Treatment for morbid obesity

Overweight and obese patients do not seem to adequately recognize their own risk for colorectal cancer

Being overweight is a risk factor for colorectal cancer; patients' adequate perception of their risk may lead to better involvement in management. The purpose of this study was to measure perception of risk for colorectal cancer in overweight and obese patients. A consecutive sample of overweight adult patients (n = 195) attending to nutritional counseling was submitted to clinical questionnaire addressing personal and family data, awareness about colorectal cancer risk factors, health status, and estimates of their own risk. Only 32% identified obesity among CCR risk factors. For 57% of participants, their own current BMI status did not confer any increased risk for CRC. Also, for half (46%) of the patients, their BMI status will not lead to an increased risk during lifetime. For 36%, an increased risk was accurately estimated as two or more. Accurate estimates tend to be made by older patients (p = 0.033), those with GI complaints (p = 0.040), or with familial history (p = 0.016). Even among patients attending to a nutritional consultation, only a third of patients seem to adequately consider their own overweight as a potential risk for colorectal cancer during lifetime.

PRACTICE IMPLICATIONS

health education programs concerning obesity must include colorectal cancer as a potential outcome for overweight patients.

Session 1: Public health nutrition: Physical activity prescription for public health

The increased prevalence of CVD deaths in the past 60 years is a result in considerable part of the influence of environmental and lifestyle changes, including decreased daily energy expenditure through physical exertion. Physical activity prescription has therefore become an important public health issue. Exercise guidelines have evolved considerably since their first publication by the American College of Sports Medicine (ACSM) in 1978. Guidelines initially focused on moderate- to vigorous-intensity exercise to develop and maintain cardiorespiratory fitness. However, in the face of escalating physical inactivity, public health agencies sought to develop an exercise prescription more palatable to the sedentary majority and in 1995 recommended the accumulation of 30 min moderate-intensity exercise on most days of the week. The unexpected result of this message was that some individuals believed that vigorous exercise was not necessary, whilst others believed that low levels of physical activity were sufficient. In 2008 the ACSM and the American Heart Association sought to clarify this position and published an updated recommendation in which: the beneficial role of vigorous-intensity exercise is explicitly stated; adults are encouraged to combine moderate- and vigorous-intensity exercise to meet the minimum recommendation of moderate-intensity physical activity for a 30 min on 5 d/week or vigorous-intensity aerobic activity for 20 min on 3 d/week; the dose-response relationship between physical activity and health is reinforced. The immense challenge for public health professionals now lies in encouraging the sedentary population to adopt a more active lifestyle.

Prevalence of overweight and obesity among adult females in the United Arab Emirates

The purpose of this present study was to investigate the prevalence of overweight and obesity in adult females in the United Arab Emirates. A total number of 724 females, age 20-90 years, were recruited from the seven Emirates. The sample was divided into three age groups, 20 to <30 years, 30 to <60 years and >60 years. Height, weight and mid-upper-arm circumference were measured in each subject. Overweight and obesity were defined as a body mass index of 25.0-29.9 kg/m2 and >30 kg/m2, respectively. The prevalence of overweight and obesity were 27% and 16%, respectively. The age group between 30 and <60 years had the highest prevalence of overweight (33%) and obesity (24%). In conclusion, the findings from our study suggest that a high proportion of adult females in the United Arab Emirates are overweight and obese. The consequences of this are a serious concern for public health and need to be addressed.

WITHDRAWN: Advice on low-fat diets for obesity

BACKGROUND

Overweight and obesity are global health problems contributing to an ever increasing noncommunicable disease burden. Calorie restriction can achieve short-term weight loss but the weight loss has not been shown to be sustainable in the long-term. An alternative approach to calorie restriction is to lower the fat content of the diet. However, the long-term effects of fat-restricted diets on weight loss have not been established.

OBJECTIVES

To assess the effects of advice on low-fat diets as a means of achieving sustained weight loss, using all available randomised clinical trials. This review focused primarily on participants who were overweight or clinically obese and were dieting for the purpose of weight reduction. Since we were particularly interested in the ability of participants to sustain weight loss over a longer period of time, we focused on studies of 'free living' men and women who were given dietary advice rather than provision of food or money to purchase food.

SEARCH STRATEGY

We searched the Cochrane Controlled Trials Register (Cochrane Library Issue 2, 2001), MEDLINE (up to February 2002), and EMBASE (up to February 2002). We also searched the Science Citation Index (up to January 2001) and bibliographies of studies identified. Date of latest search: February 2002.

SELECTION CRITERIA

Trials were included if they fulfilled the following criteria: 1) they were randomised controlled clinical trials of low-fat diets versus other weight-reducing diets, 2) the primary purpose of the study was weight loss, 3) participants were followed for at least six months, 4) the study participants were adults (18 years or older) who were overweight or obese (BMI >25 kg/m2) at baseline. Studies including pregnant women or patients with serious medical conditions were excluded. Two people independently applied the inclusion criteria to the studies identified. Disagreement was resolved by discussion or by intervention of a third party.

DATA COLLECTION AND ANALYSIS

Data were extracted by three independent reviewers and meta-analysis performed using a random effects model. Weighted mean differences of weight loss were calculated for treatment and control groups at 6, 12 and 18 months.

MAIN RESULTS

Four studies were included at the six month follow-up, five studies at the 12 month follow-up and three studies at the 18 month follow-up. There was no significant difference in weight loss between the two groups at six months (WMD 1.7 kg, 95% CI -1.4 to 4.8 kg). The weighted sum of weight loss in the low fat group was -5.08 kg (95% CI -5.9 to -4.3 kg) and in the control group was -6.5 kg, (95% CI -7.3 to -5.7 kg). There was no significant difference in weight loss between the two groups at 12 months (WMD 1.1 kg, 95% CI -1.6 to 3.8 kg). The weighted sum of weight loss in the low fat group was -2.3 kg (95% CI -3.2 to -1.4 kg) and in the control group was -3.4 kg (95% CI -4.2 to -2.6 kg). There was no significant difference in weight loss between the two groups at 18 months (WMD 3.7 kg, 95% CI - 1.8 to 9.2). The weighted sum of weight loss in the control group was -2.3 kg (95% CI -3.5 to -1.2 kg) and in the low fat group there was a weight gain of 0.1 kg (95% CI -0.8 to 1 kg). There was significant heterogeneity in the results for weight loss at six months and 12 months. Apart from one study which showed a slight but statistically significant difference in total cholesterol in the low fat group at one year follow-up, there were no significant differences between the dietary groups for other outcome measures such as serum lipids, blood pressure and fasting plasma glucose. Studies measuring other factors such as perceived wellness and quality of life reported conflicting results.

AUTHORS' CONCLUSIONS

The review suggests that fat-restricted diets are no better than calorie restricted diets in achieving long term weight loss in overweight or obese people. Overall, participants lost slightly more weight on the control diets but this was not significantly different from the weight loss achieved through dietary fat restriction and was so small as to be clinically insignificant.

You are what you ate: the Biosetpoint hypothesis

The current epidemic of obesity has developed at a rate that cannot be attributed to genetic drift. Attempts to treat obesity using diet and activity have been largely disappointing. Genes are fixed at conception, but genetic expression is known to be influenced by nutriture during the stages of growth and development, these occurring in humans from conception through arrival at adulthood. Based on an extrapolation from existing data and cultural models, it is hypothesized that there is a mechanism by which diet and lifestyle habits present during the individual stages of growth and development help to define and program genetic expression in a way that resists change. It is through this mechanism that current nutritional and lifestyle practices have impacted genetic expression and contributed to the rapid development of resistant obesity. The details of the interaction between nutrition, lifestyle and genetic expression during growth must be examined, and intervention strategies devised for early stages of growth to prevent the seeds of obesity from taking root.

Gastroplastia vertical com bandagem em y-de-roux: análise de resultados

OBJETIVO: Avaliar prospectivamente os resultados de pacientes obesos mórbidos submetidos a gastroplastia vertical com bandagem em Y-de-Roux no Hospital Universitário da Universidade Estadual de Londrina. MÉTODO: Analisamos consecutivamente 250 pacientes, sem cirurgia bariátrica prévia, que foram submetidos à cirurgia que associa a gastroplastia vertical com bandagem e derivação gastrojejunal em Y-de-Roux. Os parâmetros utilizados para análise dos resultados foram, morbidade, mortalidade e redução ponderal. O seguimento dos pacientes foi de, no mínimo, um ano. O índice de massa corpórea médio foi de 46 Kg/m². RESULTADOS: A incidência de complicações operatórias que exigiram reoperação foi de 2 %. Não houve óbito na presente série. Após um a três anos de "follow-up", observamos uma redução do peso pré-operatório em média de 37,5%. Acompanhando a perda de peso, detectamos uma importante melhora nas comorbidades, e, em alguns casos, controle total da doença associada com a obesidade. CONCLUSÕES: A gastroplastia vertical com bandagem em Y-de-Roux foi,em nosso serviço, efetiva em produzir perda de peso intensa e duradoura associada à baixa taxa de morbi-mortalidade.

Nutritional assessment and support during pregnancy

This article thoroughly updates the authors' previous review of nutritional assessment and support during pregnancy. After briefly reviewing nutrient metabolism and requirements, the authors discuss the nutritional assessment of the pregnant woman and review the nutritional support principles in hyperemesis gravidarum and other conditions that can compromise the nutritional health of mother or fetus.

Advice on low-fat diets for obesity

BACKGROUND

Overweight and obesity are global health problems contributing to an ever increasing noncommunicable disease burden. Calorie restriction can achieve short-term weight loss but the weight loss has not been shown to be sustainable in the long-term. An alternative approach to calorie restriction is to lower the fat content of the diet. However, the long-term effects of fat-restricted diets on weight loss have not been established.

OBJECTIVES

To assess the effects of advice on low-fat diets as a means of achieving sustained weight loss, using all available randomised clinical trials. This review focused primarily on participants who were overweight or clinically obese and were dieting for the purpose of weight reduction. Since we were particularly interested in the ability of participants to sustain weight loss over a longer period of time, we focused on studies of 'free living' men and women who were given dietary advice rather than provision of food or money to purchase food.

SEARCH STRATEGY

We searched the Cochrane Library (issue 2, 2001), MEDLINE (up to February 20002), and EMBASE (up to February 20002). We also searched the Science Citation Index (up to January 2001) and bibliographies of studies identified. Date of latest search: February 2002.

SELECTION CRITERIA

Trials were included if they fulfilled the following criteria: 1) they were randomised controlled clinical trials of low-fat diets versus other weight-reducing diets, 2) the primary purpose of the study was weight loss, 3) participants were followed for at least six months, 4) the study participants were adults (18 years or older) who were overweight or obese (BMI >25 kg/m2) at baseline. Studies including pregnant women or patients with serious medical conditions were excluded. Two people independently applied the inclusion criteria to the studies identified. Disagreement was resolved by discussion or by intervention of a third party.

DATA COLLECTION AND ANALYSIS

Data were extracted by three independent reviewers and meta-analysis performed using a random effects model. Weighted mean differences of weight loss were calculated for treatment and control groups at 6, 12 and 18 months.

MAIN RESULTS

Four studies were included at the six month follow-up, five studies at the 12 month follow-up and three studies at the 18 month follow-up. There was no significant difference in weight loss between the two groups at six months (WMD 1.7 kg, 95% CI -1.4 to 4.8 kg). The weighted sum of weight loss in the low fat group was -5.08 kg (95% CI -5.9 to -4.3 kg) and in the control group was -6.5 kg, (95% CI -7.3 to -5.7 kg). There was no significant difference in weight loss between the two groups at 12 months (WMD 1.1 kg, 95% CI -1.6 to 3.8 kg). The weighted sum of weight loss in the low fat group was -2.3 kg (95% CI -3.2 to -1.4 kg) and in the control group was -3.4 kg (95% CI -4.2 to -2.6 kg). There was no significant difference in weight loss between the two groups at 18 months (WMD 3.7 kg, 95% CI - 1.8 to 9.2). The weighted sum of weight loss in the control group was -2.3 kg (95% CI -3.5 to -1.2 kg) and in the low fat group there was a weight gain of 0.1 kg (95% CI -0.8 to 1 kg). There was significant heterogeneity in the results for weight loss at six months and 12 months. Apart from one study which showed a slight but statistically significant difference in total cholesterol in the low fat group at one year follow-up, there were no significant differences between the dietary groups for other outcome measures such as serum lipids, blood pressure and fasting plasma glucose. Studies measuring other factors such as perceived wellness and quality of life reported conflicting results.

REVIEWER'S CONCLUSIONS

The review suggests that fat-restricted diets are no better than calorie restricted diets in achieving long term weight loss in overweight or obese people. Overall, participants lost slightly more weight on the control diets but this was not significantly different from the weight loss achieved through dietary fat restriction and was so small as to be clinically insignificant.

Surgical treatment of morbid obesity

The prevalence of obesity is increasing rapidly, and it is a major health problem, especially in Western countries. Bariatric surgery causes significant and permanent weight loss and improves the quality of life. It ameliorates or eliminates most of the obesity-related comorbidities. Isolated gastric restriction procedures are technically easy to perform, the morbidity and mortality are low, but the weight loss is unsatisfactory in patients who ingest high-energy food. Combined gastric restriction with gastric bypass or intestinal malabsorption procedures cause greater weight loss, but more nutritional complications.

[The evaluation of the efficacy of a multidisciplinary treatment in a group of obese patients with a BMI > or = 35 and a change in lung function]

OBJECTIVE

To assess the efficacy of an interdisciplinary protocol for treating obesity in a group of patients with BMI > or = 35 and with altered respiratory function that was not necessarily related to obesity or not.

PATIENTS AND METHOD

Forty obese individuals between 18 and 60 years of age with altered respiratory function were enrolled. Spirometric values, plethysmograph volumes, arterial blood gases, and nighttime respiratory polygraphs were recorded. Following psychological and nutritional evaluation, the patients commenced year-long treatment for obesity involving a personalized diet and psychological counseling. Follow-up was weekly and individualized at first; in later sessions, patients were grouped. Lung function tests were repeated after loss of 5 kg. Sleep polygraphy was repeated after loss of 10 kg.

RESULTS

Weight loss over 15 kg was achieved by 48.6% of the patients. Respiratory function variables: FVC, FEV1, RV, ERV, PaO2 and SatO2 after treatment changed significantly from initial levels. Significant differences were also seen in the severity of sleep apnea and pressures needed for continuous positive airway pressure. Uric acid, glucose and triglyceride blood levels became normal in 89%, 61% and 50% of the patients, respectively, after weight loss. No characteristic psychological profile was identified for severe obesity, although levels of anxiety, eating behavior, marital adjustment and perception of body image were aspects that were fundamentally altered.

CONCLUSIONS

In the difficult group of obese patients with BMI > or = 35, interdisciplinary treatment has proven effective for achieving substantial weight loss, while improving respiratory function and severity of sleep disorder. This therapy, which is at present viable for few centers, deserves consideration in the interest of benefiting the increasing number of obese patients.