Adherence is a multi-dimensional construct in the POUNDS LOST trial.

Research on the conceptualization of adherence to treatment has not addressed a key question: Is adherence best defined as being a uni-dimensional or multi-dimensional behavioral construct? The primary aim of this study was to test which of these conceptual models best described adherence to a weight management program. This ancillary study was conducted as a part of the POUNDS LOST trial that tested the efficacy of four dietary macronutrient compositions for promoting weight loss. A sample of 811 overweight/obese adults was recruited across two clinical sites, and each participant was randomly assigned to one of four macronutrient prescriptions: (1) Low fat (20% of energy), average protein (15% of energy); (2) High fat (40%), average protein (15%); (3) Low fat (20%), high protein (25%); (4) High fat (40%), high protein (25%).

Adipose tissue collagen VI in obesity.

Objectives: Basic science studies show that the extracellular matrix of adipose tissue, mainly represented by collagen VI, is dysfunctional in obesity and contributes to the development of the metabolic syndrome. We hypothesized in humans that increased collagen VI alpha3-subunit (COL6A3) mRNA is associated with adipose tissue macrophage chemotaxis and inflammation and that weight gain is accompanied by changes in the expression of COL6A3.

Research Design And Methods: Adipose tissue biopsies were obtained from a cross-sectional study (n = 109), an overfeeding study (n = 9), and a pioglitazone treatment study (n = 14).

Racial differences in abdominal depot-specific adiposity in white and African American adults.

Background: There is increasing interest in understanding racial differences in adiposity in specific body depots as a way to explain differential health risks associated with obesity.

Objective: Our aim was to examine the differences in abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) between white and African American adults.

Design: The sample included 1967 adults aged 18-84 y, including 790 white women, 435 African American women, 606 white men, and 136 African American men.

Overweight and obesity: the pathogenesis of cardiometabolic risk.

Obesity, particularly abdominal adiposity, is increasingly recognized as a cause of elevated cardiometabolic risk--the risk of developing type 2 diabetes mellitus (DM) and cardiovascular disease (CVD). The predominate mechanisms appear to involve the promotion of insulin resistance, driven largely by excess free fatty acids secreted by an expanded adipose tissue mass, and the development of an inflammatory milieu due to increased secretion of inflammatory cytokines and adipokines from adipose tissue. Key proinflammatory cytokines secreted by adipocytes include tumor necrosis factor-alpha, interleukin-6, leptin, resistin, and plasminogen activator inhibitor-1.

Medications for obesity: mechanisms and applications.

Medications can significantly increase weight loss compared with placebo in most trials. In general, patients can expect a weight loss of 8% to 10% from baseline provided they adhere to the weight-loss program and take medications regularly. All medications have side effects that need to be considered before initiating treatment, however.

Alcohol consumption and diabetes risk in the Diabetes Prevention Program.

Background: Moderate alcohol consumption is associated with a decreased risk of type 2 diabetes in the general population, but little is known about the effects in individuals at high risk of diabetes.

Objectives: The objectives were to determine associations between alcohol consumption and diabetes risk factors and whether alcohol consumption was a predictor of incident diabetes in individuals enrolled in the Diabetes Prevention Program (DPP).

Design: DPP participants (n = 3175) had impaired glucose tolerance (2-h glucose: 7.

Actos Now for the prevention of diabetes (ACT NOW) study.

Background: Impaired glucose tolerance (IGT) is a prediabetic state. If IGT can be prevented from progressing to overt diabetes, hyperglycemia-related complications can be avoided. The purpose of the present study was to examine whether pioglitazone (ACTOS) can prevent progression of IGT to type 2 diabetes mellitus (T2DM) in a prospective randomized, double blind, placebo controlled trial.

Describing patterns of weight changes using principal components analysis: results from the Action for Health in Diabetes (Look AHEAD) research group.

Purpose: To demonstrate how principal components analysis can be used to describe patterns of weight changes in response to an intensive lifestyle intervention.

Methods: Principal components analysis was applied to monthly percent weight changes measured on 2,485 individuals enrolled in the lifestyle arm of the Action for Health in Diabetes (Look AHEAD) clinical trial. These individuals were 45 to 75 years of age, with type 2 diabetes and body mass indices greater than 25 kg/m(2).

Pioglitazone, but not metformin, reduces liver fat in Type-2 diabetes mellitus independent of weight changes.

Background: Pioglitazone (Pio) treatment induces weight gain in Type 2 diabetes mellitus (T2DM), which could worsen hepatic lipid accumulation, and alter adiponectin and high-sensitivity C-reactive protein (hs-CRP).

Objective: To compare changes in hepatic lipid, serum adiponectin and hs-CRP in diabetics treated with Pio (with and without weight gain) against metformin (Met) treatment, which produces weight loss.

Design: Fifty-one men and women with T2DM, naive to thiazolidinediones, entered a 16-week, open-label, parallel arm study, where participants were randomized to one of three groups: (1) Pio plus the American Diabetes Association diet (Pio+ADA); (2) Pio plus a portion control weight loss diet (Pio+PC), or (3) metformin plus ADA diet (Met+ADA).

Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates.

Background: The possible advantage for weight loss of a diet that emphasizes protein, fat, or carbohydrates has not been established, and there are few studies that extend beyond 1 year.

Methods: We randomly assigned 811 overweight adults to one of four diets; the targeted percentages of energy derived from fat, protein, and carbohydrates in the four diets were 20, 15, and 65%; 20, 25, and 55%; 40, 15, and 45%; and 40, 25, and 35%. The diets consisted of similar foods and met guidelines for cardiovascular health.

Lower total adipocyte number but no evidence for small adipocyte depletion in patients with type 2 diabetes.

Objective: We hypothesized that, compared with obese subjects, patients with type 2 diabetes have a lower total adipocyte number with fewer small adipocytes.

Research Design And Methods: Abdominal subcutaneous adipose tissue was obtained from lean and obese subjects with or without type 2 diabetes matched for BMI. Adipocyte size was measured by osmium fixation and sizing/counting in a Coulter counter.

The effects of dietary patterns on urinary albumin excretion: results of the Dietary Approaches to Stop Hypertension (DASH) Trial.

Background: Dietary studies designed to decrease the urinary albumin excretion rate (AER) typically reduce protein by increasing lower protein plant foods and decreasing higher protein animal products.

Study Design: We evaluated AER while increasing protein intake in the Dietary Approaches to Stop Hypertension (DASH) Trial (randomized, parallel group, 8 week controlled feeding).

Setting & Participants: 378 individuals without diabetes with prehypertension or stage I hypertension.

Corrective responses in human food intake identified from an analysis of 7-d food-intake records.

Background: We tested the hypothesis that ad libitum food intake shows corrective responses over periods of 1-5 d.

Design: This was a prospective study of food intake in women.

Methods: Two methods, a weighed food intake and a measured food intake, were used to determine daily nutrient intake during 2 wk in 20 women.

Lifestyle and pharmacological approaches to weight loss: efficacy and safety.

Context: Obesity results from a prolonged small positive energy balance, and its treatment needs to reverse this imbalance.

Evidence Acquisition: Citations retrieved from PubMed and The Handbook of Obesity 2008 were selected to illustrate the points.

Evidence Synthesis: Many different diets have been tried to treat obesity, and weight loss occurs with all of them.

Relation of adipose tissue to metabolic flexibility.

Metabolic flexibility is the capacity for skeletal muscle to shift reliance between lipids and glucose during fasting or in response to insulin. We hypothesized that body fat, adipose tissue characteristics, e.g.

Medications for weight reduction.

Only two drugs are currently approved for long-term use in the treatment of obesity and four others for short-term use. Evaluating the risk-benefit profile is an essential first step. For individuals who have a low body mass index for whom the risk is small, the risk profile must make the drug acceptable for almost everyone.

HF diets increase hypothalamic PTP1B and induce leptin resistance through both leptin-dependent and -independent mechanisms.

Protein tyrosine phosphatase 1B (PTP1B) contributes to leptin resistance by inhibiting intracellular leptin receptor signaling. Mice with whole body or neuron-specific deletion of PTP1B are hypersensitive to leptin and resistant to diet-induced obesity. Here we report a significant increase in PTP1B protein levels in the mediobasal hypothalamus (P = 0.

Triiodothyronine increases calcium loss in a bed rest antigravity model for space flight.

Bed rest has been used as a model to simulate the effects of space flight on bone metabolism. Thyroid hormones accelerate bone metabolism. Thus, supraphysiologic doses of this hormone might be used as a model to accelerate bone metabolism during bed rest and potentially simulate space flight.

Treatment of hypothalamic obesity with caffeine and ephedrine.

Objective: To investigate the hypothesis that the peripheral actions of caffeine and ephedrine to increase sympathetic tone and metabolic rate and to preserve lean tissue will cause weight loss in patients with hypothalamic obesity.

Methods: We present 3 case studies of consecutive patients who presented with hypothalamic obesity and were treated with caffeine (200 mg) and ephedrine hydrochloride (25 mg) 3 times a day.

Results: All patients were gaining weight at the time of initial assessment.