Effect of diet versus diet and exercise on weight loss and body composition in class II and III obesity: A systematic review

Class II and III obesity (BMI >35 kg·m2) have increased dramatically in recent years. Current clinical guidelines suggest diet and exercise as first line treatment for adults throughout the spectrum of overweight and obesity. However, to date there is no systematic review that examines the effects of diet and exercise on this high risk population. This systematic review will examine the combined effects of diet versus diet and exercise on body composition in severe obesity. Medline and Cinahl were searched for randomised controlled trials comparing diet and exercise to diet alone. Studies published until July 2013 were included if they used reliable methods for analysing body composition in adults with BMI ≥ 35 kg·m2. Five of 459 studies met the inclusion criteria. Two studies, both in older adults, reported that exercise reduced lean mass loss during weight loss. Two studies showed that exercise facilitated (greater) fat mass loss. The remaining study reported no differences in body composition when exercise is added to energy restriction. Exercise training during energy restriction for individuals with BMI ≥35 kg.m2 may influence body composition outcomes but the evidence is limited. Further studies should focus on the efficacy of different exercise protocols during energy restriction for this population in order to better inform decision making for the treatment of severe obesity in respect to favourable body composition outcomes.

Factors influencing women’s choice of weight-loss diet

Women's motives for weight-loss dieting and choice of method were investigated in 151 current and 182 prospective dieters. Problematically, appearance-motivated dieters preferred ‘fad’ diets with the promise of quick results, and prospective dieters preferred marketing information supporting such diets over health advice cautioning against their use.

The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation

To assess the clinical effectiveness and cost-effectiveness of bariatric surgery for obesity. Seventeen electronic databases were searched [MEDLINE; EMBASE; PreMedline In-Process & Other Non-Indexed Citations; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, DARE, NHS EED and HTA databases; Web of Knowledge Science Citation Index (SCI); Web of Knowledge ISI Proceedings; PsycInfo; CRD databases; BIOSIS; and databases listing ongoing clinical trials] from inception to August 2008. Bibliographies of related papers were assessed and experts were contacted to identify additional published and unpublished references. Two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text using a standard form. Interventions investigated were open and laparoscopic bariatric surgical procedures in widespread current use compared with one another and with non-surgical interventions. Population comprised adult patients with body mass index (BMI) > or = 30 and young obese people. Main outcomes were at least one of the following after at least 12 months follow-up: measures of weight change; quality of life (QoL); perioperative and postoperative mortality and morbidity; change in obesity-related comorbidities; cost-effectiveness. Studies eligible for inclusion in the systematic review for comparisons of Surgery versus Surgery were RCTs. For comparisons of Surgery versus Non-surgical procedures eligible studies were RCTs, controlled clinical trials and prospective cohort studies (with a control cohort). Studies eligible for inclusion in the systematic review of cost-effectiveness were full cost-effectiveness analyses, cost-utility analyses, cost-benefit analyses and cost-consequence analyses. One reviewer performed data extraction, which was checked by two reviewers independently. Two reviewers independently applied quality assessment criteria and differences in opinion were resolved at each stage. Studies were synthesised through a narrative review with full tabulation of the results of all included studies. In the economic model the analysis was developed for three patient populations, those with BMI > or = 40; BMI > or = 30 and < 40 with Type 2 diabetes at baseline; and BMI > or = 30 and < 35. Models were applied with assumptions on costs and comorbidity.

Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis

Post-partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post-partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post-partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self-monitoring, individual or group setting, intervention duration, intervention types, the use of technology as a support, and home- or centre-based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta-analysis (1,892 women, age 24-36 years). Studies with self-monitoring had significantly greater weight lost than those without (-4.61 kg [-7.08, -2.15] vs. -1.34 kg [-1.66, -1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (-3.24 kg [-4.59, -1.90] vs. -1.63 kg [-2.16, -1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self-monitoring and take a combined diet-and-exercise approach have significantly greater weight loss in post-partum women.

The role of the fatosphere in fat adults' responses to obesity stigma: a model of empowerment without a focus on weight loss

Obese adults face pervasive and repeated weight-based stigma. Few researchers have explored how obese individuals proactively respond to stigma outside of a dominant weight-loss framework. Using a grounded theory approach, we explored the experiences of 44 bloggers within the Fatosphere--an online fat-acceptance community. We investigated participants' pathways into the Fatosphere, how they responded to and interacted with stigma, and how they described the impact of fat acceptance on their health and well-being. The concepts and support associated with the fat-acceptance movement helped participants shift from reactive strategies in responding to stigma (conforming to dominant discourses through weight loss) to proactive responses to resist stigma (reframing "fat" and self-acceptance). Participants perceived that blogging within the Fatosphere led them to feel more empowered. Participants also described the benefits of belonging to a supportive community, and improvements in their health and well-being. The Fatosphere provides an alternative pathway for obese individuals to counter and cope with weight-based stigma.

Histopathology findings in common marmosets (Callithrix jacchus Linnaeus, 1758) with chronic weight loss associated with bile tract obstruction by infestation with Platynosomum (Loos, 1907)

Chronic weight loss in marmosets is often associated with wasting marmoset syndrome (WMS), an important disease that occurs in callitrichid colonies around the world. Even though its etiology is very difficult to determine, particular variables, such as weight loss, diarrhea and alopecia, associated or not with infestation in the pancreatic ducts with Trichospirura leptossoma (Nematoda: Thelazioidea), seem to be linked with the syndrome. This study investigated the histopathology of the lungs, duodenum, liver, gallbladder, extrahepatic bile ducts and pancreatic ducts of six common marmosets (Callithrix jacchus) suffering from severe non-diarrheic weight loss. Three individuals died naturally and the other three were euthanized. Microscopic findings showed the presence of adult flukes (Platynosomum) in the liver. These flukes, which provoke common infection in cats, were also observed inside the gallbladder as well as in the intra and extrahepatic bile ducts in common marmosets. Portal fibrosis was observed in two animals, which developed chronic fibrosing hepatopathy (biliary pattern, grade 3). The disease progresses without diarrhea and without pancreatic lesions or infestation. With the rogression, the animals presented with ascending cholangitis, cholestasis and portal fibrosis, sometimes culminating in secondary biliary cirrhosis. Therefore, this nfirmity, associated with chronic weight loss in common marmosets, could be another tiological factor linked with WMS

A weight loss protocol and owners participation in the treatment of canine obesity

O sucesso de um programa de perda de peso para animais de estimação depende da colaboração do proprietário. A adesão deste é fundamental para a correta instituição do manejo alimentar do paciente. Este trabalho teve por objetivo comparar a efetividade de um programa de perda de peso em dois grupos de cães, um mantido sob condições experimentais e outro com seus proprietários. Empregou-se a mesma ração hipocalórica para todos os animais. A quantidade fornecida foi restrita a 60% da necessidade energética de manutenção estimada para o peso corporal meta, definido como o peso autal reduzido em 15%. Os animais foram acompanhados durante 90 dias. Por meio de um questionário padronizado, estudou-se a percepção dos proprietários quanto à obesidade e seu tratamento. Verificou-se que o protocolo e a dieta empregados foram eficazes. Os animais controle apresentaram uma perda de peso média de 1,39% por semana. Os cães de proprietário perderam, em média, 0,75% do peso vivo por semana, resultado estatisticamente menor (P<0,05), o que sugere uma indisponibilidade dos mesmos em cumprir rigorosamente o tratamento. Mesmo com esta perda de peso modesta, foi perceptível a satisfação dos proprietários com os resultados obtidos. O uso de questionários demonstrou ser uma ferramenta importante na investigação das causas e no acompanhamento do tratamento da obesidade canina.

Protein Intake during Weight Loss Influences the Energy Required for Weight Loss and Maintenance in Cats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effects of weight loss on the cardiac parameters of obese dogs

A obesidade é uma das doenças nutricionais mais frequentemente observada em cães e pode provocar sérios problemas de saúde, como os distúrbios cardiovasculares. Realizou-se este estudo visando avaliar algumas das possíveis alterações estruturais e funcionais cardíacas decorrentes da correção da obesidade canina. Para isso foram utilizados 18 cães obesos divididos pelo peso corporal em Grupo I (até 15kg), Grupo II (entre 15,1 e 30 kg) e Grupo III (acima de 30 kg). Os animais foram submetidos à restrição calórica de forma a perderem 15% do peso vivo. Foram realizados os exames ecocardiográfico em modo-M, eletrocardiográfico e mensuração da pressão arterial dos animais antes do início do tratamento da obesidade e após atingirem o peso meta. Os resultados revelaram que após a redução de peso ocorreram diminuições significativas da espessura da parede livre do ventrículo esquerdo durante a sístole e diástole no Grupo III, diminuição da pressão arterial sistólica no Grupo III e também da pressão arterial média no Grupo II. Assim, concluiu-se que a perda de peso pode reverter as alterações estruturais cardíacas, como a hipertrofia excêntrica do ventrículo esquerdo em cães obesos acima de 30 kg, como também reduzir a pressão arterial sistêmica em cães obesos submetidos à restrição calórica mediante administração de dieta hipocalórica.

Administration of physiologic levels of triiodothyronine increases leptin expression in calorie-restricted obese rats, but does not influence weight loss

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)