Structured Weight Loss Program Research Articles

SHORT AND MID-TERM MEDICAL OUTCOMES OF SLEEVE GASTRECTOMY IN OBESITY IN SULAIMANI CITY. AN ANALYTICAL CROSS-SECTIONAL STUDY

Background 
 The laparoscopic sleeve gastrectomy (LSG) is a frequently performed bariatric procedure. Studies indicate that LSG can facilitate successful and sustainable weight loss.
 Objectives 
 To examine the short-term (weight reduction) and mid-term (weight maintenance, quality of life, and medical conditions) outcomes following sleeve gastrectomy in Sulaimani.
 Patients and Methods
 A cross-sectional study was conducted on 114 participants from both high-quality and Zhyan hospitals in Sulaimani. From Feb 3, 2020, to Jul 22, 2021, data was gathered by evaluating the patient data records of 114 patients. Data included patients’ demographics, preoperative BMI& comorbidities, complications, and weight loss in the first week, second,4th, sixth months, and sixth months. Also, after the sixth month, complications were recorded and analyzed by SPSS software (IBM, version 25), including frequency and percentage, mean, and standard deviation, also obtained for parametric data. The associations between the variables were tested at a P value <0.05.
 Results
 The study consists of 114 patients (71.9% female and 28.1% male), with an average age of 34.0 years (range 20- 51 years). The average preoperative BMI and weight were 41.2 kg/m2 and 110.80 kg, respectively. Six months after surgery, the average ± SD of BMI was 32.8 kg/m ± 2 4.5, and the average ± SD of weight was 87.8 kg ±14.4. The prevalence of early postoperative problems (leak, upper GI bleeding, and intraperitoneal hemorrhage) among 114 patients was 0.9% for each complication, while the proportion of early postoperative nausea was 66.7%, and vomiting was 39.5%. Preoperative sleep apnea was 34.2%; after six months of surgery, the percentage was 0%; 19.3% of patients had joint pain; after six months of surgery, the percentage was 0.9%. In addition, 14 out of 114 patients (12.3%) had preoperative Hypertension, and 2 out of 114 patients (1.75%) had diabetes; after six months, 50% of both groups discontinued medical treatment. The incidence of gallstone development six months after surgery was 13.2%. Six months following LSG, 68.4% of individuals had hair loss. 
 Conclusion
 laparoscopic sleeve gastrectomy can considerably reduce BMI six months following surgery and may help improve or eliminate obesity-related comorbidities such as Hypertension and type 2 diabetes. A laparoscopic sleeve gastrectomy is an effective option for obese adults, resulting in significant weight loss with a low incidence of postoperative complications. LSG could be recommended as a valuable single intervention therapy for patients who typically fail to achieve and obtain real benefits from a structured weight loss program.

NAFLD Epidemiology, Emerging Pharmacotherapy, Liver Transplantation Implications and the Trends in the United States.

Nonalcoholic fatty liver disease (NAFLD) is a hepatic manifestation of metabolic syndrome. The spread of obesity worldwide in pandemic proportions has led to a rapid rise of NAFLD in developed and developing countries alike. There are no approved pharmacological agents to treat steatohepatitis or advanced fibrosis but obeticholic acid recently has shown some promise in phase III trial. Currently, NAFLD is the number one etiology for simultaneous liver and kidney transplantation in the USA, second most common indication for liver transplantation (LT) and projected to become number one very soon. LT for NAFLD poses unique challenges, as these patients are generally older, obese and more likely to have a number of metabolic risk factors. Bariatric surgery is an option and can be considered if a structured weight loss program does not achieve the sustained weight loss goal. Comprehensive cardiovascular risk assessment and aggressive management of comorbid conditions are crucial in the LT evaluation process to improve post-transplant survival. Recurrent nonalcoholic steatohepatitis after LT is not uncommon, and thus warrants primary and secondary prevention strategies through a multidisciplinary approach. Prevalence of NAFLD in a donor population is a unique and growing concern that limits the access to quality liver grafts.

Effects of Exercise during Weight Loss Maintenance on Appetite Regulation in Women.

Exercise is accepted as a method to improve weight loss maintenance; however, the mechanisms by which this occurs have yet to be elucidated. In this pilot study, 13 women with obesity underwent a structured weight loss program (goal 8%-10% weight loss) and were then randomized to either a 12-wk diet (n = 7) or an aerobic exercise training (n = 6) intervention aimed at maintaining weight loss. At baseline, post-weight loss, and following the weight loss maintenance interventions, measurements of appetite (hunger and satiety) and appetite-regulating hormones (leptin, ghrelin, peptide tyrosine tyrosine, and glucagon-like peptide 1) were obtained after an overnight fast and for 3 h after a standardized test meal. Ad libitum energy intake was measured at a lunch meal. During the weight loss phase, participants lost 9.1% ± 1.1% of baseline body weight. Participants in both groups maintained weight loss during the 12-wk weight loss maintenance intervention. No differences in fasting leptin (P = 0.68) or in ghrelin (P = 0.30), peptide tyrosine tyrosine (P = 0.93), and glucagon-like peptide 1 (P = 0.98) area under the curve were detected between groups. Similarly, ratings of hunger (P = 0.99) and satiety (P = 0.65) area under the curve after the standardized test meal also did not differ between the groups nor did ad libitum energy intake at lunch. In summary, the 12-wk diet and exercise interventions were equally effective at maintaining weight loss in women, and no differences in measures of appetite regulation and food intake were found.

A structured weight loss program increases gut microbiota phylogenetic diversity and reduces levels of Collinsella in obese type 2 diabetics: A pilot study

The global obesity epidemic constitutes a major cause of morbidity and mortality challenging public health care systems worldwide. Thus, a better understanding of its pathophysiology and the development of novel therapeutic options are urgently needed. Recently, alterations of the intestinal microbiome in the obese have been discussed as a promoting factor in the pathophysiology of obesity and as a contributing factor to related diseases such as type 2 diabetes and metabolic syndrome. The present pilot study investigated the effect of a structured weight loss program on fecal microbiota in obese type 2 diabetics. Twelve study subjects received a low-calorie formula diet for six weeks, followed by a nine week food reintroduction and stabilization period. Fecal microbiota were determined by 16S rRNA gene sequencing of stool samples at baseline, after six weeks and at the end of the study after fifteen weeks. All study subjects lost weight continuously throughout the program. Changes in fecal microbiota were most pronounced after six weeks of low-calorie formula diet, but reverted partially until the end of the study. However, the gut microbiota phylogenetic diversity increased persistently. The abundance of Collinsella, which has previously been associated with atherosclerosis, decreased significantly during the weight loss program. This study underlines the impact of dietary changes on the intestinal microbiome and further demonstrates the beneficial effects of weight loss on gut microbiota.Trial registration: ClinicalTrials.gov NCT02970838.

Clinical Outcomes in Patients with Diabetes Mellitus Using a Medically Supervised Commercial Weight Reduction Program Compared to Standard Care in an Endocrine Specialty Clinic

Aims: To evaluate metabolic and anthropometric changes achieved and maintained by diabetic patients (pts) in a structured weight loss (WL) program vs usual care in an endocrine clinic (UCG).Materials and Methods: This retrospective comparison study examined 38 diabetic pts with BMI >25 undergoing the active weight loss phase of WL determined by patient goal weight and then followed for 6 months in weight maintenance phase (WM). Multiple endpoints were assessed at baseline including BMI and hemoglobin A1c (A1c). Endpoints were reassessed at 6 months in WM. The usual care group (UCG) was obtained through chart review of 26 diabetic pts with BMI > 25 in an endocrine specialty clinic who completed an education program including lifestyle counseling by a certified diabetic educator. Data were analyzed using ANCOVA and protected LSD, adjusting for age, gender, and baseline weight.Results: Patients showed a change in BMI at 6 months of -6.8 ± 0 (bsl 44 ± 8.4) and -0.7 ± 1.1 (bsl 35 ± 6.2) for HMR® pts and UCG, respectively (p < 0.05). HMR® pts had 13.4% ± 3 % WL vs 7.9% ± 4% in UCG p = 0.34). 6 month A1c was similar in HMR pts (7.5% ± 2; bsl 8.3 ± 1.9) and UCG (7.5% ± 2.3; bsl 9.8 ± 1.8). HMR® pts had a reduction of total medication usage of 28%, with at least one medication discontinued in 80% of pts, while the UCG had only 23% of pts with discontinuation of at least one medication (p < 0.05). Conclusions: Compared to CDE-led diabetic education emphasizing lifestyle change, pts in an intensive WL program utilizing weekly coaching, meal replacements, and exercise, had a significant decrease in BMI and achieved a similar A1c with reduction in medication requirements.

Weigh Forward: a clinical audit of weight management in Australian general practice.

Weigh Forward was a prospective clinical audit, aimed to assess the use and efficacy of 12-week weight management program in general practice. Twenty-eight practitioners participated in the audit, with a total of 258 patients observed. Of these, 147 (57%) were retained to 24 weeks. Practices were asked to implement a structured 12-week weight loss program, and encouraged to utilize relevant weight management guidelines as necessary. Patients were followed up regularly, and comprehensively assessed at baseline, 12 and 24 weeks. Evaluations were made of patient weight loss, practitioner willingness to utilize available weight loss interventions, practitioner set weight loss goals and the appropriateness of such goals. Overall, the 57% of completing patients lost an average of 6.1% ± 0.5% body weight, with 27.2% losing ≥10% body weight. Practitioners were hesitant to intensify treatment, and those with comorbidities were less likely (odds ratio 1.8; 95% CI 1.4-2.4) to receive intensified treatment than those without. Practitioners also tended to set high weight loss goals, with a mean goal of 17.3% body-weight loss. The clinically significant mean weight loss demonstrates that practitioners are able to generate meaningful weight loss in primary care settings, however, could benefit from increased use of available interventions.

The effects of water and non-nutritive sweetened beverages on weight loss and weight maintenance: A randomized clinical trial.

ObjectiveTo evaluate the effects of water versus beverages sweetened with non‐nutritive sweeteners (NNS) on body weight in subjects enrolled in a year‐long behavioral weight loss treatment program.MethodsThe study used a randomized equivalence design with NNS or water beverages as the main factor in a trial among 303 weight‐stable people with overweight and obesity. All participants participated in a weight loss program plus assignment to consume 24 ounces (710 ml) of water or NNS beverages daily for 1 year.ResultsNNS and water treatments were non‐equivalent, with NNS treatment showing greater weight loss at the end of 1 year. At 1 year subjects receiving water had maintained a 2.45 ± 5.59 kg weight loss while those receiving NNS beverages maintained a loss of 6.21 ± 7.65 kg (P < 0.001 for difference).ConclusionsWater and NNS beverages were not equivalent for weight loss and maintenance during a 1‐year behavioral treatment program. NNS beverages were superior for weight loss and weight maintenance in a population consisting of regular users of NNS beverages who either maintained or discontinued consumption of these beverages and consumed water during a structured weight loss program. These results suggest that NNS beverages can be an effective tool for weight loss and maintenance within the context of a weight management program.

Participation in a Structured Weight Loss Program and All-Cause Mortality and Cardiovascular Morbidity in Obese Patients With Chronic Kidney Disease

To determine if participation in a weight loss program impacted upon a composite end point of all-cause mortality and cardiovascular morbidity in obese patients with chronic kidney disease (CKD). Retrospective cohort study. All patients with a body mass index (BMI) >30kg/m(2) or >28kg/m(2) with at least 1 comorbidity (hypertension, diabetes, or dyslipidemia) referred to an established weight management program (WMP) from 2005 to 2009 at a metropolitan tertiary teaching hospital were eligible for inclusion in the study cohort. Twelve-month structured weight loss program. Combined outcome of all-cause mortality, myocardial infarction, stroke, and hospitalization for congestive heart failure; kidney transplantation waitlisting. A total of 169 obese patients with CKD commenced the WMP and 169 did not-becoming the observational control group (CON). There were no significant differences between groups for age, BMI, sex, ethnicity, smoking, hypertension, or kidney function at baseline, although CON included more patients with diabetes than WMP (49% vs. 38%, P=.03). Kaplan-Meier survival analysis with log-rank test differed between groups for the combined outcome (P=.03). Cox regression analysis with adjustment for age, sex, ethnicity, hypertension, diabetes, kidney function, baseline BMI, and smoking status, indicated that patients in WMP had a significantly longer event-free period for the combined outcome, than those in CON (adjusted hazard ratio 0.53; 95% confidence interval [CI] 0.29-0.97; P=.04). Participation in the WMP did not increase the likelihood of kidney transplantation waitlisting (odds ratio [OR] 1.06; 95% CI 0.39-2.87; P=.9). Lower baseline BMI and greater weight loss over 12months were the only factors related to kidney transplantation waitlisting (adjusted R(2)=0.426). Participation in a structured weight loss program may be associated with improved outcomes in obese patients with CKD.

Mo1314 Resolution of GERD Symptoms in a Structured Weight Loss Program

Mo1314 Resolution of GERD Symptoms in a Structured Weight Loss Program

Weigh Forward: A clinical audit of weight management in Australian general practice

Weigh Forward was a prospective clinical audit, aimed to assess the use and efficacy of 12-week weight management program in general practice. Twenty-eight practitioners participated in the audit, with a total of 258 patients observed. Of these, 147 (57%) were retained to 24 weeks. Practices were asked to implement a structured 12-week weight loss program, and encouraged to utilize relevant weight management guidelines as necessary. Patients were followed up regularly, and comprehensively assessed at baseline, 12 and 24 weeks. Evaluations were made of patient weight loss, practitioner willingness to utilize available weight loss interventions, practitioner set weight loss goals and the appropriateness of such goals. Overall, the 57% of completing patients lost an average of 6.1% ± 0.5% body weight, with 27.2% losing ≥10% body weight. Practitioners were hesitant to intensify treatment, and those with comorbidities were less likely (odds ratio 1.8; 95% CI 1.4-2.4) to receive intensified treatment than those without. Practitioners also tended to set high weight loss goals, with a mean goal of 17.3% body-weight loss. The clinically significant mean weight loss demonstrates that practitioners are able to generate meaningful weight loss in primary care settings, however, could benefit from increased use of available interventions.

Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial.

Many questions remain unanswered about the role of bariatric surgery for people with type 2 diabetes mellitus (T2DM). To determine feasibility of a randomized clinical trial (RCT) and compare initial outcomes of bariatric surgery and a structured weight loss program for treating T2DM in participants with grades I and II obesity. A 12-month, 3-arm RCT at a single center including 69 participants aged 25 to 55 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 to 40 and T2DM. Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), and an intensive lifestyle weight loss intervention (LWLI). Primary outcomes in the intention-to-treat cohort were feasibility and effectiveness measured by weight loss and improvements in glycemic control. Of 667 potential participants who underwent screening, 69 (10.3%) were randomized. Among the randomized participants, 30 (43%) had grade I obesity, and 56 (81%) were women. Mean (SD) age was 47.3 (6.4) years and hemoglobin A1c level, 7.9% (2.0%). After randomization, 7 participants (10%) refused to undergo their allocated intervention (3 RYGB, 1 LAGB, and 3 LWLI), and 1 RYGB participant was excluded for current smoking. Twenty participants underwent RYGB; 21, LAGB; and 20, LWLI, with 12-month retention rates of 90%, 86%, and 70%, respectively. In the intention-to-treat cohort with multiple imputation for missing data, RYGB participants had the greatest mean weight loss from baseline (27.0%; 95% CI, 30.8-23.3) compared with LAGB (17.3%; 95% CI, 21.1-13.5) and LWLI (10.2%; 95% CI, 14.8-5.61) (P < .001). Partial and complete remission of T2DM were 50% and 17%, respectively, in the RYGB group and 27% and 23%, respectively, in the LAGB group (P < .001 and P = .047 between groups for partial and complete remission), with no remission in the LWLI group. Significant reductions in use of antidiabetics occurred in both surgical groups. No deaths were noted. The 3 serious adverse events included 1 ulcer treated medically in the RYGB group and 2 rehospitalizations for dehydration in the LAGB group. This study highlights several potential challenges to successful completion of a larger RCT for treatment of T2DM and obesity in patients with a body mass index of 30 to 40, including the difficulties associated with recruiting and randomizing patients to surgical vs nonsurgical interventions. Preliminary results show that RYGB was the most effective treatment, followed by LAGB for weight loss and T2DM outcomes at 1 year. clinicaltrials.gov Identifier: NCT01047735.

Development of a Theoretically Driven mHealth Text Messaging Application for Sustaining Recent Weight Loss.

BackgroundMobile phone short message service (SMS) text messaging, has the potential to serve as an intervention medium to promote sustainability of weight loss that can be easily and affordably used by clinicians and consumers.ObjectiveTo develop theoretically driven weight loss sustaining text messages and pilot an mHealth SMS text messaging intervention to promote sustaining recent weight loss in order to understand optimal frequency and timing of message delivery, and for feasibility and usability testing. Results from the pilot study were used to design and construct a patient privacy compliant automated SMS application to deliver weight loss sustaining messages.MethodsWe first conducted a pilot study in which participants (N=16) received a daily SMS text message for one month following a structured weight loss program. Messages were developed from diet and exercise guidelines. Following the intervention, interviews were conducted and self-reported weight was collected via SMS text messaging.ResultsAll participants (N=16) were capable of sending and receiving SMS text messages. During the phone interview at 1 month post-baseline and at 3 months post-baseline, 13/14 (93%) of participants who completed the study reported their weight via SMS. At 3 months post-baseline, 79% (11/14) participants sustained or continued to lose weight. Participants (13/14, 93%) were favorable toward the messages and the majority (10/14, 71%) felt they were useful in helping them sustain weight loss. All 14 participants who completed the interview thought SMS was a favorable communication medium and was useful to receive short relevant messages promptly and directly. All participants read the messages when they knew they arrived and most (11/14, 79%) read the messages at the time of delivery. All participants felt that at least one daily message is needed to sustain weight loss behaviors and that they should be delivered in the morning. Results were then used to develop the SMS text messaging application.ConclusionsStudy results demonstrated the feasibility of developing weight loss SMS text messages, and the development of an mHealth SMS text messaging application. SMS text messaging was perceived as an appropriate and accepted tool to deliver health promotion content.

Adding access to online meal plans and monitoring to a structured weight loss program with resistance‐exercise promotes more positive changes in triglycerides

48 sedentary women (44.8±10 yr, 44.8±4% body fat, 33.9±6 kg/m2) were randomized to participate in the Curves Complete® weight loss and exercise program for 12‐wks with (CC‐OS) and without (CC‐NS) online support that provided access to meal plans and progress monitoring. Fasting blood samples were obtained at 0, 4, 8, &amp; 12 wks and analyzed by MANOVA. Data are presented as changes from baseline after 4, 8, and 12 wks for the CC‐OS and CC‐NS groups, respectively. Overall MANOVA analysis revealed a significant time (p=0.001) difference with no significant group × time effects (p=0.57). Univariate analysis revealed significant time effects for TG, CHL, HDL, and LDL and that participants in the CC‐OS group experienced greater changes in TG (CC‐OS − 27.1±21, −24.2±24, −23.2±20; CC‐NS 0.9±29, −6.1±22, −6.7±26 %, p=0.001) with no differences observed among groups in total CHL (CC‐OS −11.8±11, −9.1±9, −7.5±11; CC‐NS −6.0±10, −4.0±11, − 3.6±10 %, p=0.17), HDLc (CC‐OS −0.8±11, 0.3±11, 5.0±15; CCNS −3.4±9, −0.1±13, 2.5±15 %, p=0.78), LDLc (CC‐OS −11.1±15, − 9.2±13, −7.8±19; CC‐NS −7.4±15, −6.6±16, −4.7±11 %, p=0.83) or blood glucose (CC‐OS −2.2±10, −1.9±8, −2.4±12; CC‐NS 1.2±14, 1.6±12, −0.6±15 %, p=0.75). Results indicate that adding online access to meal plans and monitoring can promote more favorable changes in TG during a structured weight loss program with resistance‐based exercise.

Women who participate in a structured weight loss program with resistance‐exercise experience more favorable changes in blood lipids when compared to other popular weight loss programs

123 sedentary women were randomized into a control group (C), Curves Complete® (CC), Weight Watchers® (WW), Jenny Craig® (JC), or Nutrisystem® (NS) weight loss program for 12‐wks. Fasting blood samples were obtained at 0, 4, 8, &amp; 12 wks. Data are percent changes from baseline. Significant group × time interactions were observed in TG (C −2.2±29, −7.7±26, 0.1±24; CC −27.1±21, −24.2±24, −23.2±20; WW −8.5±32, 1.6±36, −2.7±31; JC 3.3±40, 8.0±34, 15.1±43; NS 6.9±39, 11.2±33, 11.1±29 %, p=0.002) and HDL‐c (C 0.6±11, −3.5±10; −5.0±10; CC −0.8±11, 0.3±11, 5.0±15; WW −5.1±12, −4.0±13, 0.2±14; JC −10.9±12, − 6.4±14, −5.0±16; NS −6.2±14, −6.5±12, −4.0±13 %, p=0.01). Total CHL tended to differ among groups (C 0.6±12, −0.3±12; −2.2±11; CC −11.8±11, −9.1±9, −7.5±11; WW −5.8±12, −2.8±12, 0.6±12; JC − 7.2±13, −3.3±13, −2.3±11; NS −4.9±13, −4.5±12, −3.8±16 %, p=0.07). No differences were observed among groups in LDL‐c (C −1.9±18, 1.7±23; −4.0±17; CC −11.1±15, −9.2±13, −7.8±19; WW − 1.4±20, 1.6±23, 10.4±51; JC −6.5±17, −1.7±17, −2.7±12; NS − 4.6±18, −5.5±14, −6.1±21 %, p=0.21) or blood glucose (C 1.7±8, 2.6±6; −1.3±8; CC −2.2±10, −1.9±8, −2.4±12; WW −1.5±12, −1.1±9, −1.7±8; JC −3.3±9, −2.4±11, −1.6±10; NS −0.8±16, −3.2±14, −2.9±16 %, p=0.91). Results reveal a high protein/low fat weight loss program with resistance‐training promotes more favorable changes in blood lipids compared to some other popular weight loss programs.

Women who participate in a structured weight loss program with resistance‐exercise experience more favorable changes in body composition when compared to other popular weight loss programs

127 sedentary women (46±12 yr, 45.5±5% body fat, 35.1±5 kg/m2) were randomized to participate in a control group (C) or the Curves Complete® program with online support (CC), Weight Watchers® Points Plus (WW), Jenny Craig® (JC), or Nutrisystem® Advance Select™ (NS) weight loss programs for 12‐wks. Body mass, DEXA body composition, and resting energy expenditure (REE) measurements were obtained at 0, 4, 8, &amp; 12 wks and analyzed by MANOVA. Data are presented as changes from baseline after 12‐wks. Participants in the diet groups lost similar amounts of body mass (C 0.1±3.1; CC −6.1±3.2; WW − 4.3±3.5; JC −5.3±3.8; NS −5.1±4.5 kg, p=0.001). However, participants in the CC group experienced significantly greater loss in fat mass (C −0.0±2.0; CC −5.2±2.8; WW −2.2±2.6; JC −3.5±3.3; NS −2.3±2.5 kg, p=0.001), less loss in FFM (C 0.1±2.3; CC − 0.7±2.5; WW −1.8±2.3; JC −1.8±2.1; NS −2.4±2.2 kg, p=0.002), and greater reductions in percent body fat (C −0.1±1.7; CC − 3.3±2.3; WW −0.6±2.5; JC −1.4±2.4; NS −0.2±1.7%, p=0.001). REE tended to differ among groups (C 39±190; CC 0±154; WW − 108±159; JC −27±206; NS −43±206 kcal/d, p=0.07). Results indicate that participation in the CC program promotes more favorable changes in body composition than other popular weight loss programs.

Adding access to online meal plans and monitoring improves success to a structured weight loss program with resistance‐exercise in women

51 sedentary women (44.5±10 yr, 44.9±4% body fat, 34.0±6 kg/m2) were randomized to participate in the Curves Complete® weight loss and exercise program for 12‐wks with (CC‐OS) and without (CC‐NS) online support that provided access to meal plans and progress monitoring. Body mass, DEXA body composition, and resting energy expenditure (REE) measurements were obtained at 0, 4, 8, &amp; 12 wks and analyzed by MANOVA. Data are presented as changes from baseline after 4, 8, and 12 wks for the CC‐OS and CC‐NS groups, respectively. Overall MANOVA revealed that both groups experienced improvements in body composition with minimal effects on REE. An overall significant interaction was observed among groups (p=0.02). Participants in the CC‐OS group tended to experience more favorable changes in body mass (CC‐OS − 2.6±1.3, −4.8±2.3, −6.2±3.3; CC‐NS −2.2±1.9, −3.5±3.1, −4.3±4.3 kg, p=0.08) and fat mass (CC‐OS −1.8±1.8, −3.5±2.3, −5.2±2.9; CC‐NS −2.0±2.4, −3.4±2.8, −3.8±4.0 kg, p=0.11), while FFM was preserved to a greater degree in the CC‐NS group (CC‐OS − 0.8±1.6, −1.2±2.1, −0.8±2.5; CC‐NS 0.0±1.5, 0.2±1.6, −0.2±2.0 kg, p=0.05). No significant differences were seen among groups in percent body fat (CC‐OS −0.9±1.8, −1.9±2.4, −3.3±2.3; CC‐NS − 1.5±2.3, −2.5±2.5, −2.7±3.4 %, p=0.21) or REE (CC‐OS −47±144, − 23±176, 0.4±154; CC‐NS −83±174, −65±184, −102±170 kcals/d, p=0.16). Results indicate that adding online access to meal plans and monitoring can promote more favorable changes in body composition while maintaining REE.

Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: A prospective intervention trial

Weight gain is an important risk factor for gastroesophageal reflux disease (GERD); however, whether weight loss can lead to resolution of GERD symptoms is not clear. Our aim was to measure the impact of weight loss on GERD symptoms. In a prospective cohort study at a tertiary referral center, overweight/obese subjects (BMI 25-39.9 kg/m2) were enrolled in a structured weight loss program. Weight loss strategies included dietary modifications, increased physical activity and behavioral changes. At baseline and at 6 months, BMI and waist circumference were measured and all participants completed a validated reflux disease questionnaire. A total of 332 adult subjects, mean age 46 years and 66% women were prospectively enrolled. At baseline, the mean body weight, BMI, and waist circumference were 101 (±18) kg, 35 (±5) kg/m2 and 103 (±13) cm. At 6 months, majority of the subjects (97%) lost weight (average weight loss: 13 ± 7.7 kg) and as compared with baseline, there was a significant decrease in the overall prevalence of GERD (15 vs. 37%; P < 0.01) and the mean GERD symptom score (1.8 vs. 5.5; P < 0.01). Overall, 81% of the subjects had reduction in GERD symptom scores; 65% had complete resolution and 15% had partial resolution of reflux symptoms. There was a significant correlation between % body weight loss and reduction in GERD symptom scores (r = 0.17, P < 0.05). In conclusion, the overall prevalence of GERD symptoms is high (37%) in overweight and obese subjects. A structured weight loss program can lead to complete resolution of GERD symptoms in the majority of these subjects.

Compliance With a Structured Weight Loss Program Is Associated With Reduced Systolic Blood Pressure in Obese Patients With Chronic Kidney Disease

The effectiveness of lifestyle-based weight loss programs in obese patients with chronic disease has not been widely studied. This study examined the effectiveness of a weight management program (WMP), and sought to determine factors associated with successful weight loss in obese patients with chronic kidney disease (CKD). In this prospective cohort study, all patients with a body mass index (BMI) of >30 kg/m(2) referred to our clinic from January 2005 to December 2008 and who commenced a structured WMP of an energy-reduced renal diet, exercise, and pharmacotherapy were included in the analyses. Changes in body weight and associated variables up to 24 months were assessed with intention-to-treat mixed linear models and predictors of weight loss were identified with multiple linear regression. One hundred and thirty-five patients (56% male), of mean age 52.2 years and BMI 36.4 kg/m(2) commenced the WMP. Significant weight loss was achieved for all patients at 6, 12, 18, and 24 months. Weight loss at 12 months was predicted by compliance and age, but not by baseline BMI, blood pressure (BP), stage of CKD or pharmacotherapy use. Greater compliance was associated with decreased systolic BP, with no change in mean antihypertensive medication dose. Significant weight loss was achieved, demonstrating the effectiveness of the WMP, and compliance with a structured program improved weight loss and systolic BP.

Mo1056 Reflux Symptoms are Highly Prevalent and Impact Quality of Life of Obese Subjects Participating in a Structured Weight Loss Program

Mo1056 Reflux Symptoms are Highly Prevalent and Impact Quality of Life of Obese Subjects Participating in a Structured Weight Loss Program

Sucrose and High Fructose Corn Syrup Have Equivalent Effects on Cardiovascular Risk Improvement as Part of a Structured Weight Loss Program

PURPOSE: It has been suggested that fructose promotes weight-gain more than other sugars. Additional consequences of fructose consumption have been observed independent of weight gain, such as an increased fasting and post-prandial triglyceride level, increased blood pressure and the development of insulin resistance. However, fructose consumption by itself rarely occurs, so the practical relevance of these observations is questionable. It is therefore important to understand the physiological effects of fructose consumption from its primary sources in the human diet - sucrose and high fructose corn syrup (HFCS). The purpose of this study was to investigate whether there is a difference in the risk factors for heart disease when HFCS is compared to sucrose and consumed as part of a weight loss diet. METHODS: One hundred sixty two overweight/obese, but otherwise healthy adults (age = 42.9 ± 10.3 years) were enrolled in a randomized, double blind, prospective study. Participants in each of the four intervention groups were placed on a hypocaloric diet for 12 weeks. Diets included low-fat milk sweetened with either sucrose or HFCS at either 10% or 20% of the allocated calories (25th and 50th percentile population fructose consumption levels from all sources). All participants, including those in an exercise only (EO) group, performed exercise regimes consistent with ACSM recommendations. RESULTS: Statistically significant weight loss was observed in all 5 groups (p<0.05). Loss in the 4 milk- groups was greater than in EO (-6.67 ± 8.28 vs -2.25 ± 5.86 lbs, p<0.01), and no differences were observed among the four milk consuming groups (p>0.05). DBP, glucose and HDL were unchanged (p>0.05), but reductions in SBP (114.36 ± 13.08 vs 112.03 ± 10.73mmHg, p<0.01), cholesterol (190.31 ± 39.07 vs 178.67 ± 37.78mg/dl, p<0.001), triglycerides (123.69 ± 62.15 vs 108.20 ± 51.62mg/dl, p<0.001) and LDL (113.74 ± 34.46 vs 106.52 ± 33.22mg/dl, p<0.001) were observed. Neither the identity nor the amount of sweetener affected the magnitude of these changes (p>0.05). CONCLUSION: A reduced calorie diet and exercise program predictably resulted in weight loss, even when substantial sweetener was included. Weight loss was accompanied by an overall improvement in cardiovascular risk, whether the sweetener was HFCS or sucrose.