Very low calorie diets: their efficacy, safety, and future.

Very low calorie diets used to treat moderate and severe obesity produce average weight losses of 20 kg in 12 weeks. This paper reviews the development of very low calorie diets from research on fasting in the late 1950s and examines data on the amount of dietary protein needed to achieve positive nitrogen balance. The desirability of including carbohydrate in the diet, the choice of protein sources (formula versus animal protein), and the anorectic value of ketosis are discussed, as are patient selection and the clinical course of the diet.

Treatment of obese children with and without their mothers: changes in weight and blood pressure.

Weight and blood pressure changes were evaluated in a 16-month controlled trial comparing three methods of involving mothers in the treatment of their obese adolescents (aged 12 to 16 years). The treatments were: (1) Mother-Child Separately--children and mothers attended separate groups; (2) Mother-Child Together--the children and mothers met together in the same group; and (3) Child Alone--the children met in groups and mothers were not involved. The program consisted of behavior modification, social support, nutrition, and exercise.

A comprehensive treatment plan for obese children and adolescents: principles and practice.

The problem of obesity in children must be identified early and treated seriously. The long-term psychological, social, and medical consequences of childhood obesity can be quite serious. Behavior modification has shown new promise compared to the discouraging results of traditional approaches such as inpatient starvation, the use of appetite suppressants, and dietary counseling.

The double-blind in danger: untoward consequences of informed consent.

Patients and physicians correctly identified medication assignments in 70% of the cases in a double-blind trial of an appetite suppressant. The breach of the double-blind design may have had therapeutic consequences; correct identification was associated with favorable outcome. These findings suggest that requirements for describing the side effects of medications to patients before they give informed consent may help them guess which medication they receive and thus may influence the integrity of double-blind studies and the results of controLled trials.

Estimates of food quantity and calories: errors in self-report among obese patients.

We report three studies that examine the accuracy and usefulness of food records among dieting obese patients. In study 1 errors in quantity and calorie estimates for 10 common foods averaged 63.9% (quantity) and 53.

Changes in plasma lipid and lipoprotein levels in men and women after a program of moderate exercise.

Levels of high-density lipoprotein (HDL) cholesterol and other lipids and lipoproteins of 24 men and 37 women were measured before and after a 10-week exercise program. The program involved three sessions of aerobic exercise each week, with 15-20 minutes of activity at 70% of maximal heart rate. Men and women had significantly different lipid patterns in response to exercise, despite equivalent increases in maximal oxygen uptake.

A school-based behavior modification, nutrition education, and physical activity program for obese children.

Sixty-three obese children, ages 5 to 12 yr, participated in a school-based program of behavior modification, nutrition education, and physical activity. The 10-wk program involved educating the children and those in the children's social network (parents, teachers, physical education instructor, food service personnel, school administrators, and the nurse's aide). Two methods were used to evaluate weight loss: the children were compared to a control group of obese children who did not receive the program, and the children in the program were used as their own controls by analyzing weight records for the 3 yr before the program.

Plasma fenfluramine levels, weight loss and side effects: a failure to find a relationship.

Thirty-six women were treated for 16 weeks with fenfluramine and behavior therapy. There was a strong correlation between drug dosage and plasma levels of fenfluramine. In contrast to two previous reports, however, there was no correlation between plasma levels of fenfluramine and its metabolite norfenfluramine and weight loss, nor was there any correlation between these levels and side effects.

Couples training, pharmacotherapy, and behavior therapy in the treatment of obesity.

The effects of behavior therapy with and without either pharmacotherapy or couples training were studied in 124 obese adults. In a 16-week behavioral weight-reduction program, patients were assigned to medication (fenfluramine hydrochloride) and no-medication conditions and to three spouse conditions in a 2 x 3 design. Two conditions consisted of patients with "cooperative" spouses; in one, patients were treated with their spouses, and in the other they were treated alone.

Differential changes in plasma high-density lipoprotein-cholesterol levels in obese men and women during weight reduction.

Levels of high-density lipoprotein-cholesterol (HDL-cholesterol) and other lipoproteins of 73 obese men and women were measured before and after a 16-week weight reduction program. There were significant differences between men and women. In men, a 10.

Congenital cervical spinal atrophy.

Three children presented at birth with axial hypotonia and symmetrical flaccid paresis limited to the upper extremities, and involving proximal and distal muscle groups. At birth, palmar flexion creases were poorly developed, and the hand muscles were atrophic. These clinical features, the muscle biopsy findings, and the nonprogressive course, suggest a vascular insult to the cervical spinal cord during gestation.

Evaluation and modification of exercise patterns in the natural environment.

Using a new experimental paradigm to evaluate physical activity in the natural environment, the authors made of 45,694 observations of persons using stairs or an adjacent escalator at a shopping mall, train station, and bus terminal. In study 1, stair use more than doubled for both obese and nonobese persons during two-week periods when a colorful sign encouraging use of the stairs was positioned at the stairs/escalator choice point. In study 2, stair use remained elevated for 15 consecutive days while the sign was present, decreased during a 1-month follow-up period, and returned to baseline by 3 months.

Determination of high density lipoprotein-cholesterol in stored human plasma.

This study was performed to determine the effect of frozen and unfrozen storage on plasma high density lipoprotein (HDL) cholesterol analysis. HDL-cholesterol was determined, following removal of the other lipoproteins by precipitation with heparin and MnCl(2), in fresh plasma samples and in aliquots of the samples that had been stored 1) unfrozen (4 degrees C), up to 14 days, 2) frozen (-20 degrees C), up to 14 days, and 3) frozen (-20 degrees C), 5-6 years. There were progressive changes in measured HDL-cholesterol values under all conditions of storage.

The behavioral control of obesity: a descriptive analysis of a large-scale program.

Evaluated a behavoiral treatment program for 147 obese patients in a Weight Control Clinic. Weight losses during treatment averaged 11.01 pounds with large inter-S variability.

Behavioral treatment of obesity in children.

The development of behavioral techniques for the control of obesity in children is reviewed. Techniques developed for the treatment of obese adults have recently been modified for use with children, and to date, six studies exist that have evaluated their use. The results are encouraging and it appears that behavior therapy offers new promise in the treatment of this difficult problem.