Changes in BMI and weight before and after the development of type 2 diabetes.

OBJECTIVE: To examine weight changes occurring before and after the diagnosis of diabetes and the association of these changes with treatment and microvascular complications. RESEARCH DESIGN AND METHODS: We undertook an analysis of serial examinations conducted between 1965 and 2000 in residents of the Gila River Community in Central Arizona. Data were taken from 4,226 examinations of 816 individuals in whom diabetes developed over the course of a longitudinal study and who had undergone a nondiabetic examination within 4 years preceding diagnosis. We measured changes in BMI between examinations. RESULTS: Before diagnosis of diabetes, there were steady gains in weight: mean BMI climbed between 0.43 and 0.71 kg/m(2) per year. After diagnosis, the weight gain declined, and weight loss was generally seen; the mean rate of change of BMI ranged between -0.61 and +0.22 kg/m(2) per year. When current treatment was considered, there was greater weight stability in individuals taking insulin compared with those not taking hypoglycemic medication. Medication was a statistically significant factor for change in weight for most of the time intervals analyzed. There was no statistically significant association with retinopathy or nephropathy. CONCLUSIONS: Before development of diabetes, there was a progressive rise in weight, and after diagnosis, there was a tendency toward weight loss. weight-loss interventions in individuals with diabetes will need to account for this tendency if they are to successfully modify the course of the disease.

Body image: appearance orientation and evaluation in the severely obese. Changes with weight loss.

BACKGROUND: The severely obese experience discrimination and embarrassment regarding their appearance, causing psychosocial distress. We assessed the importance of appearance, presentation and self-evaluation of appearance before and after weight loss, in severely obese subjects (BMI > 35 kg/m2). METHODS: Appearance orientation (AO) and appearance evaluation (AE) sections of the Multi-dimensional Body Self Relations Questionnaire were completed by preoperative patients and those attending an annual follow-up after Lap-Band gastric restrictive surgery over a 2-year period. AO is a measure of the importance one places in appearance. AE is a self-evaluation of one's appearance. RESULTS: Before surgery 322 consecutive patients (48 men and 274 women) completed the survey. AO was similar to that of community norms (mean scores 3.76 +/- SD 0.6 vs 3.84 +/- 0.6), with the exception of the super obese (BMI > 50 kg/m2) who placed significantly less importance on their appearance (3.34, +/- 0.8, p = 0.001). There was no change in AO at 1-4 years after surgery, with the exception of the super obese whose mean values rose to normal by 1 year. AE was very low before surgery compared with community normal values (1.6 +/- 0.6 vs 3.4 +/- 0.8, p < 0.001). Major improvement in mean AE was seen at 1 year after surgery (n = 209, 2.6 +/- 0.8, p < 0.001) and the improvement was maintained out to 4 years. The change in AE from pre-surgery to 1 year (n = 122 paired) correlated positively with the percentage of excess weight lost (r = 0.32, p < 0.01) and positively with measures of quality of life and psychological disturbance. CONCLUSION: Major improvements in appearance evaluation occur with weight loss after surgery and this is associated with psychological benefit.

Relation between appetite ratings before and after a standard meal and estimates of daily energy intake in obese and reduced obese individuals.

The aim of the present study was to relate appetite ratings before and after a standard breakfast to estimates of daily energy intake, before and after weight loss obese men and women. Nineteen obese subjects (9 men and 10 women) took part in a 15-week drug-based weight-loss program coupled to energy intake restriction. Body weight and body composition were significantly decreased in men and women. Both before and after the weight loss program, desire to eat, hunger, fullness and prospective food consumption (PFC) were measured after an overnight fast and at 10-min intervals in the hour following the ingestion of a standardized breakfast. Energy intakes were also measured and reported before and after weight loss.Fasting desire to eat and postprandial area under the curve (AUC) for hunger were significantly increased (p<0.05) after the intervention. No association was observed between measured or reported energy intakes and appetite ratings before weight loss in either men or women. Reported energy intake was not associated with appetite sensations after weight loss either. In contrast, measured energy intake was significantly associated with postprandial AUC for fullness (r=-0.90, p<0.01) and PFC (r=0.80, p<0.01) in men at the end of the program. In stepwise multiple regression analysis, only postprandial AUC for PFC contributed independently to the variance of measured energy intake after weight loss (r(2)=0.60, p=0.01).This study did not show consistent associations between averaged appetite ratings after a meal and daily energy intake, either before or after weight loss.

Does using the Internet facilitate the maintenance of weight loss?

OBJECTIVE: The purpose of this study was to investigate the effectiveness of a weight maintenance program conducted over the Internet. DESIGN: Longitudinal, clinical behavioral weight loss trial with 6-month in-person behavioral obesity treatment followed by a 12-month maintenance program conducted both in-person (frequent in-person support; F-IPS, minimal in-person support; M-IPS) and over the Internet (Internet support; IS). SUBJECTS: A total of 122 healthy, overweight adults (age=48.4+/-9.6, BMI=32.2+/-4.5 kg/m(2), 18 male) MEASUREMENTS: Body weight, dietary intake, energy expended in physical activity, attendance, self-monitoring, comfort with technology. RESULTS: Results (n=101) showed that weight loss did not differ by condition during treatment (8.0+/-5 vs 11+/-6.5 vs 9.8+/-5.9 kg, P=0.27 for IS, M-IPS and F-IPS, respectively). The IS condition gained significantly more weight than the F-IPS group during the first 6 months of weight maintenance (+2.2+/-3.8 vs 0+/-4 kg, P<0.05) and sustained a significantly smaller weight loss than both in-person support groups at the 1 y follow-up (-5.7+/-5.9 vs -10.4+/-9.3 vs -10.4+/-6.3 kg, P<0.05 for IS, M-IPS and F-IPS, respectively). Attendance at maintenance meetings was greater for the F-IPS than the IS condition over the 1 y maintenance program (54 vs 39%, P=0.04). Acceptability of assigned condition was higher for subjects in the F-IPS than IS condition. CONCLUSION: The results of this study suggest that Internet support does not appear to be as effective as minimal or frequent intensive in-person therapist support for facilitating the long-term maintenance of weight loss.

The effect of weight loss on a stable biomarker of inflammation, C-reactive protein.

Inflammation is pivotal in all phases of atherosclerosis. Increasing body weight is positively associated with inflammation. weight loss studies have shown that decreasing body weight significantly decreases C-reactive protein, the prototypic biomarker for inflammation. Reducing inflammation through weight loss could therefore be associated with reduced risk for cardiovascular disease and other obesity-associated chronic diseases.

Assessing changes in quality of life among obese participants in Kelantan, Malaysia.

The prevalence of obesity in increasing worldwide and becoming a great concern because it is associated with a number of negative health outcomes such as increased risk for type II diabetes, gall bladder disease, hypertension and heart diseases. Quality of life has become a buzz word in most of the health studies nowadays. There has been numerous weight loss studies suggesting that obesity is associated with impaired health-related quality of life. The objective of this study is to evaluate the magnitude of changes in quality of life before and after experiencing 12 weeks weight reduction program. The respondents consisted of 60 volunteers seeking treatment for losing weight through behavioural modification approach. All subjects underwent intervention consisted of downsizing their daily meal consumption and snacking, behaviour modification, physical activities such as aerobic dance and brisk walking plus dietary counselling. Participants were divided into small groups to stimulate motivation and interaction amongst them in order to achieve their weekly target weight. Quality of life of participants was assessed using the SF-36 questionnaire before and after intervention (end of program). Mean BMI at baseline was 34.8+/-5.2 kg/m2 (range, 28.10 kg/m2 to 47.40 kg/m2). Average weight loss from entry was 6.34+/-3.85% with maximum 19.06+/-2.8%. There was a significant difference of means (p<0.05) for anthropometric variables and quality of life scores between baseline and post-intervention. Nutrition knowledge by using standard questionnaire also was administered during their first visit and at the end of the program. Clearly, there was a significant difference (p<0.001) for the nutrition knowledge scores during pre and post-intervention. Their nutrition knowledge improved as well as their quality of life when they completed the program. In conclusion, practical weight loss practices such as increased activity physical, dietary modification, changes toward healthy lifestyle and group support are effective for weight loss and yield significant health and psychological benefits in obese participants.

Successful long-term weight loss with a Mediterranean style diet in a primary care medical centre.

Objective: To assess the long term (1 year) effectiveness of a weight loss programme which is based on a Mediterranean type diet and has previously been shown to be successful over the short term (3 months). Background: Increasing foods rich in Monounsaturated fat (MUFA) may be preferable to the usually prescribed low total fat diets. A Mediterranean diet which is high in MUFA but non-dense may be more effective at long-term weight loss than a low total fat diet. Methods: A Mediterranean diet has previously been shown to be effective over three months in a study following 100 consecutive patients attending a weight loss programme at a Primary Care Medical Centre. The same 100 patients were followed up 15 months after commencing the diet programme, to assess long-term effectiveness of weight loss. Results: 41 people were available for follow up. 22 of those contacted attended the surgery for review and 19 chose to be reviewed by telephone. 24 patients had maintained at least some of their weight loss, with a mean weight loss of 8.18% of starting body weight at 15 months follow up. 17 patients regained all of the weight that they had lost. 75 % (n=18) of the 24 people who had maintained at least some of the weight loss had completed the full, three-month programme. 26 of the 28 people who completed the full programme were contacted. 12 (46.2%) had maintained or lost even more weight while 6 (23.1%) had regained some but not all of their lost weight. Conclusion: The Mediterranean type diet is very effective for weight loss both in the short term and at 15 months follow up. Long term follow up of this diet programme is at least as effective as any diet or diet and drug therapy published. Individuals completing the recommended 12-week program seem to have more effective long-term weight loss. This type of diet is an alternative to current practice and is amenable to a primary care Medical Practice.

The influence of polymer blend composition on the degradation of polymer/hydroxyapatite biomaterials.

The in vitro degradation of biodegradable polymer/ceramic composites was assessed in two different environments under both static and pseudodynamic conditions. The blends, consisting of polycaprolactone, poly(lactic-co-glycolic acid), and hydroxyapatite, have potential use in bone tissue engineering applications, thus it is essential to establish a standardized method of characterizing the degradation of new biomaterials. In this study, the variation in polymer blend ratio was examined to observe a change in degradation rate. The porous blends were degraded in water and serum-containing media. A previous study examined in vitro degradation in serum-free buffer. Molecular weight loss, gravimetric weight loss, pH changes and morphological changes were evaluated. The changes in porosity were observed with scanning electron microscopy and quantitatively assessed using image analysis. There was a significant difference in molecular weight loss and gravimetric weight loss between the blends after 10 weeks in vitro. Blends containing the greatest amount of poly(lactic-co-glycolic acid) degraded most rapidly. Copyright 2001 Kluwer Academic Publishers