Association between melanocortin-4 receptor mutations and eating behaviors in obese patients: a case--control study.

Melanocortin-4 receptor (MC4R) gene mutations are involved in the leptin-melanocortin pathways that control food intake. The effect of these mutations on eating behavior phenotypes is still debated. To determine the association between functional MC4R mutations and eating behaviors, dietary intake and physical activity, we sequenced the MC4R gene in 4653 obese adults. Among them, 19 adults carriers of functional MC4R mutation were matched on age, sex and body mass index with two randomly-paired controls without MC4R mutation (n=57). We found that eating behaviors and physical activity did not differ between groups. In particular, cases were not at increased risk of binge eating disorders. Subjects carriers of MC4R mutation reported a higher proportion of dietary carbohydrates intakes (43.2±7.1 and 39.2±8.1% of total energy intake, respectively, P=0.048) and a lower proportion of dietary lipids (34.3±6.7 and 38.5±6.7% of total energy intake, respectively, P=0.018). In conclusion, mutation carriers differ from controls by a higher consumption of carbohydrates counterbalanced by a lower consumption of lipids expressed as percentage of total energy intake. However, functional MC4R mutations do not have a higher risk of compulsive eating contrary to what was previously suggested.

Eating behaviour in obese patients with melanocortin-4 receptor mutations: a literature review.

Melanocortin-4 receptor (MC4R) mutations are the most common known cause of monogenic obesity and an important contributor to polygenic obesity. MC4R mutations with partial or total loss of function, as well as the variant rs17782313 mapped near MC4R, are positively associated with obesity. MC4R is involved in the leptin-melanocortin signalling system, located in hypothalamic nuclei, that controls food intake via both anorexigenic or orexigenic signals. Impairment in this receptor might affect eating behaviours. Thus, in the case of MC4R mutation carriers, obesity could be related, at least partly, to inadequate control over eating behaviours. Many published studies address eating behaviours in MC4R mutation carriers. Most studies focus on binge eating disorder, whereas others examine various aspects of intake and motivation. Up to now, no evaluation of this literature has been performed. In this review, we examine the available literature on eating behaviours in carriers of MC4R mutations and variant rs17782313 near MC4R gene. We address binge eating disorder, bulimia nervosa, mealtime hyperphagia, snacking, psychological factors, satiety responsiveness and intake of energy and macro/micronutrient. In a small number of studies, MC4R mutations seem to impair eating behaviours or motivation, but no clear causal effects can be found in the balance of the evidence presented. Improvements in methodologies will be necessary to clarify the behavioural effects of MC4R mutations.

Effects of a 3-month supplementation with a novel soluble highly viscous polysaccharide on anthropometry and blood lipids in nondieting overweight or obese adults.

BACKGROUND: High viscosity fibre is known to exert many beneficial effects on appetite and metabolism. It could potentially help in weight management, in dieting or nondieting individuals. The present study investigated the effects of the daily intake of a novel high viscosity polysaccharide (HVP) over 3 months in nondieting obese or overweight men and women. METHODS: The study comprised a double-blind, randomised controlled clinical trial. Participants ingested 5-15 g per day of either HVP (n = 29, experimental group) or inulin (n = 30, control group) for 15 weeks. Changes in anthropometry (weight, waist and hip circumferences), blood lipids and glucose tolerance were studied from the beginning to the end of administration. Compliance and tolerance were examined. RESULTS: Differences appeared between HVP and inulin supplementation in female participants only. Mean (SD) decreases in body weight [1.6 (3.2) kg; approximately 2% of initial weight] and hip circumference [2.8 (3.6 ) cm] occurred in women of the HVP group but not in controls (Time × Group interactions, P ≤ 0.002). Total, high-density lipoprotein and low-density lipoprotein-cholesterol were lower at the end of supplementation in the women of the HVP group compared to controls (P ≤ 0.021). No effect appeared in waist circumference and triacylglycerol. No difference was noted in the number or severity of the adverse effects reported in both groups. Adverse effects were mild and agreed with commonly reported reactions to intake of dietary fibre. CONCLUSIONS: Beneficial although modest effects appeared after several weeks of daily HVP intake in nondieting obese or overweight women. The effects of HVP should be investigated in the context of a weight loss programme.

A study of fluid intake from beverages in a sample of healthy French children, adolescents and adults.

BACKGROUND/OBJECTIVES: To assess the intake of fluid in healthy French children, adolescents, adults and seniors, considering amounts, types of beverages, time and place of consumption. SUBJECTS/METHODS: Data regarding fluid intake were extracted and analyzed from the National Intake Survey, which was conducted in quota samples of the French population (Comportement et Consommations Alimentaires en France study). Seven-day questionnaires were administered to free-living individuals in 2002-2003. A total of 566 children (aged 6-11 years), 333 adolescents (aged 12-19 years), 831 adults (aged 20-54 years) and 443 seniors (aged >or=55 years) were included in this study. RESULTS: The average total intake of fluid was 1-1.3 l per day depending on age groups. Water accounted for about one-half of daily fluid intake. The contribution of other types of beverages varied with age (for example, dairy drinks in children and adolescents; alcoholic drinks in adults and seniors). Intake of sodas (including regular and light) was highest in adolescents (169 ml a day). Beverages were mainly consumed at home during meals. CONCLUSIONS: This is the first description of fluid intake in French children, adolescents, adults and seniors, considering amounts, types of beverages, time and place of intake. It shows that water is the main source of fluid in all age groups. Selection of various types of beverages is different according to age.

[Assessing various aspects of the motivation to eat that can affect food intake and body weight control]. / Deux questionnaires validés pour mesurer des aspects de la motivation à manger qui peuvent affecter le contrôle pondéral.

Over the last 30 years, several questionnaires have been developed and validated in order to assess many aspects of the motivation to eat that might be susceptible to impair adequate food intake and body weight control. A few of such questionnaires are described here, in particular, the "Three Factor Eating Questionnaire" also called the "Eating Inventory", and the "Dutch Eating Behavior Questionnaire". Critical aspects of the motivation to eat assessed by these tools are presented, such as dietary restraint, disinhibition, hunger, vulnerability to eat in response to external cues or emotional states, etc. These questionnaires were developed for use in the general population with the aim to identify critical aspects of the motivation to eat that might predispose to weight gain. They have been widely used in many countries and have allowed an improved understanding of the individual characteristics that predispose to body weight gain or resistance to weight loss. Originally, poor body weight control was attributed to a high level of dietary "restraint", or in other words, the tendency to deliberately restrict one's food intake for body weight control purposes. Such dietary restraint was suspected to lead to a number of physical and psychological difficulties, among which poor self-esteem and a paradoxical tendency to gain weight, resulting from the incapacity to maintain strict restraint over time. More recent studies have established that a motivational trait called "Disinhibition" is a strong predictor of body weight gain over time and of poor outcome of dieting. "Disinhibition" corresponds to a tendency to lose control over one's eating behavior and ingest excessively large quantities of food substances, in response to a variety of cues and circumstances. In addition to its untoward effect on weight, disinhibition also predicts various risk factors and pathologies, such as hypertension and diabetes. Other potentially critical dimensions for adequate body weight control are "emotional eating" and "externality", which represent an individual's vulnerability to eat in response to emotional states or external cues, respectively. These questionnaires have been translated into French and validated for the French population. Average data are available for normal weight and obese French men and women. A gender difference is often reported: women, and even young girls, tend to have higher scores than males for most dimensions. These questionnaires have been extensively used in populations without psychiatric disorders, with the only exception of diagnosed eating disorders such as anorexia and bulimia nervosa. The questionnaires have not been used until now in populations with other types of psychiatric disorders, such as schizophrenia or bipolar disease. Their relevance for such populations is now an important question, since last generation pharmaceutical treatments of such psychiatric disorders seem to adversely affect body weight control. It then becomes critical to know whether the psychological dimensions assessed by such questionnaires reflect the action of pharmacological agents that induce weight gain. A research project is now in progress at Sainte-Anne Hospital to investigate many dimensions of the motivation to eat, as assessed by the questionnaires, in psychiatric patients receiving various types of antipsychotic agents. The results of this original study might provide hints about the mechanisms that lead to body weight gain in patients receiving certain types of antipsychotic pharmacological agents and potentially help in preventing or reversing the weight gain associated with such treatments.

Dietary patterns and their sociodemographic and behavioural correlates in French middle-aged adults from the SU.VI.MAX cohort.

BACKGROUND/OBJECTIVES: Few studies have investigated dietary patterns among French adults. We aimed to identify dietary patterns and their relation with nutrient intakes, sociodemographic, lifestyle and other health indicators in a large population of middle-aged subjects living in France. SUBJECTS/METHODS: Dietary patterns were identified using factor analysis in 5194 women and men aged 45-60 years enrolled in the SU.VI.MAX (Supplémentation en Vitamines et Minéraux Antioxydants) study. Dietary data were based on repeated 24-h dietary records (at least six records during 2 years). RESULTS: Four patterns were identified: (1) 'alcohol and meat products'; (2) 'prudent diet'; (3) 'convenience foods'; and (4) 'starch, sauces, and vegetables'. The first pattern was positively associated with low education, smoking and overweight in both genders, as well as with abdominal obesity in women and treated hyperlipidaemia and/or hypertension in men. The second pattern was positively correlated with high education and being older than 55 years and negatively correlated with current smoking. This pattern was also associated with overweight and low waist circumference in women and with hyperlipidaemia treatment in men. The third pattern was inversely related to age and positively related to higher education in both genders. In men, higher scores were related to living alone and an urban residence. The fourth pattern was associated with high education and an urban residence in men only. CONCLUSIONS: Our study identified four dietary patterns in this population of French middle-aged adults. Associations with sociodemographic, behavioural and health-related factors were found to differ according to dietary patterns. Sex-specific relationships were also found.

Test-retest reliability and external validity of the previous day food questionnaire for 7-10-year-old school children.

The aim of this study was to assess the reliability and external validity of the Previous Day Food Questionnaire (PDFQ) designed to obtain a report of the foods eaten on the previous day by schoolchildren. Participants were 7-10-year-old school children of the first four grades of a public school in Southern Brazil (N=227). Test-retest reliability was evaluated by kappa coefficient for two administrations of the PDFQ on the same day to the same children. External validity of the PDFQ was evaluated via sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) using trained observers of the food eaten on the previous day as gold standard. The association between responses from observed food intake with those from reported food intake on PDFQ was evaluated by multivariate logistic regression, controlled for school grade, gender, time of the eating, and the variation between first and second PDFQ applications. For the reliability study, the analyses stratified by school eating occasions (3 a day) indicated that agreement level was moderate or better for all food categories. PDFQ's sensitivity ranged from 57.1% (vegetables) to 93.3% (rice), whereas its specificity ranged from 77.8% (bread/pasta) to 98% (meats). Both, PPV and NPV were reasonably high. PDFQ was highly associated with observed food intake, with effect magnitude several times larger than any other factor analyzed for all foods. PDFQ also showed good test-retest reliability, suggesting that it may generate reliable and valid data for assessing food intake at the group (school) level.

Plasma obestatin levels in normal weight, obese and anorectic women.

Obestatin is a recently discovered peptide produced in the stomach, which was originally described to suppress food intake and decrease body weight in experimental animals. We investigated fasting plasma obestatin levels in normal weight, obese and anorectic women and associations of plasma obestatin levels with anthropometric and hormonal parameters. Hormonal (obestatin, ghrelin, leptin, insulin) and anthropometric parameters and body composition were examined in 15 normal weight, 21 obese and 15 anorectic women. Fasting obestatin levels were significantly lower in obese than in normal weight and anorectic women, whereas ghrelin to obestatin ratio was increased in anorectic women. Compared to leptin, only minor differences in plasma obestatin levels were observed in women who greatly differed in the amount of fat stores. However, a negative correlation of fasting obestatin level with body fat indexes might suggest a certain role of obestatin in the regulation of energy homeostasis. A significant relationship between plasma obestatin and ghrelin levels, independent of anthropometric parameters, supports simultaneous secretion of both hormones from the common precursor. Lower plasma obestatin levels in obese women compared to normal weight and anorectic women as well as increased ghrelin to obestatin ratio in anorectic women might play a role in body weight regulation in these pathologies.

Three consecutive (1993, 1995, 1997) surveys of food intake, nutritional attitudes and knowledge, and lifestyle in 1000 French children, aged 9-11 years.

BACKGROUND & AIMS: the lifestyle of children in developed societies is susceptible to rapid changes and these may affect the nutritional status of children. Reduced physical activity and changes in diet have been proposed as contributing factors to the growth in childhood overweight and obesity. The aim of this study was to assess trends in the food-related behaviour and markers of activity/inactivity in French 9-11 year old children. METHODS: Three successive surveys (1993, 1995, 1997) were carried out in samples of 1,000 French children, aged 9-11 years. Socio-demographic, anthropometric and food-related parameters were obtained for each child, using standardized questionnaire administered by trained interviewers. RESULTS: previous-day reports of food intake by the child revealed a strong persistence of the traditional French meal structure. Breakfast was eaten by 97% of children. Over the three surveys, an increasing percentage of reported breakfasts contained at least one dairy food, one cereal food, and one fruit or juice (from 11% to 17%). Almost all children had lunch, which occurred at the school cafeteria for one-third of the subjects. The afternoon snack, a traditional meal for French children, was consumed by 86-88% of the samples. Almost all children had dinner (99%), most often at home and in the company of all family members (73-87%). Lunches and dinners were composed of several courses presented in succession, as is usual in France. The foods most preferred by the children were often rich in sugar and/or fat (fried potatoes, ice cream, nut spread, chocolate, cake, etc). The children could list 'healthy foods'competently. They also demonstrated knowledge of terms used in nutrition (e.g. calories, fats) and were aware of possible links between intake of certain substances and disease. In families of higher socio-economic strata (income, education of parents) more time was devoted to sports by the children. Over the three surveys, linear trends indicated more exercise time per week and less television viewing. A high risk of obesity was likely in very sedentary children whose proportion (33%) was stable over the 1993-1997 period. CONCLUSIONS: In general the traditional French pattern of eating persisted among these children. Although there were signs of movement towards a more complete breakfast, less television and more exercise in active children, a substantial proportion of children engaged in no sports activity outside school hours. Maintaining appropriate weight is therefore difficult in view of the plentiful supply of food available to children. Inactive children are at high risk of obesity and should be encouraged to adopt a more active lifestyle.

[Relationships between the "eating inventory" factors, socioeconomic status, anthropometric body adiposity indexes and health risks in Czech population]. / Vztahy mezi faktory "dotazniku jidelnich zvyklostí", socioekonomickým stavem, antropometrickými ukazateli akumulace tuku a zdravotnimi riziky u ceské populace.

BACKGROUND: The aim of the study was to compare and evaluate psychological traits of eating behaviour assessed using the Eating Inventory (El) known also as the Three Factor Eating Questionnaire (TFEQ) and their relationship to body adiposity, health and social characteristic in a quota sample of Czech adults. METHODS AND RESULTS: The sample included 1624 women and 1429 men who were interviewed individually by instructed investigators. The sample was quota representative--for gender, age, size of residential location, region and socioeconomic status in Czech adults. Anthropometric data were obtained together with socioeconomic and lifestyle information. Subjects filled out the EI. Health status was evaluated according to the data reported by GPs. Our results show, that women had higher restraint but lower disinhibition and hunger scores than men. Hunger and disinhibition were always strongly associated, whereas restraint was negatively related to the other two factors in men, and to hunger in women. In both men and women an educational level positively correlated with dietary restraint and negatively with hunger. However, significant negative relationship between educational level and disinhibition was revealed only in men. In backward stepwise regression analysis both dietary restraint and disinhibition predicted BMI and waist circumference. BMI and waist circumference were negatively related to restraint, but positively to disinhibition. Restraint and disinhibition were associated with prevalence of comorbidities in men, while disinhibition and hunger were in women. Individuals with high scoring in disinhibition score (upper quartile) exhibited significantly higher prevalence of hypertension, cardiovascular diseases and hyperlipidaemia than those who scored low (lower quartile). These relationships were most marked in middle-aged subjects. CONCLUSIONS: Psychological traits of eating behaviour seem to have an important role in the development and clinical expression of body adiposity. Especially disinhibition is significantly associated with BMI and waist circumference and prevalence of several pathologies.

Motivational effects of 12-week moderately restrictive diets with or without special attention to the Glycaemic Index of foods.

Low glycaemic index (GI) diets may facilitate weight loss via behavioural and/or endocrine mechanisms. This study investigated whether the outcomes of the Weight Watchers POINTS Weight-Loss System could be improved by encouraging dieters to select low GI, high-carbohydrate foods. Ninety-six women (age 20-72 years; BMI 25-40 kg/m2) were recruited as they started the Weight Watchers POINTS programme for 12 weeks. Weekly classes were randomized so that seven (forty-five women) followed the regular programme while seven others (fifty-one women) followed a revised programme encouraging the selection of low GI foods. Anthropometric and biochemical parameters were measured before and after the 12-week diets. Participants rated hunger and desire to eat using visual analogue scales on 1 d per week, several times per d. Attrition was the same in both groups (32 v. 30 %), as well as many benefits (5 % weight loss, decreases in insulinaemia and blood lipids, waist and hip circumferences, blood pressure). Hunger and desire to eat were rated consistently lower in the low GI group over the 12-week diet. Group differences in subjective sensations were especially large in the afternoon. The 12-week weight management yielded many significant anthropometric and biochemical benefits that were not improved by encouraging dieters to select low GI foods. The subjective benefits (lower hunger and desire to eat) of the low GI diet may be a worthwhile contribution to the motivation of dieters that might affect adherence to the diet over the long term.

Central adiposity in Brazilian schoolchildren aged 7-10 years.

Waist circumference (WC) is a measure of central adiposity related to elevated risk factor levels in children and adolescents. The aim of the present study was to describe WC percentiles in 7- to 10-year-old Brazilian children and to compare frequencies of obesity and overweight as defined by BMI and frequencies of excess and at risk of abdominal adiposity as defined by WC to the corresponding age and sex data from British references. A representative sample of 2919 schoolchildren of the city of Florianopolis (southern Brazil) was examined. Smoothed WC percentiles were derived using the least mean square method. Frequencies of overweight and obesity and of excess and at risk of abdominal adiposity were assessed using the 91st and 98th centiles of the British references as cut-off points. WC increased with age in both boys and girls, with higher values for boys at every age and percentile level. Nutritional status categories of children assessed by the 91st and 98th British BMI and WC centiles showed moderate agreement (weighted kappa = 0.58). Overweight was more frequent in Brazilian than British children: 15.1 % of girls and 20.1 % of boys were above the 91st percentile of the 1990 BMI for age British references. About one-quarter (22.0 % of girls and 26.9 % of boys) exceeded the 91st percentile of WC British references. The present data could be used to compare WC in children in other populations and may serve as a baseline for future studies of temporal trends in WC in Brazil.

Intense sweeteners, energy intake and the control of body weight.

Replacing sugar with low-calorie sweeteners is a common strategy for facilitating weight control. By providing sweet taste without calories, intense sweeteners help lower energy density of beverages and some foods. Reduced dietary energy density should result in lower energy intakes--but are the energy reduction goals, in fact, achieved? The uncoupling of sweetness and energy, afforded by intense sweeteners, has been the focus of numerous studies over the past two decades. There are recurring arguments that intense sweeteners increase appetite for sweet foods, promote overeating, and may even lead to weight gain. Does reducing energy density of sweet beverages and foods have a measurable impact on appetite and energy intakes, as examined both in short-term studies and over a longer period? Can reductions in dietary energy density achieved with intense sweeteners really affect body weight control? This paper reviews evidence from laboratory, clinical and epidemiological studies in the context of current research on energy density, satiety and the control of food intake.

Early adiposity rebound: causes and consequences for obesity in children and adults.

Childhood obesity is an important public health problem, with a rapidly increasing frequency worldwide. Identification of critical periods for the development of childhood and adolescent obesity could be very useful for targeting prevention measures. Weight status in early childhood is a poor predictor of adult adiposity status, and most obese adults were not obese as children. We first proposed to use the body mass index (BMI) charts to monitor individual BMI development. The adiposity rebound (AR) corresponds to the second rise in BMI curve that occurs between ages 5 and 7 years. It is not as direct a measure as BMI at any age, but because it involves the examination of several points during growth, and because it is identified at a time when adiposity level clearly change directions, this method provides information that can help us understand individual changes and the development of health risks. An early AR is associated with an increased risk of overweight. It is inversely associated with bone age, and reflects accelerated growth. The early AR recorded in most obese subjects and the striking difference in the mean age at AR between obese subjects (3 years) and non-obese subjects (6 years) suggest that factors have operated very early in life. The typical pattern associated with an early AR is a low BMI followed by increased BMI level after the rebound. This pattern is recorded in children of recent generations as compared to those of previous generations. This is owing to the trend of a steeper increase of height as compared to weight in the first years of life. This typical BMI pattern (low, followed by high body fatness level) is associated with metabolic diseases such as diabetes and coronary heart diseases. Low body fatness before the AR suggests that an energy deficit had occurred at an early stage of growth. It can be attributable to the high-protein, low-fat diet fed to infants at a time of high energy needs, the former triggering height velocity and the latter decreasing the energy density of the diet and then reducing energy intake. The high-fat, low-protein content of human milk may contribute to its beneficial effects on growth processes. Early (pre- and postnatal) life is a critical period during which environmental factors may programme adaptive mechanisms that will persist in adulthood. Under-nutrition in fetal life or during the first years after birth may programme a thrifty metabolism that will exert adverse effects later in life, especially if the growing child is exposed to overnutrition. These observations stress the importance of an adequate nutritional status in childhood and the necessity to provide nutritional intakes adapted to nutritional needs at various stages of growth. Because the AR reflects particular BMI patterns, it is a useful tool for the paediatrician to monitor the child's adiposity development and for researchers to investigate the different developmental patterns leading to overweight. It contributes to the understanding of chronic disease programming and suggests new approaches to obesity prevention.

The Eating Inventory, body adiposity and prevalence of diseases in a quota sample of Czech adults.

OBJECTIVE: To study the relationships between the Eating Inventory (EI) factors (restraint, disinhibition and hunger), body adiposity and prevalence of selected diseases in a quota sample of Czech adults. SUBJECTS AND METHODS: The sample included 1429 men and 1624 women who were interviewed individually by trained investigators. The sample was quota representative--for gender, age, size of residential location, region and socioeconomic status in Czech adults. Anthropometric data, socioeconomic and lifestyle information were obtained. Subjects filled out the EI questionnaire. Physicians reported about subjects' morbidity. RESULTS: Backward stepwise regression analysis revealed that restraint and disinhibition were significant predictors of body mass index (BMI) along with gender, age, parental obesity, weight loss attempts, present dieting and educational level. The same factors plus income predicted the waist circumference. BMI and waist circumference were negatively related to restraint but positively to disinhibition. According to logistic regression analysis restraint and disinhibition were significantly associated with hypertension, cardiovascular diseases and hyperlipidaemia. Diabetes was significantly related to restraint and hunger scores. The observed association between EI factors and diseases remained significant even when BMI and age were taken into account. CONCLUSION: As shown in earlier studies, disinhibition was positively and restraint negatively associated with BMI and waist circumference. For the first time, factors of the EI were also identified as significant predictors of diseases characterizing the metabolic syndrome.

Obesity, overweight and thinness in schoolchildren of the city of Florianópolis, Southern Brazil.

OBJECTIVE: To assess the prevalence of obesity, overweight (including obesity) and thinness in children of the city of Florianopolis (southern Brazil). DESIGN: Cross-sectional study. SUBJECTS: Representative sample of 7-10-y-old schoolchildren of the first four grades of elementary schools (1432 girls, 1504 boys). METHODS: Measurements of weight, height and triceps skinfold thickness (TSF) were taken following standard techniques. The body mass index (BMI) was computed as weight/height2. Nutritional status was defined using two references: (1) the Must et al reference for BMI and TSF to define thinness, overweight and obesity (5th, 85th and 95th percentiles, respectively); (2) the International Obesity Task Force (IOTF) BMI cutoffs to define overweight and obesity. RESULTS: Using BMI, according to the Must et al, and IOTF references, the prevalence of obesity was 10.6 and 5.5%, respectively; overweight (including obesity) affected 26.2 and 22.1% of children, respectively. According to the Must et al reference, the prevalence of thinness was 3.2%. Using TSF rather than BMI, according to the Must et al references, fewer children were classified as obese (8.0%) or overweight (20.2%) and more children were classified as thin (4.9%). CONCLUSION: This study supports the previously reported high frequencies of childhood overweight and obesity in developing countries. The data allow comparisons with other studies carried out in Brazil and other parts of the world.

Psychobehavioral and nutritional predictors of weight loss in obese women treated with sibutramine.

OBJECTIVE: To reveal whether baseline body mass index (BMI), and psychobehavioral and nutritional markers were significant predictors of the change in BMI observed after 4 and 12 months in obese women enrolled in a weight reduction program, including low-energy diet, increased physical activity, cognitive behavior therapy and sibutramine. The impact of changes in psychobehavioral and nutritional markers observed after 4 and 12 months of treatment on BMI changes was also investigated. DESIGN: During a double-blind placebo-controlled 4-month period, subjects received either sibutramine (10 mg/day) or placebo. Then, an open phase with sibutramine administered to all patients continued until month 12. SUBJECTS: In total, 80 obese women (age: 43.9+/-10.6 y, BMI: 36.7+/-4.8 kg/m(2)). MEASUREMENTS: The dependent variable was change in BMI while baseline BMI, mode of treatment, the Beck depression score, the three items (dietary restraint, disinhibition and perceived hunger) of the Eating Inventory (EI), energy and macronutrient intakes were independent variables. At 1-week dietary records were analyzed using a computer software for assessing energy and macronutrient intake. RESULTS: Multiple regression analysis revealed that the BMI loss at month 4 was significantly influenced by mode of treatment and initial BMI, whereas a borderline negative relationship was observed with the baseline restraint score. Baseline BMI, depression score, restraint score and total energy intake predicted weight loss at month 12. These predictive variables accounted for 43.8% of the variance in BMI loss at 12 months. When relationships between the BMI loss and changes in all included psychobehavioral and nutritional parameters were considered after 12 months of treatment, a drop in the disinhibition score of the EI appeared the only significant factor affecting the BMI decrease. CONCLUSIONS: Our results suggest that psychobehavioral and nutritional characteristics can be used as predictors of weight loss in response to a comprehensive weight management program including pharmacological treatment with sibutramine.

Non food-related environmental stimuli induce increased meal intake in healthy women: comparison of television viewing versus listening to a recorded story in laboratory settings.

The objective of the present study, performed under laboratory conditions, was to assess the impact of two non food-related environmental stimuli (television and auditory stimulus) on meal intake. Normal weight women (N = 48) ate lunch in the laboratory once a week for four weeks. All lunches were identical and included popular traditional foods, of which participants could eat ad libitum. The first and last lunches were eaten in the absence of the environmental stimuli (control conditions); in the other two tests, presented in random order, subjects ate while either watching television or listening to a recorded story. Energy intakes were determined for each meal, as were ratings of hunger, satiety and meal palatability. Subjects filled out the Three Factor Eating Questionnaire at the end of the meal series. Meal size was significantly larger in the presence of both environmental stimuli than in both control conditions (+11.6%, 280 kJ, p < 0.01). Television viewing induced a significant stimulation of intake, equal to, but not greater than the effect of the auditory stimulus. Ratings of hunger, satiety, and palatability were not significantly different between conditions, despite the differences in intake. These results suggest that environmental, non food-related stimuli could stimulate intake regardless of hunger-satiety or palatability conditions. Environmental stimulation of eating should be tested in other populations, eg subjects with weight control problems, and other conditions, e.g. free-living.