Weight Loss readiness in middle-aged women: psychosocial predictors of success for behavioral weight reduction.

Accurate prediction of weight loss success and failure has eluded researchers for many years. Thus, we administered a comprehensive psychometric battery before a 4-month lifestyle behavioral weight reduction program and analyzed weight changes during that period to identify baseline characteristics of successful and unsuccessful participants, among 112 overweight and obese middle-aged women (age, 47.8 +/- 4.4 years; BMI, 31.4 +/- 3.9 kg/m2). Mean weight and percentage fat losses among the 89 completers were -5.4 kg and -3.4%, respectively (p < .001). A higher number of recent dieting attempts and recent weight loss, more stringent weight outcome evaluations, a higher perceived negative impact of weight on quality of life, lower self-motivation, higher body size dissatisfaction, and lower self-esteem were associated with less weight loss and significantly distinguished responders from nonresponders among all participants. These findings are discussed as to their usefulness (i) to screen individuals before treatment, (ii) to provide a better match between interventions to participants, and (iii) to build a weight loss readiness questionnaire.

Effect of a high-protein, energy-restricted diet on body composition, glycemic control, and lipid concentrations in overweight and obese hyperinsulinemic men and women.

BACKGROUND: It is not clear whether varying the protein-to-carbohydrate ratio of weight-loss diets benefits body composition or metabolism. OBJECTIVE: The objective was to compare the effects of 2 weight-loss diets differing in protein-to-carbohydrate ratio on body composition, glucose and lipid metabolism, and markers of bone turnover. DESIGN: A parallel design included either a high-protein diet of meat, poultry, and dairy foods (HP diet: 27% of energy as protein, 44% as carbohydrate, and 29% as fat) or a standard-protein diet low in those foods (SP diet: 16% of energy as protein, 57% as carbohydrate, and 27% as fat) during 12 wk of energy restriction (6-6.3 MJ/d) and 4 wk of energy balance ( approximately 8.2 MJ/d). Fifty-seven overweight volunteers with fasting insulin concentrations > 12 mU/L completed the study. RESULTS: weight loss (7.9 +/- 0.5 kg) and total fat loss (6.9 +/- 0.4 kg) did not differ between diet groups. In women, total lean mass was significantly (P = 0.02) better preserved with the HP diet (-0.1 +/- 0.3 kg) than with the SP diet (-1.5 +/- 0.3 kg). Those fed the HP diet had significantly (P < 0.03) less glycemic response at weeks 0 and 16 than did those fed the SP diet. After weight loss, the glycemic response decreased significantly (P < 0.05) more in the HP diet group. The reduction in serum triacylglycerol concentrations was significantly (P < 0.05) greater in the HP diet group (23%) than in the SP diet group (10%). Markers of bone turnover, calcium excretion, and systolic blood pressure were unchanged. CONCLUSION: Replacing carbohydrate with protein from meat, poultry, and dairy foods has beneficial metabolic effects and no adverse effects on markers of bone turnover or calcium excretion.

Serum leptin concentrations and satiety in Parkinson's disease patients with and without weight loss.

We compared serum leptin and satiety measures in 18 Parkinson's disease (PD) patients with unintended weight loss (WL) and 18 PD patients whose weight was stable (WS). Mean serum leptin concentrations tended to be lower in WL than WS patients, but this did not reach statistical significance. Body mass index correlated with serum leptin concentrations. Ratings of hunger, satiety, fullness, and thirst did not differ between groups. However, the mean sensation of fullness before meals correlated with serum leptin in the entire cohort of patients, particularly in the WL group. The results indicate that unintended weight loss in PD patients is unlikely to be due to abnormal serum leptin concentrations. Copyright 2001 Movement Disorder Society.

Is a modest weight loss significant in the improvement of dyslipidemic patients lipid profile.

AIM: The aim of the present study was to evaluate serum lipid abnormalities and the relationship with various factors in overweight and obese patients and to assess lipid profile modifications subsequent to weight loss in a subgroup of patients. METHODS: A sample of 110 obese out-patients first and a subgroup of 34 subjects afterwards, was selected at the Human Nutrition Research Centre of the University of Pavia for a retrospective analysis. The subjects recruited were all dyslipidemic, according to the American Clinical Guidelines for the assessment of cardiovascular risk. Differences in lipid profiles in subjects with different life habits were evaluated and in a subgroup of 34 subjects compared before and after a short-term moderate hypocaloric diet. RESULTS: Sample's mean age was 46.8+/-12.6 with a mean body mass index (BMI) of 32.1+/-4.8 kg/m2 (no difference with gender). The correlation analyses showed that total cholesterol (TC) concentrations were highly correlated with age (p<0.001); no correlation was found between TC and BMI, waist hip ratio (WHR), % body fat (BF%). Triglycerides (TG) concentrations were not related to age or BMI, however there was a significant correlation between TG and WHR and with waist circumference (WC) (p<0.001). The 34 subjects selected to take part in a dietary regimen, without significant changes in life habits, lost 5.1% of their initial weight and presented a significant improvement (p<0.001) in lipid profile. CONCLUSIONS: The high correlation between lipid profile and anthropometric measurements implies further longitudinal evaluation of the validity of the anthropometric indexes in the dyslipidemic patient management. Indeed, the results suggest that modest weight loss is sufficient to obtain a significant improvement in fasting serum lipid profile of dyslipidemic overweight patients.

Maintenance of weight loss after obesity treatment: is continuous support necessary?

OBJECTIVE: This study examined outcome differences of 109 obese subjects, who participated in a 10-week cognitive-behavioral inpatient treatment followed by either a weight maintenance program or a follow-up period without professional support. METHODS: Self-rated weight loss, eating behaviors, and general psychopathology were assessed several months before treatment, when subjects were admitted, at discharge, and at the 6-, 12-, and 18-month follow-ups. Structured interviews for mental disorders and eating pathology were conducted additionally. RESULTS: The mean weight of the sample at baseline was 127 kg. weight loss of the total sample amounted to 8.0 kg (6.3%) and was completely maintained during the follow-up period. Significant reductions of eating and general psychopathology were observed at the 18-month follow-up. The outcome in the maintenance condition did not significantly differ from the outcome in the control condition. CONCLUSIONS: Weight regain after obesity treatment is not inevitable, but continuous patient-therapist contacts do not distinctly improve treatment effects.

Effect of weight reduction on serum ghrelin and TNFalpha concentrations in obese women.

Background: Ghrelin causes weight gain by increasing food intake in rodents. Tumor necrosis factor alpha (TNFalpha) is produced by adipose tissue, modulates its metabolism and stimulates catabolic processes. The aim of our study was to evaluate whether weight loss treatment modulates serum concentrations of TNFalpha and ghrelin in obese women. Methods: The study groups included 46 women: 35 obese patients and 11 controls. Serum concentrations of ghrelin and TNFalpha were measured by ELISA before and after a 3-month weight reduction treatment that consisted of a 1000 kcal/day diet and physical exercises. Body composition was determined by impedance analysis using Bodystat. Results: There were no differences in plasma ghrelin concentrations between obese patients and controls. TNFalpha serum levels were higher in obese patients than in controls (p=0.000). The mean weight loss over the 3-month treatment period was 8.7+/-4.5 kg. Following weight loss, serum ghrelin concentration increased significantly (66.3+/-13.7 vs. 73.7+/-14.8 pg/ml; p=0.002) and TNFalpha concentrations decreased significantly (6.9+/-2.6 vs. 5.2+/-1.5 pg/ml; p=0.002). Ghrelin did not show a correlation with weight or percentage of body fat. There was a positive correlation between the increase in ghrelin and the decrease in body fat percentage during weight loss (p=0.002). Conclusion: The increase in serum ghrelin and the decrease in serum TNFalpha, as observed after weight reduction treatment in obese subjects, may constitute a counter-regulatory mechanism preventing further weight loss.

Opposite regulation of interleukin-8 and tumor necrosis factor-alpha by weight loss.

OBJECTIVE: To obtain more information on the possible influence of body mass index (BMI) and weight loss on interleukin-8 (IL-8) in plasma and in the adipose tissue. Tumor necrosis factor-alpha (TNF-alpha) was used for comparison and determined in parallel with IL-8. RESEARCH METHODS AND PROCEDURES: The study was divided into three parts: 1) a cross-sectional study that included 89 subjects; 2) a 20-week intervention study in which 34 healthy obese subjects received a dietary intervention for 8 weeks followed by an additional 12 weeks on a weight-stabilization diet; 3) from this latter study, a subgroup of 8 obese subjects was investigated with a subcutaneous adipose-tissue biopsy. RESULTS: In the cross-sectional study, plasma levels of TNF-alpha (p < 0.01), but not IL-8, was correlated with BMI. However, in a subgroup (BMI, 20 to 30 kg/m(2)), IL-8 was correlated with BMI (p < 0.01). In the intervention study, weight loss and weight maintenance led to an increase in IL-8 by 30% (p < 0.05) and a decrease in TNF-alpha by 40% (p < 0.001), which were paralleled in the adipose tissue, demonstrating a 2- to 3-fold increase (p < 0.01) and a 40% to 80% decrease (p < 0.01) in IL-8 and TNF-alpha, respectively. DISCUSSION: weight loss in obese subjects was associated with opposite changes in the secretion and transcription of IL-8 and TNF-alpha in the adipose tissue, as well as in plasma. This could indicate that plasma IL-8 under some conditions may be related to changes in adipose tissue IL-8 production.

Effects of obesity and weight loss on the expression of proteins involved in fatty acid metabolism in human adipose tissue.

OBJECTIVE: Disturbances in adipocyte lipolysis in obesity may contribute to elevated circulating non-esterified fatty acid (NEFA) concentrations and insulin resistance. In experimental models, NEFA metabolism is influenced by adipocyte proteins such as adipocyte and keratinocyte lipid binding proteins (aP2/ALBP and mal1/KLBP) and fatty acid translocase (CD36). We investigated the effect of obesity and weight loss on the expression of these proteins in human subcutaneous adipose tissue. STUDY DESIGN AND SUBJECTS: Subcutaneous adipose tissue was obtained from 12 obese (body mass index (BMI) 42.4+/-1.6 kg/m(2)) and 12 lean (23.4+/-0.6 kg/m(2)) subjects. The obese subjects underwent gastric banding and biopsies were taken again after 2 y following a significant weight reduction (BMI 32.8+/-1.4 kg/m(2)). Adipose tissue proteins were quantified by Western blotting. RESULTS: Differential expression of ALBP, KLBP and CD36 was observed in lean and weight-reduced subjects compared with obese individuals. This resulted in a significantly lower ALBP/KLBP ratio in lean and weight-reduced individuals compared to obese subjects. Furthermore there was a significant influence of gender on this ratio. Moreover, the commonly used internal standard protein actin was expressed significantly higher in lean compared to obese individuals. CONCLUSION: The relative content of ALBP and KLBP in human adipose tissue changes with obesity, weight loss and gender indicating differential regulation. Differing responses in the expression patterns of adipose tissue proteins capable of binding NEFAs in response to weight changes suggest a potential importance in the development of obesity-associated complications.