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2005
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.
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2004
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.
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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.
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2002
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.
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2001
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.
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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.
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2000
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.
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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
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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.
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1999
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.
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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.
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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.
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1998
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.
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1997
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.
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1993
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.
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