Protein quantity and quality at levels above the RDA improves adult weight loss.

Evidence is accumulating that diets with reduced carbohydrates and increased levels of high quality protein are effective for weight loss. These diets appear to provide a metabolic advantage during restricted energy intake that targets increased loss of body fat while reducing loss of lean tissue and stabilizing regulations of blood glucose. We have proposed that the branched-chain amino acid leucine is a key to the metabolic advantage of a higher protein diet because of its unique roles in regulation of muscle protein synthesis, insulin signaling and glucose re-cycling via alanine. These metabolic actions of leucine require plasma and intracellular concentrations to increase above minimum levels maintained by current dietary guidelines and dietary practices in the U.S. Initial findings support use of dietary at levels above 1.5 g/kg . d during weight loss. Further, our research suggests that increased use of high quality protein at breakfast maybe important for the metabolic advantage of a higher protein diet.

Laparoscopic Roux-en-Y gastric bypass: minimally invasive bariatric surgery for the superobese in the community hospital setting.

Roux-en-Y gastric bypass (RYGB) operation has become a popular choice for weight-reduction surgery. We report an outcome analysis of our early results with laparoscopic Roux-en-Y gastric bypass for superobese (BMI >50) patients. Between January 2000 and October 2001, we operated on 71 superobese patients. The mean body mass index (BMI) of patients at time of surgery was 57 kg/m2. The prospectively collected data included patient demographics, comorbidities, operative times, postoperative weight loss, and complications. Conversion to open gastric bypass was required in one patient. The overall complication rate was 10 per cent. Preoperative comorbidities were resolved or improved in 93 per cent of patients at 1-year postoperative. Average operative time and length of hospital stay were 196 minutes and 2.3 days, respectively. Mean percentage excess weight loss at 3, 6, 9, and 12 months was 27 per cent, 39 per cent, 49 per cent, and 55 per cent, respectively. Mean BMI decreased to 36 kg/m2 over a 12-month period. Laparoscopic Roux-en-Y gastric bypass surgery for superobese patients as performed in the community hospital setting can be both safe and effective with respect to overall postoperative course, early weight loss, and reduction of comorbidity.

Behavior and lifestyle: approaches to treatment of obesity.

The increasing prevalence of overweight and obesity in adults and children demonstrates a steadily growing epidemic. This rising rate of obesity is associated with obesity related comorbidities including cardiovascular disease, hypertension, some cancers, joint disease, and particularly, type 2 diabetes. Modest weight loss (5% to 10% of total body weight) through lifestyle intervention approaches has been found to have a beneficial effect on comorbid conditions, particularly hypertension and type 2 diabetes. Effective behavioral treatment of obesity involves modification of eating and physical activity patterns to yield negative energy balance. Research studies have found that interventions that combine a low-calorie diet, increased physical activity, and behavior therapy are most effective for weight loss and maintenance. Furthermore, extended length of treatment contact, weight loss satisfaction, and social support may promote positive long-term outcomes in obese adults and children.

Effect of duodenal-jejunal exclusion in a non-obese animal model of type 2 diabetes: a new perspective for an old disease.

BACKGROUND: The Roux-en-Y gastric bypass and the biliopancreatic diversion effectively induce weight loss and long-term control of type 2 diabetes in morbidly obese individuals. It is unknown whether the control of diabetes is a secondary outcome from the treatment of obesity or a direct result of the duodenal-jejunal exclusion that both operations include. The aim of this study was to investigate whether duodenal-jejunal exclusion can control diabetes independently on resolution of obesity-related abnormalities. METHODS: A gastrojejunal bypass (GJB) with preservation of an intact gastric volume was performed in 10- to 12-week-old Goto-Kakizaki rats, a spontaneous nonobese model of type 2 diabetes. Fasting glycemia, oral glucose tolerance, insulin sensitivity, basal plasma insulin, and glucose-dependent-insulinotropic peptide as well as plasma levels of cholesterol, triglycerides, and free fatty acids were measured. The GJB was challenged against a sham operation, marked food restriction, and medical therapy with rosiglitazone in matched groups of animals. Rats were observed for 36 weeks after surgery. RESULTS: Mean plasma glucose 3 weeks after GJB was 96.3 +/- 10.1 mg/dL (preoperative values were 159 +/- 47 mg/dL; P = 0.01). GJB strikingly improved glucose tolerance, inducing a greater than 40% reduction of the area under blood glucose concentration curve (P < 0.001). These effects were not seen in the sham-operated animals despite similar operative time, same postoperative food intake rates, and no significant difference in weight gain profile. GJB resulted also in better glycemic control than greater weight loss from food restriction and than rosiglitazone therapy. CONCLUSIONS: Results of our study support the hypothesis that the bypass of duodenum and jejunum can directly control type 2 diabetes and not secondarily to weight loss or treatment of obesity. These findings suggest a potential role of the proximal gut in the pathogenesis the disease and put forward the possibility of alternative therapeutic approaches for the management of type 2 diabetes.

Postnatal weight loss in term infants: what is normal and do growth charts allow for it?

BACKGROUND: Although it is a well known phenomenon, limited normative data on neonatal weight loss and subsequent gain are available, making it hard to assess individual children with prolonged weight loss. OBJECTIVE: To establish, using data from a large prospective population based cohort study, norms and limits for postnatal weight loss and its impact on current growth reference charts. METHOD: A cohort of 961 term infants were recruited at birth and followed using parental questionnaires and community nursing returns. Routine weights were collected for half the cohort at 5 days and for all at 12 days and 6 weeks. RESULTS: Less weight loss was seen than the 3-6% suggested by previous studies, but one in five infants had not regained their birth weight by 12 days. Those lightest at birth showed least weight loss. Twenty six (3%) children had more than 10% weight loss, but none showed evidence of major organic disease. Actual weights in the first fortnight are half to one centile space lower than growth charts suggest, while birthweight centiles for children born at 37 weeks were two centile spaces lower. CONCLUSIONS: Neonatal weight loss is brief, with few children remaining more than 10% below birth weight after 5 days. Growth charts are misleading in the first 2 weeks, because they make no allowance for neonatal weight loss.

Relationship of satisfaction with body size and trying to lose weight in a national survey of overweight and obese women aged 40 and older, United States.

BACKGROUND: Despite the potential benefits of weight loss, the factors associated with weight loss behavior are only beginning to be identified. We examined the association between sociodemographic factors, perceived health, satisfaction with body size, and trying to lose weight. METHODS: Data were obtained from the 1996-1997 U.S. Women's Determinants Study. We included over 1,700 overweight and obese women aged 40 and older from the following four racial/ethnic groups: Hispanic, black, American Indian/Alaskan Native, and non-Hispanic white. RESULTS: About half of the women reported that they were satisfied or very satisfied with their body size. Satisfaction was associated with lower body mass index (BMI), greater age, lower educational level, and better self-rated health. Compared with non-Hispanic white women, women in the other racial/ethnic groups expressed greater body satisfaction. About 65% of women reported that they were currently trying to lose weight. The strongest predictor of trying to lose weight was satisfaction with body size; women who were not satisfied were nine times more likely to report trying to lose weight than those who were very satisfied. Other significant predictors were BMI, race/ethnicity, and age. CONCLUSIONS: Our findings should serve as the impetus for the inclusion of measures of body image in surveillance and intervention studies of weight loss and control. Copyright 2002 American Health Foundation and Elsevier Science (USA)

Nutritional behavior as a predictor of early success after vertical gastroplasty.

BACKGROUND: Patients' nutritional habits are seldom taken in account in planning surgery for clinically severe obesity. Our proposed hypothesis is that the patient's nutritional behavior may influence the outcome of bariatric surgery. METHODS: The impact of nutritional behavior on the postoperative weight-loss was evaluated before and after bariatric surgery. A 6-month prospective consecutive case study was carried out on patients undergoing a Silastic ring vertical gastroplasty (SRVG). Patients were interviewed and examined before and at 1, 3 and 6 months after surgery. Demographic and clinical data were collected from the patients' medical charts. Nutritional data collected from a self-filled questionnaire included information on hunger and satiety perception, nutritional behavior (intake, eating habits and maximum consistency of consumed food) and concomitant symptoms. RESULTS: The sample included 69 patients: 56 were women (81%); average age was 32 years (range 18 50). Average preoperative BMI was 43.4 +/- 5.3 kg/m2 (range 35-58). 6 months after surgery, BMI was 30.3 +/- 3.8 kg/m2 (range 21-42). weight loss forecast models showed a statistically significant role of factors related to: anthropometrical preoperative data, hunger perception, prevalence of oral mucosal sore, and nutritional behavior. CONCLUSION: The short nutrition outcomes after gastric restrictive surgery were looked at, with their impact on weight-loss success. The Eating Status concept should be part of a systematic profiling of morbidly obese patients for preoperative nutritional behavior and postoperative nutritional education, to achieve the best comprehensive treatment in regard to weight loss and quality of life.

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