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The Influence of a Meal Replacement Formula on Leptin Regulation in Obese Adults

*Corresponding author email:
Symbiosis Group
6 7*
1Zentrum für Prävention und Sportmedizin, Technische Universität München, Germany
2NIHR Clinical Research Network: Diabetes, Metabolic & Endocrine and Renal Disorders, Imperial College, London
3Department of Epidemiology & Prevention, Wake Forest University Health Sciences, Winston-Salem, North Carolina, US
4Department of Health and Human Sciences, London Metropolitan University, London, UK
5Institut für Bewegungs- und Arbeitsmedizin, Universitätsklinikum Freiburg, Germany
6Department of Nutrition, Institut für Sport und Sportwissenschaft, Universität Freiburg, Germany
7Medizinische Fakultät der Universität Freiburg, Germany
 Open Access
Research Article
*Corresponding author: Prof. Dr. med. Aloys Berg, Medizinische Fakultät der Universität Freiburg, E-mail:
Yrs: Years; BMI: Body Mass Index; kg/m2: Kilogram/
Meter2; LS: Lifestyle group; MR: Standardized meal replacement
group; MRPT: Standardized meal replacement accompanied by
supervised physical training; ng/ml: Nanogram/millilitre; kg:
Kilogram; h-CRP: High-sensitivity C-reactive protein; IL6: Human
Interleukin 6; SD: standard deviations; SPSS: Analytical Software;
BW: Body Weight; G: Gramm
Obesity levels have dramatically increased in the United
States (US) and in the majority of European countries during the
past few decades [1-3]. A study in 2001 [4] revealed increases in
obesity among US adults for both sexes and across all ages, ethnic
backgrounds, educational levels and smoking levels. A chronic
imbalance between energy intake and energy expenditure
appears to play a role in the development of obesity [5, 6].
Serum leptin levels may have a potential role in the prediction
of weight loss and weight-loss maintenance [7]. Serum leptin
       
through lifestyle changes in overweight adults [8, 9]. Leptin, as a
circulating adipokine, is a regulatory factor for food intake, energy
expenditure and body fat distribution. Leptin also participates
in a signalling system regulating the amount of adipose energy
stored in the brain [5]. In addition, leptin resistance may be
responsible, in part, for the development of obesity among the
aging population [10].
Appropriate intervention strategies to reverse body weight
gain and elevated body fat, respectively, are still a matter of
debate because additional metabolic and endocrine effects may
         
[11]. According to several studies, a high-protein, low-glycaemic
   The increasing prevalence of
overweight and obese adults warrants improved dietary strategies
for weight management and metabolic control. Hence, the objective
of this study was to investigate the effects of a high-protein diet on
leptin regulation.
This study was a secondary analysis of data collected
from a randomized controlled trial, conducted in 90 overweight adults
(age: 47.5 ± 7.5 yrs.; BMI: 31.5 ± 2.3 kg/m2) who were followed over
         
         
weight loss and intervention type. Participants were randomized
into 3 interventions groups: 1) therapeutic lifestyle changes, (LS);
2) standardized meal replacement (Almased®) (MR); and 3)
standardized meal replacement accompanied by supervised physical
training (MRPT). For the analyses, both diet groups (MR, MRPT) were
pooled into one common group and compared to the LS group in a
parallel two-group study design with endpoint assessment after 24
weeks of intervention.
 In total, 83 participants completed the 24-week study.
      
regulation occurred in all intervention participants regardless of
their group assignment (LS; MR, MRPT). Participants’ consumption
effect on serum leptin levels (-15.5 ± 7.5 and -12.5 ± 7.8 vs. -8.7 ± 6.1
ng/ml). Greater body weight reductions were also observed in the
diet groups (-8.9 ± 3.9 kg) compared to the LS group (-6.2 ± 4.2 kg).
 Leptin; Meal Replacement; Energy Metabolism; High
Protein Diet; Weight Regulation;
Page 2 of 5
 Koohkan S, Golesorkhi M, Vitolins MZ, McCarthy DH, Berg A, et al. (2016) The Influence of a Meal Replacement
Formula on Leptin Regulation in Obese Adults. J Nutrition Health Food Sci 4(4): 1-5. DOI:
© 
13]. For this reason, a subgroup analysis was performed on the
data collected from an intervention study to examine the effects
of a protein-rich meal replacement on the body composition and
metabolic conditions of overweight adults.
For the secondary data analyses, we used data collected from
a randomized controlled three-arm study including 90 men and
women. All volunteers were overweight middle-aged adults
(31.5 ± 2.3 kg/m2; 47.5 ± 7.5 yrs.); non-smokers; free from known
food allergies, metabolic diseases; and none regularly used any
For the main trial, participants were randomized into 3
intervention groups: 1) therapeutic lifestyle changes: LS; 2)
standardized meal replacement (Almased ®), MR; and 3)
standardized meal replacement accompanied with supervised
exercise/physical training (MRPT). All participants completed
a comprehensive medical examination before and after the
intervention, including body composition analysis by air
displacement plethysmography (Bod Pod®) [14] and laboratory
investigations, i.e., blood glucose, insulin, plasma lipids,
For this investigation, we analysed leptin and insulin
changes to determine the effects of age, gender, baseline level,
weight loss, and intervention type. In this analysis, the effects
of the therapeutic lifestyle vs. diet with and without supervised
exercise interventions on the selected laboratory criteria were
evaluated. We also evaluated the change from baseline to the end
of intervention at the 24-week visit.
All volunteers were interviewed and screened before
participating in this study at the Department of Sports Medicine
of the Freiburg University hospital. The study was conducted
in accordance with the Declaration of Helsinki guidelines. All
procedures involving human subjects were approved by the
Ethics Commission of Freiburg University (EK-Freiburg No.
230/01) and registered as a controlled clinical trial (ClinicalTrials.
informed consent. The clinical trial was designed and performed
according to an approved, published protocol [11].
For the secondary data analysis, both meal replacement
groups were merged into a single group (MR/MRPT) due to the
similarity of their outcomes (Table 1). The meal replacement
groups were compared to the lifestyle group (LS) in a parallel
two-group evaluation. The endpoint assessment occurred 24
weeks after the interventions.
The results are expressed as the means ± Standard Deviations
[SD] for all parameters. Descriptive, multivariable analyses were
performed to evaluate the changes from baseline using the exact
Mann-Whitney test and the ANOVA test. For each participant,
complete data sets were available in Microsoft® Excel XP
        
All analyses were performed using SPSS version 18.02.
and MRPT (p > 0.1) (Table 1).
Therefore, for this secondary data analysis, both
meal replacement groups using the meal replacement
formula were merged into a single group (MR/MRPT)
and compared to the lifestyle group (LS) with endpoint
assessment after 24 weeks of intervention (Table 2).
At baseline, all demographic, clinical and laboratory variables
were not different between groups. Independent of the
intervention (LS vs. MR/MRPT), the 83 patients who completed
       
and metabolic regulation (Table 2). The MR and MRPT groups
experienced changes in body weight (BW -8.9 ± 3.9 kg)
       
reductions compared to the LS group (-6.2 ± 4.2 kg).
    
mass, serum leptin levels, and insulin between the interventions
(Table 2). Even after adjusting for weight loss differences,
  
reductions in serum leptin levels (-13.9 ng/ml) compared with
participants in the LS group (-9.8 ng/ml) post-intervention. This
effect was not observed for insulin.
In this study, we compared the effects of different weight-
management interventions, including therapeutic lifestyle
changes and the use of a meal replacement product with or
without supervised exercise training. Overall weight and fat
        
This group also demonstrated greater improvements in blood
markers of metabolic health.
          
       
yoghurt-honey-based meal replacement product (Almased®) on
weight reduction and the regulation of insulin and leptin [11].
According to this randomized controlled trial, insulin and leptin
levels decreased more in participants using the meal replacement
compared to participants receiving lifestyle group counselling.
In the current study, we conducted a secondary analysis of the
         
        
formula on reductions in leptin and insulin levels. These results
When the leptin results were adjusted for age, gender,
baseline leptin level, body weight change, and intervention
type (LS vs. MR/MRPT), the meal replacement approach
clearly had an independent effect on plasma leptin levels and
improved the effects on leptin reduction caused by weight loss.
Therefore, the results suggest a relationship between protein
intake and leptin regulation in the overweight adults examined.
Several studies have demonstrated that an increase in the
Page 3 of 5
 Koohkan S, Golesorkhi M, Vitolins MZ, McCarthy DH, Berg A, et al. (2016) The Influence of a Meal Replacement
Formula on Leptin Regulation in Obese Adults. J Nutrition Health Food Sci 4(4): 1-5. DOI:
© 
     
 
Total cholesterol (mg/dl) 225 ±30.4 196±23.1 0.000 221±34.8 198±32.6 0.000 0.396
HDL-cholesterol (mg/dl) 59±14.1 52±10.4 0.003 59±14.0 54±15.6 0.002 0.763
LDL-cholesterol (mg/dl) 128±25.6 114±15.2 0.003 127±29.2 112±26.3 0.000 0.897
Apo B (mg/dl) 119±20.9 101±16.2 0.000 115±27.4 92.5±25.5 0.000 0.085
Leptin (ng/dl) 37.9±26.7 22.5±13.9 0.000 33.9±24.2 21.3±16.3 0.000 0.226
Insulin (µU/ml) 11.7±8.92 6.3±3.97 0.003 13.8±11.35 7.8±5.90 0.001 0.139
Glucose (mg/dl) 92±9.4 90.0±9.1 0.226 98±14.4 91.0±10.5 0.000 0.260
Data comparison between the MR and MRPT groups [11].
aFor changes before–after
bFor differences in changes between the groups
proportion of dietary protein from 15% to 30% of energy
intake with a constant level of carbohydrate intake produces a
sustained decrease in ad libitum energy intake, which may be
mediated by increased central nervous system leptin sensitivity
       
protein loss and enhancing glycaemic control [7, 11-12, 15-16].
Participants consuming a diet high in protein with a low
glycaemic index continue to lose weight after the initial weight
loss [13]. In fact, higher dietary protein intake was achieved by
reducing carbohydrate intake, which adds further support to
        
carbohydrate content (g) multiplied by glycaemic index) is
important for controlling body weight in obese patients [17-19].
found in soy protein isolates) may also contribute to the weight
loss produced by low-carbohydrate diets [7, 20]. Moreover, weight
loss interventions using meal replacement approaches together
with dietary counselling and increased physical activity lead
to substantial, favourable changes in both anthropometric and
metabolic risk factors, while preserving lean muscle mass [12, 21].
Recent studies have shown that meal replacement regimens are
safe and associated with greater weight loss than individualized
diet plans [22, 23]. A meal replacement regimen high in soy
protein may be more effective at improving body weight and body
composition and reducing associated cardio-metabolic risk factors,
such as insulin, leptin, endothelial function and anthropometric
measures compared to lifestyle interventions (e.g., fat restricting
low calorie diets and increased physical activity) [11, 24, 25].
      
      
(compared to baseline). As a soy and milk protein-based product,
the meal replacement used in this study had an energy-sparing
Soy proteins have been noted to improve receptor-mediated
transport of insulin and leptin through the blood brain barrier
                   
Body Weight
91.2±11.6 90.2±11.3 84.9±10.8
c / y
c / y
Fat Mass
36.9±6.27 36.2±6.38 30.4±7.60
c / x
c / x
127±68.4 143±66.0 137±55.2
Apolipoprotein B
115±20.3 117±23.9 105±20.9
- /c
c / x
Fasting Blood
Sugar (mg/dl)
95±14.1 95±12.2 90±9.9
a / -
c / -
8.8±3.92 12.7±10.1 7.4±3.98
- / y
c / y
HOMA- Index
2.2±1.26 3.1±2.65 1.7±1.00
- / y
c / y
37±29.2 36±25.4 28±20.7
b / y
c / y
1.8±1.25 2.2±2.05 1.8±2.30
0.27±0.22 0.30±0.28 0.23±0.16
Page 4 of 5
 Koohkan S, Golesorkhi M, Vitolins MZ, McCarthy DH, Berg A, et al. (2016) The Influence of a Meal Replacement
Formula on Leptin Regulation in Obese Adults. J Nutrition Health Food Sci 4(4): 1-5. DOI:
© 
and are responsible for an increased effect of these hormones
in the hypothalamus. This effect not only impacts appetite
regulation but may also impact peripheral insulin and leptin
resistance in obese participants [27-30]. These effects may
       
exhibit a variety of biological and molecular activities [20,25].
         
proteins important for lipid metabolism [31, 32]. The effects
of soy protein on gene expression or the regulation of nuclear
transcription factors might also, at least in part, be able to
account for the alterations observed in insulin and leptin [33,
       
this meal replacement product [20] may account for some of the
a reduction in body fat mass and hepatic fat accumulation, in
addition to improved fatty acid metabolism, which led to lower
       
insulin resistance [33].
In summary, the meal replacement strategy utilized
for weight reduction in this trial may provide therapeutic
    
including impaired glucose tolerance and leptin resistance.
      
       
milieus that are responsible for weight stabilization. Moreover,
the meal replacement product can safely and effectively produce
We thank the technical staff of the Department of
Rehabilitative und Präventive Sportmedizin, Medizinische
Universitätsklinik Freiburg renamed the Institut für
Bewegungs- und Arbeitsmedizin - for their assistance in input
operations. We also thank all general practitioners who were
engaged in supervising the lifestyle program. Last, we thank the
Almased Wellness Company (Bienenbüttel, Germany) for their
support in performing this study.
This research was funded by Almased Wellness GmbH,
Bienenbüttel, Germany. A. Berg has written “The Almased Well-
ness Concept” outlining the effects of a soy-enriched diet in ealth
and disease.
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Formula on Leptin Regulation in Obese Adults. J Nutrition Health Food Sci 4(4): 1-5. DOI:
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... Particularly in the postmenopausal women, the reduction of fat free mass (FFM) was 0.1 kg, equal to only 1 % of total weight loss. This finding is encouraging as it demonstrates that weight reduction using this type of intervention in postmenopausal women is feasibleTable 1: Results for body composition, metabolic and inflammatory status (mean ± SD) in 2 subgroups before and after 24 weeks of intervention (controls vs. SYHF intake); p-values for pre-post intra-group paired differences were p<0.05 (a), p<0.01(b), p<0.005 (c); p-values for the prepost inter-group unpaired differences were p<0.05 (x), p<0.01(y).[14,51]Controlwithout any significant reduction in lean tissue. ...
... Because of the sum of these ingredients, the SYHF product shows promise as a formula for better health and against obesity associated comorbidities as documented in the following chapter. As described in the first Almased review published in 2007[9]the following metabolic changes have been confirmed in several recently published studies during the last years[14,15,27,44,46,47,51]; all indicated effects were substantiated in publically-registered and ethically approved controlled clinical trials. It can be confirmed that the SYHF application show s reproducible results including:-a significant decrease in elevated fasting blood glucose and plasma insulin levels-a significant improvement in HOMA index levels as an indicator for insulin sensitivity-a significant decrease in serum LDL cholesterol and apolipoprotein B-a significant decrease in serum triglycerides on increased baseline values-a significant decrease of the plasma leptin levels-a significant improvement in the inflammatory profile (hs-CRP, IL-6 ...
... When the leptin results were adjusted for age, gender, baseline leptin level, changes in body weight, and intervention type (lifestyle vs. SYHF meal replacement), the meal replacement approach had a clear independent effect on plasma leptin levels and enhanced the effects on leptin reduction resulting from weight loss[51]. Therefore, the findings suggest a relationship between SYHF intake and leptin regulation in the examined overweight adults (Tab.1). ...
Full-text available
Meal replacements and food supplements are now popular commercial weight loss and nutrition products. This review describes the efficacy, effectiveness, and therapeutic use of one such product - a soy-yoghurt-honey food formulation. The original formula of this product was created more than thirty years ago and since that time it has become well established as a food supplement supporting a healthy lifestyle. Therapeutic evidence for this product is based on numerous scientific studies and clinical trials, focusing particularly on weight management and associated metabolic risk factors and published as peer-reviewed articles. Given the availability of the product and the extent to which it has been experimentally evaluated, it is timely and important that the research is brought together under a single review to consolidate the understanding for the scientific and clinical communities. This review discusses the ingredients and the broad mechanisms of action, which are probably due to the biological properties of the three base components - soy, milk, and honey. It further summarizes and discusses the laboratory and clinical intervention studies, including the biochemical and metabolic mechanisms regarding the insulin- and lipid-lowering, anti-hypertensive, anti-inflammatory, antioxidant, and anti-microbial properties of the overall food and its base products.
Full-text available
To examine the effects of protein source and isoflavones on triglyceride (TG) fatty acid (TGFA) and cholesterol biosynthesis, subjects (>50 years, LDL cholesterol >130 mg/dl) underwent a four-phase randomized cross-over feeding trial. Diets contained either isolated soy protein or common sources of animal protein (25 g/1000kcal), without or with isoflavones (49 mg/1000kcal) and were each fed for 6 weeks. Blood samples from 20 hyperlipidemic subjects (6M, 14F, 62 +/- 9 years, BMI 26 +/- 3 kg/m(2), LDL cholesterol > 160 mg/dl after feeding animal protein without isoflavones) were selected to measure TGFA fractional synthetic rate (TGFA-FSR) and free cholesterol fractional synthetic rate (FC-FSR) over 24 h as deuterium oxide uptake into TGFA and free cholesterol. Soy protein reduced TG by 12.4% (P < 0.0001), total cholesterol by 4.4% (P < 0.001), and LDL cholesterol by 5.7% (P = 0.003) compared to animal protein. The TGFA-FSR was reduced by 13.3% (P = 0.018) and FC-FSR was increased by 7.6% (P = 0.017) after the soy protein relative to the animal protein. Isoflavones had no significant effect on TG and TGFA-FSR. Isoflavones reduced total cholesterol levels by 3.1 % (P = 0.009) but had no significant effect on LDL, HDL cholesterol levels, or FC-FSR. These data demonstrate that dietary protein type modulates circulating TG and cholesterol levels in hypercholesterolemic individuals by distinct mechanisms.
Full-text available
Obesity is a global epidemic associated with aging-like cellular processes; in both aging and obesity, resistance to hormones such as insulin and leptin can be observed. Leptin is a circulating hormone/cytokine with central and peripheral effects that is released mainly by subcutaneous white adipose tissue. Centrally, leptin controls food intake, energy expenditure, and fat distribution, whereas it controls (among several others) insulin sensitivity, free fatty acids (FFAs) oxidation, and lipolysis in the periphery. Aging is associated with important changes in both the distribution and the composition of adipose tissue. Fat is redistributed from the subcutaneous to the visceral depot and increased inflammation participates in adipocyte dysfunction. This redistribution of adipose tissue in favor of visceral fat influences negatively both longevity and healthy aging as shown in numerous animal models. These modifications observed during aging are also associated with leptin resistance. This resistance blunts normal central and peripheral functions of leptin, which leads to a decrease in neuroendocrine function and insulin sensitivity, an imbalance in energy regulation, and disturbances in lipid metabolism. Here, we review how age-related leptin resistance triggers metabolic disturbances and affects the longevity of obese patients. Furthermore, we discuss the potential impacts of leptin resistance on the decline of brown adipose tissue thermogenesis observed in elderly individuals.
Full-text available
Classically, leptin resistance has been associated with increased body fat and circulating leptin levels, and the condition is believed to contribute to the onset and/or maintenance of obesity. Although a great deal is known about the central nervous system mechanisms mediating leptin resistance, considerably less is known about the role of diet in establishing and maintaining this altered hormonal state. An exciting new finding has recently been published demonstrating the existence of leptin resistance in normal-weight rats with lean leptin levels by feeding them a high-concentration-fructose diet. This finding has opened the possibility that specific macronutrients may be capable of inducing leptin resistance, independently of the amount of body fat or circulating leptin present in the treated animals. This review describes several lines of research that have recently emerged indicating that specific types of dietary sugars and fats are capable of inducing leptin resistance in experimental rodent models. The results further show that diet-induced leptin resistance is capable of increasing energy intake and elevating body weight gain under appropriate dietary challenges. It appears that biological mechanisms on multiple levels may underlie the dietary induction of leptin resistance, including alterations in the leptin blood-to-brain transport system, in peripheral glucose metabolism, and in central leptin receptor signaling pathways. What is clear from the findings reviewed here is that diet-induced leptin resistance can occur in the absence of elevated circulating leptin levels and body weight, rendering it a potential cause and/or predisposing factor to excess body weight gain and obesity.
Full-text available
Leptin resistance has been defined as reduced or absent responsiveness to the feeding and body weight inhibitory effects of the hormone in obese individuals compared with normal (lean) controls. Classically, leptin resistance has been associated with increased body fat and circulating leptin levels, and the effect is thought to contribute to the maintenance of obesity. Whereas a great deal is known about the central nervous system (CNS)3 mechanisms associated with leptin resistance, considerably less is known about the role of diet in establishing and maintaining this altered hormonal state. Recently, new data have emerged indicating that specific types of dietary sugars or fats are capable of inducing leptin resistance in the absence of elevated levels of circulating leptin and/or body fat. These findings suggest that specific macronutrients may be involved in the induction of leptin resistance prior to the development of obesity, and open the possibility that diet-induced leptin resistance may play a role in the onset of weight gain leading to obesity. This review will present new findings by 4 investigators on the role of diet in leptin resistance, including the effects of type and form of dietary sugar, the effect of dietary TG saturation, and potential metabolic and CNS mechanisms mediating these effects. These data were presented at a symposium sponsored by the ASN and held at the Experimental Biology 2012 Meeting, San Diego, CA on April 22, 2012.
Background: Ad libitum, low-carbohydrate diets decrease caloric intake and cause weight loss. It is unclear whether these effects are due to the reduced carbohydrate content of such diets or to their associated increase in protein intake. Objective: We tested the hypothesis that increasing the protein content while maintaining the carbohydrate content of the diet lowers body weight by decreasing appetite and spontaneous caloric intake. Design: Appetite, caloric intake, body weight, and fat mass were measured in 19 subjects placed sequentially on the following diets: a weight-maintaining diet (15% protein, 35% fat, and 50% carbohydrate) for 2 wk, an isocaloric diet (30% protein, 20% fat, and 50% carbohydrate) for 2 wk, and an ad libitum diet (30% protein, 20% fat, and 50% carbohydrate) for 12 wk. Blood was sampled frequently at the end of each diet phase to measure the area under the plasma concentration versus time curve (AUC) for insulin, leptin, and ghrelin. Results: Satiety was markedly increased with the isocaloric high-protein diet despite an unchanged leptin AUC. Mean (±SE) spontaneous energy intake decreased by 441 ± 63 kcal/d, body weight decreased by 4.9 ± 0.5 kg, and fat mass decreased by 3.7 ± 0.4 kg with the ad libitum, high-protein diet, despite a significantly decreased leptin AUC and increased ghrelin AUC. Conclusions: An increase in dietary protein from 15% to 30% of energy at a constant carbohydrate intake produces a sustained decrease in ad libitum caloric intake that may be mediated by increased central nervous system leptin sensitivity and results in significant weight loss. This anorexic effect of protein may contribute to the weight loss produced by low-carbohydrate diets.
Biologically active peptides play an important role in metabolic regulation and modulation. Several studies have shown that during gastrointestinal digestion, food processing and microbial proteolysis of various animals and plant proteins, small peptides can be released which possess biofunctional properties. These peptides are to prove potential health-enhancing nutraceutical for food and pharmaceutical applications. The beneficial health effects of bioactive peptides may be several like antihypertensive, antioxidative, antiobesity, immunomodulatory, antidiabetic, hypocholesterolemic and anticancer. Soybeans, one of the most abundant plant sources of dietary protein, contain 36% to 56% of protein. Recent studies showed that soy milk, an aqueous extract of soybean, and its fermented product have great biological properties and are a good source of bioactive peptides. This review focuses on bioactive peptides derived from soybean; we illustrate their production and biofunctional attributes.
Bioactive peptides (BAPs), derived through enzymatic hydrolysis of food proteins, have demonstrated potential for application as health-promoting agents against numerous human health and disease conditions, including cardiovascular disease, inflammation, and cancer. The feasibility of pharmacological application of these peptides depends on absorption and bioavailability in intact forms in target tissues, which in turn depends on structure of the peptides. Therefore, production and processing of peptides based on important structure-function parameters can lead to the production of potent peptides. This article reviews the literature on BAPs with emphasis on strategic production and processing methods as well as antihypertensive, anticancer, anticalmodulin, hypocholesterolemic, and multifunctional properties of the food protein-derived peptides. It is recommended that future research efforts on BAP should be directed toward elucidation of their in vivo molecular mechanisms of action, safety at various doses, and pharmacological activity in maintaining homeostasis during aberrant health conditions in human subjects.
Recent reports show that obesity and diabetes have increased in the United States in the past decade. To estimate the prevalence of obesity, diabetes, and use of weight control strategies among US adults in 2000. 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. 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. In 2000, the prevalence of obesity (BMI >/=30 kg/m(2)) 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. The prevalence of obesity and diabetes continues to increase among US adults. Interventions are needed to improve physical activity and diet in communities nationwide.