Summary
Objective and methods
Finding effective solutions to curb the obesity epidemic is a great global public health challenge. The need for long‐term follow‐up necessitates weight loss trials ...conducted in real‐world settings, outside the confines of tightly controlled laboratory or clinic conditions. Given the complexity of eating behaviour and the food supply, this makes the process of designing a practical dietary intervention that stands up to scientific rigor difficult. Detailed information about the dietary intervention itself, as well as the process of developing the final intervention and its underlying rationale, is rarely reported in scientific weight management publications but is valuable and essential for translating research into practice. Thus, this paper describes the design process and underlying rationale behind the dietary interventions in an exemplar weight loss trial – the TEMPO Diet Trial (Type of Energy Manipulation for Promoting optimal metabolic health and body composition in Obesity). This trial assesses the long‐term effects of fast versus slow weight loss on adiposity, fat free mass, muscle strength and bone density in women with obesity (body mass index 30–40 kg m−2) that are 45–65 years of age, postmenopausal and sedentary.
Results and conclusions
This paper is intended as a resource for researchers and/or clinicians to illustrate how theoretical values based on a hypothesis can be translated into a dietary weight loss intervention to be used in free‐living women of varying sizes.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
... our conclusion that the commercial programme is more eff ective than standard care is robust to a large range of assumptions. A P Mander, A L Ahern, I D Caterson, H Hauner, *S A Jebb ...susan.jebb@mrc-hnr.cam.ac.uk MRC Biostatistics Unit, Cambridge, UK (APM); MRC Human Nutrition Research, Cambridge CB1 9NL, UK (ALA, SAJ); Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia (IDC); and Else Kroener- Fresenius-Centre for Nutritional Medicine, Faculty of Medicine, Technische Universität München, Munich, Germany (HH)
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Objectives: To compare the resting metabolic rate (RMR) between diabetic and nondiabetic obese subjects and to develop a predictive equation of RMR for these subjects.
Research Methods and ...Procedures: Obese adults (1088; mean age = 44.9 ± 12.7 years) with BMI ≥ 35 kg/m2 (mean BMI = 46.4 ± 8.4 kg/m2) were recruited. One hundred forty‐two subjects (61 men, 81 women) were diagnosed with type 2 diabetes (DM), giving the prevalence of DM in this clinic population as 13.7%. RMR was measured by indirect calorimetry, and several multivariate linear regression models were performed using age, gender, weight, height, BMI, fat mass, fat mass percentage, and fat‐free mass as independent variables.
Results: The severely obese patients with DM had consistently higher RMR after adjustment for all other variables. The best predictive equation for the severely obese was RMR = 71.767 − 2.337 × age + 257.293 × gender (women = 0 and men = 1) + 9.996 × weight (in kilograms) + 4.132 × height (in centimeters) + 145.959 × DM (nondiabetic = 0 and diabetic = 1). The age, weight, and height‐adjusted least square means of RMR between diabetic and nondiabetic groups were significantly different in both genders.
Discussion: Severely obese patients with type 2 diabetes had higher RMR than those without diabetes. The RMR of severely obese subjects was best predicted by an equation using age, gender, weight, height, and DM as variables.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The US Food and Drug Administration (FDA) recently approved lorcaserin and the combination of phentermine and extended release topiramate (phentermine/topiramate ER) for the treatment of obesity in ...conjunction with a lifestyle intervention, expanding the therapeutic options for long-term obesity pharmacotherapy, which was previously limited to orlistat. Combination phentermine/topiramate ER is associated with greater weight loss compared to its constituent monotherapy, with a more favorable adverse effect profile. Phentermine/topiramate ER also appears to have beneficial effects on cardiometabolic risk, although longer-term cardiovascular safety data are required. While there are no head-to-head studies among the currently available obesity pharmacotherapy agents, phentermine/topiramate ER appears to have a superior weight loss profile. This review will discuss the epidemiology, natural history, and cardiometabolic risk associated with obesity, provide an overview on current obesity pharmacotherapy, and summarize the recent clinical efficacy and safety data underpinning the FDA's approval of both phentermine/topiramate ER and lorcaserin as pharmacotherapy for a long-term obesity intervention.
Aim: The aim of this study is to compare the effect of orlistat vs. placebo on the predicted 10‐year cardiovascular disease (CVD) risk in obese people with one or more cardiovascular risk factors ...treated for 12 months, in conjunction with a fat‐reduced, but otherwise ad libitum, diet.
Methods: A double‐blind, randomized, placebo‐controlled, parallel study was performed in conjunction with a fat‐reduced diet and physical activity advice for 1 year. Participants (n = 339) from eight centres in Australia and New Zealand were randomized to either orlistat (120 mg) three times daily (n = 104 women, 66 men; mean ± s.d. age = 52.0 ± 7.5 years, body mass index (BMI) = 37.6 ± 5.1 kg/m2) or placebo three times daily (n = 89 women, 80 men; age = 52.5 ± 7.4 years, BMI = 38.0 ± 4.9 kg/m2). The primary efficacy criterion was the 10‐year risk of developing CVD calculated from the Framingham equation. Secondary efficacy criteria were body weight, waist circumference, blood pressure and serum concentrations of triglycerides, cholesterol (total, LDL and HDL), glucose, insulin and glycated haemoglobin and quality of life.
Results: There was no difference in the change in 10‐year CVD risk between orlistat and placebo groups over 1 year. The orlistat group, however, had significant favourable changes in many of the individual CVD risk factors (total cholesterol, LDL‐cholesterol, glucose, glycated haemoglobin, insulin, body weight and waist circumference) and one of the domains of quality of life measured by means of the SF‐36 questionnaire (vitality), compared to the placebo group. Significant reductions in medication use for hypertension and diabetes were observed in the orlistat group, compared to those in placebo, but there were no significant differences in medication use for blood lipids.
Conclusions: Orlistat may have reduced CVD risk, as judged by the favourable changes in individual risk factors and reductions in medication use, but the method used in order to measure absolute CVD risk in this study (Framingham CVD equation) was not sensitive enough to detect the changes in this relatively low‐risk group (approximately 10% of risk of a CVD event over 10 years).
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Summary
What is already known about this subject?
The development of obesity is a multi‐factorial process that results in an alteration in the neuroendocrine hormones that help regulate appetite and ...body weight. Weight loss has been shown to alter this neuroendocrine balance so as to promote weight regain.
An intragastric balloon is an effective method to achieve significant weight loss in obese patients and is well suited for those patients who are looking for an alternative to lifestyle modification alone, and those who are not ready or suitable for surgical intervention.
Limited research has shown that the weight loss achieved with an intragastric balloon is mediated by altered secretion of the hormones that regulate appetite and weight.
What does this study add?
There are currently limited data on the effects of intragastric balloons on appetite and weight‐related hormones.
In the current study, we have investigated a broad range of gut hormones and adipokines and their response to weight loss induced by differing methods, and the subsequent effect this may have on weight regain.
This is an important research area as novel therapies and long‐term strategies are needed to counteract the unfavourable changes to the neuroendocrine control of appetite and satiety associated with diet‐induced weight loss.
This study aims to determine the effect of weight loss achieved with different methods on fasting levels of appetite hormones. Sixty‐six obese adults with metabolic syndrome were randomized to intragastric balloon (IGB) for 6 months, with a 12‐month behavioural modification programme (IGB group, ‘IGBG’) or a 12‐month behavioural modification programme alone (control group, ‘CG’). Anthropometric assessments and blood samples were taken every 3 months and total ghrelin, peptide YY (PYY), adiponectin and leptin were measured. Significant weight‐loss differences favouring the IGBG were evident between groups at all time points. Ghrelin increased when the IGB was in situ (+39.3 pmol L−1 vs. baseline) and returned to baseline after its removal (−34.7 pmol L−1). Adiponectin and PYY levels remained stable in the IGBG, with transient increases noted in the CG. There were no significant between‐group differences for ghrelin, PYY or adiponectin. In the IGBG, despite a decrease in leptin at 6 months (−11.7 ng mL−1), levels increased to baseline after IGB removal (−3.7 ng mL−1). In summary, weight loss associated with the IGB did not alter fasting levels of PYY or adiponectin. There was a return of ghrelin and leptin levels to baseline values after IGB removal. No compensatory rise in ghrelin was evident in either group 12 months after initial weight reduction, suggesting that such treatment strategies may lead to better long‐term sustainable weight loss.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Summary
The prevalence of depression in those with obesity is reported to be as high as double that in individuals of normal weight. There is potentially a bi‐directional relationship between obesity ...and depression. Some research has suggested that depression results in weight gain and obesity, and other studies have suggested that those with obesity are more likely to develop depression at a later stage. The aim of this study was to investigate the association of depression symptoms with weight change over a 12‐month study. Seventy participants undertook a 3‐month lifestyle (diet and exercise) weight loss intervention, and were followed up as part of a 12‐month study. Participants completed the Beck Depression Inventory‐II (BDI‐II) and had their body weight measured throughout the study. Baseline body mass index (BMI) of participants (mean ± standard deviation SD) was 31.1 ± 3.9 kg m−2, body weight was 89.4 ± 16.1 kg, and age was 45.4 ± 11.1 years; 63% of the cohort were female. The mean weight change from baseline to 3 months was −5.2% (±SD 4.3%), and from baseline to 12 months was −4.2% (±SD 6.1%). There was a significant decrease in BDI‐II scores over the 12‐month study, and a 1‐unit decrease in BDI‐II score was associated with a further decrease in body weight of −0.4%. The current study indicated that weight loss was associated with improvements in mood for non‐clinically depressed individuals with obesity, and these improvements persisted during a period of 3–12 months of follow‐up.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background: Thalassaemia major is a common and serious medical problem worldwide that is associated with a range of complications, including effects on multiple endocrine pathways. Minimizing or ...preventing comorbidities is important for these individuals who need life‐long multidisciplinary care and treatment. However, there are limited overviews of the endocrine complications associated with this illness, nor any consensus regarding management guidelines.
Method: A retrospective cohort analysis of β‐thalassaemia patients attending an ambulatory transfusion clinic at Royal Prince Alfred Hospital was conducted from June 2008.
Results: All of our subjects (n = 29) had at least one endocrinopathy present with 16 patients (55%) having three or more (≥3) endocrinopathies. Hypogonadism was the most prevalent followed by osteoporosis and growth failure (less than 3rd centile) with a frequency of 16/29 (55%), 14/29 (48%) and 10/29 (35%) patients respectively. Those with more endocrinopathies (≥3) had a longer duration of transfusion therapy when compared with those with fewer endocrinopathies.
Conclusion: A summary of our clinical guidelines, which have been used to monitor and manage these complications, is presented along with a discussion on the results and pathophysiology of the associated endocrinopathies.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Summary
Much healthcare expenditure is on pharmaceutical drugs. Expenditure on medications has increased both in absolute terms, and as a proportion of total health expenditure. No previous studies ...have investigated the prescribing costs by general practitioners when managing patients during a weight loss intervention. This study evaluated the medication costs by individual class during a 1‐year study in which 268 participants were randomized to one of two weight loss programmes, either standard care (SC) as defined by national guidelines, or a commercial provider (Weight Watchers) (CP). The baseline body mass index of participants (mean ± standard deviation) was 32.0 ± 2.5 kg m−2, their body weight was 87.5 ± 11.8 kg, and age 47.4 ± 11.7 years. Weight loss for the SC and CP groups was −2.6 and −6.1 kg, respectively (between group difference; P < 0.0001). The greater weight loss in the CP group compared to SC was accompanied by larger reductions in waist circumference and fat mass. The CP group also had significantly greater improvements than SC in high‐density lipoprotein cholesterol. Despite SC participants being prescribed and spending more on medications than the CP group with no better weight or metabolic outcomes, this was not of statistical significance. For both groups the highest proportion of prescriptions (≥30% of medications) was for control of risk factors for cardiovascular disease. In conclusion, this study indicates that obesity treatment via a shared care approach with a CP results in greater weight loss and some better clinical outcomes, but despite lower medication costs overall, this was not significant when compared to SC treatment.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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