Weight History in Clinical Practice: The State of the Science and Future Directions

Eliciting a weight history can provide clinically important information to aid in treatment decision‐making. This view is consistent with the life course perspective of obesity and the aim of patient‐centered care, one of six domains of health care quality. However, thus far, the value and practicality of including a weight history in the clinical assessment and treatment of patients with obesity have not been systematically explored. For these reasons, the Clinical Committee of The Obesity Society established a task force to review and assess the available evidence to address five key questions. It is concluded that weight history is an essential component of the medical history for patients presenting with overweight or obesity, and there are strong and emerging data that demonstrate the importance of life stage, duration of exposure to obesity, maximum BMI, and group‐based trajectory modeling in predicting risk for increased morbidity and mortality. Consideration of these and other patient‐specific factors may improve risk stratification and clinical decision‐making for screening, counseling, and management. Recommendations are provided for the key elements that should be included in a weight history, and several needs for future clinical research are outlined.     

Acute desensitization of lymphocyte beta-adrenergic-stimulated adenylate cyclase in old age and Alzheimer's disease

The effect of prior incubation with a single concentration of isoproterenol (10(-4) M) for 2 hours at 37 degrees C on isoproterenol-stimulated cyclic AMP accumulation in intact lymphocytes from young, old and subjects with Alzheimer's disease was studied. In lymphocytes from all three subjects groups prior incubation of cells with isoproterenol resulted in a significant reduction of cyclic AMP accumulation upon subsequent stimulation with isoproterenol.     

Large-volume liposuction: a review of 631 consecutive cases over 12 years.

Since the advent of epinephrine-containing wetting solutions and sophisticated fluid management techniques, increasingly larger and larger volumes of liposuction aspirations have been reported. Unfortunately, with these larger volumes of liposuction being routinely performed, greater rates of complications have also been reported, with the worst of these resulting in deaths. In a response to the increasing concerns over the safety of large-volume liposuction, a critical review of the senior author's own series has been performed to evaluate risks and benefits and to recommend guidelines for safe and effective large-volume liposuction. A retrospective chart review was performed on 631 consecutive patients who underwent liposuction procedures of at least 3000 cc total aspirate. All procedures were performed by the same senior surgeon between January of 1986 and March of 1998. Before September of 1996, traditional liposuction techniques were used. After September of 1996, ultrasound-assisted liposuction was performed. The superwet technique of fluid management was employed for all procedures performed after 1991. The particulars of the surgical and anesthetic techniques used are reviewed in the article. Data collection included preoperative patient demographics, preoperative and postoperative weights and measurements, and preoperative and postoperative photographs. Total aspirate volumes, fluid intakes, and fluid outputs were measured, and all complications were tallied. Average follow-up was 1 year.Results showed the majority of patients to be women, aged 17 to 74 years old. Of the preoperative weights, 98.7 percent were within 50 pounds of ideal chart weight. Total aspirate volumes ranged from 3 to 17 liters, with 94.5 percent of these under 10 liters. Fluid balance measurements showed an average of 120 cc/kg positive fluid balance at the end of the procedure, with none of these patients experiencing any significant fluid balance abnormalities. Cosmetic results were good, with a 2- to 6-inch drop from preoperative measurements, depending on the area treated. Ten percent of patients experienced minor skin contour irregularities, with most of these patients not requiring any additional surgical procedures. One year after surgery, 80 percent of patients maintained stable postoperative weights. No serious complications were experienced in this series. The majority of the complications consisted of minor skin injuries and burns, allergic reactions to garments, and postoperative seromas. The more serious complications included four patients who developed mild pulmonary edema and one patient who developed pneumonia postoperatively. These patients were treated appropriately and went on to have uneventful recoveries. The results show that large-volume liposuction can be a safe and effective procedure when patients are carefully selected and when anesthetic and surgical techniques are properly performed. Meticulous fluid balance calculations are necessary to avoid volume abnormalities, and experience is mandatory when performing the largest aspirations. Cosmetic benefits are excellent, and overall complication rates are low.     

The use of D-penicillamine in cystinuria: efficacy and untoward reactions.

A retrospective study was conducted to assess the efficacy of D-penicillamine in the management of cystinuria, as well as to define the frequency and nature of untoward reactions to this drug. Fifty-six individuals were identified who, by stone analysis and/or biochemical studies, met the accepted diagnostic criteria for phenotypic cystinuria. The majority of these patients presented in the second decade of life with evidence of stone formation: renal colic, hematuria, and/or stone passage. Thirty-five individuals were considered to have clinically advanced cystinuria because they had required at least one urinary tract lithotomy. In these advanced cases, frequency of subsequent lithotomies and episodes of renal colic per 100 patient-years of observation were used as indices to measure the efficacy of D-penicillamine treatment. By both measurements, D-penicillamine significantly improved the clinical course of patients. The incidence of acute drug sensitivity reactions (rash, fever, and/or arthropathy) was in excess of 40 percent. Delayed drug-induced proteinuria occurred in 34 percent of treated patients. We conclude that D-penicillamine is useful in the treatment of cystinuria. Because of the significant number of untoward drug reactions, however, we believe the drug should be instituted only in selected, high-risk patients.