J La State Med Soc. 2005 Jan;157
Spec No 1:S50-5. Behavior and lifestyle:
approaches to treatment of obesity. Williamson DA, Stewart TM. Pennington Biomedical Research
Center, Baton Rouge, Louisiana, USA.
The increasing prevalence of
overweight and obesity in adults and children demonstrates
a steadily growing epidemic. This rising rate of obesity
is associated with obesity related comorbidities including
cardiovascular disease, hypertension, some cancers,
joint disease, and particularly, type 2 diabetes.
Modest weight loss (5% to 10% of total body weight)
through lifestyle intervention approaches has been
found to have a beneficial effect on comorbid conditions,
particularly hypertension and type 2 diabetes. Effective
behavioral treatment of obesity involves modification
of eating and physical activity patterns to yield
negative energy balance. Research studies have found
that interventions that combine a low-calorie diet,
increased physical activity, and behavior therapy
are most effective for weight loss and maintenance.
Furthermore, extended length of treatment contact,
weight loss satisfaction, and social support may promote
positive long-term outcomes in obese adults and children.
2004
Gac Med Mex. 2004 Jul-Aug;140
Suppl 2:S27-32.
[The pathophysiology of obesity].
[Article in Spanish]. Johnstone AM, Faber P, Andrew
R, Gibney ER, Elia M, Lobley G, Stubbs RJ, Walker
BR. Departamento de Endocrinologia
y metabolismo, Instituto Nacional de Ciencias Medicas
y Nutricion Salvador Zubirin, Vasco de Quiroga 15
Seccion XVI Tlalpan C.P. 14000, Mexico, DF.
Obesity is a multi-cause syndrome.
Overfeeding and low exercise produces excess of body
fat. There are individual and population differences
in energy balance, (ethnical, diet behavior, longer
life expectancies). Genetic factors may influence
the setting of obesity, but the calorie intake, physical
activity, and lifestyle are critical determinants.
As a consequence of the complex mechanisms involved
in the pathogenesis of this syndrome and its complications,
each model used in the diagnostic and therapeutic
approach are partial. New evidences on the genetic
and neuroendocrine factors in obesity are emerging,
however, a holistic model is needed to understand
this syndrome where biologic, psychological and social
factors act together in a very intricate way. Using
this model, better understanding in prevention and
treatment is expected.
Eur J Endocrinol. 2004 Feb;150(2):185-94.
Influence of short-term dietary weight loss on cortisol
secretion and metabolism in obese men. Johnstone AM, Faber P, Andrew
R, Gibney ER, Elia M, Lobley G, Stubbs RJ, Walker
BR. Rowett Research Institute, Greenburn
Road, Bucksburn, Aberdeen AB21 9SB, UK.
OBJECTIVES: Obesity is associated
with increased inactivation of cortisol by hepatic
A-ring 5alpha- and 5beta-reductases, impaired hepatic
regeneration of cortisol from cortisone by 11beta-hydroxysteroid
dehydrogenase type 1 (11HSD1), but increased subcutaneous
adipose 11HSD1 activity enhancing local cortisol levels
in fat. Cause and effect between obesity and abnormal
cortisol metabolism is untested. DESIGN: Acute weight
loss was induced by very low calorie diet (VLCD) or
starvation in obese men. METHODS: Otherwise healthy
males (aged 20-55 years; body mass index (BMI) 30-40
kg/m2) were studied after 6 days on a weight maintenance
diet; then after either 6 days of starvation (n=6)
or 3 weeks of VLCD (2.55 MJ; n=6); then after 1 week
of weight maintenance; and finally after 2 weeks of
being allowed to feed ad libitum. Plasma samples were
obtained from indwelling cannulae at 0930 h and 1815
h and a 24 h urine collection was completed for analysis
of cortisol metabolites by gas chromatography/mass
spectrometry. RESULTS: Data are mean+/-S.E.M. BMI
fell (kg/m3) from 34.8+/-0.8 at baseline to 31.8+/-1.4
on VLCD and 32.7+/-1.1 on starvation. Starvation caused
a rise in plasma cortisol (at 0930 h from 143+/-17
to 216+/-11 nM, P<0.001) but no change in total
urinary cortisol metabolites. VLCD did not alter plasma
cortisol and markedly reduced cortisol metabolite
excretion (from 15.8+/-1.1 mg/day at baseline to 7.0+/-1.1
mg/day, P<0.001). Relative excretion of 5alpha-reduced
cortisol metabolites fell on both diets, but there
were no changes in cortisol/cortisone metabolite ratios
reflecting 11HSD activities. CONCLUSIONS: Weight loss
with VLCD in obesity reverses up-regulation of hepatic
A-ring reductases and normalises cortisol production
rate; in contrast, starvation produces acute stress
and further activation of cortisol secretion. We suggest
that activation of cortisol secretion is not an irreversible
intrinsic abnormality in obese patients, and speculate
that dietary content has an important influence on
the neuroendocrine response to weight loss.
2002
Int J Eat Disord 2002 Jan;31(1):49-56
Effect of a very low calorie diet on the diagnostic
category of individuals with binge eating disorder. Raymond NC, de Zwaan M, Mitchell
JE, Ackard D, Thuras P. Department of Psychiatry, University
of Minnesota Medical School, Minneapolis, Minnesota.
OBJECTIVE: This study examined
the factors associated with the diagnostic outcome
of obese individuals with and without binge eating
disorder (BED) 1 year after completing a very low
calorie diet (VLCD) program. METHOD: Participants
included 63 individuals with BED, 36 individuals with
subthreshold BED, and 29 individuals with no binge
eating symptoms. Diagnoses before and after VLCD were
obtained using the Structured Clinical Interview for
DSM-IV (SCID) interviews. The severity of psychiatric
symptoms were assessed using various rating scales.
RESULTS: Fifty-six percent (n = 36) of the participants
who met criteria for BED at baseline did not meet
diagnostic criteria 1 year later. None of the baseline
factors were statistically associated with outcome.
DISCUSSION: Although the main hypothesis was not supported,
absence of a BED diagnosis at 12-month follow-up after
a VLCD diet appears to be associated with less weight
gain at 1-year follow-up regardless of baseline diagnosis.
Copyright 2002 by John Wiley & Sons, Inc. Obes Res
2001 Nov;9 Suppl 4:295S-301S Very-low-calorie diets
and sustained weight loss. (A review) Saris WH. Nutrition
and Toxicology Research Institue Maastricht, Maastricht
University, The Netherlands. To review of the literature
on the topic of very-low-calorie diets (VLCDs) and
the long-term weight-maintenance success in the treatment
of obesity. RESEARCH METHODS AND PROCEDURES: A literature
search of the following keywords: VLCD, long-term
weight maintenance, and dietary treatment of obesity.
RESULTS: VLCDs and low-calorie diets with an average
intake between 400 and 800 kcal do not differ in body
weight loss. Nine randomized control trials, including
VLCD treatment with long-term weight maintenance,
show a large variation in the initial weight loss
regain percentage, which ranged from -7% to 122% at
the 1-year follow-up to 26% to 121% at the 5-year
follow-up. There is evidence that a greater initial
weight loss using VLCDs with an active follow-up weight-maintenance
program, including behavior therapy, nutritional education
and exercise, improves weight maintenance. CONCLUSIONS:
VLCD with active follow-up treatment seems to be one
of the better treatment modalities related to long-term
weight-maintenance success.
2001
Obes Res. 2001 Nov;9 Suppl
4:295S-301S Very-low-calorie diets and sustained
weight loss. Saris WH. Nutrition and Toxicology Research
Institue Maastricht, Maastricht University, The Netherlands.
OBJECTIVE: To review of the
literature on the topic of very-low-calorie diets
(VLCDs) and the long-term weight-maintenance success
in the treatment of obesity. RESEARCH METHODS AND
PROCEDURES: A literature search of the following keywords:
VLCD, long-term weight maintenance, and dietary treatment
of obesity. RESULTS: VLCDs and low-calorie diets with
an average intake between 400 and 800 kcal do not
differ in body weight loss. Nine randomized control
trials, including VLCD treatment with long-term weight
maintenance, show a large variation in the initial
weight loss regain percentage, which ranged from -7%
to 122% at the 1-year follow-up to 26% to 121% at
the 5-year follow-up. There is evidence that a greater
initial weight loss using VLCDs with an active follow-up
weight-maintenance program, including behavior therapy,
nutritional education and exercise, improves weight
maintenance. CONCLUSIONS: VLCD with active follow-up
treatment seems to be one of the better treatment
modalities related to long-term weight-maintenance
success.
Med Pregl
2001 Nov-Dec;54(11-12):534-8
Treatment of extreme obesity with a very low calorie
diet. Ivkovic-Lazar T. Klinika za endokrinologiju, dijabetes
i bolesti metabolizma, Institut za interne bolesti,
Klinicki centar, Novi Sad.
This paper presents the results
of treatment of very obese persons with a very-low-calorie
diet (VLCD). MATERIAL AND METHODS: A group of 28 extremely
obese subjects, average age 32 years, was treated in
the course of one month by the following regime: 3-4
l of mineral water with "Enemon" pulv. 3 x 1 and vitamin
substitution and allopurinol 300 mg/day. RESULTS: In
addition to a statistically significant (p < 0.5) loss
of body mass, significant changes were observed in regard
to decrease of atherogenic lipid profile (cholesterol,
triglycerides, LDL-cholesterol, apoprotein B), as well
as lowered level of hyperinsulinism which, though, was
not statistically significant. The degree of protein
catabolism did not reach statistical significance, and
the results were also more favourable with respect to
potential changes in electrolytes, as well as with respect
to the degree of hyperuricemia in regard to subjects
being under the regime of total starvation. DISCUSSION
AND CONCLUSIONS: VLCD represents an extremely efficient
and safe therapeutic procedure which, apart from body
mass loss, is characterized by favourable changes in
metabolism of lipids and a decrease in hyperinsulinism,
which eventually results in reduction of the risk from
early and accelerated atherosclerosis.
2000
Obes Rev. 2000 Oct;1(2):113-9 Long-term efficacy of dietary
treatment of obesity: a systematic review of studies
published between 1931 and 1999. Ayyad C, Andersen T. Roskilde County Hospital, DK-4000,
Roskilde, Denmark.
METHODS: MEDLINE surveys were
carried out and reference lists were cross-checked
to identify publications on long-term outcome for
dietary treatment of obesity. 898 papers were identified,
17 fulfilled our planned criteria for inclusion (dietary
treatment; adults; follow-up period > or = 3 years;
follow-up rate > or = 50% of original study group;
information on one of the success criteria: maintenance
of all weight initially lost (or further weight reduction)
or maintenance of at least nine to 11 kg of initial
weight loss; obesity complications of the patient
group not over-represented; English, German or Scandinavian
languages). RESULTS: The 17 included publications
(here of three publications on randomized clinical
trials with control group relevant for this review)
reported on 21 study groups, comprising 3030 patients.
Of these 2131 (70%) were followed-up for 3-14 years
(median 5 years). Mean initial weight loss ranged
from four to 28 kg (median 11 kg). Overall, 15% (median,
range 0-49%) of followed-up patients fulfilled one
of the criteria for success. Overall, success rates
seemed stable for up to 14 years of observation. Diet
combined with group therapy lead to better long-term
success rates (median 27%) than did diet alone (median
15%) or diet combined with behaviour modification
(median 14%). Active follow-up was generally associated
with better success rates than was passive follow-up
(19% vs. 10%). Conventional diet seemed to be most
efficacious in addition with group therapy, whereas
VLCD apparently was most efficacious if combined with
behaviour modification and active follow-up. CONCLUSION:
The literature on long-term follow-up of dietary treatment
of obesity, although limited and inhomogeneous, points
to an overall median success rate of 15% and a possible
adjuvant effect of group therapy, behaviour modification
and active follow-up.
Biomed Pharmacother
2000 Mar;54(2):74-9
Treatment of diabetes in patients with severe obesity. Scheen AJ. Department of Medicine, CHU Sart
Tilman (B35), Liege 1, Belgium.
ABSTRACT: Besides genetic predisposition,
obesity is the most important risk factor for the development
of diabetes mellitus, and weight reduction has been
shown to markedly improve blood glucose control in obese
subjects with type 2 diabetes. Therapeutic strategies
for the obese diabetic patient include: 1) promoting
weight loss through lifestyle modifications (hypocaloric
diet and exercise) and anti-obesity drugs (orlistat,
sibutramine, etc.); 2) improving blood glucose control,
essentially through the reduction of insulin resistance
(metformin, eventually thiazolidinediones) or insulin
need (alpha-glucosidase inhibitors) and, at a later
stage, the correction of defective insulin secretion
(sulphonylureas, repaglinide) or low circulating insulin
levels (exogenous insulin); and 3) treating common associated
risk factors, such as arterial hypertension and dyslipidaemias,
to improve cardiovascular prognosis. When morbid obesity
is present, both restoring a good glycemic control and
correcting associated risk factors can only be obtained
through marked and sustained weight loss. This primary
objective justifies more aggressive weight reduction
programmes, including very low-calorie diets and bariatric
surgery, but only within a multidisciplinary approach
and in well-selected patients .
Lakartidningen
2000 Sep 6;97(36):3876-9
VLCD a safe and simple treatment of obesity (A review). Rossner S, Torgerson JS. Article in Swedish Huddinge Universitetssjukhus.
This review summarizes Swedish
experience with VLCD (Very Low Calorie Diets). VLCD-treatment
is a safe and relatively simple way to induce weight
reduction in obese patients. The rapid and profound
initial weight loss reduces cardiovascular risk factors
and relieves obesity-associated symptoms. Weight loss
on the order of 20-25 kg is common after 12-16 weeks
of treatment. The long-term results, about 10% weight
reduction after two years, are similar to what can be
expected with pharmacological treatment. VLCD's should
be incorporated into long-term treatment programs including
diet, physical exercise and lifestyle modification.
A team of nurses and/or dieticians can, to a large extent,
manage a VLCD-program, restricting the need for involvement
of the physician.
1999
Adv Ther 1999 Nov-Dec;16(6):285-9 Predictors of long-term weight
reduction in obese patients after initial very-low-calorie
diet. Hoie LH, Bruusgaard D. Norsk
Legesenter, Oslo, Norway.
This prospective interventional
study assessed possible predictors of long-term weight
loss and compared them with factors previously identified
as predicting short-term variations in weight reduction
after initial treatment with a very-low-calorie diet
(VLCD). Eighty-two overweight patients with a body
mass index of at least 27 kg/m2 were recruited from
primary health-care settings into a structured weight-reduction
and maintenance program. All patients used the VLCD
for 8 weeks and were followed up 13.2 months later.
Mean body weight decreased an average of 13.3 kg during
the 8-week treatment and was still 8.6 kg below pretreatment
levels after 13.2 months. Triglyceride levels were
also significantly reduced. Sex, baseline weight,
baseline body mass index, and age predicted 37% of
the variation in short-term weight loss but had no
long-term predictive value.
J Am Coll
Nutr 1999 Dec;18(6):620-7
Long-term weight maintenance after an intensive weight-loss
program. Anderson JW, Vichitbandra S, Qian
W, Kryscio RJ. VA Medical Center and University
of Kentucky (HMR) Weight Management Program, Lexington,
USA.
This prospective study assessed
long-term weight maintenance of patients completing
an intensive very-low-calorie diet (VLCD) weight-loss
program. SUBJECTS: Individuals who had completed the
12-week core education program and lost > or = 10 kg
were recruited. RESULTS: Of 154 eligible subjects, follow-up
weights were obtained at > or = 2 years in 112 subjects
(72.7%, 72 women, 40 men). Subjects had an average initial
body mass index of 37.3 kg/m2 and an average weight
loss of 29.7 kg in five months. Six hundred and forty-five
follow-up weights (median, five per subject) were obtained
over two to seven years of follow-up from clinic visits
(70%) and self-report by telephone or mail (30%). Subjects
regained an average of 2.5% per month of their lost
weight during the first two to three years of follow-up;
however, their weight stabilized over the next four
years. Subjects regained an average of 73.4% of their
weight loss during the first three years. The average
weight loss maintained for 112 subjects was 22.8% of
initial weight loss after an average of 5.3 years of
follow-up. When successful weight maintenance was defined
as maintaining a weight loss of 5% or 10% of initial
(pre-treatment) body weight, 40% were maintaining a
5% weight loss at five years and 25% were maintaining
a weight loss of 10% at 7 years. Multiple regression
analyses suggested that age had a significant (p=0.004)
and positive effect on weight maintenance. CONCLUSIONS:
This study suggests that weight maintenance after an
intensive VLCD program is improving but still needs
intensive efforts to enable most individuals to maintain
a substantial percentage of their weight loss long-term.
Obes Res
1999 Sep;7(5):463-8
Racial differences in metabolic predictors of obesity
among postmenopausal women. Nicklas BJ, Berman DM, Davis DC,
Dobrovolny CL, Dennis KE. Department of Medicine, University
of Maryland School of Medicine, Baltimore V.A. Medical
Center, 21201, USA.
This study determined whether
there are racial differences in resting metabolic rate
(RMR), fat oxidation, and maximal oxygen consumption
(VO2max) in obese [body mass index (BMI = 34+/-2 kg/m2)],
postmenopausal (58+/-2 years) women. RESEARCH METHODS
AND PROCEDURES: Twenty black and 20 white women were
matched for fat mass and lean mass (LM), as determined
by dual energy X-ray absorptiometry. RMR and fat oxidation
were measured by indirect calorimetry in the early morning
after a 12-hour fast using the ventilated hood technique.
VO2max was measured on a treadmill during a progressive
exercise test to voluntary exhaustion. RESULTS: RMR,
adjusted for differences in LM, was 5% higher in white
than black women (1566+/-27 and 1490+/-26 kcal/day,
respectively; p<0.05); and fat oxidation rate was 17%
higher in white than black women (87+/-4 and 72+/-3
g/day, respectively; p<0.01). VO2max (L/minute) was
150 mL per minute (8%) higher (p<0.05) in white than
black women. VO2max correlated with LM in black (r=0.44,
p=0.05) and white (r=0.53, p<0.05) women, but the intercept
of the regression line was higher in white than black
women (p<0.05), with no significant difference in slopes.
In a multiple regression model including race, body
weight, LM, and age, LM was the only independent predictor
of RMR (r2 = 0.46, p<0.0001), whereas race was the only
independent predictor of fat oxidation (r2 = 0.18, p<0.05).
The best predictors of VO2max were LM (r2 = 0.22, p<0.05)
and race (cumulative r2 = 0.30, p<0.05). DISCUSSION:
These results show there are racial differences in metabolic
predictors of obesity. Determination of whether these
ethnic differences lead to, or are an effect of, obesity
status or other lifestyle factors requires further study.
1998
Br J Gen Pract 1998 May;48(430):1251-2 Obesity wars: a pilot study
of very low calorie diets in obese patients in general
practice. Molokhia M. St George's Hospital Medical
School Department of General Practice and Primary
Care, London.
In this study we aimed to determine
whether very low calorie diets (VLCDs) can be an effective
means of weight reduction in obese patients in general
practice. Twenty-six patients showed a mean reduction
in weight of 15 kg and in body mass index (BMI) of
6.1% within a 12-month period. VLCDs with regular
monitoring and feedback were shown to be effective
in reducing and maintaining weight loss for up to
a year with no reported serious side effects.
1997
Int J Obes Relat Metab Disord.
1997 Jan;21(1):22-6 VLCD versus LCD in long-term
treatment of obesity. Rossner S, Flaten H. Obesity Unit, Karolinska Hospital,
Stockholm, Sweden.
OBJECTIVE: To compare the long-term
effects of three different programs including initial
6 weeks (V)LCD diets 420 kcal/d, 530 kcal/d, 880 kcal/d)
on sustained weight loss, attrition and obesity associated
conventional cardiovascular risk factors. DESIGN:
Prospective, randomized clinical 52 weeks trial. Two
weeks of a booster (V)LCD period after week 26. SETTING:
University outpatient obesity clinic. SUBJECTS: Ninety-three
middle-aged obese patients (30 men), initial mean
BMI 38.7 kg/m2, age 20-65 y, from the waiting list.
MAIN OUTCOME MEASURES: Weight loss pattern, attrition,
reported side effects, blood pressure, blood glucose
and serum lipid levels. Repeated frequent measurements
up to week 26, intermittently up to final measurements
at week 52. RESULTS: One year attrition (30-45%),
sustained weight loss (8-15% of initial body weight)
and changes in obesity associated risk parameters
were similar in all three group. Fewer adverse events
were reported in the LCD group. CONCLUSION: The results
compare favorably with most previous reports of similar
design. VLCD (420 kcal or 530 kcal/ d and LCD 880
kcal/d) were equally effective in long term treatment
of obesity. The tendency to less side effects with
LCD suggests that such preparations deserve further
attention.
1993
JAMA 1993 Aug 25;270(8):967-74 Very low-calorie diets. National Task Force on the Prevention
and Treatment of Obesity, National Institutes of Health.
To provide an overview of the
published scientific information on the safety and
efficacy of very low-calorie diets (VLCDs) and to
provide rational recommendations for their use. DATA
SOURCES AND EXTRACTION--Original reports obtained
through a MEDLINE search for 1966 through 1992 on
VLCDs or reducing diets plus obesity, supplemented
by a manual search of bibliographies and the opinions
of experts in the field of nutrition and weight loss
therapy for obesity. Only studies of humans were cited.
DATA SYNTHESIS--Current VLCDs are usually provided
in the context of comprehensive treatment programs,
during which usual food intake is completely replaced
by specific foods or liquid formulas containing 3350
kJ/d (800 kcal/d) or less. Weight loss on VLCDs averages
1.5 to 2.5 kg/wk; total loss after 12 to 16 weeks
averages 20 kg. These results are superior to standard
low-calorie diets of 5020 kJ/d (1200 kcal/d), which
lead to weight losses of 0.4 to 0.5 kg/wk and an average
total loss of only 6 to 8 kg. There is little evidence
that intakes of less than 3350 kJ/d (800 kcal/d) result
in better weight losses than 3350 kJ. Intake of at
least 1 g/kg of ideal body weight per day of protein
of high biologic value appears to be important in
helping to preserve lean body mass. Serious complications
of modern VLCDs are unusual, cholelithiasis being
most common. CONCLUSIONS--Current VLCDs are generally
safe when used under proper medical supervision in
moderately and severely obese patients (body mass
index [weight in kilograms divided by height in meters
squared] > 30) and are usually effective in promoting
significant short-term weight loss, with concomitant
improvement in obesity-related conditions. Long-term
maintenance of weight lost with VLCDs is not very
satisfactory and is no better than with other forms
of obesity treatment. Incorporation of behavioral
therapy and physical activity in VLCD treatment programs
seems to improve maintenance.
The Anti-Aging Fasting Program consists
of a 7-28 days program (including 3 - 14 fasting days). 7-28-day low-calorie
diet program is also available .
More information
The anti-aging story (summary)
Introduction. Statistical review. Your personal
aging curve
Internal
(free radicals, glycosylation,
chelation etc.) External (Unhealthy diet, lifestyle,
wrong habits, environmental pollution, stress, poverty-change "poverty
zones", or take it easy. etc.)
2.2 Anti-aging forces
Internal
(apoptosis, boosting your immune system, DNA repair, longevity genes)
External (wellness, changing your environment;
achieving comfortable social atmosphere in your life, regular intake of
anti-aging drugs, use of replacement organs, high-tech medicine, exercise)
2.3 Aging versus anti-aging: how to tip the
balance in your favour!
3.6 What can help you make the transition
to the low-calorie life style?
Social, psychological and religious
support - crucial factors for a successful transition.
Drugs to ease the transition to caloric restriction and to overcome food
cravings (use of adaptogenic
herbs)
Food composition
Finding the right physician
These approaches taken together can add 60-80
years to your lifespan, if you start young (say at age 20).
But even if you only start later (say at 45-50), you can still
gain 30-40 years
