Effect Of Weight Loss Intervention Research Articles

Effectiveness of Primary Care–Relevant Treatments for Obesity in Adults

Letters7 February 2012Effectiveness of Primary Care–Relevant Treatments for Obesity in AdultsErin S. LeBlanc, MD, MPH and Elizabeth O'Connor, PhDErin S. LeBlanc, MD, MPHFrom Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227.Search for more papers by this author and Elizabeth O'Connor, PhDFrom Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-3-201202070-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We thank Dr. Kuller for his comments. We conducted this systematic review for the USPSTF to make its recommendation about screening and treatment of adult obesity. The USPSTF recently posted a draft recommendation for public comment but has not released its final recommendation.With regard to the articles in question, we excluded the Look AHEAD and WOMAN studies because the control groups received more than a minimal intervention, which was outside the focus of our review. Our systematic review summarized the data regarding the effectiveness of weight loss interventions compared with no intervention or usual care. We also ... Author, Article, and Disclosure InformationAffiliations: From Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227.Disclosures: Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0823. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffectiveness of Primary Care–Relevant Treatments for Obesity in Adults: A Systematic Evidence Review for the U.S. Preventive Services Task Force Erin S. LeBlanc , Elizabeth O'Connor , Evelyn P. Whitlock , Carrie D. Patnode , and Tanya Kapka Effectiveness of Primary Care–Relevant Treatments for Obesity in Adults Lewis H. Kuller Effectiveness of Primary Care–Relevant Treatments for Obesity in Adults Alan C. Moses , Yehuda Handelsman , and Daniel Einhorn Metrics 7 February 2012Volume 156, Issue 3Page: 249KeywordsConflicts of interestDisclosureHypertensionObesitySystematic reviewsWeight gainWeight loss ePublished: 7 February 2012 Issue Published: 7 February 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice

Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice

Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice

Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice

Endothelial dysfunction associated with obesity and the effect of weight loss interventions

Endothelial damage is central to the initiation and progression of atherosclerosis, while in addition vascular endothelial cells secrete several anti-atherogenic substances including the potent vasodilator nitric oxide. Increased adhesion molecule expression, in response to pathophysiological stimuli is perhaps the earliest indicator of compromised endothelial integrity. Obesity and adiposity are associated with an increased risk of CVD, influencing disease progression via a number of mechanisms, including enhanced endothelial activation. This review discusses possible mechanisms linking adiposity and more specifically regional fat depots with endothelial function and evaluates studies investigating the effect of weight loss on endothelial function, assessed by biochemical and physiological measurements. Overall, the research to date suggests that visceral adiposity is a stronger predictor of endothelial activation than overall adiposity, possibly mediated via the action of NEFA in circulation. While in general there is a suggestion that weight loss is associated with significant improvements in endothelial function, this is not apparent in all interventions and published literature to date provides less than convincing evidence for the effects of weight loss on endothelial activation.

P.3.c.037 Comparison of the efficacy and safety of amisulpride versus low-dose amisulpride plus low-dose sulpiride in treatment of schizophrenia

Rates of obesity are higher than normal across a range of psychiatric disorders, including major depressive disorder, bipolar disorder, schizophrenia and anxiety disorders. While the problem of obesity is generally acknowledged in mental health research and treatment, an understanding of their bi-directional relationship is still developing. In this review the association between obesity and psychiatric disorders is summarised, with a specific emphasis on similarities in their disturbed biological pathways; namely neurotransmitter imbalances, hypothalamus–pituitary–adrenal axis disturbances, dysregulated inflammatory pathways, increased oxidative and nitrosative stress, mitochondrial disturbances, and neuroprogression. The applicability and effectiveness of weight-loss interventions in psychiatric populations are reviewed along with their potential efficacy in ameliorating disturbed biological pathways, particularly those mediating inflammation and oxidative stress. It is proposed that weight loss may not only be an effective intervention to enhance physical health but may also improve mental health outcomes and slow the rate of neuroprogressive disturbances in psychiatric disorders. Areas of future research to help expand our understanding of the relationship between obesity and psychiatric disorders are also outlined.

Evaluation of obesity service outcomes in structured lifestyle weight management clinics at 6, 9 and 12 months

Background: Obesity remains a global epidemic and the effectiveness of weight loss interventions are constantly scrutinised. Hickson et al. (2009) concluded that specific weight loss clinics may achieve better weight loss results and therefore a better use of dietetic time then including obese patients in a general setting. A comparison of local structured weight management clinics versus general clinics was undertaken in 2010, with the conclusion that structured clinics achieve a greater mean weight loss and percentage weight loss then conventional dietetic clinics. This evaluation aimed at further assessing the effectiveness of these clinics with a focus on weight maintenance outcomes at 9 and 12 months. Methods: CLCH Dietetic Service offers a structured Lifestyle Weight Management (LWM) clinic (6 monthly appointments with reviews at 9 and 12 months). LWM outcomes were routinely collected on a central database and these data were used for comparison. These clinics aimed for ≥5% weight loss in 6 months with sustained maintenance. Patients completing the initial 6-month LWM intervention (attending at least four of the six appointments) between April 2009 and December 2010 were included. Those that were due and attended the 9- and 12-month reviews were assessed for weight maintenance; however, as a result of the staggered start dates of attendees, not all patients included in the 6-month results have completed these reviews. Results: Twenty-four patients completed the initial 6 months and, of those, 20 (83%) lost weight. After the initial 6 months, a mean weight loss and percentage weight loss of 6.2 kg and 5.5%, respectively, was achieved. Twelve of the 15 patients due for review attended at 9 months with 11 (92%) maintaining their weight loss. Ten patients were expecting their final 12-month review by December 2010 (42% of the initial 24 patients) of which seven attended and six (86%) maintained a level of weight loss. Table 1. Effect of the lifestyle weight management clinic on weight loss, body mass index (BMI) and waist circumference after 6, 9 and 12 months Results 6 months 9 months 12 months Mean weight loss (kg) 6.2 (0.6–16.5) 7.2 (1.1–17) 5.1 (1.5–13.1) Mean weight loss % 5.5 (1–14) 5.7 (0.9–13.1) 4.1 (1.3–10) Mean waist circumference loss (cm) 5.7 (1–9.5) 5.4 (3–11) 4 (2.5–6) Mean BMI loss (kg m−2) 2.1 (0.2–5.6) 2.1 (0.6–6) 1.7 (0.6–3.7) Discussion: These data demonstrates that LWM clinics achieve the aimed weight loss targets at 6 months. It is well documented that 5–10% weight loss can significantly improve health outcomes (Scottish Intercollegiate Guidelines Network, 2010). This weight loss was maintained at the 9-month review by 92% of those that attended; however, between the 9- and 12-month reviews, this weight loss decreased indicating weight regain over this period. Continued evaluation is required and consideration of support services between the 9- and 12-month review is needed to ensure ongoing weight maintenance. Conclusions: These results provide evidence that LWM clinics achieve the desired outcomes and maintenance of weight loss in those who successfully attended the LWM clinics is achievable.

Migraine and obesity: epidemiology, possible mechanisms and the potential role of weight loss treatment

Migraine and obesity are two public health problems of enormous scope that are responsible for significant quality of life impairment and financial cost. Recent research suggests that these disorders may be directly related with obesity exacerbating migraine in the form of greater headache frequency and severity, or possibly increasing the risk for having migraine. The relationship between migraine and obesity may be explained through a variety of physiological, psychological and behavioural mechanisms, many of which are affected by weight loss. Given that weight loss might be a viable approach for alleviating migraine in obese individuals, randomized controlled trials are needed to test the effect of weight loss interventions in obese migraineurs. Large-scale weight loss trials have shown that behavioural interventions, in particular, can produce sustained weight losses and related cardiovascular improvements in patients who are diverse in body weight, age and ethnicity. Consequently, these interventions may provide a useful treatment model for showing whether weight loss reduces headache frequency and severity in obese migraineurs, and offering further insight into pathways through which weight loss might exert an effect.

Update on Exercise and Weight Control

Update on Exercise and Weight Control

Effect of weight loss intervention on the association between eating behaviour measured by TFEQ-18 and dietary intake in adults

Associations between eating behaviour (cognitive restraint, emotional eating and uncontrolled eating) and dietary intake (energy, energy nutrients and fibre) were assessed in overweight or obese adults (body mass index >27kg/m2, n=49) before and after weight loss intervention in a randomized follow-up study lasting 18 months. Counselling was either intensive or short-term. Eating behaviour was assessed using the three-factor eating questionnaire-18 and dietary intake with 5-day food records at 0 and 18 months. The only difference in dietary intake between the groups was higher protein intake (% of energy, E%) in the short-term group at 18 months (18.7±3.1 E% vs. 17.1±1.7 E%). Cognitive restraint was associated with lower energy intake at 0 and 18 months (r=−0.34, r=−0.36, respectively) and higher intakes of carbohydrates (r=0.39), sucrose (r=0.33) and fibre (r=0.44) and a lower intake of fat (r=−0.43) at 18 months. Those with the highest cognitive restraint at 18 months had the lowest energy and fat intake, the highest carbohydrate and fibre intake and the greatest weight loss. The results suggest that enhancing cognitive restraint could be a target for improving weight loss counselling, although further evaluation of the causal relationship would be needed in order to find the best practices for enhancing cognitive restraint.

METABOLIC PARAMETERS IN A SUBSET OF PATIENTS IN THE SCOP STUDY

Rates of obesity are higher than normal across a range of psychiatric disorders, including major depressive disorder, bipolar disorder, schizophrenia and anxiety disorders. While the problem of obesity is generally acknowledged in mental health research and treatment, an understanding of their bi-directional relationship is still developing. In this review the association between obesity and psychiatric disorders is summarised, with a specific emphasis on similarities in their disturbed biological pathways; namely neurotransmitter imbalances, hypothalamus–pituitary–adrenal axis disturbances, dysregulated inflammatory pathways, increased oxidative and nitrosative stress, mitochondrial disturbances, and neuroprogression. The applicability and effectiveness of weight-loss interventions in psychiatric populations are reviewed along with their potential efficacy in ameliorating disturbed biological pathways, particularly those mediating inflammation and oxidative stress. It is proposed that weight loss may not only be an effective intervention to enhance physical health but may also improve mental health outcomes and slow the rate of neuroprogressive disturbances in psychiatric disorders. Areas of future research to help expand our understanding of the relationship between obesity and psychiatric disorders are also outlined.

Effects of Weight Loss Intervention on Erectile Function in Older Men with Type 2 Diabetes in the Look AHEAD Trial

Overweight men with diabetes often report erectile dysfunction (ED), but few studies have examined effects of weight loss on this problem. This study examined 1-year changes in erectile function (EF) in overweight/obese men with type 2 diabetes participating in the Look AHEAD (Action for Health in Diabetes) trial. Participants in Look AHEAD were randomly assigned to a control condition involving diabetes support and education (DSE) or to intensive lifestyle intervention (ILI) involving group and individual sessions to reduce weight and increase physical activity. Men from five of the clinical sites in Look AHEAD completed the International Index of Erectile Function (IIEF) at baseline (N = 372) and at 1 year (N = 306) (82%). Changes in EF as reported on the EF subscale of the IIEF. At 1 year, the ILI group lost a greater percent of initial body weight (9.9% vs. 0.6 %) and had greater improvements in fitness (22.7% vs. 4.6%) than DSE. EF improved more in ILI (17.3 +/- 7.6 at baseline; 18.6 +/- 8.1 at 1 year) than in DSE (18.3 +/- 7.6 at baseline; 18.4 +/- 8.0 at 1 year); P = 0.04 and P = 0.06 after adjusting for baseline differences. Using established norms for none (i.e., normal EF), and three grades (i.e., mild, moderate, and severe) ED, 8% of men in ILI reported a worsening of EF from baseline to 1 year, 70% stayed in the same category, and 22% reported improvements. In contrast, 20% of DSE reported worsening, 57% stayed in the same category, and 23% improved (P = 0.006). In this sample of older overweight/obese diabetic men, weight loss intervention was mildly helpful in maintaining EF.

Endothelial dysfunction in obesity: etiological role in atherosclerosis

To review studies of vascular endothelial dysfunction in obesity, discuss potential mechanisms of disease, and address the therapeutic effects of weight loss interventions on arterial health. Endothelial dysfunction represents the earliest abnormality in the development of vascular disease, and is pathophysiologically linked to subsequent atherosclerosis progression and cardiovascular disease events. Obesity is closely associated with a number of established cardiovascular risk factors, including diabetes mellitus, insulin resistance, dyslipidemia, and hypertension that are cumulatively damaging to the endothelium. In addition, there is now a growing recognition of non-traditional risk factors as potential modulators of the endothelial phenotype in obesity, including fat tissue production of proatherogenic adipokines, oxidative stress, and chronic inflammation. Clinical studies have demonstrated that even modest weight loss reverses endothelial dysfunction, and the restoration of arterial homeostasis could potentially reduce cardiovascular risk. Obesity is associated with altered arterial homeostasis and endothelial dysfunction. Mechanisms of disease are related to a complex interplay of metabolic and inflammatory factors that coordinately improve along with arterial function in response to weight loss interventions.

A review of weight loss interventions for adults with intellectual disabilities

Obesity is more prevalent in adults with intellectual disabilities than in the general population, and has been shown to contribute to their reduced life expectancy, and increased health needs. Relatively few studies have examined the effectiveness of weight loss interventions for adults with intellectual disabilities. However, there is evidence to support interventions that take account of the context of the lives of adults with intellectual disabilities, including carer involvement in interventions. To reduce the health inequalities experienced by adults with intellectual disabilities, there is a clear need to develop accessible, evidence-based clinical weight management services.

An Integrative Review of Interventions for Adolescent Weight Loss

The number of overweight adolescents aged 12-19 has tripled during the past 2 decades. Although health risks associated with obesity in adolescence and adulthood are well documented in the literature, little is known about the efficacy of interventions to reduce health risks of this group. The purpose of this study was to conduct a systematic review to describe the scope, domain, and effectiveness of weight loss interventions with overweight adolescents. English-language journal articles published in nursing, psychology, nutrition, medicine, and exercise physiology literature between 1980 and 2003 were retrieved. Seventeen studies using comparison or control groups and interventions directed at reductions in adolescent body mass index or body weight were identified. Descriptive findings of those studies are reported here. Five specific limitations of these studies emerged from the analysis of the interventions: the study findings have not been validated by replication, the samples failed to include adequate representation of Latino and African American male participants, family participation in studies has been inconsistent and infrequent, there is a need for attention to study dropout rates (with attrition reported as high as 45%), and there is a need for conceptual frameworks to guide the studies.

Cardiovascular News

Cardiovascular News

The effect of weight loss intervention on antihypertensive medication requirements in the hypertension optimal treatment (HOT) study

Obesity is a significant risk factor for hypertension and the cardiovascular sequelae of hypertension. Weight loss has been shown to be effective in lowering blood pressure in overweight individuals. The purpose of this study was to show the impact of a weight loss intervention on overall medication requirements for obese, hypertensive patients. This was a substudy of the Hypertension Optimal Treatment (HOT) study. HOT study patients who had a body mass index ≥27 kg/m 2 were randomized to receive either the weight loss intervention, which included dietary counseling and group support, or to serve as the control group. Patients’ weights and number of medication steps (per HOT protocol) required to achieve target diastolic blood pressure were measured at 3, 6, 12, 18, 24, and 30 months. Patients in the weight loss group lost significantly more weight than the control group only at 6 months (−3.2 ± 4.3 v −1.8 ± 2.7 kg [mean ± SD] for weight loss group versus control, respectively, P = .05). The weight loss group tended to regain weight after the first 6 months of the study. However, patients in the weight loss group used a significantly fewer number of medication steps than the control group at all time intervals except 3 months. Weight loss appears to be a useful tool in blood pressure management in patients who require medication to control their blood pressure.

H31 Effects of weight loss intervention in hot weight loss substudy participants

H31 Effects of weight loss intervention in hot weight loss substudy participants

Side-effects and efficacy of clozapine in the treatment of acute schizophrenia

Rates of obesity are higher than normal across a range of psychiatric disorders, including major depressive disorder, bipolar disorder, schizophrenia and anxiety disorders. While the problem of obesity is generally acknowledged in mental health research and treatment, an understanding of their bi-directional relationship is still developing. In this review the association between obesity and psychiatric disorders is summarised, with a specific emphasis on similarities in their disturbed biological pathways; namely neurotransmitter imbalances, hypothalamus–pituitary–adrenal axis disturbances, dysregulated inflammatory pathways, increased oxidative and nitrosative stress, mitochondrial disturbances, and neuroprogression. The applicability and effectiveness of weight-loss interventions in psychiatric populations are reviewed along with their potential efficacy in ameliorating disturbed biological pathways, particularly those mediating inflammation and oxidative stress. It is proposed that weight loss may not only be an effective intervention to enhance physical health but may also improve mental health outcomes and slow the rate of neuroprogressive disturbances in psychiatric disorders. Areas of future research to help expand our understanding of the relationship between obesity and psychiatric disorders are also outlined.