Reduction of misclassification rates of obesity by body mass index using dual-energy X-ray absorptiometry scans to improve subsequent prediction of per cent fat mass in a Caucasian population

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

•  Body mass index (BMI) is not accurate in the classification of excess body fat, failing to identify as many as half of individuals with excess per cent fat mass. •  Normal-weight obesity, which goes undiagnosed when BMI is the only measure of adiposity utilized, has been shown to be associated with an increased risk of cardiovascular comorbidities and mortality. •  Dual-energy X-ray absorptiometry (DXA) is an accurate and relatively inexpensive method for indirect assessment of body composition.

WHAT THIS STUDY ADDS

•  The formulae developed allow the clinician to utilize information from one baseline DXA scan to calculate a patient's per cent fat mass with a future change in weight, thus allowing the clinician to more accurately determine whether and when an individual patient should be classified as obese and thus be managed appropriately. •  The formulae developed enable the clinician to calculate a patient-specific BMI treatment goal, below which the patient would no longer meet the per cent fat mass criteria for obesity.

SUMMARY

Recognition is increasing for the errors of body mass index (BMI) in classification of excess body fat. Dual-energy X-ray absorptiometry (DXA) is accurate to assess body fat mass per cent (%FM), but is underutilized clinically. We examined the prevalence of obesity misclassification by BMI in comparison to body %FM by DXA scanning, and whether there is a time-stable individual relation between the %FM and the BMI in patients scanned several times. We aimed to develop a formula where, based on a single DXA scan, %FM could be predicted following a change in weight, and a patient-specific BMI threshold could be calculated (BMIT ), above which the patient would be obese by %FM criteria. Data were collected from individuals who had a DXA scan as part of a nutritional research study at the University of Copenhagen. BMI incorrectly classified 48/329 (14.6%) of men and 52/589 (8.8%) of women. The majority of men with BMI 25-27 kg m(-2) and women with BMI 24-26 kg m(-2) were misclassified. Using multiple scan data (189 men, 311 women) and calculating the patient-specific constant C = (1 - %FM/100)(3/2)  × BMI from baseline BMI and %FM, misclassification rates were halved for both genders when a personal threshold, BMIT , was used ([BMIT  = C/(0.75)(3/2) ] for men and [BMIT  = C/(0.65)(3/2) ] for women). We conclude that simple formulae allow evaluation of fatness of individual patients more accurately than BMI, with the use of one baseline DXA scan, and enable the establishment of patient-specific obesity treatment targets in clinical practice.

Monitoring of dietary changes by telephone interviews: results from Denmark

OBJECTIVES

To monitor trends in Danish food habits with respect to selected key elements, from 1995 to 1998, and to evaluate the appropriateness of the method developed for that purpose.

DESIGN AND METHOD

Two cross-sectional population surveys, in 1995 and 1998. Data collection by computer-assisted telephone interviews including 10 food-frequency questions, questions on type of fat used on sandwiches and drinking milk, and check questions on the previous day. Reproducibility was tested in a subgroup (n = 222) in the 1998 survey.

SETTING

The Danish Nutrition Council initiated the survey.

SUBJECTS

Men and women aged 15-90 years, 1007 in 1995 and 1024 in 1998. Samples of private telephone numbers were drawn from regional telephone registers, geographically stratified. Participation rates were 62%.

RESULTS

Significant differences were observed between 1995 and 1998, some of these in accordance with dietary guidelines (decreased use of whole milk and fat spread on bread, increased use of skimmed milk, salad vegetables, rice/pasta and fish). Other changes were opposite to dietary guidelines (increased use of soft butter, decreased use of soft margarine and low-fat spreads, potatoes, and fresh fruit). Differences in average consumption frequency amounted to 4-13%. Several results were confirmed by comparison with other data, and the reproducibility of the method was acceptable. Data were suitable for analysis of food use patterns, a relevant approach when assessing food habits in a lifestyle context.

CONCLUSIONS

The changes observed illustrate the dynamics of food habits and the need for frequent monitoring. This simple telephone method may be a valuable tool for that purpose, as a supplement to national dietary surveys, also in a public health context.

[Antibiotic resistance of E coli isolated from healthy persons]

INTRODUCTION

The aim of the study was to determine the antibiotic susceptibility of E. coli isolates in stools from healthy Danes.

METHODS

Sixty-nine persons from Copenhagen participated in the study. Three faecal samples from each participant were examined by culture for each of three periods. E. coli was isolated selectively and tested for sensitivity against sulfamethizole, trimethoprim, the combination of sulfamethizole and trimethoprim, ampicillin, mecillinam, cefuroxime, nitrofurantoin, and ciprofloxacin.

RESULTS

Altogether, 184 strains of E. coli were isolated from 66 of the 69 persons. Fifty-eight (31.5%) of the strains isolated from 30 persons (43.5%) were resistant to sulfamethizole, 32 (17.4%) strains isolated from 18 persons (26.1%) were resistant to trimethoprim, 31 (16.8%) strains isolated from 17 persons (24.6%) were resistant to trimethoprim + sulfamethizole, 57 (31%) strains from 31 persons (44.9%) were resistant to ampicillin, 29 (15.8%) of the strains from 24 persons (34.8%) were resistant to nitrofurantoin, two (1.1%) strains from two persons (2.9%) were resistant to cefuroxime, whereas none of the strains was resistant to mecillinam and ciprofloxacin.

DISCUSSION

The high prevalence of resistance to sulfamethizole, ampicillin, trimethoprim, and nitrofurantoin is surprising, as none of the persons had been treated with antibiotics, but it may reflect the widespread use of antibiotics in animals for food production. The consequences of the results for empiric antibiotic treatment of, for instance, urinary tract infection are discussed.

[Slimming behavior among Danes assessed by telephone interviews in 1992 and 1998]

INTRODUCTION

With the increasing prevalence of overweight and obesity, it is assumed that slimming is on the increase. The aim of the present study was to elucidate the prevalence of slimming attempts, the methods used, and whether the weight loss was maintained.

METHODS

Two independent telephone interviews were conducted in 1992 and in 1998. About 1200 adults selected at random were entered in each survey in a balanced design, which ensured an equal distribution of age, gender, and geographical regions in Denmark.

RESULTS

The prevalence of obesity increased from 10% to 13% between 1992 and 1998. The proportion of subjects who had been slimming at least once in their lives increased from 45% to 47%, with a distribution of 25% in the underweight, 38% in those of normal weight, 54% of the overweight, and 76% of the obese (p < 0.0001). The use of anti-obesity medicine on prescription and support by a primary care physician or dietician increased with increasing body mass index. Subjects who chose to change their diet or increase their physical activity were more successful in achieving and maintaining a weight loss than those who did not. Changes in diet rose significantly from 1992 to 1998, whereas the use of prescription medicine and over-the-counter protein formulas and supplements decreased. The use of prescription medicine by subjects of normal weight decreased from 11% to 2%.

CONCLUSION

About half of all adult Danes have been on a slimming diet. Those who choose to change their diet or increase physical activity are more successful in achieving a weight loss and maintaining it. Notably, one in four underweight subjects have been on a slimming diet, and one in four obese subjects have never dieted, particularly obese males. The use of prescription slimming compounds by individuals of normal weight seems to be a decreasing problem.

[The effect of sibutramine for the maintenance of weight loss. A randomized controlled clinical trial]

INTRODUCTION

Sibutramine is a tertiary amine that has been shown to induce dose-dependent weight loss and enhance the effects of a low-calorie diet for up to a year. We did a randomised, double-blind trial to assess the usefulness of sibutramine in maintaining substantial weight loss over 18 months.

METHODS

Eight European centres recruited 605 obese patients (BMI 30-45 kg/m2) for a 6-month period of weight loss with sibutramine (10 mg/day) in combination with an individualised dietary deficit programme of 600 kcal/day based on the measured resting rates of energy expenditure. Of these 605, 467 (77%) patients with more than a 5% weight loss were then randomly assigned to 10 mg/day sibutramine (n = 352) or placebo (n = 115) for a further 18 months. Sibutramine was increased up to 20 mg/day if a weight regain occurred.

RESULTS

One hundred and forty-eight (42%) subjects in the sibutramine group and 58 (50%) in the placebo group dropped out. Of the 204 subjects receiving sibutramine who completed the trial, 89 (43%) maintained 80% or more of their original weight loss, compared with nine (16%) of the 57 subjects in the placebo group (odds ratio 4.64, p < 0.001). Substantial decreases were seen over the first six months in triglycerides, VDL cholesterol, insulin, C peptide, and uric acid; changes, which were sustained in the sibutramine group, but not in the placebo group. Concentrations of HDL cholesterol rose substantially in the second year: overall increases were 20.7% (sibutramine) and 11.7% (placebo, p < 0.001). Twenty (3%) patients were withdrawn because of raised blood pressure; in the sibutramine group, from baseline to two years systolic blood pressure rose by 0.1 mmHg (SD 12.9), diastolic blood pressure by 2.3 mmHg (9.4), and pulse rate by 4.1 beats/min (11.9).

CONCLUSION

This individualised management programme achieved a weight loss in 77% of obese patients and a sustained weight loss in most patients continuing therapy for two years. Changes in the concentrations of HDL cholesterol, VDL cholesterol, and triglyceride, but not in the LDL cholesterol, exceed those expected either from a weight loss alone or when induced by other selective therapies for low concentrations of HDL cholesterol relating to coronary heart disease.

[Proper advice on nutrition. Recommendations concerning the conduct of the nutritional news]

The Committee on Proper Conduct in Public Advice on Nutrition, set up by the Danish Nutrition Council, has produced recommendations to persons involved in communicating results of nutrition research. The guidelines are targeted on scientists, industry, journalists and publishers as well as consumers to facilitate proper conduct in communication of own or other scientists' research results, which might influence consumers' choice and intake of food. The results are presented as recommendations and checklists providing the necessary requirements to bring people in a position to make the best possible evaluation of the new scientific results and to put the results into their proper perspective. The aim of this report is to improve the process so that the communicator focuses on the background information necessary for the reader/listener/viewer in the current situation to achieve a balanced view and benefit from the new scientific result.

[Dietary guidelines on obesity at Danish pharmacies. Results of a 12-week course with a 1-year follow-up. Research Group on Human Nutrition, Frederiksberg]

The increasing prevalence of obesity has created a need for alternative counselling sites. This retrospective study evaluates the results of a 12 week slimming course for obese subjects held at Danish pharmacies at one year follow-up. Two hundred and sixty-nine obese (BMI > 25 kg/m2, 32 +/- 4.5 [mean +/- SD]) paid 550 Dkr each for a 12 weeks slimming course held at 19 Danish pharmacies with groups of 8-20 subjects each. The age was between 18 to 81 years, 259 were females. The course included eight sessions of 1 1/2 hour education in nutrition and physiology aiming for a dietary change toward a low-fat, high carbohydrate diet. Self-reported body weight was assessed on at the pharmacy scale before and after the course and again after three, six and 12 months follow-up. One hundred and ninety-one or 71% of subjects completed the 12 week slimming programme. The average weight loss was 5.3 and 6.2 kg among females and males, respectively. The weight loss maintenance was assessed at one year follow-up in 122 (45%) of the subjects who entered the course and was 4.0 and 6.7 kg in 118 females and four males, respectively. At one year follow-up 40 subjects (20%) of the subjects who completed the course had maintained a weight loss > 5 kg. In conclusion, the initial weight loss, and maintenance and drop-out rate are comparable with results from general practitioners and hospital out-patient clinics, but the costs are substantially lower.

[Changes in food habits among the population from 1995 to 1998]

In order to survey trends in food habits the Danish Nutrition Council initiated two food frequency surveys, comprising ten nutritionally important foods, in 1995 and in 1998. Participants were men and women, 15-90 yrs, from similar population samples (n = 1007 in 1995, 1024 in 1998). Participation rate was 62% in 1995 and 63% in 1998. Data were collected by telephone interview. For six of the ten foods significant changes in consumption frequencies were observed: salad/raw vegetables, rice/pasta and fish were consumed more frequently in 1998, whereas consumption of meat, potatoes and fresh fruit had become less frequent. Average frequencies differed by 4-13%. In 1998 low-fat milk had become more common, whereas whole milk was now less common. More subjects now skipped fat spreads on their bread, but more chose spreads containing butterfat. Some, but not all, of the observed changes point in the right direction compared to recommendations. The results demonstrate that food habits are currently in a dynamic process.

[A randomized comparison of two weight-reducing diets. Calorie counting versus low-fat carbohydrate-rich ad libitum diet]

We compared the importance of rate of initial weight loss for long term outcome in obese patients and the efficacy of two different dietary weight maintenance programmes. An initial weight loss of 12.6 kg was achieved either by eight weeks low energy diet (2 MJ/day) (n = 21) or 17 weeks conventional hypocaloric, high protein diet (5 MJ/day) (n = 22) both supported by an anorectic compound (ephedrine 20 mg and caffeine 200 mg thrice daily). Weight loss rate had no effect on long-term weight maintenance. Randomisation to one year weight maintenance of either an ad lib, low fat, high carbohydrate diet or a fixed energy diet (< 8 MJ/day), both supported by reinforcement sessions 2-3 times monthly, resulted in a maintenance of 13.2 of initial 13.5 kg weight loss in the ad lib group versus 9.7 of 13.8 kg in the fixed energy intake group. At follow-up two years after the initial weight loss, 65% of the ad lib group and only 40% of the fixed energy intake group had maintained a weight loss of > 5 kg.

[Low energy metabolism in persons predisposed to obesity: significance of the thyroid status]

A low resting metabolic rate (RMR) for a given body composition has been identified as a risk factor for weight gain and obesity, and has also been reported in formerly obese individuals with the genetic predisposition to obesity. The possible role of thyroid hormone in low RMR was studied in a large sample of postobese women. RMR was measured by indirect calorimetry in 28 weight-stable postobese women with a family history of obesity (PO group) and in a control group of 28 nonobese women closely matched for age, fat mass, and fat-free mass. RMR was 8% lower in the PO than in the control group (95% CI: 5856 kJ/d [5520-6214] vs 6408 kJ/d [6096-6768]), (p < 0.02). The group difference remained unchanged after fat-free mass and fat mass were adjusted for (552 kJ/d, p < 0.015). The PO group had lower plasma free triiodothyronine: 2.4 (1.9-3.0) compared with 3.5 pmol/l (2.9-3.9), (p < 0.01), whereas plasma androstenedione only tended to be lower in the PO. Adjustment for differences in androstenedione did not reduce the difference in RMR, whereas adjustment for differences in plasma free triiodothyronine eliminated the group difference (96 kJ/d, p = 0.59). The present study shows that RMR for a given body composition is lower among postobese than among matched never-obese control subjects. Statistically the lower plasma free triiodothyronine concentration of the postobese subjects could explain their lower RMRs, but it remains to be established whether these findings are causally related.

[Significance of intentional weight loss on health]

The aim of the present study was critically to review how intentional weight loss in overweight and obesity influences mortality. No randomized weight loss intervention trial has included mortality as an end-point. However, even minor weight loss causes beneficial changes in risk factors for cardiovascular disease, whereas the vast majority of observational studies have linked weight loss to excess mortality. Most observational studies do not have information on intentionality of weight loss and suffer from other methodological limitations making inferences from these studies difficult. Given the available observational evidence, the possibility that intended weight loss may cause some increased mortality cannot be excluded. However, considering the totality of the evidence on effects of intended weight loss among overweight and obese subjects, there may be other benefits, such as: psycho-social and physical well-being, risk factor improvement, decreased morbidity, and in certain high-risk subgroups decreased mortality. Treatment of obesity is therefore recommended, particularly in the presence of risk factors or complications.

[Spontaneous weight loss in young subjects of normal weight after 11 weeks of unrestricted intake of a low-fat/high-fiber diet]

The present study investigated the spontaneous, unintended body weight changes observed during the first 11 weeks of an eight months' ad libitum low-fat/high-fibre diet (25.5 energy-% fat, 58.5 energy-% carbohydrate, 3.9 g dietary fiber/MJ), primarily aimed at investigating changes in blood lipid concentrations. Subjects were normal-weight, young, healthy students, 24 in the intervention group, and 24 in the control group (no diet). After 11 weeks, an overall decrease in body weight (1.3 +/- 0.4 kg) (mean +/- SEM) (p < 0.01) and fat mass (1.6 +/- 0.2 kg, p < 0.001) was observed in the intervention group. Fat-free mass remained unchanged. Initial body weight and fat mass correlated significantly to changes in body weight and fat mass. No changes were observed in the control group. In conclusion, the ad libitum intake of a low-fat/high-fibre diet led to a spontaneous, small loss of body weight and fat mass in young, normal-weight subjects.

[Prognostic markers for weight loss in the treatment of obesity]

The aim of the study was to identify prognostic metabolic markers for long-term weight loss outcome in obese women. Forty female obese patients underwent a dietary intervention of 36 weeks treatment with a 4.2 MJ/d low-fat high carbohydrate diet and were followed-up two and a half years after cessation of treatment. The maximum weight loss (mean 16.2 kg. 95% CI 14.2-18.2) was positively associated to pre-treatment 24-h energy expenditure (EE) (p < 0.01), fat oxidation (%) (p < 0.02), plasma dihydrotestosterone (DHT) (p < 0.01), and to postprandial noradrenaline concentration (p < 0.04). Together these factors could explain 41% of the variation in maximum weight loss. After 36 weeks only 24-h EE and DHT had predictive power on weight loss. Weight losses in upper and lower tertiles of DHT concentrations were 17.7 kg (14.1-21.4) and 9.8 kg (6.2-13.3) (p < 0.02) and the adjusted relative risk of losing < 10 kg in the upper compared to the lower DHT tertile was 12% (4-32%). At two and a half years follow-up 21 patients had maintained some of the weight loss (54%), while 14 patients had maintained > 5 kg weight loss (36%). High levels of pre-treatment DHT were also associated with better weight loss at two and a half years follow-up. The study suggests that long-term weight loss outcome may be predicted by pre-treatment metabolic and hormonal factors in obese women.

[Nutritional assessment of recipes distributed to households]

This study examines the nutritional standards of recipes in six pamphlets distributed to all households in Denmark. The publications all purport to contain recipes for a healthy diet. The nutritional values given in the publications are compared to calculated values and found to be almost identical. The fat content of most of the recipes is too high: recipes in the first three pamphlets had a median fat energy content of 50%. The later publications are better: 40% in two pamphlet and 33% in the last pamphlet. It is likely that the high fat content of the household distributed pamphlets contributes to the continued high fat content in the Danish diet. We suggest that the fat energy percent should be less than 30 in half the recipes and be only 30-35 on average. The energy content should not be greater than 2.5-3.5 MJ per portion. Nutritional value estimates and the nutrition information should be standardized so as to make them more accessible for the consumer who wishes to make healthy diet choices, and more instructive generally concerning general principles of an appetizing and healthy diet.

[Objective assessment of the habitual dietary fat content in patients with obesity]

A diet rich in fat may be an important precipitating factor of obesity, but studies on this relation have been hampered by the lack of an objective method to assess habitual dietary fat content. We measured 24-h fat oxidation in a respiration chamber in 38 overwight or obese and 35 nonobese women, and used it as an estimate of habitual dietary fat energy (%). After adjustment for confounders, obese women had higher oxidative fat energy than nonobese women [40.2% (37.8-42.6) vs. 36.0% (33.6-38.5), p < 0.02]. Adjusted oxidative fat energy (%) increased with increasing size of fat mass, and this relation suggest that a 10-kg change in fat mass may be caused by a change in dietary fat energy of > or = 1.6%. This objective assessment supports the contention that obese subjects consume a diet with a higher fat content than nonobese individuals, and the high-fat diet may have causal importance for the development and maintenance of obesity.

[The effect on health of dietary antioxidants and antioxidant supplements]

Reactive free oxygen radicals are formed in the reactions involved in normal cell metabolism. This formation is closely regulated e.g. by dietary antioxidants. Present knowledge suggests that an imbalance, with surplus of free radicals, can play a role in the pathogenesis of certain types of cancer, atherosclerosis, and cataract. A number of epidemiological studies have demonstrated a reduced risk of developing these diseases in persons who consume a diet with a high content of vegetables and fruit, which contains large quantities of the antioxidants: beta-carotene, vitamins C and E. Intervention studies, using supplements of these antioxidants, have so far not been able to show a beneficial effect. The apparently protective effect of fruit and vegetables may be due to other active ingredients. In Denmark the average intake of vegetables and fruit is low, and it is estimated that an increased consumption of these foods could reduce the occurrence of certain cancer types and atherosclerosis. In contrast, there is no evidence that antioxidant supplements would provide protection against disease, and their safety remains to be established.

[The importance of nutrition for the prevention of osteoporosis]

The prevalence of osteoporosis is increasing, and is a significant burden on society. Dietary composition is an important determinant of the bone mineral density in the growth period, and of the magnitude of the age related bone mineral loss, in particular among postmenopausal women. Therefore, an improvement of the diet has an important role in the prevention of osteoporosis. A sufficient intake of calcium and vitamin D can reduce the risk of fractures in postmenopausal women, and it is likely that a low calcium intake may affect peak bone mass negatively. Calcium in the Danish diet comes mainly from dairy products. Half a litre of milk and 25 g of cheese will cover most people's calcium requirement. Part of the calcium requirement may also be covered by consuming other foods such as cabbage, broccoli and beans. Children, adolescents and elderly individuals who avoid dairy products are recommended to take a calcium supplement. The status of vitamin D among the elderly can be improved by a daily outdoor stay and by a frequent intake of fatty fish such as herrings. Elderly persons who stay indoors are recommended to take a vitamin D supplement.

[Effect of 3-month exercise training on daily energy expenditure in formerly obese women with reduced and stable weight]

Predisposition to obesity has been suggested to be related to a low energy expenditure (EE). This condition could be counteracted by physical exercise. In the present study we wanted to elucidate if aerob training could increase sedentary 24-hour energy expenditure in formerly obese subjects. Seven reduced-obese premenopausal women were studied in a respiration chamber before and after a three month period of aerobic training. No significant effects of training were seen on daytime, sleeping or total 24-hour EE. However, the change in daytime EE was positively correlated to the change in VO2max. Sleeping and 24-hour respiratory quotients were slightly increased after the training period. In order to reveal a possible role of the sympathetic nervous system in the observed effect of training, additional experiments were performed with beta blockade. However, no interactions between training and beta blockade were found.

Safety and efficacy of long-term treatment with ephedrine, caffeine and an ephedrine/caffeine mixture

In a randomized, placebo-controlled, double blind study, 180 obese patients were treated by diet (4.2 MJ/day) and either an ephedrine/caffeine combination (20mg/200mg), ephedrine (20mg), caffeine (200mg) or placebo 3 times a day for 24 weeks. 141 patients completed this part of the study. All medication was stopped between week 24-26 in order to catch any withdrawal symptoms. From week 26 to 50, 99 patients completed treatment with the ephedrine/caffeine compound in an open trial design, resulting in a statistically significant (p = 0.02) weight loss of 1.1kg. In another randomized, double-blind, placebo-controlled 8 week study on obese subjects we found the mentioned compound showed lean body mass conserving properties. We conclude that the ephedrine/caffeine combination is effective in improving and maintaining weight loss, further it has lean body mass saving properties. The side effects are minor and transient and no withdrawal symptoms have been found.

Reduced plasma noradrenaline concentrations in simple-obese and diabetic obese patients

1. Obesity may be associated with a decreased activity of the sympathetic nervous system and also with a deficiency of the response to stimuli activating the sympathetic nervous system. As insulin activates the sympathetic nervous system, the present study was undertaken to measure the plasma noradrenaline concentration in the fasting state and after 75 g of oral glucose in simple-obese patients (n = 13), in non-insulin-dependent (type 2) diabetic patients (n = 37) and in normal control subjects (n = 12). 2. The fasting plasma noradrenaline concentration was similarly reduced in the simple-obese group and in the diabetic obese group compared with the control group (P = 0.005). The glucose-induced increase in plasma noradrenaline concentration was normal in the simple-obese group, but was abolished in the obese diabetic patients (P = 0.008). 3. Step-wise regression analysis indicated that independent effects on the fasting plasma noradrenaline concentration were exerted by age (r = +0.32, P = 0.002), glucose concentration (r = -0.32, P = 0.02) and the degree of obesity (r = -0.37, P = 0.007), but not by plasma insulin concentration. 4. These results show that obese patients have a reduced fasting plasma noradrenaline concentration independently of accompanying diabetes, but that the response of noradrenaline to oral glucose is only abolished in the obese diabetic patients.

[Obesity and diabetes as side-effects of beta-blockers]

Overweight and obesity may develop in individuals with genetically determined low resting energy expenditure. Drugs are among the recognised precipitating factors. The obesity promoting impact of beta-blockers is, however, less well known. Resting energy expenditure, and thermogenesis induced by stimuli such as meals, cold and heat exposure, stress and anxiety, have a facultative component mediated by the sympathoadrenal system through catecholamines working on beta-adrenoceptors. Treatment with beta-blockers reduces the facultative thermogenesis by 50-100 kcal/d, which corresponds to the weight gain of 2-5 kg/year reported in clinical trials. Treatment with beta-blockers also results in insulin resistance, which may aggravate existing diabetes and elicit diabetes in predisposed patients. Overweight and obesity are frequently complicated with hypertension and angina pectoris, which are often treated with beta-blockers. Obesity is associated with a defective sympathetic activity, and treatment with beta-blockers may further reduce facultative thermogenesis and promote weight gain. The consequence may be aggravation of hypertension, insulin resistance and other atherogenic factors. The causal therapy of android overweight and obesity complicated with diabetes or hypertension is a sufficient weight loss. If pharmacological treatment is inevitable, combined treatment with diuretics and ACE-inhibitors are most appropriate.