Effects of Chromium and Carnitine Co-supplementation on Body Weight and Metabolic Profiles in Overweight and Obese Women with Polycystic Ovary Syndrome: a Randomized,Double-Blind,Placebo-Controlled Trial

The primary aim of our study was to determine the influence of taking chromium plus carnitine on insulin resistance, with a secondary objective of evaluating the influences on lipid profiles and weight loss in overweight subjects with polycystic ovary syndrome (PCOS). In a 12-week randomized, double-blind, placebo-controlled clinical trial, 54 overweight women were randomly assigned to receive either supplements (200 μg/day chromium picolinate plus 1000 mg/day carnitine) or placebo (27/each group). Chromium and carnitine co-supplementation decreased weight (− 3.6 ± 1.8 vs. − 1.0 ± 0.7 kg, P < 0.001), BMI (− 1.3 ± 0.7 vs. − 0.3 ± 0.3 kg/m², P < 0.001), fasting plasma glucose (FPG) (− 5.1 ± 6.0 vs. − 1.1 ± 4.9 mg/dL, P = 0.01), insulin (− 2.0 ± 1.4 vs. − 0.2 ± 1.2 μIU/mL, P < 0.001), insulin resistance (− 0.5 ± 0.4 vs. − 0.04 ± 0.3, P < 0.001), triglycerides (− 18.0 ± 25.2 vs. + 5.5 ± 14.4 mg/dL, P < 0.001), total (− 17.0 ± 20.3 vs. + 3.6 ± 12.0 mg/dL, P < 0.001), and LDL cholesterol (− 13.3 ± 19.2 vs. + 1.4 ± 13.3 mg/dL, P = 0.002), and elevated insulin sensitivity (+ 0.007 ± 0.005 vs. + 0.002 ± 0.005, P < 0.001). In addition, co-supplementation upregulated peroxisome proliferator-activated receptor gamma (P = 0.02) and low-density lipoprotein receptor expression (P = 0.02). Overall, chromium and carnitine co-supplementation for 12 weeks to overweight women with PCOS had beneficial effects on body weight, glycemic control, lipid profiles except HDL cholesterol levels, and gene expression of PPAR-γ and LDLR. Clinical trial registration number: http://www.irct.ir: IRCT20170513033941N38.

     

Weight loss strategies for obese adults: personalized weight management program vs. standard care

Objective: The objective of this study was to evaluate the effect of a 32‐week personalized Polar weight management program (PWMP) compared with standard care (SC) on body weight, body composition, waist circumference, and cardiorespiratory fitness in overweight or obese adults. Research Methods and Procedures: Overweight or obese (29 ± 2 kg/m²) men and women (n = 74) 38 ± 5 years of age were randomly assigned into either PWMP (men = 20, women = 21) or SC (men = 15, women = 18). Both groups managed their own diet and exercise program after receiving the same standardized nutrition and physical activity advice. PWMP also received a weight management system with literature to enable the design of a personalized diet and exercise weight loss program. Body weight and body composition, waist circumference, and cardiorespiratory fitness were measured at weeks 0, 16, and 32. Results: Eighty percent of participants completed the 32‐week intervention, with a greater proportion of the dropouts being women (PWMP: 2 men vs. 7 women; SC: 2 men vs. 4 women). At 32 weeks, PWMP completers had significantly (p < 0.001) greater losses in body weight [6.2 ± 3.4 vs. 2.6 ± 3.6 (standard deviation) kg], fat mass (5.9 ± 3.4 vs. 2.2 ± 3.6 kg), and waist circumference (4.4 ± 4.5 vs. 1.0 ± 3.6 cm). Weight loss and fat loss were explained by the exercise energy expenditure completed and not by weekly exercise duration. Discussion: More effective weight loss was achieved after treatment with the PWMP compared with SC. The results suggest that the PWMP enables effective weight loss through tools that support self‐monitoring without the requirement of more costly approaches to program supervision.     

The Impact of Calcium and Dairy Product Consumption on Weight Loss

Objective: Recent evidence suggests that diets high in calcium and dairy products are associated with lower body weight, particularly lower body fat levels. The purpose of this study was to compare weight and body fat loss on a calorie-restricted, low-dairy (CR) vs. high-dairy (CR+D) diet. Research Methods and Procedures: Fifty-four subjects (BMI 30 ± 2.5 kg/m², 45 ± 6.6 years, 4 men) were randomly assigned to calorie-restricted (−500 kcal/d) low-dairy calcium (n = 29; ∼1 serving dairy/d, 500 mg/d calcium) or high-dairy calcium (n = 25; 3 to 4 servings dairy/d, 1200 to 1400 mg/d calcium) diets for 12 months. Main outcome measures included change in weight (kilograms) and body fat (percentage). Results: There were no significant differences between groups at baseline. At 12 months, weight and body fat loss were not significantly different. Subjects in the CR vs. CR+D conditions lost 9.6 ± 6.5 vs. 10.8 ± 5.9 kg (p = 0.56) and 9.0 ± 3.8 vs. 10.1 ± 3.6 kg body fat (p = 0.37). Discussion: These findings suggest that a high-dairy calcium diet does not substantially improve weight loss beyond what can be achieved in a behavioral intervention.     

Cholesteryl ester transfer protein in metabolic syndrome

Objective: Low high‐density lipoprotein cholesterol (HDL‐C), hypertriglyceridemia, and small dense‐low density lipoprotein (LDL) are key components of metabolic syndrome (MS). Cholesteryl ester transfer protein (CETP) mediates the transfer of triglycerides (TGs) from TG‐rich lipoproteins to HDL and LDL particles in exchange for cholesteryl esters, leading to low HDL‐C and small dense‐LDL. The aim of this study was to investigate the role of CETP in subjects with MS. Research Methods and Procedures: In a cross‐sectional cohort of 234 middle‐aged men and 252 women randomly selected from the Salzburg Atherosclerosis Prevention Program in Subjects at High Individual Risk (SAPHIR) study, MS was diagnosed according to the National Cholesterol Education Program guidelines. CETP mass was determined by enzyme‐linked immunosorbent assay and LDL size‐by‐gradient polyacrylamide gel electrophoresis. Results: Men and women with MS had lower HDL‐C (45 ± 7 vs. 58 ± 13 and 48 ± 10 vs. 71 ± 14 mg/dL for men and women, respectively; p < 0.001 for all) and higher TG levels (222 ± 71 vs. 98 ± 54 and 167 ± 67 vs. 90 ± 35 mg/dL for men and women, respectively; p < 0.001 for all) than healthy subjects. LDL size was lower in subjects with MS (256 ± 11 Å vs. 267 ± 11 Å and 262 ± 10 Å vs. 273 ± 8 Å for men and women, respectively; p < 0.001 for all). CETP mass was higher in men with MS (1.87 ± 0.78 vs. 1.40 ± 0.65 μg/mL; p < 0.001) but not in women (1.74 ± 0.79 vs. 1.62 ± 0.62 μg/mL). CETP mass correlated inversely with LDL size in both men and women (r = ?0.19, p < 0.01 and r = ?0.13, p < 0.05 in men and women, respectively). Discussion: MS is associated with increased CETP mass in men. Increased CETP mass may be responsible for reduced HDL‐C and reduced LDL particle diameter in MS.     

Use of Portion‐Controlled Entrees Enhances Weight Loss in Women

Objective: To determine the efficacy of a weight‐loss diet using packaged portion‐controlled entrees compared with a self‐selected diet based on the U.S. Department of Agriculture Food Guide Pyramid (FGP) (United States Department of Agriculture, Center for Nutrition Policy and Promotion, Washington, DC; 1996). Research Methods and Procedures: Sixty healthy women (BMI 26 to 40 kg/m²; 24 to 60 years old) were randomized into two intervention groups for an 8‐week parallel arm study. The portion‐controlled group consumed two frozen entrees daily, plus additional food servings from the FGP. The self‐selected diet group consumed a recommended number of servings from the FGP. Diets were designed to be the same in composition (55% carbohydrate, 25% protein, 20% fat) and energy level (1365 kcal). Each group met weekly to monitor compliance and take measures. Outcomes included weight, body composition by DXA, hip and waist circumference, blood pressure, fasting blood lipids, glucose, insulin, and C‐reactive protein. Significant differences were assessed using repeated measures ANOVA. Results: The portion‐controlled group (n = 26) experienced greater decreases in weight (5.6 ± 2.2 kg or 6.5% vs. 3.6 ± 2.5 kg or 4.2%), fat mass (3.6 ± 1.8 vs. 2.3 ± 1.4 kg), total cholesterol (24.4 ± 21.5 mg/dL or 12.4% vs. 13.0 ± 13.9 mg/dL or 6.7%), and fasting insulin (?1.8 ± 3.7 vs.+0.3 ± 3.8 μU/mL) than the self‐selected diet group (n = 27) (p < 0.05). Discussion: Consumption of portion‐controlled entrees resulted in greater losses of weight and fat, thereby reducing cardiovascular disease risk. Accurate portion control is an important factor in weight loss success, and use of packaged entrees is an effective method of achieving this.     

Weight loss on the web: A pilot study comparing a structured behavioral intervention to a commercial program

Objective: Internet weight loss programs have become widely available as alternatives to standard treatment, but few data are available on their efficacy. This study aimed to investigate the effectiveness of a structured behavioral weight loss website (VTrim) vs. a commercial weight loss website ( eDiets.com ). Research Methods and Procedures: A randomized, controlled trial was conducted from February 2003 to March 2005, in 124 overweight and obese subjects ages 18 years and older with a BMI of 25 to 39.9 kg/m² (mean age, 47 ± 9 years; BMI, 32 ± 3 kg/m²; 20% men). Analyses were performed for the 88 subjects who had complete follow‐up data. Participants were randomly assigned to 12‐month VTrim (n = 62) or eDiets.com (n = 62) intervention. VTrim participants had access to a therapist‐led structured behavioral weight loss program delivered on‐line. eDiets.com subjects had access to a self‐help commercial on‐line weight loss program. Body weight, social support, and use of website components were measured at 0, 6, and 12 months. Results: Repeated‐measures analyses showed that the VTrim group lost significantly more weight than the eDiets.com group at 6 months (8.3 ± 7.9 kg vs. 4.1 ± 6.2 kg; p = 0.004) and maintained a greater loss at 12 months (7.8 ± 7.5 kg vs. 3.4 ± 5.8 kg; p = 0.002). More participants in the VTrim group maintained a 5% weight loss goal (65% vs. 37.5%; p = 0.01) at 12 months. Discussion: An on‐line, therapist‐led structured behavioral weight loss website produced greater weight loss than a self‐help commercial website. Because commercial sites have great potential public health impact, future research should investigate the feasibility of incorporating a more structured behavioral program into a commercial application.     

A Pilot Internet‐Based Behavioral Weight Loss Intervention with or without Commercially Available Portion‐Controlled Foods

Objective : To evaluate the short‐term impact of portion‐controlled food provision in combination with an Internet behavioral weight loss program on weight, blood cholesterol, and blood glucose levels. Design and Methods : Fifty participants, mean age 46 ± 10.7 years and mean body mass index 35.1 ± 3.8 kg/m², were randomized to one of two study groups, an Internet behavioral weight loss program (Internet‐alone; n = 25) or an Internet behavioral weight loss program plus a commercially available portion‐controlled diet (Internet + PCD; n = 25) for 12 weeks. Results : An intent‐to‐treat analysis found that the mean weight change in the Internet + PCD group was ?5.7 ± 5.6 kg and in the Internet‐alone group (n = 25) was ?4.1 ± 4.0 kg (P = 0.26). Participants in the Internet + PCD group achieved significantly greater improvements in blood glucose (?2.6 ± 5.7 vs. 1.4 ± 11.0 mg/dl; P = 0.05) and LDL cholesterol (?8.2 ± 18.0 vs. ?0.6 ± 21.0 mg/dl; P = 0.04), compared with Internet‐alone group. Conclusions : These data suggest that there may be short‐term clinical benefit in using a PCD in conjunction with a behavioral Internet‐based weight loss program to enhance weight loss and improve health indicators.     

Weight Loss Reduces Tissue Factor in Morbidly Obese Patients

Objective: To investigate the tissue factor (TF) pathway in clinical obesity and associated metabolic syndrome. Research Methods and Procedures: Thirty‐seven morbidly obese patients (4 men; BMI, 48 ± 7 kg/m²; range, 42 to 53 kg/m²), undergoing elective gastroplasty for the induction of weight loss, were examined for hemostatic, metabolic, and inflammatory parameters at baseline and 14 ± 5 months postoperatively. Results: Weight loss significantly reduced circulating plasma TF (314 ± 181 vs. 235 ± 113 pg/mL, p = 0.04), coagulation factor VII (130 ± 22% vs. 113 ± 19%, p = 0.023), and prothrombin fragment F1.2 (2.4 ± 3.4 vs. 1.14 ± 1.1 nM, p = 0.04) and normalized glucose metabolism in 50% of obese patients preoperatively classified as diabetic or of impaired glucose tolerance. The postoperative decrease in plasma TF correlated with the decrease of F1.2 (r = 0.56; p = 0.005), a marker of in vivo thrombin formation. In subgroup analysis stratified by preoperative glucose tolerance, baseline circulating TF (402.6 ± 141.6 vs. 176.2 ± 58.2, p < 0.001) and TF decrease after gastroplasty (ΔTF: 164.7 ± 51.4 vs. ?81 ± 31 pg/mL, p = 0.02) were significantly higher in obese patients with impaired glucose tolerance than in patients with normal glucose tolerance. Discussion: Procoagulant TF is significantly reduced with weight loss and may contribute to a reduction in cardiovascular risk associated with obesity.     

The effect of pioglitazone and resistance training on body composition in older men and women undergoing hypocaloric weight loss

Age‐related increases in ectopic fat accumulation are associated with greater risk for metabolic and cardiovascular diseases, and physical disability. Reducing skeletal muscle fat and preserving lean tissue are associated with improved physical function in older adults. PPARγ‐agonist treatment decreases abdominal visceral adipose tissue (VAT) and resistance training preserves lean tissue, but their effect on ectopic fat depots in nondiabetic overweight adults is unclear. We examined the influence of pioglitazone and resistance training on body composition in older (65–79 years) nondiabetic overweight/obese men (n = 48, BMI = 32.3 ± 3.8 kg/m²) and women (n = 40, BMI = 33.3 ± 4.9 kg/m²) during weight loss. All participants underwent a 16‐week hypocaloric weight‐loss program and were randomized to receive pioglitazone (30 mg/day) or no pioglitazone with or without resistance training, following a 2 × 2 factorial design. Regional body composition was measured at baseline and follow‐up using computed tomography (CT). Lean mass was measured using dual X‐ray absorptiometry. Men lost 6.6% and women lost 6.5% of initial body mass. The percent of fat loss varied across individual compartments. Men who were given pioglitazone lost more visceral abdominal fat than men who were not given pioglitazone (?1,160 vs. ?647 cm³, P = 0.007). Women who were given pioglitazone lost less thigh subcutaneous fat (?104 vs. ?298 cm³, P = 0.002). Pioglitazone did not affect any other outcomes. Resistance training diminished thigh muscle loss in men and women (resistance training vs. no resistance training men: ?43 vs. ?88 cm³, P = 0.005; women: ?34 vs. ?59 cm³, P = 0.04). In overweight/obese older men undergoing weight loss, pioglitazone increased visceral fat loss and resistance training reduced skeletal muscle loss. Additional studies are needed to clarify the observed gender differences and evaluate how these changes in body composition influence functional status.     

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.     

Insulin Resistance in Nondiabetic Morbidly Obese Patients: Effect of Bariatric Surgery

Objective: To evaluate insulin action on substrate use and insulinemia in nondiabetic class III obese patients before and after weight loss induced by bariatric surgery. Research Methods and Procedures: Thirteen obese patients (four men/nine women; BMI = 56.3 ± 2.7 kg/m²) and 13 lean subjects (five men/eight women; BMI = 22.4 ± 0.5 kg/m²) underwent euglycemic clamp, oral glucose tolerance test, and indirect calorimetry. The study was carried out before (Study I) and after (～40% relative to initial body weight; Study II) weight loss induced by Roux‐en‐Y Gastric bypass with silastic ring surgery. Results: The obese patients were insulin resistant (whole‐body glucose use = 19.7 ± 1.5 vs. 51.5 ± 2.4 μmol/min per kilogram fat‐free mass, p < 0.0001) and hyperinsulinemic in the fasting state (332 ± 86 vs. 85 ± 5 pM, p < 0.0001) and during the oral glucose tolerance test compared with the lean subjects. Fasting plasma insulin normalized after weight loss, whereas whole‐body glucose use increased (35.5 ± 3.7 μmol/min per kilogram fat‐free mass, p < 0.05 vs. Study I). The higher insulin clearance of obese did not change during the follow‐up period. Insulin‐induced glucose oxidation and nonoxidative glucose disposal were lower in the obese compared with the lean group (all p < 0.05). In Study II, the former increased slightly, whereas nonoxidative glucose disposal reached values similar to those of the control group. Fasting lipid oxidation was higher in the obese than in the control group and did not change significantly in Study II. The insulin effect on lipid oxidation was slightly improved (p = 0.01 vs. Study I). Discussion: The rapid weight loss after surgery in obese class III patients normalized insulinemia and improved insulin sensitivity almost entirely due to glucose storage, whereas fasting lipid oxidation remained high.     

A randomized trial testing a contingency-based weight loss intervention involving social reinforcement

Even though behavioral weight loss interventions are conducted in groups, a social contingency (SC) paradigm that capitalizes on the social reinforcement potential of the weight loss group has never been tested. We tested a weight loss intervention in which participation in the weight loss group was contingent upon meeting periodic weight goals. We hypothesized that making access to the group dependent upon weight loss would improve weight outcomes. Participants (N = 62; 84% female; 94% white; age = 51.9 ± 9.0; BMI = 34.7 ± 4.5) were randomized to 6‐months of standard behavioral weight loss (SBWL) or to a behavioral program that included a SC paradigm. Both groups engaged in social cohesion activities. Participants in SC who did not meet weight goals did not attend group meetings; instead, they received individual treatment with a new interventionist and returned to group once their weight goals were met. SC did not improve overall weight loss outcomes (SC: ?10.0 ± 4.9 kg, SBWL: ?10.8 ± 6.4 kg, P = 0.63). Similarly, overall weight loss was not significantly different in the subgroup of participants in the SC and SBWL conditions who did not meet periodic weight loss goals (?7.3 ± 4.1 kg vs. ?7.1 ± 3.5 kg, P = 0.90). Surprisingly, “successful” SC participants (who met their weight goals) actually lost less weight than “successful” SBWL participants (?12.4 ± 3.2 kg vs. ?14.5 ± 4.7 kg, P = 0.02). Whereas contingency‐based treatments have been tested for other health behaviors (e.g., substance abuse), this is the first study to test a SC intervention for weight loss. This approach did not improve overall weight loss outcomes. Our attempt to offer appropriate clinical care by providing individual treatment to SC participants when needed may have mitigated the effects of the SC paradigm.     

Three-year weight change in successful weight losers who lost weight on a low-carbohydrate diet

Objective: The purpose of this study was to evaluate long‐term weight loss and eating and exercise behaviors of successful weight losers who lost weight using a low‐carbohydrate diet. Research Methods and Procedures: This study examined 3‐year changes in weight, diet, and physical activity in 891 subjects (96 low‐carbohydrate dieters and 795 others) who enrolled in the National Weight Control Registry between 1998 and 2001 and reported ≥30‐lb weight loss and ≥1 year weight loss maintenance. Results: Only 10.8% of participants reported losing weight after a low‐carbohydrate diet. At entry into the study, low‐carbohydrate diet users reported consuming more kcal/d (mean ± SD, 1895 ± 452 vs. 1398 ± 574); fewer calories in weekly physical activity (1595 ± 2499 vs. 2542 ± 2301); more calories from fat (64.0 ± 7.9% vs. 30.9 ± 13.1%), saturated fat (23.8 ± 4.1 vs. 10.5 ± 5.2), monounsaturated fat (24.4 ± 3.7 vs. 11.0 ± 5.1), and polyunsaturated fat (8.6 ± 2.7 vs. 5.5 ± 2.9); and less dietary restraint (10.8 ± 2.9 vs. 14.9 ± 3.9) compared with other Registry members. These differences persisted over time. No differences in 3‐year weight regain were observed between low‐carbohydrate dieters and other Registry members in intent‐to‐treat analyses (7.0 ± 7.1 vs. 5.7 ± 8.7 kg). Discussion: It is possible to achieve and maintain long‐term weight loss using a low‐carbohydrate diet. The long‐term health effects of weight loss associated with a high‐fat diet and low activity level merits further investigation.     

Improved Psychological Well-Being,Quality of Life,and Health Practices in Moderately Overweight Women Participating in a 12-Week Structured Weight Loss Program

Objective : To study the effects of a 12-week weight loss strategy involving increased physical activity, self-selected hypocaloric diet, and group support on psychological well-being, quality of life, and health practices in moderately obese women. Methods; Eighty women aged 20–49 years weighing between 20–50% above 1983 Metropolitan Life Insurance Tables were randomly assigned to a weight loss intervention (6279 kJ/week of physical activity, 33,258-41,462 kJ/week diet and weekly meetings) or served as controls. Subjects were tested pre and post 12-weeks. Results : The intervention group lost significant (p<0.001) body weight (kg) and body fat (%) compared to controls (-6.07 ± 4.01 kg vs. 1.31 ± 1.28 kg; 36.8%-32.5% vs. 36.2%-36.0%). Intervention subjects vs. controls achieved significant improvements (p<0.001) in body cathexis (X Change 18.6 ± 16.7 vs. 0.7 ± 8.6) and estimation of ability to achieve physical fitness (X Change 8.1 ± 7.1 vs. 0.9 ± 5.9). Various quality of life indices also improved (p<0.01) in the intervention group compared to controls (physical function: X Change 13.5.2 ± 16.7 vs. 1.4 ± 9.5; vitality: X change 21.7 ± 17.9 vs. 2.9 20.8; mental health: X change 10.4 ± 16.0 vs. 2.3 ± 10.1). Similarly, physical activity levels also improved significantly (p<0.0001) in the intervention group (4.4 ± 2.3 vs. 0.6 ± 1.3; on NASA 0–7 scale). Conclusions : Practical weight loss practices such as increased activity, self-selected hypocaloric diet, and group support are effective for weight loss and yield significant health and psychological benefits in moderately obese females.     

Leptin, superoxide dismutase, and weight loss: initial leptin predicts weight loss

Objective: Our goal was to study how plasma leptin concentration, superoxide dismutase (SOD) activity, and weight loss are related in obese adults. Research Methods and Procedures: Serum leptin concentration, SOD activities, general biochemical data, and body composition measurements were obtained for 62 overweight and obese subjects before and after an 8‐week body weight reduction (BWR) regimen. The subjects were on dietary control, performed moderate aerobic and strength training exercises, and attended educational lectures. Results: The measurement results indicated that the following criteria were significantly reduced: body weight [84.4 ± 17.0 vs. 79.3 ± 16.1 (standard error) kg, p < 0.001]; BMI (31.5 ± 4.3 vs. 29.4 ± 4.2 kg/m², p < 0.001), and fat mass (33.3 ± 10.0 vs. 29.8 ± 10.4 kg, p < 0.001). Plasma leptin levels also significantly decreased from 31.5 ± 17.6 to 26.5 ± 17.2 ng/mL (p < 0.001). Additionally, SOD activity was significantly increased from 261.4 ± 66.0 to 302.7 ± 30.9 U/mL (p < 0.001). Based on linear regression analysis results, a 3.78‐ to 8.13‐kg reduction in weight can be expected after the 8‐week BWR regimen when initial leptin concentration was 5 to 30 ng/mL. Discussion: We found that an 8‐week exercise and diet program was effective in reducing weight and fat mass and, notably, had further beneficial effects on leptin resistance and SOD activity. Additionally, this study demonstrated that initial plasma leptin concentration may be used as a predictor for weight loss outcome.     

Effects of Sibutramine Plus Orlistat in Obese Women Following 1 Year of Treatment by Sibutramine Alone: A Placebo‐Controlled Trial

Objective: This study assessed whether adding orlistat to sibutramine would induce further weight loss in patients who previously had lost weight while taking sibutramine alone. Research Methods and Procedures: Patients were 34 women with a mean age of 44.1 ± 10.4 years, weight of 89.4 ± 13.8 kg, and body mass index (BMI) of 33.9 ± 4.9 kg/m² who had lost an average of 11.6 ± 9.2% of initial weight during the prior 1 year of treatment by sibutramine combined with lifestyle modification. Patients were randomly assigned, in double‐blind fashion, to sibutramine plus orlistat or sibutramine plus placebo. In addition to medication, participants were provided five brief lifestyle modification visits during the 16‐week continuation trial. Results: Mean body weight did not change significantly in either treatment condition during the 16 weeks. The addition of orlistat to sibutramine did not induce further weight loss as compared with treatment by sibutramine alone (mean changes = +0.1 ± 4.1 kg vs. +0.5 ± 2.1 kg, respectively). Discussion: These results must be interpreted with caution because of the study's small sample size. The findings, however, suggest that the combination of sibutramine and orlistat is unlikely to have additive effects that will yield mean losses ≥15% of initial weight, as desired by many obese individuals.     

Altered Intramuscular Lipid Metabolism Relates to Diminished Insulin Action in Men,but Not Women,in Progression to Diabetes

Whether sex differences in intramuscular triglyceride (IMTG) metabolism underlie sex differences in the progression to diabetes are unknown. Therefore, the current study examined IMTG concentration and fractional synthesis rate (FSR) in obese men and women with normal glucose tolerance (NGT) vs. those with prediabetes (PD). PD (n = 13 men and 7 women) and NGT (n = 7 men and 12 women) groups were matched for age and anthropometry. Insulin action was quantified using a hyperinsulinemic‐euglycemic clamp with infusion of [6,6^?2H₂]‐glucose. IMTG concentration was measured by gas chromatography/mass spectrometry (GC/MS) and FSR by GC/combustion isotope ratio MS (C‐IRMS), from muscle biopsies taken after infusion of [U^?13C]palmitate during 4 h of rest. In PD men, the metabolic clearance rate (MCR) of glucose was lower during the clamp (4.71 ± 0.77 vs. 8.62 ± 1.26 ml/kg fat‐free mass (FFM)/min, P = 0.04; with a trend for lower glucose rate of disappearance (Rd), P = 0.07), in addition to higher IMTG concentration (41.2 ± 5.0 vs. 21.2 ± 3.4 µg/mg dry weight, P ≤ 0.01), lower FSR (0.21 ± 0.03 vs. 0.42 ± 0.06 %/h, P ≤ 0.01), and lower oxidative capacity (P = 0.03) compared to NGT men. In contrast, no difference in Rd, IMTG concentration, or FSR was seen in PD vs. NGT women. Surprisingly, glucose Rd during the clamp was not different between NGT men and women (P = 0.25) despite IMTG concentration being higher (42.6 ± 6.1 vs. 21.2 ± 3.4 µg/mg dry weight, P = 0.03) and FSR being lower (0.23 ± 0.04 vs. 0.42 ± 0.06 %/h, P = 0.02) in women. Alterations in IMTG metabolism relate to diminished insulin action in men, but not women, in the progression toward diabetes.     

The effect of obesity management on body image in patients seeking treatment at medical centers

Objective: Body image dissatisfaction is common in treatment‐seeking patients with obesity. We aimed to investigate the effects of obesity management on body image in patients with obesity attending Italian medical centers for weight loss programs. Research Methods and Procedures: A total of 473 obese patients seeking treatment in 13 Italian medical centers (80% females; age, 45.9 ± standard deviation 11.0 years; BMI, 36.8 ± 5.7 kg/m²) were evaluated at baseline and after a 6‐month weight loss treatment. Body uneasiness, psychiatric distress, and binge eating were tested by Body Uneasiness Test (BUT, Part A), Symptom CheckList‐90 (SCL‐90), and Binge Eating Scale (BES), respectively. Results: At 6‐month follow‐up, the percentage weight loss was significantly higher in men (9.0 ± 6.3%) than in women (6.8 ± 7.3%; p = 0.010). Both men and women had a significant improvement in BUT Global Severity Index and in all of the BUT subscales with the exception of the Compulsive Self‐Monitoring subscale. Linear regression analysis selected baseline psychological and behavioral measures (global score of BUT and SCL‐90) and improved psychiatric distress and binge eating as independent predictors of changes in basal body dissatisfaction in females, whereas in males, changes were associated only with baseline BUT‐Global Severity Index score, binge eating, and its treatment‐associated improvement. Pre‐treatment BMI and BMI changes did not enter the regression. Discussion: Obesity treatment, even with a modest degree of weight loss, is associated with a significant improvement of body image, in both females and males. This effect depends mainly on psychological factors, not on the amount of weight loss.     

Two-year internet-based randomized controlled trial for weight loss in African-American girls

Objective: A randomized controlled trial tested the efficacy of an internet‐based lifestyle behavior modification program for African‐American girls over a 2‐year period of intervention. Research Methods and Procedures: Fifty‐seven overweight (mean BMI percentile, 98.3) African‐American girls (mean age, 13.2 years) were randomly assigned to an interactive behavioral internet program or an internet health education program, the control condition. Overweight parents were also participants in the study. Forty adolescent‐parent dyads (70%) completed the 2‐year trial. Outcome data including BMI, body weight, body composition, and weight loss behaviors were collected at baseline and at 6‐month intervals. A computer server tracked use of the web sites. Results: An intention‐to‐treat statistical approach was used, with the last observation carried forward. In comparison with the control condition, adolescents in the behavioral program lost more mean body fat (BF) (?1.12 ± 0.47% vs. 0.43 ± 0.47% BF, p < 0.05), and parents in the behavioral program lost significantly more mean body weight (?2.43 ± 0.66 vs. ?0.35 ± 0.64 kg, p < 0.05) during the first 6 months. This weight loss was regained over the next 18 months. After 2 years, differences in fat for adolescents (?0.08 ± 0.71% vs. 0.84 ± 0.72% BF) and weight for parents (?1.1 ± 0.91 vs. ?0.60 ± 0.89 kg) did not differ between the behavioral and control programs. Discussion: An internet‐based weight management program for African‐American adolescent girls and their parents resulted in weight loss during the first 6 months but did not yield long‐term loss due to reduced use of the web site over time.