Weight loss
Weight loss following vertical banded gastroplasty: intermediate results of a prospective study.

Kalfarentzos F, Kechagias I, Soulikia K, Loukidi A, Mead N.

Nutrition Support and Morbid Obesity Clinic, Surgical Department, University Hospital of Patras, Rio, Greece. fkalfar med.upatras.gr

BACKGROUND: Morbidly obese patients who undergo purely restrictive bariatric operations may fail to maintain satisfactory long-term results. In an attempt to achieve the best possible outcome after restrictive procedures, we have employed preoperative selection criteria and are following this selected patient group over time in order to evaluate long-term success. MATERIALS AND METHODS: From June 1994 through August 2000, 166 morbidly obese patients underwent various bariatric procedures at our institution. Of these patients, 35 underwent vertical banded gastroplasty (VBG) based on selection criteria, including degree of obesity and dietary habits and eating behavior. All patients were seen at 1, 3, 6, 9, and 12 months postoperatively and yearly thereafter. Average follow-up time now is 4.1 years (29-75 mos.), and follow-up is 100%. A multivitamin and mineral supplement is administered to all patients for at least 6 months. Radiology examination is performed in all patients on the 4th postoperative day and at each yearly visit, in order to check for staple-line disruption and stomal stenosis. RESULTS: Early postoperative morbidity was 5.7%. Late postoperative morbidity was 22.8%. A significant number of patients had some degree of stomal stenosis as shown by radiology examination, but to date there has been no need for surgical revision. There has been no early or late mortality. Weight loss results expressed as average percent excess weight loss (% EWL) were as follows: 61% (28-90) at 1 year, 61% (20-90) at 2 years, 57% (13-91) at 3 years, 56% (25-87) at 4 years and 37% (24-59) at 5 years following surgery. A significant number of patients with excellent weight loss had a high frequency of vomiting. Evaluation by BAROS showed that 25% of patients had an overall unsatisfactory outcome. Anemia and iron deficiency were found in 46% and 32% of VBG patients respectively. Recurrence of preexisting comorbidities was significant if lost weight was regained. CONCLUSIONS: In spite of preoperative selection of patients for VBG, a significant percentage of patients had poor overall results in terms of weight loss, quality of life, and resolution of preexisting comorbidities. For these reasons and based on the long-term results published by others, VBG is no longer our preferred surgical option in morbidly obese patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11433898&dopt=Abstract weight loss



Weight loss
The mini-gastric bypass: experience with the first 1,274 cases.

Rutledge R.

Center for Laparoscopic Obesity Surgery, 4301 Ben Franklin Blvd., Durham, NC 27704, USA. DrR clos.net

BACKGROUND: Results of the laparoscopic Mini-Gastric Bypass (MGB) are reported. METHODS: 1,274 MGB patients are continuously monitored as part of an online computer tracking data-base system. RESULTS: Mean preoperative weight (+/- Standard Deviation) was 132 +/- 21 kg, BMI 47 +/- 7. Mean excess weight loss was 51% at 6 months, 68% at 12 months and 77% at 2 years. The mean operating-time was 36.9 +/- 33.5 minutes. The shortest time was 19 minutes. Hospital stay was 1.5 +/- 1.6 days. The overall complication rate has been 5.2%. The overall rate of deep vein thrombosis and pulmonary embolism was 0.08% and 0.16% respectively. The leak rate was 1.6%. There was one hospital death, 0.08%. Associated medical illnesses were either completely reversed or markedly improved. CONCLUSIONS: The MGB is safe, results in major weight loss, has a short operating-time, and has a short hospital stay. The MGB appears to meet many of the criteria of an "ideal" weight loss operation.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11433900&dopt=Abstract weight loss



Weight loss
Management of obesity with the new intragastric balloon.

Hodson RM, Zacharoulis D, Goutzamani E, Slee P, Wood S, Wedgwood KR.

Department of Endoscopy, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, UK.

BACKGROUND: The introduction of an endoscopically-placed Bariatric Intragastric Balloon (BIB) provided the opportunity to reexamine weight reduction methods and also study potential weight loss without resorting to surgical intervention. METHODS: 10 severely obese patients with mean age 33 years and mean body mass index 39, underwent BIB placement, 7 as a sole weight reduction procedure and 3 requiring weight reduction before repair of large incisional hernias. All patients were followed at 2-week intervals by a nurse practitioner and dietitian for 6 months. RESULTS: Mean weight loss was 18.6 kg (range 6.6-40.0), equivalent to 40% excess weight loss (EWL), range 10-81%. EWL was 54% (29-81%) in those patients who had two balloons placed, who lost an average of 30.3 kg (24.0-40.0 kg). In the patients who had only one balloon placed, mean weight loss was 10.4 kg (8.8-12.5), equal to an EWL of 19% (10-37%). CONCLUSION: These results lead us to consider BIB placement as a successful short-term measure for weight loss or for patients requiring at least weight loss before other surgery.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11433910&dopt=Abstract weight loss



Weight loss
Three years experience with the new intragastric balloon, and a preoperative test for success with restrictive surgery.

Loffredo A, Cappuccio M, De Luca M, de Werra C, Galloro G, Naddeo M, Forestieri P.

University Federico II, General and Oncological Surgery, Naples, Italy. aloffy hotmail.com

BACKGROUND: The BioEnterics Intragastric Balloon (BIB) is a smooth, spherical, saline-filled, silicone elastomer with a black radiopaque filling valve, intended to induce weight loss by limiting food consumption. This can be considered a "restrictive" procedure, and by using this balloon, we can assess the patient's eligibility for a restrictive surgical procedure (the BIB-Test). METHODS: From May 1997 to May 2000, 87 BIB were inserted in 77 moderately to severely obese patients (4 BIB in 1 patient, 2 BIB in 7 patients). 64 patients completed the treatment. Out of these, 18 (16 female, 2 male) underwent laparoscopic gastric banding after BIB removal. RESULTS: After the treatment (3-6 months), weight loss results were as follows: WL 14.3 kg, %EWL 23.5 and loss in BMI 5.3. 12 patients after the preliminary BIB, have been followed > or = 6 months after gastric banding, and have significant further weight loss. CONCLUSIONS: BIB appears to have good results. A supervised nutritional and behavioral regimen is mandatory. The balloon may be indicated to: 1) induce weight loss in patients whose obesity is not severe enough to warrant surgery; 2) reduce the surgical risk in those who are massively obese; 3) select patients for gastric restrictive surgery if they lose weight with the balloon. The data showed that patients who had good results with the BIB (positive BIB-Test) are still losing weight after subsequent gastric banding.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11433911&dopt=Abstract weight loss



Weight loss
Relationship between insulin resistance, weight loss, and coronary heart disease risk in healthy, obese women.

McLaughlin T, Abbasi F, Kim HS, Lamendola C, Schaaf P, Reaven G.

Department of Medicine, Stanford University School of Medicine Stanford, CA, USA.

Several popular books have recently been published stating that being insulin-resistant favors weight gain and/or prevents weight loss. Because this view seems to have gained widespread support in the general population, we thought it important to perform the current study testing the hypothesis that differences in insulin-mediated glucose disposal do not affect weight loss in response to calorie-restricted diets. For this purpose, we studied the change in weight and risk factors for coronary heart disease (CHD) in healthy women volunteers, defined as being obese on the basis of a body mass index (BMI) greater than 30.0 kg/m(2). The insulin suppression test was used to stratify obese women at baseline into insulin-resistant and insulin-sensitive subgroups on the basis of their steady-state plasma glucose (SSPG) concentration at the end of a 180-minute infusion of octreotide, exogenous insulin, and glucose. They were then instructed on a calorie-restricted diet plus sibutraminine (15 mg/day) for a total period of 4 months. Baseline measurements also included determination of fasting lipid and lipoprotein concentrations, and hourly (8 AM to 4 PM) determinations of plasma glucose and insulin concentrations before and after breakfast and lunch. Twenty-four women completed the 4-month period of calorie restriction: 13 classified as insulin-resistant (SSPG = 219 +/- 7 mg/dL) and 11 as insulin-sensitive (SSPG = 69 +/- 6 mg/dL). The insulin-resistant group also had higher (P =.03) plasma triglyceride (TG) concentrations and a higher ratio of total to high-density lipoprotein (HDL) cholesterol concentration (P =.02) at baseline. Both groups lost a significant amount of weight during the study, and there was no difference between the weight loss in the insulin-resistant (8.6 +/- 1.3 kg) and insulin-sensitive (7.9 +/- 1.4 kg) groups. Weight loss in the insulin-resistant group was also associated with a significant decrease in SSPG concentration (219 +/- 7 to 144 +/- 14 mg/dL), associated with significantly lower fasting TG concentrations (P <.001) and day-long concentrations of plasma glucose and insulin (P <.005). None of these variables changed in the insulin-sensitive group. These results indicate that: (1) CHD risk factors in obese women vary as a function of being insulin-resistant or insulin-sensitive; (2) dramatic variations in insulin-mediated glucose disposal do not modulate weight loss in response to calorie-restricted diets, and (3) weight loss is effective in reducing CHD risk in insulin-resistant, obese women. Given these data, it seems obvious that attempts to reduce CHD risk factors by weight loss should focus on obese individuals who are also insulin-resistant. Copyright 2001 by W.B. Saunders Company

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11436184&dopt=Abstract weight loss



Weight loss
Metabolic changes following sibutramine-assisted weight loss in obese individuals: role of plasma free fatty acids in the insulin resistance of obesity.

McLaughlin T, Abbasi F, Lamendola C, Kim HS, Reaven GM.

Department of Medicine, Stanford University, School of Medicine, Stanford, CA, USA.

The relationship between insulin-mediated glucose disposal and daylong free fatty acid (FFA) concentrations before and after sibutramine-assisted weight loss was investigated in 24 healthy, normotensive, nondiabetic, obese women (body mass index [BMI] >30.0 kg/m(2)). The 24 volunteers were defined as being insulin-resistant (IR) or insulin-sensitive (IS) on the basis of their steady-state plasma glucose (SSPG) concentration in response to a 180-minute continuous intravenous infusion of octreotide, insulin, and glucose. The mean (+/- SEM) SSPG concentrations were significantly higher (P <.001) in the IR group (219 +/- 7 v 69 +/- 6 mg/dL) at baseline. The IR group also had significantly higher plasma glucose (P =.002), insulin (P <.001), and FFA (P =.02) concentrations measured at hourly intervals from 8 AM to 4 PM, before and after breakfast (8 AM) and lunch (noon). Weight loss in response to an energy-restricted diet for 4 months and sibutramine (15 mg/d) was comparable in the 2 experimental groups (8.6 +/- 1.3 v 7.9 +/- 1.4 kg). SSPG concentrations decreased significantly (P <.001) following weight loss (219 +/- 7 to 144 +/- mg/dL) in the IR group, but there was no change in the SSPG of the IS group (69 +/- 6 to 73 +/- 7 mg/dL. The improvement in insulin sensitivity in the IR group after weight loss was associated with a significant decline in daylong plasma glucose (P >.001) and insulin (P =.02) concentrations, without a weight-loss-associated decrease in daylong plasma FFA responses. In contrast, there was no significant change in plasma glucose, insulin, and FFA concentrations following weight loss in the IS group. These results indicate that daylong FFA concentrations vary substantially in obese individuals as a function of whether they are IR or IS. Furthermore the observation that the IR group was more insulin-sensitive after weight loss, associated with lower daylong insulin concentrations in the absence of a significant decrease in circulating FFA concentrations, suggests that resistance to insulin-mediated glucose disposal in obese individuals cannot be entirely due to high FFA levels. Copyright 2001 by W.B. Saunders Company

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11436188&dopt=Abstract weight loss



Weight loss
Weight locus of control and weight-related attitudes and behaviors in an overweight population.

Holt CL, Clark EM, Kreuter MW.

Health Communication Research Laboratory, School of Public Health, Saint Louis University, MO 63108, USA. plagecl slu.edu

Rotter's [Psychol. Monogr. 80 (1966)] construct of internal-external control of reinforcement led to the conceptualization of locus of control as a personality construct that can be used to predict behavior. More specific measures of locus of control in particular behavioral domains have followed. In the present study, the Weight Locus of Control Scale (WLOC) was used to predict weight-related attitudes and behaviors of overweight individuals, as well as their responses to health education materials (HEM) on weight loss. The WLOC scores predicted responses to baseline weight-related measures such as etiology of obesity, confidence in weight loss behaviors, and behavioral intention. In addition, WLOC scores predicted participants' reactions to the HEM, as well as the actual number of weight loss ideas from the HEM that the participants tried by the 1-month follow-up assessment. The results are discussed in terms of the validity of the WLOC and implications for future development of effective HEM.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11436925&dopt=Abstract weight loss



Weight loss
Does the pattern of postpartum weight change differ according to pregravid body size?

Gunderson EP, Abrams B, Selvin S.

Kaiser Permanente Division of Research, 3505 Broadway, Oakland, CA 94611-5714, USA. epg dor.kaiser.org

OBJECTIVES: To examine differences in the pattern of weight changes during and after pregnancy among four pregravid body mass index (BMI) groups. STUDY DESIGN: Prospective cohort study of women who had two consecutive births at the University of California, San Francisco (UCSF) between 1980 and 1990. MEASUREMENTS: Maternal body weights were available before conception and delivery, and at 6 weeks postpartum for the first (index) pregnancy, and before conception for the second study pregnancy. Height and two pregravid weights were self-reported. Weights at delivery and 6 weeks postpartum were measured. Net delivery weight was defined as delivery weight minus infant birth weight. Three non-overlapping sequential weight changes were constructed: (1) net gestational gain (net delivery weight minus pregravid weight at the index pregnancy); (2) early net postpartum weight change (6-week postpartum weight minus net delivery weight); and (3) late postpartum weight change (pregravid weight at the second pregnancy minus 6-week postpartum weight). SUBJECTS: A total of 985 healthy women (age 18-41 y) from four race/ethnicity groups (Asian, Hispanic, black and white) who had a singleton, full-term, live birth for the index pregnancy followed by a second consecutive birth. RESULTS: Four race/ethnicity groups were combined (no interaction) to contrast average weight changes among pregravid BMI groups. Means adjusted for eight covariates (parity, race/ethnicity, education, mode of delivery, smoking, hypertension of pregnancy, age, height) and time intervals were not altered appreciably. Early net postpartum weight losses were similar for all pregravid BMI groups. Late (median of 2 y) postpartum weight losses were 4 kg higher in the low and average BMI groups compared with the highest BMI group. About half of the net gestational gain was lost by 6 weeks postpartum, and the percentage that was lost decreased over time. CONCLUSIONS: This study suggests that early postpartum weight loss does not vary by maternal pregravid BMI group, but late postpartum weight change does. Serial weight measurements are needed in epidemiologic studies to differentiate retention of gestational gain from weight gain during the late postpartum period.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11439300&dopt=Abstract weight loss



Weight loss
A comparison of intakes of breast-fed and bottle-fed infants during the first two days of life.

Dollberg S, Lahav S, Mimouni FB.

The Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Israel.

OBJECTIVE: In the first days of life, breast-fed infants consume minimal amounts of milk; this may be explained by substrate limitation (limited milk output) and/or by self-limitation (through low appetite and/or suck-swallow competency). The spontaneous milk intake of unrestricted formula-fed infants has not been studied to date. We compared the spontaneous formula intake of unrestricted formula-fed infants to that of breast-fed infants over the first 48 hours of life. We hypothesized that 1) spontaneous formula intake of unrestricted infants is much higher than that of breast-fed infants and 2) spontaneous formula intake correlates positively with gestational age or birthweight. METHODS: We studied 43 healthy, term infants. By maternal choice, 15 infants were exclusively breast-fed and 28 were formula-fed ad libitum every four hours. Breast-fed infants were weighed before and one hour after initiation of feeding, and intake was calculated from the difference between the measurements and corrected individually for the infant's normal postnatal decrease in body weight. Bottles offered to formula-fed infants contained 60 cc, and the remainder was carefully measured. Intakes were expressed as cc/kg/d, and weight changes as % of birthweight. Statistical methods included Student's t tests and stepwise regression analysis. RESULTS: Breast feeding on Day I was 9.6 +/- 10.3 (mean +/- SD) vs. 18.5 +/- 9.6 cc/kg/d in formula-fed infants (p=0.011); on Day 2 it was 13.0 +/- 11.3 vs. 42.2 +/- 14.2 cc/kg/d (p<0.001). Breast-fed infants lost significantly more weight on Day 2 (p=0.015). In multiple regression, when the dependent variable was the second-day intake, the significant independent variables were group (higher intake in the formula-fed group), weight loss (the higher the weight loss, the lower the intake), and first-day intake (the higher the first-day intake, the higher the second-day intake). CONCLUSION: Newborn infants offered formula ad libitum every four hours consumed much larger amounts than breast-fed infants fed according to the same schedule. In addition, weight loss was more marked in breast-fed infants on Day 2 of life.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11444415&dopt=Abstract weight loss