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Behera P, Patro BK, Singh AK, Dora S, Bandhopadhyay D, Saharia GK, Dey A, Behera SM, Subba SH. Effectiveness of peer-led intervention in control of non-communicable diseases in rural areas of Khordha district: study protocol for a cluster randomized controlled trial. Trials 2024; 25:22. [PMID: 38172967 PMCID: PMC10765738 DOI: 10.1186/s13063-023-07824-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The main contributors to death and disability from chronic illnesses in developing nations are elevated blood pressure (hypertension), blood sugar (diabetes mellitus), and blood cholesterol (dyslipidaemia). Even though there are affordable treatments, the treatment gap for these conditions is still significant. Few pilot studies from industrialized nations discuss the value of peer-led interventions for achieving community-level management of blood pressure and blood sugar. This study aims to evaluate the effectiveness of peer-led intervention compared to standard care in achieving control of selected non-communicable diseases (NCDs) in Indian context at 1 year of intervention among people of 30-60 years with hypertension and/or diabetes mellitus and/or dyslipidaemia. METHODS A cluster-randomized controlled trial will be conducted in villages of two rural blocks of the Khordha district of Odisha from August 2023 to December 2024. A total of 720 eligible participants (360 in the intervention group and 360 in the control group) will be recruited and randomized into two study arms. The participants in the intervention arm will receive a peer-led intervention model for 6 months in addition to standard care. The sessions will be based on the six domains of NCDs - self-care, follow-up care, medication, physical activity, diet, limiting substance use, mental health and co-morbidities. The mean reduction in blood pressure, HbA1C, and blood cholesterol in the intervention arm compared to the standard care arm will be the main outcome. DISCUSSION The increasing burden of NCDs demands for newer strategies for management. Peer-led interventions have proven to be useful at the international level. Incorporating it in India will have remarkable results in controlling NCDs. TRIAL REGISTRATION Clinical Trial Registry of India (CTRI) CTRI/2023/02/050022. Registered on 23 February 2023.
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Affiliation(s)
- Priyamadhaba Behera
- Department Of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Binod Kumar Patro
- Department Of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Arvind Kumar Singh
- Department Of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Susmita Dora
- Department Of Community Medicine, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, India
| | | | - Gautom Kumar Saharia
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Anupam Dey
- Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Surama Manjari Behera
- Department Of Community Medicine, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, India
| | - Sonu H Subba
- Department Of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
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Wallén S, Bruze G, Ottosson J, Marcus C, Sundström J, Szabo E, Olbers T, Palmetun-Ekbäck M, Näslund I, Neovius M. Opioid Use After Gastric Bypass, Sleeve Gastrectomy or Intensive Lifestyle Intervention. Ann Surg 2023; 277:e552-e560. [PMID: 36700782 PMCID: PMC9905206 DOI: 10.1097/sla.0000000000005192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare opioid use in patients with obesity treated with bariatric surgery versus adults with obesity who underwent intensive lifestyle modification. SUMMARY OF BACKGROUND DATA Previous studies of opioid use after bariatric surgery have been limited by small sample sizes, short follow-up, and lack of control groups. METHODS Nationwide matched cohort study including individuals from the Scandinavian Obesity Surgery Registry and the Itrim health database with individuals undergoing structured intensive lifestyle modification, between August 1, 2007 and September 30, 2015. Participants were matched on Body Mass Index, age, sex, education, previous opioid use, diabetes, cardiovascular disease, and psychiatric status (n = 30,359:21,356). Dispensed opioids were retrieved from the Swedish Prescribed Drug Register from 2 years before to up to 8 years after intervention. RESULTS During the 2-year period before treatment, prevalence of individuals receiving ≥1 opioid prescription was identical in the surgery and lifestyle group. At 3 years, the prevalence of opioid prescriptions was 14.7% versus 8.9% in the surgery and lifestyle groups (mean difference 5.9%, 95% confidence interval 5.3-6.4) and at 8 years 16.9% versus 9.0% (7.9%, 6.8-9.0). The difference in mean daily dose also increased over time and was 3.55 mg in the surgery group versus 1.17 mg in the lifestyle group at 8 years (mean difference [adjusted for baseline dose] 2.30 mg, 95% confidence interval 1.61-2.98). CONCLUSIONS Bariatric surgery was associated with a higher proportion of opioid users and larger total opioid dose, compared to actively treated obese individuals. These trends were especially evident in patients who received additional surgery during follow-up.
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Affiliation(s)
- Stefan Wallén
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Pharmacology and Therapeutic Department, Region Örebro County, University Hospital of Örebro, Sweden
| | - Gustaf Bruze
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Szabo
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Torsten Olbers
- Institute of Clinical and Experimental Medicine and Wallenberg Centre for Molecular Medicine, University of Linköping and Department of Surgery, Vrinnevi, Norrköping, Sweden
| | - Maria Palmetun-Ekbäck
- Pharmacology and Therapeutic Department, Region Örebro County, University Hospital of Örebro, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Martin Neovius
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
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Harris RA, Fernando HA, Seimon RV, da Luz FQ, Gibson AA, Touyz SW, Sainsbury A. Effects of total diet replacement programs on mental well-being: A systematic review with meta-analyses. Obes Rev 2022; 23:e13465. [PMID: 35997170 PMCID: PMC9786773 DOI: 10.1111/obr.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 12/30/2022]
Abstract
This systematic review with meta-analyses assessed the effects of total diet replacement (TDR) programs on mental well-being in clinical trial participants with a body mass index greater than or equal to 25 kg/m2 . TDR programs involve replacing all dietary requirements with nutritionally replete formula foods and are generally administered to induce rapid weight loss. To date, it is largely unclear what effects TDR programs may have on mental well-being, particularly in the long-term. To address this, we screened 25,976 references across six databases and extracted 35 publications. These 35 publications provided sufficient data to evaluate the effects of TDR programs on depression, anxiety, stress, positive affect, negative affect, vitality, role-emotional, social functioning, mental health, mental composite summary score, self-esteem, and general psychological health in 24 meta-analyses. Due to the lack of research comparing TDR programs to comparator groups, 22 of our 24 meta-analyses explored change in these mental well-being sub-domains over time in TDR programs without comparators. Specifically, we assessed the change from pre-diet (before the TDR program) to either post-diet (up to and including two months after the TDR program); and/or follow-up (more than two months after the TDR program). For depression and anxiety, we were also able to assess the change from pre-diet to mid-diet (which fell within two weeks of the diet half-way point). The remaining two meta-analyses assessed the difference in depression scores between a TDR group and a food-based comparator group from pre-diet to post-diet and from pre-diet to follow-up. Across all meta-analyses, our results found no marked adverse effects of TDR programs on any mental well-being sub-domain. In fact, clear improvements were observed for depression, anxiety, stress, vitality, role-emotional, and social functioning at post-diet. Interestingly, the improvements for depression, vitality and role-emotional were maintained at follow-up. All improvements were observed in meta-analyses without comparators. While the two comparator-based meta-analyses showed no difference between TDR programs and food-based diets in depression symptoms, there was low statistical power. For all meta-analyses containing three or more independent samples, we constructed prediction intervals to determine the range within which the mean of the true effects may fall for future populations. While these prediction intervals varied between sub-domains, we found that mean depression scores are only likely to increase (i.e., depression will worsen) in less than 3% of future TDR interventions which meet our inclusion/exclusion criteria. Taken together, we concluded that for adults with a body mass index greater than or equal to 25 kg/m2 , TDR programs are unlikely to lead to marked adverse effects on mental well-being. These findings do not support the exclusion of participants from trials or interventions involving TDR programs based on concerns that these programs may adversely affect mental well-being. In fact, by excluding these participants, they may be prevented from improving their metabolic health and mental well-being.
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Affiliation(s)
- Rebecca A Harris
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Hamish A Fernando
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,School of Biomedical Engineering, Faculty of Engineering, The University of Sydney, Darlington, New South Wales, Australia
| | - Radhika V Seimon
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia
| | - Felipe Q da Luz
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, Brazil
| | - Alice A Gibson
- Faculty of Medicine and Health, Charles Perkins Centre, Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Camperdown, New South Wales, Australia.,Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Stephen W Touyz
- School of Psychology, Faculty of Science, The University of Sydney, Camperdown, New South Wales, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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Stenberg E, Bruze G, Sundström J, Marcus C, Näslund I, Ottosson J, Neovius M. Comparison of Sleeve Gastrectomy vs Intensive Lifestyle Modification in Patients With a BMI of 30 to Less Than 35. JAMA Netw Open 2022; 5:e2223927. [PMID: 35895057 PMCID: PMC9331100 DOI: 10.1001/jamanetworkopen.2022.23927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE There is a lack of studies evaluating sleeve gastrectomy compared with intensive lifestyle treatment in patients with class 1 obesity (body mass index [BMI] 30 to <35 [calculated as weight in kilograms divided by height in meters squared]). OBJECTIVE To compare outcomes and safety of sleeve gastrectomy compared with intensive nonoperative obesity treatment in patients with class 1 obesity. DESIGN, SETTING, AND PARTICIPANTS This matched, nationwide cohort study included patients with class 1 obesity who underwent a sleeve gastrectomy or intensive lifestyle treatment between January 1, 2012, and December 31, 2017, and who were registered in the Scandinavian Obesity Surgery Registry or the Itrim health database. Participants with class 1 obesity were matched 1:2 using a propensity score including age, sex, BMI, treatment year, education level, income, cardiovascular disease, and use of antibiotic drugs, antidepressants, and anxiolytics. INTERVENTIONS Sleeve gastrectomy or intensive lifestyle treatment. MAIN OUTCOMES AND MEASURES Outcomes included weight loss after intervention, changes in metabolic comorbidities, substance use disorders, self-harm, and major cardiovascular events retrieved from the National Patient Register, Prescribed Drug Register, and Cause of Death Register as well as the Scandinavian Obesity Surgery Registry and the Itrim health database. Data were analyzed from December 1, 2021 until May 31, 2022. RESULTS The study included 1216 surgery patients and 2432 lifestyle participants with similar mean (SD) BMI (32.8 [1.4] vs 32.9 [1.4]), mean (SD) age (42.4 [9.7] vs 42.6 [12.7] years), and sex (1091 [89.7%] vs 2191 [90.1%] women). Surgery patients had greater 1-year weight loss compared with controls (22.9 kg vs 11.9 kg; mean difference, 10.7 kg; 95% CI, 10.0-11.5 kg; P < .001). Over a median follow-up of 5.1 years (IQR, 3.9-6.2 years), surgery patients had a lower risk of incident use of diabetes drugs (59.7 vs 100.4 events per 10 000 person-years; hazard ratio [HR], 0.60; 95% CI, 0.39-0.92; P = .02) and greater 2-year diabetes drug remission (48.4% vs 22.0%; risk difference 26.4%; 95% CI, 11.7%-41.0%; P < .001), but higher risk for substance use disorder (94 vs 50 events per 10 000 person-years; HR, 1.86; 95% CI, 1.30-2.67; P < .001) and self-harm (45 vs 25 events per 10 000 person-years; HR, 1.81; 95% CI, 1.09-3.01; P = .02). No between-group difference in occurrence of major cardiovascular events was observed (23.4 vs 24.8 events per 10 000 person-years; HR, 0.96; 95% CI, 0.49-1.91; P = .92). CONCLUSIONS AND RELEVANCE In this cohort study, compared with intensive nonoperative obesity treatment, sleeve gastrectomy in patients with class 1 obesity was associated with greater weight loss, diabetes prevention, and diabetes remission but a higher incidence of substance use disorder and self-harm.
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Affiliation(s)
- Erik Stenberg
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Gustaf Bruze
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Claude Marcus
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Ottosson
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Fogarasi A, Gonzalez K, Dalamaga M, Magkos F. The Impact of the Rate of Weight Loss on Body Composition and Metabolism. Curr Obes Rep 2022; 11:33-44. [PMID: 35133628 DOI: 10.1007/s13679-022-00470-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Weight loss has multiple beneficial effects on body composition and metabolism, but whether these depend on the rate at which body weight is lost is not clear. We analyzed data from studies in which the same amount of weight loss was induced rapidly or gradually. RECENT FINDINGS Thirteen studies were included in which the same percentage weight loss was achieved at slow or fast rates (range: 0.2 to 3.2 kg/week) by means of dietary calorie restriction, exercise, and bariatric surgery. Faster rates of weight loss may result in more fat-free mass and less fat mass being lost during the dynamic phase of weight reduction compared with slower rates of weight loss, in conjunction with greater declines in resting energy expenditure. However, these differences are attenuated after 2-4 weeks of stabilization at the new, lower body weight, and do not affect the rate and amount of weight regain 9-33 months later (nor the tissue composition of regained weight). Differences in waist circumference, visceral and liver fat contents, resting blood pressure, fasting blood lipid profile, and insulin and adipokine concentrations in response to different rates of weight loss are trivial. The decline in fasting glucose concentration and the improvement in insulin sensitivity after 6-11% weight loss are both greater with rapid than gradual weight loss, but not different after 18-20% weight loss. Changes in body composition and metabolism after losing the same amount of body weight at different rates are largely similar, and occasional differences are likely not meaningful clinically for the long-term management of obesity and cardiometabolic diseases.
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Affiliation(s)
- Adam Fogarasi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
| | - Katherine Gonzalez
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark
| | - Maria Dalamaga
- Department of Biological Chemistry, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Faidon Magkos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Rolighedsvej 26, 1958, Frederiksberg C, Denmark.
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Lew LC, Mat Ludin AF, Shahar S, Abdul Manaf Z, Mohd Tohit N. Efficacy and Sustainability of Diabetes-Specific Meal Replacement on Obese and Overweight Type-2 Diabetes Mellitus Patients: Study Approaches for a Randomised Controlled Trial and Impact of COVID-19 on Trial Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074188. [PMID: 35409872 PMCID: PMC8998339 DOI: 10.3390/ijerph19074188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/26/2022] [Accepted: 03/16/2022] [Indexed: 12/04/2022]
Abstract
Meal replacement (MR) is widely used in weight and diabetes management programs due to its ease of compliance and handling. However, little is known about its impact on outcomes other than glycaemic control and weight loss. Furthermore, not many studies evaluate its cost-effectiveness and sustainability. This study aimed to evaluate the efficacy of a diabetes-specific MR for the weight reduction and glycaemic controls of overweight and obese T2DM patients, as compared to routine dietary consultation. Other health outcomes, the cost effectiveness, and the sustainability of the MR will also be evaluated. Materials and Methods: This randomised controlled clinical trial will involve 156 participants who have been randomised equally into the intervention and control groups. As a baseline, both groups will receive diet consultation. Additionally, the intervention group will receive an MR to replace one meal for 5 days a week. The duration of intervention will be 12 weeks, with 36 weeks of follow-up to monitor the sustainability of the MR. The primary endpoints are weight and Hemoglobin A1c (HbA1c) reduction, while the secondary endpoints are anthropometry, biochemical measurements, satiety, hormone changes, quality of life, and cost-effectiveness. The impact of the COVID-19 pandemic on study design is also discussed in this paper. This study has obtained human ethics approval from RECUKM (JEP-2019-566) and is registered at the Thai Clinical Trials Registry (TCTR ID: TCTR20210921004).
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Affiliation(s)
- Leong Chen Lew
- Biomedical Science Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
| | - Arimi Fitri Mat Ludin
- Biomedical Science Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
- Correspondence: ; Tel.: +603-92898043
| | - Suzana Shahar
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
- Dietetic Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Zahara Abdul Manaf
- Center for Healthy Ageing and Wellness, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia; (S.S.); (Z.A.M.)
- Dietetic Programme, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia
| | - Noorlaili Mohd Tohit
- Department of Family Medicine, University Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Kuala Lumpur 56000, Malaysia;
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Ranjan P, Vikram NK, Choranur A, Pradeep Y, Ahuja M, Puri M, Malhotra A, Kumari A, Chopra S, Batra A, Balsalkar G, Goswami D, Guleria K, Sarkar S, Kachhawa G, Verma A, Kumari MK, Madan J, Dabral A, Kamath S, Rathore AM, Kumar R, Venkataraman S, Kaloiya G, Bhatla N, Kumari SS, Baitha U, Prakash A, Tiwaskar M, Tewary K, Misra A, Guleria R. Executive summary of evidence and consensus-based Clinical Practice Guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative. Diabetes Metab Syndr 2022; 16:102426. [PMID: 35248973 DOI: 10.1016/j.dsx.2022.102426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. METHODS The key clinical questions specific to weight management in midlife women were finalised with the help of a multidisciplinary team of experts in the guideline development group (GDG). Phase I included a systematic and/or narrative review to gather evidence, grading of evidence and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method and GRADE approach. RESULTS -The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the healthcare provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviours. Before initiating the management, a comprehensive assessment of clinical and lifestylerelated parameters should be completed. A personalised behavioural lifestyle modification program addressing the midlife specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife specific barriers for sustenance of healthy weight. CONCLUSION These recommendations will be useful in opportunistic screening and management of obesity in midlife women across healthcare settings.
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Affiliation(s)
- Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Ambuja Choranur
- President, Indian Menopause Society, Former Professor and Head, Department of Obstetrics and Gynaecology, Osmania Medical College, Hyderabad, India
| | - Yashodhara Pradeep
- Era Medical College and University, Ex Prof. and Head Department of Obstetrics and Gynaecology, RML Institute of Medical Sciences, KGMU, Lucknow, Vice President Elect, FOGSI, Ex Vice President, IMS, India
| | - Maninder Ahuja
- President, Society of Meaningful Life Management, Associate Editor, Journal of Midlife Health, India
| | - Manju Puri
- Head, Department of Obstetrics and Gynaecology, LHMC and SSK Hospital, New Delhi, India
| | - Anita Malhotra
- Food and Nutrition, Department of Home Science, Vice-principal, Lakshmibai College, University of Delhi, New Delhi, India
| | - Archana Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Sakshi Chopra
- Department of Home Science, University of Delhi, New Delhi, India
| | - Achla Batra
- President, Association of Obstetricians & Gynaecologists of Delhi (AOGD), Professor, Department of Obstetrics and Gynaecology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Geetha Balsalkar
- Department of Obstetrics and Gynaecology Seth G. S. Medical College, Mumbai, India
| | - Deepti Goswami
- Director Professor, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Kiran Guleria
- Department of Obstetrics and Gynaecology, University College of Medical Sciences, New Delhi, India
| | - Siddharth Sarkar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Aditi Verma
- Department of Home Science, University of Delhi, New Delhi, India
| | | | - Jagmeet Madan
- National President, Indian Dietetic Association, India
| | - Anjali Dabral
- Head, Department of Obstetrics and Gynaecology, VMMC and safdarjung Hospital, New Delhi, India
| | - Sandhya Kamath
- Ex-Professor of Medicine and Dean, Seth G S Medical College and KEM Hospital, Mumbai, and LT Municipal Medical College and General Hospital, Mumbai, India
| | - Asmita Muthal Rathore
- Director Professor and Head, Department of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India
| | - Raman Kumar
- President, Academy of Family Physicians of India, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurishankar Kaloiya
- Clinical Psychology, Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Neerja Bhatla
- Head, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - S Shantha Kumari
- President, The Federation of Obstetric and Gynaecological Societies of India, India
| | - Upendra Baitha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Prakash
- Department of Medicine, LHMC and SSK Hospital, New Delhi, India
| | | | - Kamlesh Tewary
- President, Association of the Physicians of India, India
| | - Anoop Misra
- Chairman, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, Chairman, National Diabetes, Obesity and Cholesterol Foundation (N-DOC) and President, Diabetes Foundation (India), New Delhi, India
| | - Randeep Guleria
- Director, All India Institute of Medical Sciences, New Delhi, India
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8
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Vikram N, Ranjan P, Choranur A, Pradeep Y, Ahuja M, Meeta M, Puri M, Malhotra A, Kumari A, Chopra S, Batra A, Balsalkar G, Goswami D, Guleria K, Sarkar S, Kachhawa G, Verma A, Kumari MK, Madan J, Dabral A, Kamath S, Rathore A, Kumar R, Venkataraman S, Kaloiya G, Bhatla N, Kumari SS, Baitha U, Prakash A, Tiwaskar M, Tewary K, Misra A, Guleria R. Executive summary of evidence and consensus-based clinical practice guidelines for management of obesity and overweight in midlife women: An AIIMS-DST initiative. J Midlife Health 2022; 13:34-49. [PMID: 35707299 PMCID: PMC9190956 DOI: 10.4103/jmh.jmh_7_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/03/2022] Open
Abstract
Weight gain is an independent risk factor for decline in cardiometabolic and overall health-related quality of life in midlife women. The AIIMS-DST initiative aims to develop and validate stepwise recommendations specific for weight management in midlife women. The key clinical questions specific to weight management in midlife women were finalized with the help of a multidisciplinary team of experts in the guideline development group. Phase I including a systematic and/or narrative review, grading of evidence, and expert opinion was sought to develop clinical practice recommendations for each clinical question. Phase II focused on validation of clinical practice recommendations using the peer-review, Delphi method, and GRADE approach. The guidelines provide clinical practice points to address challenges encountered by midlife women in their attempts to manage obesity via lifestyle modification techniques. The initiation of discussion would help the health-care provider to identify the weight management needs of the women, educate women on different modalities of weight management, and empower them to incorporate corrective lifestyle behaviors. Before initiating the management, a comprehensive assessment of clinical and lifestyle-related parameters should be completed. A personalized behavioral lifestyle modification program addressing the midlife-specific barriers for optimal metabolic, musculoskeletal, and mental health should be planned. A consistent follow-up is required for maintenance of corrective eating and activity habits by addressing midlife-specific barriers for sustenance of healthy weight. These recommendations will be useful in opportunistic screening and management of obesity in midlife women across health-care settings.
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Tay BSJ, Cox DN, Brinkworth GD, Davis A, Edney SM, Gwilt I, Ryan JC. Co-Design Practices in Diet and Nutrition Research: An Integrative Review. Nutrients 2021; 13:nu13103593. [PMID: 34684593 PMCID: PMC8540362 DOI: 10.3390/nu13103593] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/04/2022] Open
Abstract
Co-design, the method of involving users, stakeholders, and practitioners in the process of design, may assist to improve the translation of health evidence into tangible and acceptable intervention prototypes. The primary objective of this review was to identify and describe co-design techniques used in nutrition research. The secondary objective was to identify associations between co-design techniques and intervention effectiveness. An integrative review was performed using the databases Emcare, MEDLINE, PsycINFO and Google Scholar. Eligible studies included those that: (1) utilised participatory research or co-design techniques, (2) described development and/or evaluation of interventions aimed at improving dietary behaviours or nutrition, and (3) targeted community-dwelling adults aged ≥18 years. We identified 2587 studies in the initial search and included 22 eligible studies. There were 15 studies that utilised co-design techniques, with a strong focus on engagement of multiple stakeholder types and use of participatory research techniques. No study implemented a complete co-design process. Most studies (14/15) reporting outcomes reported positive health (maximum p < 0.001) or health behaviour outcomes attributed to the intervention; hence, associations between co-design techniques and effectiveness could not be determined. Currently published intervention studies have used participatory research approaches rather than co-design methods. Future research is required to explore the effectiveness of co-design nutrition interventions.
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Affiliation(s)
- Brenda S. J. Tay
- Nutrition & Dietetics, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- Correspondence:
| | - David N. Cox
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, 13 Kintore Avenue, Adelaide, SA 5000, Australia; (D.N.C.); (G.D.B.); (J.C.R.)
| | - Grant D. Brinkworth
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, 13 Kintore Avenue, Adelaide, SA 5000, Australia; (D.N.C.); (G.D.B.); (J.C.R.)
| | - Aaron Davis
- UniSA Creative, University of South Australia, Adelaide, SA 5001, Australia; (A.D.); (I.G.)
| | - Sarah M. Edney
- Physical Activity and Nutrition Determinants in Asia (PANDA) Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119077, Singapore;
| | - Ian Gwilt
- UniSA Creative, University of South Australia, Adelaide, SA 5001, Australia; (A.D.); (I.G.)
| | - Jillian C. Ryan
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, 13 Kintore Avenue, Adelaide, SA 5000, Australia; (D.N.C.); (G.D.B.); (J.C.R.)
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Lewgood J, Oliveira B, Korzepa M, Forbes SC, Little JP, Breen L, Bailie R, Candow DG. Efficacy of Dietary and Supplementation Interventions for Individuals with Type 2 Diabetes. Nutrients 2021; 13:2378. [PMID: 34371888 PMCID: PMC8308746 DOI: 10.3390/nu13072378] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of Type 2 diabetes (T2D) is increasing, which creates a large economic burden. Diet is a critical factor in the treatment and management of T2D; however, there are a large number of dietary approaches and a general lack of consensus regarding the efficacy of each. Therefore, the purpose of this narrative review is twofold: (1) to critically evaluate the effects of various dietary strategies on diabetes management and treatment, such as Mediterranean diet, plant-based diet, low-calorie and very low-calorie diets, intermittent fasting, low-carbohydrate and very low-carbohydrate diets, and low glycemic diets and (2) to examine several purported supplements, such as protein, branched-chain amino acids, creatine, and vitamin D to improve glucose control and body composition. This review can serve as a resource for those wanting to evaluate the evidence supporting the various dietary strategies and supplements that may help manage T2D.
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Affiliation(s)
- Jessica Lewgood
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S0A2, Canada; (J.L.); (R.B.)
| | - Barbara Oliveira
- Okanagan Campus, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC V1V1V7, Canada; (B.O.); (J.P.L.)
| | - Marie Korzepa
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (M.K.); (L.B.)
| | - Scott C. Forbes
- Department of Physical Education Studies, Faculty of Education, Brandon University, Brandon, MB R7A6A9, Canada;
| | - Jonathan P. Little
- Okanagan Campus, School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC V1V1V7, Canada; (B.O.); (J.P.L.)
| | - Leigh Breen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; (M.K.); (L.B.)
| | - Robert Bailie
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S0A2, Canada; (J.L.); (R.B.)
| | - Darren G. Candow
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S0A2, Canada; (J.L.); (R.B.)
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Brunton PA, Ratnayake J, Bodansky HJ, Mei L, Veerasamy A, Hall R. An intraoral device for weight loss: initial clinical findings. Br Dent J 2021:10.1038/s41415-021-3081-1. [PMID: 34172922 PMCID: PMC8231740 DOI: 10.1038/s41415-021-3081-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/24/2020] [Indexed: 12/13/2022]
Abstract
Introduction Obesity is a global epidemic, increasing the risk of many associated health issues.Aim The aim of this clinical study was to investigate the acceptability and tolerability of an intraoral device, designed to facilitate weight loss.Method Seven healthy obese participants were recruited. The device, which incorporated closed-field magnets with keepers to restrict mouth opening, was cemented to the participants' first molars. The participants were given a commercially available liquid diet for two weeks. The comfort and tolerability of the device were assessed using a quality of life questionnaire during review appointments at 1, 7 and 14 days and two weeks after device removal.Results The participants reached a mean weight loss of 6.36 (SD = 3.79) kilograms, which represents approximately 5.1% of their body weight. The participants had trouble pronouncing some words and felt tense and embarrassed 'only occasionally'. The participants 'hardly ever' reported a change in taste sensation or felt uncomfortable drinking. However, participants indicated that they occasionally had discomfort and felt that life in general was less satisfying. Qualitative analysis showed that the participants were happy with the outcome and were motivated to lose more weight.Conclusion The participants tolerated the device for a two-week period with satisfactory weight loss and were further motivated to continue their weight loss journey.
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Affiliation(s)
- Paul A Brunton
- University of Otago, Faculty of Dentistry, 310 Great King Street, North Dunedin 9016, New Zealand.
| | - Jithendra Ratnayake
- University of Otago, Faculty of Dentistry, 310 Great King Street, North Dunedin 9016, New Zealand
| | | | - Li Mei
- University of Otago, Faculty of Dentistry, 310 Great King Street, North Dunedin 9016, New Zealand
| | - Arthi Veerasamy
- University of Otago, Faculty of Dentistry, 310 Great King Street, North Dunedin 9016, New Zealand
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Min J, Kim SY, Shin IS, Park YB, Lim YW. The Effect of Meal Replacement on Weight Loss According to Calorie-Restriction Type and Proportion of Energy Intake: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Acad Nutr Diet 2021; 121:1551-1564.e3. [PMID: 34144920 DOI: 10.1016/j.jand.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Portion control is a useful component of weight reduction interventions and meal replacement (MR) plans represent a promising strategy for portion control. Research performed with pooled data on the effect of MR plans according to various characteristics of MR interventions remains scarce. OBJECTIVE Our aim was to assess the effects of MR-based diets compared with food-based diets on weight loss, according to calorie-restriction types and energy intake proportions from MR. METHODS Electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Embase, and Research Information Sharing Service) were searched for randomized controlled trials on weight loss results of MR-based calorie-restricted diets compared with food-based calorie-restricted diets from January 2000 to May 2020. Standardized mean differences (Hedges' g) from all study outcomes were calculated using a random-effects model. Heterogeneity was quantified by Q test and I2. Publication bias was assessed using a funnel plot and a trim and fill method. Both interventions (MR and control) were separated into very-low-energy diets and low-energy diets (LEDs). A meta-analysis of variance was conducted by dividing patient-related factors and treatment-related factors into subgroups. In multivariable meta-regressions, background variables were selected first, after which main independent variables were included. RESULTS Twenty-two studies involving 24 interventions and 1,982 patients who were overweight or obese were included. The effect size in which MR-based LED was compared with food-based LED for weight loss was small, favoring MR (Hedges' g = 0.261; 95% CI 0.156 to 0.365; I2 = 21.9; 95% CI 0.0 to 53.6). Diets including ≥60% of total daily energy intake from MR had a medium effect size favoring MR with regard to weight loss among the groups (Hedges' g = 0.545; 95% CI 0.260 to 0.830; I2 = 42.7; 95% CI 0.0 to 80.8). CONCLUSIONS The effect of MR-based LED on weight loss was superior to the effect of food-based LED, and receiving ≥60% of total daily energy intake from MR had the greatest effect on weight loss.
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Hendrie GA, Baird DL, Brindal E, Williams G, Brand-Miller J, Muhlhausler B. Weight Loss and Usage of an Online Commercial Weight Loss Program (the CSIRO Total Wellbeing Diet Online) Delivered in an Everyday Context: Five-Year Evaluation in a Community Cohort. J Med Internet Res 2021; 23:e20981. [PMID: 34096869 PMCID: PMC8218211 DOI: 10.2196/20981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/04/2020] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obesity is a global public health challenge, and there is a need for more evidence-based self-management programs that support longer-term, sustained weight loss. OBJECTIVE This study used data from the Commonwealth Scientific and Industrial Research Organisation (CSIRO) Total Wellbeing Diet Online program to determine the reach and weight loss results over its first 5 years. METHODS Participants were adults who joined the commercial weight loss program of their own volition between October 2014 and September 2019 (N=61,164). Information collected included year of birth, sex, height, weight, and usage data (eg, entries into the food diary, views of the menu, and program content). Weight loss and percentage of starting body weight lost were calculated. Members were divided into 2 groups for analysis: "stayers" were members who signed up for at least 12 weeks of the program and recorded a weight entry at baseline and at the end of the program, while "starters" began the program but did not record a weight after 12 weeks. Descriptive statistics and multiple linear regression were used to describe weight loss and determine the member and program characteristics associated with weight loss. RESULTS Data were available from 59,686 members for analysis. Members were predominately female (48,979/59,686, 82.06%) with an average age of 50 years (SD 12.6). The average starting weight was 90.2 kg (SD 19.7), and over half of all members (34,195/59,688, 57.29%) were classified as obese. At week 12, 94.56% (56,438/59,686) of the members had a paid program membership, which decreased to 41.48% (24,756/59,686) at 24 weeks. At week 12, 52.03% (29,115/55,958) of the remaining members were actively using the platform, and by week 24, 26.59% (14,880/55,958) were using the platform. The average weight loss for all members was 2.8 kg or 3.1% of their starting body weight. Stayers lost 4.9 kg (5.3% of starting body weight) compared to starters, who lost 1.6 kg (1.7% of starting body weight). Almost half (11,082/22,658, 48.91%) the members who stayed on the program lost 5% or more of their starting body weight, and 15.48% (3507/22,658) achieved a weight loss of 10% or more. Of the members who were classified as class 1 obese when they joined the program, 41.39% (3065/7405) who stayed on the program were no longer classified as obese at the end, and across all categories of obesity, 24% (3180/13,319) were no longer classified as obese at the end of the program. Based on multiple linear regression, platform usage was the strongest predictor of weight loss (β=.263; P<.001), with higher usage associated with greater weight loss. CONCLUSIONS This comprehensive evaluation of a commercial, online weight loss program showed that it was effective for weight loss, particularly for members who finished the program and were active in using the platform and tools provided. If the results demonstrated here can be achieved at an even greater scale, the potential social and economic benefits will be extremely significant.
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Affiliation(s)
- Gilly A Hendrie
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Danielle L Baird
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Emily Brindal
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Gemma Williams
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
| | - Jennie Brand-Miller
- Charles Perkins Centre and School of Life and Environmental Sciences, University of Sydney, Sydney, Australia
| | - Beverly Muhlhausler
- Nutrition and Health Program, Commonwealth Scientific and Industrial Research Organisation, Adelaide, Australia
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Tragni E, Vigna L, Ruscica M, Macchi C, Casula M, Santelia A, Catapano AL, Magni P. Reduction of Cardio-Metabolic Risk and Body Weight through a Multiphasic Very-Low Calorie Ketogenic Diet Program in Women with Overweight/Obesity: A Study in a Real-World Setting. Nutrients 2021; 13:nu13061804. [PMID: 34073344 PMCID: PMC8230107 DOI: 10.3390/nu13061804] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/10/2021] [Accepted: 05/22/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevention and treatment of obesity and its cardio-metabolic complications are relevant issues worldwide. Among lifestyle approaches, very low-calorie ketogenic diets (VLCKD) have been shown to lead to rapid initial weight loss, resulting in better long-term weight loss maintenance. As no information on VLCKD studies carried on in a real-world setting are available, we conducted this multi-centre study in a real-world setting, aiming at assessing the efficacy and the safety of a specific multiphasic VLCKD program in women with overweight or obesity. METHODS A multi-center, prospective, uncontrolled trial was conducted in 33 outpatient women (age range 27-60 y) with overweight or obesity (BMI: 30.9 ± 2.7 kg/m2; waist circumference: 96.0 ± 9.4 cm) who started a VLCKD dietary program (duration: 24 weeks), divided into four phases. The efficacy of VLCKD was assessed by evaluating anthropometric measures and cardiometabolic markers; liver and kidney function biomarkers were assessed as safety parameters. RESULTS The VLCKD program resulted in a significant decrease of body weight and BMI (-14.6%) and waist circumference (-12.4%). At the end of the protocol, 33.3% of the participants reached a normal weight and the subjects in the obesity range were reduced from 70% to 16.7%. HOMA-IR was markedly reduced from 3.17 ± 2.67 to 1.73 ± 1.23 already after phase 2 and was unchanged thereafter. Systolic blood pressure decreased after phase 1 (-3.5 mmHg) and remained unchanged until the end of the program. Total and LDL cholesterol and triglycerides were significantly reduced by VLCKD along with a significant HDL cholesterol increase. Liver, kidney and thyroid function markers did not change and remained within the reference range. CONCLUSIONS The findings of a multi-center VLCKD program conducted in a real-world setting in a cohort of overweight/obese women indicate that it is safe and effective, as it results in a major improvement of cardiometabolic parameters, thus leading to benefits that span well beyond the mere body weight/adiposity reduction.
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Affiliation(s)
- Elena Tragni
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (E.T.); (M.R.); (C.M.); (M.C.); (A.S.); (A.L.C.)
| | - Luisella Vigna
- Center of Obesity and Work EASO Collaborating Centers for Obesity Management, Occupational Health Unit, Fondazione Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Massimiliano Ruscica
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (E.T.); (M.R.); (C.M.); (M.C.); (A.S.); (A.L.C.)
| | - Chiara Macchi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (E.T.); (M.R.); (C.M.); (M.C.); (A.S.); (A.L.C.)
| | - Manuela Casula
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (E.T.); (M.R.); (C.M.); (M.C.); (A.S.); (A.L.C.)
- IRCCS MultiMedica, Sesto S. Giovanni, 20099 Milan, Italy
| | - Alfonso Santelia
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (E.T.); (M.R.); (C.M.); (M.C.); (A.S.); (A.L.C.)
| | - Alberico L. Catapano
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (E.T.); (M.R.); (C.M.); (M.C.); (A.S.); (A.L.C.)
- IRCCS MultiMedica, Sesto S. Giovanni, 20099 Milan, Italy
| | - Paolo Magni
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milan, Italy; (E.T.); (M.R.); (C.M.); (M.C.); (A.S.); (A.L.C.)
- IRCCS MultiMedica, Sesto S. Giovanni, 20099 Milan, Italy
- Correspondence: ; Tel.: +39-02-50318229
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Verberne LDM, Leemrijse CJ, Nielen MMJ, Friele RD. Intermediate weight changes and follow-up of dietetic treatment in primary health care: an observational study. BMC Nutr 2020; 6:62. [PMID: 33292684 PMCID: PMC7667732 DOI: 10.1186/s40795-020-00377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary health care data have shown that most patients who were treated for overweight or obesity by a dietitian did not accomplish the recommended treatment period. It is hypothesised that a slow rate of weight loss might discourage patients from continuing dietetic treatment. This study evaluated intermediate weight changes during regular dietetic treatment in Dutch primary health care, and examined whether weight losses at previous consultations were associated with attendance at follow-up consultations. METHODS This observational study was based on real life practice data of overweight and obese patients during the period 2013-2017, derived from Dutch dietetic practices that participated in the Nivel Primary Care Database. Multilevel regression analyses were conducted to estimate the mean changes in body mass index (BMI) during six consecutive consultations and to calculate odds ratios for the association of weight change at previous consultations with attendance at follow-up consultations. RESULTS The total study population consisted of 25,588 overweight or obese patients, with a mean initial BMI of 32.7 kg/m2. The BMI decreased between consecutive consultations, with the highest weight losses between the first and second consultation. After six consultations, a mean weight loss of - 1.5 kg/m2 was estimated. Patients who lost weight between the two previous consultations were more likely to attend the next consultation than patients who did not lose weight or gained weight. CONCLUSIONS Body mass index decreased during consecutive consultations, and intermediate weight losses were associated with a higher attendance at follow-up consultations during dietetic treatment in overweight patients. Dietitians should therefore focus on discussing intermediate weight loss expectations with their patients.
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Affiliation(s)
- Lisa D M Verberne
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands.
| | - Chantal J Leemrijse
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
| | - Markus M J Nielen
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
| | - Roland D Friele
- Nivel, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands.,Tilburg School of Social and Behavioral Sciences, Tilburg University, Tranzo, P.O. Box 90153, Tilburg, 5000 LE, The Netherlands
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Zhang Y, Chen X, Allison DB, Xun P. Efficacy and safety of a specific commercial high-protein meal-replacement product line in weight management: meta-analysis of randomized controlled trials. Crit Rev Food Sci Nutr 2020; 62:798-809. [PMID: 33938779 DOI: 10.1080/10408398.2020.1829539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Protein is suggested to be the nutrient providing the most satiety and is frequently used in meal-replacement products to achieve weight loss. Commercial products such as Herbalife high-protein (HP) products have been studied in various clinical trials, but controversy remains regarding their efficacy and safety. METHODS We searched the PubMed, Center for Clinical and Translational Research (CCTR), and Google Scholar databases for randomized controlled trials of Herbalife HP products used as meal replacement (MR) published through July 2019 in peer-reviewed journals. We reviewed changes in efficacy and safety-related outcomes in treatment and control groups, and we estimated the pooled standardized mean difference (SMD) and corresponding 95% confidence intervals (CIs) with a DerSimonian and Laird random-effects method. RESULTS By pooling data from nine identified studies (934 participants: 463 in treatment groups and 471 in control groups), we found that participants who consumed HP products experienced significantly larger decreases in body weight (SMD = -0.24; 95% CI: -0.37 to -0.10), body mass index (SMD = -0.31; 95% CI: -0.50 to -0.11), and fat mass (SMD = -0.37; 95% CI: -0.65 to -0.09) than did individuals consuming control diets. Concerning safety outcomes, the participants in the treatment group had a significantly larger decrease in aspartate aminotransferase (SMD = -0.23; 95% CI: -0.42 to -0.03). There were no significant between-group differences in alanine aminotransferase or creatinine. However, blood urea nitrogen levels increased in both groups, with a significantly larger increase in the treatment group (SMD = 0.53; 95% CI: 0.15 to 0.92). CONCLUSIONS Herbalife HP MR products appear effective and do not evidence significant risk in reducing body weight.
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Affiliation(s)
- Yijia Zhang
- Department of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, Indiana, USA
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, Indiana, USA
| | - David B Allison
- Department of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, Indiana, USA
| | - Pengcheng Xun
- Department of Epidemiology and Biostatistics, School of Public Health - Bloomington, Indiana University, Bloomington, Indiana, USA
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17
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Oberle MM, Loth KA, Schendel A, Fox CK, Gross AC. Acceptance of a meal kit programme in an outpatient paediatric weight management clinic: A qualitative pilot study. Clin Obes 2020; 10:e12371. [PMID: 32533649 DOI: 10.1111/cob.12371] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 12/19/2022]
Abstract
Lack of food preparation knowledge, time to prepare meals and concerns about fruit and vegetable spoilage before consumption are the potential barriers to home cooking. These barriers may be addressed by meal kits (bundles of recipes and ingredients). We described home cooking barriers and evaluated acceptability of meal kits, using semi-structured focus groups with caregivers and adolescent patients of an outpatient paediatric weight management clinic. One meal kit per family, containing non-perishable food, a $20 gift card to a grocery store and recipes designed by clinic dietician for two meals, were given at clinic appointments. Two in-person semi-structured focus groups were conducted within 2 weeks of meal kit receipt. Four adolescent participants (75% female; 12.7 ± 0.9 years) and eight caregivers (88% female) participated in the focus groups. Four barriers to home cooking were identified: (a) healthy food cost, (b) preparation time, (c) food preparation knowledge and (d) picky eaters. Participants felt the meal kits addressed the time and lack of food preparation knowledge barriers to home cooking. A clinical meal kit programme was acceptable to a treatment-seeking adolescent population with obesity and their caregivers.
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Affiliation(s)
- Megan M Oberle
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Katie A Loth
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Anne Schendel
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Claudia K Fox
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Amy C Gross
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Pediatric Obesity Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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18
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Abstract
Obesity is a chronic, systemic disease defined as a pathologically increased fat mass, which is associated with an increased health risk. A BMI >30 kg/m2 is usually considered as a sign of obesity. Obesity requires a multidisciplinary and multimodal treatment, which varies depending on the phase of disease and the purpose (e.g. weight loss, weight maintenance). The treatment should be based on evidence. The goal of obesity therapy is to reduce the body weight by reducing fat mass in the long term in combination with a change in behavior, which aims to improve obesity-associated risk factors, reduce obesity-related illnesses, reduce the risk of premature mortality, incapacitation and early retirement, and improve quality of life. Non-surgical lifestyle therapy comprises nutrition, exercise, behavior change ("basic therapy") which becomes more effective when combined with initial formula diet. A formula diet as initial therapy is indicated if a relative weight loss more than 10% is intended. A successful and sustained obesity therapy needs a clear structure, a well-trained team of professionals, and the coverage of the costs. Drugs can support obesity therapy, while other drugs can promote weight gain. The multimodal approach is the most effective non-surgical therapy resulting in a relative weight loss of 15-25%. The primary obesity therapy should be with a non-surgical approach, but bariatric surgery may be needed if the problem cannot otherwise be solved. A clear and realistic interface to bariatric surgery needs to be defined. Weight maintenance strategies including and beyond dietetic concepts are usually needed throughout life for long-term stabilization of body weight.
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Affiliation(s)
- Stephan C Bischoff
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany.
| | - Anna Schweinlin
- University of Hohenheim, Institute of Nutritional Medicine, Stuttgart, Germany
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19
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Beyond Body Weight-Loss: Dietary Strategies Targeting Intrahepatic Fat in NAFLD. Nutrients 2020; 12:nu12051316. [PMID: 32384593 PMCID: PMC7284418 DOI: 10.3390/nu12051316] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has emerged as the most prevalent liver disease in industrialized countries. It is regarded as the hepatic manifestation of the metabolic syndrome (MetS) resulting from insulin resistance. Moreover, insulin resistance impairs glycogen synthesis, postprandially diverting a substantial amount of carbohydrates to the liver and storing them there as fat. NAFLD has far-reaching metabolic consequences involving glucose and lipoprotein metabolism disorders and risk of cardiovascular disease, the leading cause of death worldwide. No pharmaceutical options are currently approved for the treatment of NAFLD. Exercise training and dietary interventions remain the cornerstone of NAFLD treatment. Current international guidelines state that the primary goal of nutritional therapy is to reduce energy intake to achieve a 7%-10% reduction in body weight. Meal replacement therapy (formula diets) results in more pronounced weight loss compared to conventional calorie-restricted diets. However, studies have shown that body mass index (BMI) or weight reduction is not obligatory for decreasing hepatic fat content or to restore normal liver function. Recent studies have achieved significant reductions in liver fat with eucaloric diets and without weight loss through macronutrient modifications. Based on this evidence, an integrative nutritional therapeutic concept was formulated that combines the most effective nutrition approaches termed "liver-fasting." It involves the temporary use of a low calorie diet (total meal replacement with a specific high-protein, high-soluble fiber, lower-carbohydrate formula), followed by stepwise food reintroduction that implements a Mediterranean style low-carb diet as basic nutrition.
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Sammito S, Prigge M, Latza U. Predictors for continued participation of employees in structured outpatient obesity intervention programmes. Prev Med Rep 2020; 17:101051. [PMID: 32042573 PMCID: PMC6997892 DOI: 10.1016/j.pmedr.2020.101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 01/01/2020] [Accepted: 01/11/2020] [Indexed: 11/24/2022] Open
Abstract
Background Overweight, obesity and the conditions resulting from them have become one of the major challenges for health systems all over the world. High dropout rates are particularly common among the participants in outpatient obesity intervention programmes (OIP). Limited research has examined retention in OIP. Methods Based on the data of a 24-month Bundeswehr outpatient OIP with a total of 630 participants, predisposing factors (n = 30) for continued participation beyond an early stage (0–3 months) and beyond a later stage (0–6 months) were analysed by means of a logistic regression analysis. In order to correct for multiple-comparison, the p-value was adjusted (p* < 0.0017). Results Three hundred out of 630 participants continued to participate beyond an early stage and 205 beyond a later stage. Besides an age between 40 and 50 at the beginning of the outpatient OIP, it was possible to show that knowledge of one’s blood pressure and a positive lifestyle prior to participation in the programme (higher level of sporting activity) were predisposing factors for early dropout (>3 months) in the intervention programme. Discussion The possible predisposing factors examined accounted for about 35% of the variance in a rough estimate. In order to improve long-term participation in workplace outpatient OIP, the study focused on how the motivation of older people and employees with an unfavourable cardiovascular risk profile could be improved.
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Affiliation(s)
- Stefan Sammito
- Air Force Centre of Aerospace Medicine, Research & Development, Cologne, Germany.,Otto von Guericke University Magdeburg, Medical Faculty, Department of Occupational Medicine, Magdeburg, Germany
| | - Michaela Prigge
- Federal Institute for Occupational Safety and Medicine, Unit 3.1 "Prevention of Work-related Disorders", Berlin, Germany
| | - Ute Latza
- Federal Institute for Occupational Safety and Medicine, Unit 3.1 "Prevention of Work-related Disorders", Berlin, Germany
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21
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Castaldo G, Rastrelli L, Galdo G, Molettieri P, Rotondi Aufiero F, Cereda E. Aggressive weight-loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: A proof-of-concept, single-arm, open-label clinical trial. Nutrition 2020; 74:110757. [PMID: 32222582 DOI: 10.1016/j.nut.2020.110757] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/13/2019] [Accepted: 11/27/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES A very low-calorie ketogenic diet (VLCKD) has been associated with a significant reduction in visceral adipose tissue and ketone bodies that likely possess antiinflammatory properties. We evaluated the efficacy of an aggressive weight-loss (WL) program with a ketogenic induction phase as first-line treatment for chronic plaque psoriasis. METHODS Adult patients who were overweight or obese and drug-naïve (i.e., never treated, excluding the use of topical emollients; n = 37; 30% men; age: 43.1 ± 13.8 y) with stable chronic plaque psoriasis underwent a 10-wk, 2-phase WL program consisting of a 4-wk protein-sparing, VLCKD (<500 kcal/d; 1.2 g of protein/kg of ideal body weight/d) and 6-wk balanced, hypocaloric (25-30 kcal/kg of ideal body weight/d), Mediterranean-like diet. The primary endpoint was the reduction in Psoriasis Area and Severity Index (PASI) score at wk 10. Major secondary endpoints included PASI score responses of ≥50% and ≥75%, reduction in body surface area involved, improvement in itch severity (visual analogue scale), and Dermatology Life Quality Index score at wk 10. RESULTS With a mean body weight reduction of 12.0% (-10.6 kg), the dietary intervention resulted in a significant reduction in PASI (baseline score: 13.8 ± 6.9; range, 7-32), with a mean change of -10.6 (95% confidence interval, -12.8 to -8.4; P < 0.001). PASI score responses of ≥50% and ≥75% were recorded in 36 patients (97.3%) and 24 patients (64.9%), respectively. Treatment also resulted in a significant reduction (P < 0.001) in the body surface area involved (-17.4%) and an improvement in itch severity (-33.2 points) and Dermatology Life Quality Index score (-13.4 points). CONCLUSIONS In drug-naïve adult overweight patients with stable chronic plaque psoriasis, an aggressive dietary WL program consisting of a VLCKD, followed by a balanced, hypocaloric, Mediterranean-like diet, appeared to be an effective first-line strategy to reduce disease severity.
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Affiliation(s)
- Giuseppe Castaldo
- Nutriketo Lab A.O.R.N. San Giuseppe Moscati, Contrada Amoretta, Avellino, Italy; University of Salerno, Salerno, Italy.
| | - Luca Rastrelli
- Department of Pharmacy, Faculty of Pharmacy, University of Salerno, Fisciano, Salerno, Italy
| | - Giovanna Galdo
- Oncologic Dermatology Unit, IRCCS-CROB, Rionero in Vulture, Potenza, Italy
| | - Paola Molettieri
- Nutriketo Lab A.O.R.N. San Giuseppe Moscati, Contrada Amoretta, Avellino, Italy
| | | | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Bourke S, Morton JM, Williams P. Effect of JumpstartMD, a Commercial Low-Calorie Low-Carbohydrate Physician-Supervised Weight Loss Program, on 22,407 Adults. J Obes 2020; 2020:8026016. [PMID: 32318289 PMCID: PMC7157789 DOI: 10.1155/2020/8026016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 09/10/2019] [Accepted: 11/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Commercial weight loss programs provide valuable consumer options for those desiring support. Several commercial programs are reported to produce ≥3-fold greater weight loss than self-directed dieting. The effectiveness of JumpstartMD, a commercial pay-as-you-go program that emphasizes a low-to-very-low-carbohydrate real-food diet and optional pharmacologic treatment without prepackaged meals or meal replacement, has not previously been described. METHODS Completer and last observation carried forward (LOCF) of clinic-measured weight loss (kg) in 18,769 female and 3638 male JumpstartMD participants. RESULTS Completers lost (mean ± SE) 8.7 ± 0.04 kg, 9.5 ± 0.04% with 44.5 ± 0.5% achieving ≥10% weight loss at 3 months (mo, N = 14,999 completers); 11.8 ± 0.1 kg, 12.6 ± 0.1% with 66.4 ± 0.6% achieving ≥10% weight loss at 6 mo (N = 11,805); and 11.5 ± 0.2 kg, 12.0 ± 0.2% with 57.6 ± 0.9% achieving ≥10% weight loss at 12 mo (N = 8514). LOCF estimates were -6.5 ± 0.03 kg, -7.2 ± 0.03% with 27.1 ± 0.3% achieving ≥10% weight loss at 3 mo; -7.7 ± 0.04 kg, -8.5 ± 0.04% with 36.3 ± 0.3% achieving ≥10% weight loss at 6 mo; and -7.7 ± 0.1 kg, -8.4 ± 0.1% with 34.6 ± 0.3% achieving ≥10% weight loss after 12 mo. Frequent health coach meetings was a major determinant of weight loss, with women and men attending ≥75% of their weekly appointments losing 8.8 ± 0.04 and 11.9 ± 0.1 kg, respectively, after 3 mo, 13.1 ± 0.1 and 16.5 ± 0.3 kg after 6 mo, and 16.5 ± 0.3 and 19.4 ± 0.8 kg after 12 mo. Phentermine and phendimetrazine had a minor effect in women only at 1 (6.1% greater weight loss than untreated), 2 (4.1%), and 3 mo (1.2%), but treated patients showed longer enrollment than nontreated during the first 3 (females: +0.4 ± 0.01; males: +0.3 ± 0.04 mo), 6 (females: +1.1 ± 0.04; males: +1.0 ± 0.1 mo), and 12 mo (females: +2.7 ± 0.1; males: +2.4 ± 0.2 mo). JumpstartMD produced generally greater weight loss than published reports for other real-food and prepackaged-meal commercial programs and somewhat greater or comparable losses to meal replacement diets. CONCLUSION A one-on-one medically supervised program that emphasized real low-carbohydrate foods produced effective weight loss, particularly in those attending ≥75% of their weekly appointments.
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Affiliation(s)
- Sean Bourke
- JumpstartMD, 350 Lorton Ave, Burlingame, CA 94010, USA
| | - John Magaña Morton
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Paul Williams
- Childrens Hospital Oakland Research Institute, Oakland, CA, USA
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23
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Chester B, Babu JR, Greene MW, Geetha T. The effects of popular diets on type 2 diabetes management. Diabetes Metab Res Rev 2019; 35:e3188. [PMID: 31121637 DOI: 10.1002/dmrr.3188] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/09/2019] [Accepted: 05/17/2019] [Indexed: 12/23/2022]
Abstract
Type 2 diabetes can be managed with the use of diabetes self-management skills. Diet and exercise are essential segments of the lifestyle changes necessary for diabetes management. However, diet recommendations can be complicated in a world full of different diets. This review aims to evaluate the evidence on the effects of three popular diets geared towards diabetes management: low-carbohydrate and ketogenic diet, vegan diet, and the Mediterranean diet. While all three diets have been shown to assist in improving glycaemic control and weight loss, patient adherence, acceptability, and long-term manageability play essential roles in the efficacy of each diet.
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Affiliation(s)
- Brittannie Chester
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama
| | - Jeganathan Ramesh Babu
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, Alabama
- Center for Neuroscience Initiative, Auburn University, Auburn, Alabama
| | - Michael W Greene
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, Alabama
- Center for Neuroscience Initiative, Auburn University, Auburn, Alabama
| | - Thangiah Geetha
- Department of Nutrition, Dietetics, and Hospitality Management, Auburn University, Auburn, Alabama
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, Alabama
- Center for Neuroscience Initiative, Auburn University, Auburn, Alabama
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24
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Abstract
PURPOSE OF REVIEW Obesity is increasing at an alarming rate and now poses a global threat to humankind. In recent years, we have seen the emergence of medical devices to combat the obesity epidemic. These therapeutic strategies are discussed in this review dividing them into gastric and duodenal therapies. RECENT FINDINGS Traditionally, medical devices for obesity such as the intragastric balloon have focused on reducing gastric size, but more recently there has been a shift towards developing devices that modulate neural and hormonal responses to induce early satiety thus reducing oral intake. Medical devices for obesity treatment may have a role in those patients who are struggling to control their weight despite significant lifestyle modifications such as diet and exercise and who decline or are unfit for bariatric surgery. For the wider adoption and integration of these devices in the obesity treatment paradigm, more long-term efficacy and safety data from randomised controlled trials are required.
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Affiliation(s)
- Aruchuna Ruban
- Imperial College London, St Mary’s Campus, London, W2 1NY UK
| | - Akash Doshi
- Department of Surgery & Cancer, Homerton University Hospital, London, E9 6SR UK
| | - Erika Lam
- Department of Surgery & Cancer, Homerton University Hospital, London, E9 6SR UK
| | - Julian P. Teare
- Imperial College London, St Mary’s Campus, London, W2 1NY UK
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25
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Gargallo-Vaamonde J, Perdomo CM, de la Higuera M, Frühbeck G, Salvador J. Is pharmacotherapy enough for urgent weight loss in severely obese patients? Expert Opin Pharmacother 2018; 20:367-371. [PMID: 30576254 DOI: 10.1080/14656566.2018.1559818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Carolina M Perdomo
- a Department of Endocrinology & Nutrition , Clínica Universidad de Navarra , Pamplona , Spain
| | - Magdalena de la Higuera
- a Department of Endocrinology & Nutrition , Clínica Universidad de Navarra , Pamplona , Spain
| | - Gema Frühbeck
- a Department of Endocrinology & Nutrition , Clínica Universidad de Navarra , Pamplona , Spain.,b Metabolic Research Laboratory , University of Navarra, IdiSNA , Pamplona , Spain.,c CIBEROBN, Instituto de Salud Carlos III , Madrid , Spain
| | - Javier Salvador
- a Department of Endocrinology & Nutrition , Clínica Universidad de Navarra , Pamplona , Spain.,c CIBEROBN, Instituto de Salud Carlos III , Madrid , Spain
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26
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Delahaye LB, Bloomer RJ, Butawan MB, Wyman JM, Hill JL, Lee HW, Liu AC, McAllan L, Han JC, van der Merwe M. Time-restricted feeding of a high-fat diet in male C57BL/6 mice reduces adiposity but does not protect against increased systemic inflammation. Appl Physiol Nutr Metab 2018; 43:1033-1042. [PMID: 29717885 DOI: 10.1139/apnm-2017-0706] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2023]
Abstract
Time-restricted feeding (TRF) limits the duration of food availability without altering diet composition and can combat obesity in humans and mice. For this study we evaluated the effect of timing of food access during a TRF protocol on weight gain, adiposity, and inflammation. Young male C57BL/6 mice were placed on a high-fat (HF) diet (45% fat) for 8 weeks. Food access was unrestricted (HF) or restricted to 6 h per day, either for the first half (HF-early) or the second half (HF-late) of the active phase to resemble a window of time for food consumption early or late in the day in a human population. Weight, obesity-associated parameters, and inflammation were measured. TRF reduced weight gain over the 8-week period in mice consuming the same high-fat diet. Consistent with decreased weight gain in the TRF groups, body fat percentage, liver triglycerides, and plasma leptin and cholesterol levels were reduced. Adipose tissue inflammation, measured by CD11b+F4/80+ macrophage infiltration, was reduced in both TRF groups, but systemic tumor necrosis factor-α was increased in all groups consuming the high-fat diet. The HF-late group gained more weight than the HF-early group and had increased insulin resistance, while the HF-early group was protected. Therefore, a TRF protocol is beneficial for weight management when a high-fat diet is consumed, with food consumption earlier in the day showing greater health benefits. However, increased inflammatory markers in the TRF groups suggest that diet components can still increase inflammation even in the absence of overt obesity.
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Affiliation(s)
- Laura B Delahaye
- a School of Health Studies, University of Memphis, Memphis, TN 38152, USA
| | - Richard J Bloomer
- a School of Health Studies, University of Memphis, Memphis, TN 38152, USA
| | - Matthew B Butawan
- a School of Health Studies, University of Memphis, Memphis, TN 38152, USA
| | - Jacqueline M Wyman
- a School of Health Studies, University of Memphis, Memphis, TN 38152, USA
| | - Jessica L Hill
- a School of Health Studies, University of Memphis, Memphis, TN 38152, USA
| | - Harold W Lee
- a School of Health Studies, University of Memphis, Memphis, TN 38152, USA
| | - Andrew C Liu
- b Department of Biological Sciences, University of Memphis, Memphis, TN 38152, USA
| | - Liam McAllan
- c Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Joan C Han
- c Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA
- d Department of Physiology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- e Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN 38103, USA
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Meyer A, Montastier E, Hager J, Saris WHM, Astrup A, Viguerie N, Valsesia A. Plasma metabolites and lipids predict insulin sensitivity improvement in obese, nondiabetic individuals after a 2-phase dietary intervention. Am J Clin Nutr 2018; 108:13-23. [PMID: 29878058 PMCID: PMC6600064 DOI: 10.1093/ajcn/nqy087] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/04/2018] [Indexed: 02/06/2023] Open
Abstract
Background Weight loss in obese individuals aims to reduce the risk of type 2 diabetes by improving glycemic control. Yet, significant intersubject variability is observed and the outcomes remain poorly predictable. Objective The aim of the study was to predict whether an individual will show improvements in insulin sensitivity above or below the median population change at 6 mo after a low-calorie-diet (LCD) intervention. Design With the use of plasma lipidomics and metabolomics for 433 subjects from the Diet, Obesity, and Genes (DiOGenes) Study, we attempted to predict good or poor Matsuda index improvements 6 mo after an 8-wk LCD intervention (800 kcal/d). Three independent analysis groups were defined: "training" (n = 119) for model construction, "testing" (n = 162) for model comparison, and "validation" (n = 152) to validate the final model. Results Initial modeling with baseline clinical variables (body mass index, Matsuda index, total lipid concentrations, sex, age) showed limited performance [area under the curve (AUC) on the "testing dataset" = 0.69; 95% CI: 0.61, 0.77]. Significantly better performance was achieved with an omics model based on 27 variables (AUC = 0.77; 95% CI: 0.70, 0.85; P = 0.0297). This model could be greatly simplified while keeping the same performance. The simplified model relied on baseline Matsuda index, proline, and phosphatidylcholine 0-34:1. It successfully replicated on the validation set (AUC = 0.75; 95% CI: 0.67, 0.83) with the following characteristics: specificity = 0.73, sensitivity = 0.68, negative predictive value = 0.60, and positive predictive value = 0.80. Marginally lower performance was obtained when replacing the Matsuda index with homeostasis model assessment of insulin resistance (AUC = 0.72; 95% CI: 0.64, 0.80; P = 0.08). Conclusions Our study proposes a model to predict insulin sensitivity improvements, 6 mo after LCD completion in a large population of overweight or obese nondiabetic subjects. It relies on baseline information from 3 variables, accessible from blood samples. This model may help clinicians assessing the large variability in dietary interventions and predict outcomes before an intervention. This trial was registered at www.clinicaltrials.gov as NCT00390637.
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Affiliation(s)
- Antonin Meyer
- Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Emilie Montastier
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 1048, Institute of Metabolic and Cardiovascular Diseases, University of Toulouse, Toulouse, France,Department of Clinical Biochemistry and Nutrition, Toulouse University Hospital, Toulouse, France
| | - Jörg Hager
- Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Wim H M Saris
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Arne Astrup
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Nathalie Viguerie
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 1048, Institute of Metabolic and Cardiovascular Diseases, University of Toulouse, Toulouse, France
| | - Armand Valsesia
- Nestlé Institute of Health Sciences, Lausanne, Switzerland,Address correspondence to AV (e-mail: )
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Weight loss, adverse events, and loss to follow-up after gastric bypass in young versus older adults: A Scandinavian Obesity Surgery Registry study. Surg Obes Relat Dis 2018; 14:1319-1326. [PMID: 30056048 DOI: 10.1016/j.soard.2018.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/16/2018] [Accepted: 06/05/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Young adults display particularly poor weight loss in behavioral obesity treatment; nonetheless, they have seldom been included in bariatric research. OBJECTIVES To compare weight loss, adverse events, and loss to follow-up in young (18-25 yr) versus older (≥26 yr) adults up to 5 years after Roux-en-Y gastric bypass. SETTING Nationwide, register-based study, Sweden. METHODS Prospective registry data (Scandinavian Obesity Surgery Register) were analyzed in young (22.2 yr [standard deviation (SD): 2.1], 81.6% women, mean body mass index 43.7 kg/m2 [SD: 5.4]) and older (42.6 years [SD: 9.6], 82.0% women, mean body mass index 43.4 kg/m2 [SD: 5.0]) adults undergoing Roux-en-Y gastric bypass. Groups were matched for body mass index, sex, and year of surgery. Regression analyses and mixed models were used to compare outcomes between groups. RESULTS A total of 369 young (37.0% of eligible) and 2210 older (46.1%) adults attended the 5-year follow-up. At this time, weight loss was 31.8% in young and 28.2% in older adults (P < .001), with a serious adverse event (Clavien-Dindo ≥3b) being reported in 52 (14.1%) young and 153 (6.9%) older adults (odds ratio = 2.06, 95% confidence interval: 1.45-2.92, P < .001). Loss to follow-up was higher in young versus older adults throughout the study period (range of relative risk = 1.16-1.89, P < .001). CONCLUSIONS While young adults displayed at least equal weight loss as older adults, rates of adverse events were approximately doubled, and loss to follow-up rates were higher. Future studies on the significance of and the etiology behind the higher incidence of serious adverse events are needed. Intensified clinical contact post Roux-en-Y gastric bypass should have the potential to further improve outcomes in young adults.
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Meyhöfer S, Steffen A, Kalscheuer H, Wilms B, Schmid SM. Konservative Therapie der Adipositas. SOMNOLOGIE 2018. [DOI: 10.1007/s11818-018-0159-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
PURPOSE OF REVIEW Emerging adulthood (age 18-25) represents a critical period for weight control: rate of weight gain is greatest during these years and the prevalence of overweight and obesity is estimated to be at least 40% among emerging adults. Unique behavioral, psychosocial, and cognitive risk factors among this population must be specifically addressed within weight management programs. We review extant treatment approaches, including lessons learned from the nascent literature specifically targeting this population. Lastly, we provide suggestions to inform future work in this area. RECENT FINDINGS The EARLY consortium comprises seven clinical trials targeting weight control in young adults age 18-35. Though these studies encompass a broader age range, two of the trials enrolled large numbers of 18-25-year-olds. Results from these trials and other recent pilot trials provide a foundation for next steps with respect to developing weight management interventions for emerging adults. The design of targeted weight control approaches for emerging and young adults has contributed to improved outcomes for this high-risk population. However, suboptimal engagement and variability in response pose challenges. Identifying and intervening on individual-level behavioral and psychological variables may enhance the effects of these adapted treatments.
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Affiliation(s)
- Autumn Lanoye
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin Street Box 842018, Richmond, VA, 23284, USA
| | - Kristal L Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA
| | - Jessica G LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, 830 East Main Street, Richmond, VA, 23219, USA.
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McEvedy SM, Sullivan-Mort G, McLean SA, Pascoe MC, Paxton SJ. Ineffectiveness of commercial weight-loss programs for achieving modest but meaningful weight loss: Systematic review and meta-analysis. J Health Psychol 2017; 22:1614-1627. [PMID: 28810454 DOI: 10.1177/1359105317705983] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
This study collates existing evidence regarding weight loss among overweight but otherwise healthy adults who use commercial weight-loss programs. Systematic search of 3 databases identified 11 randomized controlled trials and 14 observational studies of commercial meal-replacement, calorie-counting, or pre-packaged meal programs which met inclusion criteria. In meta-analysis using intention-to-treat data, 57 percent of individuals who commenced a commercial weight program lost less than 5 percent of their initial body weight. One in two (49%) studies reported attrition ≥30 percent. A second meta-analysis found that 37 percent of program completers lost less than 5 percent of initial body weight. We conclude that commercial weight-loss programs frequently fail to produce modest but clinically meaningful weight loss with high rates of attrition suggesting that many consumers find dietary changes required by these programs unsustainable.
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Armenise C, Lefebvre G, Carayol J, Bonnel S, Bolton J, Di Cara A, Gheldof N, Descombes P, Langin D, Saris WH, Astrup A, Hager J, Viguerie N, Valsesia A. Transcriptome profiling from adipose tissue during a low-calorie diet reveals predictors of weight and glycemic outcomes in obese, nondiabetic subjects. Am J Clin Nutr 2017; 106:736-746. [PMID: 28793995 DOI: 10.3945/ajcn.117.156216] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background: A low-calorie diet (LCD) reduces fat mass excess, improves insulin sensitivity, and alters adipose tissue (AT) gene expression, yet the relation with clinical outcomes remains unclear.Objective: We evaluated AT transcriptome alterations during an LCD and the association with weight and glycemic outcomes both at LCD termination and 6 mo after the LCD.Design: Using RNA sequencing (RNAseq), we analyzed transcriptome changes in AT from 191 obese, nondiabetic patients within a multicenter, controlled dietary intervention. Expression changes were associated with outcomes after an 8-wk LCD (800-1000 kcal/d) and 6 mo after the LCD. Results were validated by using quantitative reverse transcriptase-polymerase chain reaction in 350 subjects from the same cohort. Statistical models were constructed to classify weight maintainers or glycemic improvers.Results: With RNAseq analyses, we identified 1173 genes that were differentially expressed after the LCD, of which 350 and 33 were associated with changes in body mass index (BMI; in kg/m2) and Matsuda index values, respectively, whereas 29 genes were associated with both endpoints. Pathway analyses highlighted enrichment in lipid and glucose metabolism. Classification models were constructed to identify weight maintainers. A model based on clinical baseline variables could not achieve any classification (validation AUC: 0.50; 95% CI: 0.36, 0.64). However, clinical changes during the LCD yielded better performance of the model (AUC: 0.73; 95% CI: 0.60, 0.87]). Adding baseline expression to this model improved the performance significantly (AUC: 0.87; 95% CI: 0.77, 0.96; Delong's P = 0.012). Similar analyses were performed to classify subjects with good glycemic improvements. Baseline- and LCD-based clinical models yielded similar performance (best AUC: 0.73; 95% CI: 0.60, 0.86). The addition of expression changes during the LCD improved the performance substantially (AUC: 0.80; 95% CI: 0.69, 0.92; P = 0.058).Conclusions: This study investigated AT transcriptome alterations after an LCD in a large cohort of obese, nondiabetic patients. Gene expression combined with clinical variables enabled us to distinguish weight and glycemic responders from nonresponders. These potential biomarkers may help clinicians understand intersubject variability and better predict the success of dietary interventions. This trial was registered at clinicaltrials.gov as NCT00390637.
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Affiliation(s)
| | | | - Jérôme Carayol
- Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Sophie Bonnel
- Institute of Metabolic and Cardiovascular Diseases, French National Institute of Health and Medical Research, Paul Sabatier University, UMR1048, Obesity Research Laboratory, University of Toulouse, Toulouse, France
| | - Jennifer Bolton
- Institute of Metabolic and Cardiovascular Diseases, French National Institute of Health and Medical Research, Paul Sabatier University, UMR1048, Obesity Research Laboratory, University of Toulouse, Toulouse, France
| | | | - Nele Gheldof
- Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | | | - Dominique Langin
- Institute of Metabolic and Cardiovascular Diseases, French National Institute of Health and Medical Research, Paul Sabatier University, UMR1048, Obesity Research Laboratory, University of Toulouse, Toulouse, France.,Department of Clinical Biochemistry, Toulouse University Hospitals, Toulouse, France
| | - Wim Hm Saris
- Department of Human Biology, School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands; and
| | - Arne Astrup
- University of Copenhagen, Department of Nutrition, Exercise and Sports, Faculty of Science, Copenhagen, Denmark
| | - Jörg Hager
- Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - Nathalie Viguerie
- Institute of Metabolic and Cardiovascular Diseases, French National Institute of Health and Medical Research, Paul Sabatier University, UMR1048, Obesity Research Laboratory, University of Toulouse, Toulouse, France
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Bischoff SC, Boirie Y, Cederholm T, Chourdakis M, Cuerda C, Delzenne NM, Deutz NE, Fouque D, Genton L, Gil C, Koletzko B, Leon-Sanz M, Shamir R, Singer J, Singer P, Stroebele-Benschop N, Thorell A, Weimann A, Barazzoni R. Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clin Nutr 2017; 36:917-938. [DOI: 10.1016/j.clnu.2016.11.007] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 12/13/2022]
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Ng WL, Peeters A, Näslund I, Ottosson J, Johansson K, Marcus C, Shaw JE, Bruze G, Sundström J, Neovius M. Change in Use of Sleep Medications After Gastric Bypass Surgery or Intensive Lifestyle Treatment in Adults with Obesity. Obesity (Silver Spring) 2017; 25:1451-1459. [PMID: 28660652 PMCID: PMC5533175 DOI: 10.1002/oby.21908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the change in use of hypnotics and/or sedatives after gastric bypass surgery or intensive lifestyle modification in adults with obesity. METHODS Adults with obesity who underwent gastric bypass surgery or initiated intensive lifestyle modification between 2007 and 2012 were identified through the Scandinavian Obesity Surgery Registry and a Swedish commercial weight loss database. The two cohorts were matched on BMI, age, sex, education, history of hypnotics and/or sedatives use, and treatment year (surgery n = 20,626; lifestyle n = 11,973; 77% women, mean age 41 years, mean BMI 41 kg/m2 ). The proportion of participants with filled hypnotics and/or sedatives prescriptions was compared yearly for 3 years. RESULTS In the matched treatment cohorts, 4% had filled prescriptions for hypnotics and/or sedatives during the year before treatment. At 1 year follow-up, following an average weight loss of 37 kg and 18 kg in the surgery and intensive lifestyle cohorts, respectively, this proportion had increased to 7% in the surgery cohort but remained at 4% in the intensive lifestyle cohort (risk ratio 1.7; 95% CI: 1.4-2.1); at 2 years, the proportion had increased to 11% versus 5% (risk ratio 2.0; 95% CI: 1.7-2.4); and at 3 years, it had increased to 14% versus 6% (risk ratio 2.2; 95% CI: 1.9-2.6). CONCLUSIONS Gastric bypass surgery was associated with increased use of hypnotics and/or sedatives compared with intensive lifestyle modification.
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Affiliation(s)
- Winda L. Ng
- Department of MedicineSolna, Clinical Epidemiology Unit, Karolinska InstitutetStockholmSweden
- Clinical Diabetes and EpidemiologyBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
- School of Health and Social Development, Faculty of Health, Deakin University, GeelongVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash University, MelbourneVictoriaAustralia
| | - Anna Peeters
- School of Health and Social Development, Faculty of Health, Deakin University, GeelongVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash University, MelbourneVictoriaAustralia
| | - Ingmar Näslund
- Department of SurgeryFaculty of Medicine and Health, Örebro UniversityÖrebroSweden
| | - Johan Ottosson
- Department of SurgeryFaculty of Medicine and Health, Örebro UniversityÖrebroSweden
| | - Kari Johansson
- Department of MedicineSolna, Clinical Epidemiology Unit, Karolinska InstitutetStockholmSweden
| | - Claude Marcus
- Department of Clinical ScienceIntervention and Technology, Karolinska InstitutetStockholmSweden
| | - Jonathan E. Shaw
- Clinical Diabetes and EpidemiologyBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
- Department of Epidemiology and Preventive MedicineMonash University, MelbourneVictoriaAustralia
| | - Gustaf Bruze
- Department of MedicineSolna, Clinical Epidemiology Unit, Karolinska InstitutetStockholmSweden
| | - Johan Sundström
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Martin Neovius
- Department of MedicineSolna, Clinical Epidemiology Unit, Karolinska InstitutetStockholmSweden
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Sundström J, Bruze G, Ottosson J, Marcus C, Näslund I, Neovius M. Weight Loss and Heart Failure: A Nationwide Study of Gastric Bypass Surgery Versus Intensive Lifestyle Treatment. Circulation 2017; 135:1577-1585. [PMID: 28258170 PMCID: PMC5404408 DOI: 10.1161/circulationaha.116.025629] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 02/22/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Associations of obesity with incidence of heart failure have been observed, but the causality is uncertain. We hypothesized that gastric bypass surgery leads to a lower incidence of heart failure compared with intensive lifestyle modification in obese people. METHODS We included obese people without previous heart failure from a Swedish nationwide registry of people treated with a structured intensive lifestyle program and the Scandinavian Obesity Surgery Registry. All analyses used inverse probability weights based on baseline body mass index and a propensity score estimated from baseline variables. Treatment groups were well balanced in terms of weight, body mass index, and most potential confounders. Associations of treatment with heart failure incidence, as defined in the National Patient Register, were analyzed with Cox regression. RESULTS The 25 804 gastric bypass surgery patients had on average lost 18.8 kg more weight after 1 year and 22.6 kg more after 2 years than the 13 701 lifestyle modification patients. During a median of 4.1 years, surgery patients had lower heart failure incidence than lifestyle modification patients (hazard ratio, 0.54; 95% confidence interval, 0.36-0.82). A 10-kg achieved weight loss after 1 year was related to a hazard ratio for heart failure of 0.77 (95% confidence interval, 0.60-0.97) in both treatment groups combined. Results were robust in sensitivity analyses. CONCLUSIONS Gastric bypass surgery was associated with approximately one half the incidence of heart failure compared with intensive lifestyle modification in this study of 2 large nationwide registries. We also observed a graded association between increasing weight loss and decreasing risk of heart failure.
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Affiliation(s)
- Johan Sundström
- From Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, Sweden (J.S.); Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden (G.B., M.N.); Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden (J.O., I.N.); and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (C.M.).
| | - Gustaf Bruze
- From Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, Sweden (J.S.); Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden (G.B., M.N.); Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden (J.O., I.N.); and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (C.M.)
| | - Johan Ottosson
- From Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, Sweden (J.S.); Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden (G.B., M.N.); Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden (J.O., I.N.); and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (C.M.)
| | - Claude Marcus
- From Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, Sweden (J.S.); Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden (G.B., M.N.); Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden (J.O., I.N.); and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (C.M.)
| | - Ingmar Näslund
- From Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, Sweden (J.S.); Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden (G.B., M.N.); Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden (J.O., I.N.); and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (C.M.)
| | - Martin Neovius
- From Department of Medical Sciences, Uppsala University, and Uppsala Clinical Research Center, Sweden (J.S.); Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden (G.B., M.N.); Department of Surgery, Faculty of Medicine and Health, Örebro University, Sweden (J.O., I.N.); and Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (C.M.)
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Chang JJ, Bena J, Kannan S, Kim J, Burguera B, Kashyap SR. LIMITED CARBOHYDRATE REFEEDING INSTRUCTION FOR LONG-TERM WEIGHT MAINTENANCE FOLLOWING A KETOGENIC, VERY-LOW-CALORIE MEAL PLAN. Endocr Pract 2017; 23:649-656. [PMID: 28225305 DOI: 10.4158/ep161383.or] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Weight-loss maintenance following very-low-calorie meal plans is poorly studied. This report describes weight-loss efficacy and predictors of weight-loss maintenance of a ketogenic, very-low-calorie meal plan (protein-sparing modified fast, PSMF) in people with obesity. METHODS A total of 127 consecutive adults in the PSMF meal plan (27.2 ± 19.5 weeks) and 48 adults on a conventional, hypocaloric meal plan (23.6 ± 20.8 weeks) were retrospectively studied for percent weight change from baseline to end of intervention and at 6, 12, and 24 months postintervention. Baseline factors were analyzed for correlations with weight-loss maintenance. RESULTS At end of intervention, weight loss from baseline was greater for the PSMF group compared to the conventional intervention group (-12.4% vs. -2.6%; P<.001) but was similar between groups by 12 months postintervention. PSMF subjects who attended follow-up visits to receive instruction on gradual and limited carbohydrate refeeding after ketosis saw significant weight loss at the end of PSMF compared to those who did not follow-up to receive instruction (-17.5% vs. -8.0%; P<.001) and maintained greater weight loss through 12 months post-PSMF (-9.8% vs. -1.5%; P<.001). Higher baseline body mass index correlated with less weight loss at 12 months post-PSMF (P = .035). CONCLUSION PSMF results in effective short-term weight loss of more than 5% from baseline weight. Follow-up for limited carbohydrate refeeding instruction is important for weight-loss maintenance up to 2 years after initial weight loss. ABBREVIATIONS BMI = body mass index; PSMF = protein-sparing modified fast.
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Point V, Bénarouche A, Zarrillo J, Guy A, Magnez R, Fonseca L, Raux B, Leclaire J, Buono G, Fotiadu F, Durand T, Carrière F, Vaysse C, Couëdelo L, Cavalier JF. Slowing down fat digestion and absorption by an oxadiazolone inhibitor targeting selectively gastric lipolysis. Eur J Med Chem 2016; 123:834-848. [DOI: 10.1016/j.ejmech.2016.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 01/13/2023]
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Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus. Nutr Diabetes 2016; 6:e230. [PMID: 27643725 PMCID: PMC5048014 DOI: 10.1038/nutd.2016.36] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/21/2016] [Accepted: 07/14/2016] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED Brackground:The safety and tolerability of very low-calorie-ketogenic (VLCK) diets are a current concern in the treatment of obese type 2 diabetes mellitus (T2DM) patients. OBJECTIVE Evaluating the short-term safety and tolerability of a VLCK diet (<50 g of carbohydrate daily) in an interventional weight loss program including lifestyle and behavioral modification support (Diaprokal Method) in subjects with T2DM. METHODS Eighty-nine men and women, aged between 30 and 65 years, with T2DM and body mass index between 30 and 35 kg m(-)(2) participated in this prospective, open-label, multi-centric randomized clinical trial with a duration of 4 months. Forty-five subjects were randomly assigned to the interventional weight loss (VLCK diet), and 44 to the standard low-calorie diet. RESULTS No significant differences in the laboratory safety parameters were found between the two study groups. Changes in the urine albumin-to-creatinine ratio in VLCK diet were not significant and were comparable to control group. Creatinine and blood urea nitrogen did not change significantly relative to baseline nor between groups. Weight loss and reduction in waist circumference in the VLCK diet group were significantly larger than in control subjects (both P<0.001). The decline in HbA1c and glycemic control was larger in the VLCK diet group (P<0.05). No serious adverse events were reported and mild AE in the VLCK diet group declined at last follow-up. CONCLUSIONS The interventional weight loss program based on a VLCK diet is most effective in reducing body weight and improvement of glycemic control than a standard hypocaloric diet with safety and good tolerance for T2DM patients.
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Elliott B, Mina M, Ferrier C. Complete and Voluntary Starvation of 50 days. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:67-70. [PMID: 27547044 PMCID: PMC4982520 DOI: 10.4137/ccrep.s39776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 11/11/2022]
Abstract
A 34-year-old obese male (96.8 kg; BMI, 30.2 kg m−1) volitionally undertook a 50-day fast with the stated goal of losing body mass. During this time, only tea, coffee, water, and a daily multivitamin were consumed. Severe and linear loss of body mass is recorded during these 50 days (final 75.4 kg; BMI, 23.5 kg m−1). A surprising resilience to effects of fasting on activity levels and physical function is noted. Plasma samples are suggestive of early impairment of liver function, and perturbations to cardiovascular dynamics are also noted. One month following resumption of feeding behavior, body weight was maintained (75.0 kg; BMI, 23.4 kg m−1). Evidence-based decision-making with the fasting or hunger striking patient is limited by a lack of evidence. This case report suggests that total body mass, not mass lost, may be a key observation in clinical decision-making during fasting and starvation.
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Affiliation(s)
- Bradley Elliott
- Department of Biomedical Sciences, Faculty of Science and Technology, University of Westminster, London, UK
| | - Michelle Mina
- Department of Life Sciences, Faculty of Science and Technology, University of Westminster, London, UK
| | - Chrystalla Ferrier
- Department of Life Sciences, Faculty of Science and Technology, University of Westminster, London, UK
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Castaldo G, Monaco L, Castaldo L, Galdo G, Cereda E. An observational study of sequential protein-sparing, very low-calorie ketogenic diet (Oloproteic diet) and hypocaloric Mediterranean-like diet for the treatment of obesity. Int J Food Sci Nutr 2016; 67:696-706. [PMID: 27193396 DOI: 10.1080/09637486.2016.1186157] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The impact of a rehabilitative multi-step dietary program consisting in different diets has been scantily investigated. In an open-label study, 73 obese patients underwent a two-phase weight loss (WL) program: a 3-week protein-sparing, very low-calorie, ketogenic diet (<500 kcal/day; Oloproteic(®) Diet) and a 6-week hypocaloric (25-30 kcal/kg of ideal body weight/day), low glycemic index, Mediterranean-like diet (hypo-MD). Both phases improved visceral adiposity, liver enzymes, GH levels, blood pressure and glucose and lipid metabolism. However, the hypo-MD was responsible for a re-increase in blood lipids and glucose tolerance parameters. Changes in visceral adiposity and glucose control-related variables were more consistent in patients with metabolic syndrome. However, in these patients the hypo-MD did not result in a consistent re-increase in glucose control-related variables. A dietary program consisting in a ketogenic regimen followed by a balanced MD appeared to be feasible and efficacious in reducing cardiovascular risk, particularly in patients with metabolic syndrome.
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Affiliation(s)
- Giuseppe Castaldo
- a Clinical Nutrition Unit, A.O.R.N. "San Giuseppe Moscati" , Contrada Amoretta , Avellino , Italy
| | - Luigi Monaco
- b Ultrasonography Unit, A.O.R.N. "San Giuseppe Moscati" , Contrada Amoretta , Avellino , Italy
| | - Laura Castaldo
- a Clinical Nutrition Unit, A.O.R.N. "San Giuseppe Moscati" , Contrada Amoretta , Avellino , Italy
| | - Giovanna Galdo
- a Clinical Nutrition Unit, A.O.R.N. "San Giuseppe Moscati" , Contrada Amoretta , Avellino , Italy
| | - Emanuele Cereda
- c Nutrition and Dietetics Service , Fondazione IRCCS Policlinico San Matteo , Viale Golgi , Pavia , Italy
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Lous J, Freund KS. Predictors of weight loss in young adults who are over-weight or obese and have psychosocial problems: a post hoc analysis. BMC FAMILY PRACTICE 2016; 17:43. [PMID: 27068690 PMCID: PMC4827173 DOI: 10.1186/s12875-016-0437-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
Background The aim of this study is in a general practice trial setting to identify predictive factors for weight loss after 1 year among young adults who are over-weight or obese and who have several psychosocial problems. Methods Twenty-eight general practitioners recruited 495 patients aged 20–45 years with psychosocial problems for a randomized general preventive study to increase self-efficacy to achieve a self-prioritised goal for a better life by discussions of resources and barriers for reaching the goal. The present study is a post hoc analysis of possible predictors of weight loss among all 218 patients who have over-weight or obesity. A 23-pages questionnaire was completed before and 1 year after randomization. 111 patients had a one-hour preventive health consultation with their general practitioners focused on life coaching and a follow-up consultation within 3 months, and 107 patients had no preventive consultation. Results Twenty-two patients stated during the preventive consultation that weight loss was a prioritised goal. They had a mean weight loss of 4.7 kgs compared with 1.6 kgs in the group without this goal and 1.6 kgs in the group without preventive consultation. In a logistic regression model, predictors of weight loss or no weight loss were a) pre-interventional consideration of weight loss within 30 days, b) having weight loss as a prioritised goal for improved quality of life, c) being female, d) being in the oldest half of participants, and e) having many psychosocial problems. In a linear regression model, the predictors together explained about 11 % of the weight loss. Important predictors were: obesity (explained 4 %), pre-interventional consideration of weight loss within 30 days (3 %), and having a preventive health consultation with weight loss as a prioritised goal (2 %). Conclusions Pre-interventional consideration of weight loss within 30 days and having weight loss as a prioritised goal during the health consultation were two important predictors for weight loss. By structured interventions focussing on the patients’ priorities, self-chosen goals, their resources and barriers for reaching the goals, changes may be obtained; especially in participants with many problems who often do not accept participation in procedures on risks. ClinicalTrials gov Registration NCT 01231256, Aug. 22. 2010.
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Affiliation(s)
- Jørgen Lous
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløwvej 9A, DK-5000, Odense, Denmark.
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Lassemillante ACM, Oliver V, Hickman I, Murray E, Campbell KL. Meal replacements as a strategy for weight loss in obese hemodialysis patients. Hemodial Int 2016; 20:E18-E23. [DOI: 10.1111/hdi.12419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Veronica Oliver
- Department of Nephrology; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Ingrid Hickman
- Department of Nutrition and Dietetics; Princess Alexandra Hospital; Brisbane Queensland Australia
- Mater Research Institute-University of Queensland, Translational Research Institute; Brisbane Queensland Australia
| | - Eryn Murray
- Department of Nutrition and Dietetics; Princess Alexandra Hospital; Brisbane Queensland Australia
| | - Katrina L. Campbell
- Department of Nutrition and Dietetics; Princess Alexandra Hospital; Brisbane Queensland Australia
- Faculty of Health Sciences and Medicine; Bond University, Queensland; Australia
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Aller EEJG, van Baak MA. Evaluation of an 18-month commercial multidisciplinary obesity treatment programme. Clin Obes 2016; 6:33-41. [PMID: 26573718 DOI: 10.1111/cob.12122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/24/2015] [Accepted: 09/28/2015] [Indexed: 12/24/2022]
Abstract
The treatment of obesity is an often studied subject. Although reductions in weight and improvements in cardiometabolic risk factors are important aims of obesity treatment, improvements in quality of life and eating behaviour are also relevant outcomes. In this practice-based study, we evaluated an 18-month commercial multidisciplinary obesity treatment programme and report on treatment results for weight, cardiometabolic risk factors, eating behaviour and quality of life. From a local commercial obesity treatment centre, 426 subjects (65% female; 45.4 ± 12.2 years; body mass index 40.0 ± 6.6 kg m(-2)) were recruited. Measurements of body weight, height, body composition, waist circumference and blood pressure were scheduled at baseline and every 3 months, whereas fasting blood collections were scheduled at baseline and every 6 months. At the same time points, participants were asked to fill in questionnaires on dietary intake, eating behaviour and quality of life. After 18 months of treatment programme, average weight change [mean (95% confidence interval)] was -10.9 kg (-14.8 to -7.0; P < 0.001) for the completers (n = 181) and -10.8 kg (-14.2 to -7.4; P < 0.001) for the intention-to-treat population (n = 426). Waist circumference (mean ± standard error of the mean) (-0.13 ± 0.01 cm; P < 0.001), fat mass (-7.8 ± 1.3 kg; P < 0.001) systolic (-11.4 ± 2.0; P < 0.001) and diastolic (-7.0 ± 1.3; P < 0.001) blood pressure, triglycerides (-0.4 ± 0.1; P = 0.004) and plasma glucose (-0.6 ± 0.2; P = 0.001) were significantly reduced. The PCS scale of the SF-36 and all three scales of the three-factor eating questionnaire improved significantly over the 18-month treatment period. All collected data in this study provide evidence that a multidisciplinary treatment programme based on lifestyle modification results in significant weight loss and improvements in cardiometabolic risk factors, quality of life and eating behaviour.
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Affiliation(s)
- E E J G Aller
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - M A van Baak
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Sinha AC, Singh PM, Bhat S. Are we operating too late? Mortality Analysis and Stochastic Simulation of Costs Associated with Bariatric Surgery: Reconsidering the BMI Threshold. Obes Surg 2015; 26:219-28. [DOI: 10.1007/s11695-015-1934-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Stubbs RJ, Morris L, Pallister C, Horgan G, Lavin JH. Weight outcomes audit in 1.3 million adults during their first 3 months' attendance in a commercial weight management programme. BMC Public Health 2015; 15:882. [PMID: 26359180 PMCID: PMC4566482 DOI: 10.1186/s12889-015-2225-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 09/04/2015] [Indexed: 01/07/2023] Open
Abstract
Background Over sixty percent of adults in the UK are now overweight/obese. Weight management on a national scale requires behavioural and lifestyle solutions that are accessible to large numbers of people. Evidence suggests commercial weight management programmes help people manage their weight but there is little research examining those that pay to attend such programmes rather than being referred by primary care. The objective of this analysis was to evaluate the effectiveness of a UK commercial weight management programme in self-referred, fee-paying participants. Methods Electronic weekly weight records were collated for self-referred, fee-paying participants of Slimming World groups joining between January 2010 and April 2012. This analysis reports weight outcomes in 1,356,105 adult, non-pregnant participants during their first 3 months’ attendance. Data were analysed by regression, ANOVA and for binomial outcomes, chi-squared tests using the R statistical program. Results Mean (SD) age was 42.3 (13.6) years, height 1.65 m (0.08) and start weight was 88.4 kg (18.8). Mean start BMI was 32.6 kg/m2 (6.3 kg/m2) and 5 % of participants were men. Mean weight change of all participants was −3.9 kg (3.6), percent weight change −4.4 (3.8), and BMI change was −1.4 kg/m2 (1.3). Mean attendance was 7.8 (4.3) sessions in their first 3 months. For participants attending at least 75 % of possible weekly sessions (n = 478,772), mean BMI change was −2.5 kg/m2 (1.3), weight change −6.8 kg (3.7) and percent weight change −7.5 % (3.5). Weight loss was greater in men than women absolutely (−6.5 (5.3) kg vs −3.8 (3.4) kg) and as a percentage (5.7 % (4.4) vs 4.3 % (3.7)), respectively. All comparisons were significant (p < 0.001). Level of attendance and percent weight loss in the first week of attendance together accounted for 55 % of the variability in weight lost during the study period. Conclusions A large-scale commercial lifestyle-based weight management programme had a significant impact on weight loss outcomes over 3 months. Higher levels of attendance led to levels of weight loss known to be associated with significant clinical benefits, which on this scale may have an impact on public health.
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Affiliation(s)
- R James Stubbs
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK. .,College of Life and Natural Sciences, University of Derby, Kedleston Road, Derby, DE22 1GB, UK.
| | - Liam Morris
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK.
| | - Carolyn Pallister
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK.
| | - Graham Horgan
- Biomathematics and Statistics Scotland, The Rowett Institute of Nutrition and Health, Greenburn road, Aberdeen, AB21 9SB, UK.
| | - Jacquie H Lavin
- Nutrition and Research Department, Slimming World, Clover Nook Road, Somercotes, Alfreton, Derbyshire, DE55 4RF, UK.
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Falcone PH, Tai CY, Carson LR, Joy JM, Mosman MM, Vogel RM, McCann TR, Crona KP, Griffin JD, Kim MP, Moon JR. Subcutaneous and segmental fat loss with and without supportive supplements in conjunction with a low-calorie high protein diet in healthy women. PLoS One 2015; 10:e0123854. [PMID: 25875200 PMCID: PMC4398439 DOI: 10.1371/journal.pone.0123854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/23/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Weight loss benefits of multi-ingredient supplements in conjunction with a low-calorie, high-protein diet in young women are unknown. Therefore, the purpose of this study was to investigate the effects of a three-week low-calorie diet with and without supplementation on body composition. METHODS Thirty-seven recreationally-trained women (n = 37; age = 27.1 ± 4.2; height = 165.1 ± 6.4; weight = 68.5 ± 10.1; BMI = 25.1 ± 3.4) completed one of the following three-week interventions: no change in diet (CON); a high-protein, low-calorie diet supplemented with a thermogenic, conjugated linoleic acid (CLA), a protein gel, and a multi-vitamin (SUP); or the high-protein diet with isocaloric placebo supplements (PLA). Before and after the three-week intervention, body weight, %Fat via dual X-ray absorptiometry (DXA), segmental fat mass via DXA, %Fat via skinfolds, and skinfold thicknesses at seven sites were measured. RESULTS SUP and PLA significantly decreased body weight (SUP: PRE, 70.47 ± 8.01 kg to POST, 67.51 ± 8.10 kg; PLA: PRE, 67.88 ± 12.28 kg vs. POST, 66.38 ± 11.94 kg; p ≤ 0.05) with a greater (p ≤ 0.05) decrease in SUP than PLA or CON. SUP and PLA significantly decreased %Fat according to DXA (SUP: PRE, 34.98 ± 7.05% to POST, 32.99 ± 6.89%; PLA: PRE, 34.22 ± 6.36% vs. POST, 32.69 ± 5.84%; p ≤ 0.05), whereas only SUP significantly decreased %Fat according to skinfolds (SUP: PRE, 27.40 ± 4.09% to POST, 24.08 ± 4.31%; p ≤ 0.05). SUP significantly (p ≤ 0.05) decreased thicknesses at five skinfolds (chest, waist, hip, subscapular, and tricep) compared to PLA, but not at two skinfolds (axilla and thigh). CONCLUSIONS The addition of a thermogenic, CLA, protein, and a multi-vitamin to a three-week low-calorie diet improved weight loss, total fat loss and subcutaneous fat loss, compared to diet alone.
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Affiliation(s)
- Paul H. Falcone
- MusclePharm Sports Science Institute, Denver, CO, United States of America
| | - Chih Yin Tai
- MusclePharm Sports Science Institute, Denver, CO, United States of America
| | - Laura R. Carson
- MusclePharm Sports Science Institute, Denver, CO, United States of America
| | - Jordan M. Joy
- MusclePharm Sports Science Institute, Denver, CO, United States of America
| | - Matt M. Mosman
- MusclePharm Sports Science Institute, Denver, CO, United States of America
| | - Roxanne M. Vogel
- Metropolitan State University of Denver, Denver, CO, United States of America
| | - Tyler R. McCann
- University of Colorado, Boulder, CO, United States of America
| | - Kevin P. Crona
- University of Colorado, Denver, CO, United States of America
| | | | - Michael P. Kim
- MusclePharm Sports Science Institute, Denver, CO, United States of America
| | - Jordan R. Moon
- MusclePharm Sports Science Institute, Denver, CO, United States of America
- Department of Sports Exercise Science, United States Sports Academy, Daphne, AL, United States of America
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Sofer S, Stark AH, Madar Z. Nutrition targeting by food timing: time-related dietary approaches to combat obesity and metabolic syndrome. Adv Nutr 2015; 6:214-23. [PMID: 25770260 PMCID: PMC4352180 DOI: 10.3945/an.114.007518] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Effective nutritional guidelines for reducing abdominal obesity and metabolic syndrome are urgently needed. Over the years, many different dietary regimens have been studied as possible treatment alternatives. The efficacy of low-calorie diets, diets with different proportions of fat, protein, and carbohydrates, traditional healthy eating patterns, and evidence-based dietary approaches were evaluated. Reviewing literature published in the last 5 y reveals that these diets may improve risk factors associated with obesity and metabolic syndrome. However, each diet has limitations ranging from high dropout rates to maintenance difficulties. In addition, most of these dietary regimens have the ability to attenuate some, but not all, of the components involved in this complicated multifactorial condition. Recently, interest has arisen in the time of day foods are consumed (food timing). Studies have examined the implications of eating at the right or wrong time, restricting eating hours, time allocation for meals, and timing of macronutrient consumption during the day. In this paper we review new insights into well-known dietary therapies as well as innovative time-associated dietary approaches for treating obesity and metabolic syndrome. We discuss results from systematic meta-analyses, clinical interventions, and animal models.
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Affiliation(s)
- Sigal Sofer
- Robert H Smith Faculty of Agriculture, Food, and Environment, Institute of Biochemistry, Food Science, and Nutrition, Hebrew University of Jerusalem, Rehovot, Israel; and,Diet and Nutrition Department, Meuhedet Medical Services, Tel Aviv, Israel
| | - Aliza H Stark
- Robert H Smith Faculty of Agriculture, Food, and Environment, Institute of Biochemistry, Food Science, and Nutrition, Hebrew University of Jerusalem, Rehovot, Israel; and
| | - Zecharia Madar
- Robert H Smith Faculty of Agriculture, Food, and Environment, Institute of Biochemistry, Food Science, and Nutrition, Hebrew University of Jerusalem, Rehovot, Israel; and
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Amano S, Tsubone H, Hanafusa M, Yamasaki T, Nishizaka S, Yanagisawa H. Physical and physiological effectiveness of an overall health care program for middle-aged Japanese women with mild obesity: A pilot study. J Tradit Complement Med 2015; 5:88-95. [PMID: 26151017 PMCID: PMC4488103 DOI: 10.1016/j.jtcme.2014.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 06/18/2014] [Accepted: 07/28/2014] [Indexed: 12/30/2022] Open
Abstract
This study aimed to verify the effectiveness of an overall health care program (OHCP) for middle-aged Japanese women through assessing physical and physiological changes. The OHCP consisted of diet modification with natural alternative foods, walking and stretching exercises, and body massage and cupping treatments. Sixty-seven participants were assigned to one of three groups during a 3-year study period (2011–2013). The OHCP was performed for 3 months in each year. After the OHCP, most participants had significant decreases in the blood levels of triglycerides, low-density lipoprotein cholesterol, total cholesterol, alkaline phosphatase, γ-glutamyl transferase, and cholinesterase; body weight; body fat percentage; and body-mass index. The oxidative stress markers varied among the study years; however, a significant decrease in blood reactive oxygen-derived metabolites and a significant increase in the relative antioxidative potential were observed in 2013. In 2013, participants who were randomly selected for autonomic nervous activity measurements immediately before and after body massage and cupping treatments showed a significant predominance in parasympathetic nervous activity after the treatments. These results indicate that the OHCP in the present study is an effective and prompt method as a complementary treatment to improve the pre-obese or mild obese status without any noticeable physiological stress in most middle-aged women. However, because of the limitations of this study, the findings of this study need to be confirmed.
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Affiliation(s)
- Sho Amano
- Research Center for Food Safety, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Hirokazu Tsubone
- Research Center for Food Safety, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan ; Nonprofit Organization-Science of Food Safety and Security, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Masakazu Hanafusa
- Research Center for Food Safety, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Takeshi Yamasaki
- Nonprofit Organization-Science of Food Safety and Security, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - Saiko Nishizaka
- Slim Beauty House Co., 2-9-8 Shibuya Shibuya-ku, Tokyo 150-0002, Japan
| | - Hiroshi Yanagisawa
- Clinic Yanagisawa, 4-10-31-934 Takanawa, Minato-ku, Tokyo 108-0074, Japan
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Kaiser KA, Affuso O, Desmond R, Allison DB. Baseline participant characteristics and risk for dropout from ten obesity randomized controlled trials: a pooled analysis of individual level data. Front Nutr 2015; 1:00025. [PMID: 25599077 PMCID: PMC4296899 DOI: 10.3389/fnut.2014.00025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 11/24/2014] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Understanding participant demographic characteristics that inform the optimal design of obesity RCTs have been examined in few studies. The objective of this study was to investigate the association of individual participant characteristics and dropout rates (DORs) in obesity randomized controlled trials (RCT) by pooling data from several publicly available datasets for analyses. We comprehensively characterize DORs and patterns in obesity RCTs at the individual study level, and describe how such rates and patterns vary as a function of individual-level characteristics. METHODS We obtained and analyzed nine publicly-available, obesity RCT datasets that examined weight loss or weight gain prevention as a primary or secondary endpoint. Four risk factors for dropout were examined by Cox proportional hazards including sex, age, baseline BMI, and race/ethnicity. The individual study data were pooled in the final analyses with a random effect for study, and HR and 95% CIs were computed. RESULTS Results of the multivariate analysis indicated that the risk of dropout was significantly higher for females compared to males (HR= 1.24, 95% CI = 1.05, 1.46). Hispanics and Non-Hispanic blacks had a significantly higher dropout rate compared to non-Hispanic whites (HR= 1.62, 95% CI = 1.37, 1.91; HR= 1.22, 95% CI = 1.11, 1.35, respectively). There was a significantly increased risk of dropout associated with advancing age (HR= 1.02, 95% CI = 1.01, 1.02) and increasing BMI (HR= 1.03, 95% CI = 1.03, 1.04). CONCLUSION/SIGNIFICANCE As more studies may focus on special populations, researchers designing obesity RCTs may wish to oversample in certain demographic groups if attempting to match comparison groups based on generalized estimates of expected dropout rates, or otherwise adjust a priori power estimates. Understanding true reasons for dropout may require additional methods of data gathering not generally employed in obesity RCTs, e.g. time on treatment.
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Affiliation(s)
- Kathryn Ann Kaiser
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olivia Affuso
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Renee Desmond
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David B. Allison
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
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Yamada T, Hara K, Svensson AK, Shojima N, Hosoe J, Iwasaki M, Yamauchi T, Kadowaki T. Successfully achieving target weight loss influences subsequent maintenance of lower weight and dropout from treatment. Obesity (Silver Spring) 2015; 23:183-91. [PMID: 25324210 DOI: 10.1002/oby.20874] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/01/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The influence of the amount and rate of weight loss on subsequently regaining weight and dropout from treatment in severely obese patients targeting 5% weight loss was investigated. METHODS A total of 120 consecutive hospital patients with severe obesity (BMI: 42 ± 9 kg/m(2) ) participated in an inpatient program targeting 5% weight loss that involved goal setting, charting weight four times daily, and diet and exercise. They were followed after discharge to assess subsequent regaining of weight and dropout. RESULTS Mean weight loss was 4.9 ± 2.4% after a mean of 19 days in the hospital, and 43% of the patients achieved the target weight loss (>5%). Over the median 2-year follow-up period, greater than 5% in-hospital weight loss was associated with a significantly lower risk of regaining weight after adjustment for various factors (>5% to ≤7% loss: hazard ratio 0.30 [0.11-0.85] for regaining all of the lost weight and 0.32 [0.13-0.78] for regaining half of the lost weight). No significant relation between the amount or rate of weight loss and dropout from subsequent outpatient treatment was seen. CONCLUSIONS Successfully achieving the target weight loss in a comprehensive program predicts subsequent maintenance of lower weight without increasing the risk of dropout. Successful in-hospital weight loss might increase the motivation of obese patients.
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Affiliation(s)
- Tomohide Yamada
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Japan
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