between weight loss and increasingly severe chorea (r = -0.13), worse baseline motor performance (r = -0.12), less severe baseline depressed mood (r = 0.14), and poorer baseline independence ratings (r = 0.07). Patients who were within 0 to 2 years of symptom onset at the time of the baseline visit gained more weight than those with longer disease duration. CONCLUSIONS: weight loss following symptom onset is not a consistent feature of Huntington's disease. The mechanisms contributing to weight change in this condition are unclear and probably multifactorial. Future studies examining asymptomatic carriers of the mutation could be helpful in identifying incipience of low body weight and may be better suited for identifying clinical correlates of weight loss than studies in symptomatic patients.

Thermodynamics of weight loss diets.

BACKGROUND: It is commonly held that "a calorie is a calorie", i.e. that diets of equal caloric content will result in identical weight change independent of macronutrient composition, and appeal is frequently made to the laws of thermodynamics. We have previously shown that thermodynamics does not support such a view and that diets of different macronutrient content may be expected to induce different changes in body mass. Low carbohydrate diets in particular have claimed a "metabolic advantage" meaning more weight loss than in isocaloric diets of higher carbohydrate content. In this review, for pedagogic clarity, we reframe the theoretical discussion to directly link thermodynamic inefficiency to weight change. The problem in outline: Is metabolic advantage theoretically possible? If so, what biochemical mechanisms might plausibly explain it? Finally, what experimental evidence exists to determine whether it does or does not occur? RESULTS: Reduced thermodynamic efficiency will result in increased weight loss. The laws of thermodynamics are silent on the existence of variable thermodynamic efficiency in metabolic processes. Therefore such variability is permitted and can be related to differences in weight lost. The existence of variable efficiency and metabolic advantage is therefore an empiric question rather than a theoretical one, confirmed by many experimental isocaloric studies, pending a properly performed meta-analysis. Mechanisms are as yet unknown, but plausible mechanisms at the metabolic level are proposed. CONCLUSIONS: Variable thermodynamic efficiency due to dietary manipulation is permitted by physical laws, is supported by much experimental data, and may be reasonably explained by plausible mechanisms.

The relationship between quality of life and perceived body weight and dieting history in Dutch men and women.

OBJECTIVES: (1) To study the relationship between quality of life (QoL) and measured and perceived weight and dieting history in Dutch men and women; (2) to assess the effect of weight loss over a 5 y period on QoL. DESIGN: A cross-sectional study, in a sub-sample longitudinal over 5 y. SUBJECTS: A total of 2155 men and 2446 women, aged 20-59 and recruited from the general population from three towns in The Netherlands. MEASUREMENTS: Body weight, height, self-administered questionnaire including questions concerning demographic variables and weight loss practices as part of the Dutch Monitoring project on Risk Factors for Chronic Disease (MORGEN). The Rand-36 questionnaire was used as the QoL measure. RESULTS: In men, measured overweight (body mass index, BMI>25 kg/m(2)) was not associated with any dimension of QoL after adjustment for age, educational level and perceived overweight. Perceived overweight was related to reduced scores for general health and vitality. This relationship was independent of measured obesity. A history of repeated weight loss was associated with reduced scores for role functioning due to both physical and emotional problems. In women, measured overweight was significantly associated with lower scores for five out of eight QoL dimensions and perceived overweight with three: general health, vitality and physical functioning. A history of frequent weight loss was related to significantly reduced scores in six dimensions. However, only with history of frequent weight loss, and uniquely in women, was there a significant reduction in scores on mental health and limited emotional role functioning. Measured and perceived overweight and frequent weight loss were all related to reduced scores for physical functioning. Longitudinal data indicate that in older women weight gain of 10% body weight or more was associated with a significant deterioration in QoL. CONCLUSIONS: When looking at measures of QoL in relation to overweight it is important to separate the effects of perception of weight status and history of weight loss. We observed that the latter two factors were associated with reduced scores on several dimensions of QoL, particularly in women. These associations were observed to be independent of body weight.