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Factors of the Eating Inventory-51 (EI) were revealed as significant predictors of health risks. Associations of EI factors (restraint, disinhibition, hunger) with cardiometabolic risk parameters and selected hormones were analysed before and after an in-patient weight reduction programme. Sixty-seven women (age: 48.7 ± 12.2 years; body mass index: 32.4 ± 4.4 kg/m(2)), who exhibited stable weight on a 7 MJ/day diet during the first week, obtained a 4.5 MJ/day diet over the subsequent 3-week period. No significant relations were observed before the weight reduction. After weight loss, restraint score negatively correlated with total cholesterol, fasting blood glucose, C peptide, insulin and neuropeptide Y. Hunger score was positively related to insulin and neuropeptide Y. Disinhibition score correlated positively with lipid profile and neuropeptide Y, while negatively with adiponectin. An implementation of a standard dietary and lifestyle pattern for 3 weeks revealed significant associations between EI factors and metabolic risks in women.

The prevalence of obesity is increasing in both developed and developing countries, with rates reaching approximately 10-35% among adults in the Euro-American region. Obesity is associated with increased risks of cardiovascular diseases, type 2 diabetes, arthritis, and some type of cancers. Obesity significantly affects the quality of life and reduces the average life expectancy. The effective treatment of obesity should address both the medical and the social burden of this disease. Obesity needs to be treated within the health care system as any other complex disease, with empathy and without prejudice. Both health care providers and patients should know that the obesity treatment is a lifelong task. They should also set realistic goals before starting the treatment, whereas keeping in mind that even a modest weight loss of 5-15% significantly reduces obesity-related health risks. Essential treatment of obesity includes low-calorie low-fat diets, increased physical activity, and strategies contributing to the modification of lifestyle. Anti-obesity drugs facilitate weight loss and contribute to further amelioration of obesity-related health risks. A short-term weight loss, up to 6 months, is usually achieved easily. However, the long-term weight management is often associated with a lack of compliance, failures, and a high dropout rate. Regular physical activity, cognitive behavioral modification of lifestyle, and administration of anti-obesity drugs improve weight loss maintenance. Bariatric surgery is an effective strategy to treat severely obese patients. Bariatric surgery leads to a substantial improvement of comorbidities as well as to a reduction in overall mortality by 25-50% during the long-term follow-up. Obesity treatment should be individually tailored and the following factors should be taken into account: sex, the degree of obesity, individual health risks, psychobehavioral and metabolic characteristics, and the outcome of previous weight loss attempts. In the future, an evaluation of hormonal and genetic determinants of weight loss could also contribute to a better choice of individual therapy for a particular obese patient. A multilevel obesity management network of mutually collaborating facilities should be established to provide individually tailored treatment. Centers of excellence in obesity management represented by multidisciplinary teams should provide comprehensive programs for the treatment of obesity derived from evidence-based medicine.

Among the factors influencing weight loss and maintenance, psychobehavioral, nutritional, metabolic, hormonal and hereditary predictors play an important role. Psychobehavioral factors influence adherence to lifestyle changes and thus weight loss maintenance. The outcome of short-term weight reduction treatment is mainly affected by changes in energy and nutrient intake and physical activity and thus the impact of hormones can possibly be obscured. In order to reveal hormonal determinants of weight loss, a 4-week in-patient comprehensive weight reduction program was introduced in which food intake and physical activity were under the strict control. Women (n = 67, BMI: 32.4+/-4.4 kg; age: 48.7+/-12.2 years) who exhibited stable weight on a 7 MJ/day diet during the first week of weight management were given a hypocaloric diet yielding daily energy deficit 2.5 MJ over the subsequent 3-week period. This treatment resulted in a mean weight loss of 3.80+/-1.64 kg. Correlation analysis revealed that baseline concentrations of several hormones were significantly associated either with a higher (free triiodothyronine, C-peptide, growth hormone, pancreatic polypeptide) or with a lower (insulin-like growth factor-I, cortisol, adiponectin, neuropeptide Y) reduction of anthropometric parameters in response to weight management. In a backward stepwise regression model age, initial BMI together with baseline levels of growth hormone, peptide YY, neuropetide Y and C-reactive protein predicted 49.8 % of the variability in weight loss. Psychobehavioral factors (items of the Eating Inventory, Beck Depression score) did not contribute to weight change induced by a well-controlled short-term weight reduction program.

Short-term weight-reducing regimens were shown to influence fatty acid composition of serum lipids unfavorably. Adding long chain n-3 polyunsaturated fatty acids (n-3 LC PUFA) to a low-calorie diet (LCD) could avoid these changes. The aim of this study was to examine the effect of a short-term in-patient weight-reducing regimen including LCD with yogurt enriched by low doses of n-3 PUFA (n-3 LCD). The enriched yogurt contained 790 mg of fish oil, predominantly eicosapentaenoic (20:5n-3; EPA) and docosahexaenoic (22:6n-3; DHA). Forty obese women were randomly assigned to the group consuming LCD and joghurt either with or without n-3 enrichment. Following the 3-week diet in the n-3 LCD group a significantly higher increase in the proportion of n-3 LC PUFA (sum of n-3 FA, EPA and DHA) in serum lipids was confirmed. In phospholipids (PL) a significant difference in the sum of n-6 fatty acids was found, a decrease in the n-3 LCD group and an increase in LCD group. Significantly higher increase in the PL palmitate (16:0) was shown in the LCD group. The results suggest that low doses of n-3 fatty acid enrichment can help to avoid unfavorable changes in fatty acid composition in serum lipids after a short-term weight-reducing regimen.

Polyunsaturated fatty acids of n-3 series (n-3 PUFA) were shown to increase basal fat oxidation in humans. The aim of the study was to compare the effect of n-3 PUFA added to a very low calorie diet (VLCD), with VLCD only during three-week inpatient weight reduction. Twenty severely obese women were randomly assigned to VLCD with n-3 PUFA or with placebo. Fatty acids in serum lipid fractions were quantified by gas chromatography. Differences between the groups were determined using ANOVA. Higher weight (7.55+/-1.77 vs. 6.07+/-2.16 kg, NS), BMI (2.82+/-0.62 vs. 2.22+/-0.74, p<0.05) and hip circumference losses (4.8+/-1.81 vs. 2.5+/-2.51 cm, p<0.05) were found in the n-3 group as compared to the control group. Significantly higher increase in beta-hydroxybutyrate was found in the n-3 group showing higher ketogenesis and possible higher fatty acid oxidation. The increase in beta-hydroxybutyrate significantly correlated with the increase in serum phospholipid arachidonic acid (20:4n-6; r = 0.91, p<0.001). In the n-3 group significantly higher increase was found in n-3 PUFA (eicosapentaenoic acid, 20:5n-3, docosahexaenoic acid, 22:6n-3) in triglycerides and phospholipids. The significant decrease of palmitoleic acid (16:1n-7) and vaccenic acid (18:1n-7) in triglycerides probably reflected lower lipogenesis. A significant negative correlation between BMI change and phospholipid docosahexaenoic acid change was found (r = -0.595, p<0.008). The results suggest that long chain n-3 PUFA enhance weight loss in obese females treated by VLCD. Docosahexaenoate (22:6n-3) seems to be the active component.

Obesity has become one of the most serious public health problems affecting both the developed and developing countries today. Obesity develops as a result of the positive energy balance. Therefore the strategies in obesity prevention and management are targeted on the energy balance. Dietary weight management should be focussed on the reduction of fat intake as fat among the three macronutrients exhibits the highest energy density and the lowest satiating properties as well as the lowest postprandial thermogenesis. Although carbohydrate does not play such an important role in the pathogenesis of obesity as fat, the intake of simple carbohydrate should be reduced during the treatment of obesity and metabolic syndrome. Different metabolic consequences of the intake of individual fatty acids (polyunsaturated and n-3 fatty acids vs. saturated fatty acids), individual carbohydrates (low vs. high glycaemic index carbohydrates) and fibre should be considered during the weight management. Dietary protein positively affects the outcome of weight management through the enhancement of postprandial satiety and thermogenesis. Recently a role of consumption of calcium, phosphate and vitamin A in the body weight regulation and weight management has been also studied.

The first aim of the present study was to evaluate the changes in serum levels of cortisol, testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulphate (DHEA-S) and sex hormone-binding globulin (SHBG) in response to weight loss induced by one month of treatment with a very low-calorie diet (VLCD) in twelve pairs of female obese monozygotic twins. The second aim of the study was to investigate any within-pair resemblance in serum levels of steroids and SHBG before and after a negative balance protocol, as well as the resemblance in changes in response to therapeutic weight loss. VLCD-induced weight loss of 8.7+2.9 kg was associated with significant increases in serum testosterone (p<0.05) and SHBG (p<0.001) levels, whereas no significant changes in serum levels of cortisol, DHEA and DHEA-S were observed. Significant within-pair resemblances for both pre-treatment and post-treatment concentrations were revealed for DHEA-S (pre-treatment ICC = 0.795, p < 0.01, post-treatment ICC = 0.712, p < 0.01) and for testosterone (pre-treatment ICC = 0.594, p <0.05, post-treatment ICC = 0.735, p < 0.01). The baseline within-twin-pair resemblance in serum cortisol level at 7 a.m. (ICC=0.747, p < 0.05) was lost with VLCD treatment, while its concentration at 9 p.m. developed a within-pair similarity with weight loss (ICC = 0.824, p < 0.001). Similarly, VLCD treatment led to a significant within-pair resemblance in post-treatment level of DHEA (ICC = 0.755, p < 0.01), while no within-twin-pair resemblance was shown for either pre-treatment or post-treatment SHBG levels. None of the hormones measured exhibited any within-pair resemblance in response to VLCD-induced energy deficit, except for serum cortisol levels. A significant within-twin-pair resemblance in the changes in serum cortisol levels at 7 a. m. (ICC = 0.789, F = 8.5, p < 0.001), at 1 p.m. (ICC = 0.660, F = 4.9, p <0.01) and at 9 p.m. (ICC = 0.795, F = 8.8, p <0.001) were demonstrated even after adjustment for fat mass loss. An absence of any within-pair similarity was observed in both pretreatment and post-treatment levels of SHBG, while a significant within-pair resemblance in SHBG response to VLCD treatment (ICC = 0.658, p < 0.05) was recorded. We conclude that the significant within-twin-pair resemblance demonstrated for androgens and cortisol might suggest an important role for genetic factors in the regulation of their serum levels. Our results also suggest that the mechanisms controlling baseline levels of cortisol and SHBG differ from those influencing their responses to energy deficit induced by VLCD.

Objective: To assess the genetic contribution to determinants of therapeutic weight loss in obese female identical twins., Design: Subjects were studied for 40 days on an inpatient unit in three phases: 7 baseline days; 28 days of weight reduction by a very low calorie diet (1.6 MJ per day); and 5 days after weight reduction., Subjects: Fourteen pairs of premenopausal obese female identical twins (age: 39.0+/-1.7 y; body weight (BW): 93.9+/-21.2 kg; body mass index (BMI): 34.2+/-7.8 kg/m2)., Measurements: : Body composition by hydrodensitometry and resting metabolic rate by indirect calorimetry were assessed before and after weight loss., Results: : There was great variability among pairs in loss of weight (5.9-12.4 kg) and body fat (3.1-12.4 kg). By contrast, the intraclass correlation (ICC) within twin pairs was 0.85, P<0.001 for weight and 0.88, P<0.001 for body fat. A measure of metabolic efficiency, calculated as the difference between 'estimated' and 'measured' energy deficit showed high intrapair correlation (ICC=0.77; P<0.001)., Conclusions: The high correlation in metabolic efficiency within twin pairs in response to therapeutic weight loss suggests a strong genetic contribution.

Objective: To assess intrapair resemblance in changes of body weight, total body fat, fat distribution, resting metabolic rate, fasting respiratory quotient and cardiovascular disease risk factors in response to therapeutic weight loss in female obese identical twins., Design: Patients stayed for 40 days on an inpatient metabolic unit under careful supervision. The stay was divided into three parts: an initial period of 7 days for adjustment to the hospital environment and for baseline measurements, 28 days of the weight reduction regimen when negative energy balance was achieved mainly by a very low calorie diet (1.6 MJ per day) and 5 days of testing after weight reduction., Subjects: Fourteen pairs of premenopausal female obese identical twins (age: 39.0+/-1.7 y; body weight (BW): 93.9+/-21.2 kg; body mass index (BMI): 34.2+/-7.8 kg/m2) participated in the study., Measurements: Before and after weight loss, the following measurements were made: body composition by anthropometry and hydrodensitometry, intra-abdominal fat by ultrasonography, resting metabolic rate by indirect calorimetry. Total cholesterol, high-density lipoprotein-cholesterol, triglycerides and uric acid were determined by standard laboratory procedures. Blood pressure was measured in the morning in the recumbent position., Results: Subjects lost 8.8+/-1.9 kg of weight, from 93.9+/-21.2 to 85.1+/-10.9 kg (P<0.0001) and 6.5+/-2.3 kg of body fat (P<0.001). Weight losses varied widely among subjects, with a high correlation between losses of members of twin pairs for body weight (r=0.85; P<0.001) and for body fat (r=0.88; P<0.0001). Changes in uric acid resulting from weight loss were also correlated among members of twin pairs whereas changes in blood pressure, cholesterol and triglycerides were not., Conclusion: The great intrapair resemblance observed in very low calorie diet-induced weight and fat losses in female obese identical twins suggests an important role of genetic factors in response to the weight reduction regimen.

Eight pairs of obese female monozygotic twins were subjected to a 4-week, very-low-calorie diet (VLCD) that induced a decrease in mean body mass index from 32.9 +/- 1.1 to 29.7 +/- 1.1 kg/m2. Infusion of the beta-adrenergic agonist, isoproterenol, induced an increase in plasma levels of nonesterified fatty acids and glycerol that was more pronounced during than before VLCD. sc fat biopsies were obtained before and during VLCD to study adipocyte lipolysis. beta-adrenergic sensitivity was moderately improved during VLCD. Basal and stimulated lipolyses, and hormone-sensitive lipase activity and protein levels were increased during VLCD. Before VLCD, intrapair resemblance was found for basal and stimulated lipolysis rates. In response to the treatment, intrapair resemblance was observed for basal lipolysis and for lipolysis stimulated with agents acting on plasma membrane receptors. These results suggest that the increase of basal lipolysis during VLCD is caused by an increase of hormone-sensitive lipase expression. They support the notion that the genotype may play a role in regulating the changes of adipose tissue lipolysis rates observed during VLCD.

The effects of 28 days of a very low calorie diet (382 Cal/day)) on the beta-adrenergic lipolytic response and nutritive blood flow in sc adipose tissue were investigated in vivo using the microdialysis technique in 24 obese subjects. The diet did not modify the extracellular glycerol concentrations, but increased the local nutritive blood flow (measured by the ethanol escape method). The lipolytic response and the vasodilating effect of increasing concentrations of isoprenaline (from 0.001-10 mumol/L) added to the perfusate were enhanced after 28 days of diet. Before the diet, equimolar concentrations (100 mumol/L) of dobutamine [selective beta 1-adrenoceptor (beta 1-AR) agonist], terbutaline (selective beta 2-AR agonist), and CGP 12,177 (selective beta 3-AR agonist) increased glycerol concentration in adipose tissue. The lipolytic effect of terbutaline was the greatest, and the effect of CGP 12,177 was the least marked. After 28 days of the diet, the effects of terbutaline and CGP 12,177 were not modified, whereas the effect of dobutamine was increased and reached the effect of terbutaline. The three agonists increased nutritive blood flow; this effect was not modified during the diet. In summary, this study demonstrates an increase in the in vivo lipolytic responses to isoprenaline and dobutamine during the hypocaloric diet. Furthermore, functional beta 3-AR are present in the sc adipose tissue of obese patients; however, their activation is only weakly involved in the lipolytic process in this population and is not modified by the hypocaloric diet.

Background: Treatment of obesity with strict reducing diets is as a rule associated with the development of energetic efficiency manifested among others also by a decline of energy expenditure. The objective of the trial was to test whether addition of oils containing triacylglycerols with medium-chain fatty acid can prevent this decline and whether their administration can affect the lipid spectrum., Methods and Results: Sixty obese patients were served for a four-week period of hospitalization at the obesitology unit a low-energy diet REDITA (Promil Co., N. Bydzov) providing 1596 kJ, 37 g protein, 50 g carbohydrate and 3 g fat. Part of the treatment was regular aerobic exercise, behavioural therapy to teach correct dietary habits and physical activity; physical activity was monitored by means of pedometers. From this group during the 3rd and 4th week 11 patients with similar characteristics were separated (age, body weight, BMI and energy expenditure at rest) as in the basic group. These patients were given daily 15 ml oil containing triacylglycerols with medium-chain fatty acids, MCT OIL (Mead Johnson, Evansville), providing 545 kJ. The resting energy expenditure was assessed in all patients every morning on fasting, immediately after awakening, using indirect calorimetry and it was corrected with regard to the respiratory quotient and excretion of catabolic nitrogen. The body composition was assessed at the beginning and at the end of the trial by hydrostatic weighing. Administration of oil containing triacylglycerols with medium-chain fatty acids (MCT OIL) prevented the decline of the resting energy expenditure (130.0 +/- 9.2 kJ/kg lean body mass/day, as compared with 126.5 +/- 7.2 kJ/kg lean body mass/day in the basic group: the difference is statistically not significant). Although addition of oil increased the energy intake by 545 kJ/day, the drop of body weight and BMI was comparable with that in the group of obese patients who did not receive the oil (10.3 +/- 1.1 kg vs. 10.6 +/- 0.5 kg). While during administration of the oil the resting energy expenditure did not change (5.97 +/- 0.30 kJ/min. vs. 5.24 +/- 0.58 kJ/min.), in obese patients who were only on the strict reducing diet it declined from 5.45 +/- 0.18 kJ/min. to 4.44 +/- 0.22 kJ/min. (p < 0.01). The significant drop of total cholesterol achieved by dietotherapy alone (5.41 +/- 0.21 mmol/l vs. 6.26 0.20 mmol/l before treatment) was not affected by administration of oil (4.86 +/- 0.28 mmol/l vs. 5.69 +/- 0.35 mmol/l before treatment). HDL-cholesterol, on the other hand, declined only in obese patients with dietotherapy (1.40 +/- 0.04 mmol/vs. 1.22 +/- 0.04 mmol/l after treatment, p < 0.01). The triacylglycerol values declined significantly in both groups (p < 0.01)., Conclusions: It appears that administration of thermogenetically acting triacylglycerols with medium-chain fatty acids can prevent diet-induced energetic efficiency and can improve the long-term success of dietotherapy of obese patients.

To evaluate a long-term efficacy of very-low-calorie-diet (VLCD) treatment, 42 obese patients were reexamined 1 y after the initiation of the weight reduction by VLCD treatment for 1 mo. All the subjects participating in the long-term outpatient weight-reduction regime were divided into weight losers and regainers according to the weight change achieved at the end of 1-y follow-up. A final body weight decrease in weight losers was followed by a significant decline of total cholesterol-high-density-lipoprotein (HDL) cholesterol ratio together with significant rise of serum HDL cholesterol whereas almost all skinfold thicknesses declined. In weight regainers the sum of 10 skinfold thicknesses was the same at the end of follow-up as at the beginning of VLCD treatment, but body fat distribution was shifted towards the gynoid type when individual skinfold thicknesses were assessed. However, among the generally employed indexes of body fat distribution only waist-thigh ratio significantly decreased in weight losers. Nonsignificant differences in serum concentrations of total cholesterol, HDL cholesterol, and triglycerides between weight regainers and weight losers at the end of long-term follow-up suggest that some kind of adherence to weight reduction regime including physical exercise may favorably affect the lipid profile as well as body fat distribution independently on the body weight regained.

One-month treatment of obese patients (body mass index, 39.44 +/- 0.94, measured in kg/m2) with a very-low-calorie diet (VLCD) resulted in a significant weight loss, which was higher in men than in women. In contrast, the decrease of percent fat content was higher in gynoid obese women than in men or women with android fat distribution. In females fat mobilization was depressed at the thigh region where a substantially lower percent decrement of thigh skinfold thickness was demonstrated in comparison with males. VLCD treatment positively affected blood pressure and concentrations of total cholesterol, triglyceride, insulin, and cortisol. Total cholesterol-high-density-lipoprotein (HDL) cholesterol ratio remained unchanged and HDL cholesterol in serum significantly declined. Indexes of body fat distribution were not significantly influenced by the short-term treatment by VLCD except waist-hip ratio, which declined in android obese females. VLCD does not decrease a tolerance of physical exercise, as the metabolic response to submaximal workload on a cycle ergometer as well as the responses of cortisol, growth hormone, and prolactin remained unchanged after the treatment.

The Czechoslovak low-energy protein diet contains 1559 kj per day, incl. 33.0 g protein, 50 g carbohydrate, 4.0 g fat, 6.0 g fibre and recommended vitamin and mineral allowances. The diet was administered to 75 subjects with a mean age of 39.88 +/- 1.21 years and a body weight of 112.57 +/- 2.89 kg, and a body weight index (BMI) of 39.44 +/- 0.94, for 28 days. During treatment the body weight declined by 9.67 +/- 0.41 kg and the BMI by 3.74 +/- 0.20. At the same time there was a significant decline of the total cholesterol (p less than 0.001), LDL cholesterol (p less than 0.001), HDL cholesterol (p less than 0.01) and triacylglycerols (p less than 0.05). In 20 subjects with hyperlipidaemia similar changes of the total cholesterol and LDL cholesterol were recorded, while the decrease of HDL cholesterol (p less than 0.001) and triacylglycerols (p less than 0.001) was more marked. The nitrogen balance became during the fourth week on the diet positive (+0.64 g), there was a transitory decline of the total protein concentration. The serum amino acid concentration did not change significantly with the exception of isoleucine, the level of which increased. The serum immunoglobulin concentration did not change significantly. It may be concluded that the low-energy protein diet has a favourable impact on the lipid metabolism, without a marked negative effect on the protein metabolism.

A new very low energy formula diet containing 1560 kJ (373 kcal) per day was employed in the treatment of 49 obese patients. The treatment, of 4 weeks duration, included aerobic physical exercise and behavioural intervention. This kind of therapy resulted in a significant decrease (P less than 0.001) of both weight (-10.60 +/- 0.46 kg) and body mass index (-3.36 +/- 0.16). The fat stores represented 90.5 per cent of weight loss in women and 60.0 per cent of weight loss in men. The first very low energy formula diet produced in Czechoslovakia proved to be an efficient and safe tool for the treatment of obesity, positively affecting high blood pressure, lipid and carbohydrate metabolism in the absence of serious side-effects.