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Obesity is a complex disease due to the interaction between genetic, psychological, and environmental determinants. Sadly, implementing into practice research results is frequently difficult. Many are the obstacles: medical habits, the peculiar organization of the National health service centred on acute diseases treatment, the prevalent narrative of obesity as an aesthetic issue rather than a medical one. Obesity should be considered a chronic diseases, and should be taken into account in the National plan for Chronic Care. Than, specific implementation programmes would be planned, aimed to disseminate knwoledge and skills among the health professionals, fostering multidisciplinarity through continuing medical education of specialized teams.

The dramatic rise in the prevalence of obesity and diabetes has become a major global public health issue. "Prediabetes" is the term used for individuals whose glucose levels do not meet the criteria for diabetes but are too high to be considered normal. Prediabetes is associated with obesity, especially visceral obesity, is a high risk state for diabetes. Obesity management can delay the progression from prediabetes to type 2 diabetes and is beneficial in the treatment of type 2 diabetes. In the strategy of weight loss there are several dietary approaches available, divided between low calories diet and very low-calorie diets (VLCDs). VLCDs include the very-low-carbohydrate diet (VLCKD) can lead to a state of ketosis. Type 2 diabetes (T2D) has long been identified as an incurable chronic disease; on the contrary, there is evidence that the reversibility of type 2 diabetes is achievable using very low calorie diets or carbohydrate restriction diets. This report provides an update on the scientific evidence relating to highly low-calorie diets and the opinion of the President of the Italian Obesity Network.

Objectives: To evaluate the efficacy of treatment protocols in patients overweight/obese, pertaining to outpatient of dietary preventive of SIAN (in English: Service of Food Hygiene and Nutrition) RMA., Materials and Methods: We extracted data from the medical records of patients with BMI≥25 (2009-2012). It was conducted a descriptive analysis, univariate analysis (chi-square test; p≤0.05) and multivariate logistic regression analysis considering as "weight loss" the outcome measure., Results: There were 762 records (76.2% female; mean age 52 years). BMI average of beginning treatment: 30.26; BMI of the end of treatment: 28.37; minimum maximum range of variation of weight after treatment: -28.9 Kg and +6.5 Kg. The 55.2% of the sample has lost up to 4.9 kg, 32.4% from 5.0 to 9.9 kg, 8.1% from 10.0 to 19.9 Kg, 0.9% from 20 to 28.9 Kg. The higher initial BMI and the longer treatment, have a lower likelihood of weight loss (B=-1.267, p<0.001; B =-0.408, p<0.001); females and those who have an older age are more likely to lose weight (B=0.030, p<0.003; B=1.260, p<0.001)., Conclusions: The current study highlight the efficacy of treatment protocols in overweight/obese patients. The population that benefits from the treatment more rigidly set on the estimated caloric needs is the one that starts from lower BMI and who therefore need less time to reach a certain weight loss. Instead, those who started from higher BMI is a population supposedly "binger", more resistant to the single dietary treatment and, as recognized by the scientific community, it requires a multidisciplinary approach.

Obesity in childhood is associated with the presence of complications that can undermine health immediately or in the long term. Several conditions, such as pulmonary or orthopedic complications are strictly associated with the severity of overweight, since they are directly associated to the mechanic stress of fat tissue on the airways or on the bones. Other conditions, such as metabolic or liver complications, although increasing with the extent of overweight, are associated with insulin resistance, which can be modulated by different other factors (ethnicity, genetics, fat distribution) and can occur in overweight children as well. No less important are psychological correlates, such as depression and stigma, which can seriously affect the health related quality of life. Pediatric services for the care of childhood obesity need to be able to screen overweight and obese children for the presence of physical and psychological complications, which can be still reversed by weight loss. This article provides pediatricians a comprehensive update on the main complications in obese children and adolescents and their treatment.

Unlabelled: Obesity is increasingly encountered in dialysis patients, who have difficulty to lose weight. Several Transplant Centres require BMI <30-35 Kg/m2 at waiting-list. Thus, losing weight becomes a must for young obese patients, however the best policy to obtain it (if any) is not defined. The aim of the present case report is to suggest that tailored dialysis and intensive diets could be a successful combination, that should be tested on a larger scale. A 56-year-old obese male patient (BMI 37.7 kg/m²) on daily home hemodialysis since 10 months (ESRD due to focal segmental glomerulosclerosis) started a coach-assisted qualitative ad libitum diet. The diet, alternating 8 weeks of rapid weight loss and maintenance phases, was based on a combinations of different foods, chosen on the account of glycaemic index and biochemical properties. It was salt free and olive oil was permitted in liberal quantities. Dialysis duration was increased to allow weight loss, and dialysate Na was incremented to permit a strict low sodium diet. Over a period of 21 months, the patient attained a -18.5 Kg weight loss (50% overweight loss; BMI -6.3 Kg/m²), reaching the goal to be included in a kidney transplant waiting list. Main metabolic data remained stable (pre diet and end of the diet period: albumin 3.5-3.8 g/dL; HCO3 26.1-24.8 mmol/L discontinuing citrate) or improved (haemoglobin 11.4-12.1 g/dL, halving EPO dose; calcium 2.3-2.5 mmol/L; phosphate 1.5-1.5 mmol/L; PTHi 1718-251 pg/mL, reducing chelation)., Conclusion: Daily dialysis may allow enrolling obese hemodialysis patients in intensive weight loss programs, under strict clinical control.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Background and Aims: Arterial hypertension is a well known risk factor for cardiovascular diseases. Today, it is possible to calculate the cardiovascular risk at 10 years with the risk card. The reduction of cardiovascular risk is based on a multi-factorial approach including the lifestyle modification. In Italy, OEC study has calculated that a certain proportion of borderline hypertensives, not eligible for a pharmacological treatment, remain at risk. Borderline arterial hypertension (140-150/90-95 mmHg) in Italian population is documented in 19% of males and 14% of females.: Aim of the study is to examine the efficacy of the lifestyle changes in reducing the global cardiovascular risk in bordeline hypertensives., Materials and Methods: 102 patients affected by borderline hypertensive (46 M and 56 F, mean age: 55.6 yrs ) were enclosed in a 12 months prospective study. Three checks were programmed during the follow-up, i.e., at beginning, 6 months and 12 months later. At the start of the study every patient received a list of lifestyle changes to be respected. Pressure arterial systolic and diastolic were obtained at beginning and at the end of successive. At the last check each patient received a questionnaire to be filled up. According to the calculated score, each patient was classified as: non-responder (score: 0-3), partially responder (score: 4-6), responder (score: 7-9)., Results: A significant reduction of the globalcardiovascular risk has been observed at the end of the study in both the responders and partially responders. Such a reduction was seen to be due to positive changes in blood pressure and total, HDL, LDL cholesterol., Conclusions: This study confirmed that a non-pharmacological therapy based on lifestyle changes has to be preventively administered in the presence of a borderline hypertension because of its beneficial effects in reducing the global risk of cardiovascular disease. Therefore, we firmly think that a prompt utilization of a correct lifestyle can sort the triple effect of improving the expectancy of life, ameliorating the quality of life, reducing the social costs of arterial hypertension.

According to the World Health Organization, obesity is one of the most common nutritional problem among children. The major determinant of this enormous increase in obesity prevalence is modern lifestyle and the consumption of very caloric foods such as fast-food products. Actually, there is a strong relationship between obesity and hypertension, type 2 diabetes mellitus, dyslipidemia, obstructive sleep apnea, and orthopedic problems. The aim of this review is to discuss the main mechanisms that link obesity to cardiovascular disease.

The metabolic syndrome (MS), a cluster of risk factors, such as obesity, hyperglycemia, hypertension and dyslipidemia, contributes to the development of cardio-vascular diseases and type 2 diabetes mellitus (DM2). Insulin resistance (IR) plays a key role in MS being strongly linked to abdominal visceral fat. Treatment for obese patients with MS should aim at improving IR, delaying the onset of DM2 and at reducing cardio-vascular risk. Weight loss, first therapeutic target, may be obtained through life-style modifications and anti-obesity drugs or bariatric surgery, at need. In these patients drug therapy is necessary if therapeutic life-style changes are not sufficient. Some drugs have adverse metabolic effects, therefore the therapeutic choices must be specific and rational. Metformin, Thiazolidinediones and Acarbose are anti-hyperglycemic drugs of choice: they reduce the incidence of DM2 and IR (or improve insulin sensitivity) and they decrease or stabilize the visceral adipose tissue mass (Thiazolidinediones increases subcutaneous fat only). Also Angiotensin II receptor blockers and Angiotensin-converting enzyme inhibitors reduce the incidence of DM2 and insulin resistance and they are first-line antihypertensive drugs in MS. Calcium channel blockers, Alpha-1 antagonists and Alpha-2 agonists drugs are metabolically neutral and slight weight gains are related to the hydro-sodium retention. Beta-blockers and Diuretics, except for Indapamide and Anti-aldosterone drugs, can reduce insulin sensitivity, impair lipid profile and increase DM2 incidence; they are not first-line therapy yet they are necessary in selected cases only. Statins, Fibrates and omega-3 Fatty acids are indicated to normalize dyslipidemia. Low doses of acetylsalicylic acid are also recommended.

The prevalence of obesity is increasing rapidly in most industrialized countries and it is known that obesity is associated with increased risk of cardiovascular morbidity and mortality. Commonly, obesity is defined by the Body Mass Index (BMI). However, BMI fails to consider body fat distribution. The relationship between the risk of metabolic-cardiovascular diseases and body fat distribution indices, rather than measures of the degree of body fatness as expressed by BMI, has long been recognized. Clinical and epidemiological research has found waist circumference to be the best anthropometric indicator of both total body fat and intra-abdominal fat mass. Android obesity is associated with metabolic syndrome and increased cardiovascular risk through molecular mechanisms possibly linking the metabolic syndrome to hemostatic and vascular abnormalities. Obesity guidelines suggest the need for weight reduction using behavioural change to reduce caloric intake and increasing physical activity. A realistic goal for weight reduction is to reduce body weight by 5% to 10% over a period of 6 to 12 months. Combined intervention of a low calories diet, increased physical activity, and behaviour therapy provides better outcomes for long-term weight reduction and weight maintenance than programs that use only one or two of these modalities. The anorexiant drugs affect neurotransmitters in the brain. The sibutramine has norepinephrine and serotonin effects. Orlistat has a different mechanism of action: the reduction of fat absorption. Recently, the blockade of the endocannabinoid system with rimonabant may be a promising new strategy.

Obese adolescents are prone to several pathologies, which may begin in this period of life and have a continuity in adult age. In this review the author tries first to explain the obesity definition in infants, children, and adolescents. Some pathologies may appear in adolescent age. First of all, some features of the so called metabolic syndrome; furthermore, hormonal alteration during and after puberty, genital appearance in the obese adolescent male, respiratory problems as apnea, asthma, and the Pickwick syndrome. The non alcoholic fat liver disease is also described, and the orthopedic problems as well, owing to the overweight: from abnormal body posture to structural consequences on the skeleton. Finally, some remarks concerning pharmacological and surgical approach are presented.

In patients affected of polycystic ovary syndrome (PCOS), obesity has an high percent of incidence and represents an important factor increasing its clinic evolution, both in metabolic than in reproductive terms. For these patients non pharmacologic treatments aimed at the reduction of body weight, such as diets and physical exercise, represent the first line therapeutic approach. The aim of this review is to analyze the changes in life style and to highlight their efficacy in reducing the negative effects of PCOS on metabolism and reproductivity. Specifically different types of diet have been compared, in health or PCOS women, such as low glycemic index diets, moderate carbohydrate, high protein and low fat diets, very low carbohydrate and high fat diets and, finally, moderate carbohydrate and high monounsaturated fat diets. In the global view of the approach to the disease, different regimens of physical activity and the usefulness of a behavior therapy were also evaluated. Results obtained in health women suggest that diets higher in proteins and lower in carbohydrates are to be preferred to the conventional diet lower in fats and higher in carbohydrates. Anyway other studies are necessary to justify a similar assertion in women with PCOS. At the same way, the optimum regimen of physical exercise for PCOS women is still to be demonstrated.

Background: Obesity, is one of the most common nutritional disorder in developed countries. The association with several health disorders (i.e., type 2 diabetes mellitus, hypertension, hyperlipidemias, cholelithiasis, obstructive sleep apneas, coronary heart disease, cancer) is frequently present., Design: Obesity is, actually, measured using body mass index (BMI) determination. However, BMI isn't useful to predict body fat content. Skin-fold thickness, bioelectrical impedance analysis and/or dual energy x ray absorptiometry are specific tools with different capability to measure body composition (i.e., fat mass and fat-free mass). All these methods need a large data-base of age, sex and population reference values., Conclusions: Obesity management (dietary treatment, monitoring of weight loss, pharmacologic approach, and surgery ) is associated with several complications and errors.

In the last years, there are always more people with obesity those recourses at the specifics therapeutics treatments to answer at the behaviour food disorders. In this case, to cure the obesity more people to resort at bariatric surgical treatments or with not invasion treatments, with the objective to improve the quality of life. In reference at this problem, will be introduced a typical case as evidence towards a problem who the national nursing literature do not to be concerned with enough attention. The object will be that to increase the awareness towards mental and physical problems that obese people lived today in the society and the importance about this problem of the management nursing care.

The recent ATP III classification defines metabolic syndrome as including > or = 3 of the following characteristics: abdominal adiposity, atherogenic dyslipidemia, high blood pressure, and insulin resistance. In these patients the visceral fat may produce inflammatory cytokines that may account for an enhanced cardiovascular risk. The treatment of obese patients is complex and often ineffective: patients may initially reduce weight but subsequently regain or even increase it, according to the so-called "yo-yo syndrome". Given the difficulties of treatment of patients with increased BMI, visceral adiposity, or metabolic syndrome, a multidisciplinary approach to these patients may yield more frequent positive results. The different strategies that may be applied, in varying mix targeted to the individual patient, include diet, drugs, educational and psychological support and, in few selected cases, surgery.

A growing organism needs to have a steady availability of nutrients, in suitable quantities and in correct ratios, in order to achieve its genetic potential. Overweight and obesity in growing individuals may conceal lack of one or more nutrients. Obesity in childhood is the consequence of an excess of calories compared with the energetic waste because of the interlacing of genetic factors, metabolic factors (cellularity of the adipose tissue, deficit of thermogenesis), excessive food intake, alteration of some neuro-endocrine mechanisms which regulate bodily weight (set point theory), lack of suitable physical exercise; therefore a complicity of endogenous, exogenous, biological, psychological and social factors to which we cannot ascribe singularly a primary role. It is however necessary to start, since the first year of a child's life, a food education program as the latest acquisition shows that degenerative pathologies of metabolism start in a very precocious age and unbalanced nutrition starts since childhood. The most suitable therapeutic approach is that which takes in consideration all the aspects of obesity. This requires an intervention on several aspects: food, psychological mechanisms which sometimes are the cause of hypernutrition, attitude towards physical exercise, and also family and social behaviors concerning the patient. The traditional diet approach towards childhood obesity is based on balanced hypochaloric diets which provide about 1200-1800 kcal per day, distributed in 4 or 5 daily meals. The correct meal division educates the child to self-control and it is advantageous from a metabolic point of view because it avoids both high instability of glyco-insulin, caused by an excess of food, and because improving thermogenesis, induced by the diet, the result will consist in an increase of energetic waste. For the main meals it is advantageous to apply to a main course.

This article provides current guidelines on the treatment and prevention of childhood obesity. Since factors involved in obesity change with age, the therapeutic approach in pre-school children will be different from pupils and adolescents. The treatment will also be modulated on the basis of weight excess, weight gain velocity and complications. The main goal of the treatment should be to encourage the child and his family to have healthy lifestyle. Families who are not ready for change might benefit from counselling to improve motivation before starting treatment. A detailed alimentary and behavioural history is the start point of the treatment. The strategy of the intervention is to induce changes at three levels: 1) attitudes of parents; 2) physical activity; 3) energy intake. The treatment of the adolescents should take into account the pubertal changes and the psychological aspects of this peculiar period of life. Obesity is a chronic disease and its treatment needs long-life follow-up. The long-term results of the obesity treatment are often disappointing and we have to consider consistent prevention programs for better results.

About 2-3% of "essential" obesity in pediatric age is of endocrine or genetic origin (secondary obesity). The clinical picture of these forms is almost always characteristic; however, some patients affected by secondary obesity can present with an incomplete or atypical aspect. The aim of this review is to offer the pediatrician useful indications to correctly diagnose children presenting with obesity. It is advisable to make a careful anamnesis and an accurate medical examination in order to ascertain the causes that may have contributed to the onset and increase of weight gain. Obesity associated with mental retardation, short stature, cryptorchidism or hypogonadism, dysmorphism with facies sui generis, ocular or uditive defects, might suggest a genetic origin. Prader-Willi syndrome is the most frequent of these disorders and it is due to an alteration of chromosome 15 of paternal origin. These patients have to undergo the methilation test (easy and low cost genetic research) in order to confirm the clinical suspicion. Endocrine alterations, that play a pathogenic role in pediatric obesity (i.e., hypothyroidism, hypothalamic-pituitary diseases, pseudohypoparathyroidism), are rare. Early treatment of hormonal dysfunction generally allows to ameliorate or normalize the weight gain. In absence of specific clinical manifestations or lacking a significant clinical history, no endocrine test is required. The family pediatrician should require some routine hematochimic tests, in order to evaluate the possible presence of hyperlipidemia and/or glycometabolic complications. An oral glucose tolerance test is necessary only for patients presenting with serious weight gain, acanthosis nigricans, and for those with a family history of diabetes. In the most serious cases, a careful cardiovascular and respiratory evaluation should be performed. Children with a suspicion of secondary obesity have to be submitted to an endocrinologist, for a correct diagnosis and a specific treatment. However, the family pediatrician's assistance is essential during the follow-up period, in order to assure the patient and his/her family a proper assistance.

The centralization of body fat, particularly in abdominal or visceral depots, is associated with qualitative and quantitative lipid abnormalities. Examples of these qualitative alterations include changes in low density lipoprotein composition, namely an increased number of small or dense low density lipoprotein particles, which seem to be prone to increased lipid oxidation. Oxidative modification of low density lipoproteins is involved in atherosclerotic development of the arterial wall. Alterations of lipid composition often arise in a context of insulin resistance with hyperinsulinism. Genetic features, such as apolipoprotein E polymorphism, also play a significant role in lipoprotein metabolism. The principle treatment of obesity and associated dyslipidemia is to reduce energy intake through diet. Moderate exercise is effective, especially in patients with insulin resistance. Drug therapy is considered primarily for patients who refuse to make behavioral changes.

EUROASPIRE study has been carried out in 9 European countries with the aim of assessing coronary risk factors in high-risk patients admitted to hospital to undergo coronary revascularization procedures (coronary angioplasty or coronary artery bypass grafting) or because of angina or myocardial infarction. The results of the initial stage of the study in Italy, investigating the data from 691 hospital medical records, showed that management of risk factors in these patients was inferior than expected. In particular, the prevalence of hyperlipidaemia (63%), hypertension (40%) and diabetes (27%) was remarkably high. These results suggest that there is still a need for secondary prevention of coronary heart disease.

The male adolescent may present several endocrinological problems, the most frequent of which is the retardation or absence of puberty due to constitutional delay of growth and development. This form does not require therapy and must be distinguished from other forms of hypogonadism (primitive or secondary) by endocrine tests (LHRH test, nightly pulses LH secretion, plasmatic basal level of testosterone and after HCG, cerebral NMR). Hypogonadism treatment consists of replacement therapy with testosterone or testes stimulation with HCG or LHRH. Another frequent disease is gynecomastia, usually due to physiological enlargement of mammary gland during pubertal development, sometimes it may be secondary to hypogonadism, tumors, liver function abnormalities. Severe or psychologically disturbing gynecomastia can be corrected by reductive mammoplasty. Very often, adolescents may present diseases related to incorrect food habits. Obesity is common and anorexia is becoming an important problem also in males.

Weight gain substantially modifies the exterior appearance and the body of obese subjects assumes a shape which does not conform to esthetic concepts and socially accepted body image, thus exposing the subject to a series of difficulties. In this study the a. illustrate the importance of group treatment in this context, and also review the most recent literature on this subject.

In adult obese patients both an increase of aminotranspherase values and hepatic steatosis have been frequently showed. Conversely in childhood the existence of a liver's damage is often not investigated. To assess the prevalence of hepatic alterations in obese children, we studied 135 subjects, all affected by simple obesity, showing in a 20% of them the presence of ultrasonographic evidence of hepatic steatosis and/or hyperaminotransferasemia. Our study demonstrates the existence of silent hepatic alterations also in obese children and suggests to improve the treatment of obesity in childhood to prevent the progression of liver's damage.

We controlled, after nine months, 29 obese children, who attended the primary school, and to whom it was advised a good balanced base diet of 1200 kcal. One child wasn't obese anymore, and in 13 cases there was a sensible reduction of overweight percentage. We consider these results positively, because our aim was to obtain a gradual resolution of the overweight, trying to avoid some very dangerous relapses for the young's future. Finally, we underline the necessity to begin some conferences about the young's and family's alimentary education, as soon as possible. These conferences have to be addressed to all the teachers, parents and pupils, from the primary school.

Obesity is a social disease and amounts to a real medical problem. After considering its epidemiology, the authors discuss diagnostic methods, etiopathogenesis, clinical features, complications, and management of obesity. Special stress is laid upon particular problems concerning the causes of obesity which are often difficult to identify, and difficulties of long-term treatment. Thus it becomes obvious that the disorder must be prevented, and maximum attention must be placed on renewed weight increase.

Obesity, a pathology with a multifactorial etiopathogenesis currently has an incidence of around 6% in the adult population in Italy. Considering that this disease provokes a statistically significant reduction of life expectancy, there is an evidence need to create structures which can deal with this problem. For this purpose, the Centre for the prevention and cure of obesity was set up by the Department of Surgery and Anatomy at the University of Palermo in 1990. It makes use of the specialist skills of experts in internal medicine, dieticians, cardiologists, psychologists and surgeons. In particular the authors give a detailed description of the diagnostic iter used and the methods of follow-up adopted for patients undergoing biliopancreatic diversion (BPD) surgery. In conclusion, the authors emphasize the need for a multidisciplinary approach to this pathology since this is the only way of minimizing complications arising during BPD surgery and obtaining the best results.

Increased parietal stress, in hypertensive obese patients, produces a left ventricular hypertrophy. In this study we demonstrated that the association of amlodipine with hypocaloric diet can decrease the parietal stress. MATERIALS AND METHODS. From February to July 1993 32 hypertensive obese patients (17 males, 15 females) were treated with amlodipine 10 mg/day for six months. Sixteen patients were treated with amlodipine 10 mg/day (Group A) and 16 patients were treated with amlodipine 10 mg/day and hypocaloric diet (Group B). All patients included had a Body Mass Index > 30 and diastolic blood pressure > 100 mmHg. The patients were studied with 2D guided M-mode echocardiogram before treatment and after 6 months. RESULTS. In Group A the septal thickness, the posterior wall thickness and the left ventricular mass decreased significatively (p < 0.05). In the Group B also the left ventricular diastolic diameter and the left atrial diameter decreased. CONCLUSION. The association of a hypocaloric diet with amlodipine therapy, in hypertensive obese patients, improves the effect of the drug on ventricular hypertrophy.

The relationships between the resting energy expenditure (REE), measured by indirect calorimetry, and eating behavior, assessed by the "Three Factor Eating Questionnaire" were evaluated. The study was carried out in a group of healthy never-obese subjects and in two groups of formerly obese people, who have maintained a normal weight for more than two years. The subjects of the first formerly obese group had brought their body weight to normal by dieting. The second one comprised subjects following biliopancreatic diversion for obesity (BPD) in the long term, who maintain a normal weight because of the intestinal malabsorption due to the operation regardless of food consumption. In comparison with the other subjects, significantly higher cognitive restraint score values were observed in the post-diet subjects. Furthermore, a negative significant correlation between cognitive restraint and REE was found in the non operated subjects, while such correlation was not present in the BPD subjects. Therefore, in normal people cognitive restraint has to be considered to be related to behavioral-cognitive factors rather than biologically driven by energy requirements.

Aim of the study was to observe if the administration of an anorectic drug, d-fenfluramine, in addition to hypocaloric diet, could influence the body composition and adipose mass distribution during a weight decrease programme in 17 obese women. Drug's effects plus diet on body weight changes were compared with those of a "only-diet programme" in another group of 18 obese subjects, sex and age matched. Both groups were observed for a 6-month period. All subjects were selected on the base of Index Body Weight % within 120-200 and without any therapy for other diseases. Blood samples were drawn before, during (3rd month) and after the period of observation for the measurement of OGTT, serum lipids, liver and kidney function parameters, blood cells count. Body weight and height, body composition, waist-to-hip ratio were also evaluated. Results documented: 1) significant reduction of body weight in the group kept on the combined therapy; 2) significant variation of body composition with increment of fat free mass and adipose mass decrease; 3) significant improvement of glucose tolerance, liver and kidney function parameters. In conclusion, our data show beneficial effects of d-fenfluramine on appetite reduction, influencing the carbohydrates assumption and the consequent fat mass loss with a good tolerability of the drug.

The object of the present research was to study the effect of dexfenfluramine (d-F) and placebo (P) on compliance with dietary treatment, especially as far as changes in kcal and macronutrient intake are concerned. A double-blind study d-F vs P was performed in 36 obese females, age range 20-59 years (mean 37.22 +/- 12.41), with a mean BMI of 33.95 +/- 5.36, suffering from obesity due to overeating without complications: Outpatient control every 30 days. The study protocol provided for a 14-month double-blind treatment with daily administration of either P (2 capsules) or d-F (two 15 mg capsules). Dietary prescription of 1200 kcal (5016 kJ) was given 15 days before enrollment (T/0) and during this period enrollment criteria were checked prior to randomization. Dietary intake was checked by a three-day recall (one working day, one half-holiday and one full holiday) in basal conditions and after 6-12 and 14 months. Administration of d-F and P brought about changes in alimentary behaviour in obese patients according to the dietary regime prescribed. In our patients, no highly significant differences between d-F and P were observed; however, the effect of P on macronutrient intake (carbohydrates, lipids and proteins) tended to peter out around the 12th month. Treatment with d-F reduced the consumption of simple carbohydrates, animal fats but not of animal proteins.

On April 5th and 6th 1991, at the National Research Council (CNR) in Rome, a Consensus Conference on the relationship between Overweight, Obesity and Health was held. The Conference was sponsored by FATMA (Applied Project on Disease Factors of the CNR) and UICO (Italian Society for the Study of Obesity) with the purpose of establishing guidelines for health employees. The development of the Conference followed the methodology set down by OMAR to obtain a rational and significant consensus on the answers to 6 basic questions prepared by the Planning Committee. The questions were the pivotal point of the Conference and were brought to the attention of all the attendees and widely diffused among the medical community; they were proposed with the aim of giving an exhaustive definition of obesity, to investigate its relationship with mortality and morbidity, to highlight its social characterization, to indicate methods of evaluation and recommendations for weight loss, to select groups at risk, and to focus general guidelines for research. After the presentation of the state of the art on 18 topics by experts in the field, the 22 members of the Consensus Panel, impartial experts from a vast area of the scientific community, discussed a draft document representing the answers to the questions, which was subsequently illustrated to the 307 attendees, discussed and then approved. This paper is the definitive document of the Consensus Conference. The introduction explains the reasons which led to the decision to promote the Conference six years after the one held in the United States. The methodology is then set out. The questions are answered in the form of recommendations and backed up by data and scientific demonstrations from the literature.

The authors evaluated the usefulness of the psychological therapy in addition to usual diet treatment. Fifty subjects with severe obesity, have been randomly assigned to two different treatment groups: a) diet; b) diet plus psychotherapy. At the end of the study only the patients treated with diet plus psychotherapy showed any highly significant body weight reduction and a better diet adherence.

The commonest, most frequent causes of obesity and dietological, pharmacological and surgical means available to the physician to address and solve this type of condition are reviewed.

The use of inflatable intragastric balloons is a new non-intensive approach in the treatment of obesity when poor results are obtained by more conservative treatment. The intragastric balloons are certainly less hazardous than bariatric surgery but their long term effect on body-weight reduction it is not still proved. Several types of balloons are currently in use. The two used most widely are the Garren-Edwards Gastric Bubble and the Ballobes Balloon. The Authors report their experience with these two types of anti-obesity gastric-balloon in 60 grossly obese patients.