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Weight reduction by lifestyle intervention: Results obtained in a clinically controlled randomized study in overweight adults after one year
Abstract
There is need for practice-oriented intervention models showing how to successfully treat overweight adults. After the dates obtained after six months of a clinically controlled intervention study at the university hospital Freiburg had already been published, the results after one year now available have also shown an effective reduction of overweight in the majority of participants (up to 62%, depending on the group) after 12 months. Weight loss was achieved by the desirable reduction of body fat without adverse effect on the fat-free mass. The data have shown that it is possible to reduce body weight and fat mass by a therapeutical lifestyle intervention according to the principle of a reduced calorie balance. The study has once more shown the favourable influence of weight loss on atherogenic risk factors. Over the year, reduction of LDL cholesterol averaged 14% while increase of HDL averaged 12%. Theoretical and practical experiences made in this study have already been included into a standardized training concept for care and therapy of overweight adults. The concept called M.O.B.I.L.I.S. is nation-wide since early 2005.
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Context Recent reports show that obesity and diabetes have increased in the
United States in the past decade.Objective To estimate the prevalence of obesity, diabetes, and use of weight control
strategies among US adults in 2000.Design, Setting, and Participants The Behavioral Risk Factor Surveillance System, a random-digit telephone
survey conducted in all states in 2000, with 184 450 adults aged 18 years
or older.Main Outcome Measures Body mass index (BMI), calculated from self-reported weight and height;
self-reported diabetes; prevalence of weight loss or maintenance attempts;
and weight control strategies used.Results In 2000, the prevalence of obesity (BMI ≥30 kg/m2) was
19.8%, the prevalence of diabetes was 7.3%, and the prevalence of both combined
was 2.9%. Mississippi had the highest rates of obesity (24.3%) and of diabetes
(8.8%); Colorado had the lowest rate of obesity (13.8%); and Alaska had the
lowest rate of diabetes (4.4%). Twenty-seven percent of US adults did not
engage in any physical activity, and another 28.2% were not regularly active.
Only 24.4% of US adults consumed fruits and vegetables 5 or more times daily.
Among obese participants who had had a routine checkup during the past year,
42.8% had been advised by a health care professional to lose weight. Among
participants trying to lose or maintain weight, 17.5% were following recommendations
to eat fewer calories and increase physical activity to more than 150 min/wk.Conclusions The prevalence of obesity and diabetes continues to increase among US
adults. Interventions are needed to improve physical activity and diet in
communities nationwide.
This review considers the epidemiologic evidence of an increasing incidence of type 2 diabetes in youth, the classification and diagnostic issues related to diabetes in young populations, pathophysiologic mechanisms relevant to the increasing incidence, the role of genetics and environment, and the community challenge for prevention and treatment. Type 2 diabetes in youth has been recognized to be frequent in populations of native North Americans and to comprise some 30 percent of new cases of diabetes in the 2nd decade of life, largely accounted for by minority populations and associated with obesity. Among Japanese schoolchildren, type 2 diabetes is seven times more common than type 1, and its incidence has increased more than 30-fold over the past 20 years, concomitant with changing food patterns and increasing obesity rates. The forms of diabetes seen in children and youth include typical type 1, occurring in all races; type 2, seen predominantly in minority youth; atypical diabetes, seen as an autosomal dominantly transmitted disorder in African-American populations; and maturity-onset diabetes of the young (MODY), seen rarely and only in Caucasians. Of the nonautoimmune forms of diabetes seen in youth, only type 2 diabetes is increasing in incidence. Proper classification requires consideration of onset (acute/severe versus insidious), ethnicity, family history, presence of obesity, and if necessary, studies of diabetes related autoimmunity. Insulin resistance predicts the development of diabetes in Pima Indians, in offspring of parents with type 2 diabetes, and in other high-risk populations. African-American children and youth have greater insulin responses during glucose tolerance testing and during hyperglycemic clamp study than do whites. There is also evidence of altered beta-cell function preceding the development of hyperglycemia. Of particular interest is the evidence that abnormal fetal and infantile nutrition is associated with the development of type 2 diabetes in adulthood. The thrifty phenotype hypothesis states that poor nutrition in fetal and infant life is detrimental to the development and function of the beta-cells and insulin sensitive tissues, leading to insulin resistance under the stress of obesity. The thrifty genotype hypothesis proposes that defective insulin action in utero results in decreased fetal growth as a conservation mechanism, but at the cost of obesity-induced diabetes in later childhood or adulthood. The vast majority of type 2 diabetes in adults is polygenic and associated with obesity. Monogenic forms (MODY, maternally transmitted mitochondrial mutations) are rare, but are more likely to appear in childhood. Linkage studies of the common polygenic type 2 diabetes have emphasized the heterogeneity of the disorder. The prevention and treatment of type 2 diabetes in children and youth is a daunting challenge because of the enormous behavioral influence, difficulty in reversing obesity, and typical nonadherence in this age-group. The emerging epidemic of type 2 diabetes in the pediatric population, especially among minorities whose proportion in the U.S. population is increasing, presents a serious public health problem. The full effect of this epidemic will be felt as these children become adults and develop the long-term complications of diabetes.
To compare the time trend and seasonal variation in body mass index (BMI) and waist circumference.
Continuous monitoring health survey carried out between 1 June 1993 and 31 May 1997.
A total of 8,186 men and 9,638 women aged 20-59 y from three towns in the Netherlands.
BMI and waist circumference. Obesity was defined as BMI > or =30 kg/m(2), abdominal obesity as waist circumference > or =102 cm for men and > or =88 cm for women.
Levels of BMI and waist circumference increased between 1 June 1993 and 31 May 1997. Among women, the time trend in abdominal obesity was stronger than that in obesity. Further, levels of BMI and waist circumference were higher in winter than in summer seasons. The seasonal variation was larger for abdominal obesity than for obesity, among both men and women.
The time trend in women and the seasonal differences in both men and women were stronger for abdominal obesity than for obesity. Surveys on BMI and waist circumference are only comparable if season is taken into account. Furthermore, the waist circumference is a more sensitive indicator of variations in lifestyle and body composition than is body mass index.
Ziel vorliegender Untersuchung war die Entwicklung und Validierung eines Fragebogens zur Erfassung gesundheitswirksamer körperlicher Aktivität, sowie die Andwendung des Instruments in einer Stichprobe der erwachsenen Freiburger Wohnbevölkerung. Die Reliabilität des Fragebogens wurde anhand von Test-Retest-Untersuchungen, die im Abstand von 2 Wochen und 6 Monaten durchgeführt wurden, überprüft. Die hohen Korrelationen zwischen den Untersuchungen weisen auf eine hohe Reliabilität unseres Instruments hin. Trends im Sinne von saisonal bedingten Schwankungen fanden wir nur beim Rad fahren und der Gartenarbeit, sowie bei der abgeleiteten Basis-und Gesamtaktivität. Die Validierung erfolgte indirekt über die maximale Sauerstoffaufnahme. Es bestand eine enge Korrelation zwischen der maximalen Sauerstoffaufnahme und dem Umfang der Sportaktivitäten (partieller Korrelationskoeffizient: r=0.422, p
Prospective epidemiological studies have proven a close link between the lipoprotein profile and cardiovascular morbidity and mortality. As physical activity is accepted as a significant factor improving physical fitness and lipoprotein metabolism, there is evidence that physically active men have a lower cardiovascular risk due to their higher metabolic fitness. Physical activity and physical fitness are generally linked to higher HDL cholesterol and lower LDL cholesterol as well as lower triglyceride and insulin levels. However, in cross-sectional studies the differences in lipoprotein cholesterol evaluated by routine measures in healthy physically active individuals and sedentary controls are only minor compared to therapeutical aims. The impact of exercise and training is often more significant when the effect of exercise on lipoprotein subfractions and apolipoprotein levels are taken into account. Dramatic differences can be documented in concentrations of cardioprotective HDL subset2 and atherogenic small, dense LDL subset6 levels in relation to the individual status of aerobic fitness and body composition in adults. These observations indicate that the preventive and therapeutical use of physical activity is of particular significance in a population of cardiovascular risk or patients with reduced daily activity. Our own experience in clinical trials shows that even in short-term programs (4 weeks to 6 months) changes in activity and eating behavior may lead to important improvements of the metabolic risk and lipid profile. Understanding the complex interaction between exercise and metabolic control of the lipid profile as well as the correlation with other risk parameters will improve the knowledge of prescribing exercise programs in patients at risk.
This study examined in dietary obese and genetically obese rodents the effects of soy protein isolate (SPI) and its hydrolysate (SPI-H) on the rate of body-fat disappearance. Male Sprague-Dawley rats (4-16 wk old) and yellow KK mice (6-10 wk old) were made obese by feeding high-fat diets containing 30% fat. They were then fed energy-restricted, low-fat (5.0%), and high-protein (35% casein, SPI, or SPI-H) diets for 4 wk at 60% of the level of the energy intake of rodents on laboratory chow. The body-fat contents of rats and mice fed a high-fat diet were 27.3 and 33.6 g/100 g body weight, respectively, at the end of the obese period. For rats, the apparent absorbability of dietary energy and fat was significantly lower in the SPI and SPI-H groups than in the casein group, but vice-versa for nitrogen balance. Body-fat content in mice fed SPI and SPI-H diets was significantly lower than in those fed the casein diet. In rats, plasma total cholesterol level was lower with the SPI-H diet, and plasma glucose level was lower with the SPI and SPI-H diets than with the casein diet. These results indicate that SPI and SPI-H are suitable protein sources in energy-restricted diets for the treatment of obesity.
Evaluation of an overweight patient is the first step in any therapeutic program. The syndromes of obesity can be classified in several ways. The first is an anatomic classification based on the size, number, and distribution of fat cells and fat tissue. The second is an etiologic classification based on identification of specific diseases and settings that produce obesity. Hypothalamic injury and endocrine disease such as Cushing's disease and the polycystic ovary syndrome are three identifiable causes of obesity. In this medicated society drugs are always candidates to produce weight gain. The most common causes, however, are stopping smoking, overconsumption of high-fat foods, a decrease in the level of activity, and aging. The natural history of obesity provides a useful framework in which to view both preventive and therapeutic strategies. Some individuals will never become overweight, but of those who do, about one-third will do so during the first two decades, and the remaining two-thirds will become overweight after age 20. A number of epidemiological and metabolic factors can serve as a guide to those individuals who are at high risk. Having overweight parents tops the list, but multiple births, cessation of smoking, and a sedentary lifestyle are additional factors. Therapeutic decisions should be based on risk-benefit decisions. The risk can be assessed from the body mass index, the distribution of fat in upper or lower body obesity, the rate of weight gain, and the degree of physical inactivity. After assessing risk, the therapeutic choices can be selected from the age category of the patient. With any therapeutic activity, involvement of the patient in a realistic approach to the treatment process is essential.
To improve the individual health profile and to solve the growing overweight problem, a long-term change in the lifestyle to one which includes an energetically balanced combination of diet and activity is essential. Physical activity and the muscles involved are the primary means by which body composition and energy turnover are regulated. A state of imbalance has decisive consequences on the development of atherogenic and inflammatory risk factors. Additionally, the aging process is significantly influenced by the long-term retention or loss of muscle mass. The Deutsche Gesellschaft für Sportmedizin und Prävention (German Society for Sports Medicine and Prevention, a registered association) offers within the concept of a therapeutic lifestyle change, an educational program for overweight adults (M.O.B.I.L.I.S.).