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.

Performance of two self-report measures for evaluating obesity and weight loss.

OBJECTIVES: To evaluate performance of the obesity and weight-loss Quality-of-Life (OWLQOL) and Weight-Related Symptoms (WRSM) measures. RESEARCH METHODS AND PROCEDURES: Four studies of obese persons 18 to 75 years of age were analyzed: a 12-week initial validation study, a clinical trial using blinded endpoint data at 50 to 83 weeks, and community studies conducted in the U.S. and Europe. Fifty-six initial validation study subjects visited 1 week after screening to evaluate reproducibility. RESULTS: Overall, 6107 obese persons completed one assessment, 291 completed follow-up at 12 weeks, and 642 at >50 weeks. Psychometric analyses resulted in a 17-item OWLQOL with a single score tested on five samples that was internally consistent (alpha values > 0.90) and reproducible (intraclass correlation coefficient > 0.95). The OWLQOL score (higher is better) was associated, as expected, with the symptom measure (lower is better, -0.54), generic quality of life measure (0.53), and measures of physical (0.40) and mental functioning (0.47). The 20-item WRSM was internally consistent (alpha = 0.87) and reproducible (intraclass correlation coefficient = 0.83). The OWLQOL discriminated between genders (p < 0.001), presence of disability days (p < 0.05), levels of BMI (p < 0.05), and levels of symptom bothersomeness (p < 0.001). Evaluation at 12 weeks yielded an effect size for > or = 2.5% weight loss of 0.77 for the OWLQOL and -0.54 for the WRSM. At > or = 50 weeks for > or = 10% weight change, effect sizes were 1.63 and -0.73, respectively. DISCUSSION: The OWLQOL and WRSM are brief, valid, reproducible, and responsive self-reported outcomes for evaluating obesity and weight loss.

Intentional weight loss and death in overweight and obese U.S. adults 35 years of age and older.

BACKGROUND: Although weight loss improves risk factors for cardiovascular and metabolic disease, it is unclear whether intentional weight loss reduces mortality rates. OBJECTIVE: To examine the relationships among intention to lose weight, weight loss, and all-cause mortality. DESIGN: Prospective cohort study using a probability sample of the U.S. population. SETTING: Interviewer-administered survey. PARTICIPANTS: 6391 overweight and obese persons (body mass index > or = 25 kg/m2) who were at least 35 years of age. MEASUREMENTS: Intention to lose weight and weight change during the past year were assessed by self-report in 1989. Vital status was followed for 9 years. Hazard rate ratios (HRRs) were adjusted for age, sex, ethnicity, education, smoking, health status, health care utilization, and initial body mass index. RESULTS: Compared with persons not trying to lose weight and reporting no weight change, those reporting intentional weight loss had a 24% lower mortality rate (HRR, 0.76 [95% CI, 0.60 to 0.97]) and those with unintentional weight loss had a 31% higher mortality rate (HRR, 1.31 [CI, 1.01 to 1.70]). However, mortality rates were lower in persons who reported trying to lose weight than those in not trying to lose weight, independent of actual weight change. Compared with persons not trying to lose weight and reporting no weight change, persons trying to lose weight had the following HRRs: no weight change, 0.80 (CI, 0.65 to 0.99); gained weight, 0.94 (CI, 0.65 to 1.37); and lost weight, 0.76 (CI, 0.60 to 0.97). CONCLUSIONS: Attempted weight loss is associated with lower all-cause mortality, independent of weight change. Self-reported intentional weight loss is associated with lower mortality rates, and weight loss is associated with higher mortality rates only if it is unintentional.

Weight management and weight loss strategies of professional jockeys.

Jockeys are required to maintain very low body weight and precise weight control during competition. This study examined the weight loss and weight management strategies of professional horseracing jockeys in the state of Victoria, Australia. An anonymous, self-completed questionnaire was administered (55% response rate, n = 116). Almost half (43%) reported that maintaining riding weight was difficult or very difficult, with 75% routinely skipping meals. In preparation for racing, 60% reported that they typically required additional weight loss, with 81% restricting food intake in the 24 hours prior to racing. Additionally, sauna-induced sweating (29%) and diuretics (22%) were frequently employed to further aid in weight loss prior to racing. These rapid weight loss methods did not differ between the 51% of jockeys who followed a weight management plan compared to those who did not. The impact of these extreme weight loss practices on riding performance and health remains unknown.

Topiramate and weight loss in patients with neurodevelopmental disabilities.

STUDY OBJECTIVE: To characterize weight changes in patients with neurodevelopmental disabilities who received topiramate. DESIGN: Retrospective, observational study. SETTING: State-supported developmental center. PATIENTS: Fifteen patients with neurodevelopmental disabilities who received topiramate therapy MEASUREMENTS AND MAIN RESULTS: Monthly weights for 1 year after the start of topiramate therapy were recorded. Mean body weight at drug initiation differed significantly compared with the nadir weight during the next 12 months (52.2+/-7.5 vs 49.9+/-7.2 kg, p<0.02). Twelve patients who were receiving ad libitum oral diets demonstrated a significant decrease in body weight (52.1+/-7.5 vs 49.0+/-7.3 kg, p<0.01), whereas the three patients who received enteral nutrition through enterostomy did not experience significant weight loss. CONCLUSION: weight loss is common in patients with neurodevelopmental disabilities who receive topiramate. Since patients who received oral diets lost weight whereas those receiving enteral nutrition did not, decreased nutrient intake is the likely cause of weight loss.

Evolution of blood parameters during weight loss in experimental obese Beagle dogs.

The effects of weight loss on hormonal and biochemical blood parameters were measured monthly [carnitine, creatinine, urea, free T4 (fT4), total T4 (TT4), plasma alkaline phosphatases (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), potassium and total proteins] or bimonthly [cholesterol, triglycerides, non-esterified fatty acids (NEFA), insulin-like growth factor I (IGF-I), glucose, insulin] in eight obese Beagles dogs fed either a high protein dry diet, DP (crude protein 47.5%, on dry matter basis) or a commercial high fibre diet, HF (crude protein 23.8%, crude fibre 23.3%). The dogs were allotted to two groups according to sex and body weight (BW) and they were respectively fed with the DP or the control HF diet during 12-26 weeks, until they reach their optimal BW. The plasma basal triglycerides and cholesterol concentrations were decreased by the two diets but the difference was only significant for the DP diet. The plasma mean NEFA concentration increased regularly over the period with the HF diet, without significant difference between the two diets. No effect of diet or weight loss was observed on plasma carnitine, urea, creatinine, ALP, AST, ALT, potassium, TT4, FT4, IGF-I, glucose and insulin. weight loss induced a decrease in fT4 plasma concentration (p < 0.001). The high protein diet allowed a safe weight loss.

Is bortezomib, a proteasome inhibitor, effective in treating cancer-associated weight loss? Preliminary results from the North Central Cancer Treatment Group.

BACKGROUND: weight loss predicts a poor prognosis for cancer patients, and previous studies have implicated the ubiquitin-proteasome pathway as a major mediator of cancer-associated weight loss. The recent emergence of bortezomib, a proteasome inhibitor, now allows testing on whether proteasome inhibition is effective therapy for cancer-associated weight loss. METHODS: This study represents a subanalysis from two prior antineoplastic trials in patients with adenocarcinoma of the pancreas. The first included 46 patients with metastatic pancreatic cancer who were treated with single-agent bortezomib (intravenous doses of 1.5 or 1.3 mg/m(2) on days 1, 4, 8, and 11 of a 21-day cycle). The second included 42 patients with pancreatic cancer treated with single-agent octreotide (200 or 500 mug subcutaneously three times a day). The FACT-C questionnaire provided appetite and related data for bortezomib-treated patients. Serial weight data were available from both trials. Such data from the octreotide trial were utilized for comparative purposes because the latter holds no track record in treating cancer-associated weight loss. RESULTS: Bortezomib- and octreotide-treated patients were roughly comparable at baseline, and neither agent demonstrated notable antineoplastic effects. FACT-C data suggested stable appetite, but high patient dropout rates invite caution in interpretation. For example, in response to "I have a good appetite," mean scores for bortezomib-treated patients were 45 at baseline (n=42), 45 at the end of cycle 1 (n=26), and 44 at the end of cycle 2 (n=9). In contrast, weight data appeared more straightforward to interpret: direct comparisons of mean change in weight from baseline between bortezomib- and octreotide-treated patients showed no significant differences between groups. CONCLUSIONS: These preliminary results suggest that bortezomib shows negligible favorable effects on cancer-associated weight loss in patients with metastatic pancreatic cancer. We conclude that further study of bortezomib specifically in this setting and for this indication is not warranted.

Laparoscopic gastric bypass as a reoperative bariatric surgery for failed open restrictive procedures.

An estimated 2% of men and 6% of women in the United States are morbidly obese. These patients have a mortality rate that is six to twelve times greater than their normal-weight peers. In these extreme cases of overweight, only surgical intervention can produce substantial and sustained weight loss. However, up to 20% of these patients will require reoperation for failure to achieve or maintain an adequate weight loss. Reoperative bariatric surgery can be challenging and has traditionally been performed as an open procedure. We present seven female patients who underwent a laparoscopic Roux-en-Y gastric bypass after failing to achieve their weight-loss goals with prior open restrictive procedures. Their average BMI before surgical revision was 42.2 kg/m2. Mean operative time was 4 h 20 min, and length of hospital stay was 4.1 days. There were three complications in two patients and no deaths. Our initial experience suggests that laparoscopic gastric bypass is a safe and feasible reoperative bariatric procedure. Confirmation awaits a larger series of patients with follow-up data.