Obesity treatment: examining the premises.

Five basic premises underlie the recommendation that obese persons should lose weight: (1) obesity is physically unhealthy; (2) in obese persons, weight loss improves physical health; (3) long-term weight loss is possible; (4) the benefits of weight loss exceed the costs; and (5) weight loss is superior to or can add incrementally to the effects of alternative methods of improving the health and happiness of obese persons. Although the data are occasionally ambiguous, they generally support these premises. obesity apparently causes increased morbidity and decreased longevity, even after controlling for many plausible confounding factors. Clinical studies consistently show that weight loss reduces morbidity. No adequate data exist on which to evaluate the effects of weight loss on mortality among obese persons. Additional data are needed, but long-term weight loss seems possible, although such losses remain difficult to maintain. A crude estimate is that about 20% of obese persons who attempt to lose weight can achieve and maintain a clinically meaningful weight loss. The short-term health and psychologic costs of gradual weight loss are minor, manageable, and easily surpassed by the short-term health and psychologic benefits. Long-term effects of weight loss on mortality are difficult to judge, and further research is needed. weight loss can add incrementally to the effects of alternative methods to improve health and happiness among obese persons. Thus, these "alternatives" are better termed "complementary approaches," and their use need not preclude attempts at weight loss. Finally, we provide several guidelines to help practitioners assist obese persons in making reasonable informed decisions about weight loss.

We investigated the effect of weight reduction on blood pressure, microalbuminuria and renal function in hypertensive patients with obesity for over 12 months. Twenty-five patients with a body mass index (BMI) of over 25 were prescribed low calorie diet (25 kcal/kg). All patients had mild hypertension and microalbuminuria. They were classified into 2 groups after 12 months. Group A consisted of 10 patients who had a weight loss of at least 5%. Group B consisted of 15 patients who did not have any weight loss. The following results were obtained. (1) The percentage of patients with hyperfiltration (GFR; more than 140 ml/min) was 20%. (2) Blood pressure, fasting plasma insulin level, urinary sodium and albumin excretion rate were significantly decreased in Group A. On the other hand, these changes were not observed in Group B. (3) Reduction in mean arterial blood pressure significantly correlated with the fall in body weight. (4) Renal function did not change during the study period in both groups. (5) Urinary albumin excretion rate significantly correlated with weight reduction, decrease in blood pressure and fasting insulin levels. Blood pressure and urinary albumin excretion rate in hypertensive patients with obesity significantly decreased with weight reduction. Probably, weight loss improves insulin resistance and decrease in the plasma insulin level causes a reduction in blood pressure and urinary albumin excretion rate.

Current concepts in the management of obesity. An evidence based review.

The increasing prevalence of overweight and obesity is an important public health problem contributing to significant excess in morbidity and mortality. A cross-sectional national epidemiological household survey showed that the prevalence of obesity in female Saudi subjects was among the highest reported. obesity is a complex multifactorial chronic disease that develops from an interaction of genotype and the environment. Our understanding of how and why obesity develops is incomplete, but involves the integration of social behavioral, cultural physiological, metabolic and genetic factors. While there is agreement about health risks of over weight and obesity, there is less agreement about their management. Primary health care services should play the dominant role for obesity management. Family physicians need to assess the patient's readiness to enter weight loss therapy and take appropriate steps for motivation. weight loss and weight maintenance therapy should employ the combination of low caloric diet, increased physical activity, and behavioral therapy. weight loss drugs may be used as part of comprehensive weight loss program. weight loss surgery is an option for carefully selected patients with severe obesity Body Mass Index greater than 40. After successful weight loss, a program consisting of dietary therapy, physical activity, and behavioural therapy, which should be continued indefinitely, enhances the likelihood of weight loss maintenance.

An attempt to identify predictors of treatment outcome in two comprehensive weight loss programs.

The present study attempted to predict weight loss in, and completion of, low-calorie diet (LCD, n=167) and very low-calorie diet (VLCD, n=96) weight loss programs. Program completion and weight loss were examined in association with three groups of variables: demographic (e.g., age), medical/physical (e.g., body mass index [BMI]), and motivational/behavioral (e.g., exercise, ratings for motivation and commitment for the program). In the LCD group, age was positively associated with program completion, and commitment to the program was negatively associated with both program completion and weight loss. In the VLCD group, no variables predicted program completion, and only male gender predicted weight loss. Our results offer little to contradict previous findings that preexisting participant characteristics are of limited utility in predicting weight loss treatment outcome. In the LCD group, the negative associations of commitment with program completion and weight loss were surprising. If replicated, they might suggest the need to clarify patients' expectations about the level of commitment required for successful treatment.

The adoption of eating behaviors conducive to weight loss.

Given the plethora of eating behavior techniques that obese individuals might adopt for weight loss, it is not likely that they could, or would be willing to, adopt all of them. Therefore, the purpose of this study was to identify the specific eating behaviors conducive to weight loss adopted during the behavioral treatment of obesity, and to distinguish those that were deemed beneficial from the ones that were not. Fifty obese (BMI 32+/-4 kg/m(2), mean+/-SD), postmenopausal women (60+/-6 years old) participated in a 6-month behavior modification, dietary, low-intensity walking weight loss program. For analysis, they were divided into two groups: "no weight loss" (<or=5 kg, n=18) versus "weight loss" (>5 kg, n=32). At pre- and posttreatment women completed the Eating Behavior Inventory (EBI) that measures specific strategies conducive to weight loss. Women who lost weight increased their total eating behavior score by 20% (p<0.001) and improved the adoption of 14 eating behaviors, which was more than twice that of the non-weight losers. Topping the list of most strongly adopted behaviors were carefully watching and recording the type and quantity of food consumed. Maintaining a weight graph and weighing daily also were important to these women. Neither group of women adopted potentially helpful eating behaviors such as leaving food uneaten, refusing food offered by others, or shopping from a list. In studies of obesity treatment, attendance at class sessions is one marker of program adherence. More definitively, implementing the EBI in clinical and research obesity treatment programs will provide its leaders with insight into whether participants adopt, ignore, or fight the essential behaviors that will facilitate success toward their personal weight loss goals.

Analysis of weight loss with the biliopancreatic diversion of Larrad: absolute failures or relative successes?

BACKGROUND: The authors studied whether morbidly obese patients who failed in stated weight loss criteria may be considered absolute failures or relative successes. METHODS: 75 morbidly obese patients underwent biliopancreatic diversion (BPD) of Larrad, with a 4/5 gastrectomy (residual gastric volume 150-200 ml), a biliopancreatic limb divided 50 cm distal to Treitz' ligament, a 50-cm common limb and an alimentary limb of nearly all the bowel length (500-600 cm). Every patient had a follow-up of 5 years. A percent excess weight loss (%EWL) < 50% was considered a "failure". We analyzed the post-surgical changes in the preoperative obesity-related problems in these patients and the causes of the weight loss failure. RESULTS: At 5 years after the BPD of Larrad, 9 patients (12%) had a %EWL < 50%, with a mean %EWL of 36 in these patients. Most of these failed patients were cured or improved of their preoperative illnesses. The 2 males were alcoholics, and 6 of the 7 females had an abnormal psychological examination. Comparing the "failed" patients with the successful group, there is a statistically significant influence (p < 0.01) of lack of satiety, unmarried status, housewife or unemployed. CONCLUSION: Patients judged as a failure by weight loss criteria after bariatric surgery should not be considered absolute failures, because most of their preoperative illnesses were cured or improved, improving their quality of life. Thus, they are "relative successes".

Reduction in obesity and coronary risk factors after high caloric exercise training in overweight coronary patients.

BACKGROUND: The majority of patients with coronary heart disease (CHD) are overweight. However, little weight loss occurs with participation in a standard cardiac rehabilitation (CR) program. METHODS: Fifteen overweight patients (average body mass index of 31.0 kg/m2) with CHD completed a 4-month exercise training program in a CR program. The exercise program consisted primarily of walking long duration (60-90 minutes per session) 5 to 7 days per week at a relatively low intensity of 50% to 60% of peak VO2. Measures of body composition by dual-energy x-ray absorptiometry, body fat distribution by computed tomography, plasma lipid-lipoprotein, glucose and insulin concentrations, and peak VO2 were obtained before and after the exercise intervention. Patients maintained an isocaloric diet throughout the study. RESULTS: Patients had reductions in total body weight (-4.6 kg), fat mass (-3.6 kg), percent body fat (-2.9%), and waist circumference (-5.6 cm) (all P <.001) while maintaining fat-free mass. Subcutaneous adipose tissue was reduced by 12% (P <.001) and visceral adipose tissue was lowered by 14% (P <.001). There were favorable changes in the lipid-metabolic profile with reductions in triglyceride levels (-23.7%), total cholesterol/HDL-C ratio (-14.3%), and fasting insulin levels (-22.3%) (all P <.05). Peak VO2 increased by 21.2% (P <.001). CONCLUSIONS: The present pilot study results suggest that a high caloric training exercise training program in the CR setting may be effective in promoting weight loss and improving coronary risk factors in overweight coronary patients. Although additional research with randomized control patients is needed, this alternative to traditional CR may be considered to maximize weight loss as part of a secondary prevention program.

The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer.

The relationship between the magnitude of systemic inflammatory response and the nutritional/functional parameters in patients with inoperable non-small cell lung cancer were studied. The extent of weight loss, albumin, C-reactive protein, performance status and quality of life was measured in 106 patients with inoperable non-small cell lung cancer (stages III and IV). Survival analysis was performed using the Cox proportional hazard model. The majority of patients were male and almost 80% had elevated circulating C-reactive protein concentrations (>10 mg x l(-1)). On multivariate analysis, age (P=0.012), tumour type (0.002), weight loss (P=0.056), C-reactive protein (P=0.047), Karnofsky performance status (P=0.002) and fatigue (P=0.046) were independent predictors of survival. The patients were grouped according to the magnitude of the C-reactive protein concentrations (< or =10, 11-100 and >100 mg x l(-1)). An increase in the magnitude of the systemic inflammatory response was associated with increased weight loss (P=0.004), reduced albumin concentrations (P=0.001), reduced performance status (P=0.060), increased fatigue (P=0.011) and reduced survival (HR 1.936 95%CI 1.414-2.650, P<0.001). These results indicate that the majority of patients with inoperable non-small cell lung cancer have evidence of a systemic inflammatory response. Furthermore, an increase in the magnitude of the systemic inflammatory response resulted in greater weight loss, poorer performance status, more fatigue and poorer survival. Copyright 2002 Cancer Research UK