Risk of symptomatic gallstones and cholecystectomy after a very-low-calorie diet or low-calorie diet in a commercial weight loss program: 1-year matched cohort study.

BACKGROUND: Concern exists regarding gallstones as an adverse event of very-low-calorie diets (VLCDs; <800 kcal per day). OBJECTIVE: To assess the risk of symptomatic gallstones requiring hospital care and/or cholecystectomy in a commercial weight loss program using VLCD or low-calorie diet (LCD). DESIGN: A 1-year matched cohort study of consecutively enrolled adults in a commercial weight loss program conducted at 28 Swedish centers between 2006 and 2009. A 3-month weight loss phase of VLCD (500 kcal per day) or LCD (1200-1500 kcal per day) was followed by a 9-month weight maintenance phase. Matching (1:1) was performed by age, sex, body mass index, waist circumference and gallstone history (n=3320:3320). Gallstone and cholecystectomy data were retrieved from the Swedish National Patient Register. RESULTS: One-year weight loss was greater in the VLCD than in the LCD group (-11.1 versus -8.1 kg; adjusted difference, -2.8 kg, 95% CI -3.1 to -2.4; P<0.001). During 6361 person-years, 48 and 14 gallstones requiring hospital care occurred in the VLCD and LCD groups, respectively, (152 versus 44/10 000 person-years; hazard ratio, 3.4, 95% CI 1.8-6.3; P<0.001; number-needed-to-harm, 92, 95% CI 63-168; P<0.001). Of the 62 gallstone events, 38 (61%) resulted in cholecystectomy (29 versus 9; hazard ratio, 3.2, 95% CI 1.5-6.8; P=0.003; number-needed-to-harm, 151, 95% CI 94-377; P<0.001). Adjusting for 3-month weight loss attenuated the hazard ratios, but the risk remained higher with VLCD than LCD for gallstones (2.5, 95% CI 1.3-5.1; P=0.009) and became borderline for cholecystectomy (2.2, 95% CI 0.9-5.2; P=0.08). CONCLUSION: The risk of symptomatic gallstones requiring hospitalization or cholecystectomy, albeit low, was 3-fold greater with VLCD than LCD during the 1-year commercial weight loss program.

Increased physical activity in abdominally obese women through support for changed commuting habits: a randomized clinical trial.

BACKGROUND: Abdominally obese women can reduce their health risk through regular physical activity. There is, however, little evidence on the effectiveness of interventions that promote physical activity long-term, such as cycling and walking to and from work. METHODS: This intervention focused on physically active commuting (cycling and walking) in middle-aged (30-60 years), abdominally obese (waist circumference > or = 88 cm) women (n=120), recruited by newspaper advertisement. The intervention group was a moderate-intensity programme with physician meetings, physical activity prescriptions, group counselling and bicycles. The control group was a low-intensity group support programme with pedometers. We used a randomized, controlled, 2-armed design with 18 months duration and intention-to-treat analysis (data collection 2005-2006). Treatment success was defined as bicycling > or = 2 km/d (primary) or walking 10,000 steps per day (secondary). RESULTS: At baseline, mean (s.d.) age was 48.2 years (7.4), waist circumference 103.8 cm (7.8), walking 8471 steps per day (2646), bicycling 0 km per day. Attrition at 18 months was 10% for the intervention group and 25% in the control group (P=0.03). The intervention group was more likely to achieve treatment success for cycling than controls: 38.7 vs 8.9% (odds ratio (OR)=7.8 (95% confidence interval=4.0 to 15.0, P<0.001)), but with no difference for compliance with the walking recommendation: 45.7 vs 39.3% (OR=1.2 (95% CI=0.7 to 2.0, P=0.50)). Commuting by car and public transport were reduced by 34% (P<0.01) and 37% (P<0.001), respectively, with no differences between groups. Both groups attained similar waist reductions (-2.1 and -2.6 cm, P=0.72). CONCLUSIONS: Abdominally obese women can increase PA long-term through moderate-intensity behavioural support aimed at changing commuting habits.

Mental distress in treatment seeking young adults (18-25 years) with severe obesity compared with population controls of different body mass index levels: cohort study.

Young adults (18-25) with severe obesity constitute a challenging patient group, and there is limited evidence about their mental health status compared to population controls. Mental distress in treatment seeking young adults with severe obesity (n = 121, mean body mass index [BMI] = 39.8 kg m-2 ) was compared with matched (1:3 for age, gender and socioeconomic status) population controls of normal weight (n = 363, mean BMI = 22.4 kg m-2 ), as well as unmatched population controls with class I obesity (n = 105, mean BMI = 32.1 kg m-2 ) or severe obesity (n = 41, mean BMI = 39.7 kg m-2 ). Mental distress was measured by the General Health Questionnaire-12 (GHQ-12), and we quantified physician-diagnosed depression, present anxiety and suicide attempts. Poisson regression and linear regression analysis were used for analysing differences in mental distress between groups. Treatment seekers experienced more mental distress than normal weight controls as measured by continuous (adjusted mean: 3.9 vs. 2.2 points, P <0.001) and categorical (cut-off for mental distress ≥3 points, RR: 1.76, P <0.001) GHQ-12 scores, depression (RR: 2.18, P < 0.001), anxiety (RR: 1.97, P < 0.001) and suicide attempts (RR: 2.04; P = 0.034). Treatment seekers also experienced more mental distress as measured by continuous GHQ-12 than controls with class I obesity (adjusted mean: 2.3 points) or severe obesity (adjusted mean: 2.1; both, P < 0.001). Young adult treatment seekers with severe obesity constitute a risk group for mental distress compared to population controls of different BMI levels.

A new model of the role of psychological and emotional distress in promoting obesity: conceptual review with implications for treatment and prevention.

The lack of significant treatment and prevention progress highlights the need for a more expanded strategy. Given the robust association between socioeconomic factors and obesity, combined with new insights into how socioeconomic disadvantage affects both behaviour and biology, a new causal model is proposed. The model posits that psychological and emotional distress is a fundamental link between socioeconomic disadvantage and weight gain. At particular risk are children growing up in a disharmonious family environment, mainly caused by parental socioeconomic disadvantage, where they are exposed to parental frustrations, relationship discord, a lack of support and cohesion, negative belief systems, unmet emotional needs and general insecurity. Without adequate resilience, such experiences increase the risk of psychological and emotional distress, including low self-esteem and self-worth, negative emotions, negative self-belief, powerlessness, depression, anxiety, insecurity and a heightened sensitivity to stress. These inner disturbances eventually cause a psycho-emotional overload, triggering a cascade of weight gain-inducing effects including maladaptive coping strategies such as eating to suppress negative emotions, chronic stress, appetite up-regulation, low-grade inflammation and possibly reduced basal metabolism. Over time, this causes obesity, circular causality and further weight gain. Tackling these proposed root causes of weight gain could potentially improve both treatment and prevention outcomes.

Effects of childhood abuse on adult obesity: a systematic review and meta-analysis.

Controversy exists surrounding the role of childhood abuse in obesity development. This is a meta-analysis of observational studies on the role of childhood abuse in adult obesity. Systematic searches of PubMed, PsycInfo, Medline and CINAHL resulted in 23 cohort studies (4 prospective, 19 retrospective) with n=112,708 participants, containing four abuse types (physical, emotional, sexual, general). Four studies reported dose-response effects. A random effects model was used to quantify effect sizes, meta-regression/subgroup analysis for identifying potential moderating variables and Egger's test for publication bias. Adults who reported childhood abuse were significantly more likely to be obese (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.24-1.45, P<0.001). All four types of abuse were significantly associated with adult obesity: physical (OR: 1.28, 95% CI: 1.13-1.46), emotional (OR: 1.36, 95% CI: 1.08-1.71), sexual (OR: 1.31, 95% CI: 1.13-1.53) and general abuse (OR: 1.45, 95% CI: 1.25-1.69). Severe abuse (OR: 1.50, 95% CI: 1.27-1.77) was significantly more associated with adult obesity (P=0.043) compared with light/moderate abuse (OR: 1.13, 95% CI: 0.91-1.41). We found no significant effects of study design (prospective vs. retrospective, P=0.07), age (P=0.96) or gender (P=0.92). Publication bias was evident (Egger's test P=0.007), but effect sizes remained statistically significant in sensitivity analyses. Childhood abuse was clearly associated with being obese as an adult, including a positive dose-response association. This suggests that adverse life experiences during childhood plays a major role in obesity development, potentially by inducing mental and emotional perturbations, maladaptive coping responses, stress, inflammation and metabolic disturbances.

Does medically induced weight loss improve obstructive sleep apnoea in the obese: review of randomized trials.

Obstructive sleep apnoea is characterized by repeated periods of breathing cessation during sleep. Obstructive sleep apnoea is both common and underdiagnosed in the obese. A recent study found that as many as 86% of older obese type 2 diabetics had obstructive sleep apnoea. Obesity is independently associated with developing obstructive sleep apnoea, and the reverse may also occur. The prevalence of obstructive sleep apnoea is therefore expected to rise in the wake of the obesity epidemic. The number of partial (hypopnoea) or complete (apnoea) airway obstructions per hour (apnoea-hypopnoea index) is used to classify obstructive sleep apnoea as mild (5-14 events per hour), moderate (15-30) or severe (>30). Severe obstructive sleep apnoea is associated with a two to sixfold increase in all-cause mortality; the impact of mild and moderate obstructive sleep apnoea is less clear. Until recently, the evidence supporting a beneficial effect of weight loss on obstructive sleep apnoea has been limited by a lack of randomized trials. In 2009, at least three randomized controlled trials evaluated whether medically induced weight loss improves obstructive sleep apnoea. The treatment effect ranged from 42% to 62% improvement, although the highest estimate was seen in a very short duration study (9 weeks). Patients who either lost 10-15 kg or more, or had severe obstructive sleep apnoea at baseline, benefited most from treatment.

Long-term weight loss and weight-loss maintenance strategies.

It has been suggested that about 20% of subjects undergoing weight-loss programmes can achieve a certain degree of long-term success. At present, surgery remains the only method resulting in long-term sustained weight loss, but access remains restricted. Hence it is important to analyse, in addition to pharmacotherapy, the methods to improve the effects of diet, exercise and behavioural modification. Since these techniques are less spectacular than others, there is a risk that their potential will be overlooked, in spite of the fact that they remain the main alternative for most subjects undergoing weight-loss therapy. This review summarizes realistic treatment alternatives and also provides data from a day care treatment, a strategy not much reported in the literature. This is a standard treatment modality for diabetes but less common in obesity treatment.

Is the association between physical activity and body mass index obesity dependent?

BACKGROUND: Most studies indicate an inverse relationship between physical activity (PA) and body mass index (BMI). However, the impact of obesity on this relationship is unclear. OBJECTIVE: To scrutinize the BMI/PA relationship by analysing multiple categories of PA from a sample with a wide BMI range. DESIGN: PA was measured with accelerometry for 7 consecutive days during free-living conditions in 85 severely obese outpatients (mean BMI 42.7 kg/m(2) (s.d. 6.1); age 43.0 year (12.6)) and 193 control subjects (24.0 kg/m(2) (3.5); 41.6 year (13.0)). Six categories of PA were calculated from the accelerometer data (min/day of sedentary time, min/day of light PA, min/day of moderate PA, min/day of vigorous PA, activity counts/day and steps/day). Participants were stratified in obese and non-obese subgroups (BMI=30 kg/m(2) as cutoff). Associations between BMI and PA were examined in the total sample, and in subgroups. The impact of sex and age on the BMI/PA association was tested. RESULTS: In the total sample, the association between BMI and PA was significant in all PA categories except for time spent sedentary (P=0.68). However, in subgroup analyses, the association between BMI and PA in non-obese was only significant for activity counts/day (r=-0.16, P<0.05) and vigorous intensity PA (r=-0.15, P=0.05). After adjustment for age, vigorous PA remained significantly associated with BMI in the non-obese (r=-0.17, P<0.05). In obese individuals, significant associations between BMI and PA were found for all six PA categories (age adjusted), sedentary time (r=0.26, P=0.05), light PA (r=-0.30, P<0.01), moderate PA (r=-0.35, P<0.01), vigorous PA (r=-0.39, P<0.001), activity counts/day (r=-0.50, P<0.001) and steps/day (r=-0.54, P<0.001). CONCLUSION: The association between PA and BMI was weak in non-obese individuals. In contrast, BMI was highly significantly associated with PA in obese individuals. Longitudinal studies are needed to tease out the direction of association between PA and BMI across BMI categories, as the cross-sectional associations seem to be dependent on obesity status.

Outcome of third trimester pregnancies after cryotherapy of the uterine cervix.

A retrospective study was undertaken to assess the effect of cryotherapy of the uterine cervix on the outcome of third trimester pregnancies. It was concluded that cryosurgery of the cervix had no effect on the onset or progress of labour, or on the infant, an important advantage compared with cold-knife conization as a therapy for young women with cervical intraepithelial neoplasia.

Uterine rupture as a complication of second-trimester abortion when using prostaglandin F2 alpha together with other oxytocic agents.

A case of uterine rupture is presented following induction of second-trimester abortion using oxytocin and prostaglandin F2 alpha. A brief review of the literature is given and etiological factors and diagnostic features are discussed.

The results of cryosurgical treatment in young women with cervical intra-epithelial neoplasia.

A review is given of results from a 3-5-year follow-up of 105 young women treated with cryosurgery for a histopathologically verified dysplasia or carcinoma in situ of the uterine cervix. The recovery rate was 88%, with a slightly higher figure in the dysplasia group compared with that of carcinoma in situ. No invasive carcinoma was diagnosed and cases of treatment failure, all diagnosed within one year after cryosurgery, did not develop into a more severe form of neoplasia than previously. No recurrence has been noted so far and very few complications have been recorded. It is concluded that cryosurgery is an easy and effective method of treating cervical intra-epithelial neoplasia in young women. We stress, however, the importance of correct histopathological diagnosis prior to therapy and that after treatment the status of the patient must be checked with vaginal smears over a long period of time.

Cryosurgical treatment of cervical intraepithelial neoplasia with follow-up of five to eight years.

During 1972 to 1974, 181 women of different ages with cervical intraepithelial neoplasia were treated with cryosurgery. Of these, 170 have now been observed for 5 to 8 years. Treatment failures total 16%, but when the different age groups are considered the results are seen to be much better in young women less than 30 years of age, with only a 12% rate of failure, whereas older women have almost twice as many failures. One patient, 45 years of age, developed an early invasive cancer, but in her case pretreatment diagnosis may have been correct. Our conclusions are that cryosurgery is an easy and effective method of treating cervical intraepithelial neoplasia in young women, provided that the diagnosis prior to therapy is correct. Furthermore, we stress that after treatment the status of the patient must be checked with vaginal smears over a long period and also that at lease one endocervical curettage and directed biopsies of the vaginal cervix should be done as a control.

Patient expectations of obesity treatment-the experience from a day-care unit.

BACKGROUND: Unrealistic patient weight loss expectations in treatment of obesity may hamper the modest success which can actually be achieved. SETTING: Academic Obesity Unit Day Care Centre. OBJECTIVE: Description of weight loss expectations and weight loss concerns by questionnaire analyses. RESULTS: Patients were severely obese, with a median initial body mass index (BMI) of 40.7 kg/m(2). Weight loss expectations were generally unrealistic, with women hoping for a loss up to 42%, and men for 29% of their baseline weight (P<0.001). No effects of age on actual weight loss or weight loss expectations were observed. CONCLUSION: Gender differences in weight loss expectations may be important to acknowledge in future development of obesity treatment programmes. Realistic treatment outcome should be described early in a programme to facilitate compliance.