Body image disturbance in obese outpatients before and after weight loss in relation to race, gender, binge eating, and age of onset of obesity.

OBJECTIVE: To assess body image disturbance as a composite of three aspects (distortion, discrepancy, and dissatisfaction) in obese subjects before and after weight loss. Disturbance was then related to race, gender, binge eating behavior, and age of onset of obesity. METHODS: Eighty-two obese outpatients (24 males, 58 females) completed the Stunkard Figure Rating Scale (FRS). A Disturbance score was derived from the weighted sum of distortion, discrepancy, and dissatisfaction. The measures were repeated 4 weeks after starting a medically supervised liquid formula diet. RESULTS: Prior to weight loss, race (r =.28, p =.01) and gender (r =.25, p =.02) were each predictive of disturbance, with Caucasians and men having the most disturbance. Binge eaters exhibited more discrepancy (p =.03) and dissatisfaction (p =.005) than non-binge eaters. Early-onset subjects demonstrated more discrepancy than adult-onset subjects (p =.02). Following weight loss, disturbance scores decreased for all groups (p =.009). However, early-onset subjects still showed more discrepancy (p =.002) and more dissatisfaction (p =.005) than adult-onset subjects. DISCUSSION: Body image disturbance was viewed as a composite of three aspects. Prior to weight loss, the high disturbance score in Caucasians may be due to them experiencing greater cultural pressure to be thin. The men may have exaggerated their degree of obesity because of less denial of being overweight than women. Following weight loss, disturbance decreased for all groups but remained elevated for those with early onset, possibly because of a persistent self-image from adolescence. Copyright 2002 by Wiley Periodicals, Inc.

To study the effects of weight loss on nonalcoholic steatohepatitis (NASH) in obese patients. METHODS: It is a prospective study. Blood biochemical parameters were examined in 220 overweight or obese patients without alcoholic consumption and without detectable HBsAg. Ultrasonographic examination was performed by a fixed doctor. 45 obese patients followed a program of weight loss, including diet restriction, exercise or drug for a trial period of one year. Weight, blood biochemical tests and ultrasonic examination of liver were compared before and after the trial in all the patients. RESULTS: 75.9% of the patients were diagnosed as NASH. Logistic regression analysis revealed that the risk factors of NASH were body mass index (BMI, beta = 0.926, P = 0.021), age (beta = 0.973, P = 0.021), 2-hour postprandial glucose (beta = 0.987, P = 0.012), 1-hour postprandial net insulin in serum (beta = 1.027, P = 0.032), waist circumference (beta = 1.091, P = 0.038)and low density lipoprotein cholesterol (beta = 0.980, P = 0.041). After the treatment, 65.7% of the patients with NASH improved. The level of ALT in these patients decreased significantly (P = 0.040). The improvement of NASH correlated positively with the reduction of BMI (beta = 3.032, P = 0.010), triglycerides (TG, beta = 1.041, P = 0.025) and waist circumference (beta = 1.115, P = 0.029). The decrease of ALT level correlated with the decrease of BMI (beta = 1.165, P = 0.002), TG (beta = 0.986, P = 0.005), waist circumference (beta = 0.736, P = 0.041), and the increase of high density lipoprotein cholesterol (beta = -0.772, P = 0.016). CONCLUSION: NASH is one of the most important complications of obesity. weight loss is the mainstay of treatment for obese patients.

A receptor promoter polymorphism (HTR2C - 759C/T) is associated with obesity in women, and with resistance to weight loss in heterozygotes.

The serotonin receptor (HTR2C) helps regulate appetite and body weight. An HTR2C promoter polymorphism (-759C/T) has been associated with obesity and with weight gain in response to antipsychotic (neuroleptic) drugs. We studied this polymorphism in 120 obese women (BMI > or = 30) and 104 non-obese (BMI < or = 25) women. The C allele was commoner in the obese group (OR = 1.72 [95% CI, 1.13-2.64], P = 0.008). Ninety-five of the obese women participated in a randomized trial of psychological treatments for weight loss. Among these women, heterozygotes lost less weight during the trial than did homozygotes (6.8 vs. 9.7 kg; P = 0.047) and weighed more 6 months (90.1 vs. 83.6 kg; P = 0.006) and 12 months (91.8 vs. 84.6 kg; P = 0.009) later. Heterozygotes also had higher triglyceride levels than homozygotes. C/C subjects in the obesity trial did not differ from T/T subjects in terms of weight loss or triglycerides. In a separate RT-PCR study of 43 subjects, we found that HTR2C mRNA abundance in frontal cortex was unaffected by -759C/T status. Our data extend the evidence that HTR2C promoter variation may be a risk factor for obesity and, perhaps through heterosis, influences weight loss by obese women. Pharmacogenetic testing of HTR2C promoter variants may be valuable when evaluating anti-obesity drugs which act directly or indirectly on the receptor. Copyright 2003 Wiley-Liss, Inc.

Ghrelin: a gut-brain hormone: effect of gastric bypass surgery.

BACKGROUND: Ghrelin is a newly recognized gastric hormone with orexigenic and adipogenic properties, produced primarily by the stomach. Ghrelin is reduced in obesity. weight loss is associated with an increase in fasting plasma ghrelin. We assessed the effect of massive weight loss on plasma ghrelin concentrations and its correlation with serum leptin levels and the presence of type 2 diabetes mellitus (DM) in severely obese patients. METHODS: A prospective study was conducted on 28 morbidly obese women (BMI 56.3 +/- 10.2 kg/m2) who underwent gastric bypass, divided into 2 groups: 14 non-diabetics (NGT) and 14 type 2 diabetics (DM2). Ghrelin and leptin were evaluated before silastic ring transected vertical gastric bypass, and again 12 months postoperatively. RESULTS: Fasting plasma ghrelin concentrations were 56% lower in NGT and 59% lower in DM2 compared with a lean control group (P < 0.001). There was no difference in ghrelin levels between NGT and DM2 groups before and after surgery (P > 0.05). Ghrelin was negatively correlated with leptin before gastric bypass surgery (r = 0.51, P < 0.01). The mean plasma ghrelin concentration decreased significantly after surgery in both groups (P < 0.001). CONCLUSION: Ghrelin was inversely related to leptin concentrations. Presence of diabetes did not affect the ghrelin pattern. Reduced production of ghrelin after gastric bypass could be partly responsible for the lack of hyperphagia and thus for the weight loss.

Impact of weight loss and regain on quality of life: mirror image or differential effect?

OBJECTIVE: To compare the impact of weight regain and weight loss on health-related quality of life. RESEARCH METHODS AND PROCEDURES: Subjects were 122 (106 women, 16 men) overweight and obese participants in a weight reduction program (phentermine-fenfluramine and dietary counseling) who had initially lost at least 5% of their total body weight and then regained at least 5% of their weight during the follow-up period. Follow-up periods ranged from 10 to 41 months (mean, 28 months). Participants completed the Impact of Weight on Quality of Life-Lite, an obesity-specific health-related quality of life (HRQOL) measure, at 3-month intervals. RESULTS: Mean BMI at baseline was 40.9 +/- 6.6 kg/m(2) (range, 29.2 to 63.7 kg/m(2)). Average weight loss from entry was 18.8 +/- 6.7% (range, 6.0% to 43.7%), and average regain was 10.1 +/-4.4% of baseline weight (range, 5.0% to 30.6%). The effects of weight regain on HRQOL mirrored the effects of weight loss-rates of HRQOL change were similar in magnitude but different in direction for comparable weight loss and regain. Those with more severe initial impairments in HRQOL experienced greater improvements in HRQOL during weight loss as well as greater deterioration during weight regain than those with less severe impairments. DISCUSSION: weight loss and regain produced mirror image changes in HRQOL. The initial severity of HRQOL impairment had a greater impact on the magnitude of HRQOL change than the direction of weight change. Findings underscore the importance of maintaining weight loss for the purposes of retaining obesity-specific HRQOL benefits.

The mini-gastric bypass: experience with the first 1,274 cases.

BACKGROUND: Results of the laparoscopic Mini-Gastric Bypass (MGB) are reported. METHODS: 1,274 MGB patients are continuously monitored as part of an online computer tracking data-base system. RESULTS: Mean preoperative weight (+/- Standard Deviation) was 132 +/- 21 kg, BMI 47 +/- 7. Mean excess weight loss was 51% at 6 months, 68% at 12 months and 77% at 2 years. The mean operating-time was 36.9 +/- 33.5 minutes. The shortest time was 19 minutes. Hospital stay was 1.5 +/- 1.6 days. The overall complication rate has been 5.2%. The overall rate of deep vein thrombosis and pulmonary embolism was 0.08% and 0.16% respectively. The leak rate was 1.6%. There was one hospital death, 0.08%. Associated medical illnesses were either completely reversed or markedly improved. CONCLUSIONS: The MGB is safe, results in major weight loss, has a short operating-time, and has a short hospital stay. The MGB appears to meet many of the criteria of an "ideal" weight loss operation.

Seasonal variation of alterations in exercise-induced body composition in obese Japanese women.

Although many investigations have been conducted to determine the effects of exercise and/or diet prescription, seasonal variations in weight loss have not been thoroughly investigated in Japan. The present investigation was undertaken to determine seasonal variations in body composition and anthropometric characteristics during a weight-loss program. One hundred and twenty-seven women [mean (SD) age 44.3 (11.7) years] participated in this study. The subjects were categorized into four groups based on the season in which the weight-loss program was begun: subjects who joined our exercise program in winter (group WE), subjects who joined in summer (group SE), and two control groups, one for winter and one for summer (group WC and group SC, respectively). The subjects of groups WE and SE completed a 3-month exercise and food-restriction program. Analyses of covariance revealed that the subjects of group WE seemed to have attained more desirable changes. This group showed a decrease in body mass (-1.9 (1.5) kg) and percent body fat (-4.6 (4.8)%), while an increase in fat-free mass (1.6 (3.2) kg) during the experimental period. Our data suggest that the better season for desirable weight loss in Japan is winter, compared to summer. These alterations may be attributable, at least in part, to the fact that Japanese people are generally acclimatized to a cold climate in this season. The mechanisms involved in our speculation have not been well validated, but it seems clear that a significant difference in dietary intake might have affected the results of this study.

The role of proinflammatory cytokines in wasting disease during lymphocytic choriomeningitis virus infection.

Infection with pathogens often leads to loss of body weight, but the cause of weight loss during infection is poorly understood. We used the infection of mice with lymphocytic choriomeningitis virus (LCMV) as a model to study how pathogens induce weight loss. If LCMV is introduced into the CNS of CTL-deficient mice, the immune response against the virus leads to a severe weight loss called wasting disease. We planned to determine what components of this antiviral immune response mediate wasting disease. By adoptive transfer, we show that CD4 T cells activated by LCMV infection are sufficient to cause wasting disease. We examined the role of cytokines in LCMV-induced wasting disease using mice lacking specific cytokines or cytokine receptors. Results of adoptive transfer experiments suggest that TNF-alpha is not involved in LCMV-induced wasting disease and show that IFN-gamma contributes to the disease. Consistent with a role for IFN-gamma in wasting, we find that IFN-gamma is necessary for LCMV-specific CD4 T cell responses in the CNS, most likely because it is required to induce MHC class II expression. Our data also indicate that IL-1 is required for LCMV-induced wasting and that IL-6 contributes to the wasting disease. Additionally, our results identify alpha-melanocyte-stimulating hormone as a potential mediator of the disease. Overall, this work defines the critical role of virus-primed CD4 T cells and of proinflammatory cytokines in the pathogenesis of wasting disease induced by LCMV infection.