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Biomedical subjects

F L Greenway

Publications and source records attributed to F L Greenway.

At least 19 recordsLinked to original sources
PubMed2006

Using intranasal lidocaine to reduce food intake.

OBJECTIVE: Develop a dose-response curve for the effect of intranasal lidocaine on food intake. DESIGN: Healthy obese subjects had food intake, ratings of hunger, desire to eat, craving and fullness measured at lunch after an overnight fast. Four treatments were given as nose drops (0.5-0.6 ml per nostril) 5 min before the meal in a double-blind manner with a four period crossover design including a 7-day washout between periods. The treatments were saline, 2.5, 10 and 25 mg lidocaine per nostril. The order of administration was randomly assigned to each subject. Electrocardiograms, vital signs, chemistry panels, complete blood counts (CBC) and nasal inspections were carried out before and after each dose. SUBJECTS: Forty-seven subjects were screened, 34 were randomized and 20 subjects completed all four study periods in the trial. The subjects were 39+/-12.5 (s.d) years of age, had a weight of 91+/-13.0 kg, a height of 167+/-10.3 cm, 56% were women, 47% were African-American and 53% were Caucasian. MEASUREMENTS: Food intake, rating of hunger, desire to eat, craving and fullness are measures of efficacy. Adverse events, electrocardiograms, vital signs, chemistry panels, nasal inspections, CBC and physical exams are measures of safety. RESULTS: The mean reduction in food intake vs saline control in the 20 subjects completing all four study periods was 3.3+/-7% (s.d), 4.2+/-8.5% and 7.4+/-7.3% in the 2.5 mg, 10 and 25 mg per nostril groups, respectively (P=NS). Hunger and desire to eat in subjects who completed at least one study period decreased dose dependently (P<0.03, at the 25 mg per nostril dose). There were no clinically significant changes in safety measures, electrocardiograms, vital signs, chemistry panels, CBC or nasal inspections. CONCLUSION: Intranasal lidocaine reduced hunger and the desire to eat, but this did not translate into a significant reduction in food intake suggesting that intranasal lidocaine will not have value in treating obesity.

Administration, Intranasal↗
PubMed2006

Retention rates and weight loss in a commercial weight loss program.

OBJECTIVE: To evaluate and describe retention rates and weight loss in clients participating in a commercial weight loss program. SUBJECTS: A total of 60 164 men and women ages 18-79 years who enrolled in the Jenny Craig Platinum program between May 2001 and May 2002. METHODS: Retention rates, mean weight loss and percent weight loss were calculated on a weekly basis for the 52-week period following initial enrollment in the weight loss program. Clients were categorized based on final week of participation in the program (weeks 1-4, weeks 5-13, weeks 14-26, weeks 27-39 and weeks 40-52) and weight loss was calculated at final week. A subgroup of clients was identified based on attendance through 13, 26 and 52 weeks. Mean and percent weight loss was calculated for these subgroups of clients. RESULTS: Of the 60 164 men and women who enrolled in the weight loss program, 73% were retained in the program after 4 weeks, 42% at 13 weeks, 22% at 26 weeks and 6.6% at 52 weeks. Clients who dropped out of the program during the first 4 weeks lost 1.1+/-1.6% (mean+/-s.d.) of their initial body weight, whereas clients who dropped out between 40 and 52 weeks lost 12.0+/-7.2%. Clients in the 13-week, 26-week and 52-week cohorts lost 8.3+/-3.3, 12.6+/-5.1 and 15.6+/-7.5% of their initial body weight, respectively. CONCLUSION: Weight loss was greater among clients who were retained in the program longer. The findings from this study suggest that a commercial weight loss program can be an effective weight loss tool for individuals who remain active in the program.

Adolescent↗
PubMed2006

Safety and efficacy of NT, an herbal supplement, in treating human obesity.

OBJECTIVE: A human pilot study testing the safety and effectiveness of NT (Number Ten), a dietary herbal supplement made from rhubarb, ginger, astragulus, red sage and turmeric, to reduce food intake and cause weight loss. RESEARCH METHODS AND PROCEDURES: A total of 24 healthy women, 18-60 years, body mass index 25-35 kg/m(2) on no chronic medication were randomized to four groups of six: (1) oral freeze-dried NT 6 gm/day, (2) bed-dried NT 6 gm/day, (3) freeze-dried NT 12 gm/day or (4) placebo. Number Ten dose was escalated over 3 weeks and maintained for 8 weeks on a 700 kcal/day diet below maintenance. Food intake was measured at baseline and 4 weeks. Safety parameters were monitored weekly during dose escalation, week 6 and week 12. RESULTS: Weight loss was 1.8 kg for placebo and 0.4 kg for 500 mg NT whereas the 250 mg bed- and freeze-dried NT gained 0.43 and 0.87 kg, respectively (P=NS). The food intake increased 74 kcal with 250 mg freeze-dried NT and decreased 193.7 kcal with 500 mg freeze-dried NT (P<0.01). There was a dose-related incidence of loose stools in the NT groups, but no other toxicity was seen. Number Ten was found to contain sennosides, known laxatives and gallic acid, which is known to give weight loss in rodents. DISCUSSION: The human dose equivalent of NT used in this study was & frac16; and & frac112; of that shown to give well-tolerated weight loss in rodents. Number Ten will not be an effective dietary herbal supplement for the treatment of obesity owing to dose-limiting gastrointestinal toxicity.

Adolescent↗
PubMed2001

Psychosocial variables associated with binge eating in obese males and females.

OBJECTIVE: This study tested a psychosocial model of binge eating symptoms in obese men and women. Predictor variables included depression, dietary restraint, self-esteem, weight cycling, history of teasing, body dissatisfaction, and neuroticism. METHOD: Participants (N = 808) completed a packet of self-report questionnaires. RESULTS: Weight cycling, teasing about weight and shape, body dissatisfaction, negative affect, and dietary restraint comprised the best fitting models (original and cross-validation) for binge eating in women and men. These variables explained 61-72% of the variance in symptoms of binge eating in the samples of men and 70% of the variance in the samples of women. Although the male and female models were mostly similar, notable differences between them were found. DISCUSSION: The variables that comprise these etiological models should be considered in the development of prevention programs for obese binge eaters. Longitudinal studies, however, are needed to examine these etiological paths and to test for causal relationships.

Adult↗
PubMed2001

Body Morph Assessment: preliminary report on the development of a computerized measure of body image.

OBJECTIVE: To develop a prototype of the Body Morph Assessment (BMA), and to test the reliability and validity of this new measure of body image. The BMA is a realistic and relatively simple procedure that uses computer morphing for the assessment of body image. For the purposes of this preliminary study, a prototype of the BMA was developed for usage with white women ranging from very thin to obese. RESEARCH METHODS AND PROCEDURES: A total of 72 subjects participated in tests of reliability, content, and convergent validity of the BMA. RESULTS: The reliability and validity of the BMA was supported by the results of this study. In a test of convergent validity, the measures of current, ideal, and reasonable body size were positively correlated with their equivalents from a similar body image assessment procedure. In addition, reliability coefficients were found to be satisfactory for all variables. Participants found the human figural stimuli to be realistic. DISCUSSION: These preliminary findings support the reliability and validity of the BMA with white women. Given these positive findings, we plan to extend the procedure to males and to other racial and ethnic groups.

Adult↗
PubMed2001

Psychological and behavioral predictors of weight loss during drug treatment for obesity.

OBJECTIVE: This study investigated whether baseline eating behavior, emotions, and body image were significant predictors of change in body mass index (BMI) over 6 month and 12 month time intervals for individuals enrolled in a weight loss program that combined appetite suppressant medications and behavior therapy for obesity. METHOD: Participants were asked to complete self-report questionnaires at baseline, 6 months, and 12 months. In addition, their height and weight were measured and they were administered a body image assessment procedure at each time interval. RESULTS: At baseline, perceived hunger, dietary restraint, current body size, and trait anxiety were important components in a model for prediction of weight loss at 6 months. Perceived hunger, dietary restraint, and current body size as measured at baseline were important components in the prediction of weight loss at 12 months. These predictive variables, together with gender and initial BMI, accounted for 48.6% of the variance in weight loss at 6 months and 51.7% of the variance in weight loss at 12 months. DISCUSSION: These findings suggest that scores on certain paper and pencil tests may be useful as predictors of success or failure for individuals entering a weight loss program using pharmacological and behavioral interventions.

Anxiety↗
PubMed2001

The safety and efficacy of pharmaceutical and herbal caffeine and ephedrine use as a weight loss agent.

Since passage of the Dietary Supplement Health and Education Act of 1994, the sale of herbal dietary supplements containing caffeine and ephedrine for weight loss has become widespread in the United States. Reports of adverse events associated with the use of these non-prescription supplements have raised concerns in the United States regulatory community. Restricting the use of these products is now being considered. Such restriction should be based upon controlled clinical trials. This review of the literature in Medline relative to the use of caffeine and ephedrine in the treatment of obesity concludes that caffeine and ephedrine are effective in causing weight loss. Caffeine and ephedrine give equivalent weight loss to Diethylpropion and superior weight loss compared to dexfenfluramine. Caffeine and ephedrine have a long history of safe, non-prescription use. The adverse events accompanying acute dosing are mild and transient. Adverse events with caffeine and ephedrine reach and remain at placebo levels after 4-12 weeks of continuous treatment, but data from randomized trials up to 6 months only are available. Obesity is chronic, requires chronic treatment, its incidence is increasing and it has few effective treatments. The benefits of caffeine and ephedrine in treating obesity appear to outweigh the small associated risks. Restriction of dietary herbal supplements containing caffeine and ephedrine, often with other ingredients, should be based on controlled clinical trials of these products.

Aminophylline↗
PubMed2000

The future of obesity research.

As endocrinologists, we view better treatment as the goal of obesity research. The ideal obesity treatment would reduce body fat substantially, with preferential loss from the visceral compartment, and preserve lean tissue with a minimum of side effects. Obesity has been recognized as a chronic disease since 1985. Chronic diseases recognized before obesity may predict the future of obesity research. Initial treatments of chronic diseases commonly arise from empirical observations. These observations often stimulate basic research into the physiologic mechanisms responsible. Such cross-fertilization between the clinic and basic science is desirable and expected. As more is learned about the physiology of obesity, treatments can be expected to use more downstream mechanisms with less unwanted side effects, the reliance on surgical treatments can be expected to decline, and molecular approaches are likely to play an increasingly important role. With a better physiologic understanding of obesity, advanced clinical endpoints will become more important and molecular approaches are likely to play a more important role in discovery and treatment. Due to the availability of molecular approaches, obesity treatment is expected to advance faster than chronic disease research of the past.

Chronic Disease↗
PubMed2000

Common apolipoprotein A-IV variants are associated with differences in body mass index levels and percentage body fat.

OBJECTIVE: To determine the relationship between two common apoA-IV variants (Thr347-->Ser; Gln360-->His), and body mass index (BMI) and percentage body fat. DESIGN: Cross-sectional study. SUBJECTS: Eight-hundred and forty-eight subjects screened for participation in ongoing clinical studies. MEASUREMENTS: ApoA-IV genotype, body mass index, waist-to-hip ratio and percentage body fat by bioelectric impedance. RESULTS: Participants had an average age of 41+/-12 y and an average BMI of 28.2+/-5.5 kg/m2. Individuals homozygous for the Ser347 allele had higher BMI (32.3+/-6.6 vs 28.6+/-5.3 kg/m2; P<0.01) and percentage body fat (36.9+/-7.8 vs 31.0+/-9.6%; P<0.05) compared with individuals homozygous for Thr347. In contrast, the presence of at least one copy of the His360 allele was associated with lower BMI (27.2+/-5.0 vs 28.4+/-5.6 kg/m2; P<0.05) and percentage body fat (28.6+/-8.2 vs 30.7+/-9.1%; P<0.05). The genotype effects persisted after normalization of the data for the potential confounding effects of gender, age and race. When grouped by BMI percentile, the frequency of the Ser347/Ser347 genotype increased while the frequency of the His360 allele decreased with increasing BMI. CONCLUSIONS: These data suggest a role for apoA-IV in fat storage or mobilization and that genetic variations in the apoA-IV gene may play a role in the development of obesity.

Adipose Tissue↗
PubMed2000

The effect of an herbal dietary supplement containing ephedrine and caffeine on oxygen consumption in humans.

OBJECTIVE: To determine if an herbal dietary supplement for weight loss increases metabolism. DESIGN: Measurement of peak oxygen consumption in response to the supplement followed by a double-blind placebo-controlled crossover measurement of oxygen consumption in response to the supplement. SETTING: The study was conducted in an academic research clinic. SUBJECTS: Ten obese females (aged 41 +/- 4 years [body mass index (BMI)] 33.3 +/- 2.6 kg/m2) participated in the peak oxygen consumption test; six of these females participated in the crossover trial. INTERVENTIONS AND OUTCOME MEASURES: Peak oxygen consumption was measured for 45 minutes after taking two herbal dietary supplement capsules orally, each containing the equivalent of 10 mg of caffeine and 5 mg of ephedrine. The crossover trial measured oxygen consumption for 45 minutes after taking two herbal dietary supplement capsules or two placebo capsules orally. RESULTS: The herbal dietary supplement increased peak oxygen consumption 0.178 +/- 0.03 (SEM) kcal/min (8.01 +/- 1.35 kcal/min expressed over 45 minutes) above baseline (p < 0.0001), and 2.0 +/- 0.56 kcal/min over 45 minutes compared to placebo (p < 0.006). CONCLUSIONS: The herbal dietary supplement increased oxygen consumption when taken according to the package directions. The significance of this rise for weight loss requires further research.

Caffeine↗
PubMed2000

Root surface caries: a complication of the jejunoileal bypass.

BACKGROUND: A patient developed root surface caries and loss of teeth following the jejunoileal (JI) bypass. We attempted to confirm the association of root surface caries with the JI bypass and explore the mechanisms by which it occurs. METHODS: The number of root surface caries per year after, and an equal period of time before, a JI bypass was determined in 18 patients. These 18 patients and 5 normal controls gave stimulated saliva samples for measurement of chloride, bicarbonate and pH. 4 JI bypass patients and 4 normal controls gave timed stimulated saliva samples for measurements of volume. RESULTS: 7 of 18 JI bypass patients had >0.5 root surface caries per year after the operation but none before (p<.01). Salivary chloride was > 12 meq/l in 3 of the 18 JI bypass patients but in none of 5 controls (p<.05). The salivary pH and bicarbonate were 6.38+/-0.48 vs 6.92+/-0.21 and 2.81+/-2.1 meq/l vs 5.8+/-1.2 meq/l in the JI bypass group and the control group respectively (p<.05). The stimulated saliva was 2.3+/-1.2 vs 4.5+/-1.4 cc/min in the JI bypass group and control group, respectively (p<.02). CONCLUSIONS: Root surface caries are more frequent after JI bypass. This may be due to decreased saliva flow and a reduced salivary buffering capacity.

Adult↗
PubMed1999

Sibutramine produces dose-related weight loss.

OBJECTIVE: Sibutramine is a weight control drug that inhibits the reuptake of both serotonin and norepinephrine. In animals, it reduces food intake and increases thermogenesis and preliminary data in human beings showed weight loss. This paper reports a 24-week dose-ranging study to determine the effect of sibutramine on body weight of patients with obesity. RESEARCH METHODS AND PROCEDURES: Seven clinical centers screened 1463 patients with obesity and randomized 1047 to 24 weeks of treatment with 1 of 6 doses of sibutramine (1, 5, 10, 15, 20, or 30 mg) or placebo once daily. Six hundred eighty-three patients completed the study. A two-week placebo run-in period was used to initiate a standardized program of diet, physical activity, and lifestyle changes. RESULTS: Weight loss was dose-related and statistically significant vs. placebo (p<0.05) across all time-points for a 5 mg/day to 30 mg/day dosage of sibutramine. At week 24, percent weight loss from baseline for completers was: placebo, 1.2%; 1 mg, 2.7%; 5 mg, 3.9%; 10 mg, 6.1%; 15 mg, 7.4%; 20 mg, 8.8%; and 30 mg, 9.4%. Weight loss achieved at week 4 was predictive of weight loss achieved at week 24. Patients losing weight demonstrated an increase in serum high density lipoprotein cholesterol and reductions in serum triglycerides, total cholesterol, low density lipoprotein cholesterol, and uric acid. Small mean increases in blood pressure and pulse rate (with considerable individual variability) were observed in patients treated with sibutramine. The most frequent adverse events were dry mouth, anorexia, and insomnia. DISCUSSION: Sibutramine administered once daily for 24 weeks in the weight loss phase of treatment for uncomplicated obesity produced dose-related weight loss and was well tolerated. Improvements in serum lipids and uric acid accompany sibutramine-induced weight loss. Most of the adverse events observed on sibutramine are related to its pharmacology, including small mean increases in blood pressure and heart rate.

Adult↗
PubMed1999

Pharmaceutical cost savings of treating obesity with weight loss medications.

OBJECTIVE: To evaluate, in compliant patients, the pharmaceutical costs of treating obesity with fenfluramine/mazindol, fenfluramine/phentermine, caffeine/ephedrine, or mazindol relative to the pharmaceutical costs of treating obesity-related comorbid conditions and reducing cardiovascular risk. METHODS AND PROCEDURES: Subjects were between 18 and 60 years of age with a BMI of >30 kg/m2. Pharmaceutical costs were evaluated in 73 of 220 subjects taking medications for diabetes, hyperlipidemia, or hypertension before and after treatment using fenfluramine with mazindol or phentermine. The pharmaceutical cost of weight loss, cardiac risk reduction, and low-density lipoprotein (LDL) cholesterol reduction was calculated for fenfluramine with mazindol or phentermine, caffeine with ephedrine, or mazindol alone, and compared to approved lipid-lowering medications. RESULTS: Losses of 6% to 10% of initial body weight reduced pharmacy costs $122.64/month for insulin treated diabetes, $42.92/month for sulfonylurea-treated diabetes, $61.07/month for hyperlipidemia treated with medication, and $0.20/month for hypertension treated with medication. Blood pressure and laboratory evidence of insulin resistance improved in all medication groups. Caffeine/ephedrine was most cost-effective of the three treatments in reducing weight, cardiac risk, and LDL cholesterol. DISCUSSION: Obesity medications produced a substantial weight loss in compliant patients and resulted in a net pharmaceutical cost savings compared to treating obesity related comorbid conditions.

Adolescent↗
PubMed1999

Methods to maximize retention in weight loss studies.

OBJECTIVE: Dropouts from clinical trials decrease quality and increase costs. Free participation, paid participation, and contingency contracting are three study retention methods. Contingency contracting, or depositing a fee to be refunded contingent upon attendance in a clinical trial, has been reported to decrease dropouts without affecting weight loss. These three methods of retention were compared with a commercial weight loss clinic's practice of charging nonrefundable fees. METHODS AND PROCEDURES: Dropouts were compared in two studies testing mazindol, with one study using free care and the other using contingency contracting; two studies testing phenylpropanolamine, one using free care and the other using contingency contracting; and in studies with phenylpropanolamine on file with Thompson Medical Company using free care, paid participation, and contingency contracting. RESULTS: The dropout rate was 50% at 8 weeks in a trial of mazindol with free care vs. 7% for contingency contracting (p<0.001). The two phenylpropanolamine studies gave the same weight losses, but the dropouts were 37% at 8 weeks for free care vs. 11% for contingency contracting (p<0.001). The studies of phenylpropanolamine on file at the Thompson Medical Company had 28% dropouts at 8 weeks using free care vs. 19% for paid participation (p<0.001), and 11% for contingency contracting (p<0.005). Dropouts with contingency contracting (11%) were not different from the commercial weight loss program (13%). DISCUSSION: Contingency contracting can decrease dropouts, improve quality, and decrease costs without affecting weight loss in clinical trials for obesity.

Appetite Depressants↗
PubMed1999

Substrate oxidation and availability during acute exercise in non-obese, obese, and post-obese sedentary females.

OBJECTIVE: This study compared fat oxidation rates during an acute bout of cycle ergometry exercise (E) typical of progressive fat oxidation in healthy, but sedentary, women of different obesity histories. DESIGN: Five never-obese (NO) (mean age=25+/-3 (s.e.)y, mean body fat=25.0+/-2.8 (s.e.)%), five obese (O) (26+/-3 y, 44. 4+/-1.7%), and five post-obese (PO) (22+/-1 y, 32.2+/-3.0%) women cycled for 60 min at 60-65% peak VO2. To identify the specific effects of E, a control trial consisting of 60 min of seated rest (R) was also performed. E and R trials were counterbalanced one month apart in the follicular phase and conducted following a 3 d normalized, eucaloric diet. MEASUREMENTS: Dual energy X-ray absorptiometry (DEXA) was used to determine body composition, and all were weight stable for at least eight weeks prior to experimentation. During both trials breath by breath measurements of VO2 and RER were used to determine substrate oxidation and energy expenditure. Blood samples were collected for hormone and metabolite analysis before, and every 15 min during exercise or rest. RESULTS: All three groups showed a similar and progressive shift toward fat oxidation as exercise progressed. No group differences were observed for E energy expenditure or fat oxidation. Glycerol (P<0.0001) and free fatty acids (P<0.0001) increased similarly in all three groups, but PO maintained the highest free fatty acid level during exercise (group effect; P<0.01). E and R decreased (P<0.001 for both) insulin levels across groups, with lowest levels noted in PO and highest in O. Plasma epinephrine (P<0.0001) and norepinephrine (P<0.001) increased similarly during E in all three groups. Plasma growth hormone (GH) levels rose (P<0.05) during E, with a pronounced increase observed in PO. CONCLUSION: We conclude that exercise of equal relative intensity elicited similar fat oxidation rates among NO, O, and PO women, despite group differences in free fatty acid availability. The PO women's persistently lower insulin and higher plasma GH levels may have enhanced free fatty acid availability.

Absorptiometry, Photon↗
PubMed1999

Topical insulin in wound healing: a randomised, double-blind, placebo-controlled trial.

Two studies were carried out to assess the relative roles of insulin and zinc in the acceleration of wound healing. In the first study, six diabetic and five non-diabetic human volunteers had two uniform cuts created, one on each forearm. One forearm wound was treated with topical regular insulin (Iletin-II) and the other with normal saline four times a day until healed. Treatment was double-blind and forearms were assigned randomly. The wounds treated with insulin healed 2.4 +/- 0.8 days faster than the wounds treated with saline (P < 0.001 by paired t-test). Zinc is used to crystallise insulin. When wounds are treated with insulin, they are therefore also being treated with zinc. If insulin accelerates wound healing, it is not clear if the increase in the rate of healing would be due to insulin (a known growth factor), the zinc it contains, or a combination of the two. The second study used a randomised, double-blind, placebo-controlled design to compare the efficacy of insulin with that of a solution containing the same amount of zinc in accelerating the healing of standardised wounds in rats and humans. Although these pilot investigations did not have the power to define the relative roles of insulin and zinc with accuracy, the results suggest that zinc does play a role in the wound healing process. It is concluded that topical insulin accelerates wound healing in humans. More importantly, however, this study describes a method of creating uniform wounds in humans acceptable to an institutional review board, thus solving one of the major impediments to the scientific evaluation of human wound healing.

Administration, Cutaneous↗
PubMed1996

Surgery for obesity.

The medical risks of obesity increase exponentially as weight increases, and these risks are reduced by sustained weight loss. Behavior modification and dieting provide an approximately 6% loss of body weight at 1 year. Fenfluramine provides an approximately 8% weight loss at 1 year, which can be doubled to 16% when a drug such as phentermine, which works through a different biochemical mechanism, is added to it. This amount of weight loss is insufficient for many severely obese individuals. It was with these facts in mind that the National Institutes of Health Consensus Conference in 1992 recommended that obesity surgery is an appropriate treatment for patients with a body mass index greater than 40 kg/m2 who had failed in attempts at medical treatment and for patients with a body mass index greater than 35 kg/m2 with severe complications of obesity. Vertically banded gastroplasty and Roux-en-Y gastric bypass are the two operations presently recommended because of their relative safety and effectiveness. This article reviews previous procedures that have provided insight into the mechanisms by which these surgeries cause weight loss. The presently used surgeries and their results also are reviewed because until medical therapy improves substantially, surgery remains the most reasonable treatment option for most morbidly obese patients.

Humans↗