Weight loss
Recent weight changes and weight cycling as predictors of subsequent two year weight change in a middle-aged cohort.

Kroke A, Liese AD, Schulz M, Bergmann MM, Klipstein-Grobusch K, Hoffmann K, Boeing H.

German Institute of Human Nutrition, Department of Epidemiology, Potsdam-Rehbruecke, Germany. kroke mail.dife.de

OBJECTIVE: To evaluate the influence of recent weight changes (weight gain, loss and cycling) on subsequent weight changes. DESIGN: Prospective cohort study with 2 y of follow-up. Data analysis with a polytomous logistic regression model. SUBJECTS: A total of 18 001 non-smoking subjects, 6689 men and 11 312 women, from the general population. MEASUREMENTS: Body height and weight measurements and interview data on lifestyle habits and medical history at baseline. For follow-up, self-administered questionnaires for assessment of body weight and incident diseases. RESULTS: Recent changes in body weight, that is weight gain, weight loss and weight cycling, were significant predictors of subsequent weight changes in both men and women after controlling for age, baseline BMI and several lifestyle and behavioural characteristics as potential confounding factors. Weight cycling before baseline was the strongest predictor of subsequent large weight gain (> or =2 kg) with an odds ratio (OR) of 4.84 (95% confidence interval (CI) 3.34-7.02) in men. In women, prior weight loss was the strongest predictor of subsequent large weight gain (OR 4.77; 95% CI 3.63-6.03), followed by weight cycling (OR 3.02; 95% CI 2.15-4.25). CONCLUSION: These data indicate the need for thorough weight history assessment to identify those who are most likely to gain weight. Effective weight control before the development of obesity or after intentional weight loss due to obesity should be a primary goal in the management of obesity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11896497&dopt=Abstract weight loss



Weight loss
Snoring and Sleep Apnea in Obese Adolescents: Effect of Long-term Weight Loss-Rehabilitation.

Siegfried W, Siegfried A, Rabenbauer M, Hebebrand J.

Insula Obesity Treatment Center, Berchtesgaden, Germany.

Objective: To test the effect of a long-term weight loss rehabilitation program in extremely obese adolescents on breathing parameters during sleep. Methods: Thirty-eight extremely obese [mean body mass index (BMI) 45.3 +/- 7.9kg/m(2)] adolescents participated during a three- to nine-month period in an inpatient weight loss rehabilitation in a specialized long-term rehabilitation center. Breathing parameters were registered via a seven-channel portable screening device. Body weight and arterial blood pressure were measured before and after the long-term treatment. Results: Mean BMI decreased from 45.3 to 35.8 (p < 0.001), mean diastolic blood pressure decreased from 89 mmHg to 81 mmHg (p = 0,002). Nine patients had a RDI of >/=5 and 30 patients a RDI of <5; the mean RDI decreased from 4.08 to 3.27 (n.s.). Within the group, the RDI was >/=5 and the mean RDI decreased from 10.3/h to 5.2/h (p = 0.02). The mean SaO2 increased from 93.65 to 95.35% (p = 0.003), lowest SaO2 increased from 72.14 to 73.19% (n.s.) and snoring frequency decreased from 37.56% of total sleep time (TST) to 32.86% of TST (n.s.). Conclusion: A long-term inpatient weight loss program has a positive effect on breathing parameters during sleep in extremely obese adolescents. However, the effect on apneic events and snoring is relatively minor compared to the effect on arterial oxygen saturation. The role of obesity in the origin of respiratory events and snoring in adolescents might be overestimated.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11898113&dopt=Abstract weight loss



Weight loss
Carbon dioxide and ethylene interactions in tulip bulbs.

de Wild HP, Gude H, Peppelenbos HW.

Agrotechnological Research Institute (ATO), Bornsesteeg 59, PO Box 17, 6700 AA Wageningen, The Netherlands Applied Plant Research, Flower Bulbs, PO Box 85, Vennestraat 22, 2160 AB Lisse, The Netherlands.

The effect of CO2 on ethylene-induced gummosis (secretion of polysaccharides), weight loss and respiration in tulip bulbs (Tulipa gesneriana L.) was investigated. A pretreatment with 1-MCP prevented these ethylene-induced effects, indicating that ethylene action must have been directed via the ethylene receptor. Treatment with 0.3 Pa ethylene for 2 days caused gummosis on 50% of the total number of bulbs of cultivar Apeldoorn, known to be sensitive for gummosis. Addition of CO2 (10 kPa) reduced the ethylene-induced gummosis to 18%. In a second experiment the influence of ethylene and CO2 on respiration and FW loss of bulbs of the cultivar Leen van der Mark was studied. A range of ethylene partial pressures (0.003-0.3 Pa) was applied continuously for 29 days. Ethylene caused a transient peak in O2 consumption rate during the first days after the start of application. The relation between O2 consumption rate and ethylene partial pressure could be described by Michaelis-Menten kinetics. Respiratory peaks were reduced by CO2. This inhibition by CO2 could not totally be due to competition with ethylene at the receptor binding-site, as was indicated by the use of an O2 consumption model. Pre-treatment of bulbs with 1-MCP and subsequent exposure to CO2 showed that CO2 could influence respiration irrespective of any interaction with ethylene. Ethylene and CO2 both stimulated weight loss. The effect of combined treatments of ethylene and CO2 on weight loss was at least as strong as the sum of the separate effects, which implies that competition between ethylene and CO2 at the receptor binding-site was unlikely.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11903980&dopt=Abstract weight loss



Weight loss
Increase in plasma pollutant levels in response to weight loss is associated with the reduction of fasting insulin levels in men but not in women.

Imbeault P, Chevrier J, Dewailly E, Ayotte P, Despres JP, Mauriege P, Tremblay A.

Department of Social and Preventive Medicine, Laval University, Ste-Foy, Quebec, Canada.

Environmental pollutants can act as endocrine modulators. In this study, we examined whether weight loss-induced changes in plasma organochlorine compounds (OC) were associated with those in plasma insulin levels. Fasting insulin and the area under the curve (AUC) of insulin after a 75-g oral glucose load, plasma levels of 1 commercial polychlorinated biphenyl (PCB) mixture (Aroclor 1260), 1 PCB congener (PCB 153), and 3 pesticides (2,2'-bis(4-chlorophenyl)-1,1-dichloroethylene (p,p'-DDE), beta-hexachlorocyclohexane (beta-HCH), and hexachlorobenzene (HCB)) were measured before and after a 15-week weight loss program induced by a caloric restriction in a sample of obese men and women. Both genders showed a similar reduction in body weight (approximately 11 kg) in response to treatment, although men lost significantly more fat mass than women (mean +/- SD 9.4 +/- 4.1 v 5.9 +/- 5 kg, respectively, P <.05). Fasting insulin and AUC of insulin significantly decreased in men and women after the treatment. In response to weight loss, a significant increase in OC was observed in both genders, and this effect was more pronounced in men. The greater the increase in plasma OC levels, the greater the reduction in fasting insulin was in response to weight loss in men (-.49 < r < -.59, P <.05), but not in women (-.22 < r <.01, not significant [NS]). In both genders, no relationship was observed between changes in plasma OC levels and changes in AUC of insulin (-.41 < r < -.08, NS). In men, relationships between changes in plasma HCB, Aroclor 1260, and PCB-153 concentrations and those in fasting insulin levels in response to weight loss remained significantly correlated after correction for fat mass loss (-.46 < partial r < -.51, P values ranging from.05 to.07). These results suggest that weight loss-induced increase in plasma pollutant levels tends to be independently associated with the reduction of fasting insulin levels in men, but not in women. Further studies are needed to verify whether these findings are causally related. Copyright 2002, Elsevier Science (USA). All rights reserved.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11912558&dopt=Abstract weight loss



Weight loss
Training lay health educators to conduct a church-based weight-loss program for African American women.

Quinn MT, McNabb WL.

PURPOSE: Community-based lay health educators have been utilized in a range of settings and with a variety of health issues. However, little has been published about the specifics of training lay health educators to effectively deliver community-based programs. This paper describes the training used to prepare volunteer, church-based lay health educators to conduct a community-based weight-loss program, and the evaluation of that training. METHODS: After recruitment through their respective churches, volunteer lay health educators were given structured training in how to conduct the PATHWAYS weight-loss program. Program sessions were observed to monitor program delivery, and participation rates and weight loss were evaluated. RESULTS: The lay health educators were highly consistent in their delivery of the program content. Participant attendance was high and virtually all of the participants completed the program. Participant weight loss averaged 8.3 pounds, which correlated with session attendance. CONCLUSIONS: Given training appropriate to the structure of the program and specific to the targeted health behavior, lay health educators can reliably and effectively administer even rather complex programs.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11913005&dopt=Abstract weight loss



Weight loss
An assessment of vertical banded gastroplasty-Roux-en-Y gastric bypass for the treatment of morbid obesity.

Capella JF, Capella RF.

Department of Surgery, Hackensack University Medical Center, Hackensack, NJ, USA.

OBJECTIVE: To analyze retrospectively the mortality, morbidity, and weight loss of a specific form of gastric bypass for the treatment of morbid obesity. The technique incorporates a small pouch along the lesser curvature of the stomach, an outlet restricted by a nondistensible band and a Roux-en-Y gastric bypass. MATERIAL AND METHODS: We analyzed 652 consecutive patients with no previous bariatric surgery who underwent our present form of gastric bypass. Parameters used to evaluate the technique included mortality, weight loss at 5 years and complications. The operation is a combination of vertical banded gastroplasty and Roux-en-Y gastric bypass (VBG-RGB). The patients followed up to 5 years had an initial weight of 140 kg [range, 94 to 288] and a BMI of 50 [range, 38 to 86]. Superobese individuals (BMI of 60 [range, 48 to 86]) made up 42% of the group. RESULTS: There was an early reoperation rate of 0.5%. The incidence of late complications that required reoperation was 0.5%. There were 2 deaths in the study from pulmonary embolism for a mortality of 0.3%. At 5 years, the patients had lost an average of 58kg [range, 14 to 143] and had a percentage excess weight loss of 77 [range, 32 to 108]. Their BMI was reduced to 29 kg/m(2) [range, 20 to 43] and 93% lost more than 50% of the excess weight. CONCLUSIONS: VBG-RGB is effective in producing superior weight loss in morbid and superobese patients and has a low mortality and morbidity. We recommend this procedure without reservations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11918873&dopt=Abstract weight loss



Weight loss
[Metabolic syndroma long term results]

[Article in German]

Nord-Rudiger D.

Eleonorenklinik der LVA Hessen, Lindenfels-Winterkasten, Germany. dnr free4u.de

Several studies in obesity verify more effectiveness in weight-loss if diet and exercise were combined with behavioral modification. The main problem with all obesity treatments is a return to baseline weight after treatment ends. We have some evidence, that long-term behavioral methods may be successful to induce long-term weight-loss maintenance. Strategies for improving weight-loss maintenance in rehabilitation are discussed

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11930284&dopt=Abstract weight loss



Weight loss
Modeling the impact of adjustable gastric banding on survival in patients with morbid obesity.

Sendi P, Palmer AJ, Hauri P, Craig BA, Horber FF.

Medical Informatics and Technology Assessment Research Group, Baar, Switzerland. psendi swissonline.ch

OBJECTIVE: Morbid obesity is associated with premature death. Adjustable gastric banding may lead to substantial weight loss in patients with morbid obesity. Little is known about the impact of weight loss on survival after adjustable gastric banding. We therefore developed a mathematical model to estimate life expectancy in patients with a body mass index (BMI) > or =40 kg/m(2) undergoing bariatric surgery. RESEARCH METHODS AND PROCEDURES: We developed a nonhomogeneous Markov chain consisting of five states: the absorbing state ("dead") and the four recurrent states BMI > or =40 kg/m(2), BMI 36 to 39 kg/m(2), BMI 32 to 35 kg/m(2), and BMI 25 to 31 kg/m(2). Scenarios of weight loss and age- and sex-dependent risk of death, as well as BMI-dependent excess mortality were extracted from life tables and published literature. All patients entered the model through the state of BMI > or =40 kg/m(2). RESULTS: In men aged either 18 or 65 years at the time of surgery, who moved from the state BMI > or =40 kg/m(2) to the next lower state of BMI 36 to 39 kg/m(2), life expectancy increased by 3 and 0.7 years, respectively. In women aged either 18 or 65 years at the time of surgery, who moved from the state BMI > or =40 kg/m(2) to the next lower state BMI 36 to 39 kg/m(2), life expectancy increased by 4.5 and 2.6 years, respectively. Weight loss to lower BMI strata resulted in further gains of life expectancy in both men and women. DISCUSSION: Within the limitations of the modeling study, adjustable gastric banding in patients with morbid obesity may substantially increase life expectancy.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11943839&dopt=Abstract weight loss



Weight loss
Body image disturbance in obese outpatients before and after weight loss in relation to race, gender, binge eating, and age of onset of obesity.

Sorbara M, Geliebter A.

New York Obesity Research Center, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University-College of Physicians and Surgeons, New York, New York, USA.

OBJECTIVE: To assess body image disturbance as a composite of three aspects (distortion, discrepancy, and dissatisfaction) in obese subjects before and after weight loss. Disturbance was then related to race, gender, binge eating behavior, and age of onset of obesity. METHODS: Eighty-two obese outpatients (24 males, 58 females) completed the Stunkard Figure Rating Scale (FRS). A Disturbance score was derived from the weighted sum of distortion, discrepancy, and dissatisfaction. The measures were repeated 4 weeks after starting a medically supervised liquid formula diet. RESULTS: Prior to weight loss, race (r =.28, p =.01) and gender (r =.25, p =.02) were each predictive of disturbance, with Caucasians and men having the most disturbance. Binge eaters exhibited more discrepancy (p =.03) and dissatisfaction (p =.005) than non-binge eaters. Early-onset subjects demonstrated more discrepancy than adult-onset subjects (p =.02). Following weight loss, disturbance scores decreased for all groups (p =.009). However, early-onset subjects still showed more discrepancy (p =.002) and more dissatisfaction (p =.005) than adult-onset subjects. DISCUSSION: Body image disturbance was viewed as a composite of three aspects. Prior to weight loss, the high disturbance score in Caucasians may be due to them experiencing greater cultural pressure to be thin. The men may have exaggerated their degree of obesity because of less denial of being overweight than women. Following weight loss, disturbance decreased for all groups but remained elevated for those with early onset, possibly because of a persistent self-image from adolescence. Copyright 2002 by Wiley Periodicals, Inc.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11948646&dopt=Abstract weight loss