The Fen-Phen Finale: A Study of Weight Loss and Valvular Heart Disease

Objective : To assess weight loss, as well as the prevalence of valvular heart disease, in 21 obese women who completed 2 years of treatment by fenfluramine and phentermine (fen-phen) in June 1997. Research Methods and Procedures : Patients were 21 of 22 women who had completed a 1-year, open-label trial of fen-phen combined with lifestyle modification. This study describes the results of a second year of treatment. The presence of valvular heart disease, defined as aortic regurgitation of mild or greater severity and/or mitral regurgitation of moderate or greater severity, was assessed using two-dimensional, color Doppler and pulsed- and continuouswave Doppler examinations. Results : At 2 years, the 21 patients had a mean reduction in initial weight of 13.9 ±10.1%, which was significantly (p<<0.001) smaller than their 1-year loss of 17.1 ±8.7%. Nine of 21 patients reported that they took fen-phen irregularly during the last 4 months of the study because of fears of developing health complications. These nine patients had a 2-year weight loss of 8.7 ± 7.5%, compared with a significantly (p<0.04) larger loss of 17.6 ± 10.5% for participants who reported taking medication regularly. Six of 20 (30%) patients met criteria for valvular heart disease. None of the six had signs or symptoms of this condition. Discussion : Fenfluramine was withdrawn from the market on September 15, 1997 because of concerns that it was associated with valvular heart disease. The present findings are discussed in terms of the potentially favorable long-term benefits of combining lifestyle modification with weight loss medications that are both safe and effective.     

Relationship of Co-Morbidities of Obesity to Weight Loss and Four-Year Weight Maintenance/Rebound

This study examined the effect of weight loss (separate from energy restriction) and weight maintenance/rebound over time on blood pressure, serum lipids, and body composition in 24 obese (mean 137% ideal body weight (IEW)) females with mild to moderate hypertension. Weight loss was induced under tightly controlled General Clinical Research Center conditions until each subject had lost at least 10 kg (mean 13 kg) and attained normal body weight (<120% IBW). After 4 years subjects returned for repeat evaluation. Weight changes were compared with 24 pair-matched normal weight controls who were also followed for 4 years. With weight loss, significant improvements were seen in standing mean arterial pressure (MAP), serum total cholesterol, low-density lipoprotein cholesterol, and triglycerides. Subjects regained 11 kg (87% of the weight lost) over the 4 year follow-up period while control subjects gained only 2 kg. Subjects who chose self-selected exercise gained less weight than nonexercisers (6 kg vs. 13 kg, P<0.05). With weight regain there were significant increases in standing and supine MAP, total cholesterol, and high-density lipoprotein (HDL) cholesterol. The amount of weight regained was significantly correlated with standing MAP (r=0.73), triglycerides (r=0.43), and HDL cholesterol (r=-0.47). The percentage fat of the weight regained was no greater than that of the weight previously lost. Weight loss, distinct from energy restriction, was associated with improvements in blood pressure and serum lipid levels. The ability to sustain these improvements in the co-morbidities of obesity was directly related to the persistence and magnitude of weight loss maintenance.     

Effects of Sibutramine on Resting Metabolic Rate and Weight Loss in Overweight Women

Sibutramine, a monoamine re-uptake inhibitor, has recently been approved by the Food and Drug Administration as a weight loss agent. Sibutramine lowers body-weight in rodents by reducing energy intake and increasing energy expenditure. Sibutramine facilitates weight loss in human subjects, but it is not clear whether it acts on energy intake, energy expenditure, or both. The present study was a randomized clinical trial designed to assess the effects of sibutramine (at 10 or 30 mg/day) on body weight and resting metabolic rate (RMR). Forty-four overweight women were randomized to 1) placebo (n=15); 2) sibutramine at 10 mg/day (n=15) or, 3) sibutramine at 30 mg/day (n=14). All subjects were instructed to consume a 1200 kcal/day diet for 8 weeks while receiving drug or placebo. RMR was assessed by indirect calorimetry at baseline, at 3 hours after the first dose of drug (or placebo), and at the end of the 8-week weight-loss period. Sibutramine reduced body weight-relative to placebo, but there was no difference between weight loss on the two sibutramine doses. No significant differences in RMR between sibutramine and placebo were seen, either 3-hour post dose or after the 8-week weight-loss period. After the weight loss period, all groups were taken off medication and kept weight stable for another 4 weeks. RMR was measured again and was not different among groups. That there was no change in RMR when sibutramine was stopped further suggests that the drug does not directly affect RMR. In summary, while sibutramine was shown to be an effective weightloss agent over 8 weeks, we found no evidence that it increased RMR.     

Cardiac Parasympathetic Activity Is Increased by Weight Loss in Healthy Obese Women

Objective: We studied the effect of weight reduction on cardiac parasympathetic activity (PSA) in obese women. We also studied the relationship between the changes of PSA, resting energy expenditure (REE), and major cardiovascular risk factors. Research Methods and Procedures: Changes of cardiac vagal tone, an index of PSA, REE, and major cardiovascular risk factors, were measured in 52 healthy obese women after a 6‐month weight reduction. Ten of the women were remeasured at 12 and 24 months. Cardiac vagal tone was assessed by a vagal tone monitor and REE by indirect calorimeter. Results: Cardiac vagal tone increased significantly (p = 0.046), averaging a 9.5% weight loss in 6 months. The vagal tone increased further with weight loss during the following 6 months, and thereafter, it declined with weight regain. The increase of cardiac vagal tone correlated significantly with decreases of body weight, fat mass, waist circumference, serum insulin, and heart rate. REE adjusted for fat‐free mass and age did not change with weight loss and was not related to cardiac vagal tone at any time‐point. Discussion: Cardiac PSA activity increases with weight loss in obese women. This increase may not be maintained long‐term if body weight is regained. The rise of cardiac PSA is correlated with decreases of body fat mass, abdominal fat, serum insulin, and heart rate. Cardiac PSA is not related to REE.     

Fibrinogen in Obesity Before and After Weight Reduction

Several studies have shown that obesity is associated with atherosclerosis. The reason may be that there is often a gathering together of risk factors for cardiovascular disease in obesity. Recently plasma fibrinogen level has been identified as an important cardiovascular risk factor. The aim of the study was to investigate fibrinogen levels in obesity before and after weight reduction. Obese but otherwise healthy patients with overweight problems were studied. 448 female patients (39.1 ± 13.2 years, body mass index 38.7 kg/m²) and 136 male patients (39.4 ± 12.8 years, body mass index 40.7 kg/m²) were examined after overnight fasting. Sixty patients (44 female, 16 male) were studied after 9.5 ± 6.2 month of dieting (1200 kcal/day: 20% protein, 30% fat and 50% carbohydrates). The weight loss was 16.7 ± 11.0 kg in the female and 16.2 ± 6.7 kg in the male patients, and blood pressure, triglycerides, blood glucose and uric acid had declined. The fibrinogen level correlated with the body mass index, the waist circumference, the hip circumference and the waist to hip ratio. The fibrinogen level also correlated with insulin. A partial correlation of fibrinogen and insulin continued to exist after removing the linear effects of the other variables measured. After weight reduction, the level of fibrinogen was lower. In patients with extreme overweight and high fibrinogen levels, who reduced their BMI by 7.4 ± 1.24 kg/m², the weight loss correlated with the decrease in fibrinogen. The results suggest that fibrinogen is associated with the degree of obesity and with the fasting insulin level. Fibrinogen concentration is lowered by weight reduction. However decrease of fibrinogen was observed only in patients with considerable weight loss.     

Maintenance of Weight Loss: A Needs Assessment

This study identified facilitators and obstacles to maintenance of weight loss following a very-low-calorie-diet and behavior modification program. A survey was mailed to a random sample of 178 program completers and received a 61% response rate; the most frequent follow-up period was more than 2 years. Twenty-nine percent reported weighing the same (within 10 lbs) or less than the end of their participation in the treatment program (maintainers), while 71% reported their present weight was a mean of 65% higher than their initial weight loss (regainers). Maintainers were significantly more likely to report engaging in regular aerobic exercise, attending a maintenance support group, and confidence in their ability to manage their weight in the future, while regainers were more likely to report stress and motivation as frequent weight management obstacles. Respondents consistently identified the need for low/no cost ongoing support. Maintainers and relapsers reported similar challenges in managing their weight, yet with different results, suggesting the need to identify subgroups for which different post-treatment support options could be applied.     

An Initial Evaluation of a Commercial Weight Loss Program: Short-Term Effects on Weight,Eating Behavior,and Mood

LOWE, MICHAEL R, KAREN MILLER-KOVACH, NEMA FRYE, AND SUZANNE PHELAN. An initial evaluation of a commercial weight loss program: short-term effects on weight, eating behavior, and mood. Obes Res. 1999;7:51–59. Objective : This paper describes an initial, 4-week evaluation of a commercial weight loss program. Research Methods and Procedures : Respondents (n = 985) to newspaper advertisements in two metropolitan areas were assigned to 4 weeks of either the Weight Watchers program or to a Self-Help condition. Weight loss, psychological vitality, and eating behavior were evaluated before and after the 4-week intervention. Results : Weight Watchers participants showed greater improvements than Self-Help participants on all measures; weight losses averaged 1.87 and 0.77 kg, respectively. The superior outcomes shown by Weight Watchers participants on measures of vitality and eating behavior were still evident when extent of weight loss was controlled. Weight losses across different sites, incomes, and levels of obesity were similar. Discussion : Although the present study's intervention and outcome assessments were short-term, the promising results obtained suggest that longer term studies should be undertaken.     

Overweight,Obesity, and Blood Pressure: The Effects of Modest Weight Reduction

Several large epidemiological studies have shown an association between body mass index and blood pressure in normal weight and overweight patients. Weight gain in adult life especially seems to be an important risk factor for the development of hypertension. Weight loss has been recommended for the obese hypertensive patient and has been shown to be the most effective nonpharmacological treatment approach. However, long‐term results of weight loss programs are disappointing with people often regaining most of the weight initially lost. In recent years, a modest weight loss, defined as a weight loss of 5% to 10% of baseline weight, has received increasing attention as a new treatment strategy for overweight and obese patients. A more gradual and moderate weight loss is more likely to be maintained over a longer period of time. Several studies have confirmed the blood pressure‐lowering effect of a modest weight loss in both hypertensive and nonhypertensive patients. A modest weight loss can normalize blood pressure levels even without reaching ideal weight. In patients taking antihypertensive medication, a modest weight loss has been shown to lower or even discontinue the need for antihypertensive medication. In patients with high normal blood pressure, a modest weight loss can prevent the onset of frank hypertension. The blood pressure‐lowering effect of weight loss is most likely a result of an improvement in insulin sensitivity and a decrease in sympathetic nervous system activity and occurs independent of salt restriction. In conclusion, a modest weight loss that can be maintained over a longer period of time is a valuable treatment goal in hypertensive patients.     

Effects of Visceral Fat and Weight Loss on Lipoprotein(a) Concentration in Subjects with Obesity

ZAMBONI M, R FACCHINETTI, F ARMELLINI, E TURCATO, IA BERGAMO ANDREIS, O BOSELLO. Effects of visceral fat and weight loss on lipoprotein(a) concentration in subjects with obesity. We studied the relationships between regional body fat distribution and metabolic variables with lipoprotein(a) [Lp(a)] as well as the effects of weight loss on Lp(a) in 25 women and 9 men with obesity. Regional body fat distribution, as evaluated by the use of computed tomography; Lp(a); and fasting glucose, insulin, cholesterol, and triglycerides were analyzed before and after a very low-energy diet. No significant correlations were found between visceral, subcutaneous, and total fat and Lp(a) or between metabolic variables and Lp(a). All anthropometric variables significantly decreased after a very low-energy diet. Fasting glucose, insulin, triglycerides, and cholesterol significantly decreased after a very low-energy diet. No significant changes in Lp(a) concentration after a very low-energy diet were found. The correlation between the initial values of Lp(a) and changes of Lp(a) after a very low-energy diet was slightly significant (ρ=0.33, p<0.06). In conclusion, our study shows that Lp(a) is not influenced by obesity, visceral fat, metabolic variables, or weight loss induced by a very low-energy diet     

Physical Activity and Long-Term Maintenance of Weight Loss

To examine the effect of exercise on the long-term maintenance of weight loss, two types of literature were reviewed - correlational studies of predictors of long-term weight loss, and randomized trials comparing diet, exercise, and the combination of diet plus exercise. Both literatures were striking in the consistency with which activity emerged as a determinant of long-term maintenance of weight loss. The benefits of exercise for long-term weight maintenance were observed with different types of populations, diets, and exercise interventions. Several possible explanations for these positive effects of diet plus exercise are presented, and suggestions made for future research on ways to maximize the benefit of this approach to weight control. Since adherence to exercise may ultimately prove to be the cornerstone for long-term weight maintenance, studying ways to improve exercise adherence is recommended.     

Comparison of Obese NIDDM and Nondiabetic Women: Short- and Long-Term Weight Loss

Previous research suggests that overweight patients with diabetes lose less weight than non diabetics. We compared the response of obese women with NIDDM to non diabetic controls, matched for age and weight, to a behavior weight loss program. Forty-three overweight women (20 NIDDM, 23 non diabetic) participated in the study. NIDDM and non diabetic subjects were treated together and received the same 16-week behavioral weight loss program. Dependent measures included weight, 3-day food records, physical activity, fasting plasma glucose, and questionnaires assessing eating behavior and depressive symptomatology. Weight loss of NIDDM and non diabetic subjects at posttreatment was comparable (-7.4 ± 5.3 kg vs. ?6.4 ± 3.8 kg, respectively). Changes in caloric intake, eating behavior, exercise and depressive symptomatology were also similar between the two groups. However, during the 1-year follow-up period, NIDDM subjects regained 5.4 ± 6.1 kg compared to 1.0 ± 6.7 kg for nondiabetics (p=.058). These data indicate that NIDDM subjects can lose as much weight as their nondiabetic peers during active treatment Once treatment terminated, however, NIDDM subjects demonstrated poor weight loss maintenance. Thus the added motivation that comes from having diabetes and seeing improvements in glycemic control with weight loss were not sufficient to improve long term weight loss in diabetic subjects. A continuous care model of weight control may be particularly necessary for overweight patients with type II diabetes.     

Effects of a Personal Trainer and Financial Incentives on Exercise Adherence in Overweight Women in a Behavioral Weight Loss Program

Exercise is important for long-term weight loss, but few studies have examined ways to improve exercise adherence in overweight subjects participating in a behavioral weight loss program. This paper presents two studies, one conducted at the University of Pittsburgh and one at the University of Minnesota, that sought to improve exercise adherence by exerting more direct control over the environmental antecedents and consequences controlling exercise. Study 1 investigated the use of a personal trainer who called participants regularly and met them at their home or office at scheduled times for a walk. Study 2 investigated the effect of a lottery incentive for exercise adherence. In both studies, the effect of these manipulations was examined in the context of a 24-week standard behavioral weight control program with three supervised exercise sessions per week. Neither intervention achieved statistically significant improvements in exercise adherence compared to control conditions, perhaps due in part to the limited statistical power of the studies. Future studies should focus on better understanding the barriers to exercise and designing behavioral interventions that address these barriers.     

Weight Loss Intervention for Obese Older Women: Improvements in Performance and Function

Objectives: To determine the feasibility of a 3‐month weight loss program for obese older women with short‐term laboratory, performance, functional, and life quality outcomes. Research Methods and Procedures: This was a pre‐ and postintervention design. Community‐dwelling women (n = 26) ≥60 years old with BMI ≥30 were enrolled in a 3‐month weight loss program promoting prudent diet, behavior modification, and physical activity. The primary emphasis of the program was on health, function, and quality of life. The approach was specifically tailored to older subjects through use of large‐font instructional materials, supplementation of calcium and vitamin D, and moderate weight loss and physical activity goals. An initial assessment by a bariatric physician was followed by eight visits with a dietitian and a follow‐up physician visit. Measurements included anthropometrics, body composition, laboratories, pedometer, physical performance, Short‐Form 36 Health Status Survey (SF‐36), Life Space Assessment, and dietary assessment. Results: Eighteen participants completed the program. There was a significant decrease in mean body weight (100 ± 15 vs. 96 ± 18 kg, p = 0.006), with a mean weight loss of 4.3 ± 5.5 kg (range ?15.5 to +7.20 kg). Significant improvements were observed for diastolic blood pressure, total cholesterol, triglycerides, physical performance, pedometer‐measured step counts, and step climb and descent. Self‐rated physical functioning (SF‐36 subscore) and vitality (SF‐36 subscore) were also significantly improved. Discussion: It is feasible for self‐selected obese older women to achieve a moderate weight loss and increase in physical activity resulting in short‐term improvements in laboratory, physical performance, self‐reported function, vitality, and life quality outcomes.     

Do Psychosocial Variables Predict Weight Loss or Mental Health after Obesity Surgery? A Systematic Review

Objective: The objective of this study was to present a systematic review of psychological and psychosocial predictors of weight loss and mental health after bariatric surgery. This systematic review included all controlled and noncontrolled trials of the last 2 decades with either a retrospective or prospective design and a follow‐up period of at least 1 year. Research Methods and Procedures: The relevant literature was identified by a search of computerized databases. All articles published in English and German between 1980 and 2002 were reviewed. Results: Using the above inclusion/exclusion criteria, 29 articles were identified focusing on psychosocial predictors of weight loss and mental health after obesity surgery. Discussion: Personality traits have no predictive value for the postoperative course of weight or mental state. Apart from serious psychiatric disorders including personality disorders, psychiatric comorbidity seems to be of more predictive value for mental and physical well‐being as two essential aspects of quality of life than for weight loss postsurgery. However, depressive and anxiety symptoms as correlates of psychological stress with regard to obesity seem to be positive predictors of weight loss postsurgery. The severity of the symptoms or the disorder is more relevant for the outcome of obesity surgery than the specificity of the symptoms. It is also not solely the consumption of distinct “forbidden” foods, such as sweets or soft drinks, but rather a general hypercaloric eating behavior, either as an expression of the patient's inadequate compliance or a dysregulation in energy balance, which is associated with a poor weight loss postsurgery.     

Short‐Term Effects of Weight Loss on the Cardiovascular Risk Factors in Morbidly Obese Patients

Objective: To analyze the short‐term effects of weight loss on the cardiovascular risk factors in morbidly obese patients. Research Methods and Procedures: Five metabolic cardiovascular risk factors (blood glucose, blood pressure, total cholesterol, high‐density lipoprotein (HDL)‐cholesterol, and triglycerides) were determined before and 15.3 ± 2.1 months after laparoscopic gastric banding in 650 morbidly obese patients. Global cardiovascular risk was calculated according to the Prospective Cardiovascular Münster (PROCAM) scoring system. Results: Mean weight loss was 22.7 ± 20.4 kg. Normalization of the metabolic alteration was observed in 67.3% of patients with diabetes, 38.3% of patients with hypercholesterolemia, 72.5% of patients with low HDL‐cholesterol, 72.3% of patients with hypertriglyceridemia, and 46.7% of patients with hypertension. PROCAM score fell from 31.4 ± 11.6 to 28.0 ± 12.0 points (p < 0.001). The modifications of total cholesterol and blood pressure were unrelated to percentage weight loss. Percentage weight loss was significantly related to the reductions of fasting blood glucose, triglyceride level, and the PROCAM score and to the increase of HDL‐cholesterol concentrations observed after surgery. However, the strength of these four relationships was generally low. The variations of HDL‐cholesterol concentrations and blood pressure levels were more influenced by actual energy balance than by the extent of weight loss. Discussion: Weight loss observed in the first 12 to 18 months after gastric banding was associated with a significant improvement of single cardiovascular risk factors and global risk. On the other hand, the extent of weight loss was poorly related to the magnitude of improvement in cardiovascular risk.     

Gender Differences in the Response of Plasma Leptin Concentrations to Weight Loss in Obese Older Individuals

Plasma leptin concentration is directly related to the degree of obesity and is higher in women than in men of the same body mass index (BMI). We hypothesized that fasting plasma leptin concentrations and the response of leptin to weight loss would differ in older men and women of a similar fat mass. Plasma leptin concentrations (radioimmunoassay) and fat mass (DXA) were measured in 47 older, obese (BMI=30 ± 4 kg/m²) women and 23 older, obese (BMI=31 ± 3 kg/m²) men after a 2 to 4 week period of weight and dietary stabilization, and then in 22 of the women and 18 of the men after a 6-month weight loss intervention (250–350 kcal/d deficit). Leptin correlated with fat mass in men and women (r=0.75 and r=0.77, respectively; p values<0.0001), but women had 3-fold higher leptin levels for a given fat mass than men (p=0.01). In response to the 6-month hypocaloric diet, men and women lost a similar percentage of fat mass (?13% and ?16%, respectively), but the relative decline in circulating leptin was greater in women than men (-45% and ?21%, respectively; p<0.0001). In addition, when leptin was normalized for fat mass using the ratio method, the decrease in leptin per kilogram of fat mass was greater in women than men (-0.37 ± 0.34 vs. ?0.04 ± 0.06 ng/mL/kg; p<0.01). After weight loss, the change in leptin concentrations correlated positively with the change in fat mass in men (r=0.60; p<0.01), but not in women (r=0.31; p=0.17). Furthermore, the loss in fat mass correlated negatively with baseline leptin levels in women (r=-0.47; p<0.05), but not in men (r=0.03, p=NS). These results indicate that the decline in leptin concentration with weight loss correlates with the loss in fat mass in men; but, in women, other factors affect the decrease in leptin concentration. This suggests that the role of leptin in the regulation of obesity is gender-specific and may account for gender differences in response to hypocaloric treatment and maintenance of lost weight.     

History of Intentional and Unintentional Weight Loss in a Population-Based Sample of Women Aged 55 to 69 Years

FRENCH, SIMONE A, ROBERT W JEFFERY, AARON R FOLSOM, DAVID F WILLIAMSON AND TIM BYERS. History of intentional and unintentional weight loss in a population-based sample of women aged 55 to 69 years. Obes Res. 1995;3:163–170. Although both overweight and body weight fluctuation are related to chronic disease risk, little is known about the history of and reasons for body weight change in the general population. This paper reports the incidence of intentional and unintentional weight loss episodes during adulthood in a population-based sample of 26, 261 women aged 55 to 69 years. Intentional weight loss episodes of each of four amounts (5–9, 10–19, 20–49, 50+ lbs.) and unintentional weight loss episodes of 20 or more lbs. were recalled for each of three age periods (18–39, 40–54, 55+ years). At least one intentional weight loss episode of 5 or more lbs. was reported by 69% of women, 46% reported at least one intentional weight loss episode of 10 or more lbs, and 25% reported at least one intentional weight loss episode 20 or more lbs. At least one unintentional weight loss episode of 20 or more lbs. was reported by 29% of the women. Reasons for weight losses of 20 or more lbs. were also recalled. Women who had intentionally lost 20 or more lbs. were more likely to report weight losses due to low-calorie diets, exercise and weight loss groups, while women who had unintentionally lost 20 or more lbs. were more likely to report weight losses due to depression or stress. These findings question the common assumption that weight losses in adult women are primarily intentional and emphasize the need to distinguish the reasons for weight loss in studies examining the relationship between body weight changes and health outcomes.     

Leptin Responses to Weight Loss in Postmenopausal Women: Relationship to Sex‐Hormone Binding Globulin and Visceral Obesity

Objective: Leptin concentrations increase with obesity and tend to decrease with weight loss. However, there is large variation in the response of serum leptin levels to decreases in body weight. This study examines which endocrine and body composition factors are related to changes in leptin concentrations following weight loss in obese, postmenopausal women. Research Methods and Procedures: Body composition (DXA), visceral obesity (computed tomography), leptin, cortisol, insulin, and sex hormone‐binding globulin (SHBG) concentrations were measured in 54 obese (body mass index [BMI] = 32.0 ± 4.5 kg/m²; mean ± SD), women (60 ± 6 years) before and after a 6‐month hypocaloric diet (250 to 350 kcal/day deficit). Results: Body weight decreased by 5.8 ± 3.4 kg (7.1%) and leptin levels decreased by 6.6 ± 11.9 ng/mL (14.5%) after the 6‐month treatment. Insulin levels decreased 10% (p < 0.05), but mean SHBG and cortisol levels did not change significantly. Relative changes in leptin with weight loss correlated positively with relative changes in body weight (r = 0.50, p < 0.0001), fat mass (r = 0.38, p < 0.01), subcutaneous fat area (r = 0.52, p < 0.0001), and with baseline values of SHBG (r = 0.38, p < 0.01) and baseline intra‐abdominal fat area (r = ?0.27, p < 0.06). Stepwise multiple regression analysis showed that baseline SHBG levels (r² = 0.24, p < 0.01), relative changes in body weight (cumulative r² = 0.40, p < 0.05), and baseline intra‐abdominal fat area (cumulative r² = 0.48, p < 0.05) were the only independent predictors of the relative change in leptin, accounting for 48% of the variance. Discussion: These results suggest that obese, postmenopausal women with a lower initial SHBG and more visceral obesity have a greater decrease in leptin with weight loss, independent of the amount of weight lost.     

Effect of Internet Support on the Long‐Term Maintenance of Weight Loss

Objective: To investigate the efficacy of an Internet weight maintenance program. Research Methods and Procedures: Two hundred fifty‐five healthy overweight and obese adults (mean ± SD BMI, 31.8 ± 4.1 kg/m²) men (18%; mean ± SD age, 45.8 ± 8.9 yrs) participated in a 6‐month behavioral weight control program conducted over interactive television. Treatment was followed by a 12‐month weight maintenance program with three conditions: frequent in‐person support (F‐IPS), minimal in‐person support (M‐IPS) and internet support (IS). Main outcome measures included body weight, program adherence, and social influence components. Results: There were no significant differences among the groups in weight loss (mean ± SD) from baseline to 18 months (7.6 ± 7.3 kg vs. 5.5 ± 8.9 kg vs. 5.1 ± 6.5 kg, p = 0.23 for the IS, M‐IPS, and F‐IPS, respectively). Discussion: Participants assigned to an internet‐based weight maintenance program sustained comparable weight loss over 18 months compared with individuals who continued to meet face‐to‐face. Therefore, the internet appears to be a viable medium for promoting long‐term weight maintenance.     

Use of Very Low-Calorie Diet in Preoperative Weight Loss: Efficacy and Safety

PEKKARINEN, TUULA, PERTTI MUSTAJOKI. Use of very low-calorie diet in preoperative weight loss: Efficacy and Safety. We report the efficacy of a very low-calorie diet (VLCD)-based weight reduction program in patients with morbid obesity whose elective surgery had been postponed because of being overweight. The safety of weight loss on the immune system will also be evaluated. Thirty patients (mean age, 50 years; weight, 125 kg; BMI, 44 kg/m2) were treated. The program consisted of a 7-week to 24-week VLCD period, supported by individual sessions with a therapist, and of a refeeding period of 1 month before surgery. Two patients discontinued, and the mean weight loss of the remaining 28 patients was 19. 6 kg (15% of initial weight). In 23 patients, weight loss was 10% or more of the initial weight. After weight loss, 15 patients underwent surgery, 4 patients did not need an operation, and the remaining 9 patients were not operated on for various reasons. The numbers of circulating leukocytes, neutrophils, basophils, monocytes, CD3+, CD4+, CD8+, and natural killer cells did not change significantly by the ninth week on VLCD or by the end of the program. However, there was a significant (p<0. 05) decrease in the immunoglobulinM serum concentration during the program. In conclusion, a VLCD program is suitable for preoperative weight reduction in morbid obesity and seems not to compromise the immune system.