Clinical effects of slim-diet, with lifestyle modification for childhood obesity in community-based healthcare program: A case series.

RATIONALE: Although there are several reports on the effect of herbal medicine on weight loss in adults, evidence supporting its efficacy and safety in obese pediatrics is insufficient. Herein, we clinically investigated the preliminary experience of community-based healthcare program in cases of childhood obesity treated with an herbal complex, Slim-diet (SD), along with lifestyle modification. PATIENT CONCERNS: Seventeen subjects with childhood obesity participated in a community-based healthcare program, which consisted of twice-a-week play type physical activity and dietary counseling program with simultaneous twice-a-day administration of SD for 4 weeks. DIAGNOSES: The data of 13 obese pediatrics (body mass index [BMI] ≥ the 95th percentile for children of the same age and sex) in their 3rd to 6th grade who finally completed at least 6 visits out of a total of 8 visits of the program including baseline and endpoint assessments were analyzed. INTERVENTIONS: Participants received 20 g of SD daily. Simultaneously, play-type physical activity program with an exercise therapist and dietary counseling with a dietitian for lifestyle modification were conducted at every visit. Body composition, blood chemistry, the Korean Youth Physical Activity Questionnaire (KYPAQ) score, and the preference for salt density and sugar content were assessed at baseline and endpoint. OUTCOMES: After SD administration, body mass index decreased from 26.74 ±â€Š2.11 kg/m to 26.50 ±â€Š2.20 kg/m (P < .05) with statistically significant increases in height, weight, and skeletal muscle mass. The results of blood chemistry and the KYPAQ score showed no significant change. The preferences for salt density were improved in 8, maintained in 2, and worsened in 3 participants and those for sugar content were improved in 6 and maintained in 7 participants with no worsening. LESSONS: In the present study, we showed the clinical effects of SD with lifestyle modification in patients with childhood obesity who participated in community-based healthcare program. Further clinical studies investigating the effects of SD are required.

Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study.

Mindful eating offers promise as an effective approach for weight management and glycemic control in people with diabetes. Diabetes self-management education (DSME) is an essential component of effective self-care. Yet, little research has compared the effect of mindful eating to DSME-based treatment. This study compared the impact of these two interventions in adults with type 2 diabetes mellitus. A prospective randomized controlled trial with two parallel interventions was used. Participants included adults age 35 to 65 years with type 2 diabetes mellitus for 1 year or more, body mass index (BMI) of 27 or more, and hemoglobin A1c (HbA1c) of 7% or more who were randomly assigned to a 3-month mindful eating (MB-EAT-D; n=27) or Smart Choices (SC) DSME-based (n=25) intervention. Follow-up occurred 3 months after intervention completion. Dietary intake, physical activity, weight, HbA1c and fasting plasma glucose, and fasting insulin were assessed using repeated measures analysis of variance with contrast analysis. There was no significant difference between groups in the change in weight or glycemia at study end. Significant difference occurred between groups in the change in dietary intake/1,000 kcal of trans fats, total fiber, and sugars (all P<0.05). Mean (± standard error) reduction in weight (-2.92 ± 0.54 kg for SC vs -1.53 ± 0.54 kg for MB-EAT-D) and HbA1c (-0.67 ± 0.24% for SC and -0.83 ± 0.24% for MB-EAT-D) were significant (P<0.01). Significant reduction in energy intake and glycemic load occurred (all P<0.0001) for both groups. Training in mindful eating and diabetes self-management facilitate improvement in dietary intake, modest weight loss, and glycemic control. The availability of effective treatments gives patients with diabetes choices in meeting their self-care needs.

Comparison of a dietary intervention promoting high intakes of fruits and vegetables with a low-fat approach: long-term effects on dietary intakes, eating behaviours and body weight in postmenopausal women.

The aim of the present study was to compare the long-term effects of two dietary approaches on changes in dietary intakes, eating behaviours and body weight: (1) approach using restrictive messages to limit high-fat foods (low-fat intake; LOFAT); (2) approach emphasising non-restrictive messages directed towards the inclusion of fruits and vegetables (high intake of fruits and vegetables; HIFV). A total of sixty-eight overweight or obese postmenopausal women were randomly assigned to one of the two dietary approaches. The 6-month dietary intervention included three group sessions and ten individual sessions with a dietitian. Dietary intakes, eating behaviours and anthropometrics were measured at baseline, at the end of the dietary intervention (T = 6) and 6 months and 12 months after the end of the intervention (T = 12 and T = 18). In the LOFAT group, energy and fat intakes were lower at T = 6 when compared with baseline and remained lower at T = 12 and T = 18. In the HIFV group, fruit and vegetable intakes increased significantly at T = 6 but were no longer significantly different from baseline at T = 12 and T = 18. Dietary restraint increased at T = 6 and remained higher than baseline at T = 18 in the LOFAT group while no significant change was observed in the HIFV group. At T = 6, body weight was significantly lower than baseline in both groups (LOFAT: - 3.7 (SD 2.8) kg; HIFV: - 1.8 (SD 3.0) kg) and no significant difference in body-weight change from baseline was found between groups at T = 18. We concluded that weight loss was similar at 1-year follow-up in both dietary approaches. Despite relatively good improvements in the short term, the adherence to a 6-month dietary intervention promoting high intakes of fruits and vegetables was difficult to maintain.

State of the science: behavioural treatment of obesity.

Obesity is a global and preventable epidemic with serious health consequences for individuals worldwide, particularly for those in developed countries. The World Health Organization estimates that at least 1 billion people worldwide are overweight, and 300 million are obese. Research has demonstrated that weight losses as small as 7-10% of initial weight produce significant health benefits. These include reducing the risk of heart disease, stroke, and some cancers. This paper describes behavioural methods to modify maladaptive eating and activity habits to achieve a healthy weight. It also examines the short- and long-term results of behavioural treatment for obesity and methods to improve long-term weight control.

Dietary protein and weight reduction: a statement for healthcare professionals from the Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association.

High-protein diets have recently been proposed as a "new" strategy for successful weight loss. However, variations of these diets have been popular since the 1960s. High-protein diets typically offer wide latitude in protein food choices, are restrictive in other food choices (mainly carbohydrates), and provide structured eating plans. They also often promote misconceptions about carbohydrates, insulin resistance, ketosis, and fat burning as mechanisms of action for weight loss. Although these diets may not be harmful for most healthy people for a short period of time, there are no long-term scientific studies to support their overall efficacy and safety. These diets are generally associated with higher intakes of total fat, saturated fat, and cholesterol because the protein is provided mainly by animal sources. In high-protein diets, weight loss is initially high due to fluid loss related to reduced carbohydrate intake, overall caloric restriction, and ketosis-induced appetite suppression. Beneficial effects on blood lipids and insulin resistance are due to the weight loss, not to the change in caloric composition. Promoters of high-protein diets promise successful results by encouraging high-protein food choices that are usually restricted in other diets, thus providing initial palatability, an attractive alternative to other weight-reduction diets that have not worked for a variety of reasons for most individuals. High-protein diets are not recommended because they restrict healthful foods that provide essential nutrients and do not provide the variety of foods needed to adequately meet nutritional needs. Individuals who follow these diets are therefore at risk for compromised vitamin and mineral intake, as well as potential cardiac, renal, bone, and liver abnormalities overall.

[Principles of dietary treatment of obesity]. / Grundlagen der Diättherapie der Adipositas.

One of the first steps in a clinical approach to any obese subject should be focused on the reduction and/or normalization of any potential or existing metabolic abnormality. Overeating and/or unbalanced food intake remains the major element in the origin and maintenance of obesity. The reduction of energy intake is the basis of successful weight loss. In obese subjects there are huge amounts of energy stored, mainly in the adipose tissue, which are mobilized according to the size and duration of an energy deficit. Considerable studies have been devoted to finding the optimal dietary approach that would promote rapid weight loss while maximizing the depletion of adipose tissue and conserving body protein. During fasting adipose tissue lipolysis rate increases and liberated unesterified fatty acids are oxidized in muscle and liver. The liver produces ketones which are oxidized in muscle and brain. The energy need of the brain is not sufficiently covered by ketone oxidation, therefore additional glucose must be provided. The liver produces glucose by gluconeogenesis using amino acids from muscle protein. Because of limited protein sources, protein must be given during energy restricted diet. Besides protein also vitamins, minerals, trace elements, fiber, and linoleic acid must be substituted during fasting and during treatment with very low calorie diets. Meal replacements are helpful to fulfil all the requirements. There is consensus that the first step in dietary treatment is an energy restricted diet with a calorie deficit of at least 600 Kcal/day, but more than 800 Kcal/day must be provided, with all essential nutrients. Observing the regulations, weight reduction with appropriate diet plans improves metabolic disturbances.

A very-low-calorie conventional Japanese diet: its implications for prevention of obesity.

A very-low-calorie conventional Japanese diet of 370 kcal/day has been shown to be useful for weight reduction and its long-term maintenance. Sources of the diet were mainly from chicken fillet, egg white, fish white-meat, mushroom, seaweed and low- or non-calorie fiber-rich vegetable, and contained 4.4g fat, 38.1g protein, 45.2g carbohydrate and essential minerals and vitamins. However, metabolic and neural implications of a commercial very-low-calorie liquid formula diet have rarely been investigated from the view point of food intake and appetite regulation. Animal studies have demonstrated the rationale for efficacy of the very-low calorie conventional Japanese diet as follows: (1) Increased hypothalamic histamine suppressed food intake through H1-receptors in the ventromedial hypothalamus (VMH) and paraventricular nucleus, the satiety centers. (2) Low energy intake enhanced satiety and decreased food intake through histaminergic activation of VMH neurons. (3) Mastication activated afferent signal transmission from proprioceptors in the oral cavity to the mesencephalic trigeminal nucleus(Me5). Histaminergic systems in the hypothalamus were activated by mastication and low energy supply, which was accompanied by satiation through the action of histamine in the VMH. Usefulness of the very-low-calorie conventional Japanese diet derives from utilization of conventional Japanese food stuffs as a fiber rich, low energy food source, and from enhancement of satiation by increased mastication required of the diet. The properties of the diet seemed to effect a closed positive feedback loop between histaminergic activation in hypothalamic satiety centers and behavioral changes to enhance satiation and cause feeding suppression.

[Pregnancy and obesity. A case control study of 140 cases]. / Grossesse et obésité. A propos d'une étude cas-témoins de 140 cas.

A retrospective study of 70 fat women and 70 women of normal weight was carried out to compare their obstetric performance. The patients were assessed before pregnancy for corpulence by estimating the body mass index (IMC). Obesity was defined by having an index of 30 or above. The mean weight of the obese patients at delivery was 142 kgs and of the controls 65.4 kgs. The main risk in obese patients is a raised blood pressure (34%); and in spite of this no child showed intrauterine growth retardation. The mean weight of the newborn infants was 3.7 kgs against a mean weight of 3.2 kgs in the control group. Eighteen infants born to obese mothers were very heavy (25%). The increase in fetal weight explains why the caesarean section rate was three times as high in the obese patients as in the control due to disproportion (25%). These differences are statistically significant. Neonatal morbidity was similar in the two groups. It is debatable whether a slimming diet was worthwhile. All the same calorie intake reduced slightly to about 1.800 calories a day together with vitamin supplements is advisable. It does not have any ill effect on the fetus.

Exercise and mild essential hypertension.

The achievement of chronic blood pressure (BP) control in persons with mild hypertension is of central strategic concern in the prevention of hypertension-related morbidity and mortality. Epidemiologic and longitudinal studies suggest that regular participation in physical activity may be beneficial both in preventing hypertension and in lowering an already elevated BP. Moreover, preliminary analyses from our center suggest that cardiorespiratory fitness and, by inference, aerobic exercise may be of benefit in reducing mortality rates in hypertensive patients. When prescribing exercise with the intention of reducing an elevated BP and attenuating the risk for coronary artery disease, several factors must be considered to optimize the likelihood of a safe and effective response. These factors include specific safety aspects, and the type, frequency, intensity, and duration of exercise. In this respect, we recommend that aerobic exercise be performed at an intensity corresponding to 55 and 85% of the maximal heart rate and that the duration and frequency of training be modulated to achieve a weekly energy expenditure of between 14 and 20 kcal/kg of body weight. For those patients who require drug therapy, the interaction between the specific antihypertensive agent and exercise must also be considered.

Time-calorie displacement diet for weight control: a prospective evaluation of its adequacy for maintaining normal nutritional status.

An unsupplemented 1000 kcal (4186 kJ) diet emphasizing large quantities of unrefined complex carbohydrates was evaluated for nutritional adequacy in a 20-week weight-control program for obese adults. Assessment of nutritional status, routinely obtained upon admission, was repeated at approximately 10-week intervals on 26 patients who were losing weight while adhering to the dietary guidelines. At least one repeat assessment was obtained on all 26 patients: 13 had follow-up assessment at 10 weeks, three at 20 weeks, and ten at both 10 and 20 weeks. Weight loss averaged 0.7 kg/wk over an average of 15 weeks with a mean energy intake of 1020 kcal (4270 kJ), 55 percent of baseline. At each follow-up assessment mean skinfold thickness fell significantly whereas muscle mass was maintained according to arm muscle circumference and creatinine-height index. Mean blood levels of retinol, beta-carotene, folate, vitamin B12, ascorbic acid, thiamin, riboflavin, pyridoxine, iron, transferrin saturation and calcium excretion remained within normal limits throughout treatment. Ascorbic acid levels rose significantly. The results indicate that the experimental diet, without supplementation, can fulfil nutritional requirements while restricting energy intake for weight reduction.

Elemental content of predigested liquid protein products.

Eight commercially available partially digested gelatin liquid products that have been used as a source of protein in dietary regimens for weight reduction and for protein supplementation were analyzed for their elemental composition. These products were prepared either by dry ashing or wet digestion techniques that were suitable for the analysis of individual elements by their respective analytical methods. Analytical methods used to assess the elemental content included inductively coupled argon plasma emission spectrometry for Ca, Mg, P, Fe, Zn, Cu, Mn, Ni, Mo, V, Be, Co, Cr, Tl, Al, Te, Sn and Sb; atomic absorption spectrophotometry for Na and K; hybride generation with atomic absorption spectrophotometry for Se and As; anodic stripping voltammetry for Cd and Pb; and ion selective electrode for F. The content of almost all of the elements in these products was extremely low compared with the amounts supplied daily for normal individuals by usual sources of dietary protein, the adult United States Recommended Daily Allowances, and typical intakes from the Total Diet Study. The following elements were not detectable in significant amounts in these products by inductively coupled argon plasma emission spectrometry: Mo, V, Be, Co, Cr, Tl, Al, Te, Sn, and Sb. The results suggest that use of these predigested liquid protein products as a sole source of nutriment will result in an inadequate intake of all of the essential elements. These products contained insignificant amounts of Ce and Pb, nonessential toxic elements.