A high dietary glycemic load is associated with an increased risk of noninsulin-dependent diabetes mellitus and coronary artery disease.
To evaluate the effect of a low glycemic load diet on cardiac rehabilitation patients.
One hundred twenty patients who were advised to follow a low glycemic load diet were evaluated and compared with 1434 patients who were advised to follow the principles of Canada's Food Guide to Healthy Eating for People Four Years and Over as part of the Ontario Cardiac Rehabilitation Pilot Project.
Patients on the low glycemic load diet lost more weight at six months (2.8 kg loss versus 0.2 kg gain, P
Community Health Systems Resource Group, Ontario Community Outreach Program for Eating Disorders and Public Health Sciences, University of Toronto Health Network/Toronto General Hospital, The Hospital for Sick Children. email@example.com
We examined the prevalence of dieting and negative eating attitudes among 2279 females (aged 10-14 years) in southern Ontario. Self-report questionnaires revealed that 29.3% of the girls were currently trying to lose weight and 10.5% had scores greater than the clinical threshold for disordered eating (Children's version of the Eating Attitudes Test [ChEAT] score > or = 20). Those with elevated ChEAT scores were more likely than those with lower scores to be engaged in dieting and other extreme weight control methods.
Weight reduction is a key goal for the prevention of vascular complications in obese individuals with type 2 diabetes, but a nutritionally balanced intake is also important in this regard. We compared dietary intakes and vitamin supplement use between obese and nonobese women and men with type 2 diabetes to identify gaps in adherence to nutritional management guidelines.
We analyzed data from a longitudinal study of adults with type 2 diabetes, wherein participants were assessed once per season over 1 year. Dietary data were collected using a validated semiquantitative, self-administered food-frequency questionnaire. Given the absence of seasonal variations in anthropometric variables and dietary intake, data from multiple visits were averaged for each individual. Associations of both intake of fruit and vegetables and nutrients related to cardiovascular disease risk were compared between obese (body mass index = 30 kg/m²) and nonobese individuals through multivariable linear regression with adjustments for age, education, and energy intake.
Among the 200 participants (93 women and 107 men), 53% of women and 43% of men were obese. Compared with nonobese women, obese women consumed more saturated fat (mean difference, 1.2% of total energy intake; 95% confidence interval [CI], 3% to 2.2%) and sodium (mean difference, 0.3 g; 95% CI, 0.04 to 0.5 g), and they had a lower intake of fiber (mean difference, -2.7 g; 95% CI, -4.4 to -0.9 g) and magnesium (mean difference, -33.6 mg; 95% CI, -55.2 to -12.0 g). No differences in dietary intake were observed between obese and nonobese men, but the intakes of men overall were similar to those of obese women. Compared with nonobese participants, fewer obese individuals used vitamin/mineral supplements (women: 37% vs 48%, men: 26% vs 38%).
Obese women and both obese and nonobese men appeared to have poorer dietary quality compared with nonobese women. Our findings support the need to emphasize dietary composition in addition to weight control in diabetes.
Despite the existence of guidelines for obesity management, uncertainty remains as to what interventions comprise effective practice. This uncertainty could act as a barrier to busy health care professionals, who may lack the time and expertize to fully appraise the huge amount of literature that is published each year on obesity management. Therefore, the objectives of this review were to synthesize the available evidence, determine most effective and most promising practices for obesity management in adults, using an established methodology, and present this information according to its quality.
This synthesis review was conducted from January 2009. A detailed search of relevant databases was conducted to September 2010. Most effective and promising practices were defined using the Canadian Best Practice Initiative Methodology Background Paper, with systematic reviews (with/without meta analysis) as the most rigorous methodology for developing recommendations that were deemed most effective (level 1), and non-systematic reviews for developing recommendations deemed as most promising (level 2). Literature was reviewed and classified across these two levels of rigor, and supplemented with primary studies to further refine recommendations.
Evidence from systematic reviews and meta-analyses was classified into three intervention themes or areas of context, in which more specific most effective and/or promising practice recommendations could be nested. These intervention themes were (1) targeted multi-component interventions for weight management, (2) dietary manipulation strategies and (3) delivery of weight management interventions, including health professional roles and method of delivery. Specific recommendations accompanied each theme.
This review highlights the value of multi-component interventions that are delivered over the longer term, and reinforces the role of health care professionals. The findings will help to inform evidence-based practice for health care practitioners involved in obesity management and prevention.
The prevalences of asthma and obesity have increased substantially in recent decades in many countries, leading to speculation that obese persons might be at increased risk of asthma development. In adults cross-sectional, case-control, prospective, and weight-loss studies are in the aggregate consistent with a role for obesity in the pathogenesis of asthma. In children 3 of 4 prospective studies also show a significant association between excess weight and asthma incidence. Because of the methodologic shortcomings of many studies, these findings are inconclusive, however. Population surveys do suggest that persons with asthma are disproportionately obese compared with persons who have never had asthma. Weight-loss studies on the basis of behavioral change and bariatric studies have shown substantial improvements in the clinical status of many obese patients with asthma who lost weight. Clarifying the nature of the relationship between obesity and asthma incidence and the role of weight management among patients with asthma are both critical areas with important ramifications for the prevention and treatment of asthma.
To optimize bariatric surgery results, experts recommend regular practice of physical activity. However, no precise recommendations are available for the pre-surgical period. We aimed to evaluate, in this pilot study, the feasibility of a supervised Pre-Surgical Exercise Training (PreSET) and its short-term clinical impacts in subjects awaiting bariatric surgery.
In addition to the usual interdisciplinary lifestyle management, eight women and four men [40.8 (37.6-47.5) years old, BMI = 51.4 (43.8-53.1) kg/m(2)] underwent the PreSET, which combined both endurance and strength training. They were instructed to perform three physical activity sessions per week during 12 weeks, with at least two sessions per week on site and the possibility to complete missed sessions at home. Before and after the PreSET, anthropometric measures, body composition, physical fitness, quality of life, and physical exercise beliefs were assessed.
The subjects participated in 57.3 % of the total supervised exercise sessions proposed and presented high satisfaction rates. Our program resulted in a significant improvement in weight (p = 0.007), physical fitness (p = 0.05), and quality of life score (p = 0.012) as well as for the emotions, social interactions, and sexual life subscales (p
This study evaluated the efficacy and safety of laparoscopic adjustable gastric banding (LAGB) in a large cohort of morbidly obese patients followed for up to 5 years.
Morbidly obese patients, = 16 years of age, who underwent LAGB surgery at the Surgical Weight Loss Clinic in Ontario, Canada, between May 2005 and January 2011 were eligible for this retrospective chart review. Electronic files were searched to identify all patients who met the inclusion/exclusion criteria. Demographics, weights at baseline and follow-up visits (up to 60 months following surgery), and post-operative complications were documented. As follow-up visits occurred at unevenly spaced intervals within and across patients, modeling methods were used to more accurately assess mean % weight loss (WL) and % excess weight loss (EWL) over time.
This study included 2,815 patients (82 % female, mean age 43 years, mean baseline BMI 44.6 kg/m(2)) followed for a mean of 21.8 ± 15.4 months. Complications developed in 238 patients (8.5 %), the most frequent being prolapse/slippage (4.2 %), tubing/access port problems (1.2 %), and explantation (1.2 %). Mean %WL and %EWL progressed continuously over the first 2.5 years post-LAGB, plateauing at 20 and 49 %, respectively, for up to 5 years of follow up. Factors associated with increased weight loss were time since surgery, greater baseline weight (excess weight), older age at time of surgery, and male gender.
Weight loss was maintained for up to 5 years in our population of patients who underwent LAGB for the treatment of morbid obesity.
Cites: N Engl J Med. 2007 Aug 23;357(8):741-5217715408
Within the last decade, several authors have proposed laparoscopic sleeve gastrectomy (LSG) as a potential definitive treatment for morbid obesity. While initially perceived as being a solely restrictive procedure, it is now theorized to have additional hormonal effects (primarily the reduction of circulating levels of plasma ghrelin). However, there is limited supporting evidence for this claim. Therefore, the purpose of our study is to conduct a systematic review of the literature to clarify the effects of LSG on modulation of postoperative ghrelin concentrations. A comprehensive literature search for published or unpublished studies of sleeve gastrectomy (SG) and ghrelin written in English prior to February 2013 was performed using Pubmed, EMBASE, the Cochrane database, and Scopus. Gray literature was also searched through Google. Inclusion criteria for searches were: randomized controlled trials, non-randomized clinical trials, retrospective and prospective cohort studies, or case series. Seven studies were deemed suitable for analysis. The mean patient age was 43?±?8.8 years and female percentage was 74.4?±?15.3 %. The mean initial BMI was 46.2?±?7.8 and mean follow-up time was 9.5?±?15 months. The mean postoperative BMI was 37.3?±?5.8 over the same follow-up period. Pooled mean preoperative ghrelin levels were 698.4?±?312.4 pg/ml and postoperative levels were 414.1?±?226.3 pg/ml (P?
Laparoscopic adjustable gastric band (LAGB) has gone through major design modifications to improve clinical endpoints and reduce complications. Little is known, however, about the effects of LAGB size on clinical outcomes, or whether outcomes differ based on gender. We set out to examine the impact of band size on surgical weight loss, reoperations, comorbidity resolution, and compare outcomes within gender.
We reviewed our prospectively collected longitudinal bariatric database between 2008 and 2010, and compared patients with BMI 35-50 kg/m(2) who had undergone LAGB with the LAP-BAND® APS to those who had the larger APL. Those patients with initial BMI?>?50 kg/m(2) were excluded to reduce any possible selection bias which favors larger band use in such subjects.
Three hundred ninety-four patients met our inclusion criteria; 230 (58 %) in the APS group and 164 (42 %) in the APL group. Female patients in APS group experienced significantly higher percentage excess body weight loss at 6 months, 1 year, and 2 years in comparison to female patients in APL group (p?