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PubMedDate not supplied

[Meal replacement as a dietary therapy for weight control. Assessment in males and females with different degrees of obesity].

Obesity is a metabolic disorder characterized by an increase in the fat in adipose tissue above certain limits, manifested by morphological alterations and excess weight. This condition is one of the most significant epidemics of this century due to over-eating and the ease of access to food. On the other hand, the direct relationship between obesity and the greater risk of suffering cardiovascular disease, diabetes or cancer means that consumers are demanding products, whether medicines or foodstuffs, that will allow them to overcome this situation and improve both their physical appearance and their health. The goal of this project was to identify the efficacy and safety of a dietary product, a meal replacement, within the setting of a balanced hypocaloric diet established for weight loss. To this end, a total of 47 volunteers of both sexes between the ages of 23 and 58, all employees of the Hero España, S.A. company, took part in a test in which eleven of them acted as the "control group" and ate only the low-calorie diet while the rest formed a "problem group" and replaced one meal (with a minimum of 500 calories) with a 200-calorie meal replacement. Participants were subjected to anthropometric measurements, blood pressure testing and a blood chemistry analysis before and after the test period, as well as to weekly weight checks. Those individuals with the highest Body Mass Index showed a greater weight loss than those with a lower index. The volunteers did not note any hunger pangs until three hours after consumption of the meal replacement and the health-status parameters analyzed did not show any anomalous values. Therefore, it is concluded that the replacement product studied allows controlled weight loss over 3 weeks when accompanied by a balanced low-calorie diet and it also produces a sensation of fullness in those consuming it.

Adult↗
PubMed1993

Exercise and weight control.

Several important questions need to be answered to increase the likelihood that exercise will be accepted by the millions in the population who are obese. What is the minimum exercise "dose" (intensity, duration, frequency) and what is the optimal mode to bring about substantial fat weight loss, with minimal loss of lean mass? What is the best nutritional plan to optimize fat utilization during exercise, without impairing performance or loss of lean mass? Which diet and exercise programs maximally increase utilization of centrally deposited fat and how can hyperplastic obesity best be treated? Also of interest is the potential role of resistance exercise for weight loss, and the predictors of weight loss success. For instance, do individuals with gynoid obesity really differ from individuals with android obesity in their utilization and loss of body fat during exercise? The potential advantages of exercise include: stimulation of fat as opposed to carbohydrate oxidation; increased energy use during the exercise itself and in the postexercise period; protection of lean body mass; possible reversal of the diet-induced suppression of BMR; and other health benefits. Among other parameters, the effectiveness of exercise on weight loss may be influenced by the type, intensity, frequency, and duration of exercise bouts and the duration of the training program, the nature of the excess fat stores, i.e., whether the person has obesity characterized by hyperplastic or hypertrophic adipose tissue or central (with large-intra-abdominal depot) or peripheral obesity, the composition and caloric content of the diet, and behavioral aspects that affect adherence to the program. With respect to this latter concern, even if a person has been very successful at weight loss in a metabolic ward or intensive program, he/she must eventually return to the outside world and figure out for himself/herself how to eat real food and/or maintain an activity level that promotes weight maintenance. Because diet and exercise habits are difficult to assess and to quantify in free-living populations, it continues to be difficult to evaluate the success of diet and/or exercise prescriptions for weight loss accurately and we continue to be plagued with questions regarding the effectiveness vs. efficacy of exercise as a means to control body weight. It would seem that the wide range of health benefits derived from regular exercise would justify emphasizing increased activity for inactive people, particularly for obese, sedentary individuals, whether or not ideal body weight or significant weight loss is achieved.

Adipose Tissue↗
PubMed1992

Long-term weight control in obese children: persistence of treatment outcome and metabolic changes.

Maintenance of achieved weight loss and clinical and biochemical changes were studied in 48 obese children (relative weight greater than 120%) over a three-year period after active treatment for one year and initial observation for another year. The control group comprised 29 normal weight children (relative weight less than 120%). The children were 6-16 years old at the beginning of the study. The successful weight loser was defined as a child with a decrease of at least 10% in relative weight at the end of the initial two year study period. Twenty-two subjects (49%) were treated successfully while 23 children were unsuccessful. Three obese children dropped out of the study. In successful children the relative body weight decreased by 24.7% (P less than 0.001) during the initial two-year period, and the lower body weight was maintained during the subsequent observation. The relative height also decreased significantly in the successful subjects but was still normal at the end of the study. Success in weight reduction was associated with increased HDL-cholesterol (HDL-C) levels, increased ratio of HDL-C to total cholesterol and reduced concentrations of triglyceride and plasma insulin. All of these changes were maintained throughout the five year study period. In normal weight children concentrations of serum lipids and plasma insulin remained unchanged during the five years. In conclusion, initial success in weight loss was associated with long-term favourable changes in the serum lipid profile and reduced hyperinsulinemia. A majority of the initially successful weight losers (14 of 22) managed to maintain their reduced weight up to five years.

Adipose Tissue↗
PubMed1998

Long-term beneficial effects of a gastric reservoir on weight control after total gastrectomy: a study of potential mechanisms.

BACKGROUND: Weight loss after total gastrectomy is a regular occurrence. Reconstruction with a gastric substitute has been suggested to facilitate recovery, but few randomized studies are available. METHODS: In a randomized study comparing subtotal, total and total gastrectomy with an S-shaped pouch, 36 patients who had total gastrectomy with or without a pouch survived for more than 3 (mean 5.2) years. Body composition (four-chamber model, dual-energy X-ray absorptiometry, anthropometric data) was evaluated before operation, after 12 months and at long-term follow-up. Food intake was registered as a 4-day food record at 12 months and at long-term follow-up. RESULTS: At long-term follow-up those allocated to the gastric substitute arm had lesser degrees of weight loss consisting mainly of the depletion of body fat stores, whereas lean body mass showed no significant decrease when adjusted for the process of ageing. There was no significant difference in food intake. CONCLUSION: Reconstruction with an S-shaped gastric substitute facilitates long-term recovery after total gastrectomy and should be considered when the prognosis is favourable.

Anastomosis, Roux-en-Y↗
PubMed1988

Weight-control approaches: a review by the California Dietetic Association.

Weight reduction is considered a therapeutic success if weight loss is maintained with no expense to overall health. The California Dietetic Association, a professional organization including 5,000 registered dietitians, proposes, on the basis of a review of the current scientific literature, the following criteria for health-safety evaluation of dietary approaches. A weight-reduction diet should (a) satisfy all nutrient needs except energy, (b) meet individual tastes and habits, (c) minimize hunger and fatigue, (d) be readily obtainable and socially acceptable, (e) favor the establishment of a changed eating pattern, and (f) be conducive to improvement of overall health. Characteristics of diet approaches associated with poor outcome include (a) very-low-calorie diets, which promote rapid weight loss, (b) extremes of macronutrient restriction, and (c) reliance on formula diets or special products. The use of diets, surgery, drugs, exercise, and behavior modification is discussed.

Body Weight↗
PubMed1997

Weight control and nutrition: knowing when to intervene.

The average weight of American adults is increasing, despite vast sums being spent on attempts at weight loss. Above-average weight in midlife is associated with increased morbidity and mortality as patients age. Nonetheless, there is confusion about what are "desirable" weight levels. Commonly-used actuarial tables do not account for the modest, normal weight gains seen at midlife; therefore, age-adjusted tables are recommended. Treatment of obesity, one of the most common malnutrition disorders, is difficult, requires a "chronic disease" approach, and should be considered in the context of other risks to health.

Aged↗
PubMed1999

The impact of a shipboard weight control program.

OBJECTIVE: The specific aim was to determine whether a multifaceted approach to weight loss and physical readiness could be implemented onboard a deployed combatant ship of the U.S. Navy. RESEARCH METHODS AND PROCEDURES: Thirty-nine men (31+/-6 years old, mean+/-standard deviation) assigned to the USS ENTERPRISE (CVN 65) during a 6-month Mediterranean deployment who had failed their previous Physical Readiness Test due to excessive body weight (108+/-11 kg overweight) were randomly assigned to nutrition, cognitive-behavioral obesity treatment plus exercise or to the Navy's usual treatment (control), which is exercise alone. RESULTS: Outcomes for the treatment group were significantly better than the controls, with 8.6+/-5.0 vs. 5.0+/-4.1 kg weight loss, 8% vs. 5% reduction in original body weight, and body fat loss of 7% vs. 5%. Triglycerides declined significantly greater in the treatment group than the controls (145 mg/dL to 109 mg/dL vs. 146 mg/dL to 145 mg/dL, p<0.05), whereas depression and eating behaviors significantly improved among treated men. Problematic environmental factors were the limited variety of heart healthy foods in the galley, short meal breaks, and long mess hall lines that led to eating snacks from vending machines and frequent port calls. DISCUSSION: Although greater weight loss than would be expected of a Navy usual care group diluted the treatment effect, the treated men still fared significantly better. The physical readiness implication of this research has the potential to impact Navy health promotion programs and policy, the health and well-being of its personnel, and the Navy's ability to meet mission requirements.

Absorptiometry, Photon↗
PubMed1992

Body weight evolution during dexfenfluramine treatment after initial weight control.

While very low calorie diets (VLCD) can lead to rapid weight loss, even in patients who have often failed with conventional diets, maintaining this loss remains a clinical challenge. Since dietary re-education or more formal behaviour modification techniques are not easily applicable to large numbers of patients and are not always successful, drugs to maintain and improve upon initial VLCD success would be of clinical benefit. Pharmacological treatment of obesity has evolved in recent years with the development and licensing of potent serotonin agonists, such as dexfenfluramine (D-F). VLCD followed by D-F has been shown to be effective. A double-blind trial randomized 45 patients who had successfully completed eight weeks' VLCD treatment, to either placebo or D-F 15 mg b.d. for 26 weeks. Patients continued on a diet giving 60-75% of daily energy needs. Patients treated with D-F had lost 14.9 +/- 0.9 kg on the Cambridge diet and a further 5.8 +/- 1.8 kg during the drug treatment. In contrast, patients who received placebo regained 2.9 +/- 1.3 kg of the 13.5 +/- 1.0 kg they had lost during VLCD. The total weight loss after 34 weeks in total was thus 21.3 +/- 2.6 versus 11.3 +/- 1.9 kg. Patients were offered the option of continuing on D-F, or switching from placebo, in an open continuation of the trial. Ten patients, regaining weight on placebo, stabilized their weight without further regain over the next 24 weeks when switched to D-F.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Weighing the evidence: benefits of regular weight monitoring for weight control.

We address the assertion that weighing obese patients in weight loss programs can be a source of distress and can lead to unfavorable outcomes. Examination of the relevant literature suggests that there is no evidence that weighing by weight loss participants is a cause of negative mood or of body dissatisfaction. Further, there is little evidence that negative mood states or body dissatisfaction lead to a poor outcome in weight loss programs. To the contrary, a number of studies consistently show that more frequent weighing is associated with better weight loss and maintenance. We offer suggestions for dealing with this issue in clinical practice.

Body Weight↗
PubMed1994

Vertical Banded Gastroplasty: Stable Trends in Weight Control at 10 or More Years.

Whether long-term weight loss outcomes will succumb to adaptations in patients after gastric restrictive procedures has yet to be determined. The relationship, if any, of post-operative weight loss and maintenance to follow-up by support group and/or by surgeon, at least long-term, is uncertain. These questions have prompted review of my patients at 10-12 and at 5-10 years after vertical banded gastroplasty (VBG). Of the 118 patients (43 at 10-12 years), 65 were able to be contacted (55%). Successes were defined as patients who at the time of study interview, without operative revision, had lost at least 25% of their pre-operative excess weight. All known revisions (7) are reported as failures; only one of the seven was discovered in the study interviews. The mean body mass index of the entire study group (65) pre-operatively was 49.7, with 32% (21/65) super obese. Patient pre-operative profiles of successes and failures of both interval groups are remarkably similar. Successes were 65% in the >/= 10 year group and 68% in the 5-10 year group. Respectively, mean percent excess weight loss was 46% and 54%. Six (of seven) failures, and ten (of 13) successes, in the >/= 10 year group had 5.5 cm circumference outlets; all patients in the 5-10 year group were at 5.0 cm. Marked reduction in the follow-up pattern in the 5-10 year group failures was not significant but appears predictive. This experience suggests little deterioration in success rate, weight loss among successes, or revision requirement in VBG patients between 5 and > 10 years.

Journal Article↗
PubMed1988

Exercise in a behavioural weight control programme for obese patients with Type 2 (non-insulin-dependent) diabetes.

Two studies were conducted to determine whether adding exercise to a diet programme promotes weight loss or glycaemic control in Type 2 (non-insulin-dependent) diabetic subjects. In Study 1, 25 subjects were randomly assigned to diet plus moderate exercise or diet plus placebo exercise. All subjects exercised twice a week as a group and once a week on their own; the diet plus moderate exercise group walked a 3-mile route at each session while the diet plus placebo exercise group did very low intensity exercises such as stretching and light calisthenics. All subjects followed a calorie-counting diet and were taught behaviour modification strategies. Weight losses and improvements in glycaemic control did not differ significantly between the two treatment groups at the end of the 10-week treatment or at 1-year follow-up. In Study 2, more extreme conditions were compared: a diet only group and a diet plus exercise group. The diet plus exercise group walked a 3-mile route with the group 3 times/week and once a week on their own, while the diet only group was instructed to maintain their current low level of activity. Both groups received comparable diet and behaviour modification instruction and therapist contacts. The diet plus exercise group had significantly (p less than 0.01) better weight losses than the diet only condition at the end of the 10 week programme (-9.3 kg vs -5.6 kg) and at 1 year follow-up (-7.9 kg vs -3.8 kg).(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMed2000

The role of low-fat diets in body weight control: a meta-analysis of ad libitum dietary intervention studies.

OBJECTIVES: Low-fat high-carbohydrate diets are recommended to prevent weight gain in normal weight subjects and reduce body weight in overweight and obese. However, their efficacy is controversial. We evaluated the efficacy of ad libitum low-fat diets in reducing body weight in non-diabetic individuals from the results of intervention trials. DESIGN: Studies were identified from a computerized search of the Medline database from January 1966 to July 1999 and other sources. Inclusion criteria were: controlled trials lasting more than 2 months comparing ad libitum low-fat diets as the sole intervention with a control group consuming habitual diet or a medium-fat diet ad libitum. MAIN OUTCOME MEASURES: Differences in changes in dietary fat intake, energy intake and body weight. Weighted mean differences for continuous data and 95% confidence intervals (CIs) were calculated. RESULTS: Two authors independently selected the studies meeting the inclusion criteria and extracted data from 16 trials (duration of 2-12 months) with 19 intervention groups, enrolling 1910 individuals. Fourteen were randomized. Weight loss was not the primary aim in 11 studies. Before the interventions the mean proportions of dietary energy from fat in the studies were 37.7% (95% CI, 36.9-38.5) in the low-fat groups, and 37.4% (36.4-38.4) in the control groups. The low-fat intervention produced a mean fat reduction of 10.2% (8.1-12.3). Low-fat intervention groups showed a greater weight loss than control groups (3.2 kg, 95% confidence interval 1.9-4.5 kg; P < 0.0001), and a greater reduction in energy intake (1 138 kJ/day, 95% confidence interval 564-1712 kJ/day, P = 0.002). Having a body weight 10 kg higher than the average pre-treatment body weight was associated with a 2.6 +/- 0.8 kg (P = 0.011) greater difference in weight loss. CONCLUSION: A reduction in dietary fat without intentional restriction of energy intake causes weight loss, which is more substantial in heavier subjects.

Body Weight↗
PubMed1997

Weight loss is greater with consumption of large morning meals and fat-free mass is preserved with large evening meals in women on a controlled weight reduction regimen.

The purpose of this study was to determine whether meal ingestion pattern [large morning meals (AM) vs. large evening meals (PM)] affects changes in body weight, body composition or energy utilization during weight loss. Ten women completed a metabolic ward study of 3-wk weight stabilization followed by 12 wk of weight loss with a moderately energy restricted diet [mean energy intake +/- SD = 107 +/- 6 kJ/(kg.d)] and regular exercise. The weight loss phase was divided into two 6-wk periods. During period 1, 70% of daily energy intake was taken as two meals in the AM (n = 4) or in the PM (n = 6). Subjects crossed over to the alternate meal time in period 2. Both weight loss and fat-free mass loss were greater with the AM than the PM meal pattern: 3.90 +/- 0.19 vs. 3.27 +/- 0.26 kg/6 wk, P < 0.05, and 1.28 +/- 0.14 vs. 0.25 +/- 0.16 kg/6 wk, P < 0.001, respectively. Change in fat mass and loss of body energy were affected by order of meal pattern ingestion. The PM pattern resulted in greater loss of fat mass in period 1 (P < 0.01) but not in period 2. Likewise, resting mid-afternoon fat oxidation rate was higher with the PM pattern in period 1 (P < 0.05) but not in period 2, corresponding with the fat mass changes. To conclude, ingestion of larger AM meals resulted in slightly greater weight loss, but ingestion of larger PM meals resulted in better maintenance of fat-free mass. Thus, incorporation of larger PM meals in a weight loss regimen may be important in minimizing the loss of fat-free mass.

Adipose Tissue↗