Weight loss
Gastrostomy tube placement in head and neck cancer patients undergoing radiotherapy.

Moore R.

Department of Nutrition and Dietetics, Oxford Radcliffe Hospitals NHS Trust, Churchill Hospital, Headington, Oxford OX3 7LJ, UK Judith.Yeo orh.nhs.uk.

Background: In head and neck cancer (HNC) patients, the side effects of radiotherapy (RT) often lead to patients being unable to consume adequate nutrition and fluid (Chencharick and Mossman, 1983). Gastrostomy tube placement prior to RT can reduce incidence of severe weight loss and hospitalization during treatment (Beaver et al., 2001). However, gastrostomy tube usage is dependant upon HNC site and area of RT. The aims of the study were to identify the characteristics of those HNC patients who will require gastrostomy tube feeding during RT and utilize these data to target future patients for prophylactic tube placement prior to commencing RT and to write guidelines for the placement of feeding tubes. Method: Data were collected retrospectively regarding diagnosis, surgery and area of RT on all HNC patients who had had a prophylactic gastrostomy placed prior to RT between April 2000 and April 2002. Outcome measurements in terms of utilization of gastrostomy, body weight and nutrition related emergency admissions were recorded. Results: Thirty-five patients had a prophylactic gastrostomy placed [26 male, nine female; mean age 62 (range 26-84) years]. Of these, 26 utilized their tube for feeding or fluids during RT. The sites of radiotherapy were: bilateral RT to the oro- or nasopharynx and neck (20 patients), bilateral RT to the neck (five) and RT to the left oropharynx and neck (one). The mean weight loss during RT in patients who utilized their prophylactic gastrostomy was 3.3 (range 0-11.5%) compared to 8 (5.5-12.0%) in patients who did not have a prophylactic gastrostomy. Only one of the patients with a prophylactic gastrostomy had a hospital admission (length of stay 11 days) compared to four patients who did not [mean length of stay 21 days (range 14-29)]. Six of the nine patients who did not utilize their gastrostomy for feeding and were able to maintain their nutrition orally, received bilateral RT to the neck only. Discussion: Most of the patients who received bilateral RT to the oro- or nasopharynx required gastrostomy feeding during RT, which is consistent with findings of Beaver et al. (2001) who reported the highest incidence of weight loss in patients receiving RT to the nasopharynx or base of the tongue. Conclusion: In view of the association between the site of RT and gastrostomy utilization, hospital admissions, length of stay and weight loss, HNC patients with planned bilateral RT to the oro- or nasopharynx or with existing dysphagia should be targeted for gastrostomy tube placement prior to starting treatment. References: Beaver, M.E., Matheny, K.E., Roberts, D.B. & Myers, J.N.(2001) Predictors of weight loss during radiation therapy. Otolaryngol. Head Neck Surg. 125, 645-648. Chencharick, J.D. & Mossman, K.L. (1983) Nutritionalconsequences of the radiotherapy of head and neck cancer. Cancer 51, 811-815.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15546440&dopt=Abstract weight loss



Weight loss
Rorschach personality predictors of weight loss with behavior modification in obesity treatment.

Elfhag K, Rossner S, Lindgren T, Andersson I, Carlsson AM.

Obesity Unit, Karolinska University Hospital, Stockholm, Sweden. Kristina.Elfhag medhs.ki.se

Weight loss outcome for 49 obese patients after 6 months treatment in a behavior modification program was related to Rorschach personality characteristics according to the Comprehensive System (Exner, 2003), also including the Rorschach Oral Dependency Scale (Bornstein, 1996; Masling & Rabie, 1967). Less weight loss was predicted by signs of perceptual and cognitive distortions indicated by the Schizophrenia Index. More weight loss was predicted by Food Contents, suggesting a food preoccupation and possibly a benign dependency orientation. Patients with a focus on food and dependent needs could benefit above all from the treatment program implying learning how to handle food and eating in a supportive setting, as evidenced by more weight loss. Distortions in perception and cognition could constitute more profound difficulties in weight reduction important to recognize in obesity treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15548466&dopt=Abstract weight loss



Weight loss
Significant weight loss after laparoscopic Nissen fundoplication.

Neumayer C, Ciovica R, Gadenstatter M, Erd G, Leidl S, Lehr S, Schwab G.

Department of General Surgery, Hospital Krems, Mitterweg 10, 3500, Krems, Austria, gerhard.schwab khkrems.at.

BACKGROUND: Laparoscopic Nissen fundoplication (LNF) has evolved as a gold standard in antireflux surgery. However, the association between body weight and gastroesophageal reflux disease (GERD) is still unclear, and no data are available concerning the effect of fundoplication on body weight. We present the first report elucidating the impact of LNF on body weight in GERD patients with special emphasis on patients' quality of life. METHODS: From July 2000 to March 2003, LNF was carried out in 213 patients (85 women and 128 men) after thorough preoperative examination including clinical interview with standardized assessment of symptoms and quality of life (QoL), endosocopy, barium swallow, 24-h pH-metry, and manometry. Follow-up investigations were performed 3 and 12 months after LNF obtainable from 209 patients (98.1%) and 154 patients (72.3%), respectively. RESULTS: The mean body mass index (BMI) decreased significantly after LNF (27.6 +/- 5.6 kg/m(2) before LNF vs 26.0 +/- 3.8 kg/m(2) after LNF, p < 0.001). Twelve months after LNF, neither a tendency toward a renewed increase nor a further decrease in BMI was observable. The average body weight loss was 3.9 kg. BMI reduction was higher in women than in men (p < 0.002), and obese patients lost more weight than lean patients (p < 0.001). There was no association between BMI reduction and dysphagia. Plasma cholesterol and triglyceride levels did not change after LNF. The mean general score of the Gastrointestinal Quality of Life Index markedly improved (90.1 +/- 21.3 before LNF vs 118.0 +/- 16.2 after LNF, p < 0.01), as did the GERD-Health Related Quality of Life Index (21.9 +/- 6.4 before LNF vs 3.5 +/- 2.7 after LNF, p < 0.001). However, there was no association between changes in BMI and QoL. CONCLUSION: LNF leads to significant and persistent body weight loss.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15549628&dopt=Abstract weight loss



Weight loss
Addressing skin redundancy after major weight loss.

Sagrillo D, Kunz S.

Dawn Sagrillo, BSN, RN, CPSN, is a Nurse Associate, Aesthetic and Reconstructive Surgery Associates, Brookfield, WI.Sue Kunz, BS, RN, CPSN, is in practice at the Clinic of Cosmetic Surgery, Milwaukee, WI.

With the recent development of sophisticated bariatric surgery techniques, there has been an increasing population of patients seeking body-contouring procedures. Skin redundancy of the trunk, buttocks, breasts, upper arms, and thighs is often a significant problem. This dermatochalasis may also be the cause of medical sequelae such as intertrigo or may cause functional limitations with walking, urinating, and sexual activity. These individuals are dealing with psychosocial issues related to massive weight loss as well.The treatment of generalized skin redundancy after bariatric surgery and massive weight loss has become a challenge for the plastic surgery team. It requires strategic skills in assessing the patient, planning, timing, and executing these often complex and extensive procedures. This issue's Journal Club focuses on recent articles pertaining to outcomes, safety, timing, and techniques of body contouring secondary to weight loss.DPS.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15550817&dopt=Abstract weight loss



Weight loss
Neurobiologic changes in the hypothalamus associated with weight loss after gastric bypass.

Romanova IV, Ramos EJ, Xu Y, Quinn R, Chen C, George ZM, Inui A, Das U, Meguid MM.

Surgical Metabolism and Nutrition Laboratory, Neuroscience Program, Department of Surgery, University Hospital, SUNY Upstate Medical University, Syracuse, NY, USA.

BACKGROUND: Effects of Roux-en-Y gastric bypass (RYGB) on hypothalamic food intake regulation have not been investigated. The hypothalamic arcuate nucleus (ARC) and the magnocellular (m) and parvocellular (p) parts of the paraventricular nucleus (PVN) regulate hunger and satiety, and are under control of the orexigenic neuropeptide Y (NPY), and the anorexigenic alpha-melanocyte stimulating hormone (alpha-MSH) and serotonin (5-HT). We hypothesized that after RYGB, weight loss is associated with hypothalamic down regulation of NPY and up regulation of 5-HT and alpha-MSH. STUDY DESIGN: Obesity was induced in 12 Sprague Dawley rats using a high-energy diet for 7 weeks, and then the rats were divided into three groups (n = 4/group): RYGB, sham-operated pair-fed (PF), and sham-operated ad libitum (obese control). Ten days after operation, immunohistochemical quantification of NPY, alpha-MSH, and 5-HT(1B)-receptors in ARC and PVN was performed. Data were analyzed using ANOVA and Tukey's test. RESULTS: Body weight decreased in RYGB (417 +/- 21 g; mean +/- SE) and in PF (436 +/- 14 g) rats 10 days after operation compared with obese control rats (484 +/- 15 g; p < 0.05 for each comparison). NPY in ARC, pPVN, and mPVN decreased by 43%, 43%, and 61%, respectively in RYGB and by 55%, 42%, and 71% in PF, respectively, compared with obese controls (p < 0.05 for each pairwise comparison). RYGB versus PF did not show differences. alpha-MSH in ARC, pPVN and mPVN increased by 35%, 175%, and 67%, respectively in RYGB and by 29%, 162%, and 116% in PF, respectively, compared with obese controls (each p < 0.05). In mPVN, alpha-MSH significantly decreased by 23% in RYGB versus PF (p < 0.05). 5-HT-(1B)-receptor in pPVN increased by 58% in RYGB and by 26% in PF, compared with obese controls (p < 0.05). Compared with obese controls, 5HT-(1B)-receptor in mPVN increased by 39% in RYGB (p < 0.05) and by 9% in PF (p > 0.05). An increase of 5-HT-(1B)-receptor in pPVN and mPVN occurred in RYGB versus PF (p < 0.05). CONCLUSIONS: Obese rats that undergo weight loss after RYGB demonstrate changes in hypothalamic down regulation of NPY and up regulation of alpha-MSH and serotonin.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15555972&dopt=Abstract weight loss



Weight loss
The role of exercise for weight loss and maintenance.

Donnelly JE, Smith B, Jacobsen DJ, Kirk E, Dubose K, Hyder M, Bailey B, Washburn R.

The Center for Physical Activity and Weight Management, The Schiefelbusch Institute for Lifespan Studies, The University of Kansas, 1301 Sunnyside Ave, Robinson Center Rm 100, Lawrence, KS 66045, USA. jdonnelly ku.edu

Exercise provides a means of increasing energy expenditure and may help adjust energy balance for weight loss and maintenance. At least 30 minutes a day of moderate intensity aerobic exercise per day is recommended for weight loss and maintenance but greater amounts appear to increase the magnitude of weight loss and maintenance. Resistance training has recently been shown to have positive effects on body composition but does not typically show significant decreases in weight. Regardless of weight loss, both aerobic exercise and resistance training have been shown to diminish risk factors for cardiovascular disease and diabetes. Since exercise is only effective if sustained, behavioural strategies such as self-monitoring, goal setting, social support, etc. are used to help individuals start and maintain exercise programs and show improved results compared to exercise programs without behavioural strategies. The available evidence indicates that exercise is an important component of weight loss and perhaps the best predictor of weight maintenance.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15561636&dopt=Abstract weight loss



Weight loss
Is there an optimal macronutrient mix for weight loss and weight maintenance?

Wilkinson DL, McCargar L.

Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, T6G 2P5, Canada. dana.wilkinson ualberta.ca

Low carbohydrate diets are gaining popularity, however there is no clear consensus regarding their safety and efficacy for weight loss. Proponents of these diet plans advocate dramatic reductions in carbohydrate intake to combat insulin resistance and hyperinsulinaemia, which they claim are responsible for obesity. There are no long-term studies that directly compare the weight loss potential of low versus higher carbohydrate diets. Evidence from randomized controlled trials suggests that low carbohydrate diets may enable short-term weight loss by facilitating reduced energy intakes, however poor dietary compliance may prevent long-term success. Unbalanced nutrient profiles may increase the risk of adverse health consequences in adherents. Low carbohydrate diets should not be recommended at this time due to a lack of adequate long-term follow up data. Successful weight loss occurs through the creation of a sustained energy deficit, and should be achieved through a combination of exercise and a nutritionally balanced and varied diet.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15561637&dopt=Abstract weight loss



Weight loss
Obesity: surgical options.

Miller K.

Surgical Department, Ludwig-Boltzmann-Institute for Gastroenterology and Experimental Surgery at the General Austrian Hospital Hallein, a.o. Krankenhaus Hallein, Burgermeisterstr. 34, A-4500 Hallein, Austria. karl.miller kh-hallein.at

Conservative treatment has been shown in long-term studies to be ineffective in morbid obesity. Surgical treatments break down into restrictive, malabsorptive, combined restrictive and malabsorptive or motility-reducing procedures. Laparascopic implantation of an adjustable gastric band is an efficient restrictive measure for treating the majority of patients with this condition. The adjustable gastric band enables weight loss and food intake to be adapted to the individual patient's need. Eighty percent to 90% of these patients can expect to lose 55-70% of their excess weight. Vertical banded gastroplasty is losing ground among the restrictive options. Preliminary experiences are encouraging but the long term results are disappointing when assessed by the standard criteria. Gastric bypass is gaining ground in Europe and a standard procedure in USA. This operation is estimated to give 70-80% excess weight loss and provide better quality of life than restrictive procedures. The biliopancreatic diversion with duodenal switch combines a sleeve gastrectomy with a duodenoileal switch to achieve maximum weight loss. Consistent excess weight loss between 70 and 80% is achieved with acceptable decreased long-term nutritional complications. The laparoscopic approach to this procedure has successfully created a surgical technique with optimum benefit and minimal morbidity, especially in the super obese patient. Intra-gastric stimulation is the least invasive surgical procedure at present. However, the excess weight loss is lowest with this method at only 32% in the first 2 years after the operation. Provided safety recommendations are observed, laparoscopic operations for obesity are fairly low-risk. The mortality rate in centres with experienced staff is less than 0.3%. Surgical treatment for obesity has proved that it is the best and most effective means of preventing the life-threatening complications and serious degenerative problems associated with morbid obesity. There is no one operation that is effective for all patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15561644&dopt=Abstract weight loss



Weight loss
Rapid, simple in vivo screen for new drugs active against Mycobacterium tuberculosis.

Nikonenko BV, Samala R, Einck L, Nacy CA.

Sequella, Inc., Rockville, Maryland 20850, USA. borisnikonenko sequella.com

We evaluated the use of a simple and easy-to-obtain potential marker of tuberculosis (TB) drug efficacy, body weight, and correlated weight loss or gain with the number of CFU of Mycobacterium tuberculosis in lungs and spleens of infected mice. C3H mice were infected intravenously with 10(6) CFU of virulent M. tuberculosis H37Rv, and body weight was evaluated for several weeks after infection. At day 20, infected untreated mice consistently lost more than 25% of their body weight. Chemotherapy with selected orally active anti-TB drugs was initiated 7 days following infection and continued for 13 days. Drugs that were administered daily by gavage included isoniazid (INH), ethambutol (EMB), rifampin (RIF), and moxifloxacin (MXF). At the most effective doses, each of these drugs inhibited bacterial growth and abolished infection-induced body weight loss. Chemotherapy with 1/10 the standard dose of INH determined in accepted long-term murine models of TB also prevented body weight loss, while chemotherapy with 1/10 the standard dose of RIF did not. With only 2 weeks of chemotherapy, we observed a good reverse correlation between CFU in lung or spleen and body weight of mice. The simple measurement of weight in TB-infected drug-treated mice required only a weight balance, and go/no-go drug efficacy data was available on day 20 without the necessity of prolonged drug treatment and long (3 weeks or more) in vitro culture times to obtain organ CFU values.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15561824&dopt=Abstract weight loss