Small Reduction In Body Weight Research Articles

Calorie restriction causes multiple beneficial metabolic adaptations linearly related with the degree of weight loss in non-obese individuals: Results of CALERIE, a multicenter randomised controlled trial

BACKGROUND & AIMS: Understanding the temporal association and relative power of anthropometric, body composition and energy metabolism measurements of calorie restriction (CR) in predicting metabolic and hormonal adaptations is important, given the clinical and public health implications of excess weight and adiposity. METHODS: Anthropometric (body weight, BMI, waist circumference), body composition (body fat and lean mass by DXA), energy metabolism (leptin and total daily energy intake by doubly labelled water [DLW]) markers and an extensive assessment of cardiometabolic, inflammatory and hormonal risk factors were obtained in 191, 21–50 year old non-obese (BMI 22·0–27·9 kg/m2) women and men, who participated in the 2-yr CALERIE randomized clinical trial. Pairwise correlations for each adiposity and energy metabolism measure were calculated against each other and against each metabolic parameter. In addition, spline and linear regression models were developed to determine a threshold effect of adiposity and energy metabolism measures to trigger changes in metabolic parameters. RESULTS: Among the progressively more sophisticated measures of adiposity, body weight is the variable that is most strongly correlated with cardiometabolic and inflammatory outcomes during CR-induced weight loss in young and middle-aged non-obese men and women. Waist circumference and DXA body fat are not superior to body weight or BMI in detecting these biological modifications. We did not find a specific threshold in weight loss to be exceeded for changes in metabolic and inflammatory adaptations to occur. Even small reductions in body weight cause a significant decline in serum T3 levels, a predictor of post-CR weight regain. CONCLUSIONS: Calorie restriction with adequate nutrition causes multiple beneficial cardiometabolic and hormonal adaptations that are linearly related with the degree of weight loss in non-obese individuals. Once a baseline has been established, tracking changes in body weight is sufficient to monitor improvements in metabolic health.

Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial

BackgroundPhysical activity is associated with a reduced risk of type 2 diabetes and cardiovascular disease but limited evidence exists for the sustained promotion of increased physical activity within diabetes prevention trials. The aim of the study was to investigate the long-term effectiveness of the Walking Away programme, an established group-based behavioural physical activity intervention with pedometer use, when delivered alone or with a supporting mHealth intervention.MethodsThose at risk of diabetes (nondiabetic hyperglycaemia) were recruited from primary care, 2013–2015, and randomised to (1) Control (information leaflet); (2) Walking Away (WA), a structured group education session followed by annual group-based support; or (3) Walking Away Plus (WAP), comprising WA annual group-based support and an mHealth intervention delivering tailored text messages supported by telephone calls. Follow-up was conducted at 12 and 48 months. The primary outcome was accelerometer measured ambulatory activity (steps/day). Change in primary outcome was analysed using analysis of covariance with adjustment for baseline, randomisation and stratification variables.ResultsOne thousand three hundred sixty-six individuals were randomised (median age = 61 years, ambulatory activity = 6638 steps/day, women = 49%, ethnic minorities = 28%). Accelerometer data were available for 1017 (74%) individuals at 12 months and 993 (73%) at 48 months. At 12 months, WAP increased their ambulatory activity by 547 (97.5% CI 211, 882) steps/day compared to control and were 1.61 (97.5% CI 1.05, 2.45) times more likely to achieve 150 min/week of moderate-to-vigorous physical activity. Differences were not maintained at 48 months. WA was no different to control at 12 or 48 months. Secondary anthropometric and health outcomes were largely unaltered in both intervention groups apart from small reductions in body weight in WA (~ 1 kg) at 12- and 48-month follow-up.ConclusionsCombining a pragmatic group-based intervention with text messaging and telephone support resulted in modest changes to physical activity at 12 months, but changes were not maintained at 48 months.Trial registrationISRCTN 83465245 (registered on 14 June 2012).

Complementary and Alternative Therapies for Weight Loss: A Narrative Review.

Despite various strategies, overweight and obesity problems are still increasingly prevalent worldwide with serious health outcomes. Consequently, the continuous demand for more effective, safe and acceptable therapies for reducing body weight is also escalating—including complementary and alternative therapies (CATs). The aim of this review is to provide a summary of the most commonly- and recently-used CATs, with evaluation of their safety and efficacy for weight loss. Electronic scientific databases such as Scopus, PubMed and EBSCO Host were explored for articles that reported CATs for overweight and obesity treatment from 2015 to December 2019. Only systematic reviews, meta-analysis and randomized controlled trials (RCTs) published in English were included. Studies whereby CATs were not utilized for reducing body weight were excluded. Eight systematic reviews and meta-analyses and 11 additional RCTs with 765 participants (50.2% overweight and 49.8% obese) related to hypnotherapy, acupuncture and dietary supplements met the inclusion criteria. Their results suggested that spirulina, chitosan, probiotic, EPA + DHA, vitamin D, fiber, and herbal extract supplementation may all provide small reductions in body weight (ranging from 1-10 kg). Interestingly, hypnotherapy and acupuncture reported significantly greater reduction in body weight compared with placebo (p < 0.001 and p < 0.0001, respectively). Nonetheless, the evidence is still relatively limited and not encouraging to provide a definitive conclusion due to the methodological shortcomings and the presence of adverse events in chitosan and fiber supplementation. Hence, studies of this nature need to be further replicated and improved to corroborate the efficacy and safety of the CATs to combat weight issues.

A systematic review, meta-analysis, and meta-regression of the impact of diurnal intermittent fasting during Ramadan on body weight in healthy subjects aged 16years and above.

Studies on the effect of Ramadan diurnal intermittent fasting (RDIF) on body weight have yielded conflicting results. Therefore, we conducted a systematic review and meta-analysis to estimate the effect size of body weight changes in healthy, non-athletic Muslims practicing Ramadan fasting, and to assess the effect of covariates such as age, sex, fasting time duration, season, and country, using subgroup analysis, and meta-regression. Covariate adjustments were performed to explain the variability of weight change in response to Ramadan fasting. CINAHL, Cochrane, EBSCOhost, EMBASE, Google Scholar, ProQuest Medical, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science databases were searched from date of inception in 1950 to the end of August 2019. Eighty-five studies, conducted in 25 countries during 1982-2019, were identified. RDIF yielded a significant, but small reduction in body weight (K = 85, number of subjects, N = 4176 (aged 16-80years), Hedges' g =- 0.360, 95% confidence interval (CI) - 0.405 to - 0.315, I2 = 45.6%), this effect size translates into difference in means of - 1.022kg (95% CI - 1.164kg to - 0.880kg). Regression analysis for moderator covariates revealed that fasting time (min/day) is a significant (P < 0.05) moderator for weight change at the end of Ramadan, while age and sex are not. Variable effects for the season and country were found. RDIF may confer a significant small reduction in body weight in non-athletic healthy people aged 16years and above, directly associated with fasting time and variably correlated with the season, and country.

Titration of insulin glargine 100U/mL when added to oral antidiabetic drugs in patients with type 2 diabetes: results of the TOP-1 real-world study.

Adequate insulin titration is crucial for optimal glycaemic control in type 2 diabetes (T2D). We aimed to explore the factors and outcomes associated with titration of glargine 100U/mL (Gla-100) in patients uncontrolled on oral antidiabetic drugs (OAD) and initiating insulin therapy. Patients from the Titration and Optimization (TOP)-1 registry were stratified by the magnitude of Gla-100 up-titration during the first month (no [< 1Units (U)/day (d)], minimal [≥ 1 and < 5U/d], moderate [≥ 5 and ≤ 8U/d] and strong [> 8U/d]). The primary endpoint was a fasting blood glucose (FBG) ≤ 110mg/dL on ≥ 2 occasions and/or individual HbA1c target by 12months. Of 2308 patients, 905, 715, 409 and 279 underwent no, minimal, moderate and strong titration, respectively. Age decreased across increasing titration groups (p = 0.02) while body mass index (BMI) (p < 0.0001), FBG (p < 0.0001), and HbA1c (p < 0.0001) increased. At 12months, the proportions of patients achieving the primary endpoint were comparable across groups (66.1% overall), though a smaller proportion of no titration patients met both their individual HbA1c target and FBG ≤ 110mg/dL compared to moderate and strong titration patients (20.1% vs. 27.2% and 26.2%, p = 0.033 and 0.023, respectively). HbA1c was also comparable, though FBG was higher in the no titration group (126.2 vs. 122.6, 121.5 and 120.9mg/dL, p < 0.02). A similar, small reduction in body weight occurred in all groups; hypoglycaemia rates were comparable across groups. In real-world, titration of Gla-100 during the first month appears to coincide with a number of baseline factors. Insulin dose to meet HbA1c and FBG targets remains suboptimal in the majority of T2D patients.

A meta-analysis of the effect of chromium supplementation on anthropometric indices of subjects with overweight or obesity.

The role of chromium as a weight loss agent remains questionable, and although previous meta-analyses findings have reported small reductions in body weight in individuals with overweight/obesity following chromium supplementation, there have been significant limitations with these findings. The objective of this meta-analysis was to evaluate the current evidence for the efficacy of oral chromium supplementation in individuals with overweight/obesity from randomized controlled trials. Studies were identified by a search of electronic databases from inception to November 2018 and combined and stratified analyses were used. Twenty-one trials from 19 studies were identified which met all inclusion criteria which were suitable for statistical pooling, and data from 1316 participants were included. Pooled analysis showed significant reductions in anthropometric indices associated with body composition; for weight loss (weighted mean difference [WMD]: -0.75 kg, 95% confidence interval [CI], -1.04, -0.45, P < 0.001), body mass index (WMD: -0.40, 95% CI, -0.66, -0.13, P = 0.003 and body fat percentage (WMD: -0.68%, 95% CI, -1.32, -0.03, P = 0.04) in individuals with overweight/obesity. No changes were detected in controls. Subgroup analysis showed significant improvements in weight loss and body fat percentage, particularly for study durations ≤12 weeks and doses ≤400 μg/d. Chromium supplementation was associated with some improvements in body composition in subjects with obesity/overweight. The effect size was medium and the clinical relevance of chromium as a weight loss aid remains uncertain. Further investigation from larger and well-designed randomized controlled studies, especially in patients with diabetes, is warranted.

SAT-005 Gene Expression and Behavioral Alterations in Mice with Conditional Knockout of GR, MR, or Both GR and MR in the Hippocampus

Glucocorticoids are primary stress hormones that regulate brain function. Aberrant levels of these steroids have been implicated in the pathogenesis of cognitive impairments and psychiatric disorders. Glucocorticoids exert their effects on cells via binding the glucocorticoid receptor (GR) and the closely related mineralocorticoid receptor (MR). A distinctive feature of the hippocampus is that it expresses high levels of both GR and MR. However, the specific roles played by these receptors in mediating the direct actions of glucocorticoids in the hippocampus are poorly understood. To elucidate the in vivo function of hippocampal GR and MR, we employed emx1-cre mice to ablate GR (hippocampal GRKO), MR (hippocampal MRKO), or both GR and MR (hippocampal GRMRdKO) in the hippocampus. The single and double knockout mice were born at the expected Mendelian ratio and survived normally through 12 months of age. Small reductions in body weight were observed for the hippocampal MRKO and hippocampal GRMRdKO mice, but not the hippocampal GRKO mice. RNA sequencing performed on hippocampal RNA revealed major differences in both the basal and glucocorticoid regulated transcriptome in the single and double knockout mice. In behavioral assays, all three mutant mice exhibited reduced anxiety in the marble burying test. However, only the hippocampal MRKO and hippocampal GRMRdKO mice showed decreased anxiety in the elevated plus maze and open field tests. A forced swim test revealed no genotype differences in depression-like behavior. In a conditioned fear test, the hippocampal GRKO mice showed a reduction in context-dependent learning whereas the hippocampal MRKO and hippocampal GRMRdKO mice showed an increase in cue-dependent learning. These findings demonstrate that GR and MR regulate both common and unique signaling pathways in the hippocampus that influence anxiety and learning and memory.

L-serine supplementation lowers diabetes incidence and improves blood glucose homeostasis in NOD mice

Sphingolipids are a diverse group of lipids with important roles in beta-cell biology regulating insulin folding and controlling apoptosis. Sphingolipid biosynthesis begins with the condensation of L-serine and palmitoyl-CoA. Here we tested the effect of L-serine supplementation on autoimmune diabetes development and blood glucose homeostasis in female NOD mice. We found that continuous supplementation of L-serine reduces diabetes incidence and insulitis score. In addition, L-serine treated mice had an improved glucose tolerance test, reduced HOMA-IR, and reduced blood glucose levels. L-serine led to a small reduction in body weight accompanied by reduced food and water intake. L-serine had no effect on pancreatic sphingolipids as measured by mass spectrometry. The data thus suggests that L-serine could be used as a therapeutic supplement in the treatment of Type 1 Diabetes and to improve blood glucose homeostasis.

Do I really want to be going on a bloody diet? Gendered narratives in older men with painful knee osteoarthritis

Purpose: Small reductions in body weight can decrease osteoarthritic knee pain. Intuitively this should provide a strong incentive for weight-loss. However many people undergoing knee joint replacement (KJR) are categorised as obese. Gender theories can help us to understand differential responses to illness and therefore make an important contribution to rehabilitation. We aimed to explore barriers to weight loss in a group of older men with osteoarthritis.Materials and methods: We conducted 12 in-depth interviews, before and 1 year after surgery, with six obese men listed for KJR. Analysis was influenced by constructivist grounded theory. We abstracted conceptual themes from the data through constant comparison.Results: We identified the following themes: (1) I am big and healthy and don’t need to lose weight; (2) being this size isn’t good for me; (3) men don’t have to worry about that sort of thing; (4) I am not as active as I used to be; (5) I have worked hard all my life; (6) what is the point in trying anyway?Conclusions: Gendered narratives can make it challenging for men to lose weight. Healthcare professionals cannot ignore the influence of gender on rehabilitation and should consider gender specific strategies.Implications for rehabilitationMen may not associate being overweight with being unhealthy.Men may take pride in being in good shape and may respond better to weight loss strategies that focus on fitness not body size.Men may link weight gain with decrease in activity levels rather than overeating.Health care professionals should challenge the assumption that weight loss will follow surgery.Health care professionals cannot ignore the influence of gender on the success of rehabilitation.

Effect of Current Dietary Recommendations on Weight Loss and Cardiovascular Risk Factors

BackgroundDietary recommendations emphasize increased consumption of fruit, vegetables, and whole grain cereals for prevention of chronic disease. ObjectivesThis study assessed the effect of dietary advice and/or food provision on body weight and cardiovascular disease risk factors. MethodsHealthy overweight men (n = 209) and women (n = 710), mean age 44.7 years, body mass index [BMI] 32.4 kg/m2, were randomized between November 2005 and August 2009 to receive Health Canada’s food guide (control, n = 486) or 1 of 3 interventions: dietary advice consistent with both Dietary Approaches to Stop Hypertension (DASH) and dietary portfolio principles (n = 145); weekly food provision reflecting this advice (n = 148); or food delivery plus advice (n = 140). Interventions lasted 6 months with 12-month follow-up. Semiquantitative food frequency questionnaires and fasting blood, anthropometric and blood pressure measurements were obtained at baseline, 6 months, and 18 months. ResultsParticipant retention at 6 and 18 months was 91% and 81%, respectively, after food provision compared to 67% and 57% when no food was provided (p < 0.0001). Test and control treatments showed small reductions in body weight (−0.8 to −1.2 kg), waist circumference (−1.1 to −1.9 cm), and mean arterial pressure (0.0 to −1.1 mm Hg) at 6 months and Framingham coronary heart disease risk score at 18 months (−0.19 to −0.42%), which were significant overall. Outcomes did not differ among test and control groups. ConclusionsProvision of foods increased retention but only modestly increased intake of recommended foods. Current dietary recommendations showed small overall benefits in coronary heart disease risk factors. Additional dietary strategies to maximize these benefits are required. (Fruits, Vegetables, and Whole Grains: A Community-based Intervention; NCT00516620)

Exercise Intervention In Overweight And Obese Adolescents

BACKGROUND: The global rise in the prevalence of childhood and adolescent obesity has been linked to modifiable lifestyle factors, including lack of physical activity. However, no known meta-analysis has been conducted on the effects of exercise intervention on weight loss and metabolic risk factors in overweight and obese adolescents. OBJECTIVES: To investigate whether exercise intervention improves body composition and cardio-metabolic risk factors in overweight and obese adolescents. Data Sources: PubMed, Web of Science, SPORTDiscus, Google Scholar. Study Selection: randomized controlled trial; structured exercise intervention, alone or combined; control group received no other treatment designed to increase physical activity; participants were overweight or obese; and aged between 10 and 19 years. Appraisal and Synthesis METHODS: 1667 studies were identified. After evaluation of study characteristics and quality and validity, data from 13 studies (15 trials) involving 554 participants were extracted for meta-analysis. RESULTS: Following exercise intervention, there was a most likely moderate reduction in BMI (2.0, CI: 1.5, 2.5). There were also most likely small reductions in body weight (3.7 Kg, CI: 1.7, 5.8), body fat percentage (3.1 %, 95% CI: 2.2, 4.1), waist circumference (3.0 cm, CI: 1.3, 4.8), and a most likely trivial increase (improvement) in lean mass (1.6 Kg, 95% CI: 0.5, 2.6). Following an oral glucose tolerance test, there was a most likely large improvement in the area under the curve for insulin (162 μU/ul, 95% CI: 93, 231) and very likely moderate improvement in blood glucose (39 mg/dl, 95% CI: 9.4, 69). There were also most likely moderate improvements in the homeostatic model assessment (1.0, 95% CI: 0.7, 1.4) and systolic blood pressure (7.1 mm Hg, CI: 3.5, 10.7). The effects of exercise on total cholesterol, LDL cholesterol, HDL cholesterol, fasting insulin and fasting blood glucose were inconclusive. CONCLUSIONS: The current evidence suggests that exercise intervention in overweight and obese adolescents improves body composition, including decreased body fat and increased lean muscle mass. The limited available evidence further indicates that exercise intervention improves cardio-metabolic risk factors.

Important differences in the durability of glycaemic response among second-line treatment options when added to metformin in type 2 diabetes: a retrospective cohort study

Importance There is limited information about the durability of glycaemic control when different oral glucose-lowering therapies (GLTs) are used as add-on treatments to metformin (MET) in patients with type 2 diabetes mellitus (T2DM).Objective To compare time to treatment failure between different classes of oral GLT when used as second line (add-on) treatments to MET monotherapy at HbA1c ≥ 7.5%.Design, setting and participants A retrospective cohort study on 20,070 patients who were newly treated with a sulphonylurea (SU), dipeptidyl-peptidase-4 (DPP-4) inhibitor or thiazolidinedione (TZD) following MET therapy failure (2007–2014). Patients’ data was sourced from UK General Practices via The Health Improvement Network (THIN) database. The risk of dual therapy failure was compared between three treatment groups: MET + SU (reference group, n = 15,508), MET + DPP-4 inhibitor (n = 3,080) and MET + TZD (n = 1,482). Follow-up was until treatment substitution or intensification with a 3rd GLT, or for up to 5 years (totalling 46,430 person-years). Propensity score weighting and Cox proportional hazard regression analyses were employed.Main outcomes and measures Risk of dual therapy failure was compared between treatment groups while adjusting for baseline covariates.Results Unadjusted survival analysis showed the incidence of dual therapy failure at 1 year was 15% with SU, 23% with DPP-4 inhibitor and 8% with TZD. Corresponding failure rates at 2 years were 26, 38 and 12%, respectively. Adjusted multivariate models showed that, compared to the SU group, adding a DPP-4 inhibitor was associated with an increased risk of treatment failure (adjusted hazard ratio, aHR, 1.58; 95% CI: 1.48–1.68), while adding a TZD was associated with a reduced hazard (aHR, 0.45; 95% CI: 0.41–0.50). Baseline parameters associated with an increased hazard of intensification included HbA1c, diabetes duration, gender, smoking status and the use of statins.Conclusions and relevance In routine clinical practice, adding a DPP-4 inhibitor to MET is associated with an increased, earlier requirement for treatment intensification compared to adding an SU or TZD. Adding a TZD to MET resulted in the most durable glycaemic response.Key messagesThe Agency for Healthcare Research and Quality has suggested that the durability of glycaemic response after treatment intensification is best investigated using well-designed long-term observational studies.In routine clinical practice, among patients with T2DM receiving a second line glucose lowering treatment as add-on to MET, the addition of a Thiazolidinediones is associated with the most durable glycaemic response, followed by a Sulfonylurea and then a DPP-4 inhibitor.Factors associated with earlier dual therapy failure included concomitant use of statin therapy, being female, a smoker, those with longer diabetes duration and higher baseline HbA1c levels.The addition of a Thiazolidinediones was associated with significant weight gain (1.8 kg, p < 0.001), while add-on DPP-4 inhibitor produced a significant weight reduction (−1.8 kg, p < 0.001). A very small reduction in body weight was observed with the SU (−0.2 kg, p < 0.001).

Effectiveness of an mHealth intervention to improve the cardiometabolic profile of people with prehypertension in low-resource urban settings in Latin America: a randomised controlled trial

Poor diet and physical inactivity strongly affect the growing epidemic of cardiovascular disease worldwide. Mobile phone-based health interventions (mHealth) have been shown to help promote weight loss and increase physical activity and are an attractive approach for health-care systems with limited resources. We aimed to assess whether mHealth with advice for lifestyle improvements would reduce blood pressure, promote weight loss, and improve diet quality and physical activity in individuals with prehypertension living in low-resource urban settings in Latin America. In this parallel-group, randomised controlled trial, we recruited individuals (aged 30-60 years) with systolic blood pressure between 120 and 139 mm Hg, diastolic blood pressure between 80 and 89 mm Hg, or both from health-care centres, workplaces, and community centres in low-resource urban settings in Argentina, Guatemala, and Peru. Participants were randomly assigned to receive either monthly motivational counselling calls and weekly personalised text messages to their mobile phones about diet quality and physical activity for 12 months, or usual care. Randomisation was stratified by country, and we applied minimisation by sex and age groups. Study personnel collecting and analysing data were masked to group assignment. The primary outcomes were mean between-group differences in the changes in systolic and diastolic blood pressure from baseline to 12 months in an intention-to-treat analysis of all participants who completed assessments at 12 months. Secondary outcome measures were changes in bodyweight, waist circumference, and self-reported target behaviours from baseline to 12 months. The trial is registered with ClinicalTrials.gov, number NCT01295216. Between March 1, 2012, and Nov 30, 2012, we randomly assigned 637 participants to receive intervention (n=316) or usual care (n=321). 266 (84%) participants in the intervention group and 287 (89%) in the control group were assessed at 12 months. The intervention did not affect change in systolic blood pressure (mean net change -0·37 mm Hg [95% CI -2·15 to 1·40]; p=0·43) or diastolic blood pressure (0·01 mm Hg [-1·29 to 1·32]; p=0·99) compared with usual care. However, we noted a significant net reduction in bodyweight (-0·66 kg [-1·24 to -0·07]; p=0·04) and intake of high-fat and high-sugar foods (-0·75 [-1·30 to -0·20]; p=0·008) in the intervention group compared with the control group. In a prespecified subanalysis, we found that participants in the intervention group who received more than 75% of the calls (nine or more, from a maximum of 12) had a greater reduction of bodyweight (-4·85 [-8·21 to -1·48]) and waist circumference (-3·31 [-5·95 to -0·67]) than participants in the control group. Additionally, participants in the intervention group had an increase in the intake of fruits and vegetables and a decrease in diets high in sodium, fat, and simple sugars relative to participants in the control group. However, we found no changes in systolic blood pressure, diasatolic blood pressure, or physical activity in the group of participants who received more than 75% of the calls compared with the group who received less than 50% of the calls. Our mHealth-based intervention did not result in a change in blood pressure that differed from usual care, but was associated with a small reduction in bodyweight and an improvement in some dietary habits. We noted a dose-response effect, which signals potential opportunities for larger effects from similar interventions in low-resource settings. More research is needed on mHealth, particularly among people who are poor and disproportionally affected by the cardiovascular disease epidemic and who need effective and affordable interventions to help bridge the equity gap in the management of cardiometabolic risk factors. National Heart, Lung, and Blood Institute (US National Institutes of Health) and the Medtronic Foundation.

Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis.

Background.Overweight and obesity have negative health effects. Primary care clinicians are best placed to intervene in weight management. Previous reviews of weight loss interventions have included studies from specialist settings. The aim of this review was to estimate the effect of behavioural interventions delivered in primary care on body weight in overweight and obese adults.Methods.The review included randomized controlled trials (RCTs) of behavioural interventions in obese or overweight adult participants in a primary care setting, with weight loss as the primary outcome, and a minimum of 12 months of follow-up. A systematic search strategy was implemented in Medline, Embase, Web of Science and the Cochrane Central Registry of Controlled Trials. Risk of bias was assessed using the Cochrane Risk of Bias tool and behavioural science components of interventions were evaluated. Data relating to weight loss in kilograms were extracted, and the results combined using meta-analysis.Results.Fifteen RCTs, with 4539 participants randomized, were selected for inclusion. The studies were heterogeneous with respect to inclusion criteria and type of intervention. Few studies reported interventions informed by behavioural science theory. Pooled results from meta-analysis indicated a mean weight loss of −1.36kg (−2.10 to −0.63, P < 0.0001) at 12 months, and −1.23kg (−2.28 to −0.18, P = 0.002) at 24 months.Conclusion.Behavioural weight loss interventions in primary care yield very small reductions in body weight, which are unlikely to be clinically significant. More effective management strategies are needed for the treatment of overweight and obesity.

Hypothalamic gene expression during voluntary hypophagia in the Sprague–Dawley rat on withdrawal of the palatable liquid diet, Ensure

Sprague–Dawley rats over-consume calories over a 10week period and develop diet-induced obesity (c. 100g body weight differential vs controls) when fed a control pellet diet supplemented with chocolate Ensure liquid. Subsequent withdrawal of Ensure immediately reduces caloric intake by more than 50%, and results in weight loss, despite control pellet being available ad libitum. To assess the molecular underpinnings of this phenomenon, brains were processed for energy balance and food reward-related gene expression analysis at two time points, 24h and 4days after the withdrawal of Ensure, when energy intake was suppressed. Gene expression levels in hypothalamic arcuate nucleus and forebrain nucleus accumbens were compared with rats pair-fed to the same energy intake, i.e. imposed negative energy balance, and to controls fed control pellet ad libitum throughout. Cumulative energy intake was approximately 50% lower across the 4day post-Ensure period, giving rise to a small reduction in body weight although body adiposity and blood leptin remained elevated (c. 100% and 50%, respectively vs controls) in rats that had previously been fed Ensure. In contrast, pair-feeding reduced blood insulin and leptin by 33% and 55%, respectively. Hypothalamic expression of neuropeptide Y and agouti-related peptide was down-regulated at 24h in rats previously fed Ensure, indicative of the apparent counter-regulatory changes seen in diet-induced obesity, but was normalised between the 24h and 4day time points. By contrast, the effect of cumulative negative energy balance in the pair-fed groups increased with time, up-regulating expression of the orexigenic neuropeptides. There was also a reduction of suppressor of cytokine signalling-3 gene expression in pair-fed groups where leptin levels were low. There were no changes in opioid, dopamine receptor or cannabinoid receptor expression in the nucleus accumbens. Feedback from diet-induced obesity appears to drive voluntary hypophagia upon withdrawal of palatable diet, and to override signals from intake restriction that would otherwise set in train an anabolic drive.

A telephone-delivered behavioural intervention confers a small reduction in body weight in people with Type 2 diabetes

A telephone-delivered behavioural intervention confers a small reduction in body weight in people with Type 2 diabetes

CNS-targeted LIF Expression Improves Therapeutic Efficacy and Limits Autoimmune-mediated Demyelination in a Model of Multiple Sclerosis

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system (CNS) with an inflammatory and a neurodegenerative component. The neuropoietic cytokine leukemia inhibitory factor (LIF) is expressed in MS lesions, but its effect on lesion development is far from understood. LIF is an interesting candidate for MS therapy, as it has neuroprotective properties and may also promote the survival of myelinating oligodendrocytes (OLGs). However, therapeutic administration of LIF is complicated by its limited ability to cross the blood-brain barrier and its pleiotropic actions outside the CNS. In this study, lentiviral vectors (LVs) were used to achieve stable expression and secretion of LIF in the CNS of adult mice. CNS-targeted expression of LIF significantly reduced demyelination in a murine model of MS. In addition, local expression of LIF ameliorated clinical symptoms with enhanced efficacy compared to systemic treatment with recombinant protein. These findings demonstrate that gene therapeutic administration of LIF is a promising approach to limit lesion burden and clinical symptoms in neuroinflammatory disease.

Interaction Between Fatness and Fitness on CVD Risk Factors in Asian Youth

The purpose of this study was to investigate the effects of fatness and fitness on insulin resistance (IR) and cardiovascular disease (CVD) risk factors among Korean adolescents. A total of 322 male high school students participated Departme nt of Sport and Leisure Studies, Yonsei University, Seoup, Republic of Korea Department of Sport and Leisure Studies, Yonsei University, Seoup, Republic of Korea in the cross-sectional part of the study. To determine the interaction of fatness and fitness levels on IR and CVD risk factors, subjects were stratified into four groups based on their body mass index (BMI) and cardio-respiratory fitness. Subjects who were in the high-fat category had significantly higher IR and CVD risk score than subjects in the low-fat category regardless of their fitness level. Subjects who were in high-fat-high-fit group showed significantly lower IR and CVD risk score than high-fat-low-fit group. Twenty-nine obese and unfit subjects participated in the intervention study. Twelve weeks of exercise training significantly reduced body weight (4.11+/-0.75 kg) and improved VO(2max) which resulted in a significant improvement in IR and CVD risk score (2.16+/-0.62 vs. 0.20+/-0.75). Interestingly, improvement in cardio-respiratory fitness and small reduction in body weight in relatively short-term significantly reduced the CVD risk score to the level of low-fat-low-fit subjects. Our results show the importance of fitness in determining IR and CVD risk factors among obese adolescents.

Weight loss and quality of life in chronic heart failure patients

To evaluate the impact of a planned body weight reduction on quality of life (QoL) in obese/overweight chronic heart failure (CHF) patients. Thirty-four obese/overweight chronic heart failure patients (24 men, mean age 67.8 +/- 9.4 years) underwent a 6-month dietary programme. An assessment of clinical and biochemical parameters was executed before and after dietary programme. The QoL was judged by means of the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline and at the end of the programme. End-study BMI (P < 0.005) and body weight (P < 0.04) values were significantly reduced. We observed a significant improvement in the mean New York Heart Association (NYHA) functional class value (P < 0.02) and in the left ventricle ejection fraction (LVEF) (P < 0.05). The end-study KCCQ scores were significantly increased in seven out of eight domains. We identified a cut-off value of body weight loss of 3 kg to separate responder patients from the nonresponder ones. Only responder group patients showed a significant variation in BMI (P < 0.04), body weight (P < 0.03), mean NYHA class value (P < 0.05), LVEF (P < 0.05). Moreover, all KCCQ domain scores significantly increased in the responder group only. A diet-based body weight reduction improved the quality of life and, perhaps, the cardiac function. Benefits are already evident with a small reduction in body weight.

Abdominal Adiposity and Cardiometabolic Risk: Do We Have All the Answers?

Overweight and obesity, particularly abdominal adiposity, increase the risk for type 2 diabetes mellitus and cardiovascular disease (CVD). Metabolic syndrome, a constellation of risk factors that includes elevated triglycerides, low high-density lipoprotein cholesterol, elevated blood pressure, elevated fasting glucose, and abdominal obesity, predicts the development of CVD and diabetes to an even greater degree. Excess abdominal adipose tissue is associated with insulin resistance, the precursor to type 2 diabetes, and creates an atherogenic inflammatory milieu, characterized by high levels of C-reactive protein and other inflammatory markers (e.g., fibrinogen, plasminogen activator inhibitor–1, cytokines, and adhesion molecules). High levels of these biomarkers correlate with an increased incidence of diabetes and CVD. Recent evidence suggests that patients with nonalcoholic fatty liver disease have an increased incidence of obesity, metabolic syndrome, and insulin resistance and/or type 2 diabetes. Relatively small reductions in body weight may significantly reduce abdominal adipose tissue, reduce insulin resistance, lower triglycerides and low-density lipoprotein cholesterol, reduce inflammation, and decrease overall cardiometabolic risk.