Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management.

/pdf/european-guidelines-for-obesity-management-in-adults-3inmplyepp.pdf

European Guidelines for Obesity Management in Adults

Effects of energy-restricted high-protein, low-fat compared with standard-protein, low-fat diets: a meta-analysis of randomized controlled trials

PURPOSE Cross-sectional studies show that individuals who walk more tend to be thinner than those who walk less. This does not mean, however, that the associa- tion between higher step counts and lower weight is causal or that encouraging sedentary individuals to increase step counts helps them lose weight. METHODS In this meta-analysis, we searched 6 electronic databases and contacted pedometer experts to identify pedometer-based walking studies without a dietary intervention that reported weight change as an outcome. We included randomized controlled trials and prospective cohort studies published after January 1, 1995, in either English or Japanese, with 5 or more adult participants and at least 1 cohort enrolled in a pedometer-based walking intervention lasting at least 4 weeks. RESULTS Nine studies met the study inclusion criteria. Cohort sample size ranged from 15 to 106, for a total of 307 participants, 73% of whom were women and 27% of whom were men. The duration of the intervention ranged from 4 weeks to 1 year, with a median duration of 16 weeks. The pooled estimate of mean weight change from baseline using a fi xed-effects model and combining data from all 9 cohorts was -1.27 kg (95% confi dence interval, -1.85 to -0.70 kg). Longer intervention duration was associated with greater weight change. On average, participants lost 0.05 kg per week during the interventions. CONCLUSION Pedometer-based walking programs result in a modest amount of weight loss. Longer programs lead to more weight loss than shorter programs.

/pdf/a-meta-analysis-of-pedometer-based-walking-interventions-and-5g5gq976yv.pdf

A Meta-Analysis of Pedometer-Based Walking Interventions and Weight Loss

NYBO, L., E. SUNDSTRUP, M. D. JAKOBSEN, M. MOHR, T. HORNSTRUP, L. SIMONSEN, J. BULOW, M. B. RANDERS, J. J. NIELSEN, P. AAGAARD, and P. KRUSTRUP. High-Intensity Training versus Traditional Exercise Interventions for Pro- moting Health. Med. Sci. Sports Exerc., Vol. 42, No. 10, pp. 1951-1958, 2010. Purpose: The purpose of this study was to deter- mine the effectiveness of brief intense interval training as exercise intervention for promoting health and to evaluate potential benefits about common interventions, that is, prolonged exercise and strength training. Methods: Thirty-six untrained men were divided into groups that completed 12 wk of intense interval running (INT; total training time 40 minIwk j1 ), prolonged running (E150 minIwk j1 ), and strength training (E150 minIwk j1 ) or continued their habitual lifestyle without participation in physical training. Results: The improvement in cardiorespiratory fitness was superior in the INT (14% T 2% increase in VO2max) compared with the other two exercise interventions (7% T 2% and 3% T 2% increases). The blood glucose concentration 2 h after oral ingestion of 75 g of glucose was lowered to a similar extent after training in the INT (from 6.1 T 0.6 to 5.1 T 0.4 mM, P G 0.05) and the prolonged running group (from 5.6 T 1.5 to 4.9 T 1.1 mM, P G 0.05). In contrast, INT was less efficient than prolonged running for lowering the subjects' resting HR, fat percentage, and reducing the ratio between total and HDL plasma cholesterol. Furthermore, total bone mass and lean body mass remained unchanged in the INT group, whereas both these parameters were increased by the strength-training intervention. Conclusions: INT for 12 wk is an effective training stimulus for improvement of cardiorespiratory fitness and glucose tolerance, but in relation to the treatment of hyperlipidemia and obesity, it is less effective than prolonged training. Furthermore and in contrast

High-intensity training versus traditional exercise interventions for promoting health.

Context: There is debate over the independent and combined effects of dieting and increased physical activity on improving metabolic risk factors (body composition and fat distribution). Objective: The objective of the study was to conduct a randomized, controlled trial (CALERIE) to test the effect of a 25% energy deficit by diet alone or diet plus exercise for 6 months on body composition and fat distribution. Design: This was a randomized, controlled trial. Setting: The study was conducted at an institutional research center. Participants: Thirty-five of 36 overweight but otherwise healthy participants (16 males, 19 females) completed the study. Intervention: Participants were randomized to either control (healthy weight maintenance diet, n = 11), caloric restriction (CR; 25% reduction in energy intake, n = 12), or caloric restriction plus exercise (CR+EX; 12.5% reduction in energy intake + 12.5% increase in exercise energy expenditure, n = 12) for 6 months. Main Outcome Measures: Changes in body compos...

/pdf/effect-of-calorie-restriction-with-or-without-exercise-on-4x20wxb75z.pdf

Effect of Calorie Restriction with or without Exercise on Body Composition and Fat Distribution

The incidence of obesity is increasing rapidly. Research efforts for effective treatment strategies still focus on diet and exercise programmes, the individual components of which have been investigated in intervention trials in order to determine the most effective recommendations for sustained changes in bodyweight. The foremost objective of a weight-loss trial has to be the reduction in body fat leading to a decrease in risk factors for metabolic syndrome. However, a concomitant decline in lean tissue can frequently be observed. Given that fat-free mass (FFM) represents a key determinant of the magnitude of resting metabolic rate (RMR), it follows that a decrease in lean tissue could hinder the progress of weight loss. Therefore, with respect to long-term effectiveness of weight-loss programmes, the loss of fat mass while maintaining FFM and RMR seems desirable. Diet intervention studies suggest spontaneous losses in bodyweight following low-fat diets, and current data on a reduction of the carbohydrate-to-protein ratio of the diet show promising outcomes. Exercise training is associated with an increase in energy expenditure, thus promoting changes in body composition and bodyweight while keeping dietary intake constant. The advantages of strength training may have greater implications than initially proposed with respect to decreasing percentage body fat and sustaining FFM. Research to date suggests that the addition of exercise programmes to dietary restriction can promote more favourable changes in body composition than diet or physical activity on its own. Moreover, recent research indicates that the macronutrient content of the energy-restricted diet may influence body compositional alterations following exercise regimens. Protein emerges as an important factor for the maintenance of or increase in FFM induced by exercise training. Changes in RMR can only partly be accounted for by alterations in respiring tissues, and other yet-undefined mechanisms have to be explored. These outcomes provide the scientific rationale to justify further randomised intervention trials on the synergies between diet and exercise approaches to yield favourable modifications in body composition.

/pdf/the-role-of-diet-and-exercise-for-the-maintenance-of-fat-5cmsxw17ue.pdf

The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss.

Maximizing postprandial energy expenditure and fat oxidation could be of clinical relevance for the treatment of obesity. This study investigated the effect of prior exercise on energy expenditure and substrate utilization after meals containing varying amounts of macronutrients. Eight lean (11.6% ± 4.0% body fat, M ± SD) and 12 obese (35.9% ± 5.3% body fat) men were randomly assigned to a protein (43% protein, 30% carbohydrate) or a carbohydrate (10% protein, 63% carbohydrate) meal. The metabolic responses to the meals were investigated during 2 trials, when meals were ingested after a resting period (D) or cycling exercise (Ex+D; 65% of oxygen consumption reserve, 200 kcal). Energy expenditure, substrate utilization, and glucose and insulin responses were measured for 4 hr during the postprandial phase. Although postprandial energy expenditure was not affected by prior exercise, the total amount of fat oxidized was higher during Ex+D than during D (170.8 ± 60.1 g vs. 137.8 ± 50.8 g, p < .05), and, accordingly, the use of carbohydrate as substrate was decreased (136.4 ± 45.2 g vs. 164.0 ± 42.9 g, p < .05).After the protein meal fat-oxidation rates were higher than after carbohydrate intake (p < .05), an effect independent of prior exercise. Plasma insulin tended to be lower during Ex+D (p = .072) and after the protein meal (p = .066). No statistically significant change in postprandial blood glucose was induced by prior exercise. Exercising before meal consumption can result in a marked increase in fat oxidation, which is independent of the type of meal consumed.

Moderate exercise, postprandial energy expenditure, and substrate use in varying meals in lean and obese men.

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The role of diet and exercise for the maintenance of fat-free mass and resting metabolic rate during weight loss.

Moderate exercise, postprandial energy expenditure, and substrate use in varying meals in lean and obese men.