Weight loss
Quality of life and nutritional state in patients on home enteral tube feeding.

Loeser C, von Herz U, Kuchler T, Rzehak P, Muller MJ.

1st Medical Department, the Institute of Human Nutrition and Food Science, Reference Center of Quality of Life in Oncology, Christian-Albrechts-University of Kiel, Kiel, Germany.

OBJECTIVE: We assessed quality of life (QOL) in patients on home enteral tube feeding (HETF). The data should contribute to ethically justified decision making. METHODS:We used a prospective cross-sectional study (study 1) in 155 consecutive patients and a prospective longitudinal study (study 2) with a follow-up of 4 mo in 56 patients. QOL was assessed by proxy rating (Karnofsky and Spitzer indices) and self-rating (European Organization for Research and Treatment of Cancer [EORTC] QLQ C30) extended by a specific module. RESULTS: In study 1, weight losses 3 mo before HETF were 10.5 +/- 8.4% and 7.9 +/- 6.3% in competent (P < 0.05) and non-competent (P < 0,05) patients, respectively. The prevalences of severe malnutrition and weight loss were 50% and 73%, respectively. When compared with EORTC reference data for a general population, QOL was lower in HETF patients. The lowest QOL was seen in non-competent patients. Nutrition status explained up to 13% of the variance in QOL. In study 2, nutrition status stabilized or increased slightly in response to HETF. This was true for competent and non-competent patients and for patients with malignant and benign diseases. Concomitantly, physical functioning improved, whereas fatigue decreased. QOL increased in response to HETF in competent and non-competent patients, and 50% of the non-competent patients became competent CONCLUSIONS: .Measures of QOL research can be used in HETF patients. QOL is reduced in patients on HETF. Part of this effect is explained by malnutrition. HETF can prevent further weight loss and improve some aspects of QOL, thus allowing physicians to focus on patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12831946&dopt=Abstract weight loss



Weight loss
Children's weight-loss camps: psychological benefit or jeopardy?

Walker LL, Gately PJ, Bewick BM, Hill AJ.

Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine, University of Leeds, Leeds, UK.

OBJECTIVES: To investigate the change in body image, self-esteem, and worries in obese adolescents attending a residential, weight-loss camp. DESIGN: A longitudinal intervention study, with a nonintervention comparison group of lean adolescents. PARTICIPANTS: A total of 57 obese adolescents (age: 13,11; BMI: 32.6 kg/m(2)) and 38 normal weight comparison adolescents. MEASURES: Self-esteem, salience of weight-related issues, body shape preference, weight and height at the start, and end of the weight-loss camp (mean stay: 4 weeks). RESULTS: The obese adolescents lost 5.6 kg, reduced their BMI by 2.1 kg/m(2), and BMI s.d. score by 0.28 while comparison children gained weight. Body shape dissatisfaction significantly decreased and self-esteem increased on measures of global self-worth, athletic competence, and physical appearance, in the camp attendees. This improvement took place without any exacerbation of existing worries about appearance or weight. CONCLUSIONS: While obese adolescents had lower self-worth and greater body dissatisfaction relative to the comparison children at the start of the camp, the intervention improved their psychological state. Greater weight loss was associated with greater psychological improvement, indicating the value of the intervention and the relevance of psychological change in effective treatment.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12833121&dopt=Abstract weight loss



Weight loss
Effect of weight loss on bone metabolism: comparison of vertical banded gastroplasty and medical intervention.

Guney E, Kisakol G, Ozgen G, Yilmaz C, Yilmaz R, Kabalak T.

Medical Faculty of Adnan Menderes University, Department of Internal Medicine, Division of Endocrinology, Turkey.

BACKGROUND: We studied the effects of weight loss on bone metabolism. METHODS: 16 consecutive surgically-treated (14 female, 2 male) morbidly obese patients and 65 obese (53 male, 12 female) medically-treated patients were enrolled in an observational study. Surgical treatment for morbidly obese patients was vertical banded gastroplasty (VBG). Studies were performed prior to and 12 months after the start of treatment. Bone mineral density (BMD), bone turnover markers, sex steroids, calcium excretion and parathyroid hormone measurements were done at each visit. RESULTS: Weight loss was more prominent with surgical than with medical treatments. Bone loss was also pronounced in the surgical treatment group, and occurred at the hip level only (P<0.05). Compared to previously reported studies, where the effects of malabsorptive treatments for obesity on bone metabolism were studied, calcium excretion and parathyroid hormone levels did not change after VBG or medical therapy. For both groups, bone markers indicated an increased bone turnover, evidenced by increased urinary excretion of deoxypyridinoline and serum levels of osteocalcin (P<0.05). Sex steroid measurements revealed a decrease in estradiol levels in the surgical treatment group, but not in medical treatment group. This finding was thought to be secondary to less weight loss in the medical group. CONCLUSION: Our data indicate that weight loss causes bone loss. The bone loss is independent of the method of weight reduction. However, the mechanism of the bone loss is not clear. It may be explained partly by reduced estradiol levels in female patients. Because the mechanisms of bone disease after weight loss remain unclear, it is difficult to determine the most effective treatment. It is important to detect osteopenia early, before fractures occur. Measuring BMD appears to be the only reliable method for screening.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12841898&dopt=Abstract weight loss



Weight loss
Low-back pain in morbidly obese patients and the effect of weight loss following surgery.

Melissas J, Volakakis E, Hadjipavlou A.

Bariatric Unit, Department of Surgical Oncology, Medical School, University of Crete, Greece. melissas med.uoc.gr

BACKGROUND: Although low-back pain (LBP) is a common health problem and a source of significant discomfort, disability and work absences, its incidence, severity and outcome have not been extensively investigated in morbidly obese patients undergoing bariatric surgery. METHODS: 50 morbidly obese candidates for vertical banded gastroplasty (VBG) were asked to fill in a questionnaire, to assess the incidence and severity of any existing LBP symptoms. 50 non-obese patients, admitted to our surgical unit for management of several benign conditions, were also asked to fill in the same questionnaire and served as controls. 24 months after VBG, the morbidly obese patients were again evaluated for their LBP symptoms. RESULTS: LBP was identified in 29 morbidly obese patients (58%) preoperatively and in only 12 (24%) of the lean controls (P<0.01). 2 years after VBG, with a significant excess weight loss (P<0.0001), only 10 patients continued to have LBP but less frequently and requiring reduced doses of medications compared with the preoperative condition. In the remaining 19 patients with preoperative positive LBP history, the postoperative weight loss was associated with complete resolution of the symptoms. CONCLUSION: The frequency of LBP is significantly higher in morbidly obese patients than in lean subjects. Surgical weight reduction results in significant improvement and even disappearance of this obesity co-morbidity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12841899&dopt=Abstract weight loss



Weight loss
Laparoscopic Swedish adjustable gastric banding: a five-year prospective study.

Steffen R, Biertho L, Ricklin T, Piec G, Horber FF.

OBEX-Institute, Hirslanden Clinic, Department of Surgery, Zurich and Berne, Switzerland. Rudolf.steffen bluewin.ch

BACKGROUND: Laparoscopic adjustable gastric banding is a popular bariatric operation in Europe. However, the long-term complication rate and weight loss are still unclear. METHODS: 824 patients underwent a laparoscopic Swedish Adjustable Gastric Banding (SAGB) in a 5-year period. Preoperative data, postoperative weight loss and long-term complications were prospectively obtained for analysis. RESULTS: Mean age of the 824 patients was 43 +/- 1 years, with mean preoperative BMI 43 +/- 1 kg/m(2). No intra- or postoperative death occurred in the first 30 postoperative days. Intraoperative conversion rate was 5.2%. Peri-operative complication rate was 1.2%. 97% of the patients were available for follow-up (maximum 5 years). Long-term complications occurred in 191 patients (23.2%). 135 complications (16.4%) were related to the band, and 56 (6.8%) to the access-port or to the tube. Mean excess weight loss was 30, 41, 49, 55 and 57 % after 1, 2, 3, 4 and 5 years respectively. 82.9% of the patients obtained >50% EWL after initial treatment. CONCLUSIONS: The results of this study suggest that laparoscopic SAGB can achieve an effective weight loss, with an acceptable mortality and morbidity rate.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12841902&dopt=Abstract weight loss



Weight loss
Gastric electrical-stimulation effects on canine gastric emptying, food intake, and body weight.

Xing J, Brody F, Brodsky J, Rosen M, Larive B, Ponsky J, Soffer E.

Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland Ohio 44195, USA.

OBJECTIVE: It has been reported that electrical stimulation at the distal stomach can disrupt intrinsic gastric electrical activity and delay gastric emptying. Gastric dysrhythmia and impaired gastric emptying are associated with upper gastrointestinal symptoms and weight loss. The purpose of this study was to evaluate the effect of low-frequency/long-pulse gastric electrical stimulation (GES), at proximal and distal stomach, on canine gastric emptying, food intake, and body weight. RESEARCH METHODS AND PROCEDURES: Eight dogs were surgically implanted with four pairs of electrodes along the greater curvature and a gastric tube at the dependent part of the stomach. Liquid gastric emptying at baseline, during proximal and distal GES at 6 cycles per minute, was assessed first by a dye dilution technique. Proximal and distal GES were then randomly delivered during feeding for 10 consecutive days, and food intake and body weight were recorded daily. RESULTS: There was no significant difference in gastric emptying parameters among the various sessions. The mean daily food consumption was significantly reduced during both sessions of GES, resulting in significant immediate weight loss. Percentage weight loss was comparable between both sessions of GES. DISCUSSION: Short-term GES significantly reduced canine food intake and weight. This effect may not be related to changes in gastric emptying. GES may have a potential role in the treatment of obesity.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12529484&dopt=Abstract weight loss



Weight loss
What consumers want to know about commercial weight-loss programs: a pilot investigation.

Wang SS, Wadden TA, Womble LG, Nonas CA.

University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.

OBJECTIVE: In 1999, the Partnership for Healthy Weight Management recommended that providers of commercial weight-loss programs (and products) voluntarily disclose information concerning the safety, costs, and central components of their programs, as well as the credentials of program staff. These guidelines were drafted without the benefit of data from consumers concerning the specific information they desired. The present study provides such data. RESEARCH METHODS AND PROCEDURES: Participants were 90 women with a mean age of 44.02 +/- 9.17 years and body mass index of 36.11 +/- 4.82 kg/m(2) who were participants in one of two randomized weight-control trials. Before treatment, respondents were asked to imagine that they were "looking for a weight-loss plan" and to rate how important each of 16 factors would be in helping them select a plan. Ratings were made using 5-point scales, anchored by "not at all important" and "extremely important," (scored 1 and 5, respectively). Participants also identified the five factors that they thought were the most important, as well as the single most important. RESULTS: The mean rating for the importance of safety (4.57 +/- 0.60) was significantly greater than that for each of the 15 other variables (all p values < 0.05). In addition, significantly more respondents (27.8%) selected safety as the single most important factor than any other variable (all p values < 0.05). Other factors that were consistently judged as very important included information about diet (4.38 +/- 0.68), behavior modification (4.32 +/- 0.76), cost (4.19 +/- 0.92), and maintenance of weight loss (4.15 +/- 0.91). Staff credentials (3.88 +/- 0.83) were among the lowest rated items. DISCUSSION: The results generally support the disclosure guidelines proposed by the Partnership for Health Weight Management. Consumers, however, seem to desire information about weight loss, in addition to that concerning safety, cost, and central program components.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12529485&dopt=Abstract weight loss



Weight loss
Weight-loss practices and asthma: findings from the behavioral risk factor surveillance system.

Ford ES, Mannino DM, Redd SC, Mokdad AH, Galuska DA, Serdula MK.

Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. esf2 cdc.gov

OBJECTIVE: To describe weight-control practices and receipt of weight-loss advice among obese people with asthma. RESEARCH METHODS AND PROCEDURES: We analyzed data from the 2000 Behavioral Risk Factor Surveillance System. RESULTS: Among 13953 participants with current asthma, 27.3% had a body mass index of >or=30 kg/m2. Overall, 48.1% of participants with asthma reported trying to lose weight (64.1% among overweight or obese participants and 72.9% among obese participants). Among participants with asthma who were trying to lose or maintain weight, 74.7% reported trying to reduce their energy and/or fat intake, and 57.8% reported using physical activity. Approximately 29.7% were using the recommended combination of energy and/or fat intake reduction and physical activity of >or=150 min/wk. During the 12 months before the interview, 16.2% of overweight and 44.9% of obese participants with asthma reported receiving advice to lose weight. Among obese participants receiving weight-loss advice, 82.9% reported trying to lose weight compared to 63.8% of participants who did not receive such advice. DISCUSSION: Health professionals can play an important role in educating their patients with asthma about the importance of weight control and assisting their overweight and obese patients in setting appropriate weight goals and helping them achieve those goals.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12529489&dopt=Abstract weight loss



Weight loss
Lifestyle intervention of hypocaloric dieting and walking reduces abdominal obesity and improves coronary heart disease risk factors in obese, postmenopausal, African-American and Caucasian women.

Nicklas BJ, Dennis KE, Berman DM, Sorkin J, Ryan AS, Goldberg AP.

Department of Medicine, Division of Gerontology, University of Maryland School of Medicine, Baltimore, Maryland, USA. bnicklas wfubmc.edu

BACKGROUND: There are few empirical data to support the claim that weight loss improves coronary heart disease (CHD) risk factors in postmenopausal women; nor is it known if there are racial differences in changes of body fat distribution, lipids, glucose tolerance, and blood pressure with weight loss. This study determined the efficacy of a lifestyle weight loss intervention in reducing total and abdominal obesity and improving CHD risk factors in obese Caucasian and African-American postmenopausal women. METHODS: Body composition (dual-energy x-ray absorptiometry), abdominal fat areas (computed tomography scan), lipoprotein lipids, insulin, glucose tolerance, and blood pressure were measured before and after 6 months of hypocaloric diet and low-intensity walking in 76 overweight or obese (body mass index > 25 kg/m(2)), Caucasian (72%) or African-American (28%), postmenopausal (age = 60 +/- 5 years) women who completed the study. RESULTS: Absolute amount of body weight lost was similar in Caucasians (-5.4 +/- 3.6 kg) and African Americans (-3.9 +/- 3.6 kg), but Caucasian women lost relatively more fat mass (p <.05). Both groups decreased their subcutaneous abdominal fat, and Caucasian women decreased their visceral fat area, but there were no racial differences in the magnitude of abdominal fat lost. The intervention decreased triglyceride and increased high-density lipoprotein and high-density lipoprotein 2 cholesterol in both races, and it decreased total and low-density lipoprotein cholesterol in Caucasian women (p <.05-.0001). Fasting glucose and glucose area during the oral glucose tolerance test decreased (p <.0001) in Caucasian women, whereas insulin area decreased in both Caucasian (p <.01) and African-American (p <.05) women. Blood pressure decreased the most in women with higher blood pressures at baseline. Changes in lipids, fasting glucose and insulin, their responses during the oral glucose tolerance test, and blood pressure were not different between racial groups. CONCLUSIONS: Weight loss achieved through a lifestyle intervention of energy restriction and increased physical activity is an equally effective therapy in African-American and Caucasian obese, postmenopausal women for improving glucose and lipid CHD risk factors.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12586858&dopt=Abstract weight loss