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Weight loss is a powerful health care measure

Direct extract from:

O’Brien PE, Brown WA and Dixon JB. Obesity, weight loss and bariatric surgery. MJA 2005;183: 310 – 314.

http://www.mja.com.au/public/issues/183_06_190905/obr10369_fm.html

Substantial weight loss has major health benefits.

After major weight loss, more than two-thirds of people with type 2 diabetes no longer need treatment and return to normal fasting blood glucose, glycosylated haemoglobin (HbA1c) and serum insulin levels.

Sixty per cent of people with obesity-associated hypertension revert to having normal blood pressure without need for treatment.

In many people, obstructive sleep apnoea resolves, hypertriglyceridaemia and high-density-lipoprotein (HDL) cholesterol levels return to normal, and the fibrosis associated with non-alcoholic steatohepatitis improves or disappears.

Fertility increases in women with polycystic ovary syndrome, and depression at least partially resolves in most people.

In general, quality of life returns to normal and life expectancy improves.

In view of these outcomes, weight loss in obese people should be a major priority of doctors, public health practitioners and politicians committed to good health care.

The benefits of weight loss

Direct extract from:

Australian Government Depart of Health and Ageing, NHMRC Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults. Part 1 – Setting the Scene updated 19 March 2004, 7 – 8.

http://www.health.gov.au/internet/wcms/publishing.nsf/Content/obesityguidelines-guidelines-adults.htm

There appears to be little question that weight gain is associated with an increased risk of a number of health disorders. A related, but not necessarily contingent, question is whether weight loss leads to improvement in these conditions. A second question concerns the cost of the interventions required to achieve these benefits, if there are any. The benefits may be not only financial but also in the psychosocial costs incurred by an individual.

Modest weight losses of 5 to 10 per cent have been shown to confer health benefits,  among them decreases in hypertension-in both hypertensive and nonhypertensive individuals and improvements in blood lipids.

A more substantial 15 to 20 per cent weight loss in the first year after diagnosis can reverse the elevated mortality risk of type 2 diabetes and reduce sleep apnoea and other risk factors.

In evaluating the two-year effects of obesity surgery, Sjostrom et al. showed that a 30- kilogram weight loss can reduce the risk of diabetes 14-fold and hypertension, dyslipidaemia and hypertriglyceridaemia four-fold, as well as reduce plasma triglyceride levels by 60 per cent and hypertension by 10 per cent.

In quantitative terms, it has been shown that each 1 per cent decrease in body weight can lead to a fall of about 1mmHg in systolic blood pressure and 2mmHg in diastolic. LDL cholesterol has been estimated to reduce by 1 per cent for every kilogram lost.

In situations where the cause of weight loss is unknown, some studies have actually shown an increase in mortality with weight loss or weight cycling. However, when weight loss is intentional, modest losses have been shown to increase survival and reduce total mortality by 25 to 50 per cent. This reduction in mortality is most apparent (28 per cent) in overweight individuals with diabetes. The large weight loss in the Swedish Obese Subjects Study also points to a reduced 10-year mortality in the surgical intervention group. 

Preliminary results from the Swedish Obese Subjects Study show significant economic

benefits from weight loss. Narbro et al.compared diabetes medication costs for patients who had lost more than 15 kilograms with those for patients who had lost less than 5 kilograms and found more than a 50 per cent reduction in costs.

As noted, diabetes costs have also been shown to almost double with progression of the disease, but the progression can be considerably retarded by weight loss.

Among the non-economic benefits of weight loss are improved quality of life and improvements in psychological factors such as self-esteem.

In summary, an increasing number of well-conducted studies show that modest weight loss does appear to offer significant benefits in terms of medical, economic and personal outcomes.

The benefit-cost ratio is dependent on the type and extent of the weight-loss intervention. However, surgery, which is one of the most costly approaches to dealing with the problem, has been shown to have one of the most positive benefit-cost ratios.

The Effects of Diet-Induced Weight Loss on Sexual Function and Lower Urinary Tract Symptoms in Obese Men.

Gary A. Wittert, Cynthia Piantadosi, Andrew McAinch, Sean Martin, Susan O’Connor, Stephen G. Worthley.

Department of Medicine, University of Adelaide, SA, Australia

BACKGROUND: Obesity is associated with reproductive dysfunction in men. This study determined the effects of diet-induced weight loss on erectile function (EF), sexual desire (SD), and lower urinary tract symptoms (LUTS) in obese males.

METHODS: Fourteen obese, otherwise healthy, non-smoking men on no medication, age 42.1±11.8 yrs,18-65 yrs (mean ±SEM, range); BMI 38.65±4.7kg/m2, 30-45 kg/m2; and waist circumference 127.1±12.9cm, 104-152cm were evaluated. Baseline BP was elevated (≥ 140/90) in 4 men and fasting glucose elevated in 2. Weight-loss was induced with Kicstart™ (~800 Kcal/day) over 8 weeks. EF (international index of erectile function (IIEF)), SD (sexual desire inventory 2 (SDI-2)), and LUTS (international prostate symptom scale (IPSS)) were evaluated before and after weight-loss.  Glucose, insulin and lipids were measured in fasting plasma.

RESULTS: All men lost weight (12 ± 4.6 kg, 5.1-21.8kg) and decreased waist circumference (10.4 ± 4.5 cm, 5.0 – 20.5 cm). EF improved in 10 men. IPSS and SDI scores improved in all men.  The mean IIEF 18.07 ± 1.27; SDI-2 71 ± 2.9, and IPSS 18.0 ± 1.2 scores prior to weight loss improved post weight loss: IIEF 20.07 ± 1.27,  P<0.007; SDI-2 79.6 ± 2.02, P<0.0001; and IPSS 11.0 ± 1.6, P< 0.0001.  These changes were primarily related to improvements in metabolic state, rather than changes in weight.

CONCLUSION: In this group of men, obesity was associated with mild/moderate erectile dysfunction, and significant LUTS, which together with sexual desire improved following weight loss. The mechanism depends on improved metabolic state rather than weight per se.

Effects of Obesity and Diet-Induced Weight loss on Vascular and Cardiac Function.

Cynthia Piantadosi, Matthew I Worthley, Andrew McAinch, Stephen G. Worthley, Karen Teo, and Gary A. Wittert

Department of Medicine, University of Adelaide, South Australia 5000.

BACKGOUND: Obesity has been related to abnormalities of cardiac ventricular and vascular function, but the extent of their reversibility with weight loss remains uncertain.  The aim of this study was to determine the effects of diet-induced weight loss on cardiac and vascular function in obese men.

METHODS: Fourteen obese men age 42.1±11.8 yrs (mean ± SEM), range 18-65yrs; BMI 38.65±4.7 kg/m2 (mean ± SEM), range 30-45 kg/m2; and waist circumference 127.1± 12.9cm (mean ±SEM), range 104-152cm were enrolled.  The men had no prior diagnosis of disease, were all non-smokers and not using prescription medication. Four men had a BP ≥ 140/90; fasting plasma glucose was elevated in two. Weight loss was induced by diet (~800 Kcal/day) with Kicstart™ over 8 weeks. Ventricular structure and function and flow-mediated dilation (FMD) of the brachial artery were assessed by MRI. 

RESULTS: All men lost weight (12 ± 4.6 kg, range 5.1-21.8kg) and decreased waist circumference (10.4 ± 4.5 cm, range 5.0 – 20.5 cm).   Ejection fraction (EF) increased in all men, mean increase 50.9 ± 7.6% at baseline to 58.6 ± 6.4% following weight loss (p < 0.05). FMD increased from 3.1 ± 1.6% at baseline to 10.1 ± 3.4 % after weight loss (p = 0.06).  There was no direct relationship between change in weight, waist circumference and blood pressure and an EF or FMD.

Are meal replacements an effective clinical tool for weight loss?

Garry Egger
MJA • Volume 184 Number 2 • 16 January 2006

Summary points:-

Clinical trials show partial meal replacement products to be safe, acceptable and effective when used as part of an overall low-energy diet.

Several studies, reviews and meta-analyses now attest to the benefits of partial meal replacements.

Their use commonly results in weight loss of around 9%–10% of total body weight in the short term
(6–12 months), and 6%–8% in the long term (eg, 1–5 years), with no reported adverse effects when used as part of an overall low energy diet plan.

The benefits of partial meal replacements are even more obvious when compared with no treatment. In a 5-year study, an average weight gain of over 1 kg per year occurred in control subjects, compared with a loss of 5.8 kg in men and 4.2 kg in women using partial meal replacements.

It has been suggested that replacing two meals a day, while maintaining one other main meal, is most effective for initial weight loss, while replacing one meal a day (preferably a meal which is usually high energy, such as lunch or dinner) is enough for long-term maintenance.

Partial meal replacements have particular benefits for patients with diabetes. The effects on glucose control occur within days, and last for as long as weight loss is maintained, enabling a reduction in diabetic medications, but there are also improvements in blood pressure, and serum cholesterol and triglyceride levels.

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