Weight loss
Body image evaluations in obese females with binge eating disorder.

Lloyd-Richardson EE, King TK, Forsyth LH, Clark MM.

Brown University Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA.

Dimensions of body image in a sample of obese women diagnosed with binge eating disorder (BED; N=42) were compared with a sample of obese women without BED (non-BED; N=42), matched on age and BMI. Additionally, the relationship between BED, body image and several dimensions of treatment response was examined. Results indicated BED women were more likely to negatively evaluate their global physical appearance and have less satisfaction with specific areas of the body than were non-BED women, even after controlling for depression scores. While BED women were significantly more likely to endorse depressive symptoms, depression scores were negatively correlated with body satisfaction in non-BED women only. BED women did not fare worse in formal weight-loss treatment, as measured by length of time in treatment, group-therapy attendance, or BMI at posttreatment. The role of body image in women with BED seeking weight-loss treatment is discussed relevant to the context of potential impact of BED and negative body image on active weight-loss treatment and maintenance.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15001059&dopt=Abstract weight loss



Weight loss
The adoption of eating behaviors conducive to weight loss.

Qi BB, Dennis KE.

University of Maryland, Baltimore, MD, USA.

Given the plethora of eating behavior techniques that obese individuals might adopt for weight loss, it is not likely that they could, or would be willing to, adopt all of them. Therefore, the purpose of this study was to identify the specific eating behaviors conducive to weight loss adopted during the behavioral treatment of obesity, and to distinguish those that were deemed beneficial from the ones that were not. Fifty obese (BMI 32+/-4 kg/m(2), mean+/-SD), postmenopausal women (60+/-6 years old) participated in a 6-month behavior modification, dietary, low-intensity walking weight loss program. For analysis, they were divided into two groups: "no weight loss" (<or=5 kg, n=18) versus "weight loss" (>5 kg, n=32). At pre- and posttreatment women completed the Eating Behavior Inventory (EBI) that measures specific strategies conducive to weight loss. Women who lost weight increased their total eating behavior score by 20% (p<0.001) and improved the adoption of 14 eating behaviors, which was more than twice that of the non-weight losers. Topping the list of most strongly adopted behaviors were carefully watching and recording the type and quantity of food consumed. Maintaining a weight graph and weighing daily also were important to these women. Neither group of women adopted potentially helpful eating behaviors such as leaving food uneaten, refusing food offered by others, or shopping from a list. In studies of obesity treatment, attendance at class sessions is one marker of program adherence. More definitively, implementing the EBI in clinical and research obesity treatment programs will provide its leaders with insight into whether participants adopt, ignore, or fight the essential behaviors that will facilitate success toward their personal weight loss goals.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15001064&dopt=Abstract weight loss



Weight loss
Prevention or Surgical Treatment of Gallstones in Patients Undergoing Gastric Bypass Surgery for Obesity.

Sreenarasimhaiah J.

University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, MC 8887, Dallas, TX 75390-8887, USA. jayaprakash.sreenarasimhaiah utsouthwestern.edu

It is well known that obesity is a risk for gallstone formation and biliary sludge. Additionally, it has been clearly shown that rapid weight loss following bariatric surgery is a risk factor for cholesterol cholelithiasis. Multiple serious complications from gallstones such as cholecystitis, cholangitis, gallstone pancreatitis, and cholecystenteric fistulae may occur. Thus, it is necessary to employ medical or surgical methods to prevent or treat gallstones in this group. Therapy should be individualized. Although there is a high incidence of gallstones in this group, only a minority of individuals will develop symptomatic disease. When used in patients who are compliant, ursodeoxycholic acid therapy can be effective to prevent gallstone formation during rapid weight loss. The cost effectiveness of routine ursodeoxycholic acid therapy compared with the potential costs of complicated gallstone disease needs to be further investigated. Combined cholecystectomy with Roux-en-Y gastric bypass surgery is a safe and appropriate therapeutic option in those with preoperatively known gallstones, biliary sludge, and prior episodes of cholecystitis. However, routine cholecystectomy at the time of gastric bypass surgery is not warranted for all patients because of the increased time of operation and postoperative hospitalization, as well as all the potential complications after cholecystectomy. The approach of routine cholecystectomy in this setting subjects many patients to an unnecessary procedure because the majority will not develop symptoms or complications of gallstones. Furthermore, cholecystectomy is technically easier to perform after weight loss occurs.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15010023&dopt=Abstract weight loss



Weight loss
Leptin levels in the acute stage of ulcerative colitis.

Tuzun A, Uygun A, Yesilova Z, Ozel AM, Erdil A, Yaman H, Bagci S, Gulsen M, Karaeren N, Dagalp K.

Department of Gastroenterology, Gulhane Military Medical Academy, Ankara, Turkey.

BACKGROUND AND AIMS: Leptin, a recently discovered protein, acts as a hormonal feedback signal in regulating adipose tissue mass via hypothalamic mechanisms. Inflammatory bowel disease is often associated with anorexia and weight loss. The aim of the present study was to investigate serum leptin levels during the time course of the acute phase of ulcerative colitis (UC) and to evaluate whether leptin leads to anorexia and bodyweight loss in these patients. METHODS: Serum leptin levels of 29 male patients with acute UC and 17 healthy controls with similar age, sex and body mass index (BMI) were measured. Erythrocyte sedimentation rate (ESR), BMI, serum albumin and C-reactive protein concentrations, and white blood cell counts were determined. RESULTS: A significant increase in serum leptin levels was found in patients with acute UC when compared with controls (5.89 +/- 2.06 ng/mL and 3.64 +/- 1.69 ng/mL, respectively; p = 0.001). There was no correlation between leptin levels and BMI. CONCLUSIONS: Our findings in the acute stage of UC suggest that increased serum leptin levels may contribute to anorexia and weight loss. However, an inappropriate increase in leptin levels is independent of body mass in acute UC, and we believe that other factors may be involved in inflammation-induced increases in leptin levels.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15012781&dopt=Abstract weight loss



Weight loss
Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding.

Frigg A, Peterli R, Peters T, Ackermann C, Tondelli P.

Surgical Clinic, St Claraspital, Basel, Switzerland.

BACKGROUND: We investigated the reduction in co-morbidities following laparoscopic adjustable silicone gastric banding (LAGB). METHODS: Between December 1996 and October 2002, 295 patients with mean BMI 45 kg/m(2) were operated (79% women, average age 41 years). Mean follow-up was 44 months. Reduction in co-morbidity was scaled relative to the preoperative co-morbidity level as having been cured, improved, unchanged, or worsened. Patients needing reoperations were analyzed separately. RESULTS: The preoperative frequencies of co-morbidities were as follows: hypertension 52%, diabetes 20%, dyspnea 85%, peripheral edema 63%, sleep apnea 36%, arthralgia 89%, reflux 57%, reduced self-esteem 95%, reduced general physical performance 96%, hyperlipidemia 39%, hyperuricemia 36%, and menstrual problems 22%. Excess weight loss after 1 year was 40%, after 2 years 46%, after 3 years 47%, and after 4 years 54%. After 4 years, the rate of cure/improvement of the co-morbiditites were: hypertension 58% / 42%, diabetes 75% / 8%, dyspnea 85% / 12%, arthralgia 52% / 24%, reflux 79% / 11%, self-esteem 45% / 39%, and general physical performance 58% / 33%. We also found an improvement in stress incontinence, sleep apnea, peripheral edema, and regulation of menstruation. Greater weight loss was associated with greater reduction in dyspnea, arthralgia, self-esteem, and physical performance. Hypertension, diabetes, reflux, and edema improved independent of the amount of weight loss. Reoperated patients undergoing either rebanding or biliopancreatic diversion with duodenal switch had similar weight loss and reduction in co-morbidities as did patients treated with LAGB only. CONCLUSION: With moderate weight loss following LAGB, co-morbidities were cured in 50-80% or improved in 10-40% of all patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15018751&dopt=Abstract weight loss



Weight loss
Relationship between changes in serum leptin levels and blood pressure after weight loss.

Itoh K, Imai K, Masuda T, Abe S, Tanaka M, Koga R, Itoh H, Matsuyama T, Nakamura M.

Faculty of Nutritional Sciences, Nakamura Gakuen University, Fukuoka, Japan. itohk cc.nakamura-u.ac.jp

Insulin resistance is thought to raise blood pressure. Recently, a significant positive relationship between mean blood pressure and plasma leptin levels, but there have been no reports dealing with the relationship between blood pressure and either insulin resistance or serum leptin levels after weight loss. In the present work, we attempted to clarify the relationship between changes in blood pressure and either the serum leptin level or the insulin level in 102 moderately obese females (mean body mass index (BMI), 29.5 +/- 0.5 kg/m2; age, 47.0 +/- 0.9) during a 3 month period. No differences in age, fat-mass, homeostasis model assessment (HOMA), the summation of insulin (sigmaIRI), plasma renin activity (PRA) or 24 h norepinephrine excretion (24hU-NE) were observed between the hypertensive (HT) group (n = 31) and normotensive (NT) group (n = 71) before weight loss, but the basal serum leptin was significantly higher in the HT (16.8 +/- 1.1 ng/ml) than in the NT group (15.2 +/- 0.8 ng/ml), after adjusting for abdominal total fat. After a 3 month weight reduction program, the total abdominal fat, serum leptin and sigmaIRI significantly decreased in both groups. The systolic blood pressure (SBP)/diastolic blood pressure (DBP) significantly decreased from 144/84 to 130/77 mmHg only in the HT but not in the NT group. The PRA decreased in both groups, while the 24hU-NE significantly decreased only in the HT group. The changes in the leptin level were significantly correlated with the changes in both sigmaIRI and HOMA after weight loss in the two groups, respectively. Finally, a statistically significant positive correlation was observed between the changes in the leptin and the changes in the mean blood pressure (MBP) (r = 0.412, p < 0.05) only in the HT group. Multiple regression analysis revealed that the changes in MBP were independently associated with the changes in 24hU-NE and the changes in either sigmaIRI or HOMA in all subjects. However, a statistically significant positive correlation was observed between the changes in MBP and the changes in leptin levels even after adjusting for the total abdominal fat, 24hU-NE and either sigmaIRI or HOMA (both expressed as a percentage of the baseline value) in a multiple regression analysis only in the HT group. These results suggest that leptin may play a role in the pathophysiology of obese hypertension.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12484512&dopt=Abstract weight loss



Weight loss
Effects of laparoscopic gastric banding on body composition, metabolic profile and nutritional status of obese women: 12-months follow-up.

Giusti V, Suter M, Heraief E, Gaillard RC, Burckhardt P.

Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. vittorio.giusti chuv.hospvd.ch

BACKGROUND: Obesity is frequently associated with metabolic and cardiovascular co-morbidities and high mortality rates. Besides, because of the increasingly recognized fact that conservative therapy for morbid obesity is associated with an almost 90-95% failure rate in the long term, and probably because of the development of laparoscopic surgery,the demand for bariatric surgery is increasing rapidly.The significant weight loss observed during the first 6-12 months after gastric banding is related to the severe food restriction, related hypercatabolism, and has a potential risk of mineral and vitamin deficiencies.The aim of this study was to evaluate the effects of gastric banding on total body composition, metabolic profile and nutritional status. METHODS: 31 women were studied with median age 36 years (range 25-52), body weight 118.6 kg (range 98-156), BMI 43.6 kg/m(2) (range 36-56 kg/m(2)), percentage of excess body weight (%EW) of 107% (range 72- 166%), waist 115 cm (range 98-132) and hip 138 cm (range 119-155). Total body composition was measured before, 6 and 12 months after laparoscopic gastric banding, using dual-energy x-ray absorptiometry. Metabolic and nutritional profile were evaluated before and 1, 3, 6, 9 and 12 months postoperatively. RESULTS: There was a 23.3% reduction of total body weight and 36.8% reduction of body fat. Unfortunately we also observed a reduction of Fat Free Mass (FFM) of 9.6%. In addition, the major determinants of weight loss were the initial body weight and abdominal distribution of fat mass. Reduction of FFM was positively correlated with the rapidity of weight loss. A significant improvement of glucidic profile was observed, with disappearance of impaired fasting glucose, and normalization of the values of triglycerides in all patients. The prevalence of the metabolic syndrome decreased from 89% in preoperative conditions to 15% 1 year after gastric banding. No major nutritional deficiencies was found following gastric banding. CONCLUSIONS: This prospective study suggests that the first 6 months postoperatively are crucial for weight loss and changes in body composition. Furthermore, the significant reduction of body weight is accompanied by an important improvement of biological abnormalities.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15018754&dopt=Abstract weight loss



Weight loss
Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus.

Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D.

Departments of Surgery, University of Pittsburg, Pittsburgh, PA, USA. schauerpr msx.upmx.edu

OBJECTIVE: To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM). SUMMARY BACKGROUND DATA: The surgical treatment of morbid obesity leads to dramatic improvement in the comorbidity status of most patients with T2DM. However, little is known concerning what preoperative clinical factors are associated with postoperative long-term improvement in diabetes in the morbidly obese patient with diabetes.METHODS We evaluated pre- and postoperative data, including demographics, duration of diabetes, metabolic parameters, and clinical outcomes, in all patients with impaired fasting glucose (IFG) and type T2DM undergoing LRYGBP from July 1997 to May 2002. RESULTS: During this 5-year period, 1160 patients underwent LRYGBP and 240 (21%) had IFG or T2DM. Follow up was possible in 191 of 240 patients (80%). There were 144 females (75%) with a mean preoperative age of 48 years (range, 26-67 years). After surgery, weight and body mass index decreased from 308 lbs and 50.1 kg/m2 to 211 lbs and 34 kg/m2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%. Fasting plasma glucose and glycosylated hemoglobin concentrations returned to normal levels (83%) or markedly improved (17%) in all patients. A significant reduction in use of oral antidiabetic agents (80%) and insulin (79%) followed surgical treatment. Patients with the shortest duration (<5 years), the mildest form of T2DM (diet controlled), and the greatest weight loss after surgery were most likely to achieve complete resolution of T2DM. CONCLUSION: LRYGBP resulted in significant weight loss (60% percent of excess body weight loss) and resolution (83%) of T2DM. Patients with the shortest duration and mildest form of T2DM had a higher rate of T2DM resolution after surgery, suggesting that early surgical intervention is warranted to increase the likelihood of rendering patients euglycemic.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14530719&dopt=Abstract weight loss



Weight loss
The duodenal switch operation for the treatment of morbid obesity.

Anthone GJ, Lord RV, DeMeester TR, Crookes PF.

Department of Surgery, University of Southerm California Keck School of Medicine, Los Angeles, CA 90033-42, USA. ganthone surgery.usc.edu

OBJECTIVE: To determine the safety and efficacy of the duodenal switch procedure as surgical treatment of morbid obesity. SUMMARY BACKGROUND DATA: The longitudinal gastrectomy and duodenal switch procedure as performed for morbid obesity involves a 75% subtotal greater curvature gastrectomy and long limb suprapapillary Roux-en-Y duodenoenterostomy. This results in a restricted caloric intake and diversion of bile and pancreatic secretions to induce fat malabsorption. Broad acceptance of this procedure has been impeded because of concerns that the malabsorptive component may produce serious nutritional complications. METHODS: Review of data collected prospectively from all patients who underwent duodenal switch as the primary surgical treatment of morbid obesity at a single institution during the 10-year period beginning September 1992. Operative morbidity and mortality, weight loss, volume of food intake, and bowel function were recorded. Sequential measurements of serum albumin, hemoglobin, and calcium levels were obtained to assess metabolic function and nutrient absorption. RESULTS: Duodenal switch was performed as the primary operation in 701 (81%) of a total 863 patients undergoing bariatric surgery during the period of study. The average body mass index (BMI) was 52.8 (range, 34-95). Perioperative mortality was 1.4%, and morbidity (including leaks, wound dehiscence, splenectomy, and postoperative hemorrhage) occurred in 21 patients (2.9%). Weight loss averaged 127 pounds at 1 year, 131 at 3 years, and 118 at 5 or more years (% EBWL of 69%, 73%, and 66%, respectively). The mean number of bowel movements was fewer than 3 per day. Patients reported and maintained a mean restriction of 63% of their preoperative intake (approximately 1600 calories), with no specific food intolerance, at 3 or more years follow-up. At 3 years, serum albumin remained at normal levels in 98% of patients, hemoglobin in 52%, and calcium in 71%. No patients reported dumping, and marginal ulcers were not seen. CONCLUSIONS: The longitudinal gastrectomy with duodenal switch is a safe and effective primary procedure for the treatment of morbid obesity. It has the advantage of allowing acceptable alimentation with a minimum of side effects while producing and maintaining significant weight loss. These results are achieved without developing significant dietary restrictions or clinical metabolic or nutritional complications.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14530733&dopt=Abstract weight loss