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PubMed1991

The cost-effectiveness of work-site wellness programs for hypertension control, weight loss, and smoking cessation.

The cost-effectiveness of work-site wellness programs for reducing cardiovascular disease risks of employees was examined at three manufacturing plants. A fourth plant was used as a control site to estimate levels of risk reduction achieved from wellness screening and preexisting services, without further interventions. The cardiovascular disease risks included in the study were hypertension, obesity, and cigarette smoking. The annual direct cost per employee for postscreening interventions was $2.97 for site 1 (control site), $17.68 for site 2 (health education), $30.96 for site 3 (health education plus follow-up counseling), and $38.31 for site 4 (health education, follow-up counseling plus plant organization for health promotion). Of the three experimental sites, sites 3 and 4 were more effective and more cost-effective than was site 2, both in terms of engaging employees at risk of cardiovascular disease into treatment or program participation and of reducing their risks or preventing relapse. For engaging employees into treatment/program participation, sites 3 and 4 were nine to ten times more cost-effective than was site 2; for reducing risks/preventing relapse, sites 3 and 4 were five to six times more cost-effective than was site 2. At sites 3 and 4, the total direct cost per percent of risks reduced/relapse prevented was less than one dollar ($.67 and $.74, respectively) per employee per year. Program costs may vary considerably across companies because of differences in salary structures and overhead costs. These are held constant in this report for comparison across program models.

Adult↗
PubMed1992

Long-term weight control study. IV (weeks 156 to 190). The second double-blind phase.

To assess continued efficacy of anorexiants after 3 years of use, 52 participants (43% of those starting) entered a second double-blind trial to compare 60 mg sustained-release fenfluramine plus 15 mg phentermine resin versus placebo added to behavior modification, caloric restriction, and exercise. Although participants in both the active medication and placebo groups gained weight, participants receiving fenfluramine plus phentermine (n = 27) gained significantly (p less than 0.01) less (4.4 +/- 0.5 kg or 5.3% +/- 0.5% of initial weight) than participants receiving placebo (n = 24) (6.9 +/- 0.8 kg or 8.5% +/- 1.1% of initial weight). At week 190, both groups were still below their initial weight (fenfluramine plus phentermine group, 5.0 +/- 1.4 kg; placebo group, 2.1 +/- 1.2 kg; p less than 0.01). Overall, 12 participants (23.5% of those still in the study) were greater than or equal to 10% below initial weight. One participant dropped out during this phase because of personal reasons and loss of medication efficacy. During the 30 weeks, participants receiving fenfluramine plus phentermine had 26 moderate or severe complaints versus eight participants receiving placebo. Fenfluramine plus phentermine provided better appetite control and only slightly more bother. Analysis of participant response in this phase by treatment assignment in the first double-blind phase (weeks 6 to 34) indicated that initial receipt of medication did not have negative learning effects. Eleven participants receiving active medication between weeks 6 and 34 and receiving placebo between weeks 160 to 190 gained 5.1 +/- 1.0 kg. In contrast, 13 participants originally taking placebo gained 8.3 +/- 9 kg in this second double-blind phase.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

The usefulness of dietary medium-chain triglycerides in body weight control: fact or fancy?

Compared to long-chain triglycerides (LCT), medium-chain triglycerides (MCT) display some specific physico-chemical, and biological characteristics. Thus, MCT are currently used in clinical nutrition as energy-yielding substrates, and have been advocated for three decades as a useful mean for body weight reduction. This review encompasses most aspects of MCT metabolism arguing this slimming hypothesis pro and con. Findings in support of the opinion (lower energy density, control of satiety, rapid intrahepatic delivery and oxidation rates, poor adipose tissue incorporation) may be invalidated by counteracting data (stimulation of insulin secretion and of anabolic-related processes, increased de novo fatty acid synthesis, induced hypertriglyceridemia). The balance between these two opposing influences depends on the composition (energy intake, nature of ingredients, MCT/LCT ratio, octanoate/decanoate ratio) and duration of the regimen. Due to the high energy level (around 50%) of MCT necessary to achieve body weight loss, long-term compliance to such slimming regimens is unlikely in human nutrition.

Adipose Tissue↗
PubMed1990

Does emotional eating interfere with success in attempts at weight control?

Questionnaire responses from a convenience sample were used to test for hypothesized relationships between changes over time in individuals' reported frequency of emotional eating and estimates of their success in attempts to reduce body weight over periods of at least 1 year. Respondents were 187 English adults, whose distribution of estimated Body Mass Indices (BMI) approximately that of the general population. Initial BMI was significantly (p less than 0.001) positively associated with reported frequency of emotional eating. Moreover, respondents indicating initially relatively high levels of emotional eating who reported a reduction in that level were found to lose significantly (p less than 0.01) more reported weight and to be significantly (p less than 0.05) more successful at approaching target weight over the period of the study than respondents who continued to report high levels of emotional eating. Similarly, respondents who reported an increase from initially relatively low levels of emotional eating, while not losing significantly less reported weight, were significantly (p less than 0.05) less successful at approaching target weight than those respondents who continued to report low levels of emotional eating.

Adult↗
PubMed2004

Weight control measures among university students in a developing country: a cultural association or a risk behavior.

OBJECTIVE: The purpose of the study was to determine the prevalence of university students, in Lebanon, trying to lose weight and assess the relation of trying to lose weight with demographic, scholastic and health behavioral factors. METHODS: The study was cross-sectional conducted in the academic year 2000-2001. A proportionate random sample of 2,013 students was selected among five public and private universities in Beirut. Participants completed a self-administered anonymous questionnaire that included questions on trying to lose weight, demographic, scholastic, and health behavioral factors including smoking, alcohol, and seat belt use. Bivariate and stepwise logistic regression analyses were performed to examine the association between trying to lose weight and the above-mentioned characteristics. RESULTS: The overall prevalence of students trying to lose weight was 30%, with 71% of them being under weight or normal weight. Use of medications and inducement of vomiting constituted 12% and 11%, respectively. Stepwise logistic regression analysis showed that the variables significantly associated with trying to lose weight were socio-economical factors rather than risky behaviors. Students who were at increased odds of performing such methods were females OR = (2.08, 95% CI = 1.6-2.5), employed (OR = 1.36, 95% CI = 1.01-1.8), and registered in a private university (OR = 1.69, 95% CI = 1.25-2.0). The major of students was also a significant predictor. CONCLUSION: In Lebanon, weight reduction could be re-enforced by socio-economical factors and not necessarily be an adolescent risk behavior.

Adult↗
PubMed1976

Chorionic gonadotropin in weight control. A double-blind crossover study.

Two hundred two patients participated in a double-blind random cross-over study of the effectiveness of human chorionic gonadotropin (HCG) vs placebo in a wieght reduction program. Serial measurements were made of weight, skin-fold thickness, dropout rates, reasons for dropping out, and patient subjective response. There was no statistically significant difference between those receiving HCG vs placebo during any phase of this study (P greater than .1).

Adult↗
PubMed1990

Management strategies for weight control. Eating, exercise and behaviour.

Obesity is a major health and social problem worldwide for which no single satisfactory treatment exists. Because of the prevalence of the disease, numerous therapeutic strategies have been attempted--often unsuccessfully. Weight loss programmes based on dietary restriction of caloric intake and nutritional education, exercise, surgical (gastroplasty, gastric bypass) and procedural (gastric balloon, waist cord, jaw wiring, liposuction) intervention and pharmacotherapy (appetite suppressants, thermogenic agents, bulking agents) used alone or in combination, have produced weight loss in the short to medium term; however, weight is generally regained on discontinuation of treatment. Behaviour modification programmes appear to offer the highest success rate in the long term. Weight loss is not rapid, although losses of 10 to 15 kg have been achieved after 6 months, and this may be increased when behaviour modification therapy is combined with more aggressive treatments such as severe caloric restriction or jaw wiring. Behaviour modification is particularly beneficial in special patient groups such as the obese elderly, children or adolescents, and disabled patients. Thus, although it appears that each of the treatments developed for the management of obese patients has its place, the cornerstone of therapy for most patients remains a programme of dietary restriction, combined with exercise and behaviour modification.

Behavior Therapy↗
PubMed2001

Is family-based behavioral weight control appropriate for severe pediatric obesity?

OBJECTIVE: Although the efficacy of family-based behavioral treatment for moderate pediatric obesity has been well established, few studies have focused on the treatment of severe obesity. We sought to evaluate the acceptability and feasibility of a family-based intervention for severely obese children. METHOD: Twenty-four families with children aged 8-12 years who were > or =160% of their ideal body weight participated in a 10-12-session behavioral intervention. Participants were weighed and their heights measured at the start of each treatment session and during a follow-up visit 4-13 (M = 7.8) months posttreatment. Children also completed measures of depressive symptoms and anxiety at pretreatment, posttreatment, and follow-up, and eating attitudes were assessed at pretreatment and follow-up. RESULTS: One third of the families did not complete treatment. However, children who completed the program lost a significant amount of weight and reported significant improvements in depression, anxiety, and eating attitudes that were maintained over time. DISCUSSION: A short-term, family-based behavioral intervention was successful in moderating weight gain for most children and had positive effects on children's mood and eating disorder symptoms. Future randomized, controlled trials of longer interventions are necessary to determine the success of this approach.

Adult↗
PubMed1991

Weight control and exercise.

Obesity in the United States can truly be called a national epidemic. The associated health risks and diseases present a tremendous drain to the economy. The most effective program to lose and maintain a desirable body weight incorporates a combination of restriction in caloric intake with an increase in caloric expenditure through exercise. A gradual approach of losing 1 or 2 pounds per week has proved to be the most effective. Men should strive to maintain approximately 15% body fat and women 25% body fat. Weight-reduction programs that demonstrate phenomenal weight loss in a short period will not work over the long term and may represent a significant health risk. The ability to lose fat and maintain a desirable body weight is not easy but can be attained through a firm commitment to a healthy life style.

Adipose Tissue↗
PubMed1996

Effects of meal frequency on body composition during weight control in boxers.

The effects of meal frequency on changes in body composition by food restriction were investigated. Twelve boxers were divided between a two meals day-1 group (the 2M group) and a six meals day-1 group (the 6M group). Both groups ingested 5.02 MJ (1200 kcal) day-1 for 2 weeks. Although there was no difference in change of body weight by food restriction between the two groups, the decrease in lean body mass (LBM) was significantly greater in the 2M group than in the 6M group. The decrease in urinary 3-methylhistidine/creatinine was significantly greater in the 6M group than in the 2M group. These results suggest that the lower frequency of meal intake leads to a greater myoprotein catabolism even if the same diet is consumed.

Adult↗
PubMed1992

Long-term weight control study. II (weeks 34 to 104). An open-label study of continuous fenfluramine plus phentermine versus targeted intermittent medication as adjuncts to behavior modification, caloric restriction, and exercise.

Between weeks 34 and 104, we explored different schema for administering fenfluramine plus phentermine in open-label fashion. At week 34, the original placebo group participants began taking fenfluramine plus phentermine (placebo-to-active group). Those receiving fenfluramine plus phentermine between weeks 6 and 34 either continued to receive medication or began targeted intermittent therapy. Participants who did not lose 10% of initial weight received an augmented dose (60 mg fenfluramine plus 30 mg phentermine. The placebo-to-active group lost an additional 9.1 +/- 0.8 kg (mean +/- SEM) in the period from week 34 to week 60. At week 60, they were assigned to either continue medication, intermittent therapy, or augmented therapy. More than 68% (83) of the original participants completed up to study week 104. At that point, overall weight loss was 10.8 +/- 0.7 kg (11.6 +/- 0.8% of initial weight); participants who continued to receive fenfluramine plus phentermine lost 11.6 +/- 0.8 kg, participants receiving intermittent therapy lost 11.6 +/- 1.3 kg, and participants receiving augmented therapy lost 6.5 +/- 1.5 kg. Although 41% of the participants complained of dry mouth, neither serious adverse effects nor evidence of medication abuse appeared. There were 29 dropouts in the period from weeks 34 to 104. Sixteen of those were related to medication (adverse effects, lack of efficacy, and fear of medication). Overall, fenfluramine plus phentermine used in conjunction with behavior modification, caloric restriction, and exercise continued to be efficacious for up to 2 years.

Adult↗
PubMed2004

Management of nonalcoholic fatty liver disease: weight control.

With obesity reaching epidemic proportions in the United States, it is imperative that hepatologists have an understanding of the medical ramifications and methods of treatment. Evaluation of nonalcoholic fatty liver disease may get the patient into the office,but weight reduction may provide a therapeutic hurdle. This article provides an overview of current obesity treatment.

Appetite Depressants↗
PubMed2006

A physiological role of breast milk leptin in body weight control in developing infants.

OBJECTIVE: Leptin, a hormone that regulates food intake and energy metabolism, is present in breast milk. The aim of this study was to determine whether milk leptin concentration is correlated with maternal circulating leptin and BMI and with body weight gain of infants. RESEARCH METHODS AND PROCEDURES: A group of 28 non-obese women (BMI between 16.3 and 27.3 kg/m(2)) who breast-fed their infants for at least 6 months and their infants were studied. Venous blood and milk samples were obtained from mothers at 1, 3, 6, and 9 months of lactation, and leptin concentration was determined. Infant body weight and height were followed until 2 years of age. RESULTS: During the whole lactation period, milk leptin concentration correlated positively with maternal plasma leptin concentration and with maternal BMI. In addition, milk leptin concentration at 1 month of lactation was negatively correlated with infant BMI at 18 and 24 months of age. A better negative correlation was also found between log milk leptin concentration at 1 and at 3 months of lactation and infant BMI from 12 to 24 months of age. DISCUSSION: We concluded that, in a group of non-obese mothers, infant body weight during the first 2 years may be influenced by milk leptin concentration during the first stages of lactation. Thus, moderate milk-borne maternal leptin appears to provide moderate protection to infants from an excess of weight gain. These results seem to point out that milk leptin is an important factor that could explain, at least partially, the major risk of obesity of formula-fed infants with respect to breast-fed infants.

Adult↗