Search PubMed⌕ Search

Biomedical subjects

J S Garrow

Publications and source records attributed to J S Garrow.

At least 55 records · Page 3Linked to original sources
PubMed1987

A cross-sectional cost/benefit audit in a hospital obesity clinic.

A cross-sectional survey was made of the 25 men and 127 women attending a hospital obesity clinic over a period of 6 weeks. Among the men the mean (+/- s.d.) age was 37 (+/- 14) years, weight 115.2 (+/- 25.4) kg, height 1.70 (+/- 0.09) m, and Quetelet's index 39.6 (+/- 6.4) kg/m2. Among the women the corresponding values were 41 (+/- 15) years, 102.2 (+/- 22.3) kg, 1.60 (+/- 0.07) m, and 40.3 (+/- 9.2) kg/m2. The most common reasons for wishing to lose weight among both men and women was to improve appearance, shortness of breath and pain in weight-bearing joints. About one-third of the patients tested had raised fasting plasma triglyceride levels. Only one had tests indicating hypothyroidism, and two were hyperthyroid. None of these characteristics predicted how long the patient would continue to attend the clinic. Weight loss was calculated according to the duration of attendance at the clinic, and the method of treatment. Two men and 15 women were treated by jaw-wiring, and the remainder by dietary advice alone. No anorectic or thermogenic drugs were used. Among men treated by diet alone the mean weight loss after 1-3 months, 4-6 months, 7-12 months and greater than or equal to 13 months attendance was 5.0 +/- 6.2 kg, 12.4 +/- 11.0 kg, 12.4 +/- 10.2 kg and 13.0 +/- 5.2 kg respectively. Two men treated by jaw-wiring had lost 23.9 and 57.9 kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Failure of carbohydrate to spare leucine oxidation in obese subjects.

Leucine kinetics were studied in six obese subjects (W/H2 = 39 +/- 4) and six normal subjects (W/H2 = 21 +/- 3) before and after an oral load of 150 g glucose. An intravenous infusion of 1(-13)C leucine was given to the fasting subjects for 450 min: a steady state of plasma leucine enrichment was established 90 min after the start of the infusion, and the glucose load was given 220 min after the start of the infusion. Compared with the lean controls the obese subjects showed a greater area under the curve of blood glucose after the glucose load (P less than 0.025) and higher insulin and glucagon levels both before and after the meal (P less than 0.05), thus indicating the well-known insulin insensitivity of obese (but not diabetic) subjects with respect to glucose metabolism. After the glucose load the lean subjects showed a significant and sustained decrease in leucine oxidation (from 20.0 +/- 2.2 to 13.3 +/- 1.5 mumol/kg LBM/h: P less than 0.01). This response is similar to that observed when insulin-dependent diabetic subjects are given insulin. However the obese subjects showed no decrease in leucine oxidation after the glucose meal (20.3 +/- 1.9 before, and 21.2 +/- 3.6 after). This indicates that obese subjects show insensitivity to the action of insulin with respect to protein metabolism as well as carbohydrate metabolism.

Administration, Oral↗
PubMed1987

Treatment of morbid obesity by nonsurgical means: diet, drugs, behavior modification, exercise.

Treatment of morbid obesity requires that the patient should achieve a negative energy balance of at least 350,000 kcal. Dietary treatment under metabolic ward control in time achieves any desired weight loss, but few morbidly obese patients can maintain dietary restriction for long enough as outpatients. The objective of both surgical and nonsurgical treatments is, in effect, to encourage (or force) the patient to diet. Drug treatment and exercise are ineffective in long-term massive obesity, but behavior therapy or jaw-wiring followed by the fitting of a waist cord can achieve worthwhile weight loss maintained for 3 years of follow-up.

Behavior Therapy↗
PubMed1987

Morbid obesity: medical or surgical treatment? The case for medical treatment.

We should ask about any therapy: (1) is it safe? and (2) is it effective? The best therapy is that which has the greatest chance to do good with the least chance to cause harm. Medical treatment is certainly safer than surgery, since (by my definition) surgery always involves a general anaesthetic, and morbidly obese patients are bad anaesthetic risks. Obesity also increases other surgical risks, so all published series of surgically-treated obese patients report some mortality. Surgeons will claim that surgery is much more effective than medical treatment, which has negligible success in morbid obesity. However all surgical bypass or banding procedures cause weight loss by restricting food intake, so if food intake can be equally restricted without surgery the results are just as good. In our experience jaw-wiring (which does not require a general anaesthetic) produces similar weight loss to gastroplasty. However the most difficult problem in morbid obesity is the maintenance of reduced weight many years after treatment. We have too few good long-term follow-up data after either medical or surgical treatment, but about half our patients treated with jaw-wiring and a waist cord maintain their weight loss on 3 years follow-up, zero mortality from the procedure. The results of surgical and medical treatments depend on the skill and care with which they are applied, and the way in which patients are selected. If patients are given treatment B if they are considered unsuitable for treatment A then the results from treatment A will be better.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Effect of diet on energy expenditure and plasma norepinephrine in lean and obese Pima Indians.

To assess whether thermogenesis or sympathetic nervous system (SNS) function might differ between lean and obese human subjects, studies of thermic and sympathetic responses to standard stimuli were undertaken in Pima Indians, an ethnic group with a high prevalence of obesity. Plasma levels of norepinephrine (NE) and energy expenditure at rest and in response to feeding, exercise, and graded infusions of NE were compared in five lean and five obese Indians during a period of weight maintenance (WM), after 3 weeks of overfeeding (OF) and, in the obese, also after 6 weeks of underfeeding (UF). Basal energy expenditure, when adjusted for fat free mass, was equivalent during WM and increased 3% with OF (P less than 0.01) in both groups. Thermic responses to exercise or a test meal did not differ in lean and obese and did not change with OF, while thermic responses to NE infusion fell during OF to a greater degree in obese than lean (P less than 0.05). A similar pattern (decreased effect in obese with OF) was also noted in the glycemic response to infused NE (P less than 0.05). Although not quantitatively different in lean and obese, the plasma NE concentration appeared to vary more in response to feeding or dietary alteration in the obese than lean, a finding that may reflect lower plasma clearance of NE in the obese. These studies, therefore, raise the possibility that overfeeding in obese Pima Indians may limit the contribution of sympathetically mediated thermogenesis to energy expenditure, though the implications of this for body weight regulation are speculative.

Adolescent↗
PubMed1986

Effect of impaired glucose tolerance and type II diabetes on resting metabolic rate and thermic response to a glucose meal in obese women.

We examined the hypothesis that patients with impaired glucose tolerance or type II diabetes mellitus have reduced glucose-induced thermogenesis and that this perpetuates obesity in them by reducing energy expenditure. The thermic response after a 75-g glucose meal for 150 minutes was significantly lower in five obese women with diabetes (7.18 +/- 1.8 kcal) and five other obese women with impaired glucose tolerance (6.4 +/- 0.8 kcal) than in five obese women with normal glucose tolerance (16.7 +/- 2.4 kcal) and five lean healthy control subjects (14.0 +/- 2.2 kcal, P less than 0.05). However, obese women with diabetes or impaired glucose tolerance had a significantly higher resting metabolic rate (RMR) (307.0 +/- 9.7 mL O2/min) than predicted for them on the basis of their age, body weight, and total body potassium (274.8 +/- 8.0 mL O2/min, p less than 0.01). The predicted RMR in obese women with normal glucose tolerance test (GTT) (286.0 +/- 5.0 mL O2/min) was not different from their observed RMR (272.0 +/- 6.0). Thus the total energy expenditure during the meal of obese women with diabetes (254 +/- 32 kcal/150 min) and obese women with impaired glucose tolerance (221 +/- 5 kcal/150 min) was higher than that of obese women with normal glucose tolerance (201 +/- 9 kcal/150 min). All three obese groups had a higher total energy expenditure than the lean group (158 +/- 4 kcal/150 min, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Description of a human direct calorimeter, with a note on the energy cost of clerical work.

1. A heat-sink calorimeter, suitable for the measurement of energy expenditure in human subjects over periods up to 26 h, is described. 2. The performance of the calorimeter is illustrated by a study of four normal subjects at rest or performing clerical work for a period of 7.5 h. Each condition was measured in duplicate in each subject. On the resting days the subjects were recumbent, and on the working days they were seated throughout the measurement period. Heart rate was monitored by infra-red telemetry and physical activity by an ultrasound movement detector. Urinary cortisol excretion was also measured as an indicator of stress. 3. In each subject the mean heat loss on working days was higher than that on resting days: the increase ranged from 5.1% to 16.7%, with a mean value of 10.0% (P = 0.015). There was no significant difference between resting and working days in heart rate, physical activity or urinary cortisol excretion. 4. The present study confirms that tiring clerical work has very little effect on 24 h energy expenditure.

Adult↗
PubMed1986

Effect of exercise on obesity.

The changes in fitness and body composition which accompany physical training in people of normal weight would be very valuable in the treatment of obesity. However, one of the most marked disabilities arising from obesity is a reduced exercise tolerance, so severely obese patients are unable to perform the exercise which would bring these benefits. It has been suggested that exercise may confer benefits on the obese person by reducing voluntary food intake, or by causing a prolonged elevation of metabolic rate. There is no good evidence for these claims. Obesity is best treated by a combination of dietary restriction and exercise: the more severe the obesity the more important the diet component of treatment, but exercise becomes more important with the management of mild obesity or the prevention of obesity.

Adult↗
PubMed1986

Chronic effects of over- and under-nutrition on thermogenesis.

This paper reviews the evidence on the magnitude of the changes in energy expenditure during over- and underfeeding periods. It is of interest to know whether these changes can be explained by the predicted effects of the extra feed (or the missing feed) on dietary-induced thermogenesis (DIT) and the effects of changes in body composition and resting metabolic rate. Chronic overfeeding of both lean and obese subjects result in an increase in thermogenesis to a similar extent according to several studies. This increase is probably greater than it can be explained by a simple effect of DIT and the underlying mechanisms remain obscure. Underfeeding causes marked decrease in metabolic rate, and the lowering of thermogenesis is explained by the effect of prolonged underfeeding on body composition, particularly by the decrease in fat-free mass.

Body Weight↗
PubMed1986

A computer-controlled indirect calorimeter for the measurement of energy expenditure in one or two subjects simultaneously.

An indirect calorimeter is described with which it is possible to make recordings of oxygen uptake, carbon dioxide production and respiratory quotient in one or two subjects simultaneously. The gas analysers sample expired air from the two patients and room air in a continuous cycle which lasts 15 min; a microcomputer is used to switch solenoid valves, read the gas analysers and output the results to a printer. A butane lamp is described which is made from components of a camping cooker. This can be used to simulate two patients, and enables the operator to check the function of the calorimeter quickly and inexpensively. If there is an error in the system the printout indicates whether the fault is likely to be a leak or an error in a gas analyser.

Calorimetry↗
PubMed1985

Losing fat.

Explore the source record for details and available documents.

Adipose Tissue↗
PubMed1985

Are pre-obese people energy thrifty?

Metabolic rate and fat-free mass tend to be higher in obese people than in lean people. It has been suggested that pre-obese people have a low metabolic rate and only acquire their high metabolic rate from the storage of lean tissue which they gain while becoming obese. To test this hypothesis resting metabolic rate was related to percentage fat, with fat-free mass held constant, in 104 women with body fat ranging from 6% to 60% of body-weight. Results showed that the greater the percentage fat, the greater the metabolic rate. It is difficult to believe that fat people with a high metabolic rate relative to fat-free mass once had a low metabolic rate.

Adipose Tissue↗