Weight Loss In Obese Patients Research Articles

Relation of dieting and voluntary weight loss to psychological functioning and binge eating.

Voluntary weight loss in obese patients consistently reduces negative emotions such as depression and anxiety in the short term. Dieting by persons of normal weight is associated with low self-esteem and depressive symptoms. Dieting is linked to the development and maintenance of eating disorders such as anorexia nervosa and bulimia nervosa, although the precise nature of this association is unclear. Dieting cannot be a sufficient causal condition and must combine with other still undetermined vulnerabilities to cause eating disorders. Identification of these risk factors must precede the development of effective programs to prevent eating disorders.

Understanding and treating dyslipidemia associated with noninsulin-dependent diabetes mellitus and hypertension.

Hypertension and diabetes appear to increase coronary heart disease risk in part by causing an abnormality in lipid metabolism. Most affected are patients with familial dyslipidemic hypertension (FDH) and noninsulin-dependent diabetes mellitus (NIDDM). The lipid disorders most often encountered in these patients are increased levels of triglycerides, very low-density lipoprotein (VLDL) cholesterol, and small, dense low-density lipoprotein (LDL) cholesterol, and low levels of high-density lipoprotein (HDL) cholesterol. These abnormalities appear to result from increased hepatic secretion of VLDL particles due to increased concentrations of free fatty acids and glucose, reduced VLDL clearance due to reduced activity of lipoprotein lipase, and reduced LDL clearance due to glycosylation of ligand proteins. Treatment of the dyslipidemia associated with FDH should follow the guidelines from the National Cholesterol Education Program. Treatment in men and women with NIDDM should be considered when LDL cholesterol levels are 130 mg/dl or above, triglyceride levels are 200 mg/dl or above, or non-HDL cholesterol levels are 160 mg/dl or greater. Aggressive lifestyle changes should be initiated first, including weight loss in obese patients, control of glucose levels in those with NIDDM, avoidance of antihypertensive drugs that may worsen lipid levels in patients with FDH, and eating a diet restricting saturated fat and cholesterol. Addition of lipid-altering drugs should be considered if such changes do not achieve effective lipid control. The agent should be tailored to the patient's lipid profile, in general by using bile acid resins, niacin, or reductase inhibitors to lower LDL cholesterol and gemfibrozil or niacin to lower triglycerides. Niacin should be avoided in patients with NIDDM.

MANAGEMENT OF OBSTRUCTIVE SLEEP APNEA

Although the indications for treatment of obstructive sleep apnea are controversial, there is general agreement that treatment is warranted in patients with a combined apnea and hypopnea frequency of 20 events per hour of sleep. General therapeutic measures include abstinence from alcohol and weight loss in obese patients. A minority of patients with specific abnormalities of the nose, pharynx, or jaw may require surgical management. In the absence of specific upper airway abnormalities, the most effective treatment is nasal continuous positive airway pressure or, if necessary, bilevel positive airway pressure during sleep. The role of uvulopalatopharyngoplasty remains controversial, due in part to the reported variability in long-term efficacy of this procedure. Drug therapy may be effective in selected patients.

Comparative weight loss in obese patients restarting a supplemented very-low-calorie diet

Successive weight losses were compared for 21 patients restarting a very-low-calorie diet (VLCD) after weight regain. Patients broke VLCD2 sooner (3.8 vs 9.8 wk) and lost less (9.4 vs 19.1 kg), but weight-loss rates did not differ significantly (0.83 vs 0.71 kg/wk). Net loss post-VLCD2 was 12.0 kg. Restart patients had difficulty adhering to the repeat VLCD, which resulted in lower losses. However, similar weight-loss rates and significant net weight loss suggest repeat VLCDs can be effective.

A double-blind, randomized, sham-controlled trial of the gastric bubble for obesity

We investigated the effect of an endoscopically placed gastric balloon, the Garren-Edwards gastric bubble (GEGB), on weight loss in obese patients. Fifty-nine obese patients were entered into a prospective double-blind study and randomized into two groups. In one group (34 patients) the GEGB was inserted, and in the other group (25 patients) a sham insertion was done. All patients participated in a standard weight loss program consisting of dietary therapy, behavior modification, and physical exercise. The bubble was removed endoscopically after 3 months from both groups. Patients were followed for an additional 9 months after bubble removal and weight loss was monitored. Weight loss was the same in both groups at 3 months (18.7 lb vs. 17.2 lb). This was true whether determined by change in pounds, percentage of body weight, or body mass index. We concluded that the GEGB was of no added benefit as compared with sham insertion, when combined with a standard weight loss program. Because of the lack of proven efficacy and the relatively high cost, we recommend that such devices be restricted to controlled studies until significant benefits are proven.

Single-dose naloxone acutely reduces eating in obese humans: Behavioral and biochemical effects

Evidence from animal and clinical experimentation has suggested that endogenous opioid peptides are involved in the modulation of eating behavior (Morley et al. 1983). For example, acute administration of naloxone reportedly reduces eating in normal-weight (Trenchard and Silverstone 1983; Cohen et al. 1985) and obese (Atkinson 1982; Wolkowitz et al. 1985) humans and reduces binging in normal-weight bulimic women (Mitchell et al. 1986). Chronic or subchronic administration of naltrexone, however, has generally been ineffective in promoting significant weight loss in obese patients (Atkinson et al. 1985; Maggio et al. 1985; Malcolm et al. 1985; Mitchell et al. 1987). Although opiate antagonist strategies may not provide clinically useful weight reduction treatments, they may broaden our understanding of endogenous opioid influences on appetite, feeding, and satiety. administration did significantly decrease mean caloric intake (Wolkowitz et al. 1985). In this report, we present additional analyses of naloxone effects on specific macronutrient consumption and on subjective ratings of hunger, fulhress, and physical side effects. To test whether or not resultant effects were related to pituitary and/or hypothalamic opiate receptor blockade (Naber et al. 1981), we also examined relationships between naloxone-induced increases in plasma cortisol and subsequent behavioral change.

Changes in Breathing and the Pharynx after Weight Loss in Obstructive Sleep Apnea

The effect of weight loss following dietary restriction on disordered breathing on the pharyngeal airway is controversial in patients with obstructive sleep apnea (OSA). We therefore prospectively studied eight patients before and after dietary-induced weight loss. Mean weight loss was 20.6 kg +/- 12.8 SD. After weight loss there were significant improvements in PO2 and PCO2 measured during wakefulness, and in the number of desaturation episodes per hour of sleep, average desaturation per episode, and number of movement arousals. The number of apneas and hypopneas significantly decreased in six of eight patients. There was a significant correlation between body mass index and number of disordered breathing events. Nasopharyngeal collapsibility and pulse flow resistance decreased in awake patients after weight loss. We conclude that moderate weight loss in obese patients with OSA improves oxygenation during both sleep and wakefulness, decreases the number of disordered breathing events in many patients, decreases the collapsibility of the nasopharyngeal airway.

Resting Metabolic Rates of Obese Women after Rapid Weight Loss*

Reduced energy expenditure associated with reduced energy intake has been used as an explanation for resistance to weight loss in obese patients. Decreases in serum T3 concentrations and body cell mass induced by restriction of energy intake may contribute to the reduced energy needs. In the present study, mean resting metabolic rate (RMR) was reduced by 9.4% after 5 weeks of a very low energy diet (472 Cal/day) in six obese women, and the mean serum T3 concentration decreased 46%. However, the lowest RMR values measured were similar in these subjects (mean, 1328 Cal/day; range, 1110-1578 Cal/day) to RMR values of lean women (n = 19; mean, 1241 Cal/day; range, 938-1450 Cal/day) and moderately overweight women ingesting ad libitum diets (n = 8; mean, 1335 Cal/day; range, 1064-1533). Decreases in total body potassium (10%) and 24-h urinary creatinine excretion (23%) suggested that there was a substantial loss of body cell mass during weight loss, whereas nitrogen balance suggested that changes in body cell mass were slight. These data and those of previous studies indicate that even after rapid weight loss, the resting energy requirements of obese or previously obese subjects are not abnormally low relative to those of nonobese subjects, even though the concentrations of T3, a major thermogenic hormone, are substantially reduced. The hypometabolic response to weight loss cannot explain the failure of obese subjects to lose weight on weight-reducing regimens.

Maintenance of weight loss in obese patients after jaw wiring

In treatment of obesity restriction of food intake is necessary to achieve good results. Various operations have been devised to prevent patients overeating, but in this study jaw wiring was used to limit food intake. This procedure produces weight loss in obese patients but when the wires are removed the weight is usually regained. This report studied a group of patients whose weight loss was maintained after the wires were removed. A nylon cord fastened round the waist of the patient after weight reduction was found to act as a psychological barrier to weight gain. Seven patients were followed for 4-14 months after removal of jaw wires and regained a mean of only 5.6 kg of the 31.8 kg lost while their jaws were wired. This procedure compares favourably with other treatments for severe obesity.

Maintenance of weight loss in obese patients after jaw wiring.

In treatment of obesity restriction of food intake is necessary to achieve good results. Various operations have been devised to prevent patients overeating, but in this study jaw wiring was used to limit food intake. This procedure produces weight loss in obese patients but when the wires are removed the weight is usually regained. This report studied a group of patients whose weight loss was maintained after the wires were removed. A nylon cord fastened round the waist of the patient after weight reduction was found to act as a psychological barrier to weight gain. Seven patients were followed for 4-14 months after removal of jaw wires and regained a mean of only 5.6 kg of the 31.8 kg lost while their jaws were wired. This procedure compares favourably with other treatments for severe obesity.

Blind-loop reflux in relation to weight loss in obese patients treated with jejunoileal anastomosis.

In 10 patients operated on with jejunoileal anastomosis for obesity, rate and degree of weight loss showed no significant correlation to the following roentgenological parameters: gastric emptying time, small bowel transit time, and degree and duration of reflux to the excluded ileum. A predominant feature in all patients was a slowness of gastrointestinal passage. The absolute size of the weight loss was approximately the same in all patients irrespective of their initial weight. This means that the most obese patients (150 kg and more) stabilized their weight at a too high level. It is concluded that a more effective treatment of patients with extreme obesity should consist in shortening the intestine left in function, and not in an extended surgical procedure aiming at avoiding reflux into the blind loop.

Components of weight loss in obese patients subjected to prolonged starvation.

ArticleComponents of weight loss in obese patients subjected to prolonged starvation.H Gilder, G N Cornell, W R Grafe, R Macfarlane, J W Asaph, W T Stubenbord, G M Watkins, J R Rees, and B ThorbjarnarsonH Gilder, G N Cornell, W R Grafe, R Macfarlane, J W Asaph, W T Stubenbord, G M Watkins, J R Rees, and B ThorbjarnarsonPublished Online:01 Sep 1967https://doi.org/10.1152/jappl.1967.23.3.304MoreSectionsPDF (2 MB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat Previous Back to Top Next Download PDF FiguresReferencesRelatedInformationCited ByUse of the cellular model of body composition to describe changes in body water compartments after total fasting, very low calorie diet and low calorie diet in obese men9 February 2010 | International Journal of Obesity, Vol. 34, No. 5Fasting ? the ultimate diet?Obesity Reviews, Vol. 8, No. 3The control of partitioning between protein and fat during human starvation: its internal determinants and biological significance9 March 2007 | British Journal of Nutrition, Vol. 82, No. 5Energy: Caloric RequirementsDietary Treatment of ObesityThe effects of intravenous protein--calorie supplementation on the tissue composition of postoperative body weight lossPostgraduate Medical Journal, Vol. 50, No. 585Fasting—A review with emphasis on the electrolytesThe American Journal of Medicine, Vol. 50, No. 2LIPOLYSIS AND GLUCOSE TOLERANCE IN OBESE SUBJECTS DURING PROLONGED STARVATION24 April 2009 | Acta Medica Scandinavica, Vol. 190, No. 1-6Relationships between oxygen consumption and body composition of obese patientsMetabolism, Vol. 19, No. 6 More from this issue > Volume 23Issue 3September 1967Pages 304-10 https://doi.org/10.1152/jappl.1967.23.3.304PubMed6047948History Published online 1 September 1967 Published in print 1 September 1967 Metrics

Metabolic effects of controlled jejunocolic bypass.

THE metabolic effects of malabsorption due to loss of extensive lengths of small bowel in humans has been studied haphazardly. The small bowel was usually removed as an emergency measure, and metabolic comparisons to the preoperative state could not be made. Experimentally, Kremin et al 1 in 1954, showed in dogs that resections of controlled lengths of small bowel resulted in impaired fat absorption and loss of weight. Payne et al 2 and Lewis et al 3 produced weight loss in obese patients by means of controlled jejunocolic bypass. This procedure made it possible for them to study the metabolic changes that may result from exclusions of large segments of small bowel from the digestive tract. Since March 1963, 11 obese patients have undergone controlled jejunocolic bypass at the Royal Victoria Hospital, Montreal. Our observations on the metabolic effects of this operation are presented. Material and Methods Selection of Patients.

FUNCTIONAL CHANGES IN LIVER, HEART AND MUSCLES, AND LOSS OF DEXTROSE TOLERANCE

A short time after the appearance of the first clinical report on the use of dinitrophenol, 1 we began a series of studies of its effects in producing weight loss in obese patients. It seemed important to determine whether the metabolic stimulation produced by the drug was accompanied by evidence of injury to the patients. Dinitrophenol first came to the attention of the medical profession as an industrial poison. 2 Although during the World War poisoning of those working with it in munitions plants was frequent, 3 physicians and drug manufacturers, undeterred by the early history of the drug, have brought about a tremendous usage during the past year. One clinic has supplied to physicians, or to patients on physicians' prescriptions, over 1,200,000 capsules of 0.1 Gm. each, corresponding to about 4,500 patients treated with the drug in one year. More than twenty wholesale drug firms are marketing the compound.