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ABSTRACT: Aims/hypothesis. Tumour necrosis factor alpha (TNFα) is a candidate gene for the development of obesity, which in turn is a major risk factor for diabetes mellitus. The aim
of our study was to investigate whether a previously known NcoI-sensitive polymorphism (–308 G/A) in the promoter region of the TNFα gene was related to body weight.¶Methods. Genotyping was done in 239 male and 342 female non-diabetic subjects with a marked variation in body mass index (BMI).¶Results. We found three genotypes; AA (n = 13), AG (n = 158) and GG (n = 410). When the material was divided according to sex, allele specific phenotypic differences were confined to women. The
female subjects carrying the AA genotype were markedly more obese than both the AG and GG carriers (mean BMI = 41.4 vs 32.3 and 31.7 kg/m2, respectively, p = 0.02). The body fat content of female AA carriers was increased by one-third compared with AG/GG carriers (p = 0.02). We found no differences between genotypes with respect to waist-to-hip ratio, blood pressure or metabolic variables.
Among obese female subjects (BMI > 27 kg/m2), we also found that the BMI and body fat content of AA carriers (n = 7) were also higher than for AG/GG carriers.¶Conclusion/interpretation. The AA-variant at position –308 in the promoter region of the TNFα gene could be an important genetic factor behind excessive fat accumulation in women. [Diabetologia (2000) 43: 117–120]
Diabetologia 04/2012; 43(1):117-120. · 6.81 Impact Factor
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ABSTRACT: Previous meta-analyses investigating blood pressure effects of anti-obesity drugs have included studies using non-licensed doses, but not data from head-to-head studies. Furthermore, although diabetes is an important comorbidity in obesity, variation in blood pressure effects across diabetes status has not been investigated. The objective of this study was to estimate the effects on systolic (SBP) and diastolic blood pressure (DBP) of orlistat and sibutramine. Medline, EMBASE, the Cochrane controlled trials register and reference lists of identified articles from 1990 to February 2009 were searched. All placebo-controlled randomized controlled trials of 12-month duration or randomized head-to-head studies of any duration on adults using standard doses were included. Studies/study arms were excluded if they only evaluated weight maintenance after weight loss. Randomized controlled trials were identified, subjected to inclusion and exclusion criteria, and reviewed. Random effects models were used for assessment of weighted mean differences. Eighteen placebo-controlled (12 orlistat, 5540 patients; 6 sibutramine, 1495 patients) and four head-to-head trials (348 patients) met the inclusion criteria. Three orlistat and three sibutramine studies examined overweight subjects with type 2 diabetes (T2DM), as did two head-to-head trials. Mean baseline SBP ranged from 119 to 153 mmHg, and mean DBP from 69 to 98 mmHg. Overall, the placebo-controlled SBP change was -1.9 (95% CI; -2.7, -1.1) mmHg for orlistat, and 0.5 (-1.1, 2.1) mmHg for sibutramine. The corresponding values for DBP were -1.5 (-2.2, -0.8) and 1.7 (0.7, 2.6). Compared with patients without diabetes, diabetic patients treated with orlistat experienced smaller and non-significant reductions of SBP (-0.9; -2.6, 0.7 vs. -2.2; -3.0, -1.3) and DBP (-1.0; -2.4, 0.3 vs. -1.6; -2.4, -0.8). For sibutramine, higher on-treatment elevations in SBP (1.6; -1.3, 4.5 vs. 0.1; -1.8, 2.0) and DBP (2.4; 0.6, 4.1 vs. 1.4; 0.3, 2.5) were seen in patients with vs. without diabetes. In head-to-head trials, the overall differences between sibutramine and orlistat were small and non-significant for both SBP (1.0; -2.3, 4.3) and DBP (-0.2; -2.9, 2.5). In conclusion, in the studies using approved sibutramine doses, the drug caused significant elevations in DBP, while the overall SBP effect was near null. Moreover, absence of a blood pressure-lowering effect of orlistat ad a higher DBP elevation by sibutramine were observed for persons with diabetes. Head-to-head studies indicated that an indirect comparison of placebo-adjusted blood pressure effects may overestimate the adverse effects associated with sibutramine, but these studies were small, of shorter duration and of lower quality.
Obesity Reviews 12/2009; 11(11):777-91. · 7.04 Impact Factor
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ABSTRACT: The objective of this article was to estimate the risk of discontinuation due to adverse events in trials of orlistat, sibutramine and rimonabant. Medline, EMBASE, the Cochrane controlled trials register and reference lists of identified articles were searched from 1990 to May 2008. All randomized placebo-controlled trials of 12-24 months of duration on adults using licensed doses were included. Studies/study arms were excluded if they evaluated weight maintenance after weight loss. Trials were identified, subjected to inclusion and exclusion criteria and reviewed. Data on participants, interventions and discontinuation were extracted and trials rated for quality based on established criteria. A random effects model was used to estimate pooled risk ratios, risk differences and number needed to harm (NNH). A total of 28 trials met the inclusion criteria (16 orlistat, 7 sibutramine and 5 rimonabant). The risk ratios for discontinuation due to adverse events were significantly elevated for rimonabant (2.00; 1.66-2.41) and orlistat (1.59; 1.21-2.08), but not sibutramine (0.98, 0.68-1.41). Compared with placebo, the risk difference was the largest for rimonabant (7%, 5-9%; NNH 14, 11-19), followed by orlistat (3%, 1-4%; NNH 39, 25-83), while no significant difference was seen for sibutramine (0.2%, -3 to 4%; NNH 500). The most common adverse events leading to withdrawal were gastrointestinal for orlistat (40%) and psychiatric for rimonabant (47%). Corresponding information was unavailable for sibutramine. In conclusion, available weight loss drugs differ markedly regarding risk of discontinuation due to adverse events, as well as in underlying causes of these events. Given the large number of patients eligible for treatment, the low NNH for rimonabant is a concern.
Obesity Reviews 06/2009; 10(5):564-75. · 7.04 Impact Factor
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ABSTRACT: 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.
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).
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).
Abdominally obese women can increase PA long-term through moderate-intensity behavioural support aimed at changing commuting habits.
International journal of obesity (2005) 05/2009; 33(6):645-52. · 4.34 Impact Factor
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ABSTRACT: The i.v. fat tolerance test (IVFTT), in which the elimination rate of the fat emulsion Intralipid® is determined, has been performed in 60 patients with massive obesity. These patients were compared with a control group of matched subjects of normal weight with the same plasma TG concentrations. The hyperbolic correlations which were found between the plasma TG concentration and the IVFTT value did not differ between the two groups. The IVFTT value was correlated rather to the plasma TG value than to total body weight. The IVFTT values were higher in women of both groups. Twenty-three obese patients were studied with IVFTT before and after a jejuno-ileal bypass operation. Concomitant with a mean weight reduction from 129 to 104 kg, plasma TG was significantly reduced from 1.92 to 1.40 mmol/l. The IVFTT value rose significantly from 3.99 to 5.83 %/ min. However in the individual cases the pattern was highly variable, as some patients lost weight considerably without major effects on the IVFTT value, whereas others had a marked fall of plasma TG and rise of IVFTT value concomitant with a very moderate weight loss. The results suggest that the reduced IVFTT values in massive obesity are of the same order as seen in primary hyper-lipidaemia and that the removal sites for the Intralipid® emulsion are not proportionate to the amount of adipose tissue. Other factors than weight loss, such as changes of blood flow in the splanchnic region, could possibly account for the increased IVFTT values after jejuno-ileal bypass operations.
Journal of Internal Medicine 04/2009; 195(1‐6):279 - 285. · 5.48 Impact Factor
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ABSTRACT: Disability pensions incur huge societal costs in many countries. In Sweden, the three greatest drivers of such productivity losses are musculo-skeletal, circulatory and psychiatric disorders, all closely associated with weight status. We identified 16 studies investigating the body mass index (BMI)-disability pension relation. In cross-sectional studies, a significantly greater proportion of obese compared with normal weight subjects were disability pensioners. In longitudinal studies, a J-shaped relation with BMI was generally found in both men and women of various ages. Different definitions of obesity status complicated interpretation, as several studies mixed the underweight and normal weight, which appear to have different disability pension risks. In middle-aged men, relative risks were elevated for circulatory causes only for the overweight and obese, while associations for mental disorders were similar in the underweight and overweight but much higher in the obese. In both sexes, monotonic increases and decreases were seen for circulatory and respiratory causes respectively. In intervention studies, reduced disability pension incidence and increased gainful employment were reported after surgery. In summary, BMI was significantly associated with disability pension, but the direction of causality may vary with underlying cause. Interventions had positive productivity effects in the morbidly obese, but whether this holds for the overweight remains to be proven.
Obesity Reviews 11/2008; 9(6):572-81. · 7.04 Impact Factor
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ABSTRACT: 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.
Obesity Reviews 10/2008; 9(6):624-30. · 7.04 Impact Factor
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ABSTRACT: 1. To identify characteristics of individuals seeking help for their weight problem via an internet-based programme. 2. To identify indicators of long term success in such a programme.
An internet-based weight club (www.viktklubb.se) was used consisting of standard algorithms for calculating body mass index (BMI), food energy content and exercise energy cost. All members filled in basic data and could volunteer to fill in additional research related questions. Together with data on treatment success, attrition, and use of the various components of the programme, this information was automatically monitored and downloaded to a database.
Eighty-six percent of the members were female, and the age range was wide (range 18-101 years; mean 40.3 +/-11.5 years). At baseline, BMI of the entire group was 29.3 +/-5.1 kg/m(2) with 39% obese and 45% overweight. Among the completers, 16% changed from overweight or obese to normal weight. This corresponded to 29% of the members losing 5-9.9% of their initial body weight and 20% losing > or =10% of their. The strongest predictors of weight loss were activity in the weight club as judged by number of logins and diary entries, and sex.
A sizeable, but seemingly random, dropout rate was observed, together with significant dose-response effects between activity in the internet-based program and weight-loss among completers. Given its low cost and high accessibility at 24 hours a day, this form of programme delivery is interesting to evaluate and develop further, especially regarding attrition.
Scandinavian Journal of Public Health 08/2008; 37(1):75-82. · 1.39 Impact Factor
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ABSTRACT: To study the associations between weight loss with sibutramine and orlistat with psychological aspects that may interact with patients' response to these drugs.
A total of 478 obese patients with a mean body mass index of 42 +/- 12 kg/m(2) gave self-reported, retrospective data on different types of previous weight loss treatments (sibutramine and orlistat, and Weight Watchers used as a control condition) including the amount of weight lost with these treatments, eating behaviour (Dutch Eating Behaviour Questionnaire) and personality (NEO Personality Inventory - Revised).
Greater weight loss with sibutramine was associated with lower levels of restrained eating and higher levels of 'neuroticism', in particular 'anxiety' and 'depression'. Greater weight loss with orlistat was associated with aspects of the personality dimension 'conscientiousness' (e.g. 'order' and 'deliberation').
Sibutramine may exert its greatest effect in patients whose eating is a 'natural' response to hunger rather than regulated by cognitions and conscious controls. Patients with low levels of restraint could be more sensitive to the satiety-enhancing effect of sibutramine. They may be able to reduce their food intake without cognitive interference and/or start to control their eating most radically in response to enhanced satiety. Enhanced satiety may also help patients withstand a wish to eat triggered by psychological distress. Possible central nervous system effects on mood could also have reduced eating, which was related to distress. The administration regimen of orlistat is more demanding, requiring greater adherence. This can account for the finding that personality attributes such as conscientiousness are important for success.
Diabetes Obesity and Metabolism 07/2008; 10(6):498-505. · 3.38 Impact Factor
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ABSTRACT: To assess the impact on sexual function attributed to lower urinary tract dysfunction in a female obese population.
We performed a case-control study based on the registry of a university hospital obesity unit. A consecutive sample of women with body mass index(BMI) >or=30 (obese) was randomly matched by age, gender and residential county to control subjects using the computerized Register of the Total Population. Data were collected by a self-reported postal survey including the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12).
The questionnaire was completed and returned by 279/446 patients (62%) and 430/892 control subjects (48%). Obese women reported significantly lesser satisfaction with their sexual life, more frequent symptoms of urinary incontinence at intercourse, more often fear of urine leakage at intercourse, a higher tendency toward avoiding intercourse and more frequent feelings of guilt and disgust during intercourse (P<0.001). While considering sexual function in a subset of women with urge or stress urinary incontinence, the overall PISQ-12 scores were significantly lower in obese women compared to their age-matched nonobese controls for both the conditions (P<0.001). In an adjusted multivariate analysis, a BMI >30 was independently associated with a significantly increased risk for sexual dysfunction (odds ratio (OR) 1.8; 95% confidence interval (CI) 1.1-2.9), as were symptoms of urge or stress urinary incontinence (OR, 2.0; 95% CI, 1.3-3.1 and OR, 2.6; 95% CI, 1.7-4.0), respectively.
Urge and stress urinary incontinences are more common and have greater impact on sexual function in obese women.
International journal of obesity (2005) 06/2008; 32(8):1312-8. · 4.34 Impact Factor
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ABSTRACT: Randomized controlled trials (RCTs) directly comparing weight loss drugs approved in the European Union were reviewed and the results analysed by meta-analysis. Eight RCTs including 885 patients were found comparing weight loss of orlistat and sibutramine, while no study including rimonabant was found. The median study duration was 7 months (range 3-12). Four of the seven studies comparing sibutramine and orlistat mono-therapy showed that sibutramine was significantly more efficacious for weight loss, while the remaining three showed equivalence. The weighted mean difference in weight loss was 2.2 kg (95% CI 0.5-3.9) favouring sibutramine. Three studies investigated orlistat and sibutramine as combination therapy, and two found it to be significantly better than orlistat alone, but not better than sibutramine alone. Based on these head-to-head RCT data, sibutramine appears to be significantly more efficacious for achieving weight loss than orlistat. This is concordant with indirect evidence from previous meta-analyses, where the respective compounds were compared with placebo. Only four studies reported attrition, and the pooled risk ratio was 0.6 (0.3-1.4) indicating lower dropout for sibutramine. This information together with an understanding of the clinical properties of each drug should help to guide the prescribing physician in the selection of adequate drug therapy for obesity.
Obesity Reviews 02/2008; 9(5):420-7. · 7.04 Impact Factor
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ABSTRACT: To investigate if eating habits among adolescents are related to body fatness and gender.
Cross-sectional study.
Obesity Unit, Huddinge University Hospital, Sweden, 2001-2002.
Two hundred and seventy-five girls and 199 boys, aged 16-17 years.
Questionnaires were used for dietary intake and meal frequency, BodPod for measuring body fatness (BF%). In all, 169 girls and 128 boys were classified as adequate reporters (AR) of energy intake, and were used in the dietary analyses. The whole sample was used in the meal frequency analyses.
The correlation between reported energy intake and weight in the AR group was 0.23 (P<0.01) for girls and 0.36 for boys (P<0.001). The correlations were inverse or not significant in the whole sample. The following variables correlated significantly with a high BF% (r (s)=+/-0.2): a low intake of milk in both girls and boys, a high intake of fibre and alcohol and a low intake of sugar in girls and a low intake of breakfast cereals in boys. Those with regular breakfast habits had healthier food choices than others, but this was not related to BF%. Boys had more meals per day (4.9 vs 4.6, P=0.02), especially early in the morning and late at night, whereas girls reported a higher relative intake of light meals and fruit and a lower intake of milk than boys.
A few associations between eating habits and body fatness were found, but without any obvious patterns. The true differences in eating habits between lean and overweight adolescents are probably very small.
European Journal of Clinical Nutrition 04/2007; 61(4):517-25. · 2.46 Impact Factor
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ABSTRACT: Previous studies have indicated that fish protein may have a greater effect on satiety compared to other protein sources of animal origin.
To compare the effects of fish protein and beef protein meals on hunger and satiety.
Twenty-three normal non-smoking, healthy males aged 20-32 years, body mass index 22.5+/-1.8 (s.d.) kg/m(2) participated in a study, with within-subjects design and 1 week between test days. In the morning of the test days, subjects received a standardized breakfast. Four hours after breakfast, subjects were served an iso-energetic protein-rich (40 energy % protein) lunch meal, consisting of either a fish protein dish or a beef protein dish. Four hours after the start of the lunch meals, an ad libitum standardized evening meal was served and the intake of food was measured. Appetite was rated by visual analogue scales (VAS) immediately before and after the meals, as well as every hour between the meals. After the evening meal until bedtime, subjects were asked to record in detail foods and drinks consumed.
The repeated VAS-ratings of hunger, satiety and prospective consumption were modelled in a random effects model, taking pre-lunch VAS-ratings into account. After the fish meal, the point estimates were lower for hunger (-2+/-4.8), higher for satiety (8.7+/-6.0) and lower for prospective consumption (-4.9+/-4.7), but they did not reach statistical significance (P satiety=0.88; P hunger=0.15; P prospective=0.30). However, the energy intake at the evening meal displayed significant differences with subjects eating less after the fish protein lunch (2765 vs 3080 KJ, P<0.01) without feeling less satiated. No later energy compensation after the evening meal was found on the test day.
Although no significant differences in VAS-ratings of satiety or hunger were detected, subjects displayed an 11% reduction in energy intake at the subsequent evening meal.
European Journal of Clinical Nutrition 08/2006; 60(7):897-902. · 2.46 Impact Factor
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ABSTRACT: The aim of the present study was to assess the criterion validity of a newly developed self-reported last 7-day physical activity questionnaire (SAPAQ) for use in Swedish adolescents with a wide variation in body fatness.
We compared the self-reported total number of MET-minutes with objectively assessed variables of physical activity obtained by accelerometry in 49 (18 male, 31 female subjects) 17-year-old adolescents.
Self-reported physical activity was significantly and inversely related to time spent sedentary (r=-0.45; P<0.001) and significantly and positively associated with time spent in physical activity (r=0.51; P<0.001) and the total amount of physical activity (r=0.49; P<0.001). Gender and body fat did not affect the associations between self-reported and objectively assessed physical activity.
Our results indicate that the newly developed questionnaire is a valid method for ranking individuals in terms of the total amount of physical activity in Swedish adolescents.
International Journal of Obesity 06/2006; 30(6):1019-21. · 4.69 Impact Factor
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ABSTRACT: Although the prevalence of obesity in Sweden still is low in an international perspective, the development during the last decades is alarming in adults, adolescents and children alike. The prevalence of obesity [body mass index (BMI) > 30 kg m-2] in adults has doubled during the last two decades and is now approximately 10% in both men and women, according to estimates based on self-reported BMI from repeated random samples of the population. However, prevalence estimates based on measured BMI from the WHO MONICA study indicate that the self-reported data result in underestimates. In military conscripts, the prevalence of obesity (BMI > 30 kg m-2) almost quadrupled to 3.2% from 1971 to 1995, while the overweight fraction (BMI > 25 kg m-2) more than doubled to 16.3%. The development in younger age groups seems to be similar; the prevalence of overweight [International Obesity Task Force (IOTF)/Cole] in children aged 10 years in Gothenburg has doubled to 18% (2.9% obese) during the last decade, and similar figures have been reported in other studies. However, most reports on childhood overweight stem from the larger metropolitan areas, and hence may be underestimates because of the urban-rural influence on obesity-status. Recent data from non-urban areas in the northern part of Sweden estimate the prevalence of overweight (BMI > 20 kg m-2) in 10-year-olds to above 30%. In the most comprehensive study in children, including both rural and urban areas, BMI was measured among all children aged 10 years (n = 5517; 92.7% of the population) in the county of Ostergotland, and the prevalence of overweight (IOTF/Cole) was 22% in both boys and girls, of which 4% and 5% were obese respectively.
Obesity Reviews 02/2006; 7(1):1-3. · 7.04 Impact Factor
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ABSTRACT: Weight loss is difficult to achieve and maintaining the weight loss is an even greater challenge. The identification of factors associated with weight loss maintenance can enhance our understanding for the behaviours and prerequisites that are crucial in sustaining a lowered body weight. In this paper we have reviewed the literature on factors associated with weight loss maintenance and weight regain. We have used a definition of weight maintenance implying intentional weight loss that has subsequently been maintained for at least 6 months. According to our review, successful weight maintenance is associated with more initial weight loss, reaching a self-determined goal weight, having a physically active lifestyle, a regular meal rhythm including breakfast and healthier eating, control of over-eating and self-monitoring of behaviours. Weight maintenance is further associated with an internal motivation to lose weight, social support, better coping strategies and ability to handle life stress, self-efficacy, autonomy, assuming responsibility in life, and overall more psychological strength and stability. Factors that may pose a risk for weight regain include a history of weight cycling, disinhibited eating, binge eating, more hunger, eating in response to negative emotions and stress, and more passive reactions to problems.
Obesity Reviews 03/2005; 6(1):67-85. · 7.04 Impact Factor
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ABSTRACT: Despite growing concern about weight-related problems among children, no universally accepted classification system for childhood obesity exists. There is a number of proposed international body mass index (BMI)-based systems in use and national variants also exist in many countries. The absence of a universally accepted standard and confusion concerning which classification system to use on national levels complicate monitoring of the development of the obesity epidemic, stratification for selective interventions in public health, screening in clinical practice and comparisons between studies. Some proposed international classification systems have not only been recommended for global monitoring and comparisons between studies, but also for clinical and national epidemiological use in some countries. Possible discrepancies may thereby lead to inefficiencies in health care delivery and prevention programmes. The problems associated with misclassification of individuals at risk may lead to overconsumption of health care resources by lower-risk individuals and underconsumption by higher-risk individuals, which is costly both in terms of foregone health improvements and in terms of wasteful monetary usage. The aim of this paper was to review the specific problems associated with BMI as a measure of adiposity in childhood, the most commonly used classification systems for childhood obesity based on BMI, and how their performance can be evaluated.
Obesity Reviews 06/2004; 5(2):105-14. · 7.04 Impact Factor
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ABSTRACT: To study the relationship between degree of obesity and personality measures of mental distress.
The Rorschach method (Comprehensive System) and the Beck Depression Inventory. General descriptors were also included. Participants were 120 obese patients with a mean body mass index (BMI) of 41 (+/- SD 6) kg/m2.
Depression, stress or psychopathology such as distortions in perception and cognitions were not related to the degree of obesity. Body concern and body-related anxiety (An+Xy) were more common in relatively lower degrees of obesity. According to general descriptors heavier patients had lower educational and socio-economic level, and more bodily pain problems.
Depression was not related to body weight, in spite of findings of more depression in obesity compared to normal weights. Other factors than severity of obesity would account for the mental distress in obese patients. The differences in body concern and anxiety in varying degrees of obesity could be related to the social and educational context, where attitudes toward obesity differ. Less Rorschach signs of body concern in the morbidly obese contrasted with more self-reported bodily pain problems.
Eating and weight disorders: EWD 04/2004; 9(1):35-43. · 0.63 Impact Factor
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ABSTRACT: Numerous referrals to our Obesity Unit state that 'treatment with Orlistat did not work'. This surprised us, since Orlistat has been well documented to result in long-term sustained moderate weight loss. A simple questionnaire to 70 such patients, however, revealed that in many cases the referral physician had not observed basic rules and regulations, nor given appropriate information on Orlistat use.
International Journal of Obesity 12/2003; 27(11):1434-5. · 4.69 Impact Factor
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ABSTRACT: Weight gain is common after pregnancy. Most studies suggest that weight gain associated with a pregnancy is between 0.5 and 3.8 kg up to 2.5 y of follow-up. However, 73% of the female patients at our obesity clinic identified pregnancy as an important trigger for marked weight retention. The majority retained more than 10 kg after each pregnancy. The aim of this study was to examine long-term weight development after pregnancy in a 15 y follow-up of women who took part in the Stockholm Pregnancy And Women's Nutrition (SPAWN) study.
The SPAWN study is a long-term follow-up study of women who delivered children in 1984-85 in Stockholm (n=2342). A total of 1423 participants (response rate=61%) completed questionnaires, which covered eating behaviour and exercise, demographic information including social situation and status and details of the pregnancy before, during and up to 1 y after pregnancy. After 15 y, these women were invited to take part in the follow-up study. Anthropometric measurements and the same questionnaire data were collected from the 563 women who participated (response rate=40%). The sample was divided into two main groups: those who were normal weight before pregnancy and remained normal weight, and those who were normal weight before pregnancy and had become overweight at 15 y follow-up.
Those women who became overweight had a higher pre-pregnant body mass index (BMI) (22.3+/-1.5 vs 20.5+/-1.6 kg/m(2), P<0.001), gained more weight during pregnancy (16.3+/-4.3 vs 13.6+/-3.7 kg, P<0.001) and had retained more at 1 y follow-up. The women who became overweight had a steeper weight trajectory gaining more from 1 y follow-up to 15 y follow-up (11.1+/-6.5 vs 4.5+/-6.5 kg, P<0.001), with a higher BMI at 15 y follow-up of 27.5+/-2.6 vs 22.5+/-2.3 5 kg/m(2) (P<0.001). However, differences between those who became overweight and those who did not could not be explained by age, number of children and various socioeconomic factors. Features of pregnancy that did differ between the two groups were breastfeeding and smoking cessation. However, women who became overweight had lower lactation scores than women who remained normal weight. Relatively more subjects of the group that became overweight stopped smoking during pregnancy.
Pregnancy is a vulnerability factor for some women to become overweight. This study attempted to identify those factors that place initially normal weight women on a steeper weight trajectory as a result of pregnancy. Demographic, behavioural, physical and psychological characteristics only partly explain the weight gain observed at 15 y follow-up. Further research is required to investigate the relative role of these characteristics in predicting postpregnancy weight development.
International Journal of Obesity 12/2003; 27(12):1516-22. · 4.69 Impact Factor
