. 2009 May 14;2(Suppl 2):214–256. doi: 10.1159/000213163
Obes Facts. 2009 May 14;2(Suppl 2):214.
Introduction
Little is known about the physiologic effects of whole body vibration exercise on humans body. The aim of this study is to examine the effects of whole body vibration exercise on body weight and body compositions.
Methods
One hundred twelve healthy college students were separated into two groups, whole body vibration exercise group and control group. The exercise program was more than 10 minutes of whole body vibration exercise and the frequency was more than 3 times per week during 3 months. Body weight and body composition were checked at the beginning and the end point of this study.
Results
Total 91 subjects finished this study (56 males, 35 females). After study, body weight and body composition change were compared. No significant difference was found in body weight, body mass index, muscle mass, fat mass, body fat ratio, visceral fat area between study and control groups in male. In female, slight increase was found in body weight (1.1±1.1kg vs 0.3±1.9kg, P=0.027), fat mass (0.8±0.9kg vs −0.3±1.4kg, P=0.008) and body fat ratio (1.0±1.5% vs −0.6±2.4%, P=0.031) in study group compared with control group (P<0.05), and this increase mainly occurred in normal weight group not in overweight or obese group.
Conclusion
The results of this study suggest that whole body vibration exercise has no effect on reducing body weight and fat mass, visceral fat area and on increasing muscle mass.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):214.
Introduction
Recent studies suggest that obesity in childhood may be associated with an impaired impulse regulation such as attention deficit- hyperactivity disorder (ADHD). Further on, there are indices that ADHD may be a potent factor limiting successful weight control. In a randomized controlled trial we investigated the comparative efficacy of a of parent-only and parent–child and analysed the moderator effect of a comorbid ADHD on treatment course.
Methods
Fifty-six obese children and their families were randomly assigned to a 16-session cognitive behavioural therapy (CBT) for the parents only or for a combined treatment of parents and children. We assessed children's percent overweight; mental disorders according to the structured interview for mental disorders in childhood, “Kinder-Diagnostisches Interview für Psychische Störungen (K-DIPS)” and the children's behavioural problems and competences according to the CBCL.
Results
Both treatments reduced children's percent overweight significantly and equally by 6-month follow-up. Also both treatments provided similar results in reducing general behaviour problems (externalizing and internalizing behaviour problems), global and social anxiety, and depression. We further found that children suffering from a comorbid ADHD responded later and less pronounced to the treatment. Long-term efficacy is currently evaluated.
Conclusion
Our results point to a comparable efficacy of the two treatments. If replicated, these findings have important implications for the treatment of childhood obesity. ADHD should be assessed in obese children and proper treatment should be provided.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):214.
Introduction
In children the lifestyle treatment of children with obesity usually includes efforts to change diet, physical activity and behaviours. The aim of the study was to assess lifestyle treatment for children with obesity and compare the one-year outcome of two models with different emphasis on physical activity to each other and to controls.
Methods
A total of 66 children with obesity, defined by the IOTF criteria, 8.5 to 12.8 years of age, were enrolled and randomly assigned to either a conventional lifestyle treatment model (A) or a model emphasising physical activity (B). A dietician and a nurse delivered the A-model, while a physiotherapist replaced the nurse in the B-model. Both A and B had 12 monthly treatment sessions during one year. A total of 55 children, 27 in A and 28 in B, could be evaluated after one year. A control group (n=138) matched for age, gender and BMI was created from the waiting list.
Results
Age, gender or BMI-z-score did not differ at baseline between controls, drop-outs and children in A and B-models. The difference in BMI z-score from baseline at 12 months for model A, B and controls was −0.32, −0, 36 and −0.14 respectively (p<0.001 for A or B vs controls, ns for A vs B).
Conclusion
The lifestyle treatment model intended to stimulate physical activity had a non-significant better reduction in BMI z-score compared to conventional treatment. Both treatment options had a significant reduction of BMI z-score compared to non-treated controls.
Conflict of interest: None. Funding: Grants from the Västra Götalands Region
Obes Facts. 2009 May 14;2(Suppl 2):214–215.
Introduction
Child and adolescent obesity is increasingly prevalent, and can be associated with significant health consequences. The aim of this review is to assess the efficacy of interventions for treating obesity in children and adolescents. .
Methods
We searched eight electronic databases from 1985 to May 2008. We selected randomised controlled trials (RCTs) of lifestyle (i.e. dietary, physical activity and/or behavioural therapy), drug and surgical interventions with a minimum of six months follow up (three months for drug therapy). Two reviewers independently assessed trial quality and extracted data following the Cochrane Handbook.
Results
We included 64 RCTs with 5230 participants. Twelve lifestyle interventions focussed on physical activity and sedentary behaviour, six on diet, and 36 on behaviourally orientated treatment programs. Two drug trials involved metformin, two orlistat and five sibutramine. No surgical intervention was eligible for inclusion. Overall, studies varied greatly in intervention design, outcome measurements and methodological quality. Meta-analyses indicated a reduction in overweight at 6 and 12 months follow up in: i) lifestyle interventions involving children; and ii) lifestyle interventions in adolescents with or without the addition of orlistat or sibutramine. A range of adverse effects was noted in drug RCTs.
Conclusion
This review shows that combined behavioural lifestyle interventions can produce a significant and clinically meaningful reduction in overweight in childhood. In obese adolescents, consideration should be given to the use of either orlistat or sibutramine, as an adjunct to lifestyle interventions, although this approach needs to be carefully weighed up against the potential for adverse effects.
Conflict of interest: None disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):215.
Introduction
The stability of parental perceptions of their child's weight status during adolescence has not been examined. This study aimed to examine parental classification of their adolescent's weight status at 13 and 15 years and the corresponding predictors of misclassification.
Methods
Families were participants of the Nepean Longitudinal Study. Parents completed a questionnaire on perceptions of their adolescent's weight status in 2002, when the children were 13 years and two years later (n=263). Data were collected on predictors of weight misclassification including self-assessed puberty, parental adiposity and education. Body mass index (BMI) was derived from objective measures and weight status was defined using IOTF criteria.
Results
Between 13 and 15 years of age, overweight/obesity prevalence increased from 17%/9% to 21%/8% and parental perception of ‘overweight’ in their adolescent decreased from 12% to 11%; <1% were classified as ‘markedly overweight’. Underweight (5%) and perception of underweight (9%) was stable. Parental misclassification of adolescent weight status was 27% at both time points but this varied between weight groups; <3% misclassified normal weight adolescents as overweight, and the majority of overweight/obese adolescents were misclassified as non-overweight (13y: 57%; 15y: 62%). At 15 years, weight status misclassification was more prevalent in overweight parents (P=0.031) and those with overweight sons (P=0.001). At both time points, misclassification was greater in overweight adolescents with relatively lower BMIs (P<0.001) and was not associated with puberty or parental education level.
Conclusion
Overweight recognition in adolescence was poor but could be an amendable target in the pathway to overweight management.
Conflict of Interest: None disclosed. Funding: This study was funded by a National Health and Medical Research Council (NHMRC) Project Grant #206501 and Meat and Livestock Australia. Vanessa Shrewsbury is supported by an NHMRC Biomedical Postgraduate Scholarship. Sarah Garnett is supported by an NHMRC Australian Clinical Research Fellowship # 457225.
Obes Facts. 2009 May 14;2(Suppl 2):215.
Introduction
The aim of the study was to compare the weight outcomes of two randomized groups assigned to either a conventional individual treatment (IT) programme or a new group lifestyle treatment (GT) programme which included physical training and parent education.
Methods
Seventy-five adolescents with obesity were included, aged 8.9-12.5 yrs, 38 of them were randomized to the GT- and 37 to the IT group. A control group (C) of 138 untreated adolescents referred to the obesity clinic was matched for age, gender and anthropometric data with the treated subjects at baseline. The outcome measures of weight and BMI were related to Swedish national reference data with SDS-scores.
Results
BMI SDS were +3.24 GT; +3.19 IT and +3.19 C at baseline. Sixty children completed the study (IT n= 31; GT n=29). Both treatment groups and controls had a significant decreased in BMI SDS (GT= −0.29, IT= −0.31 C= −0.13 p<0.001, respectively) . No significant differences on the outcome measures were found between the two intervention groups. The treatment groups had a significantly larger reduction in BMI than the control group (p<0.001). However large differences were found within the treatment groups (IT sd=2.2; GT sd=1.6) after 12 months.
Conclusion
The two treatment groups gave similar results although there was a large variation in weight loss which suggests that other variables play a significant role on outcome. Further research needs to be undertaken to identify the relevant independent variables to identify the suitability of treatment options to individual children and families.
Obes Facts. 2009 May 14;2(Suppl 2):215.
Introduction
The need for an early successful obesity therapy in adolescents becomes more and more urgent with increasing comorbidities and financial burden.
Methods
The rehabilitation centre Insula treats extremely obese adolescents (average age at begin of therapy 15,92 +/− 2,23 years). Major elements of the therapy are behavioural psychotherapy, sports- and nutrition-therapy and medical diagnosis and treatment of comorbidities. With the help of general practitioners 98 consecutively treated patients were followed up 18 month after therapy.
Results
31 males (36,5%) and 54 females (63,5%) participated in the full program lasting 5,74 +/− 2,20 months in average. The average BMI at admission was 41,52 +/− 6,70 kg/m2 and the BMI SDS was 3,23 +/-0,41. The average BMI at discharge was 33,85 +/− 5,59 kg/m2, BMI-SDS 2,52 +/− 0,54 respectively. In 67 of the 85 patients (78,82%) weights and heights were reported. The follow up time was 17,76 +/− 3,23 months. At catamnesis the average BMI was 38,26 +/− 7,21 kg/m2 and the BMI-SDS was 2,84 +/− 0,60. Catamnestic BMI-SDS reduction resulted in 82,7% (n = 54) of the 67 reporting patients. Considering all non reporting patients and all non completers as a failure, long term success was found in 55,1%. Multiple regression analysis reveals that the psychological variables “sports” (p=.005), “craving” (p=.000), “occupation with weight and shape” (p=.036), “efficiency” (p=.000) and “disinhibition” (p=.003) predict successful weight management.
Conclusion
The long term results and the proven reversibility of the co-morbidities in young extremely obese adolescents with high motivation justify a specific long term in patient therapy. Psychological predictors for long-term success will be discussed.
Obes Facts. 2009 May 14;2(Suppl 2):215–216.
Objective
The goal was to identify and model pre-treatment predictor variables associated with changes in body mass index-standard deviation score (BMI-SDS) in obese children.
Methods
248 children participated in a multidisciplinary cognitive behavioural therapy program between 1995 and 2007 and were included in a prospective study. At the start of the program their antropometric, somatic, demographic and psychosocial baseline variables were assessed. The Child Behaviour Checklist and Family Cohesion and Adaptability Scales psychological questionnaires were used to measure behaviour and family functionality level respectively. Primary outcomes were BMI-SDS. The linear MIXED model procedure was used for the analysis of variables on changes in BMI-SDS over time
Results
Higher BMI-SDS were associated with male gender, drop out status, foreign ethnicity and overweight caregivers. The BMI-SDS decrease over time was negatively influenced by drop out during the program, higher baseline BMI-SDS, older age, foreign ethnicity and a clinical CBCL Total T-score. Drop out probability increased on decreasing BMI-SDS reductions in the first 3 months (OR: 25.24).
Conclusions
This study provides a predictive model for the individual BMI-SDS course in a multidisciplinary childhood overweight therapy program. The model can be used to recognize children prone to be less succesfull in therapy. Possibly, those children can benefit from an alternative, specialised or individualised treatment program. Usage of this model could improve BMI-SDS reductions in childhood overweight and obesity therapy programs.
Conflict of interest: No conflict of interest reported. Financial Disclosure: No financial disclosure reported.
Obes Facts. 2009 May 14;2(Suppl 2):216.
Introduction
Obesity is the second most common preventable cause of death after smoking in Britain today and is responsible for more than 9,000 premature deaths per year in England. At present, more than half of the British adult population is overweight and obesity has trebled in the last 20 years to 22% of men and 23% of women. Synthetic estimates suggest that 13 wards in the Basildon and Thurrock within South West Essex localities have a population where over 25% are obese and that all of the wards in Basildon have populations where at least 20% are obese.
A pilot scheme enabling NHS South West Essex to buy subsidised vouchers of Weight Watchers (WW) and Slimming World (SW)
General Practioners (GP) are responsible for the initial assessment of obese patients including their motivation levels and referring to appropriate services and for monitoring patients’ success after the 12 weeks of weight management support. Should the patient show a successful weight reduction in 12 weeks and not achieved a desirable Body Mass Index (BMI), the referring GP may provide additional complimentary vouchers for 12 weeks. The initial criteria for referral was, adult with BMI>28 with co-morbidities and BMI>30 which was later changed to BMI>28.
Methods
Quantitative methods included an analysis of the WW and SW referral scheme database, which included GP referrals, attendance and weight-loss data from 01st October 2007 until 30th May 2008.
Results
During the pilot period between 1st October 2007 until 30th May 2008, 437 patients were referred to the commercial slimming programmes 28 GP surgeries. The mean BMI was 37.8 Kg/m2 and the mean weight loss was 5.6 Kgs
56% of Clients attending WW and 54% of clients attending SW sessions lost 5% or more weight during the 12-week programme.
Conclusion
Patients who have completed their 12 week programme both Slimming World and Weight Watchers have shown almost identical efficacy in achieving 5% weight reduction for clients - on average a clinically significant amount.
The weight reduction of clients within both Slimming World and Weight Watchers suggest that life style changes advocated at these meetings followed by regular GP monitoring have been adopted by the vast majority of people referred.
The uptake and enrolment of the patients has improved as new GP practices have signed up to this programme and the PCT seeks to include all the GP practices within South West Essex to deliver these programmes.
Conflict of Interest: None Disclosed. Funding: NHS South West Essex, Basildon UK, funded research relating to this abstract.
Obes Facts. 2009 May 14;2(Suppl 2):216.
Obesity and type 2 diabetes are two clinical conditions caracterized by a reduction of cholesterol absorption. We have studied plasmatic levels of two indexes of cholesterol synthesis (lathosterol and desmosterol) and three indexes of cholesterol absorption (sitosterol, campesterol and colestanol) in 52 normal subjects (N) and in 52 type 2 diabetic subjects (D) with good metabolic control, treated with diet and/or oral hypoglycaemic agents and a BMI= 28.8±5.4 kg/m2. Both groups were administred a diet with similar amounts of phytosterols.
In N there was an inverse correlation between synthesis and absorption indexes, while in D such correlation was lacking. In N there was a direct and significant correlation between lathosterol and total cholesterol, LDL cholesterol and triglycerides and an inverse correlation with HDL cholesterol; a direct and significant correlation between the absorption indexes and HDL cholesterol and an inverse correlation with triglycerides.
In D there was a direct and significant correlation between lathosterol, sitosterol, campesterol and total cholesterol, HDL cholesterol, LDL cholesterol (p=0.01 at least) and between lathosterol and BMI (p=0.05). We then divided the D patients in two groups: GROUP A: BMI < 30 kg/m2; GROUP B: BMI < 30 kg/m2.
There was no differences between the two groups in synthesis and absorption indexes.
In the B group there was an inverse and significant correlation between lathosterol and colestanol (p = 0.006) and desmosterol and colestanol (p=0.007) and a loss of the correlation between lathosterol, total cholesterol, LDL cholesterol and triglycerides what was observed in the A group. In conclusion our study demonstrates in D: 1) the loss of normal inverse relationship between synthesis and absorption only in non obese; 2) direct correlation between cholesterol synthesis, lipid profile and BMI; 3) loss of direct correlation between hepatic cholesterol synthesis and lipid profile in obese.
Obes Facts. 2009 May 14;2(Suppl 2):216–217.
Introduction
Obesity is a result of environment influences as social status, customs, high energy intake, low physical activity and internal factors, genes, metabolic status, endocrinological diseases. The external factors modify not only the energy balance but the issues of lifestyle attitude. Integrated therapy of obesity means multifactorial and multidisciplinary approaches.
The goal
of our study is these integrated approach therapy of a group of obese, very well motivated as they were addressed in the Reductostart program.
Cases and methods
We initiated an intention to treat study, longitudinally, 12 month period of follow up, initial randomization of 6 month, 107 patients, from 287 total cases, for the first year.
Results and discussions
Synoptically we found:
• 10% good results with only lifestyle modifications.
• 87% good results with both. (table)
• 3% of failure.
| Group | Weight (kg) | % adipose tissue | Ap (cm) | Bmi(kg/mp) |
|---|---|---|---|---|
| Initially | 96,55±18 | 37,94±8,7 | 102±9,2 | 33,89±12,5 |
| La 1 an | 86,05±12 | 29,64±4,5 | 89±5,6 | 28,9±8,8,7 |
| Δ | 10,5±6¤ | 7,5±4,2¤ | 13±4,6¤ | 4,99±3,6¤ |
¤
p<0,005
Conclusions
We obtained good results for all the anthropometrically parameter, after 1 year of treatment. The cornerstone was: high motivation and integrated treatment. Sibutramine is a good choice as it has dual effects: energy balance and eating disorders. We could achieve also a multifactorial approach of treating obese persons as integrated treatment. The Reductostart program offers a good selection and motivation to treat for both patient and medical team.
Key words
integrative intervention, Reductostart programe, wheight loss management.
Obes Facts. 2009 May 14;2(Suppl 2):217.
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Obes Facts. 2009 May 14;2(Suppl 2):217.
Introduction
Eating disorders are often observed in obese adolescents and the food behavior of them can cause a hormonal dysfunction in the components of the neuroendocrine system. The aim of this study was to evaluate the effect of long-term multidisciplinary therapy on eating disorders, body composition and anorexigenic and orexigenic factors in obese adolescents.
Methods
Third-seven obese adolescents (20 girls and 17 boys) with eating disorders symptoms aged between 14 and 19 y, with obesity, BMI < 95th percentile of CDC, were submitted to long-term multidisciplinary therapy (nutrition, psychology, exercise and clinical support) during 1 year. Bulimic and binge eating symptoms were measured by Bulimic Investigatory Test Edinburgh and Binge Eating Scale, respectively. Anorexigenic and orexigenic factors were measured by radioimmunoassay, body composition by pletismography, visceral and subcutaneous fat by ultrassonography.
Results
After 1 year of multidisciplinary therapy the adolescents reduced significantly body mass (kg), body mass index (BMI kg/m2), body fat mass (%), visceral and subcutaneous fat (cm) besides bulimic and binge eating symptoms. Neuropeptide Y (NPY) concentrations decreased significantly at the end of therapy, however Melanin-concentrating hormone (MCH) increased significantly. On the other hand, it was observed an improvement in -melanocyte stimulating hormone (-MSH) and significant reduction in hyperlepitinemia after 1 year. In addition, after 1 year of therapy it was observed a negative correlation between leptin and MCH.
Conclusion
In conclusion, long-term multidisciplinary therapy was effective to improve anorexigenic and orexigenic factors that influence the food intake besides avoids the development of eating disorders in obese adolescents.
Conflict of interest: none disclosed. Funding: AFIP, FAPESP 2006/00684-3, FAPESP 2008/53069-0, FAPESP (CEPID/Sleep #9814303-3 S.T) CNPq, CAPES, CENESP, FADA, and UNIFESP-EPM, supported the CEPE-GEO Multidisciplinary Obesity Intervention Program.
Obes Facts. 2009 May 14;2(Suppl 2):217.
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Obes Facts. 2009 May 14;2(Suppl 2):217.
Introduction
In spite of intensive research in the field of obesity, there are still lack of knowledge about factors that promote a successful recovery process in weight loss management and maintenance. This project search for methods that can be used to investigate recovery processes to reveal the success factors that promote life style changes.
Methods
Literature search on behavior change, mixed methods design, qualitative design and micro genetic design was used to explore outcome of treatment progresses.
Results
The used methods seem to explain only a small part of the outcome of treatment, while communication, hope and expectation mean more for the result. It seems that the strongest associations between changing processes and result are connected to interpersonal aspects in the therapeutic process, and the challenge is to find methods where this aspect can be studied. The complementary mixed-method study, qualitative and quantitative methods might be used to measure overlapping, but also different facts of the phenomenon, yielding an enriched, elaborated understanding of the phenomenon.
Conclusion
By synthesizing the qualitative data; data connected to the “changing process”, with quantitative measurements, connected to the “product”, we might get new insight of what the characteristics of a successful recovery to a healthier lifestyle are.
Conflict of Interest: None disclosed. Funding: Research relating to this abstract was funded by The Norwegian Nursing Association.
Obes Facts. 2009 May 14;2(Suppl 2):217–218.
Introduction
Binge Eating Disorder (BED) is the disorder that has been associated most frequently with childhood obesity. The characteristic of “loss of control” over eating is the most important factor in identifying eating disorders (Marcus & Kalarchian, 2003; Morgan et al., 2002). Impulsivity has been related to BED and to childhood obesity. Research suggests that obese children have more deficits in impulse control than normal weight children.
Methods
The sample consisted in 44 obese children seeking treatment from a pediatric unity and 45 normal weight children from a primary school (9 to 16 years-old). The sample was evaluated on impulsivity (BAS/BIS), and binge-eating episodes (C-BEDS).
Results
The percentage of BED and overeating episodes in the obese group is higher that in the non-obese group. However, when only LOC is considered, both groups report having this kind of episode occasionally, and there were no differences between them. There are no differences in impulsivity between obese and non obese group, but the children which shows loss of control episodes scores higher in this variable.
Conclusion
According to our results, the experience of LOC is common in children in general, despite their weight. According to previous research the presence of binge eating episodes is more common in clinical obese samples. It is important to note and assess the presence of episodes of binge eating in children seeking weight loss treatment.
Obes Facts. 2009 May 14;2(Suppl 2):218.
Introduction
From “Emotional Intelligence” concept (Mayer e cols, 1997; 2000), that in this study is redefined, it is studied the context the personal strategies in Emotional Competence (Goleman, 1998; Saarni, 2000) differences in a person before (obese) and after (non obese) a 39Kg weight loss, by the self conscience, self motivation, emotions management, empathy and emotions management in a group.
Methods
Qualitative and longitudinal study (two years), conducted by deep interviews with two instruments: Veiga Branco Emotional Intelligence Capacities Scale and interview guide. The case study is about a 42 year old female, widow, with 122Kg (initial) and 83Kg now. The weight loss was induced by gastric band, healthy process.
Results
Initially (obese) the self conscience profile was focused mostly in the interaction and rumination of negative emotions connected to “personal defect by the fat”, the self motivation profile before and after the weight loss is evidently egocentric, the emotion management profile before and after weight loss present adaptive strategic differences with more body exposure.
Conclusion
Good levels of self conscience, self motivation, emotion management, empathy and emotions management in a group before and after weight loss. The thin self conscience and self motivation profiles present more focused in credibility of a better body image and in the achieving of individual and social opportunities.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):218.
Introduction
There is growing evidence that the glycaemic index (GI) of the diet is important with respect to body weight and metabolic disease risk. However, research is limited by the paucity of GI values for commonly-consumed carbohydrate-rich foods in European nutrient databases. A new methodology has been developed for consistent assignment of GI values to foods across centres in the Diogenes intervention study.
Methods
GI values were assigned according to 5 decreasing levels of confidence: 1) Measured - for country specific foods; 2) Published - from published sources; 3) Equivalent - where published values for similar foods existed; 4) Estimates - three values (45/63/85) were selected representing low/medium/high GI ranges; 5) Nominal − 70, where no other value could be assigned with sufficient confidence. Foods from national food composition tables were used for Denmark, Netherlands, UK, Germany and Czech Republic whereas Spain, Greece and Bulgaria used the UK food tables.
Results
GI values were assigned to over 10,000 foods. The contribution to carbohydrate intake of foods assigned levels 1-2 ranged from 20% in the Czech Republic to around 45% in the Danish and Dutch cohorts. Including level 3 increased the figure to almost 90% in Denmark, 75% in the UK, but only 50% in Spain and Czech Republic.
Conclusion
The degree of confidence of assigned GI values differs across Europe. This standardised approach of assigning GI values to European foods will be made available to other researchers to further investigation into the effects of dietary GI. (Diogenes number 1.54)
Conflict of Interest: None Disclosed. Funding: Research relating to this research was funded by the EU contract nr: Food −2005-CT-513946
Obes Facts. 2009 May 14;2(Suppl 2):218.
Arterial stiffness is emerging as one of the most important determinants of increased systolic and an important cause of a host of complications of atherosclerosis. The most often used measure of arterial stiffness is pulse wave velocity (PWV). Since low glycaemic index (GI) diets have beneficial effects on body weight related variables such as appetite and energy intake, and high prevalence of insulin resistance in obese subjects, we examined the postprandial effect of the GI of meals on plasma insulin and PWV.
Eleven subjects were recruited for this randomized crossover study. After a 10-hour fasting over night, PWV was measured by Sphygmocor® and fasting blood sample was taken. Then an isocaloric low GI (GI 46) or high GI (GI 66) breakfast with identical carbohydrate (60 gram), protein (19 gram), fat (12 gram) and fibre (12 gram) was provided. Blood samples were taken at 30 minutes intervals for 2.5 hours. PWV was re-measured 4 hours after start of the meal. In the non-intervention leg, no breakfast was given (subjects remained fasted) and no blood sample was taken. The area under the curve (AUC) for postprandial insulin after low and high GI breakfast was calculated.
| Beginning of the study m/s | End of the study m/s | Mean difference m/s | AUC for Insulin | |
|---|---|---|---|---|
| Non-intervention | 6.3±0.9 | 6.3±1.0 | 0.05±0.18 | n/a |
| Low GI | 6.4±1.0 | 6.2±1.0 | − 0.17±0.27 | 10088±4700 |
| High GI | 6.1±0.8 | 6.2±0.8 | 0.06±0.2 | 16250±7600 |
There was a significant reduction in PWV and insulin after the low GI intervention (multivariate ANOVA, paired t-test, pvalue <0.05). This study suggests that some of the beneficial effects of a low GI diet may relate to improved postprandial vascular function. This may be used as part of advice for a healthy life-style in prevention of obesity and its complications.
Obes Facts. 2009 May 14;2(Suppl 2):218–219.
Introduction
This 2-year randomized controlled study evaluated the effects of a weight control program on several key eating self-regulation variables, and assessed how eating-related changes predicted 12-month (intervention's end) and 24-month weight reduction, in overweight/obese women.
Methods
239 women (37.6±7.1y; 31.5±4.1kg/m2) participated in a 1-year behavioral program (86% retention). Controls received a health education program. The Dutch Eating Behavior Questionnaire (DEBQ), the Three-Factor Eating Questionnaire, and the Eating Self-Efficacy Scale assessed eating behavior at baseline and one year. Single and multiple mediation, and indirect effects were evaluated following Preacher and Hayes (2008).
Results
Intervention effects were favorable and significant for all eating behavior variables (12-month effect sizes 0.30-1.59; p<0.002 vs. controls) and for 12-month (−7.3±5.9%) and 24-month (−5.5±7.7%) weight change (p<0.001). Adjusted for intervention group, independent predictors of 12-month weight change were flexible cognitive restraint (p=0.001) and DEBQ emotional eating (p=0.004); for 24-month outcomes, only flexible restraint entered the stepwise regression model (p=0.02). Emotional eating (12-month) and flexible restraint (12-month and 24-month) partially mediated intervention effects on weight (R2=0.30 and 0.08 for 12-month and 24-month change, respectively); total indirect effects were B= −0.14 (p<0.001) for 12-month, and B= −0.06 (p=0.03) for 24-month outcomes.
Conclusion
Widespread positive effects on eating behavior were observed as a result of this intervention, namely reductions in external and emotional eating, and increases in cognitive restraint and self-efficacy. Although all changes were significantly associated with intervention-related weight loss, especially emotional eating and flexible restraint, only the latter mediated long-lasting intervention effects on body weight (i.e. weight loss maintenance).
Funding: Research relating to this study was funded by the Portuguese Science and Technology Foundation, Calouste Gulbenkian Foundation, Oeiras City Council, IBESA, and Nestlé - Portugal.
Obes Facts. 2009 May 14;2(Suppl 2):219.
Introduction
The protein leverage hypothesis [1] predicts that when protein availability changes, protein (P): non-protein (NP) energy alters to preserve P intake. This randomised crossover study investigated energy intake (EI) in humans consuming diets of varying P:NP energy under standardised conditions.
Methods
10 lean, healthy, unrestrained eaters attended 3 five-day residential periods. On days 1-3 subjects consumed ad libitum food providing 10, 15, or 25%P, 60, 55 or 45% carbohydrate, and 30% fat. EI was calculated. On day 4 EI was fixed. Subjects completed hourly appetite visual analogue scales and were weighed on days 1 and 5.
Results
One subject was excluded as EI exceeded requirements by 52 − 84%. EI while consuming 25%P (8.1 MJ/d, SE 1.0) was significantly lower than 15%P (8.7 MJ/d, SE 1.0) (P = 0.001). There was no evidence of a difference between 10%P (8.4 MJ/d, SE 1.0) and 15%P or 25%P. AUC fullness scores were significantly higher during 25%P (871.3 mm, SE 76) than 15%P (787.6 mm, SE 75.9) (P = 0.001) or 10%P (810.1 mm, SE 75.9) (P = 0.018). There was no evidence of a difference between treatments in the change in body mass over five days (25%P −0.40 kg, SE 0.26, 15%P −0.34 kg, SE 0.26, 10%P −0.34kg, SE 0.34) (P = 0.96).
Conclusion
Modest increases in the proportion of energy from protein increase fullness and decrease EI, supporting the protein leverage hypothesis. However, the effect size is small and lacks a dose response effect when protein intake is reduced.
Conflict of Interest: None Disclosed. Funding: Research relating to this abstract was funded by MRC Human Nutrition Research and the Wellcome Trust Clinical Research facility.
References
- [1].Bliddal H, Christensen R. Obes Rev. 2006 Nov;7((4)):323–331. doi: 10.1111/j.1467-789X.2006.00252.x. [DOI] [PubMed] [Google Scholar]
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Obes Facts. 2009 May 14;2(Suppl 2):219.
Introduction
Epidemiological evidence suggests a beneficial role of whole grains in chronic diseases. This study aimed to investigate the effects of intake of 48g whole grain on appetite and food intake compared to refined grain.
Methods
In a randomised, crossover study 14 healthy adults (5M:9F, 26±5.4 years, BMI 21.8±2.8kg/m2) consumed, within their normal diets, either 2 whole grain bread rolls (providing 48g milled whole grains over 2 rolls) or a control roll (refined grain) for 3 weeks. Changes to appetite and food intake were assessed using 7 day dietary records completed during the last week of each intervention, and a postprandial study day (at the beginning and end of each intervention) where subjective measures of appetite were taken and an ad libitum test meal given to quantify food intake.
Results
There was no significant difference between the whole grain and control interventions in energy intake from the 7 day dietary records or in subjective appetite ratings for hunger, fullness or prospective food consumption on the postprandial study days. There was also no significant difference in energy intake at the ad libitum test meal, either between treatments or from beginning to end of each intervention. However, at the end of the interventions systolic blood pressure was significantly lower with whole grains compared to control (112.4mmHg vs 117.1mmHg; p=0.04).
Conclusion
This study found that in healthy people whole grains do not appear to affect appetite or food intake; however there did appear to be a beneficial effect of whole grains on systolic blood pressure.
Conflict of Interest: None. Funding: Research relating to this abstract was funded by Premier Foods.
Obes Facts. 2009 May 14;2(Suppl 2):219–220.
Introduction
Although prealbumin is known as a sensitive nutritional marker in patients with chronic renal disease, virtually there are no studies for prealbumin in renal transplant patients. Therefore, incidence of both, malnutrition and obesity, have been mentioned in these patients. The aim is to determine prealbumin levels and compare it with other nutritional, anthropometric markers and clinical data, in renal transplant patients.
Methods
154 renal transplant patients participated in this study. Renal transplant patients were divided into 3 groups, based on the year of transplantation (1st year, 1st-2nd year, 3rd-10th year). The definition of malnutrition was based on Kidney Disease Outcomes Quality Initiative (K/DOQI) for biochemical markers and on WHO Consultation on Obesity for anthropometric markers.
Results
Prealbumin levels indicate severe malnutrition in renal transplant patients (6.79±23.02mg/dl) whereas albumin levels are normal based on K/DOQI (4.29±0.46g/dl). Cholesterol and creatinine levels are slightly high compared with normal values (216.63±48mg/dl, 1.6mg/dl, respectively). Prealbumin levels were significantly positive correlated with albumin (r=0.202, p=0.015). Furthermore, prealbumin levels were significantly higher in the 1-2nd transplant group compared with the 1st year transplant group (p=0.027). Furthermore, immunosuppressive treatment (cyclosporine and prograff) and the type of the kidney donor (cadaver-living, related-unrelated) did not have any significant association with prealbumin levels.
Conclusions
Prealbumin is a more sensitive marker of nutritional status compared with serum albumin. Albumin and other anthropometric markers indicate normal nutritional status. However, prealbumin is an independent nutritional marker and its level appears to be very low in patients with renal transplantation, especially in the 1st year transplant patients.
Obes Facts. 2009 May 14;2(Suppl 2):220.
Introduction
Osteoarthritis of the knees often limits physical activity and prevents weight reduction [1]. We tested the hypothesis that radiological severity of OAknees would not affect response to an effective weight loss programme using very low energy diet (VLED) or part-formula/part-food low energy diet (LED)[2].
Methods
Forty seven obese (BMI>30) patients (mean age 62.8 years, 3 men, 44 women) with OA in one or both knees were X-rayed. A total Kellgren-Lawrence (KL) score (sum of all 3 compartments, medial, lateral and patellar) was calculated (range: 0-12). Body weight was measured at 0 and 8 weeks and patients used products from the ‘Cambridge Health & Weight Plan’ (415 kcal or 810 kcal/d). For the purposes of this report data for both diet treatments were pooled.
Results
One of the initial 48 patients withdrew early. Body weight was reduced by 11.4kg (95%CI 10.2-12.5 kg), (11.0% of initial body weight (p<0.0001) from 102.4 kg (SD 13.2; range 84.4–143.8 kg), BMI 38.0 kg/m2 (SD 3.6; range 31.0–48.4). Median total K-L score was 5 (range: 1–10), medial compartment 2 (0–4), lateral compartment 1 (0–3), patellar compartment 2 (0–4). K-L score and BMI at baseline (r=0.21; P=0.17) were not correlated.
Conclusion
Whereas knee OA may often be perceived as a barrier to successful weight loss these patients achieved meaningful weight loss on the ‘Cambridge Health & Weight Plan’. The results show that radiographic knee status is not important for weight loss. Bad knees are no excuse for not losing weight.
Funding: The Oak Foundation, The Velux Foundation, The Cambridge Health and Weight Plan, The Danish Rheumatism Association, The Augustinus Foundation, The Danielsen Foundation.
References
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- [2].Identification number: NCT00655941
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Obes Facts. 2009 May 14;2(Suppl 2):220.
Introduction
In order to learn more about the effects of weight loss programs on physiological and social-psychological parameters, we evaluated four different approaches.
Methods
Thirty-nine women, aged 30-65 y and BMI between 27 and 40 kg/m2, were randomly assigned to one of four programs: 1.a commercial weight loss program with two visits per week, 2. using two self-help books of Sonja Bakker (SHB), 3. visits to a dietician once per month, 4. receiving information on a healthy diet. At baseline and after 3, 12, 20, 29 and 40 weeks, anthropometry and blood pressure were measured, and participants filled out questionnaires on physical activity, and food consumption. In total 7 subjects, divided over the intervention groups, left the study but were only partly lost for measurements.
Results
Only the CWLP-group had a significant weight loss as compared to the control group. After 40 weeks, the CWLP group lost on average 12.1% (95% CI 1.6 − 16.7%) of their initial weight, the SBH group −4.1% (95% CI −2.0-10.1%), the dietician group −6.7% (95CI 3.6-9.7%), and the control group −4.7% (95CI, 0.9-8.5%). All groups significantly decreased their energy intake, but significant reductions in waist circumference, blood pressure, and increase in intense physical activity were only seen in the CLWP-group.
Conclusion
We conclude that intensive personal guidance seems to be the most successful approach to achieve weight loss for the medium-long term.
Conflict of interest: CLWP Ladyline provided equipment and personnel for guidance of the women in the CLWP group. Funding: No funding
Obes Facts. 2009 May 14;2(Suppl 2):220.
Introduction
Detrimental effects of a high salt intake beyond blood pressure have been reported e.g. increases in left-ventricular mass. However the effects of salt on vascular function as assessed by brachial artery flow-mediated-dilatation (FMD) are unknown. Our aim was to determine the effects of a low salt compared with a usual salt diet on measures of vascular function.
Methods
Subjects followed a 50mmol Na/day diet (LS) and a 150mmol Na/day normal salt diet (NS) for two weeks in a randomised cross-over manner. Both diets were similar in potassium and saturated fat content. After each intervention, FMD, pulse wave velocity (PWV), augmentation index (AI), systolic (SBP) and diastolic (DBP) blood pressure were measured.
Results
29 obese, normotensive subjects (BMI 31.6±2.8 (kg/m2, SBP 116±10 mmHg) completed the study. The LS diet improved FMD from 3.37±2.10% to 4.89±2.42% (NS vs LS respectively, P=0.001). SBP decreased by 5mm Hg on LS (P=0.02). 24-hour sodium excretion was decreased on LS compared with NS (LS 64.1±41.3 vs. NS 156.3±56.7 mmol/24hr; P<0.05). There was no correlation between change in FMD and change in 24-hour sodium excretion or change in BP. AI and PWV did not change.
Conclusions
Modest salt reduction improved endothelium-dependant-vasodilation in normotensive subjects independently of the changes in blood pressure. These results have implications for the dietary management of individuals at risk of cardiovascular disease.
Conflict of Interest: The authors have no conflict of interest in relation to this abstract. Funding: This study was funded by the CSIRO PHealth Flagship
Obes Facts. 2009 May 14;2(Suppl 2):220–221.
Introduction
Quality of Life (QoL) is impaired in people with type 2 diabetes (DM2). An improvement in QoL could increase patients’ compliance with their diabetes treatment, resulting in positive adjustments in lifestyle and diabetes care and is thus very important. Therefore we evaluated the effects of a very low calorie diet (VLCD) +/- exercise on QoL in obese, insulin-treated, DM2 patients.
Methods
27 obese, insulin-dependent DM2 patients were assigned to a 16-week VLCD+/-exercise with cessation of all glucose-lowering medication. Before and after the intervention, anthropometric measurements, glycemic control and QoL were assessed. Four different health-related QoL questionnaires were used (SF-36, HADS, NHP and MFI-20). Patients were compared to healthy controls of the same gender, age and geographical area.
Results
All patients lost a significant amount of weight (−26.0±1.2kg) and had considerably better glycemic control (HbA1C 7.8±0.2% vs 6.2±0.2%) without any medication. QoL improved with respect to anxiety, depression, total score (HADS, P<0.01), general fatigue, physical fatigue (MFI-20, P<0.001), activity, motivation (MFI-20, P<0.01), energy, physical ability (NHP, P<0.01), physical functioning, health change (SF-36, P<0.001), role limitations due to physical problems, social functioning (SF-36, P<0.05) and general health perception (SF-36, P<0.01). No additional effect from exercise was observed on QoL scores. At baseline, patients had significantly lower QoL scores in 14 of the 22 parameters than healthy controls. After the 16 week intervention only 5 of the 22 parameters differed from healthy controls.
Conclusion
A 16-week VLCD+/-exercise induces considerable weight loss, metabolic improvement, and major improvements in QoL in obese, insulin-dependent DM2.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):221.
Introduction
Fatty acids of marine origin, i.e. docosahexaenoic and eicosapentaenoic acid (DHA and EPA, respectively) act as hypolipidemics, but they do not improve glycemic control in diabetic patients. Thiazolidinediones, like rosiglitazone, i.e. specific activators of peroxisome proliferator-activated receptor-gamma improve whole-body insulin sensitivity. We hypothesized that a combination treatment by a DHA and EPA concentrate (DHA/EPA) and rosiglitazone would provide, by complementary mechanisms, additive beneficial effects on dyslipidemia and impaired glucose tolerance (IGT) in obesity.
Methods
Male C57BL/6 mice were fed high-fat diet. The effects of DHA/EPA (replacing 15% dietary lipids), or rosiglitazone (10 mg/kg diet), or combination of both DHA/EPA and rosiglitazone on body weight, adiposity, metabolic markers and adiponectin in plasma, liver and muscle gene expression and metabolism were analyzed. Hyperinsulinemic-euglycemic clamps were used to characterize the changes of glucose homeostasis. The effects of the treatments were also studied in obese diabetic mice, following the high-fat feeding.
Results
DHA/EPA and rosiglitazone exerted additive effects in prevention of obesity, dyslipidemia, and IGT, while suppressing hepatic lipogenesis and inducing adiponectin. The improvement of IGT and insulin-sensitivity was largely independent on fat accumulation, it reflected a synergistic effect of DHA/EPA and rosiglitazone on muscle glucose metabolism, while hepatic glucose output was decreased by DHA/EPA and not by rosiglitazone. The combination treatment even reverted obesity, dyslipidemia and IGT.
Conclusion
DHA/EPA and rosiglitazone may be used as a complementary therapies to counteract dyslipidemia and insulin resistance. The combination treatment may reduce dose requirements and hence the incidence of adverse side-effects of the thiazolidinedione therapy.
Obes Facts. 2009 May 14;2(Suppl 2):221.
Introduction
Psychotropic drugs are frequently associated with weight gain. Typical antipsychotics that have been recently released have better results when treating the disease, but the problem of weight increase still remains. The results of a long term dietary intervention program in psychiatric patients are presented in this study.
Methodology
365 psychiatric patients (mean age 39,3 +/− 11,2 years) participated in the study (290 women and 75 men). Anthropometric measurements, measurement of Basal Metabolic Rate (BMR), dietary intake, clinical and biochemical data (total cholesterol, LDL cholesterol, triglycerides, etc.) were collected. A personalised diet, based on the Mediterranean diet, was given for weight control in each patient by a dietician. The patients were visiting the dietician every two weeks. Results were analysed after three and six months of intervention. The statistical analysis was processed with SPSS.
Results
According to the results, mean BMI of the participants was 34,6 +/− 6,7 and mean % body fat was 38,8 +/− 7,7. The mean body weight decrease was 5,7 +/− 4,5 Kg after three months and 9,1 +/− 6,2 Kg after six months. The mean % body fat decrease was 2,6 +/− 3 Kg and 4.,4 +/− 3,8 Kg respectively. Mean weight loss was higher for patients with depression compared with patients with psychosis, schizophrenia etc. Mean total cholesterol, LDL cholesterol, triglycerides and blood sugar values were also decreased.
Conclusion
The dietary intervention program for psychiatric patients has been very successful in reducing body weight, body fat and improving specific biochemical parameters.
Obes Facts. 2009 May 14;2(Suppl 2):221.
Introduction
Recent studies have shown binge eating disorder (BED) to be the most common eating disorder diagnosis, with special high prevalence rates among people seeking for weight loss treatments. Specific instruments to assess BED are needed, as the Questionnaire on Eating and Weight Patterns-Revised (QWEP-R; Spitzer, Yanovski and Marcus, 1994). The aim of this study is to validate this questionnaire into Spanish population.
Methods
Participants of this study were 467 people who completed the QWEP-R questionnaire in order to be assessed regarding binge eating disorder. The sample was formed by clinical sample (27%), general sample (34%) and undergraduate students (39%). The mean age was 33.3 years (SD = 14.8) and the mean Body Mass index (BMI) was 26.7 (SD = 8.8). The 26% of the sample were men, while the 74% of participants were women. The 42% of the sample were overweight or obese people.
Results
According to the binge eating criteria proposed by the DSM-IV, the 1.8% was diagnosed as binge eaters (n=8). Also, two people were diagnosed with purging bulimia nervosa and one person was diagnosed with non-purging bulimia nervosa. Of those people with binge eating disorder, most of them (87.5%) were overweight or obese and only the half of them belonged to the clinical sample, while the other half were students.
Conclusions
This study provides with the first questionnaire in Spanish language specifically designed to diagnose binge eating disorder. Most of the binge eaters of this sample were overweight and obese people, but not necessary belonging to the clinical sample.
Conflicts of interest: The authors declare no conflicts of interest. Funding: Research related to this abstract was funded by grant 2008FIC 00119, from the Generalitat de Catalunya.
Obes Facts. 2009 May 14;2(Suppl 2):222.
Introduction
Determining critical periods for weight gain is crucial when dealing with increased obesity levels among all ages. This study purposed in assessing potential change in body weight (BW) during a two-week long holiday season (Greek-Orthodox Easter) in male and female medical students.
Methods
92 healthy male and female medical students (23.9±2.4 yrs, 74,6±12.1 kg, 1,737±0,101 m, 24,2±4.1 kg/m2) completed two visits within the weeks prior to and immediately following the Greek-Orthodox Easter break (GOEb). BW was measured to the nearest 0.1 kg using a balance beam scale, while participants were dressed in minimal clothing. Height was measured to the nearest 0.1 cm using a stadiometer. Paired t-tests were used to assess changes in BW pre and post GOEb with additional analysis by gender and body mass index (BMI).
Results
Average BW was found significantly higher overall (P<0.05) after the GOEb (+1,3 kg), and also when stratified by gender (P < 0.05) (males: +1,2 kg, females: +1,0 kg). After classification for BMI (>/=,< 25kg/m2) a significant weight gain was found in the overweight/obese subgroup (P<0.05), while for the normal BMI group the weight gain was borderline non significant (P=0,058)
Conclusion
Our data show a significant weight gain during the GOEb, which in long-term (if subjects retain this weight gain throughout the year) can lead to overweight and/or obesity. Neverthells, the overweight/obese subgroup (which had the the greatest BW increasement) may be at higher risk for weight gain and further obesity development during every holiday season.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):222.
Introduction
To compare the effect of a high-protein-diet (HP) versus a normal-protein-diet (NP) in women with polycystic ovary syndrome (PCOS).
Methods
A controlled 6-month trial was conducted in 58 women with PCOS. The women were randomized to two ad libitum diets: HP (>40 E% protein and 30 E% fat) and NP (<15 E% protein, 30 E% fat). The women received monthly dietary counselling. At baseline, 3 and 6 months anthropometric measurements were performed and blood samples collected.
Results
27 completed the study. The HP-group increased fat and protein intake (to 26 E%), and decreased carbohydrate intake. The NP-group decreased fat and increased carbohydrate intake (protein 14 E%). The HP-group reduced more weight (HP: 7.7±1.6kg, NP: 3.2±1.1kg; P=0.002) and waist circumference (HP: 7.4±1.5cm, NP: 3.6±1.3cm; P=0.04) than the NP-group. The HP-group decreased glucose concentrations, which persisted after adjusting for weight changes. After adjusting for changes in waist circumference the LS-means for total (P=0.02) and free testosterone (P=0.03) was higher in the HP-group compared to the NP-group. In the intention-to-treat analysis the difference in testosterone was only a trend. In the intention-to-treat analysis a lower response in C-peptide (P=0.04) and triacylglycerol (P<0.05) in the HP-group compared to the NP-group was shown; the difference in triacylglycerol disappeared after adjusting for weight changes. No differences in sex-hormone-binding-globulin, total cholesterol, HDL or LDL between the groups were seen.
Conclusion
Ad libitum HP diets are a promising treatment approach for PCOS-women, although further investigations in the effect of a HP diet on testosterone concentrations are needed.
Conflict of Interest: None Disclosed. Funding: Research relating to this abstract was funded by the Foundation for Professional Development of Practices of Medical Specialists, and the Danish Meat Association
Obes Facts. 2009 May 14;2(Suppl 2):222.
Background
Weight regain is a complex accomplishment that depends on many environmental, behavioral and genetic influences. The Three Factor Eating Questionnaire (TFEQ)-R18 measures 3 aspects of eating behavior.
Objective
We examined the biological, psychological, and genetic determinants associated with weight regain following a weight-loss program using meal replacements.
Methods
Thirty-two obese female (n=32) followed an 8-wk diet with meal replacement drinks (diet's; SUNTORY Ltd.) under the guidance of a dietician. Nutritional counseling sessions were conducted 4 times (at baseline, at 1 wk, 4 wks, and 8 wks). Body weight, body composition, leptin concentration, dietary intake (based on 3-day food records), attitude toward eating (measured by the TFEQ-R18), physical activity, and polymorphisms of the ADRB3 genes were measured. One-year follow-up data were also collected.
Results
The drop out rate was 9.4%. Body weight loss was 4.6+/-1.9 kg and weight regain was 1.6+/-3.6 kg (+29.9+/-116.8). The cognitive restraint (CR) score at the 2-month intervention negatively correlated with weight loss (r= −0.615). The initial uncontrolled eating (UE) and emotional eating (EE) score were positively correlated with weight regain (r=0.486 and r=0.531, respectively), although the CR score did not correlate with weight regain. There was no difference in weigh regain between genotypes. The initial UE score or EE score was associated with weight regain independent of the weight loss and ADRB3 Trp64Arg allele on multiple regression analysis.
Conclusion
These findings suggest that both UE and EE at baseline predict weight regain, although initial CR is not useful.
Conflict of interest: None Disclosed. Funding: Research relating this abstract was funded by SUNTORY Ltd.
Obes Facts. 2009 May 14;2(Suppl 2):222–223.
Introduction
This study attempted to evaluate the effectiveness of nutrition education especially, in high nutrient density diet which promotes low carbohydrate, high protein and fiber.
Methods
35 women participated in the 12 week health management program with individualized fitness exercise and diet education (appropriate amount of food, recommendations for daily fruit, vegetable, seaweed and dairy products intake, regular dietary habits, etc.) in Suwon health promotion center, Korea. Anthropometric measurement, body composition measurement, a 3-days food record for dietary intake and questionnaire response including nutritional knowledge and eating habits were conducted at the beginning and the end of this program.
Results
Intake of carbohydrate decreased significantly compared to that before the education (p<0.05). When comparing the ratio of carbohydrate: protein: fat, it was changed from 59.1: 17.0: 23.8 (before the education) to 56.2: 19.0: 24.8 (after the education). The ratio of protein was significantly increased after educational program (p<0.05). The energy-adjusted intake of riboflavin and animal calcium became closer the dietary reference intake. After the program, nutritional knowledge and eating habit score increased significantly (from 64.4 to 73.3, from 78.2 to 83.2, respectively, p<0.01). Body Mass Index, body fat percent and visceral fat area significantly decreased in the overweight and obese group, but it did not in the normal weight group (p<0.05).
Conclusion
These results show that nutrition education which focuses on a nutrient density diet could help improve dietary habits, diet quality and body composition in Korean women.
Obes Facts. 2009 May 14;2(Suppl 2):223.
Introduction
The role of glycemic index on appetite and weight regulation is not yet clarified.
Aim
The objective of our study was to investigate the effect of diets varying in glycemic index (GI) (low vs. high) on the anthropometric parameters in overweight and obese patients.
Materials and methods
The study was randomized intervention trial for a 4-month period with ad libitum intake of low vs. high glycemic index foods. A total of 40 subjects were enrolled in the trial randomized into three dietary intervention arms: 1-st group (n=15) on low GI diet; 2-d group (n=15) on high GI diet and 3-d group (n=10) on control diet. All the patients were with normal values of arterial blood pressure, serum lipids and blood sugar. The mean values before the study were: age-40.38 years, body weight-90 kg, BMI-33.5, fat mass-34.5 kg, fat free mas-54.14 kg, waist circumference-100.5 cm, hip circumference-114 cm, waist-to-hip ratio-0.88.
Results
At the end of the dietary intervention period the anthropometric parameters were beneficially decreased in both groups (low vs. high GI diets). No significant differences were observed within the groups in the studied parameters.
Conclusion
The results from our study show that there is no effect of the different glycemic index diets in the treatment of overweight and obese patients.
Obes Facts. 2009 May 14;2(Suppl 2):223.
Introduction
Increased sugar containing beverage (SCB) consumption has been associated with excessive weight gain in adolescents. We compared the self-reported intake of SCB in adolescents from the DOiT study (targeting all first year students of prevocational education) with those from the GO4IT study (targeting overweight and obese adolescents attending an outpatient hospital ward).
Methods
All adolescents (mean age 12.7±0.5 y) completed a questionnaire on consumption of SCB. DOiT participants completed the questionnaire at school, GO4IT participants at the VUMC obesity outpatient ward. Groups were compared with t-test for independent samples. Regression analysis was conducted to asses the relation between BMI category and SCB consumption. Means (SD) are presented.
Results
| DOiT | GO4IT | |||
|---|---|---|---|---|
| Normal weight (n=552) | Overweight (n=119) | Obese (n=15) | Obese (n=36) | |
| Height (m) | 1.58 (0.1) | 1.60 (0.1) | 1.61 (0.1) | 1.62 (0.1) |
| Weight (kg) | 44.6 (7.0) | 58.7 (7.8) | 76.7 (10.8) | 85.4 (12.2) |
| BMI (kg/m2) | 17.7 (1.8) | 22.8 (1.7) | 29.3 (2.8) | 32.4 (3.0) |
| BMIsds | − 0.25 (0.87) | 1.56 (0.33) | 2.63 (0.29) | 2.96 (0.26) |
| SCB consumption (ml/day) | 884 (710) | 736 (592) | 551 (427) | 449 (491) |
The GO4IT group reported a significant lower SCB consumption compared to the total DOiT group (p<0.001); however, SCB consumption between the GO4IT group and the obese DOiT subgroup was comparable (p=0.49). SCB consumption decreased with 191 ml/day (95% CI: −274 to −108) per BMI category.
Conclusion
Self-reported intake of SCB was significantly lower among obese adolescents. Possible explanations are that obese adolescents underreported their SCB consumption or that the lower SCB consumption is due to dieting behavior.
Conflict of Interest: None Disclosed. Funding: Research was funded by The Netherlands Organization for Health Research and Development (ZONmw) and the Dutch Heart Foundation.
Obes Facts. 2009 May 14;2(Suppl 2):223–224.
Introduction
Weight reduction in obese patients with osteoarthritis (OA) knees is difficult to achieve due to reduced mobility [1]. Proven weight loss methods are needed. We studied body weight response to a Very Low-Energy Diet (VLED) or Low-Energy Diet (LED) followed by a 1200 kcal/d diet as part of an ‘efficacy in OA trial’ [2].
Methods
Patients, weighed weekly over 16-weeks, consumed ‘Cambridge Health & Weight Plan’ (CHWP) products, providing 415 kcal/d or 810 kcal/d for 8 weeks [2,3] followed by a 1200kcal/d diet for 8-weeks (part food, part formula [2 CHWP products]). Data from the VLED & LED diets was pooled for this report.
Results
Forty-seven (44F) obese patients with OA knees (mean age 62.8 years, SD: 6.9; range: 50-75 y), and motivated to lose weight participated. Baseline average body weight was 102.4 kg (SD 13.2; range 84.4–143.8 kg), BMI 38.0 kg/m2 (SD 3.6; range 31.0–48.4). One patient of the initial 48 withdrew early. Calculated as intention-to-treat (N=47) weight reduced significantly (P<0.0001) by 11.4 kg (95%CI 10.2-12.5 kg), (11.0% reduction of initial body weight - IBW) after the VLED/LED diet [3]. By 16 weeks they had lost 17% (95% CI: 16–19%) of IBW (see FIGURE). Weight regain did not occur during the 1200 kcal/d diet.
Conclusion
A Cambridge (CHWP) formula based VLED/LED followed by a part food, part formula 1200kcal/d diet gave effective, clinically meaningful weight loss in a secondary care environment. The low drop-out rate indicated a high level of acceptability.
Conflicts of interest: ARL is Medical Director of CHWP. Funding: The Oak Foundation, The Velux Foundation, The Cambridge Health and Weight Plan.
Figure 1.
Obes Facts. 2009 May 14;2(Suppl 2):224.
Introduction
Higher concentrations of leptin and lower adiponectin levels have been implicated in the development of insulin-resistance, the metabolic syndrome (MetS) and increased risk of cardiovascular disease (CVD). The purpose of this study was to assess the influence of adipocytokines on atherosclerosis progress in obese patients.
Methods
110 obese patients (aged 52±7 years), were compared to a non-obese group of 50 patients (aged 54±4 years), all without clinical evidence of atherosclerosis. BMI < 30 kg/m2 was used as criteria for determining obese patients. BFM and body fat percent (%BF) were measured using bioimpedance analysis (BIA). Fasting plasma glucose, HbA1c, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, plasma insulin, adiponectin and leptin were measured according to standard procedures. Insulin resistance was measured using HOMA-IR index.
Results
Mean BMI, mean %BF, mean BFM and mean WHR were significantly greater in obese group (BMI− 33.12 kg/m2 vs 28.6; %BF − 35.26 vs 26.46; BFM − 31.39 kg vs 24.76; WHR − 1.17 vs 1.02). BMI was statistically correlated with BFM (p<0.0001) and %BF (p<0.0001). Intima-media thickness was significantly increased in obese patients (0.87 +/− 0.07 mm vs. 0.77 +/− 0.06, p=0.002) and was correlated with %BF (p<0.001), WHR (p=0.016), leptin values (p<0.001), adiponectin values (p<0.05) and leptin/adiponectin ratio (p<0.001).
Conclusions
In obese patients IMT is significantly greater compared to non-obese subjects and it is correlated with waist-to-hip ratio, body fat percent and body fat mass, leptin, adiponectin and leptin/adiponectin ratio, suggesting that adipocytokines levels may predict atherosclerosis progression.
Conflict of interest: None Disclosed; Funding: A part of this study was supported by the Romanian National Authority for Scientific Research as a part of the PNCDI 2 program DIADIPOHEP 41-008/2007.
Obes Facts. 2009 May 14;2(Suppl 2):224.
One of the most significant problems of obesity treatment is the problem of motivation of patients to observance of recommendations of the doctor.
The aim of the present study was working out of the most effective strategy of treating patients with obesity I-III in ambulance.
Methods
70 women with a obesity I-III (BMI 30-45) at the age of 20 − 50 years were studied, and follow-up were 2 − 9 months. Weight losses were assessed by data of the bioimpedance analysis and anthropometrics tests. To patients recommended a diet, caloric content 1200 − 1600 kcal in depends on settlement value of the basic exchange, based on food pyramid.
Results
The received results have shown that the greatest weigh loss was marked within the first month of therapy - on 5,1% from baseline; the maximum reduction - by 9 month on 18,2±5,3%. The reduction of fatty weight within the first month has made 10%, in a distance − 5,4% a month. We have shown linear dependence between degree of weight loss in the first month of treatment and adherence to treatment.
Conclusion
For optimum motivation of patients on weight reduction we recommend to achieve more considerable reduction of weight of a body in the first month.
Obes Facts. 2009 May 14;2(Suppl 2):224.
Background
Up to 80% of the diabetes mellitus type 2 population are overweight. Effective weight control can lead to improvement or even resolution of diabetes. Bariatric surgery represents a suitable option for sustained weight loss in severely obese-diabetic subjects. Conservative treatment results in reduced weight loss for diabetic patients when compared to a non-diabetic control group. There is little evidence whether this difference also exists after bariatric surgery.
Methods
The change in the diabetic status and weight loss in 85 (26m/59f, BMI 48.3 kg/m2) morbidly obese diabetic subjects undergoing bariatric surgery in a single institution was analysed. Evidence of stable treatment was required with oral antidiabetic agents or insulin. The control group consisted of 85 morbidly obese, non-diabetic patients, matched for age, sex, BMI and type of bariatric procedure.
Results
Mean excess weight loss (EWL) was 38.4% after six, 49.5% after 12 and 54.7% after 24 months in the diabetic group. In 76 (60.32%) subjects of 126 diabetes resolved completely and 36 subjects (28.57%) had significantly improvement of diabetes during 12 months. The control group exhibited an average EWL of 41.7% at 6 months, 54.1% at 12 and 58.6% after 24 months. There was no significant difference in weight loss between both groups at 6, 12 and 24 months.
Conclusion
Laparoscopic bariatric surgery resulted in significant, sustained weight loss leading to resolution or amelioration of diabetes in almost all patients. Contrary to conservative treatment there was no difference in EWL between the diabetic and non-diabetic group.
Key words
bariatric surgery, excess weight loss, diabetes mellitus
Obes Facts. 2009 May 14;2(Suppl 2):225.
Introduction
DEXA is a body composition evaluation method that can be associated to metabolic and anthropometric conditions.
Objective
To correlate the abdominal fat, estimated by DEXA, with anthropometric and metabolic characteristics in obese children and adolescents.
Methods
147 obese children and adolescents (44 boys, 54.4%pubertal, 10.9±1.5 years, BMI 29.7±4.2 kg/m2, BMIZscore 2.2±0.3) were evaluated by DEXA and classified into terciles according to the abdominal fat mass: Low Abdominal Fat (G1:3.32-10.9kg), Medium Abdominal Fat (G2:11-14.5kg) and High Abdominal Fat (G3:14.6-27.5kg). Metabolic (systolic-SBP and diastolic-DBP blood pressure, lipid profile, HOMA-IR, uric acid, leptin and adiponectin) and anthropometric (waist circumference-WC) data were obtained. ANOVA and Multiple Linear Regression tests were performed with SPSS.
Results
When we analyzed G1 and G3 we observed an association between abdominal fat mass and WC(cm) (G1=84.8±6.9 G3=105±7.8,p<0,0001), SBP(mmHg)(G1=106±14.8 G3=116±15.7,p = 0,002), DBP(mmHg)(G1=65.2±11.2 G3=73.8±13.1,p = 0,003), HOMA-IR(G1=2.3±1 G3 = 4.6±2.2,p<0,0001), HDL(mg/dL)(G1=45.5±10.5 G3=39.2±8,p<0,007), total triglycerides(mg/dL)(G1=88.1±44.1 G3=109±50.3,p = 0,036), uric acid(G1=4.5±0.9 G3=5.4±1.2,p<0,0001), adiponectin(µg/mL)(G1=13.9±5.5 G3=10.5±3.1,p = 0,008) and leptin(ng/mL)(G1=25.9±13.7 G3 = 47.4±23.9,p<0,0001). After adjustment to age and pubertal stage, the abdominal fat mass was associated to WC (β = 0.83,p<0.0001), SBP (β =0.31,p = 0.001), DBP (β =0.26,p = 0.005), HOMA-IR (β = 0.49,p<0.0001), HDL (β = −0.27,p=0.004), total triglycerides (β =0.18,p = 0.052), uric acid (β = 0.25,p=0.004) and leptin (β =0.58,p<0.0001).
Conclusion
Abdominal fat mass evaluated by DEXA could be used as an indicator of metabolic profile in obese children and adolescents.
Obes Facts. 2009 May 14;2(Suppl 2):225.
Introduction
It is unclear whether physical activity (PA) confounds the association between waist circumference (WC) and obesity related risk in the severely obese.
Methods
Severely obese outpatients (n=42) from an obesity outpatient clinic underwent a program of weight loss and increased PA (9 M, 33 F; age 44.4±13.1 yrs; BMI 41.9±5.5 kg/m2). PA was measured with the MTI accelerometer (7164, 2.2) during one week. Time spent sedentary (TSS), moderate and vigorous PA (MVPA), and total activity counts (TAC) was quantified. WC and metabolic risk factors were assessed according to standard protocols. A metabolic risk factor summary score (zMS-ob) was calculated from standardized values of systolic blood pressure, fasting plasma glucose, triglycerides and inverse HDL-cholesterol. All variables were measured at baseline and after 1 year.
Results:
All three PA variables were associated with WC at follow-up (r Δ TSS= −0.35, P=0.03; r Δ MVPA=0.36, P=0.03; r Δ TAC=0.37, P=0.02, adjusted for age, sex and baseline WC). None of the PA variables were associated with zMS-ob or HOMA-IR when including Δ?WC as a covariate. Δ?WC was associated with HOMA-IR and zMS-ob both before and after adjustment for all three PA variables (HOMA-IR unadjusted: β=0.126, P=0.002; HOMA-IR PA adjusted: β=0.108, P=0.010; zMS-ob unadjusted: β=0.138, P<0.001; zMS-ob PA adjusted: β=0.131, P=0.002).
Conclusions
PA was associated with reduced WC, but not with metabolic syndrome score or HOMA-IR. There was no evidence of effect modification by PA on the association between WC and obesity related risk factors in the severely obese.
Obes Facts. 2009 May 14;2(Suppl 2):225.
Introduction
Therapeutic tools for treatment of obesity are available but often not effective. We aimed to explore body changes in women participating in a commercial nationwide comprehensive weight loss program (CWLP) and to identify factors associated with weight loss outcomes.
Methods
Anonimized data of 1716 women (14-78 yrs), participating in a CWLP (including exercises, dietary advice, and personal coaching) was used. Women were classified as successful if they were able to reach 100% or more of their final weight loss goal. Predictors of weight loss were identified using multiple regression models.
Results
Baseline BMI of the women was 29.7 kg/m2 and mean CWLP duration was 40.2 wks. During CWLP they lost on average 8.6% (7.1 kg) of their initial weight, compared to a mean goal of −13.9%. Women who reached their goal were older, had less previous diet attempts, had lower weight loss goals, but reached more weight loss compared to the women who were not successful. Weight loss was mainly predicted by weight loss goal, but also by CWLP duration, baseline BMI, and number of pregnancies.
Conclusion
Women with lower and probably more realistic weight loss goals appear to be better able to reach their goal, and have better BMI loss outcomes.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):225–226.
Introduction
Overweight and obesity during pregnancy are associated with an increased risk of range of adverse health outcomes for women and their babies, including pre-eclampsia and hypertension, gestational diabetes, caesarean section and stillbirth. Complications for the infant include macrosomia, admission to neonatal intensive care, and treatment of hypoglycaemia.
The aim of our systematic review was to assess the benefits and harms of dietary and lifestyle interventions during pregnancy to improve maternal and infant outcomes for pregnant women who are overweight or obese.
Methods
Randomized controlled trials comparing any form of dietary or lifestyle intervention during pregnancy for women who are overweight or obese with no treatment to improve maternal and infant health were considered. The Cochrane Controlled Trials Register (CENTRAL), PUBMED, and the Australian and International Clinical Trials Registry, were searched; date of last search November 2008.
Results
We identified four published trials (one in abstract form) and four ongoing randomised trials. The published randomised trials compared a variety of dietary and lifestyle interventions ranging in intensity, and involving a total of 324 overweight or obese pregnant women. Meta-analysis indicates a dietary and a lifestyle intervention was effective in limiting weight gain during pregnancy (3 trials, 199 women, weighted mean difference −4.17kg, 95% CI −6.0 to −2.34). There were no statistically significant differences identified between the intervention and standard care groups for maternal or infant health outcomes.
Conclusion
There is limited information available assessing the benefits and harms associated with dietary and lifestyle interventions for overweight and obese pregnant women. Further evaluation through randomized trials with adequate power is required.
Obes Facts. 2009 May 14;2(Suppl 2):226.
Background
The aim of this study was to explore longitudinal changes in self-perceived mental health in patients with morbid obesity who participated in a lifestyle change weight loss program at a rehabilitation centre. The program consisted of a comprehensive diet and exercise intervention plus education in cognitive therapy techniques. Study participants were resident at the centre for six, four, and two weeks, with intervening periods of increasing length at home, up to the one year follow-up.
Methods
In this prospective cohort study, 47 patients (31 women and 16 men, mean age 44.5 years) completed the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) before -and one year after the treatment started. The follow-up rate was 80%. A paired t-test was used to analyze longitudinal changes in Body Mass Index (BMI), BDI and BAI. Multiple regression analysis was used to study if the degree of BMI-loss was associated with one-year follow-up data of BDI and BAI.
Results
The mean BMI was reduced from 44.8 kg/m2 (SD 6.4) to 39.5 kg/m2 (SD 6.6), p<0.001. The mean BDI was reduced from 11.4 (SD 6.7) to 5.8 (SD 8.8), p<0.001. The mean BAI was reduced from 10.0 (SD 7.5) to 5.1 (SD 6.7), p<0.001. No associations were found between the degree of BMI-loss, BDI and BAI.
Conclusion
The lifestyle modification program was associated with a significant improvement in BMI and self-perceived mental health.
Conflict of interest: None. Funding: The study was financially supported by Sogn og Fjordane University College, F⊘rde, Norway.
Obes Facts. 2009 May 14;2(Suppl 2):226.
Introduction
A decrease in resting energy expenditure (REE) occurs with weight loss which has been shown to contribute to weight relapse. It is therefore important to compose a standard value which can be used to determine the losses of REE for a given weight loss with different interventions.
Methods
A literature search was conducted through the MEDLINE database using the keywords resting metabolic rate (RMR), REE, sleeping metabolic rate (SMR), basal metabolic rate (BMR) weight loss, obesity, diet, exercise, drug therapy, and bariatric surgery. From this search, 90 publications met inclusion criteria. Relative REE changes were determined for each study and recorded as kcal/kg weight loss. Means of similar studies combining different sexes and interventions were established.
Results
Combining all studies regardless yielded a relative REE decrease of −15.3 +/− 8.6 kcal/kg weight loss from a total of 3002 subjects. The combined studies on females showed an REE decrease of −15.1 +/-9.4 kcal/kg weight loss while males had a loss of −16.8 +/− 9.2 kcal/kg weight loss. The majority of retrieved studies focused on the effect of an energy restriction diet on females and the mean REE loss for this group was −18.7 +/− 10.2 kcal/kg weight loss.
Conclusion
Overall, it seems that males have a greater relative decrease in REE in comparison to females. Furthermore, interventions lasting more than two weeks but less than six weeks produced greater relative REE losses in comparison to those which were six weeks or longer.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):226.
Introduction
The aim of the study was to assess the external reasons of resignation from the group weight-loss program.
Methods
The study group involved 217 (175 women and 42 men) subjects starting 3-month complex group weight reduction program. The treatment was free and consisted of sessions every two weeks with a doctor, a psychologist, a dietician and a physiotherapist. All sessions were performed in 20 person groups. The number of patients who resigned from the program were counted after each session. After finishing therapy all the patients were asked to fill up a questionnaire concerning the level of education, marital status, working hours, distance between the place of living and the place of therapy, costs of travel and the level of satisfaction from the therapy and its effects.
Results
45% of participants completed the therapy. 133 study subjects (61.3%) answered to the questionnaire. We observed significant dependency between distance from the place of living and the place of therapy and the moment of resignation. Costs of transport also influenced the decision of resignation from the therapy. Subjects whose cost of transport was the highest (6.1±5.5 Euro) resigned after the first meeting. There were no correlations between the time of resignation and the gander, marital status, the level of education as well as the working hours of the participants.
Conclusion
Important factors influencing the time of resignation from the complex group weight- loss program were the distance between the place of living and the place of therapy and the costs of transport.
Obes Facts. 2009 May 14;2(Suppl 2):226–227.
Background
Obesity surgery seems to be an effective treatment for morbid obesity, inducing significant weight loss and better quality of life. The purpose of this study was to obtain descriptions of patient's experience of quality of life two years after obesity surgery. What challenges do patients meet, and how are these handled? What are their experiences with health care services?
Methods
Qualitative methods with in-depth interviews of six participants operated for morbid obesity with the duodenal switch procedure.
Results
To be morbidly obese was described as very difficult, and obesity surgery was considered as the only solution. Two years after surgery the patients experienced a new and better life; they had more energy and were more active and social. Several reported a better self-confidence. New habits concerning food and eating gave them more control over food-consumption, and they also experienced better control over other areas in life. The participants were afflicted of diarea, gas and redundant skin. Some of them said that too much attention on their body was difficult, and that they had trouble identifying with the “new” body. Information and follow-up after surgery was reported as necessary for a successful result.
Conclusion
The participants experienced improvements in quality of life despite striving with side-effects after the operation and identity problems concerning their “new” body. The informants want better information about diet and lifestyle. The study also shows that more focus should be given on the experienced bodily changes after bariatric surgery.
Conflict of interest: None. Funding: The study was financially supported by Sogn og Fjordane University College, F⊘rde, Norway.
Obes Facts. 2009 May 14;2(Suppl 2):227.
Introduction
anorexigenic and orexigenic factors and resting metabolic rate play an important role in the energy balance and they are directly related with obesity. In this way, it was verified the effects of long-term multidisciplinary therapy on orexigenic and anorexigenic factors and resting metabolic rate in obese adolescents.
Methods
Twenty obese adolescents (11 girls and 9 boys) aged between 14 and 19 y, with simple obesity, BMI < 95th percentile of CDC, were submitted to intensive long-term multidisciplinary therapy (nutrition, psychology, aerobic exercise and clinical support) during 12 months. Orexigenic (Ghrelin and Melanin-Concentrating Hormone) and anorexigenic (Leptin and α-Melanocyte Stimulating Hormone) factors concentrations were measured by a radioimmunoassay (RIA) kit. Resting metabolic rate (RMR) was measured by indirect calorimetry. Body composition was measured by pletismography, and visceral and subcutaneous fat were analyzed by ultrassonography.
Results
After therapy the entire group reduced significantly body mass (100 to 90.1 kg), BMI (35.2 to 31.4 kg/m2), visceral (5.05 to 3.02 cm) and subcutaneous fat (3.57 to 2.70 cm), RMR (1917.5 to 1569 Kcal/day), leptin concentration from median 5.95 ng/mL (1.69-40.96 ng/mL) to 2.6 ng/dL (0.77-8.67 ng/dL) besides increase MCH concentration from median 3.52 ng/mL (0.74-23.52 ng/mL) to 13.32 ng/mL (5.54-26.4 ng/mL).
Conclusion
Our investigation demonstrated that long-term multidisciplinary therapy was effective to improve body composition, anorexigenic and orexigenic factors contributing to obesity control.
Conflict of interest: none disclosed. Funding: AFIP, FAPESP 2006/00684-3 and 2008/53069-0, FAPESP (CEPID/Sleep #9814303-3 S.T) CNPq, CAPES, CENESP, FADA, and UNIFESP-EPM, supported the CEPE-GEO Multidisciplinary Obesity Intervention Program.
Obes Facts. 2009 May 14;2(Suppl 2):227.
Introduction
Obese people with high leptin concentrations can present an alteration in the food intake control that can lead to depression. The obesity can have effects in psychiatric disorders, this way, a long-term multidisciplinary therapy is essential to control these comorbities. The objective is to verify the effects of a long-term multidisciplinary therapy on depression in obese adolescents.
Methods
fourth-three post-puberty obese adolescents were enrolled, including 20 boys and 23 girls were submitted to long-term multidisciplinary therapy (psychology, nutrition, exercise and clinical support) during one year. The level of depression was analyzed by a validated questionnaire, the Beck Depression Inventory (BDI). Leptin concentrations were measured by radioimmunoassay.
Results
it was observed a significant decrease in the depression levels (from 16.59 to 12.16). The depression score was not different between boys and girls, however after 1 year, girls presented a significant improvement. In this study, we could also observe a positive correlation between leptin and depression levels (r= 0.39, p=0.023) at baseline conditions. After one year of intervention, leptin (from 19.6 ng/mL to 15.35 ng/mL) and depression scores presented a significant reduction.
Conclusion
Our investigation demonstrated that long-term multidisciplinary therapy was effective to improve the depression levels, mainly in obese girls and in leptin concentrations in both genders.
Conflict of interest: none disclosed. Funding: AFIP, FAPESP 2006/00684-3 and 2008/53069-0, FAPESP (CEPID/Sleep #9814303-3 S.T) CNPq, CAPES, CENESP, FADA, and UNIFESP-EPM, supported the CEPE-GEO Multidisciplinary Obesity Intervention Program.
Obes Facts. 2009 May 14;2(Suppl 2):227–228.
Introduction
There is a striking and highly positive correlation between obesity and others cardiovascular disease risk factors. The carotid artery intima-media thickness is an earlier subclinical marker of atherosclerosis and it is related with obesity and their comorbidities. The aim of study was to compare the effects of short and long-term multidisciplinary therapy on carotid artery intima-media thickness and cardiovascular disease risk factors in obese adolescents.
Methods
Twenty-six obese adolescents aged between 14 and 19 years, with obesity, BMI < 95th percentile of CDC, were submitted to long-term multidisciplinary therapy (exercise, nutrition, psychology, and clinical support) during 1 year. The carotid artery intima-media thickness was analyzed by B-mode ultrasonography, body composition was measured by pletismography and visceral and subcutaneous fat were analyzed by ultrasonography. Blood samples were collected to analyze glycemia and lipid profile and insulin resistance was calculated by HOMA-IR.
Results
The short-term multidisciplinary therapy (6 months) promoted a significant decrease in total body mass, body mass index, body fat mass (%), visceral and subcutaneous fat, insulin concentration, HOMA-IR, waist circumference, total cholesterol, LDL-cholesterol and diastolic and systolic blood pressure. However, to promote a significant improvement in carotid artery intima-media thickness and glucose concentration it was necessary long-term intervention (1 year).
Conclusion
Our investigation demonstrated that long-term multidisciplinary therapy was more effective than short-term to improve carotid artery intima-media thickness promoting obese control and avoiding the development of cardiovascular disease.
Conflict of interest: none disclosed. Funding: AFIP, FAPESP 2006/00684-3 and 2008/53069-0, FAPESP (CEPID/Sleep #9814303-3 S.T) CNPq, CAPES, CENESP, FADA, and UNIFESP-EPM, supported the CEPE-GEO Multidisciplinary Obesity Intervention Program.
Obes Facts. 2009 May 14;2(Suppl 2):228.
Introduction
Overweight and obesity are an increasingly common problem worldwide. Adults who are overweight or obese have increased adverse health outcomes and report poorer quality of life than people of normal weight. Obesity and overweight in pregnancy is associated with a number of well documented adverse outcomes for mother and infant. The most effective approach to improve these health outcomes is still under investigation. Preconception care is often advocated as a means of improving health outcomes in this group of women.
Methods
Randomised controlled trials, quasi-randomised trials and cohort studies comparing the effects of a specialised program of preconception care (provision of information, screening for obesity related health problems, and/or dietary or exercise advice) for women who are overweight or obese, with no specific preconception care or routine preconception care on maternal and infant pregnancy outcomes were considered. The Cochrane Controlled Trials Register (CENTRAL), PUBMED and the Australian and International Clinical Trials Registry were searched (date of last search November 2008).
Results
No trials meeting our search criteria were identified.
Conclusion
There is an urgent need for well designed and good quality trials assessing the benefits of a specialised program of preconception care for women who are overweight and obese with the aim to improve maternal and infant health during and after pregnancy.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):228.
Introduction
Dietary interventions are more effective in achieving weight loss when combined with other strategies, such as increasing physical activity levels and/or psychological interventions to promote behavior change. The objective of the current study was to examine and to compare the effects of only aerobic (AT) or aerobic- plus resistance-training (COMB) on metabolic syndrome risk factors in obese adolescents submitted to a short-term multidisciplinary therapy.
Methods
Sixty-four post-puberty obese adolescents aged 16.5+1.74 years were randomly placed into either aerobic training (n= 32) or aerobic- plus resistance-training (n= 32). Body composition was measured by pletismography, maximal oxygen consumption was measured using a graded exercise test. Blood samples were collected to analyze glycemia, insulinemia, lipid profile and insulin resistance was calculated by HOMA-IR.
Results
After intervention, aerobic and aerobic- plus resistance-training groups demonstrated a significant (p< 0.05) reduction in body mass, body mass index, body fat, and visceral fat. Maximal oxygen consumption increased in both groups. Percentage of body fat, total and LDL cholesterol, systolic and diastolic blood pressure and insulin resistance decreased in the aerobic- plus resistance-training group only. Fat-free mass decreased in aerobic and increased in the aerobic- plus resistance-training group.
Conclusion
The major finding of this study was that aerobic- plus resistance-training was more efficient than only aerobic training to metabolic risk factors on obesity control in adolescents.
Conflict of interest: none disclosed. Funding: AFIP, FAPESP 2006/00684-3, FAPESP 2008/53069-0, FAPESP (CEPID/Sleep #9814303-3 S.T) CNPq, CAPES, CENESP, FADA, and UNIFESP-EPM, supported the CEPE-GEO Multidisciplinary Obesity Intervention Program.
Obes Facts. 2009 May 14;2(Suppl 2):228–229.
Introduction
The Small Changes project focuses on individuals making small, achievable lifestyle alterations over a period of three months supported by researchers who have expertise in nutrition, physical activity and behavioural change techniques. The intervention arm of the programme runs for three months. Although short term results are encouraging it is the long term behavioural adaptations (including reduced energy consumption) that are sought by researchers in this area. This poster shows the results from participants returning data on energy intake at six months.
Method
10 subjects completed the 3 month intervention and completed diet diaries at baseline and 6 months.
Results
Reductions in energy intake were significant (p=.017) between baseline and 6 months.
Conclusion
investigators have commented on the underreporting of energy intake by obese subjects, however, In the present investigation commensurate weight loss appears to have accompanied the reported energy reduction and also has been maintained at the 6 month time point (p=.035). These findings warrant a longer term follow up of at least one year to examine whether the Small Changes approach maintains weight loss in obese subjects at 12 months and beyond. Further investigation is also needed into the ‘drop out’ rate, although all subjects completed the programme and completed anthropometry and other measures, return of the self-completed food diaries was poor.
Conflict of interest: none disclosed. Funding: Research relating to this abstract was received from: All Saints Educational Trust a charity that seeks to aid nutritional education based in London United Kingdom. www.aset.org.uk
| NPY (ng/mL) | Ghrelin (ng/mL) | |||||
|---|---|---|---|---|---|---|
| Weight loss | Baseline | 6 months | 1 year | Baseline | 6 months | 1 year |
| 1st (<2.5kg) | 0.70 (0.27-8.53) | 1.16 (0.52-10.36) | 0.71 (0.56-468) | 4.8 (1.61-42.66) | 4.86 (1.21-13.3) | 5.24 (2.40-23.47)€£ |
| 2nd (≥2.5kg<8kg) | 1.71 (0.49-4.2) | 6.68 (0.93-17.08)■ | 1.96 (0.05-9.33)£ | 8.53 (1.25-15.56) | 4.50 (2.28-8.0) | 4.78 (2.77-8.49) |
| 3nd(≥8kg< 14kg) | 2.26 (0.71-9.24) | 1.87 (0.81-20.54) | 0.65 (0.24-4.28) | 8.49 (3.68-32.67) | 7.33 (1.13-11.61) | 7.49 (2.01-32.67) |
| 4th (≥14kg) | 0.94 (0.3-5.69) | 2.38 (0.28-13.09) | 0.74 (0.39-1.17) | 4.55 (1.34-13.3) | 2.84 (1.73-9.92) | 8.01 (2.69-20.07) |
€
difference between basal and 1 year
£
difference between 6 months and 1 year
■
difference between 1st and 2th quartiles at the same time
Obes Facts. 2009 May 14;2(Suppl 2):229.
Introduction
Non-alcoholic fatty liver disease is an emerging clinical problem among patients of all ages, includes a broad spectrum of liver tissue alterations. Studies suggest that visceral adipose tissue and several adipocytokines have been implicated in the pathogenesis of NAFLD.
Objective
to assess the effect of multidisciplinary therapy on metabolic profile and pro-inflammatory cytokines in obese adolescents with NAFLD.
Methods
52 adolescents aged 15-19 y, with BMI ≥ P95, consisting of 36 patients without and 16 with NAFLD, diagnosed by ultrasonography were submitted to long-term multidisciplinary intervention (1 year) (nutrition, psychology, exercise and clinical support). Blood samples were collected to analyze glycemia, hepatic transaminases, lipid profile, leptin and TNF-alpha. The cytokines was measured by ELISA (Enzyme-linked Immunosorbent Assay) and insulin resistance by HOMA-IR.
Results
At baseline conditions, the NAFLD patients showed significant major values of body mass, visceral fat, insulin, VLDL, ALT and GGT. After one year of intervention, both group presented a significant reduction in the BMI, % fat, body fat mass, visceral fat, insulin, HOMA-IR, TG and Leptin. The hepatic transaminases, ALT and GGT reduced significantly only in NAFLD patients. It was observed strongly positive correlation between visceral fat and TNF-alpha (r = 0.99), ALT and GGT only in NAFLD patients.
Conclusion
Important clinical parameters present more altered in obese patients with NAFLD, mainly the visceral adipose tissue, and the long-term multidisciplinary obesity intervention was effective to reduce them, improving the metabolic profile and inflammatory state, emphasis the potential therapeutic implications.
Conflict of interest: none disclosed. Funding: AFIP, FAPESP 2006/00684 and 2008/53069-0, 3, FAPESP (CEPID/Sleep #9814303-3 S.T) CNPq, CAPES, CENESP, FADA, and UNIFESP-EPM, supported the CEPE-GEO Multidisciplinary Obesity Intervention Program.
Obes Facts. 2009 May 14;2(Suppl 2):229.
Introduction
deregulation of the neuroendocrine system occurs as a consequence of obesity resulting impairment during weight loss therapy. Energy homeostasis depends on the balance existing between adipose tissue and some neuroendocrine system.
Objective
to assess the effect of long-term weight loss in ghrelin-neuropeptide Y system of obese adolescents
Methods
twelve obese adolescents aged 15-19 y, with BMI < P95, were submitted to long-term multidisciplinary intervention (nutrition, psychology, exercise and clinical support). Blood samples were collected to analyze NPY and Ghrelin concentrations by ELISA.
Results
Table 1. NPY and Ghrelin concentrations in obese adolescents according to weight loss quartiles at baseline, after 6 months and 1 year of multidisciplinary intervention.
Conclusion
Our results demonstrate that the 2nd quartile of weight loss specifically during the middle point of therapy was critical to control the neuroendocrine energy balance, however long-term therapy with a massive weight loss was effective to improve the neuroendocrine ghrelin-neuropeptide Y system.
Conflict of interest: none disclosed. Funding: AFIP, FAPESP 2006/00684 and 2008/53069-0, 3, FAPESP (CEPID/Sleep #9814303-3 S.T) CNPq, CAPES, CENESP, FADA, and UNIFESP-EPM, supported the CEPE-GEO Multidisciplinary Obesity Intervention Program.
Obes Facts. 2009 May 14;2(Suppl 2):229–230.
Aim
to assess the efficacy of the hormonal therapy in the treatment of the menopausal disorders in obese women.
Materials and methods
linical, laboratory, ultrasound, X-ray, and cytological examinations. When the patients were questioned, Kupperman menopausal index, Spielberger test assessing personality and reactive anxiety, Beck scale assessing the presence and markedness of depression and eating behavior tests(emotional, external, restrictive), were used. We treated 34 obese women with natural menopause and menopausal disorders. Patients received 1 mg 17β-estradiol and 2 mg drosperinone for 1 year.
Results
treatment of menopausal disorders was successful in all patients. The markedness of vasomotor disorders decreased, the Beck scale and Spielberger test score improved. In 48% cases, the decrease of the body mass (5,7±1,9kg), body mass index (2,8±1,6kg/m2), waist circumference(9±3,2cm), metabolic values, HOMA index, and slight reduction in blood pressure was noted. In 78% cases, these changes combined to improvement of emotional and external eating behavior. The side effects were minimal, of temporary character and did not influence therapy compliance.
Conclusion
Hormonal therapy using 1 mg 17β-estradiol and 2 mg drosperinone is efficacious in the treatment of menopausal disorders in obese women. This therapy has additional favorable effect on metabolic and anthropometric variables, possibly due to combined influence on metabolic processes and eating behavior.
Obes Facts. 2009 May 14;2(Suppl 2):230.
Introduction
The safety of long-term low-carbohydrate and very-low-calorie diets on liver and kidney function remains uncertain.
Methods
In a randomized controlled trial, 120 obese patients were screened for 3 months on a low fat, reduced-calorie diet. Patients who lost less than 5% weight were randomized and treated for 9 months on a low-carbohydrate (protein sparing modified fast –PSMF) or a very-low-calorie commercial diet (LighterLife - LL).
Results
Subjects on LL (n=34) lost significantly more weight than patients on PSMF (n=38) (−15.1 SD 21.1 vs −1.9 SD 5.0; P<0.0001). LL demonstrated improvements in creatinine (µmol/L) (82.6 SD 9.2 vs 79.8 SD 6.6; P=0.015), eGFR (mL/min) (77.1 SD 11.6 vs 79.7 SD 11.4; P=0.013), ALT (U/L) (30.0 SD 17.8 vs 23.2 SD 8.9; P=0.039), ALKP (U/L) (81.6 SD 19.6 vs 75.0 SD 22.1; P=0.001), GGT (U/L) (33.8 SD 33.7 vs 24.1 SD 17.7; P=0.049) from baseline to 9 months. In PSMF, with the exception of increased urea, no other renal or hepatic changes were observed.
Conclusions
Improvements in renal function with LL were limited either directly to increased fluid intake or indirectly to the reduced creatine intake. Improvements in liver function tests could be attributed to a decrease in the fatty infiltration associated with obesity. The significant increase in urea in PSMF was a direct result of increased protein intake. The use of PSMF had no adverse effects on hepatic or renal function. The results tend to support improvements in renal function and hepatic function using LL.
Conflict of Interest: None disclosed. Funding: Research relating to this abstract was funded by LigherLife
Obes Facts. 2009 May 14;2(Suppl 2):230.
Introduction
Dieting and weight loss have been associated with changes in quality of life.
Methods
In a randomized controlled trial, 120 obese patients were screened for 3 months on reduced-calorie diet. Patients who lost less than 5% weight were randomized onto either a protein sparing modified fast (PSMF) or a commercial VLCD (LighterLife - LL) combined with weekly cognitive behaviour therapy (CBT). Questionnaires assessed mood, behaviour and quality of life after the 3-month screening period and 3- and 9-months post-randomisation.
Results
Patients on LL lost 8 times more weight (P < 0.0001) than PSMF. Patients on LL significantly improved in Physical Activity Level (PAL), General health (General Health Questionnaire –GHQ), sleepiness (Epworth Sleepiness Scale - EPS), the “physical” section of the WHO Quality of Life (WHOQoL phys) questionnaire and “likeliness to eat” in response to external cues (Dutch Eating Behaviour Questionnaire -DEBQ) at 3 months, but only in PAL at 9 months. Weight loss was significantly correlated to PAL, GHQ, and WHoQoL phys at 3 and 9 months. Patients on PSMF significantly improved in the “likeliness to eat” in response to emotional cues (DEBQ) at both times and also in depression (Beck Depression Inventory - BDI) at 3 months. Weight loss was significantly correlated to WHOQoL phys at both times.
Conclusion
There were clear associations between improving weight and overall quality of life in LL. The poor association in PSMF was probably due to the limited weight loss and lack of CBT.
Conflict of interest: None disclosed. Funding: Research relating to this abstract was funded my LighterLife
Obes Facts. 2009 May 14;2(Suppl 2):230.
Introduction
We aimed to improve the outcome of commonly used weight reduction programs.
Methods
517 obese subjects (BMI 35±5 kg/m2) followed a 10 weeks weight reduction program, consisting of a low fat diet for breakfast and lunch, and after a break of 4h, a low carb diet for dinner. Laboratory testing was done at week 0 and 10, in a subgroup (n = 81) acetone and insulin we measured before and after dinner. Weight reduction and the number of non completers were monitored and compared to those before 2006, when neuro-endocrinological treatment was not available.
Results
At the start of the low carb period, acetone was elevated (4.9±3.9 mg/dl, mean + SD) in plasma, and increased after the low carb meal. Dietary protocols showed a recommendable intake of fat (20-30% of energy intake), carbohydrates (50 − 60%), and protein (15 − 25%). Mean weight loss was 6% of initial body weight during the 10 weeks program and laboratory testing confirmed improvement of plasma lipids and glucose. Including neuro-endocrinological treatment improved the rate of completers from 85% to 97%.
Conclusion
FaCts diet allows for a weight reduction comparable to that observed with a low carb diet, but provides a more balanced nutrient intake. Active training of hunger and satiety related to neuro-endocrinological factors improves patients’ adherence.
Obes Facts. 2009 May 14;2(Suppl 2):230–231.
Purpose
During gait two factors stress the knee: the load produced by the weight on the joint surface and the muscle contractions acting on the knee by their moments. A weight loss may influence both factors.
Methods
16 obese (BMI>30) patients with symptomatic knee OA were studied before and after a significant weight loss obtained by the Cambridge dietTM. Three-dimensional gait analyses were studied at various walking speeds. Joint moments were calculated using standard inverse dynamics, and medial compartment loads were estimated.
Results
The mean body weight was 101.4 kg (SD 3.5) before and 88.0 kg (SD 2.6) after the diet. Medial compartment load and joint moments are given in table 1.
Conclusions
In obese KOA patients weight loss significantly reduces knee joint loads during walking. Changes in medial compartment loads following weight loss are closer related to changes in peak extensor moments than to peak adduction moments.
Conflicts of interest: None disclosed. Funding: An unrestricted grant from Cambridge Diet™ sponsored the project.
Table 1.
| Absolute reduction | Percent change | P | Bodyweight normalised reduction | P | |
|---|---|---|---|---|---|
| Peak medial Compartment load | 505.0 N (SD 103.0) | -20.9% | <0.0001 | 0.4 N/kg (SD 1.0) | 0.70 |
| Peak extensor moment (internal) | 22.1 Nm (SD 7.4) | -33.6% | 0.007 | 0.1Nm/kg (SD 0.1) | 0.22 |
| Peak adduction moment (external) | 10.5 Nm (SD 1.9) | -18.2% | <0.0001 | 0.0 Nm/kg (SD 0.0) | 0.13 |
Obes Facts. 2009 May 14;2(Suppl 2):231.
Methods
Body sway (posturography) during free standing and in balance-challenging position (tandem position -joint feet in the line) were measured in 57 obese (mean age 12.8±3.1 yrs, BMI 29.8±4.3 kg/m2) and in 56 lean children (mean age 11.6±2.8 yrs, BMI 17.1±3.0 kg/m2). The following posturographic parameters were measured by means of AMTI's AccuGait portable force-plate: total path length of center-of-pressure (COP) in anterior-posterior (AP) plane: (Y) [cm] and in medio-lateral (ML) plane: × [cm]; COP velocity in AP plane: Vy [cm/s] and in ML plane: Vx [cm/s]; maximal COP displacements in AP and ML planes: RY and RX [cm].
Results
| Free standing | Tandem position | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Y | X | Vy | Vx | RY | RX | Y | X | Vy | Vx | RY | RX | |
| obese | 28.5 | 22.8 | 0.9 | 0.8 | 2.3 | 1.6 | 78.5 | 61.7 | 2.6 | 2.1 | 4.3 | 4.1 |
| lean | 44 | 37.4 | 1.5 | 1.3 | 2.6 | 2.1 | 88.5 | 64.2 | 2.9 | 2.1 | 4.4 | 3.6 |
| p | 0.001 | 0.001 | 0.001 | 0.001 | NS | 0.05 | NS | NS | NS | NS | NS | 0.05 |
During free standing obese children present shorter COP path length and lower values of COP velocity in both AP and ML planes and lower value of maximal COP displacement in ML plane. In tandem position only the value of maximal COP displacement in ML plane has higher value in obese than in lean children.
Conclusion
Obese children seem to be more stable in free standing position, while in balance-challenging position their bodies sway more in ML plane, which is probably a result of increased inertia due to excessive body weight.
Conflict of Interest: Non disclosed. Funding: No funding
Obes Facts. 2009 May 14;2(Suppl 2):231.
Background
Musculoskeletal pain (MSP) is commonly reported by patients with morbid obesity. Few studies have however reported longitudinal changes in such pain after bariatric surgery.
Methods
In this prospective cohort study, 51 patients with morbid obesity were treated with the “duodenal switch procedure”. Data was obtained before surgery and after two years. Fifty-four percent of the patients were women, the mean age was 38 years, and the mean BMI was 51.8. MSP was assessed by a standardized questionnaire (self-reported presence or non presence of chronic pain in the lower back and/or in the lower limbs). The patients also completed the bodily pain items of the Short Form-36 survey.
Results
The mean BMI decreased from 51.8 (SD 7.5) to 31.8 (SD 5.6), p<0.001. Thirty-three of the patients (65%) reported that they suffered from MSP before surgery. Two-years after surgery only 12 patients (24%) reported MSP, p<0.001. Patients reporting MSP before surgery had a mean bodily pain score of 26.4 (SD 18.5) compared to 60.7 (SD 27.2) in those who did not, p<0.001. After surgery those who still reported MSP had a mean bodily pain score of 60.5 (SD 25.7), compared to 82.3 (SD 19.5) in those who did not, p=0.007.
Conclusion
In this study MSP was associated with severe bodily pain, especially before treatment. Two years after surgery the patients reported a large reduction in the prevalence of MSP, and of bodily pain in general.
Conflict of interest: None. Funding: The study was financially supported by Sogn og Fjordane University College, F⊘rde, Norway.
Obes Facts. 2009 May 14;2(Suppl 2):231–232.
Introduction
There are few effective evidence-based treatments for obese adolescents. We used Mandometer® therapy, a computerized device providing feedback during meals to slow down speed of eating and reduce intake to supplement lifestyle advice to reduce excess adiposity.
Methods
A randomised controlled trial investigating the impact of Mandometer® therapy compared to our clinic's standard behavioural modification approach for weight loss in obese patients (n=106, aged 9-17 years). Primary outcome: change in Body Mass Index Standard Deviation Score (SDS) over 12-months. Secondary outcomes: Body Fat SDS, Metabolic Status, Quality of Life (PedsQL4.0) evaluation, change in portion size and speed of eating.
Results
91 children completed a 12-month assessment. Those receiving Mandometer® therapy had significantly lower mean BMI SDS at 12-months in comparison to those receiving standard care (baseline adjusted mean difference 0.27 [95%CI 0.14 to 0.41]; p<0.001). Significantly greater improvements were seen in those receiving Mandometer® therapy for Body fat SDS, HDL-Cholesterol, Total Cholesterol/HDL Cholesterol ratio and portion size. Eating speed reduced in the Mandometer® arm (11%) compared to a gain in the standard arm (4%). Quality of life improved in both arms during the study with no significant difference between the two at 12-months. Economic analysis (for 12-month completers) showed those receiving Mandometer® therapy cost £739 (931EUR) (95%CI £701 to £777) more than those receiving standard care, or £270 (340EUR) per 0.1 BMI SDS improvement.
Conclusion
Improving eating behaviour through Mandometer® therapy is a beneficial addition to lifestyle modification. Its potential benefits may also prove useful in other population groups.
Conflict of Interest: C Bergh and P Sodersten each own 28.35% of stock in the Mando Group AB. Funding: Research relating to this abstract was funded by the BUPA Foundation
Obes Facts. 2009 May 14;2(Suppl 2):232.
Introduction
The degree of motivation before starting the treatment represents a pretreatment predictor of successful weight management. The aim of this study is to develop and validate a new self-reported questionnaire of motivation and readiness to change before starting a lifestyle modification program (the TREatment MOtivation and Readiness test (TRE-MORE).
Methods
We identified 12 items grouped in 5 areas (1. current lifestyle, 2. obstacles, 3. pleasure, 4. sharing the problem, 5. motivation to solve the problem). TRE-MORE was evaluated in a consecutive series of 96 obese patients attending our Outpatient Clinic. Validation of the questionnaire was performed through: test-retest reliability, internal consistency, clinical correlates, concurrent validity.
Results
The drop-out group showed significantly lower area 2, and area 5 scores (respectively 2.7±0.72, 2.7±0.77; p<0.01), compared to group which did not have a drop-out (respectively 3.35±0.80, 3.56±0.92). Subjects who lost more than 5% of their initial weight showed significantly higher (3.5±0.82; p<0.05) area 5 scores compared to the other group (3.00±0.89). With linear regression (using BMI, and age as covariate), a significant correlation of drop out categorization was observed with area 5 score. Only area 5 represents at the moment a good model for predicting the weight loss. The area under the ROC curve for area 5 scores was 0.678 (95% CI, 0.525-0.831, p = 0.044).
Conclusions
TRE-MORE represents a validated and easy-to-use questionnaire assessing at the meantime treatment motivation and readiness with adequate predictive capacity for weight loss
Obes Facts. 2009 May 14;2(Suppl 2):232.
Introduction
The degree of motivation before starting the treatment represents a pretreatment predictor of successful weight management. The aim of this study is to develop and validate a new self-reported questionnaire of motivation and readiness to change before starting a lifestyle modification program (the TREatment Motivation and REadiness test (TRE-MORE).
Methods
We identified 12 items grouped in 5 areas (1. current lifestyle, 2. obstacles, 3. pleasure, 4. sharing the problem, 5. motivation to solve the problem). TRE-MORE was evaluated in a consecutive series of 96 obese patients attending our Outpatient Clinic. Validation of the questionnaire was performed through: test-retest reliability, internal consistency, clinical correlates, concurrent validity.
Results
The drop-out group showed significantly lower area 2, and area 5 scores (respectively 2.7±0.72, 2.7±0.77; p<0.01), compared to group which did not have a drop-out (respectively 3.35±0.80, 3.56±0.92). Subjects who lost more than 5% of their initial weight showed significantly higher (3.5±0.82; p<0.05) area 5 scores compared to the other group (3.00±0.89). With linear regression (using BMI, and age as covariate), a significant correlation of drop out categorization was observed with area 5 score. Only area 5 represents at the moment a good model for predicting the weight loss. The area under the ROC curve for area 5 scores was 0.678 (95% CI, 0.525–0.831, p = 0.044).
Conclusions
TRE-MORE represents a validated and easy-to-use questionnaire assessing at the meantime treatment motivation and readiness with adequate predictive capacity for weight loss
Obes Facts. 2009 May 14;2(Suppl 2):232.
Background
The obesity epidemic increase the demand of blood sampling in obese subjects for the identification of obesity co-morbidities. In obese children, venous cannulation (VC) is regularly associated with technical problems and pain since the veins are hidden in the subcutaneous adipose tissue, which makes it difficult to visualize and feel the veins.
Aim
To compare two commonly used methods to reduce procedural pain in children, nitrous oxide and midazolam.
Methods
60 obese children 13,8 (7-18), mean (range), with planned blood sampling were selected. The effects of midazolam (MI) 0,3 mg × kg (−1) max 15 mg, nitrous oxide 50% (NO) and 10% (placebo) on pain (NRS 0-10), procedure time and quality as well as recovery time (estimated by fingertapping) were compared in a double-blind randomised study. The study was approved by the ethical committee at Karolinska Institutet.
Results
All procedures were successfully performed with NO while 1 VC (5%) were not possible to perform with MI and 2 (10%) with placebo. Pain, estimated separately by parents and children, was significantly higher with both MI and placebo than with NO. There was no difference in time required for the entire procedure. The mean recovery time after the procedure was 18min for NO, 128min for MI (p<0.001) and 18min for placebo.
Conclusion
Pretreatment with nitrous oxide seems to be better than both midazolam and placebo in obese children. The midazolam dose required in obese children results in an unfavourable long recovery time due to the lipophilic nature of midazolam.
Obes Facts. 2009 May 14;2(Suppl 2):233.
Aims
To investigate the relationship between normal renal function [estimated glomerular filtration rate (GFR)] and visceral adiposity measured by computed tomography (CT) in apparently healthy Korean women.
Methods
A total of 425 apparently healthy women were recruited. We assessed body composition with CT and divided the study population into 2 groups based on fat distribution, the visceral fat dominant group (VFG) and subcutaneous fat dominant group (SFG). GFR was estimated using the abbreviated Modification of Diet in Renal Disease (MDRD) and quadratic equation.
Results
After adjustment for age, mean blood pressure, body mass index (BMI), fasting glucose, homeostasis model assessment of the insulin resistance (HOMA-IR) index, triglyceride, high density lipoprotein (HDL)-cholesterol, low density lipoprotein (LDL-cholesterol), high-sensitivity C-reactive protein (hs-CRP) levels, and mean brachial-ankle pulse wave velocity (baPWV), the VFG showed significantly lower GFR levels compared to the SFG. GFR level was negatively correlated with visceral fat areas after adjustment for age. By stepwise multiple regression analysis, age, triglyceride, and visceral fat areas independently affected GFR levels.
Conclusion
Our study shows that even in apparently healthy women, visceral fat seems to be an important contributor to renal impairment. Further studies on the causality between visceral adiposity and renal function are warranted.
Conflicts of interest statement: None declared. Acknowledgements: There was no funding/outside support for this study.
Obes Facts. 2009 May 14;2(Suppl 2):233.
Waist-to-Height Ratio (WtHR) as a predictor index for metabolic and cardiovascular disease risk (MCVDR) factors has gained little experience about children. Aim of this preliminary study is to consolidate its usefulness in childhood.
Methods
167 obese children (M/F 89/78; age 4.5 to17.5 years) were studied. Anthropometry, blood pressure (BP), and venous fasting triglycerides, cholesterol, HDL-C, LDL-C, glucose, insulin data were collected. According to literature, both a standard 0.5 WtHR cut-off (Maffeis, 2008) and a 3-strata model (Kahn, 2005) were considered. 2, Student's t-test, and Spearmann's correlation test were performed.
Results
Only using the 3-strata model percentages of higher WtHR among subjects with pathologic triglycerides, HDL-C, glucose, insulin, and systolic BP are greater than among subjects with normal values. High OR could be found only for triglycerides, glucose, insulin, systolic BP. Applying either models, and considering all the parameters, insulin alone showed a good OR (3.00) and statistically significant differences at both χ2 and t-test.
Conclusions
The ORs shown by our preliminary study, and by others’ studies, outline that WtHR predicts high MCVDRs among obese paediatric subjects. Powerness of this prediction, however, can vary considerably, depending on the WtHR value chosen. Wider studies are needed to determine which value is the most powerful. The studies will also help to understand how much this effect is a causal one, not a casual one.
Obes Facts. 2009 May 14;2(Suppl 2):233.
Background
Unrealistic weight loss goals may impede the success of weight loss attempts.
Objective
To investigate the frequency of unrealistic personal weight loss goals and their association with other patient characteristics in people with obesity at the start of a dietary weight loss program.
Design
Personal weight loss goals were assessed using the ‘Goals and Relative Weight Questionnaire’. A personal weight loss goal was defined as unrealistic if it exceeded the medically advised goal by more than 50%. Obesity-related beliefs were measured by the ‘Obesity Cognition Questionnaire’ and the eating behavior self-efficacy scale of the ‘Obesity Psychosocial State Questionnaire’.
Subjects
90 obese patients; 26 men and 64 women, mean age 42.6 years (range 18 − 68), BMI between 30 and 50 kg/m2.
Results
Unrealistic personal weight loss goals were observed in 49% of the patients. They were more frequent in younger patients (p = 0.03) and in patients who attributed their obesity to a physical cause (r = 0.35, p = 0.001). Realistic goals were more common among patients who attributed their obesity to a behavioral cause (r = −0.28, p = 0.008).
Conclusions
This study confirms that discrepancies in weight loss goals between obese patients and professionals are common, especially in younger patients and in patients who attribute their obesity to a physical cause. Future research should examine whether adjustment of unrealistic personal weight loss goals and related attributions improves treatment outcome.
Conflict of interest: None disclosed. Funding: This work was supported by funds from the Dutch Network for Registration of Home Enteral and Parenteral Nutrition (RET) and the Dutch Dietetic Association (NVD).
Obes Facts. 2009 May 14;2(Suppl 2):233–234.
Introduction
The most appropriate frequency of follow up for successful weight management remains unclear. Implementing weight loss programs needs to balance the need for regular review with the availability of resources and expertise. This study aimed to identify a relationship between attendance to appointments and weight loss achieved after a multidisciplinary weight loss program for obesity and to identify psychological or demographic factors that may influence attendance.
Methods
Ninety-four obese participants (25 male / 69 female) were recruited into a clinical outpatient setting for an intensive weight loss program (IP) involving weekly review by a Dietitian and Exercise Physiologist for 4 months followed by a weight maintenance program (MP) involving monthly review for 8 months. Demographic and psychological (quality of life, self motivation, depression, social support, locus of control and body image) data were collected at baseline.
Results
The mean age was 45±8 years and body mass index 38.0±6.6 kg/m2. Participants attended 71.4±27% of all appointments (IP appointments 71.1±28%; MP appointments 65.0±33%). Overall attendance was positively correlated with total amount of weight loss (r=0.41. p=<0.001). Attendance during the IP was significantly associated with the amount of weight lost during IP (r=0.56, p=<0.001), however attendance during the MP was not associated with the ability to maintain this weight loss at 12 months. Older age was significantly associated with attendance rates (p=0.02) however no other baseline psychological predictors of attendance were identified.
Conclusion
Attendance during initial intensive intervention is associated with better outcomes in the short term but continued high attendance does not guarantee maintenance of weight loss long term.
Funding: National Health and Medical Research Council (NHMRC) of Australia provided funding for this study. IH is a NHMRC Australian Clinical Research Fellow.
Obes Facts. 2009 May 14;2(Suppl 2):234.
Background
The short and long-term effects of conventional weight-management programs were unsatisfactory and thus obese people repeatedly call for alternative therapies, including dietary supplements. We investigate the effect on feeling of satiation of a dietary supplement made up of two natural active substances Phaseolus vulgaris e Cynara scolymus.
Methods
A 2-months randomized, double-blind, placebo-controlled trial was conducted. 40 overweight and obese (BMI 25-35) men and women aged 30-65 years were recruited. Twenty subjects were randomized to P. vulgaris and C. scolymus complex in association with personalized diet (T), and 19 to placebo together with diet (P). The primary end point was hunger/satiety score (Haber's scale). Unpaired t test was applied to differentiate the two groups. Finally, changes in BMI from the baseline were tested by paired t test or analogous non-parametric test.
Results
Two groups showed a similar Haber's mean score at baseline (T: −2.84±1.73 vs. P:– 2.76±0.88, t=0.18 p=0.85). At the end of supplementation, in the treated group the hungry/satiety score was significantly higher than in control group (0.66±2.40 vs. −2.86±1.51, t= −5.39, p<0.0001). Furthermore BMI improved significantly with respect to baseline in treated group (31.8±2.3 vs. 30.8±2.2, t=5.55 p<0.0001) as well as in placebo one (30.7±2.6 vs. 30.1±2.4, p=0.001), but the difference between treatment was not statistically relevant.
Conclusion
The findings indicate that the assumption of a Phaseolus vulgaris and Cynara scolymus complex improved feeling of satiation in a group of healthy, overweight or obese subjects, as demonstrated by the hunger/satiety score.
Conflict of Interest: Payment received from Indena spa (Milan, Italy). Funding: Research relating to this abstract was funded by Indena spa (Milan, Italy).
Obes Facts. 2009 May 14;2(Suppl 2):234.
Introduction
Different psychological theories suggest that change in domain-specific motivation (e.g., physical activity) could spill over to other areas of health behavior motivation. This study extends this research by testing how general and exercise-specific behavioral regulation predicts changes in eating behavior self-regulation, during weight management.
Methods
239 overweight/obese women, M=38.0 (±6.8) years, BMI 31.3 (±4.1) kg/m2 participated in a one-year RCT on behavioral weight management. Main focus of the intervention was increasing physical activity, promoting autonomy, and internal/intrinsic motivational regulation, following Self-Determination Theory. The comparison group received a general health education program. Motivation towards exercise and treatment were assessed at baseline and 12 months with the Self-Determination Scale and the Treatment Self-Regulation Questionnaire. Eating self-regulation was measured via the Three-Factor-Eating Questionnaire, Dutch Eating Behavior Questionnaire, and Eating Self-Efficacy Scale.
Results
Stepwise hierarchical regressions controlling for treatment self-determination showed that change in autonomous exercise motivation uniquely predicts cognitive restraint (β=0.16, p=.004), disinhibition (β= −0.16, p=.004), external (β= −0.19, p=.01) and emotional eating (β= −0.19, p=.01), and eating self-efficacy (β=0.19, p=.01) over 12 months. These associations held when controlling for the intervention effect by first forcing group membership into the regression model (cognitive restraint: β=0.16, p=.04; disinhibition: β= −0.16, p=.04; external eating: β= −0.19, p=.01; eating self-efficacy: β=0.16, p=.03).
Conclusion
Increases in feelings of autonomy and intrinsic motivation towards exercise predict concurrent improvements in several important markers of eating self-regulation. Self-determination and motivational orientation (e.g., autonomous vs. controlled) may be mechanisms underlying previous observations of covariance between changes in exercise and eating behaviors during weight control.
Conflict of Interest: None Disclosed. Funding: Research relating to this abstract was funded by the Portuguese Science and Technology Foundation, the Calouste Gulbenkian Foundation, Oeiras City Council, IBESA, Nestlé-Portugal.
Obes Facts. 2009 May 14;2(Suppl 2):234–235.
Introduction
Resting energy expenditure (REE) is most accurately assessed clincially by indirect calorimetry (IC). It can also be estimated using predictive equations.
Objective
To compare resting energy expenditure calculated by 2 commonly used predictive equations - Mifflin St Jeor (MSJ) and Harris Benedict equations (HB) with measurements of REE obtained via IC.
Methods
166 sedentary and multi-racial overweight and obese Singaporean patients (115 females; 69.3%) were measured for height and weight and REE via IC using the MedGem (Healthetech, Colorado), a validated portable indirect calorimeter. REE was also predicted using the MSJ and HB equations. Accuracy was determined by correlation coefficients and agreement between methods by Bland-Altman plots. Prediction accuracy was defined as the percentage of individuals whose predicted REE is within±10% of measured REE.
Results
The mean body mass index (BMI) was 31.34kg/m2 (±6 kg/m2). The mean measured REE by MedGem, predicted REE by MSJ and HB were 1605kcal (±332.43kcal), 1524kcal (±281.61kcal) and 1627.14 (±299.11kcal) respectively. The Pearson correlation between the MedGem and the MSJ and HB equations was 0.745 (r2 = 0.555) and 0.729 (r2 = 0.531) respectively. From the Bland-Altman plots, agreement between REE measurements via IC and MSJ equation was 48.2% (37.3% underestimation; 14.5% overestimation). This was similar for HB equation (50.6%; 30.1% underestimation; 19.3% overestimation).
Conclusion
REE calculated by MSJ and HB equations correlates poorly with REE measured by IC. Therefore, these equations should not be used as a stand alone tool for calculating energy requirements in overweight and obese individuals for weight loss.
Obes Facts. 2009 May 14;2(Suppl 2):235.
Introduction
Childhood obesity is escalating around the world with harmful effects on children's health and quality of life. The aim of the study was to assess the effectiveness of a family-based behavioral treatment program in a clinical setting in Iceland.
Methods
Participants were 84 obese children aged 7-13 years (BMI < 2.5 SDS) and one participating parent for each child. Treatment was delivered in 12 weeks distributed over 18 weeks. Children's height and weight were measured before and after treatment and BMI was calculated. Children were also assessed with the Strength and Difficulties Questionnaire (SDQ), Children's Depression Inventory (CDI), Multidimensional Anxiety Scale for Children (MASC) and The Piers-Harris Self Concept Scale (Piers-Harris). Measures were followed up at 6 months.
Results
A total of 73% of participants completed all measures. Psychological and behavioral problems were prevalent at baseline. No significant difference was detected in psychological outcomes at baseline between children who completed treatment and those who dropped out prematurely (p < 0.05). Over the course of treatment children's BMI decreased by an average of 2.0 points (p < 0.001) and psychological measures improved significantly (CDI: 48.3 vs. 44.9; MASC: 53.09 vs. 49.9; Piers-Harris: 56.9 vs. 60.4). Higher anxiety scores at baseline correlated significantly with better improvements on children's BMI post treatment (p = 0.016). Improvements in BMI and psychological well-being were mostly maintained at 6 month follow-up.
Conclusions
Results indicate that a family-based behavioral treatment is effective in clinical settings in Icelandic children. The treatment significantly decreases overweight and the psychological well-being is positively affected.
Obes Facts. 2009 May 14;2(Suppl 2):235.
Introduction
A hospital-based Consultant-led, multi-disciplinary Obesity Clinic (OC) was established in DGRI in 2007. This team included Consultants, an Obesity Nurse, Dietitian, Co-ordinator, Exercise Physio and Nursing support. Education, support, pharmacological intervention and frequency of follow-up were based on individualised patient requirements and needs. Our aim was to assess whether the OC was satisfying the needs of our patients.
Methods
Between February 2007 and July 2008, 100 consecutive return patients to the OC were asked to complete a questionnaire.
Results
95% ‘strongly agreed’ that it was important to have a multi-disciplinary team managing their care. 62% ‘strongly agreed’ that exercise classes should be provided. 53% ‘strongly agreed’ that access to Psychology would be a worthwhile addition.
96% reported that they were ‘treated with kindness and respect’ and 99% that they were either ‘mostly satisfied’ or ‘very satisfied’ with the DGRI Obesity Clinic service.
Conclusion
The vast majority of patients who attend the OC are satisfied with the service they receive, but there is scope for further improvement (for example more Exercise and Psychology input).
Conflict of Interest: SG, JY, AH, PP and EB have received funding from Roche and Abbott to attend European and International Scientific meetings. Funding: None
Obes Facts. 2009 May 14;2(Suppl 2):235.
Introduction
In clinical practice, sexual complaints are frequent. Nevertheless, they are usually underestimated by health professionals. This study aims to analyse the relation between sexual functioning and quality of life (QoL) in women with obesity participating in an individualized treatment program for losing weight.
Methods
A group of 67 women with obesity, aged between 21 and 61 (M=41.36; SD=9.99); 68.7% married, 9% divorced, 16.4% single, and 6% widow was studied. Participants answered to the socio-demographic questionnaire, to Sexual Functioning Questionnaire and to SF-36, in the context of a clinical interview, after their informed consent.
Results
Results suggest that sexual problems are negatively related to all QoL domains, namely physical functioning (r= −.55; p<.0001), role-physical (r= −.56; p<.0001), bodily pain (r= −.59; p<.0001), general health (r= −.50; p<.0001), vitality (r= −.44; p<.0001), social functioning (r= −.32; p<.05), role-emotional (r= −.41; p<.0001), and mental health (r= −.38; p<.01). Sexual satisfaction is negatively related to QoL (Note: higher values in this scale mean lower satisfaction): physical functioning (r= −.43; p<.0001), role-physical (r= −.42; p<.0001), bodily pain (r= −.42; p<.0001), general health (r= −.41; p<.0001), vitality (r= −.48; p<.0001), social functioning (r= −.27; p<.05), role-emotional (r= −.31; p<.05), and mental health (r= −.35; p<.01).
Conclusion
Sexual problems and sexual satisfaction are moderately related to all QoL domains in patients with obesity. These results emphasize the importance of approaching sexuality in clinical practice and in scientific research.
Obes Facts. 2009 May 14;2(Suppl 2):235–236.
Introduction
In Greece, the prevalence of metabolic syndrome (MetS) in general population is 23% (Athyros VG et al. Curr Med Res and Opinion, 20: 1691-1701, 2004). The aim of this study was to estimate the role of waist circumfrrence (WC) in the prevalence of MetS in patients with upper airway resistance syndrome (UARS).
Methods
After polysomnography 568 patients (373 men and 193 women) with UARS (Group A) and 306 (220 men and 86 women) snorers (Group B) were studied for MetS according to ATPIII–NCEP criteria. In each group, MetS was estimated firstly according to medical history and clinical examination (subgroup MetS-1), secondly according to laboratory biochemical results (subgroup Mets-2) and thirdly after the correction of blood pressure based on the 24hour ambulatory measurements (subgroup MetS-3). The results were compared to the results of 2511 patients with obstructive sleep apnea syndrome (OSAS, Group C). The SPSS 11.00 was used for statistical analysis.
Results
Group A and B had the same mean age, WC, and prevalence of MetS. The prevalence of WC and MetS was significantly lower in Groups A and B than in Group C (p<0.000).
Conclusion
The prevalence of MetS was significantly lower in snoreres and in the UARS group than in the OSAS group, attributed to significantly lower values of WC.
Obes Facts. 2009 May 14;2(Suppl 2):236.
Introduction
With the increasing prevalence of obesity effective lifestyle interventions in routine clinical practice are essential. Weight loss and improvement in health related quality of life (HRQOL) are important outcome measures for weight management programmes.
Methods
Patients were recruited from GCWMS, which is a National Health Service multidisciplinary, evidence based, weight management programme incorporating dietitians, physiotherapists and clinical psychologists. In line with national guidelines the programme uses a multi-component approach (SIGN 1996, NICE 2006) delivered in a group format. Each session has three components: diet, physical activity and psychology, all delivered by a dietitian. Patients completed the initial group based 18 week lifestyle intervention (see appendix 1 for summary). Weight loss data was calculated after 18 weeks. Change in HRQOL was measured by the Impact of Weight on Quality of Life-Lite (Crosby et al, 2004) which was completed prior to and at the end of the 18 weeks intervention.
Results
120 patients agreed to participate in the study with a mean BMI of 44.1kg/m2. The 18 week intervention was completed by 65.8% of patients. After 18 weeks mean weight loss was 4.1% and 34.4% of patients achieved a weight loss of at least 5%. Overall HRQOL and 4 out of the 5 individual measures of quality of life (physical function, self esteem, work life and sexual life) improved significantly after the 18 week intervention.
Conclusion
The 18 week lifestyle intervention delivered in a health care setting, under routine conditions, was effective in achieving clinically significant weight loss and a meaningful improvement in HRQOL.
References
(1) Scottish Intercollegiate Guidelines Network (SIGN). (1996). Obesity in Scotland. Integrating prevention with weight management. (2) National Institute for Clinical Excellence (NICE), (2006). Obesity (No. 43). NICE; London (3) Crosby et al (2004) An integrated method to determine meaningful changes in health-related quality of life. Journal of Clinical Epidemiology 57 (2004) 1153–1160
Conflict of Interest: None disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):236.
Introduction
Identifying psychological factors that may improve weight loss is important and may better inform the development of behavioural strategies used in lifestyle interventions. This study aimed to identify psychological factors associated with successful weight loss after a lifestyle program.
Methods
Ninety-four obese participants (25 male/69 female) completed an intensive weight loss program involving weekly review by a Dietitian and Exercise Physiologist for 4 months followed by a weight maintenance program involving monthly review for 8 months. Demographic and psychological (quality of life, self motivation, social support and locus of control) data were collected at months 0, 4 and 12.
Results
The mean age was 45±8 years and body mass index 38.0±6.6 kg/m2. Mean weight loss at 12 months was 6.1±7.0% body weight. Patients who achieved and maintained ≥3% body weight loss demonstrated a higher attendance rate to appointments, a significant increase in recruitment of social support, higher social functioning and a greater perceived influence of other people in relation to their weight problems compared to those who did not achieve 3% weight loss. There was no difference in internal locus of control or self-motivation between those who did and did not lose weight.
Conclusion
Weight loss programs that include strategies that help patients to develop a system for social and family support structures and identify the role of people other than themselves in contributing to their lifestyle choices may result in better outcomes than programs that focus solely on personal behavioural changes.
Funding: The National Health and Medical Research Council (NHMRC) of Australia provided funding for this study. IH is an NHMRC Australian Clinical Research Fellow.
Obes Facts. 2009 May 14;2(Suppl 2):236–237.
Introduction
Obese individuals’ self-perceptions and day-to-day aspects of obesity have a largely unrecognised influence on uptake of weight loss programmes. We previously reported the feasibility of self-assessment in a secondary care setting, using a standardised, validated questionnaire.
Methods
97 patients initially assessed for self-perceptions using this questionnaire were followed-up for a period of up to 22 months between January 2007 and November 2008. Follow-up information for each patient was correlated with data obtained from the questionnaires.
Results
As of November 2008, 58 (59.79%) patients were still being followed-up [Group 1], 23 (23.71%) patients had self-discharged during weight intervention [Group 2], and 16 (16.49%) did not progress beyond the initial clinic visit [Group 3]. The mean duration of follow-up in Group 1 was 16.72 months, and 7.04 months in Group 2. The mean number of consultations per annum in Group 1 was 5.48, and 8.13 in Group 2. However, the non-attendance rates (per patient per annum) were much lower in Group 1 − 0.71 DNA(Did not Attend)s and 0.74 CNA(Could not Attend)s, compared to 1.87 DNAs and 2.87 CNAs in Group 2.
Increased participation in weight management programmes was associated with (a) more severe difficulties in activities of daily living; (b) body mass index (BMI) < 50 kg/m2; (c) feelings of increased loneliness; (d) greater confidence. Perceived support exhibited a more complex pattern.
Conclusions
Individuals’ self-perceptions affect their uptake of and participation in weight loss programmes. Physical, social and emotional needs should be taken into account when planning weight management programmes.
Conflict of Interest: none disclosed. Funding: none.
Obes Facts. 2009 May 14;2(Suppl 2):237.
Introduction
Specialist Weight Management Clinics are newly implemented centres throughout the United Kingdom that focus solely on weight loss in obese persons. The National Institute of Clinical Excellence states the best practice guidelines for the management of weight loss, and thus can be used to assess their effectiveness.
Methods
A retrospective study was conducted on a total of thirty two patients who had attended the weight management clinic in Gwent, Wales, for over twelve months. This clinic is run by specialists (Doctor, Dietitian, Nurse, Psychologist and Exercise Therapist). The weights of each client at baseline, 6-9months after baseline and 12months after baseline were collected and compared to the weight loss expected from the NICE guidelines at those time intervals. This data was further analysed to evaluate whether a person's gender influences their degree of weight loss.
Results
Statistically significant weight loss was identified between baseline and 6 months (t = 3.029) along with a statistically significant maintenance of that loss (t = 1.425). 47% achieved the NICE Guideline weight loss target at six months, and 100% maintained this weight loss to twelve months. 50% of the female population achieved the NICE Guideline target as opposed to 43% of the male population, with maintenance at 100% and 83% respectively.
Conclusion
Weight loss and its maintenance was achieved, this demonstrated the success of the multidisciplinary approach in these Specialist Weight Management Clinics. Further evaluation highlighted areas for improvement in order to achieve a higher success rate as expected from the NICE Guidelines.
Conflicts of interest: None declared. Funding: No funding.
Obes Facts. 2009 May 14;2(Suppl 2):237.
Introduction
The management of childhood obesity is difficult and needs to be adapted to the age, degree of overweight, family background, motivation, location and availability of health providers. Family-based behavioural therapy aiming to modify family lifestyle and microenvironment, and to reinforce parental role are promising. In the context of the development of a Swiss national therapeutic program, our goal was to create standardized educational manuals for children, parents and health providers.
Methods
A multi-disciplinary team (pediatricians, dietitians, psychiatrists, psychologists, and physical education teachers) created educational manuals for children, adolescents and parents, as well as an information guide for health providers. The development of manuals was based on literature review, current recommendations and contacts with international teams. Manuals can be used in group or individual setting.
Results
Manuals include modules which contain information on diet (balance, structure, portion size, taste, nibbling, marketing), physical activity (active transports, leisure-time and sports), sedentary activities (television, computer), behaviour change techniques, parenting and coping with psychosocial problems commonly experienced by obese children, such as teasing and body image concerns. They include exercises and workshops, adapted to the child's age and degree of autonomy. Techniques include self-awareness, goal setting, cognitive behaviour strategies, stimulus control, coping skills training and contingency management.
Conclusion
The management of childhood obesity can differ significantly between health providers. It is urgent to improve training and to provide standardized educational supports to optimize the therapy. We are currently evaluating the efficacy of these methods in a randomised controlled trial. Preliminary results will be presented.
Conflict of Interest: None. Funding: Swiss National Science Foundation # 3200B0-120437, University Hospitals of Geneva
Obes Facts. 2009 May 14;2(Suppl 2):237.
Introduction
Weight at birth (BW) has been shown as positively associated with adult obesity, the association with growth in specific periods of early childhood remains unclear. The overall purpose was to explore the association between BW and weight on later stages until early adulthood.
Methods
Data were collected anonymously from 250 health records from students of the Military Academy of Thessaloniki. Data collected included weight and height at birth as well as at 6 months, at 1st, 3rd, 5th, 10th, 15th year and last data was for the 20th year of life. Neverthells, Body Mass Indices (BMI) for all age stages were calculated. Complete data were available for 229 canditates(141 males − 87 females). Associations between predictor and outcome variables were assessed with linear regression modelling.
Results
Size at birth and postnatal growth were both positively associated with overweight/obesity in adulthood. Increased weight gain in infancy showed positive association with overweight/obesity in adolscent and early adulthood, however increased weight gain in infancy was not correlated to birthweight.
Conclusion
Increased weight gain during the first two years of life swow stronger effect than size at birth on predicting adolscent and/or early adulthood weight, therefor suggesting infancy to be a more crucial period.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):238.
Introduction
Rising rates of obesity have serious implications for public health. Primary care health professionals should be able to help patients lose weight but the lack of good evidence-based interventions deters many from trying. We successfully piloted a nurse-led computer-aided weight loss support package (including pedometers) in eight general practices. We demonstrated that this could make a substantial contribution to improving weight management services and that a randomised controlled trial was feasible.
Methods
The intervention combines key evidence-based components of programmes recognized as essential for successful weight loss and behaviour change. These include motivational interviewing, tailored goal setting, self-monitoring, structured eating plans, increased physical activity, positive reinforcement, and relapse prevention. A total of 380 participants aged 18+ years with BMI≥ 27 kg/m2, will be recruited from general practices in Camden Primary Care Trust (PCT), randomised to an intervention or control group. The intervention will comprise fourteen one-to-one sessions with a nurse over a period of twelve months and the provision of a pedometer. Participants in the control group will be referred to alternative services provided by Camden PCT in its Adult Obesity Care Pathway. The primary outcomes of the trial are changes in weight, waist circumference and percent body weight, and the incremental cost per QALY at one year. An integral process evaluation will be conducted to explore intervention delivery and receipt by interviewing a sample of health professionals and participants.
Conclusion
The study will provide robust evidence to aid policy on provision of weight management services in primary care.
Conflict of Interest: No conflict of interest. Funding: Research relating to this abstract was funded by Camden Primary Care Trust
Obes Facts. 2009 May 14;2(Suppl 2):238.
Background
Patient experience and continuous improvement methodology play a critical role in development of weight management services. We investigated factors associated with compliance, drop-out and success to drive our model of continuous improvement.
Method
Independent qualitative researchers approached and conducted interviews with non-starters (NS) (referred but never attended) (n= 18/53), low-attenders (LA) (attended ≤2 sessions before lost to follow up) (n = 23/48) and high-attenders (HA) (completed ≥4 sessions) (n= 23/ 23) from 574 referrals to the Counterweight Programme. Information on patients’ level of social deprivation was gathered using the Scottish Index of Multiple Deprivation.
Results
No statistically significant link between NS, LA, HA and measures of social deprivation were found. Among the most frequent reasons given for NS was lack of information about Counterweight by referring staff (n= 18,100%) and difficulty in contacting clinicians delivering the programme to arrange appointments (n= 7, 39%). 83% (n= 15) expressed an interest in having a new appointment post interview. Social and logistical reasons were among reasons for the drop-out in LA; 87% interviewed were interested in restarting. HA cited family support as important for success and gave similar scores for confidence and understanding (8.2).
Conclusion
Factors that may improve compliance and success with Counterweight are easier contact and logistical aspects of appointments, with more information pre-recruitment. A number of new systems have been implemented through on-going Continuous Improvement.
Obes Facts. 2009 May 14;2(Suppl 2):238.
Introduction
Childhood obesity is associated with an increased risk of cardiovascular and endocrine morbidity. There are few studies that have quantified change in metabolic parameters secondary to weight loss.
Methods
A prospective study investigating the metabolic changes associated with BMI Standard Deviation Score (SDS) improvement over a 12-month period in obese patients (n=88, age 9-17). Patients were participating in a randomised trial of behavioural modification of diet and exercise. Measurements were taken at baseline and 12-months for BMI SDS, body composition (Tanita Bioimpedance [BC-418MA]), insulin sensitivity (HOMA-R) and glucose metabolism estimated by oral glucose tolerance test, fasting lipids, High Sensitivity ‘C’ Reactive Protein (HsCRP), and blood pressure.
Results
Clinically significant improvements (>17% reduction) in body composition measures (mean waist circumference SDS, body fat SDS, truncal fat) were found with a BMI SDS loss of ≥0.5. A similar improvement in BMI SDS was needed to have significant reductions in key metabolic risk factors (triglycerides [30%], LDL-Cholesterol [15%], HsCRP [46%]). A reduction of ≥0.25 BMI SDS was significantly associated with improved diastolic blood pressure. Insulin sensitivity improved with increasing reductions in BMI SDS whilst the most insulin sensitive children at baseline were the most likely to achieve BMI SDS changes of ≥0.5 regardless of baseline BMI SDS.
Conclusion
Although some improvement in body composition and cardio-metabolic risk can be seen with BMI SDS changes ≥0.25 in obese adolescents, far greater benefits accrue from losing at least 0.5 of an SDS. The most insulin sensitive individuals seem best able to effect these changes.
Conflict of Interest: None disclosed. Funding: Research relating to this abstract was funded by the BUPA Foundation, the HSA Charitable Trust for Nurses and Johnson & Johnson/Ethicon Nurse Education Trust Fund.
Obes Facts. 2009 May 14;2(Suppl 2):238–239.
Background
Childhood obesity in the United Arab Emirates is 2 to 3 times higher than the published international standards (Al Hadaad et al, 2005). In 2007, the Expert Committee revised guidelines for obesity evaluation and treatment in primary care (Barlow et al, 2007). The purpose of this study was to examine the practices and attitudes of primary care physicians toward diagnosis and treatment of childhood obesity.
Method
Physicians caring for children were asked to complete an anonymous questionnaire. Data on personal and professional details, methods of body weight assessments, treatment and, familiarity with the Expert Committee recommendations were collected.
Results
Physician specialty included 85% general practitioners, 7% family practitioners and 6% pediatricians. Majority (80%) of physicians used the correct method to diagnose obesity. Only 24% reported receiving formal training in child anthropometry. Furthermore, only 59% discuss weight and lifestyle issues with all patients regardless of presenting weight at least once a year, while 45% weigh all children, and plot on growth chart. Majority (63%) of physicians were not aware of the Expert Committee recommendations. Lack of parental involvement, physicians’ time and support services were the top 3 barriers to managing childhood obesity.
Conclusion
This study provides directions and priorities to improve the ability of physicians to address childhood obesity. Physicians could benefit from further training and advocacy efforts.
Conflict of Interest: None disclosed
Obes Facts. 2009 May 14;2(Suppl 2):239.
Introduction
The rapid increase in the prevalence of childhood obesity has prompted policy makers and researchers to find effective interventions for its prevention and treatment. In the bid to find answers, researchers should remember what is entailed in conducting rigorous evaluations of such complex interventions.
Methods
We recently completed a feasibility trial of WATCH-IT, a 12-month community intervention for obese children, which was developed and piloted in Leeds. We sought to provide ‘proof of concept’ as well as considering methodological issues including; feasibility of identification and recruitment of children; acceptability of randomisation to no-treatment control arm; acceptability of outcome measurements; sustainability of participation; and an accurate sample size estimate.
Results
We successfully recruited the desired number of participants (70) within the 6 month time frame. Most participants were referred by GPs, but self-referred children were more likely to be randomised. Acceptability was good, with 25% loss to follow-up. The study also allowed us to design an optimal order for taking assessments to maintain blinding; and develop and test trial specific outcome measures. Data have been used to calculate sample size for a multi-site trial, and (considering clustering) estimate that 1120 participants are needed.
Conclusion
The trial provided invaluable information that has informed the design of future multi-centre community based trials for obese children. We present these lessons, which provide evidence in support of the conduct of feasibility studies such as those involved in childhood obesity.
Conflict of interest: None disclosed. Funding: Research relating to this abstract was funded by the Wellcome Trust
Obes Facts. 2009 May 14;2(Suppl 2):239.
Introduction
A hospital-based Consultant-led, multi-disciplinary Obesity Clinic (OC) was established in DGRI in 2007. Education, support, pharmacological intervention and frequency of follow-up were based on individualised patient requirements and needs. There was no access to bariatric surgery.
Our aim was to assess whether the OC could successfully reduce weight, waist circumference and HbA1c (a marker of insulin resistance).
Methods
Between February 2007 and January 2008, each new patient's weight, waist circumference and HbA1c were collected at 0, 3, 6, 9 and 12 months following each patient's initial attendance at the OC.
Results
The mean BMI of new patients was 44. Of the 96 patients that continued to attend the OC beyond 3 months, at 12 months there was a reduction in weight of 7.4% (mean 121 to 112kg), a reduction in waist circumference of 7.4% (mean 129 to 119cm) and a reduction in HbA1c from a mean of 6.3 to 5.7%.
Conclusion
The DGRI OC can successfully reduce weight, waist circumference and HbA1c in patients referred to DGRI Specialist Multi-disciplinary Obesity Clinic at 12 months.
Conflict of Interest: SG, JY, AH, PP and EB have received funding from Roche and Abbott to attend European and International Scientific meetings. Funding: None
Obes Facts. 2009 May 14;2(Suppl 2):239.
Introduction
Prevalence of child and adolescent obesity has increased steadily in recent decades. As a primary unit of socialisation the family exert a crucial influence on the child with respect to verbal and bodily expressions. Previous research indicates that child and adolescent obesity is correlated with parental socio-economic background. Research further indicates that many parents of overweight children fail to recognise their children's weight problems and that this misperception is correlated with socio-economic factors.
Method
To enhance understanding of the pathways by which family-bound socio-economic factors affect child and adolescent obesity as well as parental perception of child weight level this study utilizes an explicit empirical model along with sociological theory of social class and lifestyles. The study is based on Danish micro panel data with information on BMI, food purchases, exercise behaviour, socio-demographics as well as an extensive battery of illicit attitudes on health and nutrition.
Results
Results suggest that distinct lifestyles based on differences in objective conditions as well as values concerning food, nutrition, exercise, and body view can be discerned and that variations in child weight and parental perception of child ideal-weight are strongly driven by social class and lifestyle differences. Children and adolescents belonging to particular social classes are more prone towards overweight while parents from the same classes more often misjudge their children's weight level.
Conclusion
If the increasing level of child and obesity prevalence is to be alleviated an understanding of family background and parental influence is crucial.
Obes Facts. 2009 May 14;2(Suppl 2):239–240.
Introduction
Obese patients have unrealistically high weight loss expectations (Grave 2004). The impact of unrealistic expectations on weight loss in weight management programmes is unclear (Teixeira 2002 and 2004).
Methods
Patients were recruited from GCWMS, which is a National Health Service multidisciplinary, evidence based, weight management programme incorporating dietitians, physiotherapists and clinical psychologists. In line with national guidelines the programme uses a multi-component approach (SIGN 1996, NICE 2006) delivered in a group format. Each session has three components: diet, physical activity and psychology, all delivered by a dietitian. Patients completed the initial group based 18-week lifestyle intervention (see appendix 1 for summary). Weight loss expectations were measured at baseline and after 18 weeks using the Goals and Relative Weights Questionnaire (Foster 1997). Weight loss was calculated after 18 weeks.
Results
120 patients agreed to participate in the study, mean BMI 44.1kg/m2. The 18 week intervention was completed by 65.8% of patients. Mean weight loss was 4.1%. See table 1 for weight loss expectations.
There was no correlation between weight loss expectations at baseline and weight loss after 18 weeks. Weight loss expectations after 18 weeks were significantly lower than at baseline.
Conclusion
Weight loss expectations at baseline were unrealistic and not related to weight loss after 18 weeks. The programme successfully lowered weight loss expectations after 18 weeks but they still remained unrealistic which may impact on long term weight control.
Conflict of Interest: None disclosed. Funding: No Funding
Table 1.
| Mean weight loss expectation | Baseline | After 18 weeks |
|---|---|---|
| Dream | 40.9% | 32.7% |
| Goal | 19.2% | 15.4% |
| Disappointed | 12.2% | 6.9% |
Obes Facts. 2009 May 14;2(Suppl 2):240.
Introduction
In assessing obesity clinically, one must use the easiest, quickest and most cost- effective measures available, whilst not compromising the accuracy of BMI estimation. We aimed to devise a formula for estimating BMI using mid arm circumference measurements only.
Methods
One hundred and twenty two subjects were recruited. They were divided into three sub-groups, (normal, obese, diabetics with and without obesity). Mid arm circumference, weight and height were measured. Regression analysis was performed and a formula (Haboubi-Kennedy formula) for estimation was created.
Results
Regression equations for control group and obese non-diabetics were significant at less than the 1% level (t = 0.057 and 0.0066 respectively), whilst the equations for obese diabetics and all obese subjects were significant at the 0% level (t = 0.000).
Pearson rank coefficients also showed significant correlations at less than the 0.1% level for control group, obese non-diabetics, obese diabetics and all obese subjects.
A formula for all obese individuals was calculated as:
BMI = (MUAC − 27.7) / 0.188
This is named the Haboubi-Kennedy formula (or H-K formula) for estimating BMI from a single MUAC measure of the dominant arm.
Conclusion
Mid upper arm circumference measurements can feasibly estimate BMI when the correct formula for the body shape of the individual is considered.
Obes Facts. 2009 May 14;2(Suppl 2):240.
Introduction
BORIS is a new Swedish national quality register for childhood obesity. The aim is that all children, 5-18 years, undergoing treatment for obesity should be registered in the database. We can now report the first results and trends.
Methods
All BORIS data registered as of end September 2008 was included in the analyses. Data was analysed with a built-in statistics tool.
Results
Close to 3 000 children were registered (47% girls), a two-fold increase during the last year. 50% of the major regional clinics had joined. In total 33 units participated, representing first, secondary and tertiary level of treatment. Mean age at start of treatment was 12.0±3.4 years and 11.3±3.6 years for children with treatment initiated during 2008. Relative obesity, BMI SDS, at start of treatment was 5.4±1.5 for all children and 5.0±1.6 for patients with start of treatment in 2008. Over 5 years, the decrease in BMI SDS was 1.44 for boys and 0.97 for girls. The decrease in relative obesity over one year was larger for patients starting treatment during 2007 (−0.75) compared to during 2006 (−0.52).
Conclusion
Treatment is initiated late for children with obesity in Sweden and almost only severely obese children are offered clinical treatment. The trend is positive: for children whose treatment was initiated during 2008 the age and relative obesity at start of treatment has decreased. Treatment results have also been enhanced from 2006 to 2007, possibly indicating improved treatment methods and increased competence.
Conflict of Interest: None disclosed. Funding: Research relating to this abstract was funded by Swedish Association of Local Authorities and Regions / The National Board of Health and Welfare.
Obes Facts. 2009 May 14;2(Suppl 2):240–241.
Introduction
Even though it is known that ezetimibe is a selective inhibitor of cholesterol absorption from GI and orlistat decreases fat absorption within the gut lumen by inhibiting intestinal and pancreatic lipase, the effect of their combination to overweight and obese patients has not been studied profoundly yet.
| Weight loss | Adiponectin (µg/mL) | Leptin (ng/mL) | ||
|---|---|---|---|---|
| Baseline | 6 months | Baseline | 6 months | |
| 1s* (<2.5kg weight loss) | S.S2 (4.12-10.SS) | 6.9S (S.67-11.07) | S0.S0 (2.7-49.96) | 1S.77 (1.24-49.9S) |
| 2nd (≥2.5kg<8kg weight loss) | S.17 (S.64-10.SS) | 10.06 (2.84-11.S4) | 7.4S (S.4S-47.86) | 6.77 (S.99-S8.29) |
| 3rd (≥8kg< 14kg weight loss) | 4.88 (2.71-10.74) | 6.22 (2.78-10.7S) | 8.7S (1.69-48.64) | S.78 (1.S6-49.91) |
| 4th (≥14kg weight loss) | S.89 (S.01-10.SS) | 10.21 (637-10.6S)* | 40.96 (2.78-49.64) | S.07 (0.47-6.2S)* |
*
difference between basal and 6 months
Objective
The study involved 46 subjects with a BMI >29Kg/m2 and hypercholesterolemia >220mg/dl. They were on eucaloric diet, while 16 were on ezetimibe, 10mg daily(group I) 16 were on orlistat 120mg tds (group II) and 14 on the combination of two.(group III). At the beginning of therapy and after 4 months, BMI, waist circumference, BW, were registered of all patients. Furthermore their lipid profile was recorded.
Results
There was a decline in TG, total and LDL cholesterol of all groups. In group III the decline in LDL-chol was 32,8% statically much greater of that of group I (17,5%) and group II (15%) (p< 0,05). Also in group III as in group II there was a significant decrease of not only waist circumference but BW too, in comparison to group I in which no such benefits were achieved. No side effects were reported.
Conclusion
It is proved that combination of orlistat and ezetimibe has a synergic act at the lipid panel of obese hypercholisterinemic patients, has no serious side effects and improves the body indexes.
Obes Facts. 2009 May 14;2(Suppl 2):241.
Objective
Assess Adapted Physical Activity (APA) plan, with its different techniques, and the patient's adherence to it, during a plan of weight maintenance.
Materials and Methods
170 surveys were performed to a group of both genders patients slimmed. Reasons for starting the plan, frequency, adherence, and characteristics of the population were evaluated. The average age was 43 years. All had normal weight, BMI 20,5 and 25. Gender: 17% male and 83% female.
Techniques: APA (OMS), Body-Walk, Corpus Dance, Spine gym, Adapted Arabian Dance.
Characteristics
The plan implies respecting 3 stages: Warming up, Development, Calming down. It's aerobic, without oxygen debt nor located pain, and respecting gradual heart rate increase and decrease, and passive elongation exercises.
Results
86% of the sample performed some kind of physical activity: 64% 2 to 3 times a week, 21% 4 to 5 times a week, and 15% daily. Moreover, grupal 46%, 16% with friends, 11% with relatives, and alone 27%. Among the adherents, medical prescription 39%, pleasure 45% and need and obligation 16%.
Conclusions
APA during the slimming stage is important for maintaining weight loss. Emphasizing the importance of increasing it gradually. With this workline, patients are more active and achieve more adherence, frequency and continuity, but also a greater percentage of therapeutic successes in the long term is accomplished.
Obes Facts. 2009 May 14;2(Suppl 2):241.
Introduction
Adiponectin and leptin are released by adipose tissue and are correlated with obesity and metabolic syndrome. The aim of this study was to assess the effect of multidisciplinary therapy on adiponectin and leptin levels in obese adolescents.
Methods
52 adolescents aged 15-19 y, with BMI ≥ P95, were submitted to multidisciplinary intervention (6 months) (nutrition, psychology, exercise and clinical support). Blood samples were collected and leptin and adiponectin were measured by ELISA.
Results
Table - Obese adolescent adiponectin and leptin serum levels from baseline or 6 months after multidisciplinary therapy. The patients were divided according to the weight loss quartiles.
Conclusion
Our results show that patients which present a massive weight loss (4th quartile) had a significant increase in adiponectin and decrease in leptin serum levels. These could suggest an improvement in the control of risk for obesity-related disorders, particularly metabolic syndrome and diabetes in adolescent obese submitted to multidisciplinary intervention.
Conflict of interest: none disclosed. Funding: AFIP, FAPESP 2006/00684 and 2008/53069-0, 3, FAPESP (CEPID/Sleep #9814303-3 S.T) CNPq, CAPES, CENESP, FADA, and UNIFESP-EPM, supported the CEPE-GEO Multidisciplinary Obesity Intervention Program.
Obes Facts. 2009 May 14;2(Suppl 2):241–242.
Introduction
Insulin resistance is considered the onset mechanism for abdominal obesity co-morbidities especially when visceral fat depots exist. This study aims at identifying the presence of insulin resistance calculated by the Homa-IR index and its associations with laboratory and anthropometric findings in adolescents.
Methods
Cross-sectional study with 338 adolescents of both sexes aged 14-19 years, Tanner stage >=4 from Sao Paulo city, Brazil enrolled in public schools. Following parameters were evaluated: weight/height, arterial blood pressure, glycemia, insulin, total cholesterol, HDL-C, LDL-C, triglycerides, AST, ALT, GGT. Ultrasonography and DXA were performed to study hepatic steatosis and body composition, respectively. Student t-test (unpaired) was used to assess insulin resistance calculated by HOMA-IR (cutoff point 3.43). From the 12 continuous variables analyzed, seven presented highly significant associations (p<0.0001).
Results
Means for insulin resistant /sensitive groups were Body Mass Index (Kg/m2) 32.05 / 24.54, Systolic Blood Pressure(mmHg) 117.52 / 107.22, Diastolic Blood Pressure(mmHg) 72.55 / 67.10, HDL-c(mg/dL) 46.27 / 49.51, Triglycerides (mg/dL) 98.07 / 83.33), Trunk fat (%) 38.91 / 25.86, Hepatic steatosis (%) 33.33 / 10.32.
Conclusions
This study showed that adolescents with insulin resistance presented higher mean values for metabolic/anthropometric variables. Such group present great risk to develop cardiovascular diseases and type II diabetes in the future.
Conflict of Interest: None Disclosed. Funding: No Funding.
Obes Facts. 2009 May 14;2(Suppl 2):242.
Objective
To evaluate if the reduction of weight through VLCD + SMR and cognitive behavioral group treatment, modifies the depressive symptoms and behaves as a risk factor that leads to the suffering of depression on obese and overweight patients.
Methods and Materials
96 patients treated between 2005 − 2008 were analyzed. According to their BMI when admitted, such were diagnosed to be either obese or overweight; also found to be treatment free of pharmaceutical or psychotherapy for obesity, anxiety disorders, depression or other psychiatric disorders. They had fulfilled a dietary plan with VLCD, supplements, therapeutic groups and adapted physical therapy (AFA) and had reached their desired healthy weight. Percentages of patients with a pre and post treatment depression diagnostics were calculated by means of the Modified Beck depression inventory (BDI-II).
Results
Out of the sample selected, 56.75% were women. The average age was of 44.3 years old. The prevalence of depression pre-treatment was of 37.83% (IC95%: 22-54%). In this group 64.3% of patients presented obesity and 35.7% overweight. 35.7% were classified as ‘on the limit’ of clinical depression, 57.1% moderate depression, and 7.1% severe depression. No cases of depression were detected after finalizing the weight-loss treatment, finding 57.1% of patients in the range of normality and 42.8% with mood disturbances.
Conclusion
The treatment for obesity as the baseline illness with VLCD, therapeutic groups and AFA has shown to solve the depressive symptoms in both genders. This information provides more evidence on the harmful effects of obesity on the individual's mental health.
Obes Facts. 2009 May 14;2(Suppl 2):242.
Introduction
Since May 2002, 51 BioEnterics Intragastric Balloons (BIB) were placed in 50 obese patients (previously ineffectively treated by diet for minimum three months) to study the clinical possibilities of this system. The aim of study was the evaluation of the efficacy of this device in terms of weight loss.
Methods
Data were retrospectively recruited from our data-base. 18 patients were male and 32 female; mean age was 43 years (20-72); mean weight was 125,7 kg (82-190), and mean BMI was 43.5 kg/m2 (32,8-64,2). After diagnostic endoscopy, the BIB balloon was positioned and was filled with saline (450-700 ml). We placed and removed the balloon under conscious sedation or general anesthesia. BIB was removed in the majority of patients 6 months after insertion. The patients were given an individually defined balanced diet about 1200kcal/day; follow-up involved a monthly check-up.
Results
Mean weight loss was 16,4 kg (0-51); mean reduction in BMI was 5.7 kg/m2 (0-16,8). Complications observed were: balloon intolerance (5 removals within the first tree months), no serious complications were observed.
Conclusions
The BIB-treatment is an effective procedure, that may be considered as another step to reduce weight in patients previously ineffectively treated by diet.
Conflict of interests: None Disclosed/Payment received from BioEnterics. Funding: No Funding/Research relating to this abstract was funded by BioEnterics.
Obes Facts. 2009 May 14;2(Suppl 2):242.
Introduction
Maintaining weight loss in an obesogenic environment is challenging. LighterLife is a commercial weight-management programme for patients with BMI >29kg/m2. Weight loss is initiated via a nutritionally complete very-low-calorie diet (VLCD), which is used in conjunction with transactional analysis and cognitive behavioural therapy techniques (TCBT) specifically developed for behavioural modification in weight management. LighterLife recognises the challenge of long-term weight maintenance facing many patients following their initial weight loss, by offering an ongoing weight-maintenance programme. This focuses on establishing a healthier diet and lifestyle, as well as empowering patients with coping mechanisms drawn from the continuing use of TCBT to support the maintenance of ongoing behaviour change.
Aim
To determine mean percentage average weight maintenance during follow-ups at year 1 and year 2 after initial weight loss.
Method
A cohort of n=134 patients with a BMI>29kg/m2 had weekly weight measurements carried out by their LighterLife weight-management counsellors whilst on the LighterLife Programme, following screening suitability for a VLCD with their general practitioner and LighterLife's medical department.
Results
At year one following a mean weight loss of 18.4kgs, the cohort maintained, on average, 72% of their initial weight loss. At year 2, the cohort of 134 patients maintained, on average, 46% of their initial weight loss.
| Average percentage of weight maintained after 2yrs following mean weight loss of 18.4 kgs. | |
|---|---|
| 1 year | 2 years |
| 72% | 46% |
Conclusion
The LighterLife Programme can successfully assist patients to maintain their weight loss. However, this success may rely on patients continuing on the weight-maintenance stage of the LighterLife Programme, following their initial weight loss.
Conflict of interests: none. Funding: no funding
Obes Facts. 2009 May 14;2(Suppl 2):242–243.
Introduction
The aim of this study was to test a three-level model in which body image, represented by several of its dimensions, predicted perceived choice and behavioural regulations for obesity treatment, which in turn influenced psychological well-being.
Methods
Participants were 142 overweight women (age: 38.0±6.7 yr; BMI: 31.9±4.1 kg/m2), entering a behavioural weight management program. They completed a comprehensive battery of body image questionnaires - Body Shape Questionnaire, Social Physique Anxiety Scale, Body Image Assessment, Body Dissatisfaction Scale (EDI-2), and Physical Self Perception Profile –, the Treatment Self-Regulation Questionnaire, and the Self-Determination Scale. The Rosenberg Self-Esteem and SF-36 questionnaires assessed psychological well-being. The causal model was tested using partial least squares latent variable modelling.
Results
Well-being was positively influenced by perceived choice (p<0.05), negatively by controlled regulation (p<0.01), but not influenced by autonomous regulation. Behavioural regulations were influenced by body image: perceived choice by physical self-worth (PSW, p<0.05); autonomous regulation by body image discrepancy (p<0.05); controlled regulation by body shape concerns (BSC, p<0.001) and social physique anxiety (SPA, p<0.001); all positively. Mediation effects were found: controlled regulation mediated BSC–well-being relations, except for vitality and mental health, and SPA–well-being relations, except for vitality; perceived choice mediated PSW–well-being relations, except for emotional health.
Conclusions
Poor body image may be detrimental to well-being in treatment-seeking overweight/obese women, to the extent it increases controlled regulation and decreases perceived choice (a marker of self-determination). Body image should be addressed during obesity treatment, particularly its importance/salience in one's personal life, as a way of increasing autonomy and well-being.
Conflict of Interest: None Disclosed. Funding: Research relating to this abstract was funded by the Portuguese Science and Technology Foundation, the Calouste Gulbenkian Foundation, Oeiras City Council, IBESA, Nestlé-Portugal.
Obes Facts. 2009 May 14;2(Suppl 2):243.
Introduction
Hypertension is a known cardiovascular risk factor, and was originally considered as being ‘essential’. However, it is in fact secondary to obesity1. A 4.5kg weight gain increases the risk of developing hypertension by 20%2. As part of the clinical supervision advocated for very-low-calorie diets (VLCD)3, monthly blood-pressure measurements are mandatory for patients on the LighterLife Programme, a commercial weight-management programme using a nutritionally complete VLCD in conjunction with transactional analysis and cognitive behavioural therapy techniques (TCBT) specifically developed for patients with a BMI >29kg/m2. Following weight loss, LighterLife offers a free weight-maintenance programme for ongoing patient support to help maintain lifestyle changes.
Aim
To assess mean systolic/diastolic blood-pressure readings over a period of 12 weeks in a cohort of n=200 patients using the LighterLife Programme.
Method
Following a successful initial clinical-screening process, 200 patients with a BMI>29 m2 underwent monthly blood-pressure checks with their healthcare provider whilst on the LighterLife Programme.
Results
Systolic/diastolic blood pressures decreased by 8.6% and 6.6% from baseline, following 12 weeks on the LighterLife Programme.
| Systolic blood pressures | |||
|---|---|---|---|
| Baseline | Week 4 | Week 8 | Week 12 |
| 133.33 | 124.975 | 124.19 | 122.87 |
| Diastolic blood pressures | |||
|---|---|---|---|
| Baseline | Week 4 | Week 8 | Week 12 |
| 83.01 | 81.215 | 79.29 | 77.58 |
| Mean weight (kg) during 12 weeks | |||
|---|---|---|---|
| Baseline | Week 4 | Week 8 | Week 12 |
| 109.54 | 101.80 | 95.36 | 90.45 |
Conclusion
Systolic/diastolic blood pressures reduced significantly following 12 weeks on the LighterLife Programme, with a 22.5kg mean weight reduction. By being prophylactic in weight reduction, we hope to prevent/attenuate possible future cardiovascular insults.
Conflict of interests: None. Funding: No funding
Obes Facts. 2009 May 14;2(Suppl 2):243.
Introduction
In recent years, several studies reinforce the assumption that obesity is a chronic disease associated to significant QoL impairment. This study aims to analyse QoL of women with obesity participating in an individualized treatment program for losing weight and compare their QoL with the normative values for the general Portuguese population.
Methods
A group of 67 women with obesity, aged between 21 and 61 (M=41.36; SD=9.99); 68.7% married, 9% divorced, 16.4% single, and 6% widow was studied. Participants answered to the socio-demographic questionnaire and to SF-36, in the context of a clinical interview, after their informed consent. Data was analyzed considering the age cohorts according to the Portuguese SF-36 validation for the general population: Group 1 aged between 15-24; Group 2 aged between 25-44; Group 3 aged between 45-64).
Results
Results suggest that, in Group 1 (15-24 years old), a considerable number of patients report lower QoL in the following domains: physical-functioning (100%), bodily-pain (80%), general-health (75%), social-functioning (75%), mental-health (80%), emotional-role (60%); physical-role (40%) and vitality (80%). In Group 2, an important number of patients report lower bodily-pain (72.5%), social-functioning (80%), general-health (70%), mental-health (62.5%), physical-functioning (80%), vitality (70%), emotional-role (53.8%); and physical-role (48.7%). In Group 3, data reveal lower QoL in social-functioning (40.9%), mental-health (81%), bodily-pain (72.7%), physical-functioning (76.2%), vitality (77.3%), general-health (76.2%), emotional-role (54.5%) and physical-role (52.4%).
Conclusion
All the age-groups report a considerable percentage of patients with lower QoL comparing to general Portuguese population. These results reinforce the importance of developing psychological intervention programs in order to promote QoL.
Obes Facts. 2009 May 14;2(Suppl 2):244.
Introduction
Stigma is an attribute that is deeply discrediting to individuals. The likelihood of obese individuals feel stigmatized and discriminated is substantial. The aim of this study is to access self perception of stigma in obese women with a five items scale, asking about stigma free of settings and specific situations, and correlate it with quality of life (QoL).
Methods
A group of 67 women with obesity, aged between 21 and 61 (M=41.36; SD=9.99); 68.7% married, 9% divorced, 16.4% single, and 6% widow was studied. Participants answered to the socio-demographic questionnaire, SF-36 and to a stigma scale, in the context of a clinical interview, after their informed consent. Data was analysed with bivariate correlation.
Results
Results suggest that stigma is significantly (p<.05) and positively correlated with all SF-36 dimensions: physical-functioning (r=.28), bodily-pain (r=.43), general-health (r=.44), social-functioning (r=.47), mental-health (r=.46), emotional-role (r=.55), physical-role (r=.46) and vitality (r=.41). The physical (r=.48) and mental (r=.59) components also correlate positively with stigma (p<.001).
Conclusion
Stigma is significantly and negatively associated to QoL. These results reinforce the importance of developing psychological intervention programs in order to support patients with obesity that feel discriminated because of their illness.
Obes Facts. 2009 May 14;2(Suppl 2):244.
Introduction
Spirituality is an important dimension in the context of human suffering resulting from chronic diseases. The aim of this study is to access spirituality in obese women with a five items scale, asking about spiritual believes and hope/optimism, and correlating it with quality of life (QoL).
Methods
A group of 67 women with obesity, aged between 21 and 61 (M=41.36; SD=9.99); 68.7% married, 9% divorced, 16.4% single, and 6% widow was studied. Participants answered to the socio-demographic questionnaire, SF-36 and to the spirituality scale, in the context of a clinical interview, after their informed consent. Data was analysed with bivariate correlation.
Results
Results suggest that spirituality is significantly and positively correlated to the following QoL dimensions: general-health (r=.32; p<.05), social-functioning (r=.26;p<.05), mental-health (r=.30; p<.05), and vitality (r=.37; p<.01). Physical-functioning, physical-role, bodily-pain and role-emotional revealed not to be significantly related to spirituality (p>.05). Data analysis also suggest that QoL is not significantly related to spiritual believes (p>.05), however hope/optimism is significantly related to physical-functioning (r=.32; p<.01), role-physical (r=.26; p<.05), general-health (r=.40; p<.01), vitality (r=.52; p<.0001), social-functioning (r=.41; p<.01), role-emotional (r=.29; p<.05), and mental health (r=.46; p<.0001).
Conclusion
Spirituality is significantly and positively associated with QoL. These results reinforce the importance of spirituality as an essential part of the adjustment process to chronic diseases, such as obesity.
Obes Facts. 2009 May 14;2(Suppl 2):244.
Background
Our previous investigations revealed, that 20% of obese and overweight patients have behavioral eating disorder (bulimia nervosa), which divides in two types - reactive (type 1) and autochtonous (type 2).
Methods
We studied 36 patients, divided into three groups - alimentary obese patients, obese patients with type 1 bulimia nervosa and obese patients with type 2 bulimia nervosa. The quality of life was evaluated with questionnaire SF-36 Health Status Survey. The results were compared on two parameters: physical and psychological component of health.
Results
The results shows reduction of quality of life in alimentary obese patients patients, where the physical component of health was impaired more and in patients with bulimia nervosa type 1, where both components of health were impaired. In the group with bulimia nervosa type 2 the quality of life was better, but the psychological component of health was noticeably more affected.
Conclusions
So obese patients with and without bulimia nervosa have impaired quality of life, but physical and psychological component of health is affected differently depending on the type of eating disorder
Obes Facts. 2009 May 14;2(Suppl 2):244–245.
Introduction
Waist circumference measurement is gaining popularity as an indicator for cardiovascular risk and type 2 diabetes. It is a good predictor of abdominal fat1, which is affiliated with dyslipidaemia, insulin intolerance and other risk factors. Men with a waist ≥102cm and women with a waist ≥88cm are at increased risk of co-morbidities. This is reduced to ≥85cm and ≥80cm respectively in the Asian population. WHO2 recommends the adjunct approach of identifying risk factors using an approach of waist circumference and BMI measurement.
Aim
To assess mean waist circumference over a period of 12 weeks in a cohort of n=180 male and female patients using the LighterLife Programme from a service evaluation. LighterLife is a commercial weight-management programme using a nutritionally complete very-low-calorie diet (VLCD) in conjunction with transactional analysis and cognitive behavioural therapy techniques (TCBT) specifically developed for patients with a BMI >29kg/m2. Following weight loss, LighterLife offers a free weight-maintenance programme for ongoing patient support to help maintain lifestyle changes, thus reducing the risk of associated co-morbidities.
Method
A cohort of n=180 patients with BMI>29kg/m2 had monthly waist circumference measurements taken by their LighterLife weight-management counsellors, following screening suitability for a VLCD with their general practitioner and LighterLife's medical department.
Results
A 14% mean reduction in waist circumference was observed following 12 weeks on the LighterLife Programme.
| Waist measurement (cm) | |||
|---|---|---|---|
| Baseline | Week 4 | Week 8 | Week 12 |
| 110.3776 | 104.282 | 99.2491 | 99.2559 |
Conclusion
The risk of co-morbidity development is clinically considered to be reduced, following the significant waist reduction from baseline in obese patients.
Obes Facts. 2009 May 14;2(Suppl 2):245.
Introduction
A 10% reduction in weight reduces fasting glucose up to 50% in newly diagnosed diabetic patients, leads to a 10% reduction in total cholesterol and a 40% reduction in related deaths1. LighterLife is a commercial weight-management programme using a nutritionally complete very-low-calorie diet (VLCD) in conjunction with transactional analysis and cognitive behavioural therapy techniques (TCBT) specifically developed for patients with a BMI >29kg/m2. Following weight loss, LighterLife offers a free weight-maintenance programme for ongoing patient support to help maintain lifestyle changes, thus reducing the risk of associated co-morbidities.
Aim
To determine mean average weight loss and BMI reduction for female patients during the weight-loss stage of the LighterLife Programme.
Method
A cohort of n=7215 women with a BMI>29kg/m2 had weekly weight measurements carried out by their LighterLife weight-management counsellors whilst on the LighterLife Programme, following screening suitability for a VLCD with their general practitioner and LighterLife's medical department.
Results
After 12 weeks on the LighterLife Programme in 2008, a mean BMI reduction of 6.51kg/m2 and a mean weight loss of 17.51kg in female patients were observed.
| Mean start weight | 99.16kg |
| Mean start BMI | 36.87kg/m2 |
| Mean weight loss at 12 weeks | 17.51kg |
| Mean % weight loss | 17.66% |
| Mean BMI reduction | 6.51kg/m2 |
Conclusion
The LighterLife Programme can successfully assist obese women to reduce BMI by 6.51kg/m2, and to lose an average of 17.51kg, which is in excess of 10% of their body weight, in 12 weeks. This may improve health outcomes by reducing the risk of weight-related co-morbidities.
Conflict of interests: none. Funding: no funding
Obes Facts. 2009 May 14;2(Suppl 2):245.
Introduction
Orlistat 60mg was recommended for EU approval as a non-prescription weight loss medicine (adults; BMI >28kg/m2) in October 2008. European obesity management guidelines emphasise risk reduction and health improvement in addition to weight loss [1]. A general population survey was conducted to understand current weight loss behaviours and the potential impact of non-prescription orlistat on the diagnosis of comorbidities.
Methods
The survey involved 7863 adults in Denmark, France, Germany, Hungary, Italy, Poland, Spain and the UK. Telephone interviews were conducted with >900 adults from each country.
Results
Data are presented for respondents with a BMI >28kg/m2 (N=1721; 22%). Most (86%) reported seeing a doctor at least once in the last 12 months, and 58% were under a doctor's care e.g. for hypertension (33%), osteoarthritis (17%), or heart disease (16%). Diet and exercise were the most common weight loss behaviours, whereas use of weight loss treatments (prescription medicines, 7%; pills not needing a prescription, 12%) was less widespread. While 50% of respondents had tried to lose weight in the last 12 months, only 18% had asked a doctor for help. Of those who had ever been advised to lose weight by a doctor (N=700), diet (66%) and exercise (63%) had been recommended most frequently.
Conclusion
Weight loss activities typically address diet and exercise and are consumer-led. As an additional weight loss tool available directly to consumers, orlistat 60mg is unlikely to reduce opportunities for the diagnosis of comorbidities. Importantly, users will be encouraged to discuss their health risks with physicians.
Obes Facts. 2009 May 14;2(Suppl 2):245.
Background
Obesity leads to many chronic diseases including cardiovascular disease (CVD) and metabolic syndrome (MS). Therefore Necessity of Nutrition Education is continuously increasing in Korea.
Objective
The purpose of this study was to investigate what the best effective item in the nutrition education was.
Methods
Thirty-eight male office workers (means age 43.5±6.7 yrs, mean BMI 28.3±2.9) volunteered for 12 weeks of nutrition education on dietary habit, physical activity and weight loss plan. The intervention included 5 times of 30 minute 1:1 interview counseling by a registered dietitian. Anthropometric data, questionnaire and blood samples were measured before and after 12 weeks nutrition education. Water intake, fiber intake, saturated fat intake, nutrition knowledge, and physical activity was assessed before and after the nutrition education.
Results
Subjects who showed an increase in water intake, their total Kcal consumption was reduced (p<0.01). Subjects with increased fiber intake had significantly decreased T-chol level (p<0.05). Subjects who reduced their saturated fat intake showed decreased levels of T-chol and TG (p<0.05). Subjects who increased their physical activity had lower body fat (%), visceral fat level and waist circumference (p<0.01). Subjects who increased their Nutrition knowledge showed decreased body fat (%) (p<0.05).
Conclusion
Nutrition education combined with physical therapy had significantly changed their lifestyle and dietary habit. The result showed that such change of lifestyle appeared to be more effective than nutrition education alone.
Conflict of interest: N/A. Funding: N/A
Obes Facts. 2009 May 14;2(Suppl 2):246.
Introduction
A 10% reduction in weight reduces fasting glucose up to 50% in newly diagnosed diabetic patients, leads to a 10% reduction in total cholesterol and a 40% reduction in related deaths1. LighterLife is a commercial weight-management programme, offering a programme specifically designed for men and using a nutritionally complete very-low-calorie diet (VLCD) in conjunction with transactional analysis and cognitive behavioural therapy techniques (TCBT) specifically developed for patients with a BMI >29kg/m2. Following weight loss, LighterLife offers a free weight-maintenance programme for ongoing patient support to help maintain lifestyle changes, thus reducing the risk of associated co-morbidities.
Aim
To determine mean average weight loss and BMI reduction for male patients during the weight-loss stage of the LighterLife Programme.
Method
A cohort of n=2200 men with a BMI>29kg/m2 had weekly weight measurements carried out by their LighterLife weight-management counsellors whilst on the LighterLife Programme, following screening suitability for a VLCD with their general practitioner and LighterLife's medical department.
Results
After 8 weeks on the LighterLife Programme in 2008, a mean BMI reduction of 4.65kg/m2 and a mean 14.84kg weight loss in male patients were observed.
| Mean start weight | 119.17kg |
| Mean start BMI | 37.35kg/m2 |
| Mean weight loss at 8 weeks | 14.84kg |
| Mean % weight loss | 12.45% |
| Mean BMI reduction | 4.65kg/m2 |
Conclusion
The LighterLife Programme can successfully assist obese men to reduce BMI by 4.65kg/m2, and to lose an average of 14.84kg, which is in excess of 10% of their body weight, in 8 weeks. This may improve health outcomes by reducing the risk of weight-related co-morbidities.
Conflict of interests: none. Funding: no funding
Obes Facts. 2009 May 14;2(Suppl 2):246.
Objective
Study eating behavior of persons asking for dietitian's help to lose weight, in order to develop the most effective weight loss program.
Material and Methods
We have examined 67 persons that applied to our medical nutrition center to lose weight. They fell into the following groups: A1 overweight males (3); A2 obese males (7); B1 overweight females (19); B2 obese females (13); C normal weight females (25).
Results
The DEBQ analysis revealed disturbed eating behavior in 65 persons (95.5%) that applied to the nutrition center to lose weight. Group C showed REB in 22 persons (88%), EEB, in 20 (80%), and EXEB, in 22 (88%).
Group B1 showed REB in 17 persons (89.5%), EEB, in 13 (68.42%), and EXEB, in 14 (73.68%).
Group B2 showed REB in 9 persons (69.23%), EEB, in 8 (61.54%), and EXEB, in 12 (92.31%).
Group A1 showed REB in 3 persons (100%), EEB, in 0 (0%), and EXEB, in 3 (100%).
Group A2 showed REB in 5 persons (71.4%), EEB, in 5 (71.4%), and EXEB, in 6 (85.7%).
Conclusions
1. Disturbed eating behavior is found in 95.5% persons applying to the nutrition center to lose weight.
2. The External EB is the most frequent type.
3. In contrast to overweight persons, obese persons would have EEB more, and REB less frequently.
4. In contrast to females, males have a more pronounced REB and a less pronounced EEB.
5. All types of eating behavior disorders can be found in obese males, in contrast to obese females, who do not have REB.
6. In contrast to normal weight and overweight females, obese females have a more pronounced EEB and EXEB.
Conflict of Interest: None disclosed. Funding: No funding.
Obes Facts. 2009 May 14;2(Suppl 2):246.
Introduction
Reduced physical activity (PA) may play a role in the etiology of obesity. However the amount and intensity of PA in free-living conditions is difficult to measure. The aim was to evaluate the usefulness of the accelerometer Actical® to measure PA and to discriminate potential differences between lean and obese subjects.
Methods
We studied information obtained with the Actical® (Mini-Mitter-Respironics, Bend, OR, USA) worn in the wrist, ankle or hip, and compared it with the SenseWear®ArmBand (BodyMedia, Pittsburgh, PA, USA) measuring PA-associated and total energy expenditure. In a different study, we determined the PA of 27 lean (9 male/18 female) and 22 obese (10 male/12 female) volunteers. As PA declines dramatically with age, subjects with similar ages were included in the study. Individuals wore the Actical® on the wrist the whole day for 6 consecutive days with the device recording at 15-s epochs. Anthropometric variables and blood biochemistry were analysed.
Results
Data regarding PA obtained with the Actical® was similar independently of the location and comparable to the one obtained with the ArmBand. Obese subjects exhibited a reduced PA as evidenced by the amount of movement recorded by the accelerometer (LE: 359±119 vs OB: 293±74, counts/min P<0.05). The amount of PA showed a significant correlation with BMI (r= −0.33, P<0.05) and circulating insulin concentrations (r= −0.48, P<0.05).
Conclusions
Determination of PA by the accelerometer Actical® worn on the wrist represents a useful tool in the clinical setting in order to make obese patients realise the amount and intensity of their PA.
Conflict of Interest: The authors declare that they have no conflict of interest. Funding: This work was funded by the ISCIII (FIS PI061458 and FISPI06/90288), Department of Health of the Gobierno de Navarra (20/2005) and Fundación MAPFRE. CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN) is an initiative of the ISCIII, Spain.
Obes Facts. 2009 May 14;2(Suppl 2):247.
Introduction
In meta-analytic approach, short-term diet or diet plus exercise programs (16 weeks) produced a 1 year weight loss of 6.6 and 8.6 kg, respectively. This prospective uncontrolled study was initiated to determine the effect of a 1 year lifestyle intervention on weight reduction and concomitant drop-out rate.
Methods
42 women and 17 men enrolled in 3 intervention programs with group sizes of 15-20 patients. The 1 year intervention consisted of 20 group meetings of 1.5 hours once every 1-4 weeks, including recommendations on healthy energy-reduced diet (1.500-2.200 kcal/day), eating behaviour, daily physical activity, and stress management. To promote daily physical activity, 15-20 units of exercise therapy of 1 hour were offered once every 1-4 weeks in the first 7-9 months. Due to attendance at the last meeting, data from 25 women (median, range, age 48 years, 18-69, BMI 32.2 kg/m2, 25.5-51.4) and 11 men (57 years, 22-70, 33.0 kg/m2, 27.1-54.3) were evaluated after 1 year.
Drop-out was defined as participation in less than 83% of program duration (10/12 months).
Results
After 52 weeks, the weight differences were (mean, range) −9.6% (−22.8/-2.4) of initial body weight and −8.7 kg (−20.0/-2.0) in women, and −9.0% (−20.4/-3.3) and −10.4 kg (−24.5/-4.0) in men with p=0.77 and 0.46 (women/men), respectively. The drop-out rate was 23.8% (10/42) in women, and 23.5% (4/17) in men.
Conclusion
This 1 year cost-efficient lifestyle intervention produced a weight loss of 9% of initial body weight with a drop-out rate of 24%. 1 year interventions may have a better outcome with acceptable drop-out rates. The long-term benefit remains to be evaluated.
Conflict of Interest: None Disclosed. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):247.
Introduction
The rising prevalence of obesity has led to research techniques determining body composition. Several methods are available; hydro-densitometry, total body dual X-ray absorptiometry (DXA) and 40K spectrometry are accurate and reproducible but expensive, uncomfortable and trained technicians requiring. Body Impedentiometric Analysis (BIA) is easy, non-invasive, relatively inexpensive and can be performed in almost any subject.
Aims is to compare estimations of body composition using single frequency bioelectrical impedance analysis (BIA) and DXA in overweight and obese subjects.
Methods
An observational cohort study was performed on a consecutive series of 59 obese with a follow up of 3,6,12 months. The parameters measured were: weight loss, waist, BMI, blood pressure, FFM, Fat Mass (FM), Total Body Water (TBW), Muscle Mass (MM). 59 overweight and obese subjects (59 female; age 58±19 years; BMI 31.5±4.9 kg /m2) underwent BIA and DXA assessment of body composition at the same time.
Results
The primary aim of weight loss interventions in obesity is the loss of FM. FM can be determined rapidly and routinely. The mean value and standard deviation between estimates of FM percentage obtained by BIA (32.49±6.86 kg) and DEXA (34.23±6.06 kg) presented no significant difference (p = 0.15).
Conclusion
The data presented in this study show an absolute good agreement between BIA and total body DXA. BIA could be an easy to use instrument useful in monitoring obese patients following a weight loss program based on lifestyle intervention.
Obes Facts. 2009 May 14;2(Suppl 2):247.
Introduction
In Bulgaria we have experience with the use of yoghourt in the prevention and treatment of obesity and metabolic syndrome.
Aim
The aim was to investigate the curative and profilactic effect of the probiotic low-fat yoghurt (0.5%), fermented with Bifidus ActiRegularis, Lactobacillus bulgaricus and Streptococcus thermophilus in patients with obesity.
Materials and methods
106 subjects (75 women, 31 men; mean age 41.6 years, mean BMI 34.8 kg/m2, mean fat mass 39%) were unrolled in the study. The subjects received a moderate hypocaloric diet (~1100 kcal/daily). The dinner consisted of 290 g low fat yoghurt − 111 kcal, 12.77 g - proteins, 1.45 g fat, and 11.31g carbohydrates.
Results
At the end of the third month we determined a reduction of body weight and body fat and an increase in the lean body mass/fat mass ratio. Body weight (resp. BMI) decreased with 7.6%, fat mass - with 6%. Moreover, we observed reduction of the visceral fat mass, measured by impedance apparatus, as well as of the waist circumference and the sagittal diameter. Therefore, the cardio-vascular risk decreases significantly.
Conclusion
The results are strongly associated with the low-fat and hypocaloric content of the diet, and the specific effect of Bifidus ActiRegularis on the gastro-intestinal passage.
The consumption of low-fat yoghurt (0.5%) for dinner leads to strong satiety feeling and prevents the night - eating syndrome symptoms.
Obes Facts. 2009 May 14;2(Suppl 2):247.
Turkey
Introduction
Intracellular calcium plays a key rol in the metabolic disorders associated with obesity and insülin resistance. Recent reports have shown an inverse relationship between serum calcium levels and metabolic risk factors such as body weight, blood pressure, plasma lipids. We investigated the relationship between serum calcium levels and metabolic risk factors in over weight and obese women in Turkish women.
Methods
Over weight(BMI>25 kg/m2) 872 and obese(BMI>30 kg/m2) 3877 women were enrolled into the study. The patients were divided into three group according to the serum calcium concentrations, Group I (n=1249) consist of serum Ca ≤ 9.20 mg/dL, group II (n=1659) consist of serum Ca 9.20 to 9.60 mg/dL and, group III (n=1841) consist of serum Ca >9.60 mg/dL. The groups were compared for metabolic risk markers.
Results
Fasting glucose, insulin, HOMA, A1c, total cholesterol, LDL-cholesterol, triglycerides and, systolic and diastolic blood pressures were significantly high in Group III compared to Group I and Group II (p<0.05). There was no difference for weight, BMI and body fat mass-regards of whole body adiposity-, waist circumference, sagital waist height and calculated abdominal fat mass-regards of intra-abdominal adiposity-between the groups (p>0.05).
Conclusion
The mechanism by which calcium plays a pathogenetic role in weight control, energy balances, and hypertension is not fully understood. The data obtained from this study indicates that high calcium concentrations is associated with several metabolic risk markers. So serum calcium concentrations can be suggested as a risk marker for atherosclerotic disease in overweight and obese women.
Obes Facts. 2009 May 14;2(Suppl 2):248.
Introduction
Short-term weight loss programs are very popular in Poland. Participants achieved weight loss success in short-term, but regain is common. The aim of the study was evaluation of changes in body weight, body composition and cardiovascular fitness status in obese pre- and postmenopausal women who participated in a short - term weight loss intervention.
Methods
Twenty pre- (n = 10) and post- (n = 10) menopausal women participated in short-term treatment program (6 days) for obesity (pre-menopausal: age 44.0±1.5 years, BMI 32.3±2.6 kg/m2; postmenopausal: age 59.0±3.0 years, BMI 35.1±3.6 kg/m2). Weight reduction was achieved by the use both hypo-calorie diet 1004.5 +/− 56 kcal/day (and 30 minute guided moderate intensive exercise program for 5 days. Change of body weight, fat mass, fat free mass and cardiovascular fitness index were determined before and after weight reduction program.
Results
Both groups achieved a comparable weight loss (pre- vs. post-menopausal: 2.5±0.6 kg vs 2.9±0.8 kg; n.s.). In both groups of women 54% weight loss was attributed to a reduction in fat free mass (premenopausal:-1.3±0.4 kg vs postmenopausal: −1.6±0.7 kg; n.s). After weight loss program cardiovascular fitness index was unchanged.
Conclusion
Participation in short-term body weight reduction program was contributed to decrease of metabolic active tissue, thereby to decrease resting metabolic rate in pre- and postmenopausal women.
Obes Facts. 2009 May 14;2(Suppl 2):248.
on the behalf of the SCOUT Investigators
Introduction
Estimated overweight prevalence in Australia (AUS) is ~48%/30% in men/women; 19%/22% are obese. Weight-management is important in preventing diabetes and in reducing CV risk in this population. AUS obese/overweight patients, ≥55 yr with CV disease and/or type-2-diabetes-mellitus (T2DM) with ≥1 other risk factor, are participating in the ongoing multi-regional Sibutramine Cardiovascular Outcomes (SCOUT) Trial, assessing if sibutramine-hydrochloride-monohydrate (SIB)-assisted weight loss with diet+exercise can be superior to diet+exercise alone in reducing CV morbidity/mortality. Data from the 6-week lead-in pre-randomisation period were used to assess if initial responses differed from those observed outside of AUS.
Methods
872 patients received single-blind SIB with weight-management in AUS during the 6-weeks. Baseline demographics and body-weight (BW), BMI, blood-pressure (BP) and pulse-rate (PR) changes were assessed vs. rest-of-the-world (ROW; N=9870).
Results
In treated patients, >80% AUS and ROW had T2DM with a risk factor±CV disease. Patients with initial and lead-in period measurements are included.
Baseline
Median age 63 and 64 yrs for AUS and ROW. Men comprised 63% and 57% of AUS and ROW groups, and median HbA1c among diabetic patients was 7.3 and 7.2 %total Hb (n=669 and 7504). Median changes at the end of 6 weeks (LOCF) for AUS and ROW were −2.5 and −2.1 kg BW (n=861 and 9824), −0.9 and −0.8 kg/m2 BMI (n=861 and 9822), −2.5/0.0 and −3.0/–1.0 mmHg BP (n=863 and 9831), and 3.0 and 1.5 bpm PR (n=863 and 9825).
Conclusion
These early findings suggest that SIB has potential to support weight-management independent of region.
Conflict of Interest: Payment received from Abbott Laboratories for participation in the Executive Steering Committee of the SCOUT study. Funding: Research relating to this abstract was funded by Abbott Laboratories.
Obes Facts. 2009 May 14;2(Suppl 2):248.
on the behalf of the SCOUT Investigators
Introduction
Life expectancy has fallen in many Eastern-European (EE) populations due to cardiovascular (CV) disease; contributing factors: obesity and type-2-diabetes-mellitus (T2DM) increases. Weight management is important in T2DM prevention and CV-risk reduction. EE (Czech Republic, Hungary, Poland, Romania, Slovakia) obese/overweight patients ≥55 yr with CV disease and/or T2DM with ≥1 other risk factor, are participating in the ongoing multi-regional Sibutramine Cardiovascular Outcomes (SCOUT) Trial, assessing if sibutramine-hydro-chloride-monohydrate (SIB)-assisted weight loss with diet+exercise can be superior to diet+exercise alone in reducing CV morbidity/mortality. Data from the 6-week lead-in pre-randomisation period were used to assess if initial responses differed from those observed outside of EE.
Methods
4645 patients received single-blind SIB with weight management in EE during the 6 weeks. Baseline demographics and body-weight (BW), BMI, blood-pressure (BP), pulse-rate (PR) changes were assessed vs. rest-of-the-world (ROW; N=6097).
Results
In treated patients, >80% EE and ROW had T2DM with a risk factor+CV disease.
Baseline: Median age 62 and 63 yrs for EE and ROW. Men comprised 55% and 60% of EE and ROW groups. Median HbA1c among diabetic patients was 7.0 and 7.4 %total Hb (n=3592 and 4581). Median changes at end of 6 weeks (LOCF) for EE and ROW were −2.2 and −2.1 kg BW (n=4631 and 6054), −0.8 and −0.8 kg/m2 BMI (n=4631 and 6052), −3.0/–1.0 and −3.5/–0.5 mmHg BP (n=4631 and 6063), and 0.5 and 2.5 bpm PR (n=4631 and 6057).
Conclusion
These early findings suggest that SIB has potential to support weight management independent of region.
Conflict of Interest: Payment received from Abbott Laboratories for participation in the Executive Steering Committee of the SCOUT study. Funding: Research relating to this abstract was funded by Abbott Laboratories.
Obes Facts. 2009 May 14;2(Suppl 2):249.
on the behalf of the SCOUT Investigators
Introduction
As obesity and its consequences increase worldwide, regional data on weight management are limited. The ongoing multi-regional Sibutramine Cardiovascular Outcomes (SCOUT) Trial is the first large-scale randomized trial to assess if sibutramine-hydrochloride-monohydrate (SIB)-assisted weight loss with diet+exercise can be superior to diet+exercise alone in reducing cardiovascular (CV) morbidity/mortality in overweight/obese patients with CV disease and/or type 2 diabetes mellitus (T2DM) and another risk factor. Data from the 6-week lead-in pre-randomisation period were used to assess if initial weight responses in Western Europe (WE=Belgium, Denmark, France, Germany, Italy, Portugal, Spain, UK) differed from those observed outside of WE.
Methods
4424 patients received single-blind SIB with weight management during the 6-weeks. Baseline demographics and body-weight (BW), BMI, blood-pressure (BP) and pulse-rate (PR) changes were assessed vs. rest-of-the-world (ROW; N=6318).
Results
In treated patients, >80% WE and ROW had T2DM with a risk factor+CV disease. Patients with lead-in period measurements were included.
Baseline: Median age 64 and 62 yrs for WE and ROW. Men comprised 62% and 55% of WE and ROW groups. Median HbA1c among diabetic patients was 7.4 and 7.1 %total Hb (n=3229 and 4944). Median changes at end of 6 weeks (LOCF) for WE and ROW were −2.1 and −2.2 kg BW (n=4395 and 6290), −0.7 and −0.8 kg/m2 BMI (n=4393 and 6290), −4.0/–0.5 and −3.0/–1.0 mmHg BP (n=4402 and 6292), and 2.5 and 1.0 bpm PR (n=4396 and 6292).
Conclusion
These early findings suggest that SIB has potential to support weight management independent of region.
Conflict of Interest: Payment received from Abbott Laboratories for participation in the Executive Steering Committee of the SCOUT study. Funding: Research relating to this abstract was funded by Abbott Laboratories.
Obes Facts. 2009 May 14;2(Suppl 2):249.
on the behalf of the SCOUT Investigators
Introduction
The global obesity epidemic is sweeping South/Central America (SCA). Weight-management is important in preventing diabetes and reducing CV risk in this population. In SCA (Mexico, Brazil), obese/overweight patients, ≥55 yr with CV disease and/or type-2-diabetes-mellitus (T2DM) with ≥1 other risk factor are participating in the ongoing multi-regional Sibutramine Cardiovascular Outcomes (SCOUT) Trial, to assess if sibutramine-hydrochloride-monohydrate (SIB)-assisted weight loss with diet+exercise can be superior to diet+exercise alone in reducing CV morbidity and mortality. Data from the 6-week lead-in pre-randomisation period were used to assess if initial responses differed from those observed outside of SCA.
Methods
801 patients received single-blind SIB with weight-management in SCA during the 6-weeks. Baseline demographics and body-weight (BW), BMI, blood-pressure (BP) and pulse-rate (PR) changes were assessed vs. rest-of-the-world (ROW; N=9941).
Results
In treated patients, >90% SCA and >80% ROW had T2DM with a risk factor+CV disease. Patients with initial and lead-in period measurements are included.
Baseline: Median age 63 yrs for SCA and ROW. Men comprised 50% and 59% of SCA and ROW groups, and median HbA1c among diabetic patients was 7.6 and 7.2 %total Hb (n=683 and 7490). Median changes at the end of 6 weeks (LOCF) for SCA and ROW were −2.1 and −2.2 kg BW (n=798 and 9887), −0.8 and −0.8 kg/m2 BMI (n=798 and 9885), −2.0/0.0 and −3.5/–1.0 mmHg BP (n=798 and 9896), and 2.5 and 1.5 bpm PR (n=798 and 9890).
Conclusion
These early findings suggest that SIB has potential to support weight-management independent of region.
Conflict of Interest: Payment received from Abbott Laboratories for participation in the Executive Steering Committee of the SCOUT study. Funding: Research relating to this abstract was funded by Abbott Laboratories.
Obes Facts. 2009 May 14;2(Suppl 2):249–250.
METRONOM STUDY GROUP
Introduction
Previous experience demonstrated the efficacy of orlistat in improvement of metabolic syndrome (MSy) parameters.
Objectives
To assess change of MSy parameters (IDF 2005 criteria)-waist circumference (WC), glycaemia (GL), triglycerides (TG), high density lipoproteins (HDL), systolic and dyastolic blood pressure (SBP, DBP) after 26 weeks of treatment with prescribed orlistat.
Methods
126 patients (age 47.96±10.45 years; male:female ratio 2.12) with MSy, received orlistat (120 mg tid) for obesity treatment for study period of 26 weeks. Patients had reduced food intake for 600 kCal, total energy intake was at least 1200 kCal/day and moderate physical exercise has been recommended. Clinical efficacy has been assessed by measuring WC, GL, TG, HDL, SBP and DBP at 4, 8, 12, 16, 20, and 26 week. General linear model was used for significance of parameters’ change.
Results
WC decreased for 16.2 cm and 13.43 cm after 26 weeks in men and women respectively (p<0.0001). GL (6.72 mmol/L at baseline and 5.41 mmol/L after 26 weeks) and TG (2.87 mmol/L at baseline, and 1.82 mmol/L after 26 weeks) were reduced during study period (p<0.0001). HDL increased (1.10 mmol/L at baseline vs. 1.33 mmol/L after 26 weeks, p<0.0001). SBP and DBP significantly decreased after 4 weeks, and remained at the lower level to the end of study period (144.21 mmHg at baseline vs. 127.83 mmHg after 26 weeks for SBP; 90.51 mmHg at baseline vs. 80.31 mmHg after 26 weeks for DBP).
Conclusion
Orlistat treatment for 26 weeks resulted in significant improvement of metabolic syndrome parameters.
Obes Facts. 2009 May 14;2(Suppl 2):250.
Introduction
We conducted a systematic review of the effects of Metformin on BMI and fasting insulin in obese children and adolescents without diabetes.
Methods
We searched MEDLINE, EMBASE, the Cochrane Register of Controlled Trials, the metaRegister of Controlled Trials, and key journals. Inclusion criteria: 1) aged <20 years; 2) obese. Exclusion criteria: 1) known monogenic or genetic syndromes predisposing to obesity; 2) diabetes, polycystic ovary syndrome, or other chronic health problem. Double-blind, randomised placebo-controlled trials with a follow-up of at least six months were included. Primary outcome measures of interest were changes in BMI (kg/m2) and fasting insulin (µU/mL).
Results
Five studies were included (322 trial completers). In all studies Metformin groups had greater reduction in BMI than placebo controls. Compared to placebo, Metformin reduced BMI by 1.47 kg/m2 (95% CI 0.73 to 2.21 kg/m2), with moderate heterogeneity in estimates (I2=66.9%). Metformin lowered levels of fasting insulin by 10.61 µU/mL (95% CI 6.59 to 14.63 µU/mL) more than placebo, and HOMA-IR by 2.01 (95% CI 0.75 to 3.26) more than placebo. Gastrointestinal problems were more commonly reported in Metformin than placebo groups (risk difference 10-15%).
Conclusion
Metformin is effective in reducing BMI in the short term (equivalent to 0.4 SD in obese populations), and has a clinically important effect on fasting insulin and HOMA-IR. Small sample size and selected study populations limit the generalisability of findings. Studies with other outcomes relevant to cardio-metabolic risk and longer follow up are needed.
Conflict of interest: None declared. Funding: MHP is funded by the ESRC
Obes Facts. 2009 May 14;2(Suppl 2):250.
Pharmacological studies indicated that opioids stimulate food intake and regulate drinking. Our data documented that beta-endorphin plays a role in alcohol abuse as well as in regulation of immune system during alcohol treatment. Beta-endorphin has relatively high affinity for the µ, delta and kappa subtypes of opioid receptors. Here we investigate the effect of opioid blocker naltrexone on alcohol and food intake as well on NK cell function. Male rats were treated with naltrexone for a period of 2 weeks with or without ethanol. Alcohol decreased the body weight, the spleen weight and NK cell cytolytic activity. Naltrexone abolished the effects of alcohol. Moreover, naltrexone regulated the food intake of animals, exposed to alcohol. Naltrexone increased the blood levels of IFN-gama and the NK cell activity of both pair-fed and alcohol-fed rats. Beta-endorphin has been proposed to produce its feeding effects through the activation of
µ receptors, although it has affinity for µ, delta and kappa. Our published data documented that naltrexone affects the activity of delta receptors and blocks predominantly µ receptors on immune cells. Our results suggest that opioid receptors play roles in the regulation of food intake and alcohol effects on immune system and food intake.
Obes Facts. 2009 May 14;2(Suppl 2):250.
Introduction
When the long term efficacy of dietary and behavior counseling to reverse the obesity epidemic does not meet the expectation, a pharmacotherapeutic intervention becomes an alternative. Unfortunately there are at present no effective and safe anti-obesity medicine available, though a number of plants have been claimed to have such an activity. Orthosiphon stamineus, a popular medicinal herb originating from Southeast Asia, is present in commercial herbal slimming preparations which claim to have a lipolysis and appetite suppression effect. However, it was thought that the weight loss effect obtained after Orthosiphon herbal consumption is only temporarily due to its diuretic effect. The cannabinoid receptor type 1 (CB1) is a G-protein coupled receptor which is widely expressed in the brain. Blocking the CB1 by an antagonist ligand results in an anorectic effect. This project aims at screening for appetite suppression compounds from Orthosiphon stamineus leaf.
Methods
The CB1 bioassay is used as a screening method. Liquid-liquid partition fractionation of Orthosiphon leaf methanol extract by using n-hexane, chloroform, n-butanol, and water, followed by several chromatographic separation steps was applied to isolate the active compounds. NMR spectroscopy will be used to identify the active compounds.
Result
Bioassay guided fractionation by using CB1 assay and chromatographic methods resulted in several active fractions. Further isolation, identification and functional assay of the active compounds as antagonist of the CB1 receptor are in progress.
Conclusion
The obtained active fractions in this project might eventually give scientific support for the commercial use of Orthosiphon stamineus in herbal slimming preparations.
Conflict of interest: None disclosed. Funding: Research relating to this abstract is funded by Senter-Novem
Obes Facts. 2009 May 14;2(Suppl 2):250–251.
Introduction
Sibutramine is a centrally acting aid to weight loss treatment which increases satiety. Therefore, it plays a crucial role in obesity management. In the UK, the National Health Service supports such treatment when combined with lifestyle changes. Recommendations have been well established but there is little research into how individuals view this drug. This study explores the views of obese and overweight patients taking sibutramine prescribed in primary care and identifies their expectations of this drug.
Methods
Semi-structured interviews were conducted with seven individuals prescribed sibutramine from three GP practices in northern England. Participants’ views and experiences were transcribed verbatim and analysed using the Framework approach.
Results
Although the majority of participants were initially unaware of sibutramine as an anti-obesity drug, all participants prescribed it expected to lose weight. It was apparent they lacked an understanding of how sibutramine works and some did not experience any effect on their appetite. Their views on sibutramine as an appropriate measure for weight management varied and changed with experience. Even though most participants lost weight with sibutramine, they all continued seeking weight loss alternatives post medication.
Conclusion
Understanding patients’ experiences and expectations of sibutramine could be a crucial factor in enhancing patients’ outcomes. Ensuring patients receive appropriate information and manage their expectations from the start could increase compliance and therefore effective treatment. It is important that there is regular support in primary care during and after sibutramine interventions; particularly concerning advice on diet, physical activity and group support.
Funding: Research relating to this abstract was funded by Sheffield Health and Social Research Consortium (UK).
Obes Facts. 2009 May 14;2(Suppl 2):251.
Introduction
Physical activity (PA) during pregnancy may reduce the risk of maternal and fetal complications..
Methods
255 women were consecutively selected from the prenatal clinic. Mean age was 28±4 years, BMI before pregnancy varied from 16.3 to 48.8 kg/m2. To measure PA, we can use the validated Baecke questionnaire (BA). An alternative is the Kaiser Physical Activity Survey (KPAS) for women. The mean goal of this study is to evaluate the changes of PA during pregnancy in relation to BMI and gestational weight gain (GWG).
Results
Gestational weight gain was 12.9±6.0 kg; mean birth weight was 3.3±0.6 kg. PA level at the beginning of pregnancy was 7.4±1.2 (BQ) versus 9.4±1.6 (KPAS). At the time of delivery, PA-level decreased to 6.7±1.1 (BQ) and 8.2±1.8 (KPAS) (p=0.0001). Correlation coefficients at every trimester between BQ and KPAS varied from 0.805 to 0.845 (p<0.01). Cohen's kappa coefficients of agreement (CK) varied from 0.568 to 0.463 during pregnancy, indicating moderate agreement. No relationship could be observed between any parameter at the start of pregnancy, neither between GWG and PA during pregnancy.
Conclusion
A significant decrease in PA during pregnancy could be observed. GWG did not relate to PA levels. The results from both questionnaires were comparable although there was only a moderate agreement using CK. Women must be more informed on the importance of PA during pregnancy. Both questionnaires can be used as indicators of PA level.
Conflict of interest: None. Funding: Research related to this abstract was funded by ‘The Danone Institute, Belgium’
Obes Facts. 2009 May 14;2(Suppl 2):251.
Introduction
Pregnancy is often associated with postpartum weight retention. The purpose of this study was to investigate the influence of gestational weight gain during early adulthood on body composition in premenopausal women.
Methods
The sample consisted of 75 healthy premenopausal women (age: 49.8±1.9 yrs; BMI: 23.3±2.1 kg/m2) participating in a longitudinal study on the effect of menopause on body composition and cardiovascular risk factors. A physician-administered questionnaire was used to gather information regarding gestational history. Body composition was measured using dual-energy x-ray absorptiometry and abdominal fat with computed tomography. Women were divided into 3 groups based on their pregnancy weight change (Δ) and in relation to the recommendation of the Institute of Medicine (IOM): G1: Δ weight < IOM (n=19); G2: Δ weight = IOM (n=33); G3: Δ weight < IOM (n=23).
Results
High pregnancy weight gainers (G3) were significantly heavier at pre-menopause than low pregnancy weight gainers (G1) (63.3 kg vs 57.8 kg; P<0.05). Fat-free mass was significantly higher in G3 compare to G1 (41.1 kg vs 36.6 kg; P=0.002). No significant difference was observed between the 3 groups for %fat, fat mass, waist circumference, visceral and subcutaneous abdominal adipose tissue. Furthermore, weight gain during the woman's last pregnancy was positively correlated with weight (r = 0.33; P < 0.001) and fat-free mass (r = 0.28; P < 0.05) at pre-menopause.
Conclusion
In our cohort, women who reported more gestational weight gain during their pregnancy were heavier at pre-menopause compared to those who gained less weight than recommended by the Institute of Medicine.
Conflict of Interest: None Disclosed. Funding: Research relating to this abstract was funded by the Canadian Institute of Health Research (CHIR)
Obes Facts. 2009 May 14;2(Suppl 2):251–252.
Introduction
The aim of this report was to evaluate cardiorespiratory fitness change during the national preventive weight management program in one Community Health Centre (CHC).
Methods
Overweight subjects (women aged 45-70 years, men aged 35-65 years) referred to the national reducing weight program after the preventive examination by their family practitioners for evaluation of the cardiovascular risk factors. 52 subjects participated in a 12-week lifestyle weight management program consisting of group-based workshops and group physical activity. Group physical activity was lead by the physiotherapist and was performed at CHC, 60 minutes per week. At the beginning and after the completion of weight management program a 2 km walking test for assessment of cardiorespiratory fitness was performed. Weight and cardiorespiratory fitness changes during the 12-week program were analyzed with paired samples t-test.
Results
Women (N=41, age 56±12 years, BMI 32.5±4.6 kg/m2, waist circumference 101±13 cm) and men (N=11, age 58±11 years, BMI 32.8±4.8 kg/m2, waist circumference 113±11 cm) who participated in the weight reduction program had a drop-out frequency rate of 26.9% in 12 weeks. Weight loss and reduction of waist circumference at program completion were 3.4±2.6 kg and 5.3±6.0 cm, respectively. Cardiorespiratory fitness index at the beginning and after 12 weeks was 62±48 and 77±24, P=NS. Also, walking time and maximal aerobic capacity did not significantly change during 12 week period.
Conclusions
Although weight and waist circumference decreases during weight management program, the cardiorespiratory fitness did not improve. The long-term efficacy of national weight reduction program remains to be evaluated.
Funding: No funding.
Obes Facts. 2009 May 14;2(Suppl 2):252.
Introduction
The assessment of dietary fat intake is a critically important first step in clinical decision-making regarding dietary and pharmacotherapeutic advice on coronary risk reduction in overweight patients. The aim of this study was to compare combined effects of Step 1-diet and fibrate (gemfibrozil) treatment with dietary intervention alone on serum and erythrocyte membrane phospholipids (PL) fatty acid (FA) composition in overweight patients with hyperlipidemia.
Methods
32 study participants with hyperlipidemia were randomly divided in two groups. In D group (BMI 27.57±1.99, male 7, postmenopausal female 9) subjects followed AHA Step 1 diet (< 30% of total from fat, < 10% of energy from saturated fat, and < 300 mg cholesterol per day). D+F group (BMI 27.39±1.45, male 7, postmenopausal female 9) followed Step-1 diet and were receiving gemfibrozil (300mg/twice per day). Serum lipid levels were measured and PL serum and erythrocyte FA compositions analyzed at the beginning and after 12 weeks of treatment.
Results
Both treatments significantly decreased SFA, and increased total PUFA in serum and erythrocyte membrane. Combined gemfibrozil-diet treatment increased dihomo-γ-linolenic, arachidonic (AA), docosapentaenoic, alfa-linolenic and eicosapentanoic acid in serum PL. Decreased levels of palmitoleic acid in erythrocyte membrane PL were observed in our study after combination of gemfibrozil-diet therapy. In human obesity palmitoleic acid is reported to correlate with index of adiposity and insulin concentration.
Conclusion
AA increased in erythrocyte membrane PL after gemfibrozil–diet combination, which indicates the beneficial effect on several important physiological functions (inflammation, vascular tone, hemostasis etc.) in relation to cardiometabolic risk.
Conflict of Interest: None. Funding: Research relating to this abstract was funded by Serbian Ministry of science project number 145071
Obes Facts. 2009 May 14;2(Suppl 2):252.
Introduction
A female with a body mass index (BMI) 41kg/m2 (120kg) underwent laparoscopic gastric banding (GB) for weight loss. Over 12 months she lost 75kg, to BMI 19kg/m2 (56kg) and also developed bulimic behaviour. Two years after GB, due to excessive weight loss and maladaptive behaviour, she had the band fully deflated. Following which she was able to eat unrestricted and within five days presented to hospital having gained 12kg in weight. Examination revealed anasarca and biochemistry showed hypophosphatemia 0.29mmol/L (normal 0.8–1.4); albumin 34g/L (35-50); deranged liver function tests. Investigations to exclude pathological oedema forming state were normal. Re-feeding syndrome (RS) was diagnosed. She made rapid recovery with diuretic therapy.
Discussion
GB involves, introduction of an adjustable band encircling the proximal portion of the stomach, leading to pressure on gastrooesophageal junction and reduction in appetite. Average weight loss, two years after GB is around 20%. 56% weight loss in this case was probably due to both: restriction of the band and bulimic behaviour. RS describes a clinical presentation of marked oedema and metabolic disturbances that occur following re-feeding, amongst malnourished individuals. Patients can develop fluid and electrolyte disorders with systemic complications, due to sudden shift from fat to carbohydrate metabolism after re-feeding.
Conclusion
GB is widely used to treatment morbid obesity. Band deflation/removal may be required for a variety of reasons such as excessive weight loss and persistent vomiting. Rapid release of the band without additional supplementation of electrolytes may be dangerous as RS represents risk to these patients.
Conflict of interest: None. Funding: No funding.
Obes Facts. 2009 May 14;2(Suppl 2):252.
Background
Patients with metabolic syndrome (MS) differ in their nutrients intake dependent on ethnicity The aim of the study was to assess the dietary habits in Polish patients with MS.
Methods
55 patients (35-70 yrs) with MS were asked to continue their typical diet and complete the 3 day food diary. The percentage of macronutrients intake were calculated according to BMI. Additionally fasting lipids were determined.
Results
The mean percentage of macronutrients intake in different BMI .* p< 0,05.
| BMI kg/m2 | % carbohydrate | % protein | % fat | % SFA | % MUFA | % PUFA |
|---|---|---|---|---|---|---|
| 25-30 | ||||||
| mean | 46.96 | 18.42 | 33.44* | 13.92 | 12.29 | 4.5* |
| SD | 8.45 | 0.81 | 8.53 | 5.67 | 2.96 | 0.37 |
| 30-35 | ||||||
| mean | 41.26* | 17.87 | 37.83 | 13.36 | 15.27 | 6.41 |
| SD | 5 | 4.76 | 6.25 | 3.53 | 3.06 | 2.43 |
| 35-40 | ||||||
| mean | 43.61 | 17.84 | 37.78 | 13.3 | 15.41 | 6.17 |
| SD | 6.97 | 3.78 | 5.58 | 2.69 | 3,26 | 2.33 |
The highest fasting total cholesterol and LDL were in BMI group 25-30 kg/m2 (6,34 mmol/l±1,38; 4,69 mmol/l±0,98 respectively). Obese patients with BMI 35-40 kg/m2 had the highest TG concentration (2,06 mmol/l±0,82).
Conclusion
Obese patients intake more fat, MUFA and PUFA than overweighted. Total cholesterol and LDL level were lower in obese patients compared to overweighted pointing to the lower power to discriminate the risk of obesity complications.
Supported by: Lipgene- (Contract FOOD-CT-2003-505944)
Obes Facts. 2009 May 14;2(Suppl 2):253.
Introduction
Morbid obesity in childhood requires adequate treatment. A large body of evidence shows that pediatric obesity has a wide range of important adverse consequences. Currently, there is a lack of effective treatment regimes for morbid obese children. We compared the feasibility and efficacy of hospitalization with an intensive ambulatory program.
Methods
Randomized controlled trial. 90 Morbidly obese children (body mass index (BMI) for age < 30 and additional morbid symptoms), 60% female, referred to a tertiary pediatric center in the Netherlands. Randomization to either hospitalization or ambulatory treatment.
Results
Inpatient treatment versus ambulatory treatment: BMI [-6.2 (−12.4 to −0.1) v. −3.4 (−9.4 to 2.5)], BMI-z [(−0.6 (−1.3 to 0.1) v. −0.3 (−0.9 to 0.3)], abdominal circumference [-12.0 cm (−28.6 to 4.7) v. −5.1 cm(−20.8 to 10.6)], body fat [-13.9 kg (−21.0 to −6.8) v. −6.4 kg(−13.5 to 0.7)], percentage body fat [-7.3 (−12.1 v −2.5) v. −3.1 (−7.1 to 0.9)], total cholesterol [-18.8 mg/dl (−58.3 to 20.7) v. 0.5 mg/dl (−44.3 to 45.3)] and LDL [-14.9 mg/dl (−47.9 to 18.2) v. 2.8 mg/dl (−36.5 to 42.0)]. Waist circumference, hip circumference, systolic and diastolic blood pressure, HDL, triglycerides, insulin, glucose, HOMA-IR, ASAT and ALAT all decreased after 26 weeks in both treatment programs but they did not meet significance in between group P-values.
Conclusion
Clinical inpatient treatment of morbidly obese children is more effective in reducing body weight, body mass index and BMI-z-score than an intensive ambulatory program.
Conflict of interest: none. Funding: No funding.
Obes Facts. 2009 May 14;2(Suppl 2):253.
Introduction
Little is known on patterns of change over time in body composition, especially lean body mass (LBM), during massive weight loss after Roux-en-Y gastric bypass (RYGB) in obese patients. We performed sequential measurements of total and regional body composition in patients after RYGB, and we compared data of these patients after surgery to a non-surgical control group of similar age and body fatness.
Methods
We used dual-energy X-ray absorptiometry before and at 3, 6 and 12 months after RYGB in 50 women (before surgery: age 39.7±11.3 y; BMI 44.8±5.9 kg/m2; mean±SD) and in 54 control obese women referred for non-surgical weight management.
Results
During one-year follow-up after RYGB, there was a continuous decrease in body weight (−36.6±14.0 kg at one year), total fat mass (FM)(−26.2±10.0 kg), as well as in trunk and appendicular FM. In contrast, the decrease in total LBM (−10.2±5.7 kg at one year), as well as trunk and appendicular LBM, plateaued after 3-6 months. Rates of loss in weight, FM and LBM were highest during the first 3-month period after RYGB (6.4±1.9, 4.0±1.6, and 2.5±1.3 kg/month, respectively), then decreased continuously for FM but plateaued for LBM. There was no evidence of a decrease in total, trunk or appendicular LBM in weight-reduced subjects compared to the control group.
Conclusion
Follow-up of these obese patients revealed a differential pattern of change in FM and LBM over time. Despite an important loss in LBM, especially during the 3-6 month initial period after RYGB, LBM appears to be spared therafter.
Obes Facts. 2009 May 14;2(Suppl 2):253.
Introduction
Psychological assessment is widely regarded as an integral part of the evaluation process for patients undergoing bariatric procedures. There is some debate, however, about the role psychological factors play in surgical outcome. Reliable and consistent psychological predictors of surgical outcome have not yet been identified. Nonetheless, psychological assessment is crucial in order to identify behavioural and emotional factors which may influence the patient's quality of life following surgery. There are no formal Europe-wide protocols to advise psychologists working with a surgery-seeking population on the most appropriate assessment methods.
Methods
Existing international literature was reviewed and combined with clinical observations in order to develop psychological assessment recommendations. The clinical utility of measures was examined through use in a routine bariatric clinical setting.
Results
The psychometric measures identified as potentially useful in the assessment of the bariatric surgery candidates included the Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Questionnaire on Weight and Eating Patterns-Revised (QWEP-R), Clinical Outcomes Routine Evaluation (CORE) and the Millon Behavioural Medicine Diagnostic (MBMD). A face-to-face clinical interview with an experienced clinical psychologist was also fundamental to the assessment process.
Conclusions
A thorough evaluation provides a valuable opportunity to identify any additional needs that surgery patients may have in order to help them cope with the radical life change which results from bariatric surgery. We conclude that there is a need to standardise the psychological assessment of patients seeking surgery. Collaboration between clinical centres working within this specialist area is recommended in order to formalise psychological assessments.
Conflict of Interest: None disclosed. Funding: No funding
Obes Facts. 2009 May 14;2(Suppl 2):253.
withdrawn
Obes Facts. 2009 May 14;2(Suppl 2):253–254.
Introduction
Prevalence of psychological disorders in severe obesity is high. Depression has been identified as a cause or a consequence of obesity. Gastric bypass is one of the main treatments for severe obesity. The impact of this surgery on depression has not been investigated extensively up to now.
Aim
To assess the impact of gastric bypass on levels of depression, anxiety, quality of life, and other behavioral and psychological factors.
Methods
84 adult patients with severe obesity were assessed before and 1 year after gastric bypass, using the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) and the Eating Disorder Inventory (EDI).
Results
| Mean ± S.D. before surgery |
Mean ± S.D. 1 year after surgery |
Sig. | |
|---|---|---|---|
| BMI | 43,3± 5,5 | 28,6± 4.7 | <0.01 |
| BDI (Depression) | 9,1± 5,8 | 1,9± 2,8 | <0.01 |
| BAI (Anxiety) | 16,0± 12,8 | 5,3± 6,7 | <0.01 |
| IWQOL-Lite (Physical function) | 52,3± 17,7 | 7,7± 12,4 | <0.01 |
| IWQOL-Lite (Self-esteem) | 65,4± 25,6 | 11,4± 19,6 | <0.01 |
| IWQOL-Lite (Sexual life) | 43,5± 30,2 | 7,5± 14,6 | <0.01 |
| IWQOL-Lite (Public distress) | 39,7± 24,9 | 4,8± 12,2 | <0.01 |
| IWQOL-Lite (Work) | 36,8± 21,7 | 4,7± 10,2 | <0.01 |
| EDI bulimia | 17,8± 19,6 | 1,0± 3,6 | <0.01 |
| EDI body dissatisfaction | 79,2± 22,8 | 21,1± 23,5 | <0.01 |
| EDI ineffectiveness | 18,7± 19.2 | 6,7± 8,9 | <0.01 |
Conclusion
Depression and anxiety, quality of life and the behavioral and psychological factors assessed with EDI significantly improved after surgery.
Obes Facts. 2009 May 14;2(Suppl 2):254.
Introduction
This study examined the spectrum symptomatology (subthreshold conditions and atypical symptoms) in bariatric surgery candidates. Spectrum scores were correlated with the weight loss (WL) as BMI% reduction at 6, 12, 24 months after bariatric surgery.
Methods
259 patients (mean-age 41.90; BMI 44.5) were examined a self-report Interview for Panic (SCI-PAS), Mood (SCI-MOOD), Eating (SCI-ABS), Obsessive-Compulsive (SCI-OBS), and Social-Phobia (SCI-SHY) spectra. 157 patients were candidates to SAGB and 102 to RYGBP.
Results
Spectrum scores were significantly higher in RYGBP than SAGB candidates.
After 6, 12 and 24 months, SAGB patients’ BMI decreased from 42.7 to 35.8, 33.2, 32.4; RYGBP patients’ BMI decreased from 52. to 39.1, 35.8, 34.2 Best results were achieved in patients who underwent RYGBP surgery.
In SAGB the negative predictors domains were: ‘rhythmicity’ for SCI-MOOD (β= −0,192) at 6 months and ‘fear-control’ for SCI-PAS at 6 (β= − 0,208). and 12 (β= − 0,394) months.
At 12 months were else ‘specific-phobia’ for SCI-SHY (β= − 0,308), ‘hypercontrol’ (β= − 0,394) for SCI-OBS. The only positive predictor was the domain ‘repetition-automation’ for SCI-OBS at 24 months (β=0.224).
Conclusion
RYGBP candidates show significantly higher scores than SAGB. Some domains are negative predictors of WL in SAGB candidates To our knowledge anxiety and mood subthreshold symptoms can affect on patient's ability to adhere to post-operative behaviour changes.. The only positive predictor is the domain ‘repetition-automation’ of SCI-OBS that, we can hypothesized, it could be associated to a better compliance to dietary and behaviour modifications.
Obes Facts. 2009 May 14;2(Suppl 2):254.
Introduction
There is a need for better assessment of body composition in severely obese subjects. The objective was to compare fat mass (FM) estimates by a bioelectrical impedance analysis (BIA) device recently made available to dual-energy X-ray absorptiometry (DEXA) as reference method, before and after surgically-induced weight loss.
Methods
Measurements by BIA (BC-420MA, Tanita) and DEXA (Hologic W) were performed before (n=45) and 6 months after Roux-en-Y gastric bypass (RYGB) (n=22) in obese women (age: 39.0±10.7 years, BMI: 44.8±4.5 kg/m2, m±SD, at baseline). Comparison of mean values between methods were performed by t-tests; relationships between variables were assessed by Pearson correlations; agreement between methods was studied using the Bland Altman method.
Results
At baseline, compared with DXA, BIA overestimated FM by 2.7±5.7 kg (p<0.0025). FM estimates by BIA and DXA were significantly correlated (r2=0.71, p<0.0001). Limits of agreement between methods for FM assessment were 2.7±11.4 kg (from −8.7 to +14.1 Kg). Six months after RYGB, mean weight loss was 31.7±9.6 kg. Mean FM loss after RYGB did no differ between methods (−1.2±0.8 kg, p=0.08). Estimates of FM loss by BIA and DEXA were significantly correlated (r2=0.7, p<0.0001).
Conclusion
The BC-420 MA BIA device overestimated FM compared to DXA in severely obese women at baseline. This is in agreement with previous studies in obese subjects with a lower mean BMI than our population. Preliminary results obtained after RYGB suggest that this device may be relevant for the follow up of FM after obesity surgery.
Obes Facts. 2009 May 14;2(Suppl 2):254–255.
Introduction
Gastric bypass surgery is becoming one of the main treatment modalities for severe obesity. It is however definitive and requires a long-term follow-up. As such, it requires thorough and extensive assessment of factors leading to present for surgery.
Aim
To asses the impact of demographic variables, depression, history of efforts to loose weight, physical health and information about gastric bypass surgery in presenting for surgery.
Methods
All patients presenting for gastric bypass surgery from 2004-2007 were assessed using a semi-structured interview. Variables assessed with the interview included presence of clinical depression, binge eating disorder, onset of obesity, history of efforts to loose weight, main reasons for presenting for surgery and degree of information on gastric bypass surgery.
Results
294 patients were assessed with the interview. Mean body mass index was 43.8. There was a high prevalence of depression (30% in women and 12.4% in men) and binge eating disorder (20%). Women presented more often for esthetical reasons than men and had a longer history of dieting than men. Men had more often sought the help of a dietician, had taken less often weight loss medication, and presented more often for reasons related to health, mobility and pain. Furthermore, men were better informed about the surgery than women. Young patients (<30 years) presented more often for esthetical reasons than older patients.
Conclusion
There are many different reasons for presenting for bypass gastric surgery. In addition, reasons vary according to gender and age.
Obes Facts. 2009 May 14;2(Suppl 2):255.
Introduction
We aimed to examine whether morbidly obese patients referred to bariatric surgery are characterized by a higher prevalence of major obesity related comorbidities such as type 2 diabetes (T2DM), hypertension and obstructive sleep apnea (OSA), than those offered conservative therapy.
Methods
A total of 511 consecutive morbidly obese patients, 70% women, with a mean (SD) age of 42 (12) years, attended our tertiary care centre between December 2005 and March 2007. All patients were examined by a multidisciplinary team and offered conservative or surgical treatment. Chi-square test, independent sample t-test and multiple logistic regression were used for statistics.
Results
A total of 203 (40%) patients underwent bariatric surgery. The surgery group was characterized by a significantly higher mean (SD) BMI [46.6(6.2) vs. 43.7(5.9) kg/m2], earlier debut of obesity (39% vs. 29% before 12 years of age, p=0.020) and a lower proportion of patients >60 years (4% vs. 10%, p=0.008), as compared with the conservative group. In contrast, the groups did not differ significantly with respect to age, gender or obesity related comorbidities (data not shown). Multiple logistic regression including gender, age, BMI, T2DM, hypertension, OSA, and debut age of obesity, revealed that only BMI was an independent predictor of referral to surgery (OR=1.08; 95% CI 1.04-1.11), p<0.001).
Conclusion
Our results indicate that increasing BMI, but not obesity related comorbidities, predict treatment choice in morbidly obese patients.
Conflict of Interest: None Disclosed. Funding: Jakobsen, GS is a PhD fellow at the Morbid Obesity Center, Vestfold Hospital Trust Hofs⊘, D has received unrestricted educational grants from Novo Nordisk A/S, South-Eastern Norway Regional Health Authority and Vestfold Hospital Trust St⊘rdal Lund, R has received an educational grand from Vestfold Hospital Trust
Obes Facts. 2009 May 14;2(Suppl 2):255.
Introduction
Weight loss after bariatric surgery may be compromised if a specific dietary assessment does not contribute to identifying the most appropriate surgical procedure. Patients self referring for bariatric surgery frequently assume that a gastric band will solve their weight problems. However, certain eating habits and behaviours e.g. comfort eating and bingeing, may indicate a gastric bypass as the more appropriate procedure. A dietetic assessment tool to help identify behaviours that would influence surgery choice and outcomes is presented.
Methods
The assessment tool was developed and piloted in 54 patients. The procedure they thought appropriate was recorded. Their dietary habits were assessed using a specifically designed dietetic tool which targeted particular eating habits including meal pattern, food choices, portion sizes, and snacking preferences. These were discussed with patients in relation to how they would affect the expected weight loss after surgery.
Results
28 (52%) of patients assessed have had, or are scheduled to have, surgery. Of these, 24 (86%) patients’ decisions to opt for a particular procedure were influenced by the results of the assessment, giving individuals confidence that the recommended procedure was more likely to deliver their weight loss expectations.
Conclusion
Robust dietetic assessment using our tool, targeting specific eating patterns, can help identify the most appropriate bariatric procedure to optimise surgical outcomes and assist patients understand the importance of a healthy post operative intake. This tool can help identify an appropriate bariatric procedure, relevant to a patient's dietary habits.
Conflict of interest: None. Funding: None
Obes Facts. 2009 May 14;2(Suppl 2):255.
Introduction
Rising prevalence of morbid obesity leads to increase of bariatric surgery. Lack of post-surgery feeding guidelines leads to heterogeneous practices. In the Valais region of Switzerland, three surgeons operate in a central setting, and substantial differences in refeeding practices are observed.
Our goal was to develop a consensus for a feeding protocol between all implicated professionals.
Methods
Scientific evidence, opinions and objective data were gathered through:
Literature review and Internet search.
Request for feeding protocols of all Swiss and some European and American Centres practicing bariatric surgery.
Phone interview of the patients who underwent a bariatric surgery at least three months ago.
Semi-directed interview of the surgeons and dieticians.
Questionnaire among surgery ward's nursing staff.
Nutritional values’ calculation for each type of feeding-protocol in use.
Three scenarios with examples of meal plans were presented during a multidisciplinary consensus meeting.
Results
The feeding protocol starts as soon as radiographic exam shows no anastomotic leak. The new protocol provides 3 meals, 3 snacks and 2 litres of drinks per day, vitamin and mineral supplementation. Food texture evolves over time:
Liquid: 1 day
Blended and smooth: 3 days
Blended: 21 days
Normal, with gradual increase in quantities.
Conclusion
The large consultation process and implication of all professionals in the discussion over the different scenarios facilitated the reach of a consensus. It will be necessary to observe the new protocol implementation and to verify if there is a sustained change in practice.
Conflict of Interest: None. Funding: No Funding
Obes Facts. 2009 May 14;2(Suppl 2):255–256.
Introduction
Dissatisfaction with one's body image, which refers to body size evaluation and appearance approval, is the most common psychological consequence of being obese person.
The study question is: how BMI changes influence the level of satisfaction of bariatric patients with their weight and appearance following Vertical Banded Gastroplasty (VBG)?
Methods
Patients were tested four times: before surgery (stage I: N=65, age 38.57±8.99, BMI 48.72±6.78), as well as three months after VBG (stage II: N=65, BMI 39.18±5.93), six months after VBG (stage III: N=65, BMI 34.68±5.32) and finally twelve months after VBG (stage IV: N=40, BMI 30.35±5.04). Seven-grade Likert scale was used as an indicator of patients’ satisfaction with their weight and appearance.
Results
BMI values did not correlate with the patient's satisfaction with their weight and appearance at any of the four stages. Positive correlations between the patients’ satisfaction with their weight and appearance were observed at stage I (r=0.37, p<.01), stage II (r=0.72, p<.0001), stage III (r=0.78, p<.0001) and stage IV (r=0.76, p<.0001). The Wilcoxon signed-rank test revealed highly significant differences between patients’ satisfaction with their weight and appearance at stages I - III.
Conclusion
In our sample discontentment with one's body image is connected with the very presence of obesity and not its scale. Weight and appearance satisfaction substantially improves three and six months after VBG surgery and remains rather stable between stages III and IV.
Obes Facts. 2009 May 14;2(Suppl 2):256.
Introduction
Leptin is considered to exert dual effect on bone metabolism: anabolic (through peripheral pathways) and antiosteogenic (through central nervous system).
Aim
To examine bone metabolism and leptin concentration in patients with morbid obesity before and after bariatric surgery (BS).
Patients and methods
41 patients with morbid obesity (mean age 35y, BMI 45,5 kg/m2) selected for BS were included in the prospective study. Bone mineral density (BMD) in the lumbar spine (LS) and proximal femur (PF) was measured by DXA, serum parathyroid hormone (PTH), 25-hydroxyvitaminD (25OHD) and leptin concentrations were examined before and 6 months after BS.
Results
Before operation mean BMD was within the upper limit of the population reference range. Mean serum PTH was increased to 83,13pg/ml, 25OHD decreased to 4,91ng/ml. Elevated leptin concentration (mean 37,09ng/ml) was positively correlated with BMI. There was no correlation of leptin with BMD (in LS and PF), PTH and 25(OH)D.
Following the operation mean BMI decreased by 13,72 kg/m2, mean BMD in LS increased by 0,07 g/cm2 (p=0,004), in PF decreased by 0,04 g/cm2 (p=0,01). PTH decreased by 38,94 pg/ml (p=0,007) and leptin by 30,59 ng/ml (p=0,0001). Leptin was positively correlated with BMI but not with BMD (in both sites), PTH, 25(OH)D.
Conclusions
1. Weight loss after BS is accompanied by changes in BMD, regression of secondary hyperparathyroidism and decrease in serum leptin. 2. No correlations of serum leptin with BMD (in LS and PF), serum PTH and 25(OH)D were found neither before nor six months after BS.
Obes Facts. 2009 May 14;2(Suppl 2):256.
Introduction
The concept of health-related quality of life (HRQL) refers to the patient's perception of the influence of the disease and the course of its treatment on his/her everyday functioning. The study question is: how Vertical Banded Gastroplasty (VBG) influence the sense of quality of life of bariatric patients?
Methods
Patients were tested four times: before surgery (stage I: N=65, BMI 48,72±6,78), as well as three months after VBG (stage II: N=65, BMI 39,18±5,93), six months after VBG (stage III: N=65, BMI 34,68±5,32) and finally twelve months after VBG (stage IV: N=45, BMI 30,35±5,04). The Nottingham Health Profile was used as an indicator of HRQL.
Results
In comparison with pre-surgery period, the HROL of obese patients treated with VBG improved significantly in the basic dimensions of NHP: energy (I/II p<.0001, II/III p<.001, I/III p<.0001), pain (I/II p<.0001, II/III p<.001, I/III p<.0001), emotional reactions (I/II p<.01, II/III p<.01, I/III p<.0001), (I/III p<.01, II/III p<.05, III/IV p<.05), social isolation (I/IV p<.05) and physical mobility (I/II p<.0001, II/III p<.0001, I/III p<.0001, I/IV p<.0001). Moderate, but significant positive correlations were observed between BMI value and energy (I-IV), pain (I and II), emotional reactions (III), sleep (I) and physical mobility (I-IV).
Conclusion
One of the effects of VBG surgery is a substantial improvement in the patients’ HRQL. Positive changes of treatment appear in a relatively short period of time, which is particularly valuable for patients discouraged by many years of ineffective struggle with obesity.