Significant Improvements In Waist Circumference Research Articles

A147 - Endoscopic Revision With Argon Plasma Coagulation for Failed Roux-And-Y Gastric Bypass (Rygb). First Large Series

A1c (HgbA1c) were reduced by 6cm (p o 0.01) and -0.15% (p o 0.05), respectively. Improvements were also seen in triglycerides, HDL, LDL, ALT, and AST. At trial exit, IWQOL-Lite mean scores improved across all domains: þ10.5, þ14.4, þ1.9, þ9.6, þ6.9, and þ9.1 for PF, SE, SL, PD, W, and O, respectively. An improvement of greater than 7.7 in any domain is considered statistically significant. Conclusions: This study demonstrates clinically significant weight loss with ElipseTM, the first procedureless gastric balloon. The weight loss was similar to that seen in prior studies of endoscopically placed balloons. There were no serious adverse events. In addition, ElipseTM therapy led to a significant improvement in waist circumference, HgbA1c, and overall quality of life.

Abstract P111: A Cluster Randomized Controlled Trial to Examine the Effects of Tai Chi and Walking Exercises on Weight Loss, Metabolic Syndrome Parameters, and Bone Mineral Density

Introduction: Tai Chi and walking are both moderate-intensity physical activity (PA) that can be easily practiced in daily life. The purpose of this study was to better understand that after practicing these two types of PAs in a relative short term and keeping the stable dietary intake in this period, how much body weight would be reduced and what extent the metabolic syndrome parameters would be improved; and if a significant weight loss was observed, whether this exercise-induced weight loss had adverse effect on bone mineral density (BMD). Methods: Three-hundred seventy-four healthy and physically inactive adults (45.8±5.3 years) from 9 geographic areas in Hong Kong were randomized to 12 weeks training (45 minutes per day, 5 days per week) of Tai Chi (n=124) or self-paced walking (n=121), or control group (n=129) at area level. Body weight, fat and lean mass, waist circumference, blood pressure and regional BMD, as well as the fasting blood samples were obtained at the beginning and end of trial. Fasting blood glucose (FBG), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides were analyzed. Results: On average, Tai Chi and walking groups lost 0.50 and 0.76 kg of body weight, 0.47 and 0.59 kg of fat mass, respectively (all p<0.001). No significant changes were observed for lean mass and BMD. Two intervention groups had significant improvements in waist circumference and FBG. The between-group difference of waist circumference and FBG was -3.7 cm and -0.18 mmol/L for Tai Chi vs. control; and -4.1 cm and -0.22 mmol/L for walking vs. control (all p<0.001). No significant differences were observed regarding blood pressure, total cholesterol, HDL-C, LDL-C and triglycerides compared to control (all p>0.05). The effects on all outcomes between Tai Chi and walking were similar (all p>0.05). Among intervention groups, change in lean mass, not fat mass or total weight loss, was significantly correlated to the change in BMD. Conclusions: 12-week Tai Chi and walking exercises can produce moderate weight loss and improve the waist circumference and FBG in middle-aged Hong Kong Chinese people, with no additional effects on BMD.

The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders: a meta-analysis.

AimsThe aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined.Material and MethodsWe searched four databases for randomized controlled trials (RCTs) that compared lifestyle interventions to control conditions in patients with psychotic disorders. Lifestyle interventions were aimed at weight loss or weight gain prevention, and the study outcomes included bodyweight or metabolic parameters.ResultsThe search resulted in 25 RCTs -only 4 were considered high quality- showing an overall effect of lifestyle interventions on bodyweight (effect size (ES) = −0.63, p<0.0001). Lifestyle interventions were effective in both weight loss (ES = −0.52, p<0.0001) and weight-gain-prevention (ES = −0.84, p = 0.0002). There were significant long-term effects, two to six months post-intervention, for both weight-gain-prevention interventions (ES = −0.85, p = 0.0002) and weight loss studies (ES = −0.46, p = 0.02). Up to ten studies reported on cardiometabolic risk factors and showed that lifestyle interventions led to significant improvements in waist circumference, triglycerides, fasting glucose and insulin. No significant effects were found for blood pressure and cholesterol levels. Four studies reported on depressive symptoms and showed a significant effect (ES = −0.95, p = 0.05).ConclusionLifestyle interventions are effective in treating and preventing obesity, and in reducing cardiometabolic risk factors. However, the quality of the studies leaves much to be desired.

Weight Loss and Metabolic Improvement in Morbidly Obese Subjects Implanted for 1 Year With an Endoscopic Duodenal-Jejunal Bypass Liner

To evaluate safety, weight loss, and cardiometabolic changes in obese subjects implanted with the duodenal-jejunal bypass liner (DJBL) for 1 year. The DJBL is an endoscopic implant that mimics the duodenal-jejunal bypass component of the Roux-en-Y gastric bypass. Previous reports have shown significant weight loss and improvement in type 2 diabetes for up to 6 months. Morbidly obese subjects were enrolled in a single arm, open label, prospective trial and implanted with the DJBL. Primary endpoints included safety and weight change from baseline to week 52. Secondary endpoints included changes in waist circumference, blood pressure, lipids, glycemic control, and metabolic syndrome. The DJBL was implanted endoscopically in 39 of 42 subjects (age: 36 ± 10 years; 80% female; weight: 109 ± 18 kg; BMI: 43.7 ± 5.9 kg/m); 24 completed 52 weeks of follow-up. Three subjects could not be implanted due to short duodenal bulb. Implantation time was 24 ± 2 minutes. There were no procedure-related complications and there were 15 early endoscopic removals. In the 52-week completer population, total body weight change from baseline was -22.1 ± 2.1 kg (P < 0.0001) corresponding to 19.9 ± 1.8% of total body weight and 47.0 ± 4.4% excess of weight loss. There were also significant improvements in waist circumference, blood pressure, total and low-density lipoprotein cholesterol, triglycerides, and fasting glucose. The DJBL is safe when implanted for 1 year, and results in significant weight loss and improvements in cardiometabolic risk factors. These results suggest that this device may be suitable for the treatment of morbid obesity and its related comorbidities. This study was registered at www.clinicaltrials.gov (NCT00985491).

The effect of aerobic exercise on the metabolic risk profile of breast cancer survivors 2-6 months post chemotherapy.

244 Background: Current literature suggests that weight gain during treatment for breast cancer is associated with a poorer prognosis and an increased risk of developing secondary health problems such as the metabolic syndrome (MetSyn). Physical activity (PA) can alter features of the MetSyn and improve body composition by reducing abdominal adiposity. We report metabolic results of a prospective randomized controlled trial (PEACH trial; Walsh JM, et al. [2010] BMC Cancer. 10[42]) which examines the effect of an exercise intervention on the metabolic risk profile of breast cancer survivors 2-6 months post chemotherapy. Methods: All subjects gave written informed consent and were randomized to an 8-week, twice weekly aerobic exercise intervention programme or a usual care control group consisting of routine medical advice about PA. The five clinical features of the MetSyn were measured: waist circumference (WC), resting blood pressure (BP), triglycerides, high-density lipoprotein cholesterol (HDL-C) and fasting glucose. Insulin resistance was estimated by the homeostatic model assessment (HOMA). Statistical analysis was carried out using independent sample t-tests with significance set at p &lt; 0.05. Results: Twenty-six breast cancer survivors participated (mean (± SD) age 48.13 (8.75) years). At baseline, 50% (n = 13) of subjects were overweight and 23.1% (n = 6) were obese, with 73.1% (n = 19) centrally obese. 34.6% (n = 9) of subjects were classified with the MetSyn. There were no significant differences between groups at baseline. Intention-to-treat analysis showed no significant changes, however, analysis of those who adhered to &gt; 70% of the supervised exercise intervention showed a significant improvement in WC when compared to the control group (p &lt; 0.05). Conclusions: Results show that an 8-week aerobic exercise intervention significantly reduced WC but did not modify other features of the MetSyn. The decrease in WC demonstrated by this short intervention may have important implications in terms of improving survival and the metabolic risk profile of breast cancer survivors. Final follow-up assessments are ongoing and will enable change in WC over time to be evaluated further.

Heartwatch: the effect of a primary care-delivered secondary prevention programme for cardiovascular disease on medication use and risk factor profiles

Heartwatch is a secondary prevention programme of coronary heart disease (CHD) in primary care in Ireland. The aim was to further examine the effect of the Heartwatch programme on cardiovascular risk factors and treatments of patients with a follow-up of 3.5 years. Prospective cohort study of 12,358 patients with established CHD (myocardial infarction, percutaneous cardiac intervention, coronary artery bypass graft) recruited by participating general practitioners; patients invited to attend on a quarterly basis, with continuing care implemented according to defined clinical protocols. Changes in risk factors and treatments at 1, 2, 3 and 3.5-year follow-up from baseline were made using paired t-test for continuous and McNemar's test for categorical data. Important changes in systolic and diastolic blood pressure, total and low-density lipoprotein cholesterol and smoking status were observed at 1, 2, 3 and 3.5 years (P < 0.0001) with significant increase in proportions of patients within the target. However, changes in body mass index were small, with no significant improvement in waist circumference. There was a significant increase in prescription of secondary preventive medications and good patient compliance. Males were more likely to be within the target for systolic blood pressure, total cholesterol, waist circumference and exercise level at 3.5 years, but less likely for body mass index. Studies of cardiac rehabilitation without any follow-up programmes show that over time patients revert in part to previous lifestyle habits; this primary care-delivered programme has shown sustained improvements in major risk factors, particularly smoking, blood pressure and cholesterol, and treatments for CHD. Weight management presents a greater challenge.

Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients

Physicians frequently prescribe medications for weight loss but offer minimal lifestyle counseling despite the additional benefits of combining both interventions. To compare 5 methods of delivering a lifestyle modification program to obese patients receiving sibutramine. Randomized, 6-month, open-label study. Participants were assigned to intervention groups by using a computer-generated schedule of randomly permuted blocks. Block length was 5. 12 independent research clinics with experience running obesity trials. 376 patients with obesity (body mass index > or =30 and <40 kg/m(2)). High-frequency face-to-face lifestyle modification counseling (HF-F2F) (n = 74), low-frequency face-to-face counseling (LF-F2F) (n = 76), high-frequency telephone counseling (HF-TEL) (n = 76), high-frequency e-mail counseling (HF-EMAIL) (n = 74), or no dietitian contact (self-help [SELF]) (n = 76). All participants received sibutramine, 10 mg/d; a lifestyle manual; and access to a weight-loss Web site. Percentage change in body weight at 6 months was the primary outcome. Secondary end points included changes in waist circumference; lipid, glucose, and insulin levels; blood pressure; weight-related symptoms; and quality of life at 6 months. At 6 months, the mean weight loss, relative to baseline, in the HF-F2F and HF-TEL groups was similar (8.9% [95% CI, 8.0% to 9.8%] and 7.7% [CI, 6.8% to 8.7%]) and significantly greater than that in the other groups (LF-F2F, 6.4% [CI, 5.4% to 7.3%]; HF-EMAIL, 5.9% [CI, 5.0% to 6.8%]; and SELF, 5.2% [CI, 4.3% to 6.1%]). All groups showed significant improvements in waist circumference, high-density lipoprotein cholesterol and triglyceride levels, and measures of quality of life and weight-related symptoms. There were no serious adverse events and no differences in minor events among groups. Most participants were women, and the attrition rate was 30%. High-frequency telephone contact with a dietitian was similar to HF-F2F contact for supporting lifestyle modification in obese patients trying to lose weight. The findings might be used by providers and health systems to promote healthy lifestyle changes for their patients. Pfizer Global Research and Development.

Plasma visfatin concentrations after a lifestyle intervention were directly associated with inflammatory markers

Background and aims The biological activity and regulation of the novel adipokine visfatin are still largely unknown. Our aim was to evaluate if visfatin plasma concentrations may be influenced by a lifestyle intervention. Methods and results Out of 335 dysmetabolic patients from a population-based cohort, randomized to receive a lifestyle intervention program (intervention group) or family physician usual care (controls), 20 patients per group were randomly selected for plasma visfatin determination. The before–after variation (Δ) in visfatin concentration at 1-year from randomization, and the correlations between Δvisfatin and intervention-induced changes in waist circumference, fasting glucose, markers of inflammation, and oxidative stress were evaluated. The intervention group showed a significant improvement in waist circumference, and many metabolic/inflammatory variables, while the controls worsened. Visfatin concentrations slightly decreased in the former and significantly increased in the controls (Δvisfatin = −2.4 vs 66.0 ng/ml, p < 0.001). In robust regression models, the following variables resulted associated with Δvisfatin: Δwaist circumference, Δfasting glucose, Δhs-CRP (high-sensitivity C-reactive protein) and ΔTNFα (tumor necrosis factor-α). Significant effects on Δvisfatin of ΔTNFα ( β = 16.8; 6.1–25.6; p = 0.003) and, modified by group, of Δhs-CRP ( β = 29.8; 95% CI 15.4–44.2; p < 0.001 and β = 4.2; 2.9–5.5; p < 0.001 in the control and intervention group, respectively) were detected. By controlling for Δwaist, the effects of ΔTNFα and of Δhs-CRP on Δvisfatin by group did not change, while Δwaist was no longer associated. The association between Δvisfatin and Δglucose was no longer significant, after adjusting for Δhs-CRP. Conclusion Visfatin values increased with waist circumference and were associated with variations of inflammatory markers, suggesting participation in inflammatory mechanisms.

Fit for Life Steps: Results of a Community Walking Intervention in the Rural Mississippi Delta

A collaborative community--university--U.S. Department of Agriculture(USDA)/Agricultural Research Service (ARS) partnership developed and implemented a 6-month walking intervention whereby volunteer coaches were trained to lead community walking groups in a rural Mississippi Delta Community. Assess the feasibility of implementing community-based participatory research (CBPR), increase physical activity, and improve anthropometric and biological measures. This quasi-experimental design examined body mass index, percent body fat, waist circumference, blood pressure, blood glucose, lipid profile, self-reported walking, stages of change, social support, self-efficacy, and decisional balance at enrollment, 3 months, and 6 months. Participants were primarily African-American (99%) women (97%). Changes were evaluated using repeated measures analysis of variance (ANOVA) and Friedman's test. Community members actively participated in assessing the problem, identifying the intervention, intervention planning, data collection, and evaluation. Of the 83 enrolled participants, 66 (80%) completed the intervention. Participants exhibited significant improvements in waist circumference (-1.4 inches), systolic blood pressure (-4.3 mmHg), and high-density lipoprotein (HDL) cholesterol (+7.9 mg/dL); (PA <A .001). Self-reported walking per day was 44.8 (SD+52.2) minutes at enrollment, 76.6 (SD+166.6) minutes at 3-months, and 65.9 (SD+89.7) minutes at 6 months (PA =A .154). A positive stage of change shift occurred in 57% of participants; however, no significant positive changes occurred in the other psychosocial variables. The process of developing and implementing this CBPR walking intervention was considered successful as evidenced by the community's active contribution and participation in each phase of this research, the undertaking and application of basic research components, significant improvements in several anthropometric and biological values, and sustainability of the collaborative partnership.