Effects of dietary fiber intake before meals on weight loss and hunger in a weight-reducing club

The effects of dietary fiber on subjective hunger ratings and weight losses were studied in 135 members of a weight loss club. After a run-in week, 100 members were randomly given one sachet of either bran or ispaghula granulate before meals for two weeks. Thirty-five controls only rated hunger. One hundred and eight members completed the trial: 23 controls, 45 on ispaghula and 40 on bran. No change in hunger ratings was found in the controls. Both fiber preparations lowered hunger ratings during weeks 2 and 3 compared to the run-in week. Ratings were similarly reduced at all meals. The mean (+/- SD) weight reductions during the trial were 4.6 +/- 2.7 kg for the controls, 4.2 +/- 3.2 kg for the ispaghula group and 4.6 +/- 2.3 kg for the bran group (p greater than 0.05 for all). In spite of recent changes in the diet towards food rich in dietary fibers, addition of extra dietary fiber immediately before meals reduced hunger feelings but had no effect on weight reduction.

Melatonin secretion related to side-effects of beta-blockers from the central nervous system

In two studies of hypertensive patients the relationship between beta-blocker-induced CNS side-effects and the nightly urinary secretion of melatonin was analysed. In one group (n = 10) placebo, atenolol (mean dose 86 mg/day) or propranolol (mean dose 305 mg/day) were given in a double-blind, randomised design. In the other (n = 13) 100-400 mg metoprolol was given daily (mean dose 197 mg). After 4 weeks of treatment all beta-blockers reduced melatonin excretion, but the effect was significant only for metoprolol. Sleep disturbance records revealed more disturbed nights in the metoprolol group compared with the propranolol and the atenolol groups, even when the difference in age between the groups was controlled for. In the metoprolol group a significant relationship (p less than 0.05) was found between the fall in melatonin and the percentage of disturbed nights. Severe CNS side-effects, such as nightmares, occurred only in patients treated with metoprolol (21%), which in all cases were accompanied by low levels of melatonin. Our data suggest that the CNS side-effects during beta-blockade are related to a reduction of melatonin levels.

Serum lipid and lipoprotein levels in long-term insulin-dependent diabetes mellitus. Relation to residual insulin secretion, microvascular lesions and environmental factors

The aim of the present study concerning patients with long-term insulin-dependent diabetes mellitus was to determine whether the serum lipid and lipoprotein concentrations differ in subjects with and without residual insulin secretion. We also investigated whether factors such as sex, smoking, physical activity and microvascular lesions were associated with particular lipoprotein profiles. C-peptide excretion (greater than or equal to 0.2 nmol) in 24-hour urine samples was used as an indicator of residual insulin secretion. Twenty-two pairs of patients with and without residual insulin secretion matched for age at onset and disease duration were participating in the investigations of glycaemic control and microvascular lesions. The HbA1c was significantly lower in C-peptide excretors than in the non-excretors (6.9 +/- 0.3 vs. 7.9 +/- 0.3%, p less than 0.025). The lipids and lipoprotein fractions were all within normal limits. The HDL2/3 ratio was significantly higher in C-peptide excretors than in non-excretors (1.72 +/- 0.28 vs. 1.10 +/- 0.09, p less than 0.05). Multiple regression analysis showed that factors, such as physical activity, body mass index and glycaemic control could explain more of the variation in the different lipid and lipoprotein fractions than residual C-peptide excretion alone. The only fraction correlating with C-peptide excretion was HDL3 cholesterol. It is concluded that minute residual insulin secretion per se is of minor importance for the regulation of lipids and lipoproteins. Glucose control and residual insulin secretion together with environmental factors seem to be of great importance for the regulation of the lipid and lipoprotein levels in insulin-dependent diabetes mellitus.

Three year's follow-up of members of a Swedish commercial weight-reducing club

The weight changes of 676 members of a commercial weight loosing club were analysed and a questionnaire was given to a subgroup of 150 participants. The median age at entry was 48 years. The Broca index (kg/cm - 100) ranged from 0.85 to 1.70. Only 15 males participated. The initiative to join the club came from the member herself in 59% of the cases; only 3% were referred by a physician. The drop-out frequency during an 8-week "Slim Club" course was 55%. Members who participated in more than 4 of the 8 weekly sessions had a mean weight loss of 6.2 kg (range 0.5 - 15). Members with higher initial weights lost more than those who were less overweight. The mean cost of each kg lost was about 40 Sw. cr./kg (approximately 9 US$). After 3 years, 367 members could be contacted for an interview. Their initial mean weight (+/- S. D.) was 76.1 +/- 9.8 kg. After the initial course the mean weight was 70.5 +/- 9.4 kg (p less than 0.001). Three years later the reported mean weight was 72.3 +/- 10.1 kg (p less than 0.001 versus initial weight). Thus even a short course may have significant long-term effects on weight loss. The weight-reducing club may therefore be a helpful tool in the treatment of overweight subjects.

Intravenous fat tolerance test with Intralipid in chronic renal failure

The intravenous fat tolerance test with Intralipid has been used to evaluate the triglyceride (TG) removal capacity in 34 male patients with varying degree of chronic renal failure (CRF). The investigations were repeated in 10 patients after 2-3 years when the renal function had deteriorated further. The fractional removal rate of Intralipid (k2) was low compared to controls, regardless of degree of renal function, etiology of renal disease or treatment with antihypertensive drugs. The k2 value did not change in patients investigated twice, although there was a considerable decrease in renal function. Both in patients and controls there was a strong negative correlation between k2 and the very low density lipoprotein (VLDL) TG concentration. However, at the same k2 value, the VLDL TG concentration was higher in patients than in controls. These data suggest that the hypertriglyceridemia commonly seen in patients with CRF is caused both by an increased VLDL production and a decreased VLDL removal from the circulation. Furthermore, these changes in TG metabolism are induced early in the course of renal insufficiency.

Long-term beta 1-selective adrenergic blockade and adrenergic receptors in human subcutaneous adipocytes

The influence of beta-adrenergic blockade with metoprolol, a beta 1-selective agent, on the adrenergic regulation of lipid mobilization was explored in subcutaneous adipocytes removed from 13 patients with essential hypertension. Treatment with metoprolol, which was associated with adequate beta-adrenergic blockade and an antihypertensive effect, resulted in a significant increase (p less than 0.05) in the binding of the beta-adrenergic antagonist (-)-(3H)-dihydroalprenolol and a 50% increase (p less than 0.01) in the maximum lipolytic response to the beta-adrenergic agonist isopropylnoradrenaline. In 7 patients with normotriglyceridaemia the total plasma triglyceride level increased significantly (p less than 0.025) during metoprolol treatment, a change that was due to an increase in the very low density lipoprotein triglycerides. The findings suggest that chronic treatment with the beta 1-selective adrenergic blocker metoprolol leads to a significant increase in beta-adrenoceptor density and an increase in the lipolytic response to beta-adrenergic agonists. This latter finding may, in some measure, account for the increased plasma triglyceride level observed.

Long-term effects of pindolol on serum lipoproteins in hypertensive patients

Serum lipoproteins were analysed in 11 hypertensive patients before and after 2 and 16 months on pindolol therapy. In all patients significant blood pressure reductions were achieved with a mean pindolol dose of 13 mg (range 5-30) per day at 16 months' follow-up. After 2 months a significant increase by 35% was found in VLDL TG and cholesterol concentrations, but after 16 months all lipoprotein values had reverted to pretreatment levels. HDL did not change during pindolol therapy. It is not established whether the lack of long-term effects of pindolol on serum lipoprotein is specifically due to its high degree of intrinsic sympatomimetic activity.

Long-term weight loss and weight-loss maintenance strategies

It has been suggested that about 20% of subjects undergoing weight-loss programmes can achieve a certain degree of long-term success. At present, surgery remains the only method resulting in long-term sustained weight loss, but access remains restricted. Hence it is important to analyse, in addition to pharmacotherapy, the methods to improve the effects of diet, exercise and behavioural modification. Since these techniques are less spectacular than others, there is a risk that their potential will be overlooked, in spite of the fact that they remain the main alternative for most subjects undergoing weight-loss therapy. This review summarizes realistic treatment alternatives and also provides data from a day care treatment, a strategy not much reported in the literature. This is a standard treatment modality for diabetes but less common in obesity treatment.

Disability pension, employment and obesity status: a systematic review

Disability pensions incur huge societal costs in many countries. In Sweden, the three greatest drivers of such productivity losses are musculo-skeletal, circulatory and psychiatric disorders, all closely associated with weight status. We identified 16 studies investigating the body mass index (BMI)-disability pension relation. In cross-sectional studies, a significantly greater proportion of obese compared with normal weight subjects were disability pensioners. In longitudinal studies, a J-shaped relation with BMI was generally found in both men and women of various ages. Different definitions of obesity status complicated interpretation, as several studies mixed the underweight and normal weight, which appear to have different disability pension risks. In middle-aged men, relative risks were elevated for circulatory causes only for the overweight and obese, while associations for mental disorders were similar in the underweight and overweight but much higher in the obese. In both sexes, monotonic increases and decreases were seen for circulatory and respiratory causes respectively. In intervention studies, reduced disability pension incidence and increased gainful employment were reported after surgery. In summary, BMI was significantly associated with disability pension, but the direction of causality may vary with underlying cause. Interventions had positive productivity effects in the morbidly obese, but whether this holds for the overweight remains to be proven.

Head-to-head studies evaluating efficacy of pharmaco-therapy for obesity: a systematic review and meta-analysis

Randomized controlled trials (RCTs) directly comparing weight loss drugs approved in the European Union were reviewed and the results analysed by meta-analysis. Eight RCTs including 885 patients were found comparing weight loss of orlistat and sibutramine, while no study including rimonabant was found. The median study duration was 7 months (range 3-12). Four of the seven studies comparing sibutramine and orlistat mono-therapy showed that sibutramine was significantly more efficacious for weight loss, while the remaining three showed equivalence. The weighted mean difference in weight loss was 2.2 kg (95% CI 0.5-3.9) favouring sibutramine. Three studies investigated orlistat and sibutramine as combination therapy, and two found it to be significantly better than orlistat alone, but not better than sibutramine alone. Based on these head-to-head RCT data, sibutramine appears to be significantly more efficacious for achieving weight loss than orlistat. This is concordant with indirect evidence from previous meta-analyses, where the respective compounds were compared with placebo. Only four studies reported attrition, and the pooled risk ratio was 0.6 (0.3-1.4) indicating lower dropout for sibutramine. This information together with an understanding of the clinical properties of each drug should help to guide the prescribing physician in the selection of adequate drug therapy for obesity.

An Internet-based weight loss programme -- a feasibility study with preliminary results from 4209 completers

AIMS

1. To identify characteristics of individuals seeking help for their weight problem via an internet-based programme. 2. To identify indicators of long term success in such a programme.

METHODS

An internet-based weight club (www.viktklubb.se) was used consisting of standard algorithms for calculating body mass index (BMI), food energy content and exercise energy cost. All members filled in basic data and could volunteer to fill in additional research related questions. Together with data on treatment success, attrition, and use of the various components of the programme, this information was automatically monitored and downloaded to a database.

RESULTS

Eighty-six percent of the members were female, and the age range was wide (range 18-101 years; mean 40.3 +/-11.5 years). At baseline, BMI of the entire group was 29.3 +/-5.1 kg/m(2) with 39% obese and 45% overweight. Among the completers, 16% changed from overweight or obese to normal weight. This corresponded to 29% of the members losing 5-9.9% of their initial body weight and 20% losing > or =10% of their. The strongest predictors of weight loss were activity in the weight club as judged by number of logins and diary entries, and sex.

CONCLUSIONS

A sizeable, but seemingly random, dropout rate was observed, together with significant dose-response effects between activity in the internet-based program and weight-loss among completers. Given its low cost and high accessibility at 24 hours a day, this form of programme delivery is interesting to evaluate and develop further, especially regarding attrition.

Who will lose weight on sibutramine and orlistat? Psychological correlates for treatment success

AIM

To study the associations between weight loss with sibutramine and orlistat with psychological aspects that may interact with patients' response to these drugs.

METHODS

A total of 478 obese patients with a mean body mass index of 42 +/- 12 kg/m(2) gave self-reported, retrospective data on different types of previous weight loss treatments (sibutramine and orlistat, and Weight Watchers used as a control condition) including the amount of weight lost with these treatments, eating behaviour (Dutch Eating Behaviour Questionnaire) and personality (NEO Personality Inventory - Revised).

RESULTS

Greater weight loss with sibutramine was associated with lower levels of restrained eating and higher levels of 'neuroticism', in particular 'anxiety' and 'depression'. Greater weight loss with orlistat was associated with aspects of the personality dimension 'conscientiousness' (e.g. 'order' and 'deliberation').

CONCLUSION

Sibutramine may exert its greatest effect in patients whose eating is a 'natural' response to hunger rather than regulated by cognitions and conscious controls. Patients with low levels of restraint could be more sensitive to the satiety-enhancing effect of sibutramine. They may be able to reduce their food intake without cognitive interference and/or start to control their eating most radically in response to enhanced satiety. Enhanced satiety may also help patients withstand a wish to eat triggered by psychological distress. Possible central nervous system effects on mood could also have reduced eating, which was related to distress. The administration regimen of orlistat is more demanding, requiring greater adherence. This can account for the finding that personality attributes such as conscientiousness are important for success.

Sexual function in obese women: impact of lower urinary tract dysfunction

OBJECTIVE

To assess the impact on sexual function attributed to lower urinary tract dysfunction in a female obese population.

DESIGN

We performed a case-control study based on the registry of a university hospital obesity unit. A consecutive sample of women with body mass index(BMI) >or=30 (obese) was randomly matched by age, gender and residential county to control subjects using the computerized Register of the Total Population. Data were collected by a self-reported postal survey including the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).

RESULTS

The questionnaire was completed and returned by 279/446 patients (62%) and 430/892 control subjects (48%). Obese women reported significantly lesser satisfaction with their sexual life, more frequent symptoms of urinary incontinence at intercourse, more often fear of urine leakage at intercourse, a higher tendency toward avoiding intercourse and more frequent feelings of guilt and disgust during intercourse (P<0.001). While considering sexual function in a subset of women with urge or stress urinary incontinence, the overall PISQ-12 scores were significantly lower in obese women compared to their age-matched nonobese controls for both the conditions (P<0.001). In an adjusted multivariate analysis, a BMI >30 was independently associated with a significantly increased risk for sexual dysfunction (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.1-2.9), as were symptoms of urge or stress urinary incontinence (OR, 2.0; 95% CI, 1.3-3.1 and OR, 2.6; 95% CI, 1.7-4.0), respectively.

CONCLUSION

Urge and stress urinary incontinences are more common and have greater impact on sexual function in obese women.

Topiramate in the treatment of obese subjects with drug-naive type 2 diabetes

AIM

The aim of this study was to examine the efficacy and safety of topiramate as an adjunct to diet and exercise in drug-naive, obese subjects with type 2 diabetes.

METHODS

Drug-naive individuals with type 2 diabetes, body mass index (BMI) of > or =27 and <50 kg/m(2) and haemoglobin A(1c) (HbA(1c)) of <10.5% were enrolled into the study. All the individuals participated in a non-pharmacologic weight loss program (Pathways to Change((R)); Johnson & Johnson Healthcare Systems, Piscataway, NJ, USA) throughout the trial. After a 6-week placebo run-in, the subjects were randomized to placebo, topiramate 96 mg/day or topiramate 192 mg/day. Subjects were scheduled for 8-week titration and 52-week maintenance phases. The study was ended early; efficacy data were reported for a predefined modified intent-to-treat (MITT) population (n = 229), with 40 weeks of treatment. All the subjects who provided any safety data were included in the safety population (n = 535).

RESULTS

Baseline mean weight was 103.7 kg, BMI 36 kg/m(2) and HbA(1c) 6.7% across all treatment groups. By the end of week 40, the placebo, the topiramate 96 mg/day and topiramate 192 mg/day groups lost 2.5, 6.6 and 9.1% of their baseline body weight respectively (p < 0.001 vs. placebo, MITT population using last observation carried forward). The decrease in HbA(1c) was 0.2, 0.6 and 0.7% respectively (p < 0.001 vs. placebo, MITT). Topiramate significantly reduced blood pressure and urinary albumin excretion; a weight-loss-independent HbA(1c) improving effect of topiramate was demonstrated. Adverse events were predominantly related to central nervous system (CNS).

CONCLUSIONS

Topiramate as an add-on treatment to lifestyle improvements produced significant weight loss and improved glucose homeostasis in obese, drug-naive subjects with type 2 diabetes. These treatment advantages should be balanced against the occurrence of adverse events in the CNS.

Influence of diffusion on models for nonequilibrium wetting

It is shown that the critical properties of a recently studied model for nonequilibrium wetting are robust if one extends the dynamic rules by single-particle diffusion on terraces of the wetting layer. Examining the behavior at the critical point and along the phase transition line, we identify a special point in the phase diagram where detailed balance of the dynamical processes is partially broken.

Eating habits in relation to body fatness and gender in adolescents--results from the 'SWEDES' study

OBJECTIVE

To investigate if eating habits among adolescents are related to body fatness and gender.

DESIGN

Cross-sectional study.

SETTING

Obesity Unit, Huddinge University Hospital, Sweden, 2001-2002.

SUBJECTS

Two hundred and seventy-five girls and 199 boys, aged 16-17 years.

METHOD

Questionnaires were used for dietary intake and meal frequency, BodPod for measuring body fatness (BF%). In all, 169 girls and 128 boys were classified as adequate reporters (AR) of energy intake, and were used in the dietary analyses. The whole sample was used in the meal frequency analyses.

RESULTS

The correlation between reported energy intake and weight in the AR group was 0.23 (P<0.01) for girls and 0.36 for boys (P<0.001). The correlations were inverse or not significant in the whole sample. The following variables correlated significantly with a high BF% (r (s)=+/-0.2): a low intake of milk in both girls and boys, a high intake of fibre and alcohol and a low intake of sugar in girls and a low intake of breakfast cereals in boys. Those with regular breakfast habits had healthier food choices than others, but this was not related to BF%. Boys had more meals per day (4.9 vs 4.6, P=0.02), especially early in the morning and late at night, whereas girls reported a higher relative intake of light meals and fruit and a lower intake of milk than boys.

CONCLUSIONS

A few associations between eating habits and body fatness were found, but without any obvious patterns. The true differences in eating habits between lean and overweight adolescents are probably very small.

False-positive breath-alcohol test after a ketogenic diet

A 59-year-old man undergoing weight loss with very low calorie diets (VLCD) attempted to drive a car, which was fitted with an alcohol ignition interlock device, but the vehicle failed to start. Because the man was a teetotaller, he was surprised and upset by this result. VLCD treatment leads to ketonemia with high concentrations of acetone, acetoacetate and beta-hydroxybutyrate in the blood. The interlock device determines alcohol (ethanol) in breath by electrochemical oxidation, but acetone does not undergo oxidation with this detector. However, under certain circumstances acetone is reduced in the body to isopropanol by hepatic alcohol dehydrogenase (ADH). The ignition interlock device responds to other alcohols (e.g. methanol, n-propanol and isopropanol), which therefore explains the false-positive result. This 'side effect' of ketogenic diets needs further discussion by authorities when people engaged in safety-sensitive work (e.g. bus drivers and airline pilots) submit to random breath-alcohol tests.

A comparison of effects of fish and beef protein on satiety in normal weight men

BACKGROUND

Previous studies have indicated that fish protein may have a greater effect on satiety compared to other protein sources of animal origin.

OBJECTIVE

To compare the effects of fish protein and beef protein meals on hunger and satiety.

DESIGN

Twenty-three normal non-smoking, healthy males aged 20-32 years, body mass index 22.5+/-1.8 (s.d.) kg/m(2) participated in a study, with within-subjects design and 1 week between test days. In the morning of the test days, subjects received a standardized breakfast. Four hours after breakfast, subjects were served an iso-energetic protein-rich (40 energy % protein) lunch meal, consisting of either a fish protein dish or a beef protein dish. Four hours after the start of the lunch meals, an ad libitum standardized evening meal was served and the intake of food was measured. Appetite was rated by visual analogue scales (VAS) immediately before and after the meals, as well as every hour between the meals. After the evening meal until bedtime, subjects were asked to record in detail foods and drinks consumed.

RESULTS

The repeated VAS-ratings of hunger, satiety and prospective consumption were modelled in a random effects model, taking pre-lunch VAS-ratings into account. After the fish meal, the point estimates were lower for hunger (-2+/-4.8), higher for satiety (8.7+/-6.0) and lower for prospective consumption (-4.9+/-4.7), but they did not reach statistical significance (P satiety=0.88; P hunger=0.15; P prospective=0.30). However, the energy intake at the evening meal displayed significant differences with subjects eating less after the fish protein lunch (2765 vs 3080 KJ, P<0.01) without feeling less satiated. No later energy compensation after the evening meal was found on the test day.

CONCLUSION

Although no significant differences in VAS-ratings of satiety or hunger were detected, subjects displayed an 11% reduction in energy intake at the subsequent evening meal.

Prevalence of obesity in Sweden

Although the prevalence of obesity in Sweden still is low in an international perspective, the development during the last decades is alarming in adults, adolescents and children alike. The prevalence of obesity [body mass index (BMI) > 30 kg m-2] in adults has doubled during the last two decades and is now approximately 10% in both men and women, according to estimates based on self-reported BMI from repeated random samples of the population. However, prevalence estimates based on measured BMI from the WHO MONICA study indicate that the self-reported data result in underestimates. In military conscripts, the prevalence of obesity (BMI > 30 kg m-2) almost quadrupled to 3.2% from 1971 to 1995, while the overweight fraction (BMI > 25 kg m-2) more than doubled to 16.3%. The development in younger age groups seems to be similar; the prevalence of overweight [International Obesity Task Force (IOTF)/Cole] in children aged 10 years in Gothenburg has doubled to 18% (2.9% obese) during the last decade, and similar figures have been reported in other studies. However, most reports on childhood overweight stem from the larger metropolitan areas, and hence may be underestimates because of the urban-rural influence on obesity-status. Recent data from non-urban areas in the northern part of Sweden estimate the prevalence of overweight (BMI > 20 kg m-2) in 10-year-olds to above 30%. In the most comprehensive study in children, including both rural and urban areas, BMI was measured among all children aged 10 years (n = 5517; 92.7% of the population) in the county of Ostergotland, and the prevalence of overweight (IOTF/Cole) was 22% in both boys and girls, of which 4% and 5% were obese respectively.